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Gandini R, Uccioli L, Spinelli A, Del Giudice C, Da Ros V, Volpi T, Meloni M, Simonetti G. Alternative techniques for treatment of complex below-the knee arterial occlusions in diabetic patients with critical limb ischemia. Cardiovasc Intervent Radiol 2012; 36:75-83. [PMID: 22278664 DOI: 10.1007/s00270-012-0344-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/23/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access. MATERIALS AND METHODS Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 ± 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56 patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted. RESULTS Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 ± 1.1 vs. 15.7 ± 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively). CONCLUSION The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.
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Affiliation(s)
- Roberto Gandini
- Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Policlinico di Tor Vergata, 00133, Rome, Italy
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Kirk J, Wilson R, Kovacs F, Tennant W, Braithwaite B, Habib S. Successful extra-anatomical recanalization of occluded superficial femoral arteries using the Outback device--a report of 2 cases. Vasc Endovascular Surg 2011; 46:62-5. [PMID: 22156160 DOI: 10.1177/1538574411422959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We report 2 cases where the Outback catheter facilitated extra-anatomical bypass after vessel perforation during attempted subintimal vessel dissection. REPORT Attempted subintimal angioplasty of the superficial femoral artery (SFA) resulted in vessel perforation in 2 patients with chronic SFA occlusion and limb ischemia. Due to the lack of other endovascular or surgical options, the Outback catheter was used to reenter the patent lumen distal to the perforation. A stent graft was then deployed from proximal to the perforation to beyond the reentry point with successful outcomes. DISCUSSION Although the reentry devices are typically used to enter the lumen from the subintimal plane, this novel technique involves using the Outback catheter to enter from the extravascular compartment and facilitate bypass of the SFA occlusion via an extra-anatomical route. This novel technique can be used to restore in-line blood flow when attempted endovascular revascularization failed due to vessel perforation.
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Affiliation(s)
- James Kirk
- Department of Radiology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
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103
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Setacci C, de Donato G, Teraa M, Moll F, Ricco JB, Becker F, Robert-Ebadi H, Cao P, Eckstein H, De Rango P, Diehm N, Schmidli J, Dick F, Davies A, Lepäntalo M, Apelqvist J. Chapter IV: Treatment of Critical Limb Ischaemia. Eur J Vasc Endovasc Surg 2011; 42 Suppl 2:S43-59. [DOI: 10.1016/s1078-5884(11)60014-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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104
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Setacci C, Sirignano P. Commentary. Subintimal angioplasty of femoropopliteal artery occlusions: the long-term results. Eur J Vasc Endovasc Surg 2011; 42 Suppl 1:S16-8. [PMID: 21855013 DOI: 10.1016/j.ejvs.2011.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C Setacci
- Department of Vascular and Endovascular Surgery, University of Sienna, Viale Bracci 1, Siena, Italy
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105
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Abstract
Available and improved options for the treatment of femoral-popliteal disease have increased over the last decade. Even though most patients suffering from claudication due to femoral-popliteal disease are treated with aggressive medical and noninvasive methods, patients with limb-threatening disease and severely lifestyle-limiting symptoms are treated with invasive treatments, which include endovascular treatment options. Unfortunately, the unique forces involved in this vascular segment have challenged the long-term patency and clinical effectiveness of these treatments. The purpose of this brief review is to discuss treatment strategies and options for patients with femoral-popliteal disease. Included in this discussion will be the review of data from recent published studies and late-breaking trials as it pertains to certain treatment strategies.
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Affiliation(s)
- Adam Ryan Geronemus
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, Miami, Florida
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106
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Use of the CrossBoss catheter for crossing superficial femoral artery chronic total occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 13:58-61. [PMID: 21741325 DOI: 10.1016/j.carrev.2011.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/17/2011] [Accepted: 05/23/2011] [Indexed: 11/23/2022]
Abstract
The CrossBoss chronic total occlusion catheter has been developed for the treatment of coronary chronic total occlusions. We report a novel use of the CrossBoss catheter for the crossing of a superficial femoral artery chronic total occlusion in three patients after conventional guidewire techniques failed.
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107
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Ko YG, Shin S, Kim KJ, Kim JS, Hong MK, Jang Y, Shim WH, Choi D. Efficacy of stent-supported subintimal angioplasty in the treatment of long iliac artery occlusions. J Vasc Surg 2011; 54:116-22. [DOI: 10.1016/j.jvs.2010.11.127] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 11/16/2022]
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108
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Slim H, Tiwari A, Ahmed A, Ritter J, Zayed H, Rashid H. Distal versus Ultradistal Bypass Grafts: Amputation-free Survival and Patency Rates in Patients with Critical Leg Ischaemia. Eur J Vasc Endovasc Surg 2011; 42:83-8. [DOI: 10.1016/j.ejvs.2011.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 03/20/2011] [Indexed: 10/18/2022]
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Yan BP, Moran D, Hynes BG, Kiernan TJ, Yu CM. Advances in Endovascular Treatment of Critical Limb Ischemia. Circ J 2011; 75:756-65. [DOI: 10.1253/circj.cj-11-0103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital & Institute of Vascular Medicine, The Chinese University of Hong Kong
| | - Darragh Moran
- Department of Cardiology, Cork University Hospital, University College Cork School of Medicine
| | - Brian G Hynes
- Section of Interventional Cardiology and Vascular Medicine, Massachusetts General Hospital
| | - Thomas J Kiernan
- Department of Cardiology, Cork University Hospital, University College Cork School of Medicine
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital & Institute of Vascular Medicine, The Chinese University of Hong Kong
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110
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Kong JH, Hur J, Kim DS, Kim SW. The Outback ® LTD TM Catheter: The Novel Re-Entry Technique in Recanalization of Chronic Inflow Occlusion of the Superficial Femoral Arteries in 3 Cases. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joon Hyuk Kong
- Department of Thoracic and Cardiovascular Surgery, Kangpuk Samsung Hospital, Sungkyunkwan University College of Medicine
| | - Jin Hur
- Department of Thoracic and Cardiovascular Surgery, Andong General Hospital
| | - Duk Sil Kim
- Department of Thoracic and Cardiovascular Surgery, CHA Gumi Medical Center, College of Medicine, CHA University
| | - Sung Wan Kim
- Department of Thoracic and Cardiovascular Surgery, CHA Gumi Medical Center, College of Medicine, CHA University
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111
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Subintimal angioplasty for femoro-popliteal occlusive disease. J Vasc Surg 2010; 52:1410-6. [DOI: 10.1016/j.jvs.2010.03.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 03/18/2010] [Accepted: 03/20/2010] [Indexed: 11/20/2022]
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112
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Pierret C, Tourtier JP, Bordier L, Blin E, Duverger V. [Subintimal angioplasty and diabetic foot revascularisation]. Presse Med 2010; 40:10-6. [PMID: 20980123 DOI: 10.1016/j.lpm.2010.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/15/2010] [Accepted: 09/06/2010] [Indexed: 01/17/2023] Open
Abstract
Diabetic wounds foot are responsible for 5-10% minor or major amputation in France. In fact, amputation risk of lower limbs is 15-30% higher for diabetic patients. University of Texas classification (UT) is the reference for diabetic foot wound. It distinguish non ischemic and ischemic wound with more amputation. If ischaemia is combined, revascularization may be considered for salvage of the limb. Some revascularization techniques are well known: as surgical by-pass, angioplasty with or without stent, or hybrid procedures with the both. Subintimal angioplasty is a more recent endovascular technique, in assessment for old patients who are believed to be unsuitable candidates for conventional by-pass or angioplasty.
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Affiliation(s)
- Charles Pierret
- HIA Val-de-Grâce, service de chirurgie viscérale et vasculaire, 75005 Paris, France.
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113
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Evaluation of a dedicated balloon catheter for infrapopliteal difficult calcified lesions in diabetic patients with critical limb ischemia. Cardiovasc Intervent Radiol 2010; 34:170-3. [PMID: 20658135 DOI: 10.1007/s00270-010-9941-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to assess the technical performance and immediate procedural outcome of a new balloon catheter in the treatment of calcified lesions in infrapopliteal arterial disease. Sixty-one patients (81 vessels) with infrapopliteal arterial disease were evaluated. Seventy-four of the 81 treated vessels had total occlusions. The ReeKross 18 peripheral transluminal angioplasty catheter (ClearStream, Wexford, Ireland) is an 0.018-inch guidewire system with 4F sheath compatibility and a rigid shaft intended for enhanced pushability. Only technical procedural outcomes were recorded. In 37 of 61 patients (50 infrapopliteal severely stenosed or occluded vessels), an attempt with a standard balloon was made before the ReeKross 18 was used. In 24 patients, the ReeKross 18 was used as the primary catheter in 23 cases involving crural arteries and in 8 cases involving the foot. The ReeKross 18 crossed the lesion in 55 of 59 (93.2%) patients and 72 of 77 (94.5%) vessels, respectively. Postdilatation results for the 51 patients (64 target lesions) in whom ReeKross 18 balloon dilation was achieved showed <30% residual stenosis in all but 4 patients (5 lesions). Of the patients treated with the ReeKross 18 as the primary catheter, the technical success rate (no adjunctive treatment/stent) was obtained in 20 of 24 (83.3%) patients (27 of 31 [87.1%] target lesions). In the treatment of difficult calcified lesions, the choice of a high-pushability angioplasty catheter, such as the ReeKross 18, warrants consideration.
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Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FGR, Gillespie I, Ruckley CV, Raab GM. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 2010; 51:5S-17S. [PMID: 20435258 DOI: 10.1016/j.jvs.2010.01.073] [Citation(s) in RCA: 384] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/20/2009] [Accepted: 01/24/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND A 2005 interim analysis of the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial showed that in patients with severe lower limb ischemia (SLI; rest pain, ulceration, gangrene) due to infrainguinal disease, bypass surgery (BSX)-first and balloon angioplasty (BAP)-first revascularization strategies led to similar short-term clinical outcomes, although BSX was about one-third more expensive and morbidity was higher. We have monitored patients for a further 2.5 years and now report a final intention-to-treat (ITT) analysis of amputation-free survival (AFS) and overall survival (OS). METHODS Of 452 enrolled patients in 27 United Kingdom hospitals, 228 were randomized to a BSX-first and 224 to a BAP-first revascularization strategy. All patients were monitored for 3 years and more than half for >5 years. RESULTS At the end of follow-up, 250 patients were dead (56%), 168 (38%) were alive without amputation, and 30 (7%) were alive with amputation. Four were lost to follow-up. AFS and OS did not differ between randomized treatments during the follow-up. For those patients surviving 2 years from randomization, however, BSX-first revascularization was associated with a reduced hazard ratio (HR) for subsequent AFS of 0.85 (95% confidence interval [CI], 0.5-1.07; P = .108) and for subsequent OS of 0.61 (95% CI, 0.50-0.75; P = .009) in an adjusted, time-dependent Cox proportional hazards model. For those patients who survived for 2 years after randomization, initial randomization to a BSX-first revascularization strategy was associated with an increase in subsequent restricted mean overall survival of 7.3 months (95% CI, 1.2-13.4 months, P = .02) and an increase in restricted mean AFS of 5.9 months (95% CI, 0.2-12.0 months, P = .06) during the subsequent mean follow-up of 3.1 years (range, 1-5.7 years). CONCLUSIONS Overall, there was no significant difference in AFS or OS between the two strategies. However, for those patients who survived for at least 2 years after randomization, a BSX-first revascularization strategy was associated with a significant increase in subsequent OS and a trend towards improved AFS.
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Affiliation(s)
- Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Heart of England NHS Foundation Trust, Solihull Hospital, Lode Lane, Birmingham, UK.
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115
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Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FGR, Gillespie I, Ruckley CV, Raab GM. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Analysis of amputation free and overall survival by treatment received. J Vasc Surg 2010; 51:18S-31S. [DOI: 10.1016/j.jvs.2010.01.074] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 06/08/2009] [Accepted: 01/24/2010] [Indexed: 11/17/2022]
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116
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Uccioli L, Gandini R, Giurato L, Fabiano S, Pampana E, Spallone V, Vainieri E, Simonetti G. Long-term outcomes of diabetic patients with critical limb ischemia followed in a tertiary referral diabetic foot clinic. Diabetes Care 2010; 33:977-82. [PMID: 20200304 PMCID: PMC2858201 DOI: 10.2337/dc09-0831] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We describe the long-term outcomes of 510 diabetic patients with critical limb ischemia (CLI) and an active foot ulcer or gangrene, seen at the University Hospital of Rome Tor Vergata, a tertiary care clinic. RESEARCH DESIGN AND METHODS These patients were seen between November 2002 and November 2007 (mean follow-up 20 +/- 13 months [range 1-66 months]). The Texas Wound Classification was used to grade these wounds that were either class C (ischemia) and D (ischemia+infection) and grade 2-3 (deep-very deep). This comprehensive treatment protocol includes rapid and extensive initial debridement, aggressive use of peripheral percutaneous angioplasty, empirical intravenous antibiotic therapy, and strict follow-up. RESULTS The protocol was totally applied (with percutaneous angioplasty [PA+]) in 456 (89.4%) patients and partially (without percutaneous angioplasty [PA-]) in 54 (10.6%) patients. Outcomes for the whole group and PA+ and PA- patients are, respectively: healing, n = 310 (60.8%), n = 284 (62.3%), and n = 26 (48.1%); major amputation, n = 80 (15.7%), n = 67 (14.7%), and n = 13 (24.1%); death, n = 83 (16.25%), n = 68 (14.9%), and n = 15 (27.8%); and nonhealing, n = 37 (7.25%), n = 37 (8.1%), and n = 0 (0%) (chi(2) <0.0009). Predicting variables at multivariate analysis were the following: for healing, ulcer dimension, infection, and ischemic heart disease; and for major amputation, ulcer dimension, number of minor amputations, and age. Additional predicting variables for PA+ patients were the following: for healing, transcutaneous oxygen tension [DeltaTcPo(2)]; and for major amputation, basal TcPo(2), basal A1C, DeltaTcPo(2), and percutaneous angioplasty technical failure. CONCLUSIONS Early diagnosis of CLI, aggressive treatment of infection, and extensive use of percutaneous angioplasty in ischemic affected ulcers offers improved outcome for many previously at-risk limbs. Ulcer size >5 cm(2) indicates a reduced chance of healing and increased risk of major amputation. It was thought that all ulcers warrant aggressive treatment including percutaneous angioplasty and that treatment should be considered even for small ischemic ulcers.
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Affiliation(s)
- Luigi Uccioli
- 1Department of Internal Medicine, University of Tor Vergata, Rome, Italy.
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117
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A Novel Device for True Lumen Re-Entry After Subintimal Recanalization of Superficial Femoral Arteries: First-in-Man Experience and Technical Description. Cardiovasc Intervent Radiol 2010; 34:166-9. [PMID: 20425110 DOI: 10.1007/s00270-010-9859-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
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118
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Abstract
Many patients with severe intermittent claudication (IC) or critical limb ischemia (CLI) have chronic total occlusions (CTO) in their lower extremity vascular bed. The successful treatment of these lesions is becoming increasingly more important as the population ages and the prevalence of diseases such as diabetes mellitus and its consequences increases. Many of these patients have significant comorbidities and may benefit from less invasive treatment options. Several endovascular techniques have now become well established in the treatment of these lesions. Additionally, several new adjunctive tools have been developed to enhance the technical success of CTO revascularization. These tools and techniques offer a minimally invasive alternative for limb salvage in this compromised patient population and have become an established practice in many centers. Although some concerns about procedure durability and lower rates of primary patency exist, particularly when compared to surgical bypass, the limb salvage and amputation-free survival rates are much more encouraging. Advantages of these techniques compared to surgical bypass are reduced morbidity and mortality, reduced anesthesia requirements, and potential reductions in length of hospital stay and cost. In addition, bypass options are typically preserved after endovascular treatment. The more conventional and some newer endovascular treatment approaches, some of the adjunctive tools and techniques used in CTO revascularization as well as their clinical results will be discussed in this review.
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Zander T, Rabellino M, Baldi S, Blasco O, Maynar M. Infrainguinal revascularization using the Crosser®vibrational system. MINIM INVASIV THER 2010; 19:231-6. [DOI: 10.3109/13645701003644137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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120
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121
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Angioplasty or Primary Stenting for Infrapopliteal Lesions: Results of a Prospective Randomized Trial. Cardiovasc Intervent Radiol 2009; 33:260-9. [DOI: 10.1007/s00270-009-9765-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 11/06/2009] [Indexed: 10/20/2022]
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122
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123
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Safety and Short-term Outcomes following Controlled Blunt Microdissection Revascularization of Symptomatic Arterial Occlusions of the Pelvis and Lower Extremities. J Vasc Interv Radiol 2009; 20:1541-7. [DOI: 10.1016/j.jvir.2009.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 07/06/2009] [Accepted: 08/21/2009] [Indexed: 11/20/2022] Open
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124
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Lyden SP. Techniques and outcomes for endovascular treatment in the tibial arteries. J Vasc Surg 2009; 50:1219-23. [DOI: 10.1016/j.jvs.2009.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 02/11/2009] [Accepted: 02/11/2009] [Indexed: 10/20/2022]
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125
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Charalambous N, Schäfer PJ, Trentmann J, Hümme TH, Stöhring C, Müller-Hülsbeck S, Heller M, Jahnke T. Percutaneous Intraluminal Recanalization of Long, Chronic Superficial Femoral and Popliteal Occlusions Using the Frontrunner XP CTO Device: A Single-Center Experience. Cardiovasc Intervent Radiol 2009; 33:25-33. [PMID: 19777300 DOI: 10.1007/s00270-009-9700-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 08/21/2009] [Indexed: 10/20/2022]
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126
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Gandini R, Chiappa R, Di Primio M, Di Vito L, Boi L, Tsevegmid E, Simonetti G. Recanalization of the Native Artery in Patients with Bypass Failure. Cardiovasc Intervent Radiol 2009; 32:1146-53. [DOI: 10.1007/s00270-009-9690-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
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127
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Always contact a vascular interventional specialist before amputating a patient with critical limb ischemia. Cardiovasc Intervent Radiol 2009; 33:469-74. [PMID: 19688364 PMCID: PMC2868169 DOI: 10.1007/s00270-009-9687-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/15/2009] [Accepted: 07/22/2009] [Indexed: 11/27/2022]
Abstract
Patients with severe critical limb ischemia (CLI) due to long tibial artery occlusions are often poor candidates for surgical revascularization and frequently end up with a lower limb amputation. Subintimal angioplasty (SA) offers a minimally invasive alternative for limb salvage in this severely compromised patient population. The objective of this study was to evaluate the results of SA in patients with CLI caused by long tibial occlusions who have no surgical options for revascularization and are facing amputation. We retrospectively reviewed all consecutive patients with CLI due to long tibial occlusions who were scheduled for amputation because they had no surgical options for revascularization and who were treated by SA. A total of 26 procedures in 25 patients (14 males; mean age, 70 ± 15 [SD] years) were evaluated. Technical success rate was 88% (23/26). There were four complications, which were treated conservatively. Finally, in 10 of 26 limbs, no amputation was needed. A major amputation was needed in 10 limbs (7 below-knee amputations and 3 above-knee amputations). Half of the major amputations took place within 3 months after the procedure. Cumulative freedom of major amputation after 12 months was 59% (SE = 11%). In six limbs, amputation was limited to a minor amputation. Seven patients (28%) died during follow-up. In conclusion, SA of the tibial arteries seem to be a valuable treatment option to prevent major amputation in patients with CLI who are facing amputation due to lack of surgical options.
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Keeling AN, Khalidi K, Leong S, Given MF, McGrath FP, Athanasiou T, Lee MJ. Subintimal Angioplasty: Predictors of Long-term Success. J Vasc Interv Radiol 2009; 20:1013-22. [DOI: 10.1016/j.jvir.2009.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 05/06/2009] [Accepted: 05/06/2009] [Indexed: 11/24/2022] Open
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129
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Comment on: Below-Knee Bare Nitinol Stent Placement in High-risk Patients with Critical Limb Ischemia and Unlimited Supragenicular Inflow as Treatment of Choice “K.P. Donas, A. Schwindt, T. Schönefeld, J. Tessarek, G. Torsello”. Eur J Vasc Endovasc Surg 2009; 37:694-5. [DOI: 10.1016/j.ejvs.2009.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 11/18/2022]
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Setacci C, Chisci E, de Donato G, Setacci F, Iacoponi F, Galzerano G. Subintimal angioplasty with the aid of a re-entry device for TASC C and D lesions of the SFA. Eur J Vasc Endovasc Surg 2009; 38:76-87. [PMID: 19427245 DOI: 10.1016/j.ejvs.2009.03.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 03/27/2009] [Indexed: 10/20/2022]
Abstract
AIM The aim of this prospective study was to assess the clinical effectiveness and related midterm patency of subintimal angioplasty (SAP) in patients suffering from critical limb ischaemia (CLI) in a single tertiary care university centre. The secondary aim was to evaluate the safety and clinical effectiveness of using a re-entry device when re-canalisation by SAP was unsuccessful. METHODS From January 2005 to December 2007, consecutive patients suffering from CLI (Rutherford clinical categories: 4-6) were treated with SAP. All patients included in the study had occluded SFA (TASC C and D) and underwent clinical and ultrasound follow-up examinations at day 30 and at 3, 6, 9 and 12 months, and then yearly. A re-entry device (Outback, Cordis Corporation, Miami Lakes, Florida, USA in all cases) was only used when re-canalisation by simple SAP was unsuccessful, and stenting was used when residual stenosis was >30% or there was a flow-limiting dissection. Factors that could modify the outcome were analysed. RESULTS In this study, 145 patients were treated, with a technical success rate of 83.5% (121 of 145) for simple SAP. Stenting was performed in 43% (n=62) of successful SAP procedures. No death occurred in the perioperative period, while the 30-day mortality was 4.8% (7 of 145). The re-entry device (Outback) was used in 24 cases (16.5%). The technical success of the re-entry device was 79% (19 of 24), with a 90% success rate of stent placement at the site of re-entry. Complications occurred in 6.2% of all procedures (n=9) (three arterial perforations (2.1%), three distal embolisations (2.1%), two femoral artery pseudo-aneurysms (1.4%) and one arterio-venous fistula (0.7%)). Factors capable of independently affecting the patency were renal insufficiency (p=0.03), current smoking (p=0.01) and diabetes (p=0.04). The primary patency at 1 and 3 years was 70% and 34% and the secondary patency at 1 and 3 years was 77% and 43%, respectively. At the same time intervals, the limb-salvage rate was 88% and 49%. CONCLUSIONS SAP with the aid of a re-entry device for TASC C and D lesions of the SFA seems to be safe and clinically effective in patients suffering from CLI, according to the experience at our centre. Further follow-up and more data are necessary to confirm these findings.
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Affiliation(s)
- C Setacci
- Department of Surgery, University of Siena, Siena, Italy.
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Primary Infrainguinal Subintimal Angioplasty in Diabetic Patients. Cardiovasc Intervent Radiol 2008; 31:713-22. [DOI: 10.1007/s00270-008-9366-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 05/07/2008] [Accepted: 05/08/2008] [Indexed: 10/22/2022]
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