1
|
Csavajda A, Toth K, Kovacs N, Rona S, Vamosi Z, Berta B, Kulcsar FZ, Bertrand OF, Hizoh I, Ruzsa Z. The Clinical Impact of Access Site Selection for Successful Thrombolysis and Intervention in Acute Critical Lower Limb Ischaemia (RAD-ALI Registry). Life (Basel) 2024; 14:666. [PMID: 38929649 PMCID: PMC11205031 DOI: 10.3390/life14060666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Acute limb ischaemia (ALI) is of great clinical importance due to its consequent serious complications and high comorbidity and mortality rates. The purpose of this study was to compare the acute success and complication rates of CDT performed via transradial, transbrachial, and transfemoral access sites in patients with acute lower limb vascular occlusion and to investigate the 1-year outcomes of CDT and MT for ALI. Methods: Between 2008 and 2019, 84 consecutive patients with ALI were treated with CDT in a large community hospital. Data were collected and retrospectively analysed. The primary ("safety") endpoints encompassed major adverse events (MAEs), major adverse limb events (MALEs), and the occurrence of complications related to the access site. Secondary ("efficacy") endpoints included both technical and clinical achievements, treatment success, fluoroscopy time, radiation dose, procedure time, and the crossover rate to an alternative puncture site. Results: CDT was started with radial (n = 17), brachial (n = 9), or femoral (n = 58) access. CDT was technically successful in 74/84 patients (88%), but additional MT and angioplasty and/or stent implantation was necessary in 17 (20.2%) and 45 cases (53.6%), respectively. Clinical success was achieved in 74/84 cases (88%). The mortality rate at 1 year was 14.3%. The cumulative incidence of MAEs and MALEs at 12 months was 50% and 40.5%, respectively. After conducting multivariate analysis, history of Rutherford stage IIB (hazard ratio [HR], 3.64; 95% confidence interval [CI], 1.58-8.41; p = 0.0025), occlusion of the external iliac artery (HR, 27.52; 95% CI, 2.83-267.33; p = 0.0043), being a case of clinically unsuccessful thrombolysis (HR, 7.72; 95% CI, 2.48-23.10; p = 0.0004), and the presence of diabetes mellitus (HR, 2.18; 95% CI, 1.01-4.71; p = 0.047) were independent predictors of a high MAE mortality rate at 12 months. For MALEs, statistically significant differences were detected with the variables history of Rutherford stage IIB (HR, 4.30; 95% CI, 1.99-9.31; p = 0.0002) and external iliac artery occlusion (HR, 31.27; 95% CI, 3.47-282.23; p = 0.0022). Conclusions: Based on the short-term results of CDT, acute limb ischaemia can be successfully, safely, and effectively treated with catheter-directed thrombolytic therapy with radial, brachial, or femoral access. However, radial access is associated with fewer access site complications. A history of Rutherford stage IIB, occlusion of external iliac artery, unsuccessful thrombolysis, and the presence of diabetes mellitus were independently associated with an increased risk of MAEs. A history of Rutherford stage IIB and external iliac artery occlusion are independent predictors of MALEs.
Collapse
Affiliation(s)
- Adam Csavajda
- Department of Invasive Cardiology, Bacs-Kiskun County Hospital, Teaching Hospital of the Albert Szent-Györgyi Medical School, University of Szeged, Nyiri Street 38, 6000 Kecskemet, Hungary; (K.T.); (N.K.); (S.R.); (Z.V.); (B.B.)
| | - Karoly Toth
- Department of Invasive Cardiology, Bacs-Kiskun County Hospital, Teaching Hospital of the Albert Szent-Györgyi Medical School, University of Szeged, Nyiri Street 38, 6000 Kecskemet, Hungary; (K.T.); (N.K.); (S.R.); (Z.V.); (B.B.)
| | - Nandor Kovacs
- Department of Invasive Cardiology, Bacs-Kiskun County Hospital, Teaching Hospital of the Albert Szent-Györgyi Medical School, University of Szeged, Nyiri Street 38, 6000 Kecskemet, Hungary; (K.T.); (N.K.); (S.R.); (Z.V.); (B.B.)
| | - Szilard Rona
- Department of Invasive Cardiology, Bacs-Kiskun County Hospital, Teaching Hospital of the Albert Szent-Györgyi Medical School, University of Szeged, Nyiri Street 38, 6000 Kecskemet, Hungary; (K.T.); (N.K.); (S.R.); (Z.V.); (B.B.)
| | - Zoltan Vamosi
- Department of Invasive Cardiology, Bacs-Kiskun County Hospital, Teaching Hospital of the Albert Szent-Györgyi Medical School, University of Szeged, Nyiri Street 38, 6000 Kecskemet, Hungary; (K.T.); (N.K.); (S.R.); (Z.V.); (B.B.)
| | - Balazs Berta
- Department of Invasive Cardiology, Bacs-Kiskun County Hospital, Teaching Hospital of the Albert Szent-Györgyi Medical School, University of Szeged, Nyiri Street 38, 6000 Kecskemet, Hungary; (K.T.); (N.K.); (S.R.); (Z.V.); (B.B.)
| | - Flora Zsofia Kulcsar
- Heart and Vascular Centre, Semmelweis University, Varosmajor Street 68, 1122 Budapest, Hungary; (F.Z.K.); (I.H.)
| | - Olivier F. Bertrand
- Quebec Heart-Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada;
| | - Istvan Hizoh
- Heart and Vascular Centre, Semmelweis University, Varosmajor Street 68, 1122 Budapest, Hungary; (F.Z.K.); (I.H.)
| | - Zoltan Ruzsa
- Department of Internal Medicine, Invasive Cardiology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, 6725 Szeged, Hungary;
| |
Collapse
|
2
|
Patrone L, Falcone G, Coscas R, Lichaa H, Antaredja M, Fanelli F, Blessing E. Retrograde Peroneal Artery Approach to Treat Infra-Inguinal Arterial Chronic Total Occlusions: A Multicentre Experience and Technical Considerations. J Clin Med 2024; 13:2770. [PMID: 38792312 PMCID: PMC11121828 DOI: 10.3390/jcm13102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Retrograde access of the peroneal artery (PA) is considered technically challenging and at risk of bleeding. The aim of this multicentre retrospective study was to assess the safety, feasibility, and technical success of this access route for infrainguinal endovascular recanalizations. Methods: We retrospectively analyzed 186 consecutive patients treated over a 7-year period (May 2014-August 2021) who underwent endovascular recanalization of infra-inguinal lesions using a PA access route. In all cases, retrograde PA access was obtained following a failed attempt to cross the occlusion via the antegrade route. Results: Among the 186 patients, 120 were males (60.5%) and the mean age was 76.8 ± 10.7 years old (44-94 years). One hundred and thirteen patients (60.7%) suffered from chronic limb threatening ischemia (CLTI). All patients presented with chronic total occlusions (CTO) and a failed conventional antegrade recanalization attempt. Retrograde access was performed under angiographic guidance in 185 cases (99.5%). It was successfully established in 171 cases (91.9%). The total rate of retrograde puncture-related complications was 2.1% (two puncture site bleedings of which one necessitated fasciotomy and two cases of arteriovenous fistulas managed conservatively). The Major Adverse Event (MAE) rate at 30 days was 1.6% (3/186). Conclusions: Retrograde recanalization of challenging infra-inguinal lesions via PA is safe and effective in experienced hands.
Collapse
Affiliation(s)
- Lorenzo Patrone
- West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow HA1 3UJ, UK;
| | - Gianmarco Falcone
- Interventional Radiology Department, Ospedale Careggi, 50134 Firenze, Italy; (G.F.); (F.F.)
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France;
| | - Hady Lichaa
- Tennessee Health Science Center, Ascension Saint Thomas Heart, Nashville, TN 37203, USA;
| | - Muliadi Antaredja
- Department of Angiology, Clinic for Vascular Medicine, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Fabrizio Fanelli
- Interventional Radiology Department, Ospedale Careggi, 50134 Firenze, Italy; (G.F.); (F.F.)
| | - Erwin Blessing
- Department of Angiology, Clinic for Vascular Medicine, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
| |
Collapse
|
3
|
Shaprynskyi VV. LATE RESULTS OF TREATING PATIENTS WITH OCCLUSIVE-STENOTIC LESIONS OF THE AORTA INFRARENAL SEGMENT'S MAIN ARTERIES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1239-1245. [PMID: 37364079 DOI: 10.36740/wlek202305216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To analyze the results of surgical treatment in the late postoperative period after using modern types of surgical technologies for occlusive-stenotic atherosclerotic lesions of the infrarenal aorta's main arteries. PATIENTS AND METHODS Materials and methods: The total of 420 patients were operated on. The patient's age ranged from 45 to 87 years (in the mean, 66.7±2.3 years). Men pre¬dominated - 375 (89.29%), and women were 45 (10.71%). According to the ischemia classification by Rutherford - 324 (77%) patients fell under categories 4, 5, 6 of the classification. 98 patients were operated on by the open method, 243 by the endovascular method, and 79 by the hybrid method. We assessed such indices as: postoperative thrombosis, limb amputations, mortality, and repeated operations performed due to complications or unsuccessful results of the primary operation. RESULTS Results: It was ascertained, a decrease in the number of postoperative complications from 7.87% to 4.39% (t=2,11, p=0,035), repeated operations - from 7.87% to 4.39% (t=2,11, p=0,035), amputations - from 3.63% to 2.19% (t=1,24, p=0,214) and mortality - from 3.03% to 1.09% (t=2,03, p=0,042) in the group where in-depth examination methods were applied, a treatment algorithm based on individual anatomical and hemodynamic features was implemented, techniques for performing operations were improved. CONCLUSION Conclusions: The analysis of late results of surgical interventions showed that the largest number of complications was found in the group of patients with multistory occlusive-stenotic lesions of arteries.
Collapse
Affiliation(s)
- Vasyl V Shaprynskyi
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| |
Collapse
|
4
|
Shaprynskyi VV, Shaprynskyi YV. CLINICAL OUTCOMES AND COMPLICATIONS OF ENDOVASCULAR SURGERY IN PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2635-2639. [PMID: 36591746 DOI: 10.36740/wlek202211115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: To review the results of endovascular treatment in patients with chronic threatening ischemia of lower extremities as well as to assess the level of complications developed after the use of modern endovascular technologies. PATIENTS AND METHODS Materials and methods: 243 patients with occlusive-stenotic lesions of major arteries of infrarenal aorta, operated on by various endovascular techniques, were studied. 51 of them (20.98%) had multi-level lesions. All experimental group patients (83) were thoroughly evaluated preoperatively including assessment of probable development of arterial thrombosis of affected extremity after the surgery. Besides, endovascular treatment algorithm developed and introduced by the authors on the basis of individual anatomical and hemodynamic parameters was used. RESULTS Results: Thrombosis was the major early postoperative complication in both study groups, being registered in 21 patients (10.6%). The incidence of thrombosis was statistically higher in the control group as compared to experimental group - 11.53% and 7.14%, respectively (p<0.05). 15 patients of both groups underwent amputations - 12 patients (7.5%) in the control group, and 3 patients (3.6%) in experimental group. Early postoperative mortality rate was 2.56% in the control group, while there were no deaths in experimental group in early postoperative period. CONCLUSION Conclusions: Continuous ultrasound monitoring, avoidance of subintimal positioning of endovascular devices, use of rotary-mechanical thromboaspiration, drug-coated balloons and stents, regional thrombolytic therapy, as well as the concept of angiosome-directed therapy used in the study for restoration of artery patency, made it possible to improve treatment outcomes and decrease complications.
Collapse
Affiliation(s)
- Vasyl V Shaprynskyi
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | | |
Collapse
|
5
|
Korleski H, DiChiacchio L, Araujo L, Hall MR. Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report. Vasc Endovascular Surg 2021; 56:49-52. [PMID: 34142625 DOI: 10.1177/15385744211026451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. CASE PRESENTATION The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. DISCUSSION The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.
Collapse
Affiliation(s)
- Hee Korleski
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Luiz Araujo
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Michael R Hall
- University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Medical Center, Baltimore, MD, USA
| |
Collapse
|
6
|
Pezold M, Blumberg S, Sadek M, Maldonado T, Cayne N, Jacobowitz G, James H, Berland T. Antegrade Superficial Femoral Artery Access for Lower Extremity Arterial Disease Is Safe and Effective in the Outpatient Setting. Ann Vasc Surg 2020; 72:175-181. [PMID: 33271278 DOI: 10.1016/j.avsg.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antegrade superficial femoral artery (SFA) access for peripheral artery disease reduces the time, radiation, and contrast required with contralateral common femoral access (CFA). Yet, this technique remains underutilized in the treatment of SFA, popliteal and tibial disease, and there remains limited data on the safety and effectiveness of antegrade SFA access in the outpatient setting. METHODS A retrospective review of lower extremity peripheral arterial interventions in our office-based endovascular suite was conducted from 2013 to 2018. Interventions necessitating CFA access such as iliac, common femoral, or deep femoral artery revascularization were excluded (n = 206). In addition, interventions potentially requiring large sheaths not amenable to SFA access (e.g., popliteal aneurysm) were excluded. Relevant demographic and treatment variables including postoperative complications were abstracted. RESULTS We identified 718 patients, who underwent revascularization of the SFA, popliteal and tibial arteries. Antegrade SFA access was chosen in 448 patients (62.4%) with the remaining 270 patients having retrograde CFA access. Antegrade SFA access was achieved primarily with a 4-French sheath, while a majority of retrograde CFA interventions utilized a 6-French sheath for access (87.7% vs 69.5%, P < 0.001). Significantly less fluoroscopy (9.5 vs 16.4 min, P < 0.001) and contrast (25.4 vs 38.5 mL, P < 0.001) were used during SFA access compared with retrograde access. Technical success was achieved in 93.2% with antegrade SFA vs 94.8% retrograde CFA access (P = 0.42). The overall rate of complications was low for both cohorts (2.7% vs 3.7%, P = 0.78) and there were no statistical differences in access site complications (1.1% vs 1.5%, P = 0.94), hematoma (0.7% vs 1.1%, P = 0.84), and pseudoaneurysm (0.4% vs 0%, P = 0.98) between techniques. CONCLUSIONS Percutaneous antegrade SFA access can be performed safely in the outpatient setting and remains an effective alternative to retrograde CFA access with significantly less utilization of fluoroscopy and contrast.
Collapse
Affiliation(s)
- Michael Pezold
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Sheila Blumberg
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Mikel Sadek
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Thomas Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Neal Cayne
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Herbert James
- New York University School of Medicine, New York, NY
| | - Todd Berland
- Division of Vascular Surgery, New York University Langone Health, New York, NY.
| |
Collapse
|
7
|
Vance AZ, Leung DA, Clark TW. Tips for pedal access: technical evolution and review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:685-691. [PMID: 29905414 DOI: 10.23736/s0021-9509.18.10627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pedal access has become an indispensable technique for endovascular therapy of complex lower extremity peripheral vascular disease. From an option as a single access in a patient lacking traditional access approaches to a critical maneuver in combined antegrade-retrograde approaches during the treatment of complex chronic total occlusions, pedal access is an essential tool for any endovascular physician treating peripheral arterial disease. Anticipatory planning is critical in the successful utilization of pedal access. The appropriate tibiopedal vessel should be chosen and combined with the ideal access technique. Knowledge of the current medical devices available for pedal access and post-procedural hemostasis is key and can ease the learning curve. We present the evolution of pedal access with a review of the literature and technical tips to incorporate into everyday practice.
Collapse
Affiliation(s)
- Ansar Z Vance
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA -
| | - Daniel A Leung
- Department of Vascular and Interventional Radiology, Christiana Care Health System, Newark, DE, USA
| | - Timothy W Clark
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
8
|
Van Pham P, Vu NB, Nguyen HT, Phan NK. Isolation of endothelial progenitor cells from human adipose tissue. BIOMEDICAL RESEARCH AND THERAPY 2016. [DOI: 10.7603/s40730-016-0024-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|