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Mousa A, Abdelmohsen AA, Nasr MA, Zakaria MY, Sharabi SA, El Kasaby MI, Abd El Hamid AA, Abdul Hakim S, Nassar AK, El Azzazy M, Elkalla MA, Sharabi A. Adjunctive proximal aortic and aortodistal prosthetic wrapping of vascular anastomoses for Adamantiadis-Behçet's aortic/aortoiliac aneurysms: A revisit. Asian J Surg 2023; 46:483-491. [PMID: 35750611 DOI: 10.1016/j.asjsur.2022.05.167] [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: 02/14/2022] [Revised: 05/04/2022] [Accepted: 05/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We described our local experiences with a single-layer wrapping technique for the vascular anastomoses in patients with Adamantiadis-Behçet's aortic/aortoiliac aneurysms using InterGard Silver-impregnated Dacron® patch prosthesis. METHODS Between January 2013 to December 2019, we retrospectively reviewed 20 patients presented with Adamantiadis-Behçet's aortic/aortoiliac aneurysms. All patients presented with Adamantiadis-Behçet's aortic/aortoiliac aneurysms. Two groups were analyzed, Group I, considered as a control group (n = 20). While group II (n = 20), of which prosthetic wrapping was performed. Follow up took place for a maximum of 24 months. RESULTS during a six-year retrospective study period, 20 patients were recruited. They included 15 males and five females (ratio 3:1). The median age was 30.5 ± 4.2 years. Anastomotic pseudoaneurysms were reported in group I (control, [non-wrapping group]). While group II doesn't (wrapping group). Paired samples t test revealed a significant difference between those underwent wrapping and those with non-wrapping (p = .019 and .038). False aneurysms were reported in 80% of the non-wrapping group as estimated by the Kaplan-Meier curves. While Log-rank test results revealed a significant difference between both the studied groups (p < .008). Primary graft patency was 90% at 24 months as reported by the Kaplan-Meier survival method. CONCLUSIONS adjunctive wrapping for vascular anastomoses using Intergard Silver-impregnated Dacron® patch in patients with Adamantiadis-Behçet's aortic/aortoiliac aneurysms is an applicable, simple, and reliable technique. It was associated with low morbidity and mortality rates. Moreover, we discussed a relatively old technique aiming to explore its success and safety in treating arterial aneurysms in Adamantiadis-Behçet's disease patients.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt.
| | - Abdelhalim A Abdelmohsen
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed A Nasr
- Department of Vascular Surgery and Endovascular Therapy, Assuit University Hospital, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt
| | - Mohamed Y Zakaria
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Sherif A Sharabi
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed I El Kasaby
- Department of Ophthalmology, Al-Zahara'a University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Aida A Abd El Hamid
- Department of Clinical Pathology, Al-Zahara'a University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Sami Abdul Hakim
- Department of Rheumatology and Rehabilitation, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Abdelfattah K Nassar
- Department of Rheumatology and Rehabilitation, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed El Azzazy
- Department of Diagnostic and Interventional Radiology, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mai A Elkalla
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Alaa Sharabi
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
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Hwang K, Park SW. [Current Strategy in Endovascular Management for Below-the-Knee Arterial Lesions]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:541-550. [PMID: 36238794 PMCID: PMC9432451 DOI: 10.3348/jksr.2021.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 06/16/2023]
Abstract
The below-the-knee arterial tree is the thinnest of all the leg vessels and is an important path for blood flow to the foot. Hence, lesions including stenosis, especially obstruction, may lead to critical limb ischemia which represents the most severe clinical manifestation of peripheral arterial disease. It is characterized by the presence of ischemic rest pain, ischemic lesions, or gangrene attributable to the objectively proven arterial occlusive disease. Typically, the atherosclerotic disease process involving the below-the-knee arterial tree is diffuse in the majority of patients. The cornerstone of therapy is vascular reconstruction and limb salvage. Revascularization should be attempted whenever technically possible, without delay, in patients presenting critical limb ischemia and when the clinical status is not hopelessly non-ambulatory. Therefore, endovascular treatment can become the gold standard for the full range of patients including below-the-knee, limiting the clinical role of the classically trained surgeons.
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Endovascular Relining of Chronically Occluded Infrainguinal Venous Bypass Grafts. Ann Vasc Surg 2021; 74:339-343. [PMID: 33508456 DOI: 10.1016/j.avsg.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Treatment of chronically occluded infrainguinal venous bypass grafts in patients presenting with recurrent chronic limb threatening limb ischemia (CLTI) represent a clinical challenge. Recent case reports have suggested the use of endovascular recanalization techniques without preceding thrombolysis. This study assesses feasibility and mid-term outcomes of this technique. RESULTS A retrospective review of 5 consecutive patients (3 men, 2 women, mean age 70 ± 5 years) presenting with chronic venous bypass graft occlusion and recurrence of CLTI during 1 year was performed. Patients were treated with relining of the bypass grafts. Patients were followed up at median 26 (6-36) months. All patients were treated successfully with restoration of flow in the grafts using recanalization and relining technique without thrombolysis. In 4 patients, a Viabahn stentgraft (SG) was used with the addition of interwoven nitinol stents (INS) in 3. In 1 patient, the graft was treated with INS without the addition of a stentgraft. No peripheral embolization was encountered during the procedures. One patient occluded the relined grafts after 6 months. The remaining 4 grafts were all patent at 24-month follow-up. A total of 6 reinterventions (in 3 patients) were performed to reach 80% secondary patency. CONCLUSIONS This case series demonstrate feasibility and promising mid-term results, from relining of chronically occluded infra-inguinal venous bypass grafts using stent grafts, interwoven and bare-metal stents without preceding thrombolysis. The technique could be an alternative treatment option in the treatment of these challenging cases.
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Preliminary Experience of Viabahn Stent Graft Inside the Occluded Prosthetic Bypass Graft for the Treatment of Above Knee Femoropopliteal Bypass Occlusion. Cardiovasc Intervent Radiol 2019; 43:223-230. [DOI: 10.1007/s00270-019-02376-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
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Chan YC, Cheng S. Angioplasty and Stenting of Distal Anastomotic Stenosis of Femoropopliteal Bypass Graft Using Helical Interwoven Nitinol Stents. Int J Angiol 2016; 25:e25-e28. [PMID: 28031646 DOI: 10.1055/s-0034-1370888] [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: 10/24/2022] Open
Abstract
Minimally invasive endovascular options of angioplasty and stenting can be used to treat distal anastomotic stenoses in lower limb bypass grafts, but stents near the knee joint may fracture. The nitinol helical interwoven structure of the Supera stents (IDEV Technologies Inc., Houston, TX) has improved flexibility and kink resistance. We report a patient who received salvage angioplasty and Supera stenting of the distal anastomosis of femoropopliteal bypass grafts with good mid-term results. Considering the high radial strength and fracture resistance, these Supera stents may be a good treatment option in salvaging failing bypass grafts.
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Affiliation(s)
- Yiu Che Chan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Stephen Cheng
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong
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Yanagiuchi T, Kimura M, Shiraishi J, Sawada T. Endovascular Treatment for Infra-inguinal Autologous Saphenous Vein Graft Occlusion Using Self Expanding Nitinol Stents. EJVES Short Rep 2016; 30:16-19. [PMID: 28856296 PMCID: PMC5573116 DOI: 10.1016/j.ejvssr.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction For patients with infra-inguinal autologous vein bypass graft occlusion, conventional open surgical repair or endovascular treatment (EVT) for native vessel occlusion have generally been performed. Report A 73 year old female with non-healing ulcer and gangrene of the left lower leg was diagnosed as having infra-inguinal autologous saphenous vein graft occlusion. In this case, surgical repair such as patch angioplasty, interposition graft, or replacement graft did not seem promising because of repeated previous infection in the polytetrafluoroethylene (PTFE) vascular prosthesis and absence of available autologous vein due to past surgery. Moreover, there was no chance of crossing the native vessel, since the proximal superficial femoral artery (SFA) had already been resected. Thus, EVT was performed for the occluded autologous vein graft, implanting multiple self expanding bare nitinol stents throughout the vein graft achieving complete revascularization, good medium term patency, and dramatically improved wound healing. Conclusion Endovascular recanalization using multiple bare stents could be an alternative treatment for infra-inguinal autologous vein graft occlusion. This report highlights EVT for infra-inguinal autologous vein graft occlusion. Self-expanding nitinol bare stents were implanted throughout the vein graft. Just after the procedure, we confirmed sufficient expansion of the nitinol stents. The treated vessel had good patency without repetitive intervention for 15 months. The ulcer and gangrene gradually healed.
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Affiliation(s)
- T Yanagiuchi
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - M Kimura
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - J Shiraishi
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - T Sawada
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
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Mathur K, Ayyappan MK, Hodson J, Hopkins J, Duddy MJ, Tiwari A, Vohra RK. Stenting as a bail-out option after failed percutaneous transluminal angioplasty in infrainguinal vein bypass grafts. Vascular 2015; 24:383-9. [PMID: 26306586 DOI: 10.1177/1708538115602835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the safety and efficacy of bare and covered stents in infrainguinal vein grafts after failure of PTA for treating graft stenoses. METHODS An analysis of a prospective database of all patients who underwent stenting of infrainguinal vein bypass grafts at this institution between 1 January 2008 and 31 December 2012 was carried out. The main outcome considered was primary patency, which was reported at 1, 6 and 12 months. RESULTS A total of 18 patients with a mean age of 73 years (range: 56 to 86) were included. The indications for stent placement were significant recoil (7, 39%), graft rupture (6, 33%), residual vein cusps (3, 17%) and aneurysmal degeneration (2, 11%). There was a high overall technical success rate of 94% (17/18) and arrest of haemorrhage was achieved in all cases of graft rupture. The primary patency at 1, 6 and 12 months was 89%, 71% and 59%, respectively. CONCLUSION The use of bare and covered stents in infrainguinal vein grafts appears safe and effective. They are an excellent bail-out option for the treatment of graft rupture and give acceptable short-term results.
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Affiliation(s)
- K Mathur
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - M K Ayyappan
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - J Hodson
- Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham, UK
| | - J Hopkins
- Department of Interventional Vascular Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - M J Duddy
- Department of Interventional Vascular Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - A Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - R K Vohra
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
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Rabellino M, García-Nielsen L, Zander T, Baldi S, Estigarribia A, Zerolo I, Cheves H, Llorens R, Maynar M. Primary stenting immediatly after surgery in occluded anastomoses of aortoaortic tube graft: a case report. Cardiol Res Pract 2010; 2010. [PMID: 20721279 PMCID: PMC2913794 DOI: 10.4061/2010/521326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/22/2010] [Indexed: 01/16/2023] Open
Abstract
The conventional elective open procedures for abdominal aortic aneurysm repair are reliable and yield durable results. The aortoaortic tube graft has the lowest morbidity incidence when compared with different techniques. Albeit infrequent, thrombosis can be present in the first 30 days. Its treatment consists in thrombectomy and anastomosis evaluation, but with an increase in morbidity, especially in patients with urgent reintervention. This is a case report of a patient with aortoaortic tube graft, who present critical left limb ischemia immediately after surgical procedure. Angiography showed complete occlusion of left common iliac artery, affecting the distal graft anastomosis. The occlusion was resolved with endovascular treatment, and a noncovered, self-expanding, nitinol stent was deployed (primary stenting) covering the distal bypass anastomosis, with no complications and complete lower limb perfusion recovery. One month later, the patient was still asymptomatic, with distal pulse palpable and ankle-brachial index 1.
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Affiliation(s)
- M Rabellino
- Department of Endovascular Therapy, Hospital Hospiten Rambla, General Franco 115, 38001 Santa Cruz de Tenerife, Spain
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Biondi-Zoccai GGL, Sangiorgi G, Lotrionte M, Feiring A, Commeau P, Fusaro M, Agostoni P, Bosiers M, Peregrin J, Rosales O, Cotroneo AR, Rand T, Sheiban I. Infragenicular Stent Implantation for Below-the-Knee Atherosclerotic Disease: Clinical Evidence From an International Collaborative Meta-Analysis on 640 Patients. J Endovasc Ther 2009; 16:251-60. [PMID: 19642789 DOI: 10.1583/09-2691.1] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Basile A, Tsetis D, Chlouverakis G, Calcara G, Ardita G, Giulietti G, Di Salvo M, Granata A, Lupattelli T, Patti MT. Treatment of anastomotic stenoses of peripheral bypass grafts with cutting balloon angioplasty. Radiol Med 2008; 113:719-26. [DOI: 10.1007/s11547-008-0275-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Accepted: 11/07/2007] [Indexed: 11/30/2022]
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