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Vakhitov D, Salminen A, Protto S. To patch, or not to patch a common femoral artery, that is the question. Vascular 2024; 32:997-1004. [PMID: 37155584 DOI: 10.1177/17085381231174702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES There is no strong evidence to support or reject the use of patch angioplasty (PA) after femoral endarterectomy (FE). The current study aimed to assess early postoperative complications and compare primary patency (PP) rates after FE in patients treated with PA versus direct closure (DC). METHODS This is a retrospective study of patients admitted during 06/2002-07/2017 with signs and symptoms of chronic lower limb ischemia (Rutherford categories 2-6). Patients with angiographically confirmed stenoses or occlusions of the common femoral arteries (CFAs) and managed with FE with or without PA were included in the study. Early postoperative wound complications were assessed. The PP analysis was based on imaging-confirmed data. The impact of PA on the patency was evaluated in a confounder-adjusted Cox regression model. PP rates were compared with log-rank between the PA and DC groups using Kaplan-Meier survival analysis in the propensity score-matched (PSM) cohorts. RESULTS A total of 295 primary FEs were identified. The patients' median age was 75 years. A total of 210 patients were managed with PA and 85 with DC. Altogether, 38 (12.9%) local wound complications were registered, 15 (5.1%) of which required re-interventions. There were 9 (3.2%) cases of deep wound infection, 20 (7.0%) seromas, and 11 (3.9%) cases of major bleeding, with no significant difference between the PA and DC groups. All of the infected patches were made of synthetic material, and 83% of them were removed. The PP analysis was performed on 50 PSM patient pairs with a median age of 74 years. The median imaging-confirmed follow-up lengths were 77 months (IQR = 47 months) for the PA patients and 27 months (IQR = 64 months) for the DC patients. The preoperative median diameter of the CFA was 8.8 mm (IQR = 3.4). The 5 year primary patency rates of CFAs with a minimum diameter of 5.5 mm managed with PA or DC exceeded 91%, p > 0.05. Female sex was associated with the loss of PP, odds ratio 4.17, p = 0.046. CONCLUSIONS Wound complications after FE with or without patching are not uncommon and often lead to reoperations. The PP rates of CFAs with a minimum diameter of 5.5 mm and accomplished with or without patching are comparable. Female sex is associated with the loss of patency.
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Affiliation(s)
- Damir Vakhitov
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Akseli Salminen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Sara Protto
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
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2
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Chaney M, Joshi G, Cataneo Serrato JL, Rashid M, Jacobs A, Jacobs CE, White JV, Schwartz LB, El Khoury R. The natural history of isolated common femoral endarterectomy for chronic limb-threatening ischemia. J Vasc Surg 2024:S0741-5214(24)01229-1. [PMID: 38823529 DOI: 10.1016/j.jvs.2024.05.050] [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: 01/29/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Occlusive disease of the common femoral artery can generate profound lower extremity ischemia as the normal collateral pathways from the profunda to the superficial femoral artery cannot adequately develop. In patients with lifestyle-limiting claudication, isolated common femoral endarterectomy (CFE) is highly effective. Because CFE does not provide direct, in-line flow to the plantar arch, it has been felt to provide inadequate revascularization to patients with chronic limb-threatening ischemia (CLTI). The purpose of this retrospective clinical study was to report and assess the natural history of selected patients with CLTI treated with isolated CFE (without concomitant infrainguinal revascularization). METHODS Consecutive CFEs performed in a large, urban hospital for CLTI between 2014 and 2021 were reviewed. Patient characteristics, limb, and anatomical stages using the Wound, Ischemia, foot Infection (WIfI) and Global Limb Anatomic Staging System were tabulated. Limb-specific and survival-related end points were analyzed. RESULTS Fifty-eight patients presenting with CLTI underwent isolated CFE (mean age, 74 ± 10 years; 62% male, 90% current or prior smoker). Comorbidities included diabetes (52%), coronary artery disease (55%), congestive heart failure (22%), and end-stage renal failure on hemodialysis (5%). Patients presented with either rest pain (36%) or tissue loss (64%); the latter group exhibited advanced limb threat (68% in WIfI stage 3 or 4). The majority of patients had associated severe infrainguinal disease (50% Global Limb Anatomic Staging Systems 3). After a median follow-up of 17 months (range, 10-29 months), vascular reintervention was required in 7 patients (12%). One patient (2%) required major limb amputation after presentation in WIfI stage 4 (W3I3fI0). Indeed, WIfI stage 4 was a significant univariate predictor of the need for subsequent infrainguinal bypass (P = .034). CONCLUSIONS Isolated CFE as primary therapy in highly selected patients with CLTI was safe and effective. Index limb stage is predictive of the need for associated infrainguinal revascularization in this complex population.
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Affiliation(s)
- Michael Chaney
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | - Gaurang Joshi
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | | | - Mohammed Rashid
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Abraham Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Chad E Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Lewis B Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Rym El Khoury
- Department of Surgery, Division of Vascular Surgery, NorthShore University Health System, Evanston, IL.
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3
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Channane H, Shaporov A, Sandica A, Atay S, Snopok I, Frunza T, Viebahn R. Popliteal endarterectomy at the leg level with venous enlargement patch: about 14 cases. J Surg Case Rep 2023; 2023:rjad398. [PMID: 37426043 PMCID: PMC10329460 DOI: 10.1093/jscr/rjad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
The incidence of lesions of the popliteal artery below the knee constitutes one of the greatest problems in revascularization of the lower limb. Firstly, this segment constitutes the departure of the leg tripod, decisive crossroads for a subsequent endovascular intervention. On the other hand, it constitutes a fairly used relay point in the event of an indication for a pedal bypass. It is assumed that the performance of a popliteal endarterectomy with an enlargement by medial approach in patients with a localized lesion at this level constitutes an effective therapeutic approach and can facilitate any gesture of crural bypass or endovascular dilation later. We present a retrospective review of all patients who underwent popliteal endarterectomy with venous patch plasty for localized popliteal disease in our institution over the past 3 years.
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Affiliation(s)
- Hamid Channane
- Correspondence address. Department of General and Vascular Surgery, Ruhr University, In der Schornau, 23–25, 88492 Bochum, Germany. Tel: +4923429980097; Fax: +492342993209; E-mail:
| | - A Shaporov
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - A Sandica
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - S Atay
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - I Snopok
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - T Frunza
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - R Viebahn
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
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4
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Noronen K, Söderström M, Kouhia S, Venermo M. Bovine pericardial patch: A good alternative in femoral angioplasty. J Vasc Surg 2023; 77:225-230. [PMID: 35987464 DOI: 10.1016/j.jvs.2022.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two methods are scarce. In this retrospective study, we aimed to discover the differences between BPP and AVP closure in long-term durability. METHODS This study consisted of all femoral endarterectomies with BPP closure performed in Helsinki University Hospital from January 1, 2014, to December 31, 2017. For comparison, the same number of consecutive patients who underwent femoral endarterectomy with AVP closure from January 1, 2014, to October 16, 2016, were reviewed. Follow-up ended December 31, 2020. The mean follow-up was 19 months (range, 0-74 months) in the BPP group and 22 months (range, 0-79 months) in the AVP group. The primary endpoint was primary patency. Secondary endpoints were restenosis at patch site detected by imaging or perioperatively, patch rupture, and deep surgical wound infection. Propensity score analysis was performed for adjustment of differences between the AVP and BPP groups. RESULTS Overall primary patency was superior in the AVP group compared with the BPP group: at 1 year, 96.5% vs 85.0% and at 5 years, 83.0% vs 72.3% (P = .04). In propensity score-matched pairs (n = 92), no difference was found between the groups in primary patency: 95.7% and 95.7% at 1 year and 92.5% and 78.6% at 5 years (P = .861) or in freedom from restenosis: 100% and 100% at 1 year and 89.1% and 84.0% at 5 years (P = .057). Deep wound infections occurred slightly more often after BPP closure (8%) than after AVP closure (4%), but the difference was not statistically significant (P = .144). There were no patch ruptures in the BPP group, but in the AVP group, there were five ruptures (3.5%) (P = .024). CONCLUSIONS BPP is compatible to AVP in femoral endarterectomy in patency and can be regarded as the safer choice considering the risk of patch rupture.
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Affiliation(s)
- Katariina Noronen
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
| | - Maria Söderström
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Sanna Kouhia
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
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5
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Sutter W, Hentgen B, Mercier L, Delattre M, Ouldsalek E, Bensaid B, Renard R, Fallouh A, Feito B, Cheysson E, Davaine JM. Surgical treatment of femoral artery bifurcation without material. Technique and follow up. Ann Vasc Surg 2022; 86:190-198. [PMID: 35513126 DOI: 10.1016/j.avsg.2022.04.027] [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: 09/24/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Complete eversion of the femoral tripod is interesting to reduce clinical consequences of wound infection, in particular for patients at high risk (eg: obese, diabetics, cancer). Experience and follow up of this technique are scarce. The different technical possibilities and results are reported here. METHODS Single center prospective study including patients operated on for femoral occlusive lesions using eversion of the common femoral artery and its bifurcation. Clinical and imaging preoperative data, surgical technique and follow up are detailed. RESULTS Thirty-five patients (37 limbs) have been included between June 2014 and April 2016. Mean Rutherford index was 3.6 and 65% of the patients were claudicants. Lesions were limited to the common femoral artery in 14 (38%) of the cases and spread to the superficial femoral artery in 2 (7%) and to the three branches in 21 (57%) of the cases, respectively. Postoperatively, one death, one major amputation and 3 reinterventions were noted, resulting in a 8% rate of major complications. The mean follow up was 37 months. At this time, 11 MACE, 9 deaths and no additional major amputation were noted. The mean Rutherford index was 1.7 (P<.001) and 3 reinterventions were necessary (1 for septic occlusion at 3 months and 2 for restenosis at 12 and 42 months), translating into a primary and secondary patency rates of 93.3% and 96.1%. CONCLUSION This work further confirms that eversion of the femoral tripod is safe and effective. This experience adds to the existing body of the literature and describe alternative techniques of eversion. The technique should be considered when treating patients at high risk of postoperative infection.
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Affiliation(s)
- W Sutter
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Hentgen
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris
| | - L Mercier
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris
| | - M Delattre
- Clinical Research Unit, Centre Hospitalier René Dubos, Pontoise, France
| | - E Ouldsalek
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Bensaid
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - R Renard
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - A Fallouh
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Feito
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - E Cheysson
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - J M Davaine
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris.
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Lin Y, Li W, Liu W, Liu M, Li Y, Chen Y. Mid-term outcomes of endovascular treatment and risk factors for recurrence in patients with Trans-Atlantic-Inter-Society II C/D femoropopliteal lesions. Quant Imaging Med Surg 2021; 11:2028-2039. [PMID: 33936984 DOI: 10.21037/qims-20-221] [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: 11/06/2022]
Abstract
Background The purpose of this study was to determine the efficacy of interventional endovascular treatment (EVT) and the risk factors for postoperative restenosis in patients with Trans-Atlantic Inter-Society Consensus (TASC) II C/D femoropopliteal lesions. Methods A total of 55 patients who received EVT for TASC II C/D femoropopliteal lesions (64 affected limbs) from October 2014 to September 2017 were examined. The mean lesion length was 19.6±5.3 (range, 15.5-26.4 cm). The femoropopliteal lesions were classified as TASC II C and TASC II D in 39 and 16 cases, respectively. The ankle-brachial index (ABI), primary patency rate, secondary patency rate, and limb salvage rate were monitored in follow-up evaluations for up to 24 months. A Cox regression model was used to evaluate the correlation between each of these factors and the restenosis rate after EVT. Results Patent TASC II C/D femoropopliteal lesions were present in 59 of the 64 limbs. The mean ABI values for the dorsal pedal artery and posterior tibial artery increased 1 month after treatment from a baseline level of 0.35±0.12 to 0.89±0.10 and from 0.43±0.15 to 0.90±0.13, respectively (P<0.01). The mean follow-up time was 19.3 (range, 6-24) months. The cumulative primary patency rates at 1, 3, 6, 12, 18, and 24 months were 98.3%, 91.5%, 84.3%, 61.1%, 53.1%, and 31.1%, respectively. The secondary patency rates at 12 and 24 months were 70.4% and 60.0%, respectively. Factors with a high hazard ratio included male sex, TASC II D, smoking, and diabetes mellitus (DM). Conclusions EVT had a safe and satisfactory mid-term therapeutic effect on TASC II C/D femoropopliteal lesions. Male sex, TASC II D (compared to TASC II C), smoking, and DM were risk factors for restenosis. EVT has a secondary patency rate comparable to that of open surgery and can be considered a first-line treatment for TASC II C/D femoropopliteal lesions.
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Affiliation(s)
- Yisheng Lin
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Weihao Li
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Wendao Liu
- Department of Interventional Radiology, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
| | - Min Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Chen
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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7
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Allen KB, Adams JD, Badylak SF, Garrett HE, Mouawad NJ, Oweida SW, Parikshak M, Sultan PK. Extracellular Matrix Patches for Endarterectomy Repair. Front Cardiovasc Med 2021; 8:631750. [PMID: 33644135 PMCID: PMC7904872 DOI: 10.3389/fcvm.2021.631750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Patch repair is the preferred method for arteriotomy closure following femoral or carotid endarterectomy. Choosing among available patch options remains a clinical challenge, as current evidence suggests roughly comparable outcomes between autologous grafts and synthetic and biologic materials. Biologic patches have potential advantages over other materials, including reduced risk for infection, mitigation of an excessive foreign body response, and the potential to remodel into healthy, vascularized tissue. Here we review the use of decellularized extracellular matrix (ECM) for cardiovascular applications, particularly endarterectomy repair, and the capacity of these materials to remodel into native, site-appropriate tissues. Also presented are data from two post-market observational studies of patients undergoing iliofemoral and carotid endarterectomy patch repair as well as one histologic case report in a challenging iliofemoral endarterectomy repair, all with the use of small intestine submucosa (SIS)-ECM. In alignment with previously reported studies, high patency was maintained, and adverse event rates were comparable to previously reported rates of patch angioplasty. Histologic analysis from one case identified constructive remodeling of the SIS-ECM, consistent with the histologic characteristics of the endarterectomized vessel. These clinical and histologic results align with the biologic potential described in the academic ECM literature. To our knowledge, this is the first histologic demonstration of SIS-ECM remodeling into site-appropriate vascular tissues following endarterectomy. Together, these findings support the safety and efficacy of SIS-ECM for patch repair of femoral and carotid arteriotomy.
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Affiliation(s)
- Keith B Allen
- St. Luke's Hospital of Kansas City, St. Luke's Mid America Heart Institute, Kansas City, MO, United States
| | - Joshua D Adams
- Carilion Clinic Aortic and Endovascular Surgery, Roanoke, VA, United States
| | - Stephen F Badylak
- Department of Bioengineering, Department of Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - H Edward Garrett
- Cardiovascular Surgery Clinic, University of Tennessee, Memphis, Memphis, TN, United States
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Rümenapf G, Morbach S, Rother U, Uhl C, Görtz H, Böckler D, Behrendt CA, Hochlenert D, Engels G, Hohneck A, Sigl M. [Diabetic foot syndrome-Part 2 : Revascularization, treatment alternatives, care structures, recurrency prophylaxis]. Chirurg 2021; 92:173-186. [PMID: 33237367 PMCID: PMC7875854 DOI: 10.1007/s00104-020-01313-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Diabetic foot syndrome (DFS) is the most frequent reason for major amputations in Germany. The majority of foot lesions are triggered by repetitive pressure in diabetic polyneuropathy. Peripheral arterial occlusive disease (PAOD) impairs wound healing and is the main risk factor for amputations. The treatment of wounds and infections as well as timely revascularization are decisive. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusion processes. Both procedures are complementary. Bypass surgery is of great importance for neuroischemic DFS. Multidisciplinary centers that provide revascularization in DFS can achieve an improvement of arterial blood flow in 90% of the cases and reduce the amputation rate by up to 80%. Due to the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of exceptional importance (podological and orthopedic technical care, foot surgery).
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Affiliation(s)
- G Rümenapf
- Oberrheinisches Gefäßzentrum Speyer, Diakonissen-Stiftungs-Krankenhaus Speyer, Paul-Egell-Straße 33, 67346, Speyer, Deutschland.
| | - S Morbach
- Abteilung Diabetologie und Angiologie, Fachbereich , Innere Medizin, Marienkrankenhaus gGmbH Soest, Soest, Deutschland
| | - U Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Görtz
- Klinik für Gefäßchirurgie, Bonifatius Hospital Lingen, Lingen, Deutschland
| | - D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C A Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - D Hochlenert
- Centrum für Diabetologie, Endoskopie und Wundheilung Köln, Köln, Deutschland
| | - G Engels
- Chirurgische Praxis am Bayenthalgürtel, Köln, Deutschland
| | - A Hohneck
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
| | - M Sigl
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
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9
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Peters AS, Meisenbacher K, Weber D, Bisdas T, Torsello G, Böckler D, Bischoff MS. Isolated femoral artery revascularisation with or without iliac inflow improvement - a less invasive surgical option in critical limb ischemia. VASA 2021; 50:217-223. [PMID: 33435742 DOI: 10.1024/0301-1526/a000934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Isolated femoral artery revascularisation (iFAR) represents a well-established surgical method in the treatment of peripheral arterial disease (PAD) involving common femoral artery disease. Data for iFAR in multilevel PAD are inconsistent, particularly in patients with critical limb ischemia (CLI). The aim of the study was to evaluate the outcome of iFAR in CLI regarding major amputation and reintervention and to identify associated risk factors for this outcome. Patients and methods: The data used have been derived from the German Registry of Firstline Treatment in Critical Limb Ischemia (CRITISCH). A total of 1200 patients were enrolled in 27 vascular centres. This sub-analysis included patients, which were treated with iFAR with/without concomitant iliac intervention. For detection of risk factors for the combined endpoint of major amputation and/or reintervention, selection of variables for multiple regression was conducted using stepwise forward/backward selection by Akaike's information criterion. Results: 95 patients were included (mean age: 72 years ± 10.82; 64.2% male). Of those, 32 (33.7%) participants reached the combined endpoint. Risk factor analysis revealed continued tobacco use (odds ratio [OR] 2.316, confidence interval [CI] 0.832-6.674), TASC D-lesion (OR: 2.293, CI: 0.869-6.261) and previous vascular intervention in the trial leg (OR: 2.720, CI: 1.037-7.381) to be associated with reaching the combined endpoint. Conclusions: iFAR provides a reasonable, surgical option to treat CLI. Lesion length (TASC D) seems to have a negative impact on outcome. Further research is required to better define the future role of iFAR for combined femoro-popliteal lesions in CLI - best in terms of a randomised controlled trial.
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Affiliation(s)
- Andreas S Peters
- Department of Vascular and Endovascular Surgery Heidelberg, University Hospital Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery Heidelberg, University Hospital Heidelberg, Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital Münster GmbH, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster GmbH, Münster, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery Heidelberg, University Hospital Heidelberg, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery Heidelberg, University Hospital Heidelberg, Germany
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10
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Shibuya T, Watanabe KI, Nakamura T, Fujimura H, Shintani T, Sawa Y. Endarterectomy Using the Lateral Approach with an Ultrasonic Surgical Aspirator Device for Heavily Calcified Peripheral Arterial Occlusive Disease. Ann Vasc Dis 2019; 12:216-221. [PMID: 31275477 PMCID: PMC6600106 DOI: 10.3400/avd.oa.19-00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To present a new and easy technique for performing endarterectomy in patients with peripheral arterial occlusive disease (PAD) having dollop calcification at the common femoral artery (CFA). Materials and Methods: We developed a procedure for angioplasty for PAD using a supersonic surgical suction device, based on the new concept of “to create a new lumen to dig tunnel in calcification.” Ultrasonic surgical aspiration device was inserted into the intravascular space from outside the area of the target lesion and only internal calcification was removed. Results: We performed this technique in three patients who had PAD with dollop calcification at CFA. We succeeded in performing endarterectomy easily and safely. This method does not require vascular wall closure suture at calcified lesion or intimal fixation suture of dollop calcification. Conclusion: We address the technical difficulty in treating highly calcified lesions that could not be dealt with conventional endarterectomy. Our new method is one of the options for revascularization of heavily calcified lesions.
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Affiliation(s)
- Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Cardiovascular Surgery, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Ken-Ichi Watanabe
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Cardiovascular Surgery, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Takashi Nakamura
- Department of Vascular Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hironobu Fujimura
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Takashi Shintani
- Department of Cardiovascular Surgery, Nippon Life Hospital, Osaka, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Jia X, Sun ZD, Patel JV, Flood K, Stocken DD, Scott DJA. Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease. Br J Surg 2018; 106:13-22. [DOI: 10.1002/bjs.11026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 01/09/2023]
Abstract
Abstract
Background
Endovascular intervention has emerged as a potential alternative to open surgery in treating common femoral artery (CFA) atherosclerotic disease. The aim of this systematic review was to assess the safety and efficacy of both techniques.
Methods
Thirteen electronic databases from 1980 to 3 January 2018 were searched. Study quality was assessed using the National Institute for Health and Care Excellence Interventional Procedure Programme quality assessment tool. Safety and efficacy outcome measures were analysed.
Results
Thirty-one studies reporting 813 endovascular procedures and 3835 endarterectomies were included. Only two small RCTs have been reported. The methodological quality of available studies was generally low and follow-up short. Safety endpoint assessment revealed a similar risk of wound haematoma for endovascular intervention and endarterectomy (5·5 (95 per cent c.i. 0·2 to 17·2) versus 3·9 (1·7 to 6·9) per cent respectively), a lower risk of wound infection with endovascular procedures (0 versus 5·9 (3·4 to 9·0) per cent) and a lower risk of wound lymph leakage (0 versus 5·7 (3·3 to 8·6) per cent). Efficacy endpoint assessment at 1 year identified that endovascular intervention had a lower primary patency rate than endarterectomy (78·8 (73·3 to 83·8) versus 96·0 (92·2 to 98·6) per cent respectively), a higher revascularization rate (16·0 (6·1 to 29·4) versus 5·8 (1·0 to 14·2) per cent) and a similar amputation rate (2·7 (1·2 to 4·8) versus 1·9 (0·7 to 3·8) per cent).
Conclusion
Endovascular intervention of CFA disease appears to reduce the risk of wound complications but is associated with a lower patency rate and increased rates of subsequent revascularization procedures. Standardization of the endovascular technique and quantification of the proportions of patients suitable for either technique are required.
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Affiliation(s)
- X Jia
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Z D Sun
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - J V Patel
- Radiology Department, Leeds General Infirmary, Leeds, UK
| | - K Flood
- Radiology Department, Leeds General Infirmary, Leeds, UK
| | - D D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Perou S, Pirvu A, Morel J, Magne JL, Elie A, Spear R. Femoral Bifurcation Endarterectomy with Transection-Eversion of the Superficial Femoral Artery: Technique and Results. Ann Vasc Surg 2018; 53:177-183. [PMID: 30012452 DOI: 10.1016/j.avsg.2018.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We evaluated the results of femoral bifurcation endarterectomy using the eversion technique with transection of the superficial femoral artery (femoral bifurcation endarterectomy with eversion [FBEE]). METHODS We included all patients who underwent a femoral revascularization using the eversion technique, with or without antegrade or retrograde revascularization, from January 2006 to December 2015. Data were retrospectively collected. Primary and primary assisted patency (PAP) of the femoral bifurcation were analyzed. Secondary outcomes were 30-day postoperative complications. RESULTS A total of 129 patients (143 limbs) underwent consecutive FBEE (86.8% men, with a mean age of 69.7 years). Patients presented with claudication (93, 65%) and critical ischemia (46, 32.2%). Primary patency was 96.3%, 94.6%, and 93% at 1, 2, and 5 years, respectively. PAP was 99% at 3 time points. Reintervention was necessary in 8 patients during follow-up. The 30-day mortality was 0.7% (1 patient), and the access complication rate was 18.8% (n = 27), of which only 2.8% (n = 4) were major complications. CONCLUSIONS This retrospective study confirmed the efficiency and the reproducibility of this technique for the treatment of femoral bifurcation lesions. This technique allowed treating extensive atherosclerotic lesions of the deep femoral artery and may be associated with antegrade and retrograde revascularizations.
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Affiliation(s)
- Sébastien Perou
- Department of Vascular, Grenoble University Hospital, Grenoble, France; Department of Thoracic Surgery, Grenoble University Hospital, Grenoble, France.
| | - Augustin Pirvu
- Department of Vascular, Grenoble University Hospital, Grenoble, France; Department of Thoracic Surgery, Grenoble University Hospital, Grenoble, France
| | - Jessica Morel
- Department of Vascular, Grenoble University Hospital, Grenoble, France; Department of Thoracic Surgery, Grenoble University Hospital, Grenoble, France
| | - Jean-Luc Magne
- Department of Vascular, Grenoble University Hospital, Grenoble, France; Department of Thoracic Surgery, Grenoble University Hospital, Grenoble, France
| | - Amandine Elie
- Department of Vascular, Grenoble University Hospital, Grenoble, France; Department of Thoracic Surgery, Grenoble University Hospital, Grenoble, France
| | - Rafaelle Spear
- Department of Vascular, Grenoble University Hospital, Grenoble, France; Department of Thoracic Surgery, Grenoble University Hospital, Grenoble, France
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13
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Elsherif M, Tawfick W, Elsharkawi M, Campell R, Hynes N, Sultan S. Common femoral artery endarterectomy in the age of endovascular therapy. Vascular 2018; 26:581-590. [PMID: 29759039 DOI: 10.1177/1708538118772682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Common femoral artery endarterectomy (CFE) is the standard treatment for common femoral artery occlusive disease. We aim to assess the medium term outcomes of CFE with or without further concomitant procedures. DESIGN A retrospective observational study. METHODS All patients who underwent either isolated CFE (ICFE), CFE with angioplasty for occlusive arterial disease (CFEA) or concomitant CFE with endovascular aortic aneurysm repair (CFEE) were included. Patient demographics follow up, clinical improvement, types of CFE closure, patency rates, and survival-free amputation were noted. RESULTS From 2002 to 2015, 1512 patients were referred with a diagnosis of critical limb ischemia. Of those, 1134 required revascularization. Sixty-one patients underwent 66 CFE. Ten limbs underwent an ICFE, 35 had CFEA, and 21 underwent CFEE. Demographics were comparable in all groups. Twenty-seven were closed primarily, while 39 required patch closure (12 venous, 8 Dacron, 19 biological). Technical success was 100% in ICFEs, 94% in CFEA, and 100% for CFEE ( p = 0.274). Immediate clinical success was 100% in both CFE and CFEE, but was 85.7% in CFEA ( p = 0.035). Immediate hemodynamic success was similar in all three groups ( p = 0.73). Sustained hemodynamic success was 30% in ICFE, 54.3% in CFEA, and 23.8% in CFEE ( p = 0.056). At two years, the primary patency was 90% in ICFE, 74.3% in CFEA, and 100% in CFEE ( p = 0.049). Primary-assisted patency was 90% in ICFE, 82.9% in CFEA, and 100% in CFEE ( p = 0.17). Secondary patency was 90% in ICFE, 94.3% in CFEA, and 100% in CFEE ( p = 0.409). Re-intervention was required in 26.9% of primary closures, versus 12.8% with patch closures ( p = 0.279). Amputation-free survival was 100% in ICFE, 80% in CFEA, and 100% in CFEE ( p = 0.056). CONCLUSION CFE is a reliable and dependable procedure, even in the absence of good distal runoff.
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Affiliation(s)
- Mohamed Elsherif
- 1 Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland
| | - Wael Tawfick
- 1 Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland
| | - Mohamed Elsharkawi
- 1 Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland
| | - Ruth Campell
- 1 Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland
| | - Niamh Hynes
- 1 Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland.,2 Department of Vascular and Endovascular Surgery, Galway Clinic, Royal College of Surgeons of Ireland Affiliated Hospital, Doughiska, Galway, Ireland
| | - Sherif Sultan
- 1 Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland.,2 Department of Vascular and Endovascular Surgery, Galway Clinic, Royal College of Surgeons of Ireland Affiliated Hospital, Doughiska, Galway, Ireland
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14
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van Haelst ST, Haitjema S, de Vries JPP, Moll FL, Pasterkamp G, den Ruijter HM, de Borst GJ. Patients with diabetes differ in atherosclerotic plaque characteristics and have worse clinical outcome after iliofemoral endarterectomy compared with patients without diabetes. J Vasc Surg 2017; 65:414-421.e5. [DOI: 10.1016/j.jvs.2016.06.110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/25/2016] [Indexed: 01/16/2023]
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15
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Kuma S, Tanaka K, Ohmine T, Morisaki K, Kodama A, Guntani A, Ishida M, Okazaki J, Mii S. Clinical Outcome of Surgical Endarterectomy for Common Femoral Artery Occlusive Disease. Circ J 2016; 80:964-9. [PMID: 26902450 DOI: 10.1253/circj.cj-15-1177] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although common femoral artery endarterectomy (CFE) is the standard treatment for occlusive disease of the common femoral artery (CFA), several studies have noted encouraging results for endovascular therapy in this anatomical area. METHODS AND RESULTS A retrospective multi-center study of 118 consecutive limbs from 111 symptomatic patients undergoing CFE between April 1998 and December 2014 was performed. Seventy-five CFE were performed on limbs for intermittent claudication and 43 CFE were performed for critical limb ischemia (CLI). The prevalence of perioperative complications was higher in patients with CLI than in the claudication patients. The technical success rate was 99% in all cases. The 1- and 5-year primary patency rates were 100% and 100% for claudication and 95% and 95% for CLI, respectively. The assisted-primary patency rates were 100% at both time points in both groups. Freedom from major amputation at 1 and 5 years was 100% and 100% in the claudication patients and 93% and 82% in the CLI patients, respectively. The 1- and 5-year overall survival rates were 97% and 89% in the claudication patients and 69% and 33% in the CLI patients, respectively. CONCLUSIONS CFE is a safe, effective and durable procedure for occlusive disease of the CFA. This procedure should remain the standard treatment for this anatomical region.
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Affiliation(s)
- Sosei Kuma
- Department of Vascular Surgery, Fukuoka Higashi Medical Center
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16
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Dufranc J, Palcau L, Heyndrickx M, Gouicem D, Coffin O, Felisaz A, Berger L. Technique and results of femoral bifurcation endarterectomy by eversion. J Vasc Surg 2015; 61:728-33. [DOI: 10.1016/j.jvs.2014.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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17
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Ziegler KR, Cruz J, Muhs BE, Indes JE, Sumpio BE, Chaar CI. Iatrogenic Profunda Femoris Stenosis after Superficial Femoral Artery Stenting. Am Surg 2014. [DOI: 10.1177/000313481408000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kenneth R. Ziegler
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Joshua Cruz
- Department Of Diagnostic Radiology Yale New Haven Hospital New Haven, Connecticut
| | - Bart E. Muhs
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Jeffrey E. Indes
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Bauer E. Sumpio
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Cassius I. Chaar
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
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Ohana M, El Ghannudi S, Girsowicz E, Lejay A, Georg Y, Thaveau F, Chakfe N, Roy C. Detailed cross-sectional study of 60 superficial femoral artery occlusions: morphological quantitative analysis can lead to a new classification. Cardiovasc Diagn Ther 2014; 4:71-9. [PMID: 24834405 DOI: 10.3978/j.issn.2223-3652.2014.01.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/30/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Current clinical classification of superficial femoral artery (SFA) occlusions as defined by TASC II guidelines is limited to length and calcifications analysis on 2D angiograms, while state-of-the-art cross-sectional imaging like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provides much more detailed anatomical information than traditional invasive angiography: quantitative morphological analysis of these advanced imaging techniques could therefore be the basis of a refined classification. METHODS AND RESULTS Forty-six patients (65% men, 68±11.6 years) that underwent lower limb CTA were retrospectively included, totalizing 60 SFA occlusions. Lesions were classified as TASC II stage A in 3% of cases, stage B in 20%, stage C in 2% and stage D in 75%. For each pathological artery, curved multiplanar reconstructions following the occluded SFA course were used to measure the total length and the mean diameter of the occluded segment. Color-coded map provided an accurate estimation of calcifications' volume. Thirty-nine percent of the occlusions were total. Mean occluded segment length was 219±107 mm (range, 14-530 mm); mean occluded segment diameter was 6.1±1.6 mm (range, 3.4-10 mm); mean calcifications' volume in the occluded segment was 1,265±1,893 mm(3) (range, 0-8,815 mm(3)), corresponding to a percentage of 17.4%±20% (range, 0-88.7%). Shrinked occluded occlusions were defined by a mean diameter under 5 mm and heavily calcified occlusions by a mean percentage of calcifications above 4%. Use of these thresholds allowed the distinction of four groups of patients: heavily calcified occlusions with preserved caliber (56%), non-calcified occlusions with preserved caliber (19%), non-calcified occlusions with small caliber (15%) and heavily calcified occlusions with small caliber (10%). CONCLUSIONS SFA OCCLUSIONS ARE DISPARATE: this simple morphological study points out TASC II classification weaknesses for SFA occlusions, as quantitative cross-sectional imaging analysis with measurement of mean occluded diameter and percentage of calcifications can refine it. This could be particularly useful in the management of TASC II type D lesions, for which new endovascular revascularization techniques are arising, and where a CTA or MRA-based morphological classification could provide support in choosing between them. KEYWORDS Computer-assisted image processing; femoral artery; multidetector computed tomography; magnetic resonance angiography (MRA); peripheral arterial disease.
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Affiliation(s)
- Mickaël Ohana
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Soraya El Ghannudi
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Elie Girsowicz
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Anne Lejay
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Yannick Georg
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Fabien Thaveau
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Nabil Chakfe
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Catherine Roy
- 1 Radiology Department, 2 Vascular Surgery Department, Nouvel Hôpital Civil-Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
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Common Femoral Artery Endarterectomy for Lower-Extremity Ischemia: Evaluating the Need for Additional Distal Limb Revascularization. Ann Vasc Surg 2012; 26:946-56. [DOI: 10.1016/j.avsg.2012.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/19/2012] [Accepted: 02/27/2012] [Indexed: 11/20/2022]
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Hirsch AT, Allison MA, Gomes AS, Corriere MA, Duval S, Ershow AG, Hiatt WR, Karas RH, Lovell MB, McDermott MM, Mendes DM, Nussmeier NA, Treat-Jacobson D. A Call to Action: Women and Peripheral Artery Disease. Circulation 2012; 125:1449-72. [DOI: 10.1161/cir.0b013e31824c39ba] [Citation(s) in RCA: 232] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Isolated Endarterectomy of Femoral Bifurcation in Critical Limb Ischemia: Is Restoration of Inline Flow Essential? Angiology 2010; 62:119-25. [DOI: 10.1177/0003319710381994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This retrospective study reviews clinical outcomes of isolated common femoral endarterectomy (CFE) for critical limb ischemia (CLI), in particular whether poor runoff and inability to restore inline flow has negative impact. In 30 patients, runoff was assessed on preoperative angiograms and categorized into groups based on Society of Vascular Surgery criteria. Data were evaluated using Cox Regression survival analysis. Freedom from secondary revascularization was not affected by runoff score (hazard ratio for compromised and poor groups being 1.8 (95% CI 0.16 to 20.8) and 1.47 (95% CI 0.09 to 24.3), respectively; P = .894). Distal inline flow was not achieved in 25 (83%) patients, but this was not associated with significantly worse outcome (P = .295, log-rank test). In conclusion, CFE can be performed in CLI with high technical success and there is no significant effect of runoff score on recurrence of symptoms. Limb salvage can be achieved even if options to restore inline flow are limited.
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Evans C, Peter N, Gibson M, Torrie EP, Galland RB, Magee TR. Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty. Ann R Coll Surg Engl 2010; 92:347-52. [PMID: 20501022 DOI: 10.1308/003588410x12664192075099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Retrograde transpopliteal angioplasty (PA) is a potentially useful alternative technique for endovascular treatment of infra-inguinal arterial disease when antegrade transfemoral puncture (FA) is technically not possible or appropriate. This study aimed to investigate the outcomes of PA compared with FA during a 5-year period. PATIENTS AND METHODS A retrospective study was performed to assess 88 PA and 275 FA performed between January 2003 and January 2008. Assessments of patients, indication for procedure, disease site, stenosis severity, procedure outcomes and time to further intervention were recorded. RESULTS FA was used to treat more patients with critical ischaemia (42.2% vs 30.7%; P = 0.014)). PA was used to treat more proximal superficial femoral lesions (P < 0.001) and occlusive lesions (P = 0.001). Overall, 84.1% of PA and 82.5 % of FA were technically successful. There was no difference in local puncture site complication rates. Significantly more FA resulted in distal thrombus/embolism (8.4% vs 3.4%; P = 0.044). Further intervention was required in 27.3% of PA and 36.0% of FA. The time interval to re-intervention was not different between the groups. CONCLUSIONS PA is safe with comparable success rates and long-term outcomes to an FA. PA is a useful alternative approach for treating occlusive, proximal disease.
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Affiliation(s)
- C Evans
- Department of General Surgery, Royal Berkshire Hospital, Reading, UK
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23
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Kukkonen T, Korhonen M, Halmesmäki K, Lehti L, Tiitola M, Aho P, Lepäntalo M, Venermo M. Poor Inter-observer Agreement on the TASC II Classification of Femoropopliteal Lesions. Eur J Vasc Endovasc Surg 2010; 39:220-4. [DOI: 10.1016/j.ejvs.2009.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 11/07/2009] [Indexed: 12/01/2022]
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