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Jie Z, Zhao Z. Challenging Conventional Treatment: Retrograde Implantation of a Covered Stent in Superior Mensenteric Artery Occlusion Case. Vasc Endovascular Surg 2024:15385744241278042. [PMID: 39179511 DOI: 10.1177/15385744241278042] [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: 08/26/2024]
Abstract
Background: This case report describes a novel endovascular technique for treating superior mesenteric artery (SMA) occlusion, a condition leading to chronic mesenteric ischemia (CMI). Traditional treatment methods for CMI, primarily due to SMA stenosis, are often complex and risky, particularly for patients unsuitable for conventional surgery. Objective: This study details the application of retrograde recanalization followed by the deployment of a VIABAHN covered stent in a patient with complete SMA ostium occlusion. Methods: The procedure's success in re-establishing mesenteric blood flow demonstrates its potential as a less invasive, safer alternative to traditional surgical approaches. This technique's innovation lies in its retrograde approach, allowing for effective treatment in cases where antegrade access is unfeasible. Results: The patient showed significant symptom improvement without procedural complications, underscoring the method's efficacy and safety. Conclusion: These findings suggest that retrograde stent implantation can be a viable option for managing SMA occlusions, especially in high-risk surgical cases. The successful application of this technique in this case contributes to the evolving landscape of endovascular interventions in vascular surgery and offers a promising direction for future research and clinical practice in treating SMA-related conditions.
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Affiliation(s)
- Zhang Jie
- Department of Intervention and Vascular Surgery, Lishui Municipal Central Hospital, Lishui, China
- Department of General Surgery, Lishui Municipal Central Hospital, Lishui, China
| | - Zeyi Zhao
- Department of Intervention and Vascular Surgery, Lishui Municipal Central Hospital, Lishui, China
- Department of General Surgery, Lishui Municipal Central Hospital, Lishui, China
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Barillà C, Pipitò N, Squillaci D, Castellana FM, Fittipaldi A, De Caridi G, Benedetto F. Popliteal-to-Distal Extreme Bypass in Endovascular Era. Ann Vasc Surg 2024; 104:276-281. [PMID: 38588950 DOI: 10.1016/j.avsg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) is characterized by rest pain and tissue loss, with an annual mortality rate of 20% and amputation rate of 40%, if not treated. Open bypass surgery is recommended in CLTI, depending on the availability of good quality venous material, outflow artery patency, and surgical expertise. The aim of the study is to analyze primary patency, limb salvage, and survival rate in patients undergoing popliteal-to-distal bypass. METHODS All consecutive patients who underwent popliteal-to-distal bypass surgery between January 2016 and December 2021 were enrolled in the study. Primary outcomes were primary patency, limb salvage, and overall survival. Secondary outcomes included amputation-free survival and secondary patency. RESULTS Forty-nine patients were included during the study. Technical success was achieved in 100% of cases. Target outflow artery was in 27% (n. 13) of cases the anterior tibial artery, in 27% (n. 13) the dorsalis pedis, in 2% (n. 1) the peroneal artery, in 30% (n. 15) the retromalleolar tibial artery, in 10% (n. 5) the medial plantar artery, and in 4% (n. 2) the tarsal artery. Two-year primary patency was 85% ± 5. Secondary patency rates were 86% ± 3 at 2 years. The overall survival was 81% ± 6 at 2 years, the amputation-free survival was 70% ± 9, and the limb salvage rate was 81% ± 6. CONCLUSIONS Popliteal-to-distal bypass requires high technical expertise to be performed. When a good autologous vein and adequate outflow artery are present, they can be feasible with good patency rates and overall survival.
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Affiliation(s)
- Chiara Barillà
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Narayana Pipitò
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Domenico Squillaci
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Federica Maria Castellana
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Alessandra Fittipaldi
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy.
| | - Giovanni De Caridi
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Filippo Benedetto
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
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Alonso AG, Kobzeva-Herzog A, Siracuse JJ. Alternative access for peripheral vascular interventions. J Vasc Surg Cases Innov Tech 2023; 9:101232. [PMID: 37408940 PMCID: PMC10319322 DOI: 10.1016/j.jvscit.2023.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023] Open
Abstract
Percutaneous endovascular interventions for advanced lower extremity peripheral arterial disease are becoming increasingly used, often as first-line treatment of chronic limb threatening ischemia. Advancements in endovascular techniques have provided safe and effective alternative revascularization options, especially for high-risk surgical patients. Although the classic transfemoral approach results in high technical success and patency rates, an estimated 20% of lesions remain challenging to access via an antegrade approach. As such, alternative access sites are important in the endovascular armamentarium for the management of chronic limb threatening ischemia. The goal of this review is to discuss alternative access sites, specifically the transradial, transpopliteal, and transpedal approaches, in addition to transbrachial and transaxillary access, and their outcomes in peripheral arterial disease and limb salvage.
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Affiliation(s)
| | | | - Jeffrey J. Siracuse
- Correspondence: Jeffrey J. Siracuse, MD, MBA, Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, 85 E Concord St, Boston, MA 02118
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Gani F, Jammeh ML, Zayed MA. Modified bare-back micro-retrograde tibial arterial access to facilitate peripheral endovascular therapy. J Vasc Surg Cases Innov Tech 2023; 9:101204. [PMID: 37333864 PMCID: PMC10273279 DOI: 10.1016/j.jvscit.2023.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/12/2023] [Indexed: 06/20/2023] Open
Abstract
Patients with critical limb threatening ischemia often present with complex segmental peripheral arterial chronic total occlusions, which might not be amenable to traditional antegrade revascularization techniques. For these patients, alternative retrograde revascularization techniques could be necessary. In the present report, we describe a novel modified retrograde cannulation technique using a bare back technique that eliminates the need for conventional tibial access sheath placement and, instead, facilitates distal arterial blood sampling, blood pressure monitoring, retrograde administration of contrast agents and vasoactive substances, and a rapid-exchange strategy. This cannulation strategy can serve as part of the armamentarium in the treatment of patients with complex peripheral arterial occlusions.
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Affiliation(s)
- Faiz Gani
- Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, MO
| | - Momodou L. Jammeh
- Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, MO
| | - Mohamed A. Zayed
- Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, MO
- Department of Radiology, School of Medicine, Washington University in St Louis, St Louis, MO
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St Louis, St Louis, MO
- Veterans Affairs St Louis Health Care System, St Louis, MO
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Dubosq M, Renard R, Jayet J, Mercier L, Javerliat I, Castier Y, Coggia M, Coscas R. Single Primary Retrograde Access to Treat Femoro-Popliteal Occlusive Lesions. J Endovasc Ther 2023:15266028231188868. [PMID: 37515490 DOI: 10.1177/15266028231188868] [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: 07/31/2023]
Abstract
INTRODUCTION The retrograde puncture of a distal artery is considered a bailout procedure in case of anterograde approach failure for peripheral artery disease (PAD) treatment. A single primary retrograde access has been suggested as an efficient and safe option. As scant data are available, we present our results using this approach. MATERIAL AND METHODS Between August 2019 and October 2022, we performed this technique in selected patients with femoro-popliteal PAD. Chronic total occlusions (CTOs) were selected on the basis of the CTOP classification. An ultrasound-guided retrograde puncture of a tibial artery at the ankle level was performed, followed by the preferential use of 4F materials. Hemostasis of the puncture site was obtained using manual compression. Postoperative duplex scan examination systematically included an evaluation of the punctured artery. Demographics, intraoperative, and follow-up data were collected retrospectively. The results are expressed as means with standard deviations and numbers with percentages when appropriate. RESULTS In total, 55 procedures were performed in 46 patients (9 bilateral). Of these, 57% (N=26) were considered at risk for femoral puncture (obesity, history of groin surgery, challenging crossover approach) and 54% (N=25) presented with critical limb-threatening ischemia (CLTI). The TASC-II femoro-popliteal classification was generally B (60%) and also C (33%) or D (7%). Mean lesion length was 105.6±49.4 mm and 65% were CTOs. Most patients were operated in an outpatient setting (N=25; 54%) under potentialized local anesthesia (N=41, 89%). The punctured site was the posterior tibial artery in 73% (N=40). The procedure time was 65.1±25.7 minutes, and the fluoroscopy time was 10.7±8.5 minutes. The technical success rate was 100%. There were no intraoperative complications. All patients could walk the same day. One CLTI patient presented an erysipelas related to the puncture in postoperative period. At 30 days, the primary patency of the treated and the punctured arteries were 98% and 100%, respectively. CONCLUSION A single primary retrograde access can be used safely to treat femoro-popliteal PAD. It represents a valuable alternative to the femoral puncture and allows fast ambulation. Prospective and long-term studies on larger populations are necessary to confirm our results. CLINICAL IMPACT This study demonstrates that a single primary retrograde access can be used safely without damaging the punctured artery to treat femoro-popliteal lesions, especially in claudicant patients. Chronic total occlusions can be treated successfully using this technique. This approach represents a valuable alternative to the femoral puncture and allows fast ambulation without risk of major bleeding.
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Affiliation(s)
- Maxime Dubosq
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Régis Renard
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Mercier
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Intelligent Algorithm-Based Analysis on Ultrasound Image Characteristics of Patients with Lower Extremity Arteriosclerosis Occlusion and Its Correlation with Diabetic Mellitus Foot. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7758206. [PMID: 34616537 PMCID: PMC8487825 DOI: 10.1155/2021/7758206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 12/20/2022]
Abstract
Objective The study focused on the correlation between lower extremity arteriosclerosis and diabetic mellitus (DM) foot, and it was explored by virtue of ultrasound images processed by an intelligent algorithm. Methods A total of 60 DM foot patients admitted to our hospital in the past three years were selected and divided into two groups according to their condition. Patients with DM foot alone were in group B (30 cases), and patients with DM foot combined with lower extremity arteriosclerosis occlusion were in group C (30 cases). 30 healthy people were in group A as a control. Color Doppler ultrasound was used to examine the arteries of the lower extremities of all subjects. It the intramedia thickness (IMT) from the femoral artery to the dorsal foot artery was recorded, whether there was plaque in the artery or knowing the size of the plaque, its echo, and distribution, and whether the artery had stenosis. Next, the stenosis percentage was calculated. Additionally, the general information of patients was analyzed. At the same time, an intelligent algorithm was used to process ultrasound images, and its effects on image quality were evaluated. Results Doppler ultrasound images processed by Artificial Bee Colony (ABC) had less noise and better quality, and key information about the lesion was clearly displayed. There was no statistical difference between the general data of the three groups of patients; group B and group C had higher IMT value, plaque incidence, arterial stenosis incidence, and degree of stenosis versus group A, and there were statistically significant differences between groups B and C. In particular, the incidence of femoral artery stenosis and the degree of stenosis were significantly higher in group C than in group B. The rate of stenosis above grade I in group C was as high as 71%, while that in group B was only 19%; in Group C, the incidence of stenosis above grade II was 30%, and that in group B was 13.1%. Compared with group A, group B and group C had decreased peak arterial blood velocity (PSV), resistance index (RI), and pulse index (PI), and there were statistically significant differences between groups B and C. Conclusion DM foot is a risk factor for arteriosclerosis occlusion; color Doppler ultrasound demonstrates good diagnostic effects on arteriosclerosis occlusion; the algorithm proposed in this study can improve the quality of Doppler ultrasound images and has a high application value.
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Giannopoulos S, Palena LM, Armstrong EJ. Technical Success and Complication Rates of Retrograde Arterial Access for Endovascular Therapy for Critical Limb Ischaemia: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2020; 61:270-279. [PMID: 33358346 DOI: 10.1016/j.ejvs.2020.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Antegrade crossing techniques via transfemoral access are often challenging and may be associated with technical and clinical failure when treating patients with critical limb ischaemia (CLI). The objective of this study was to summarise all available literature regarding retrograde endovascular treatment of patients with CLI and to investigate the technical success and complication rate of retrograde access. METHODS A systematic literature search was performed in PubMed, Scopus, and Cochrane Central until May 2020. A meta-analysis of 31 observational studies (29 retrospective and two prospective; 26 and five studies with low and moderate risk of bias, respectively) was conducted with random effects modelling. The incidence of adverse events peri-procedurally and during follow up were calculated. RESULTS The 31 studies enrolled 1 910 patients who were treated endovascularly for femoropopliteal and/or infrapopliteal lesions causing CLI. Most of the patients had diabetes while more than half of the overall population had coronary artery disease and dyslipidaemia. All lesions were located in the infra-inguinal segment and most were chronic total occlusions (96%; 95% CI 85%-100%). Seven studies reported moderate or severe calcification in approximately half of the cases (45%; 95% CI 30%-60%). The overall technical success of the retrograde approach was 96% (18 studies; 95% CI 92%-100%). Perforation, flow limiting dissection, distal embolisation, and local haematoma at the retrograde access site were infrequent and observed in 2.1%, 0.6%, 0.1%, and 1.3% of the patients, respectively. The six month primary patency rate was 78% (five studies; 95% CI 46%-99%), the six month limb salvage rate was 77% (four studies; 95% CI 70%-84%). CONCLUSION The results indicated that the retrograde or bidirectional antegrade/retrograde approach is safe and effective and facilitates angioplasty when antegrade treatment fails. However, prospective studies with standardised wound care and surveillance protocols are needed to investigate retrograde techniques in patients with CLI who failed antegrade revascularisation, to improve long term limb salvage and survival.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Centre, University of Colorado, Denver, CO, USA
| | - Luis M Palena
- Endovascular Surgery Unit, Endovascular Interventions & Research, Foot & Ankle Clinic, Maria Cecilia Hospital, Cotignola, Italy
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Centre, University of Colorado, Denver, CO, USA.
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Zhang B. Indications for the retrograde tibial artery approach in lower extremity revascularization need to be addressed. J Vasc Surg 2020; 71:717. [PMID: 32040435 DOI: 10.1016/j.jvs.2019.08.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Bihui Zhang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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