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Tanaka S, Nakamura T, Yoshida R, Yoshizako T, Kaji Y. Successful revascularization of the occluded anterior tibial artery using ultrasound-guided puncture of the occluded dorsal pedal artery: A case report with literature review. Radiol Case Rep 2024; 19:5164-5168. [PMID: 39263507 PMCID: PMC11388046 DOI: 10.1016/j.radcr.2024.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 09/13/2024] Open
Abstract
A bidirectional approach is necessary for treating critical limb ischemia with complex, multiple lesions. We report an ultrasound-guided bidirectional puncture through an occluded vessel to treat an obstruction extending from the anterior tibial artery to the dorsal foot artery in a patient with toe gangrene and rest pain. This technique effectively restored arterial patency and is a promising approach for managing challenging critical limb ischemia occlusions.
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Affiliation(s)
- Shota Tanaka
- Matsue Seikyo General Hospital, Department of Radiology, 8-8-8, Nishitsuda, Matsueshi, Shimane, 690-8522, Japan
| | - Tomonori Nakamura
- Matsue Seikyo General Hospital, Department of Radiology, 8-8-8, Nishitsuda, Matsueshi, Shimane, 690-8522, Japan
| | - Rika Yoshida
- Shimane University, Faculty of Medicine, Department of Radiology, 89-1, Enyacho, Izumoshi, Shimane, 693-8501, Japan
| | - Takeshi Yoshizako
- Shimane University, Faculty of Medicine, Department of Radiology, 89-1, Enyacho, Izumoshi, Shimane, 693-8501, Japan
| | - Yasushi Kaji
- Shimane University, Faculty of Medicine, Department of Radiology, 89-1, Enyacho, Izumoshi, Shimane, 693-8501, Japan
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2
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Nugteren MJ, Ünlü Ç, Samim M, Scheffer HJ, de Borst GJ, Hazenberg CEVB. Inter- and Intra-observer Agreement of the Peripheral Arterial Calcium Scoring System in Patients Undergoing (Infra)Popliteal Endovascular Interventions. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03839-1. [PMID: 39187653 DOI: 10.1007/s00270-024-03839-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/10/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Peripheral arterial calcification is an important predictor of outcomes after both conservative and endovascular treatment. Digital subtraction angiography (DSA)-based calcification scores are limited by low sensitivity and inter-observer agreement. The Peripheral Arterial Calcium Scoring System (PACSS) assesses the severity of target lesion calcification. The newly introduced modified PACSS (mPACSS) also evaluates target vessel calcification. This study aimed to assess the inter- and intra-observer reliability of PACSS and mPACSS on computed tomography angiography (CTA) in (infra)popliteal endovascular interventions. METHODS A random sample of 50 limbs from the prospective multicenter Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) were included. Three experienced independent raters scored PACSS on CTA. Three months later, one blinded rater assessed the same 50 CTA scans, keeping track of assessment time. The reliability of the original 5-step PACSS, a simplified binary PACSS (0-2 vs 3-4) and the 7-step mPACSS were tested using Cohen's and Fleiss' kappa statistics. RESULTS In total, 50 limbs (mean age 70.1 ± 11.0, 29 men) with 41 popliteal and 40 infrapopliteal lesions were scored. Inter-observer agreement of PACSS and binary PACSS were moderate (κ = 0.60) and substantial (κ = 0.72), respectively, while intra-observer agreement was almost perfect in both scores (κ = 0.86). Inter- and intra-observer agreement of mPACSS were moderate (κ = 0.48) and substantial (κ = 0.77), respectively. Mean assessment time for an experienced rater was 3.43 ± 0.93 min per CTA scan. CONCLUSION Both the semi-quantitative PACSS and mPACSS scores for (infra)popliteal arteries can be performed reliably on pre-operative CTA.
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Affiliation(s)
- Michael J Nugteren
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Morsal Samim
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester J Scheffer
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Constantijn E V B Hazenberg
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
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Tan M, Ueshima D, Iida O, Soga Y, Tobita K, Hayakawa N, Fujihara M, Mori S, Tsubakimoto Y, Nakao S, Tokuda T, Horie K, Kato T, Kaneko N, Ando H, Iwata S, Nakagawa Y, Sunaga D, Urasawa K. Clinical validity of the Japanese below-the-knee chronic total occlusion scoring system for the prediction of successful guidewire crossing. J Vasc Surg 2024:S0741-5214(24)01528-3. [PMID: 39029811 DOI: 10.1016/j.jvs.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/06/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE To validate the Japanese below-the-knee (J-BTK) chronic total occlusion (CTO) score for the prediction of successful guidewire crossing (S-GC) in angiographic evaluation. METHODS A prospective, multicenter, nonrandomized study examined 751 consecutive BTK CTOs in 497 patients treated with endovascular therapy in 16 Japanese medical centers from April 2021 to March 2022. The cohort was classified into 2 groups: an S-GC group and a failed guidewire crossing group. RESULTS The J-BTK CTO score, which assigned one point to "Blunt type at the proximal entry point," one point to "Calcification at the proximal entry point," one point to "Reference vessel diameter <2.0 mm," one point to "CTO length ≥200 mm," and two points to "No outflow of the target vessel," was used to categorize BTK CTOs into 4 grades with varying probabilities of S-GC: grade A (J-BTK CTO score of 0 and 1), grade B (score of 2 and 3), grade C (score of 4 and 5), and grade D (score of 6). Rates of S-GC in each grade (grades A, B, C, and D) were 97.5%, 89.1%, 62.5%, and 27.3%, respectively. The area under the receiver-operating characteristic curve for S-GC was 0.8304. Although the previous J-BTK CTO study enrolled only de novo lesions, both de novo and restenotic lesions were evaluated in this study. De novo lesions have a lower chance of S-GC (odds ratio: 0.24, 95% confidence interval: 0.09-0.67) in the multivariate analysis, and the area under the receiver-operating characteristic curve of the modified J-BTK CTO score, which additionally assigned two points to "De novo lesion," was 0.846. The modified J-BTK CTO score showed an appropriate calibration (Hosmer-Lemeshow P = .957). CONCLUSIONS The J-BTK CTO score and the modified J-BTK CTO score predict the probability of an S-GC of BTK CTOs and stratify the difficulty of endovascular therapy for BTK CTOs in angiographic evaluation.
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Affiliation(s)
- Michinao Tan
- Department of Cardiology, Tokeidai Memorial Hospital, Sapporo, Japan.
| | - Daisuke Ueshima
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Osamu Iida
- Osaka Police Hospital Cardiovascular Division, Osaka, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Naoki Hayakawa
- Department of Cardiology, Asahi General Hospital, Chiba, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan
| | | | - Sho Nakao
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Taku Kato
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan; Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Nobuhito Kaneko
- Heart Center, Kasukabe Chuo General Hospital, Saitama, Japan
| | - Hiroshi Ando
- Heart Center, Kasukabe Chuo General Hospital, Saitama, Japan
| | - Shuko Iwata
- Department of Cardiology, Tokeidai Memorial Hospital, Sapporo, Japan
| | - Yuya Nakagawa
- Department of Cardiology, Hakodate Medical Association Hospital, Hakodate, Japan
| | - Daisuke Sunaga
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Kazushi Urasawa
- Department of Cardiology, Tokeidai Memorial Hospital, Sapporo, Japan
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Buturak A, Tatli E, Erkin A. A novel troubleshooting technique for below-the-knee artery occlusions with proximal cap ambiguity: Transpedal Retrograde Wire Just Marker Technique. Vascular 2024:17085381241247101. [PMID: 38609872 DOI: 10.1177/17085381241247101] [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: 04/14/2024]
Abstract
BACKGROUND Chronic total occlusions with ambiguous proximal caps pose a challenging problem in below-the-knee artery endovascular interventions. CASE REPORT We defined a new technique for antegrade puncture and penetration of an ambiguous proximal cap in a 52-year old male patient with a non-healing wound on his right forefoot. Anterior tibial artery (ATA) was determined as the target vessel; however, its origin and course could not be determined. A retrograde guidewire (Asahi Gladius 0.018 inch, Asahi Intecc) was advanced into the distal ATA via transpedal loop following pedal loop angioplasty. This guidewire was advanced through and parked to the tibioperoneal trunk with a small distal loop at the tip. While the looped wire was held in its position as a marker for ATA ostium, a second guidewire (Asahi Gladius 0.018 inch, Asahi Intecc) with the guidance of 4F vertebral catheter (Vert Catheter, Merit Medical) successfully penetrated the ambiguous cap and subsequent target vessel revascularization was achieved with 2.5/150 mm peripheral balloon angioplasty catheter (Minerva SC 0.018 inch, BrosMed Medical). CONCLUSION Transpedal Retrograde Wire Just Marker Technique is a novel and practical technique which can be used in chronic total occlusions of below-the-knee arteries with ambiguous proximal caps.
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Affiliation(s)
- Ali Buturak
- Department of Cardiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkiye
| | - Ersan Tatli
- Department of Cardiology, Focus Heart and Arrhythmia Center, Sakarya, Turkiye
| | - Alper Erkin
- Department of Cardiovascular Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Troisi N, Canovaro F, Adami D, Berchiolli R. Successful extreme foot revascularization with plaque cracking (percutaneous direct needle puncture of calcified plaque) technique of medial tarsal artery. J Vasc Surg Cases Innov Tech 2023; 9:101282. [PMID: 37767351 PMCID: PMC10520446 DOI: 10.1016/j.jvscit.2023.101282] [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: 03/26/2023] [Accepted: 07/13/2023] [Indexed: 09/29/2023] Open
Abstract
The percutaneous direct needle puncture of calcified plaque technique is a valuable method to allow for extreme revascularization of occluded below-the-ankle vessels. We report the case of an antegrade recanalization technique from the peroneal artery to medial plantar artery to achieve external "cracking" of a calcified plaque of the medial tarsal artery.
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Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Canovaro
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Hayakawa N, Kodera S, Miwa H, Ichihara S, Hirano S, Arakawa M, Inoguchi Y, Kushida S. Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries. CVIR Endovasc 2023; 6:48. [PMID: 37855917 PMCID: PMC10587042 DOI: 10.1186/s42155-023-00399-2] [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: 08/29/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Revascularization with endovascular therapy (EVT) for complex below-the-knee (BTK) chronic total occlusion (CTO) remains a challenging problem. The Japanese-BTK (J-BTK) CTO score is reported as an indicator of the difficulty of BTK CTO, with the guidewire (GW) passage success rate decreasing as the grade increases. We previously reported an effective GW crossing method for the intravascular ultrasound (IVUS)-guided parallel wiring of complex BTK CTO. In this study, we investigated the feasibility of EVT using IVUS-guided wiring for BTK CTO. MATERIALS AND METHODS This single center, retrospective study analyzed 65 consecutive BTK CTO vessels in which IVUS-guided wiring was attempted after the failure of a conventional antegrade wiring approach from November 2020 to November 2022. The primary endpoint was the clinical success of the target CTO vessel. The secondary endpoints were the GW success rate per grade based on the J-BTK CTO score, number of GW used for CTO crossing, fluoroscopy time, and complications. RESULTS Target vessels were the anterior tibial artery (66.2% of cases), peroneal artery (9.2%), and posterior tibial artery (24.6%). Blunt type CTO entry was performed in 55.4% of cases, calcification of entry was observed in 24.6% of cases, the mean occlusion length was 228.2 ± 93.7 mm, mean reference vessel diameter was 2.1 ± 0.71 mm, and outflow was absent in 38.5% of cases. J-BTK CTO scores of 0/1 (grade A), 2/3 (grade B), 4/5 (grade C), and 6 (grade D) were seen in 18.5%, 43.1%, 36.3%, and 1.5% of cases, respectively. The clinical success rate was 95.4%. The GW success rate by J-BTK CTO grade was as follows: grade A (100%), B (100%), C (91.7%), and D (0%). The mean number of GW used was 3.4 ± 1.4, the mean fluoroscopy time was 72.3 ± 32.5 min, and complications occurred in 7.7% of cases. CONCLUSION This study showed a very high clinical success rate despite the difficulty of BTK CTO. IVUS-guided EVT might be a feasible strategy for complex BTK CTO.
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Affiliation(s)
- Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Miwa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Shinya Ichihara
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Satoshi Hirano
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Masataka Arakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Yasunori Inoguchi
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Shunichi Kushida
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
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Kuroki MT, Parikh UM, Chandra V. How I do it: Pedal access and pedal loop revascularization for patients with chronic limb-threatening ischemia. J Vasc Surg Cases Innov Tech 2023; 9:101236. [PMID: 37496650 PMCID: PMC10366544 DOI: 10.1016/j.jvscit.2023.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
An increasing proportion of patients with chronic limb-threatening ischemia are older and have multiple comorbidities, including diabetes and renal failure. For those who are not candidates for a surgical bypass, this set of patients presents a challenge to vascular surgeons and interventionalists owing to the complex below-the-knee and increasingly below-the-ankle disease pattern that can fail traditional approaches for endovascular intervention. Two techniques, the retrograde pedal access and the pedal-plantar loop technique, can be useful in these settings and in skilled hands can be used safely, with a high technical success rate. In patients with chronic limb-threatening ischemia who are not candidates for a single-segment saphenous vein bypass, the retrograde pedal access technique can be used not only in the setting of failed antegrade treatment, but also primarily when faced with a difficult groin or as an adjunct during a planned antegrade-retrograde intervention. The pedal plantar loop technique allows for retrograde access to tibial vessels without retrograde vessel puncture and additionally offers the ability to treat the pedal-plantar arch, which may have added benefit in wound healing. We describe the tips and tricks for these two techniques used in our limb salvage practice.
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Affiliation(s)
| | | | - Venita Chandra
- Correspondence: Venita Chandra, MD, Clinical Professor of Surgery, Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Rd, Ste CJ350H, Palo Alto, CA 94304
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Tokuda T, Oba Y, Kagase A, Matsuda H, Suzuki Y, Murata A, Ito T, Hirano K. Feasibility and impact of extra-vascular ultrasound-guided endovascular treatment for infrapopliteal artery occlusive disease. Catheter Cardiovasc Interv 2023; 101:870-876. [PMID: 36877810 DOI: 10.1002/ccd.30615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/09/2022] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE This study aimed to examine the feasibility and impact of extra-vascular ultrasound (EVUS)-guided intervention for infrapopliteal (IP) artery occlusive disease. MATERIALS AND METHODS A retrospective analysis was performed using data collected from patients who underwent endovascular treatment (EVT) for IP artery occlusive disease between January 2018 and December 2020 at our institution. A total of 63 consecutive de novoocclusive lesions were compared according to the recanalization method utilized. Propensity score matching analysis was performed to compare the clinical outcomes of the methods utilized. The prognostic value was analyzed based on the technical success rate, distal puncture rate, radiation exposure, amount of contrast media, postprocedural skin perfusion pressure (SPP), and procedural complication rate. RESULTS Eighteen matched pairs of patients were analyzed using propensity score-matched analysis. Radiation exposure was significantly lower in the EVUS-guided group than in the angio-guided group, with 135 and 287 mGy (p = 0.04) exposure on average, respectively. There were no significant differences between the two groups in terms of technical success rate, distal puncture rate, the amount of contrast media, postprocedural SPP, and procedural complication rate. CONCLUSION EVUS-guided EVT for IP occlusive disease achieved a feasible technical success rate and significantly reduced radiation exposure.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiro Oba
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Hiroaki Matsuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yoriyasu Suzuki
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Akira Murata
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Keisuke Hirano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
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Hata Y, Iida O, Asai M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Tsujimura T, Matsuda Y, Higashino N, Toyoshima T, Takahara M, Mano T. Predictive impact of the Global Limb Anatomic Staging System (GLASS) on perioperative outcomes in patients with chronic limb-threatening ischaemia with isolated below-the-knee lesions. Heart Vessels 2022; 37:1957-1961. [PMID: 35612597 DOI: 10.1007/s00380-022-02095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022]
Abstract
Although the global vascular guidelines recently proposed the Global Limb Anatomic Staging System (GLASS) as an anatomical classification for chronic limb-threatening ischaemia (CLTI), prediction of perioperative outcomes using the GLASS classification in patients with CLTI due to isolated below-the-knee (BTK) lesions has not been well studied.This retrospective study included 585 patients with CLTI due to isolated BTK lesions who underwent endovascular therapy (EVT). The severity of arterial lesions was graded using the GLASS infrapopliteal (IP) and inframalleolar (IM) classifications and defined as follows: non-severe IP, 0-3; severe IP, 4; non-severe IM, P0-1; and severe IM, P2. The outcome measures were technical failure, defined as recanalisation failure of the target artery path, and perioperative failure, defined as a composite of all-cause death, major amputation, or repeat revascularisation within 30 days.Technical and perioperative failures occurred in 9.4% (n = 55) and 9.9% (n = 58) patients, respectively. Compared to patients with non-severe IP and IM, those with both severe IP and IM were significantly associated with technical and perioperative failures (odds ratio [OR]: 13.87 [95% confidence interval (CI) 4.69-41.02, P < 0.001] and OR: 2.18 [95% CI 1.08-4.38, P = 0.041], respectively).The GLASS classification may have predictive value for technical and perioperative failure in patients with CLTI due to isolated BTK lesions after EVT.
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Affiliation(s)
- Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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10
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Sato Y, Morishita T, Tan M, Hayashi T, Miwa T, Hieda S, Urasawa K. Prediction of Technical Failure of Inframalleolar Angioplasty in Patients with Chronic Limb-threatening Ischemia. Eur J Vasc Endovasc Surg 2022; 63:852-863. [DOI: 10.1016/j.ejvs.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/11/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022]
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An AnteOwl WR intravascular ultrasound-guided parallel wiring technique for chronic total occlusion of below-the-knee arteries. CVIR Endovasc 2022; 5:18. [PMID: 35347485 PMCID: PMC8960544 DOI: 10.1186/s42155-022-00294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although endovascular therapy is used to treat chronic limb-threatening ischemia, long chronic total occlusion (CTO) is still challenging to treat. Especially in patients with poor run-off below-the-knee (BTK) arteries, it is difficult to perform a retrograde approach, and even guidewire passage may be difficult. Case presentation We treated two cases of chronic limb-threatening ischemia using our novel extreme antegrade guidewire crossing technique by AnteOwl WR intravascular ultrasound (IVUS)-guided parallel wiring to a BTK artery (EXCAVATOR technique). Case 1 was a 70-year-old man with ulceration of the right toe. The AnteOwl WR IVUS was intentionally advanced into the subintimal space of the posterior tibial artery, and the totally intraplaque route was advanced by IVUS-guided parallel wiring that was successfully passed from the lateral plantar aspect to the true lumen of the digital artery. Case 2 was a 76-year-old woman with rest pain and cyanosis of the right lower limb. Angiography showed total occlusion from the superficial femoral artery to BTK arteries. AnteOwl WR IVUS-guided parallel wiring was repeatedly performed until the distal true lumen of the peroneal artery was reached, and revascularization was successfully achieved via the antegrade approach alone. Conclusions With its excellent crossable performance, good image quality, and high navigational ability within the CTO, the AnteOwl WR can be used to pass parallel wiring into the distal true lumen for BTK CTO.
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Haraguchi T, Fujita T, Kashima Y, Tsujimoto M, Watanabe T, Sugie T, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K. The "Direct tip injection in occlusive lesions (DIOL)" fashion. CVIR Endovasc 2021; 4:87. [PMID: 34905136 PMCID: PMC8671592 DOI: 10.1186/s42155-021-00276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background The successful intervention for peripheral artery disease is limited by complex chronic total occlusions (CTOs). During CTO wiring, without the use of intravascular or extravascular ultrasound, the guidewire position is unclear, except for calcified lesions showing the vessel path. To solve this problem, we propose a novel guidewire crossing with plaque modification method for complex occlusive lesions, named the “Direct tip Injection in Occlusive Lesions (DIOL)” fashion. Main text The “DIOL” fashion utilizes the hydraulic pressure of tip injection with a general contrast media through a microcatheter or an over-the-wire balloon catheter within CTOs. The purposes of this technique are 1) to visualize the “vessel road” of the occlusion from expanding a microchannel, subintimal, intramedial, and periadventitial space with contrast agent and 2) to modify plaques within CTO to advance CTO devices safely and easily. This technique creates dissections by hydraulic pressure. Antegrade-DIOL may create dissections which extend to and compress a distal lumen, especially in below-the-knee arteries. A gentle tip injection with smaller contrast volume (1–2 ml) should be used to confirm the tip position which is inside or outside of a vessel. On the other hand, retrograde-DIOL is used with a forceful tip injection of moderate contrast volume up to 5-ml to visualize vessel tracks and to modify the plaques to facilitate the crossing of CTO devices. Case-1 involved a severe claudicant due to right superficial femoral artery occlusion. After the conventional bidirectional subintimal procedure failed, we performed two times of retrograde-DIOL fashion, and the bidirectional subintimal planes were successfully connected. After two stents implantation, a sufficient flow was achieved without complications and restenosis for two years. Case-2 involved multiple wounds in the heel due to ischemia caused by posterior tibial arterial occlusion. After the conventional bidirectional approach failed, retrograde-DIOL was performed and retrograde guidewire successfully crossed the CTO, and direct blood flow to the wounds was obtained after balloon angioplasty. The wounds heeled four months after the procedure without reintervention. Conclusions The DIOL fashion is a useful and effective method to facilitate CTO treatment.
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Affiliation(s)
- Takuya Haraguchi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan.
| | - Tsutomu Fujita
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Yoshifumi Kashima
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Masanaga Tsujimoto
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Tomohiko Watanabe
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Takuro Sugie
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daisuke Hachinohe
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Umihiko Kaneko
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Ken Kobayashi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daitaro Kanno
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Katsuhiko Sato
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
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