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Nwachuku EC, Farber A. Open Surgical Therapy for Peripheral Artery Disease. Curr Cardiol Rep 2024; 26:211-220. [PMID: 38342801 DOI: 10.1007/s11886-024-02027-4] [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] [Accepted: 01/25/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE OF REVIEW The surgical management of symptomatic peripheral artery disease (PAD) has changed in the last few decades. Improvement in endovascular technology has resulted in more complex lesion once reserved for open surgery being addressed in an endovascular fashion. Even with these advances, there are lesions and patients that are better managed with an open surgical procedure. The aim of this review is to describe the most commonly performed open surgical procedures for PAD. RECENT FINDINGS The recently published Best Endovascular versus Best Surgical Therapy (BEST-CLI) trial was an international, prospective, randomized controlled trial that aimed to investigate which revascularization (endovascular vs. surgical bypass) approach was superior for limb salvage. The evidence supports an open surgical bypass as an initial approach. The advancements made in the surgical management of PAD have provided options for patients who were once deemed poor surgical candidates. The goal continues to be utilization of the best available tools to address patient disease. In this current era, it is important to be familiar with the open surgical therapies.
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Affiliation(s)
- Emmanuel C Nwachuku
- Department of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alik Farber
- Department of Surgery, Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Galyfos G, Charalampopoulos G, Chamzin A, Triantafillou A, Michalopoulou V, Intzes N, Kimpizi D, Zarmakoupis K, Sigala F, Filis K. Extra-anatomic bypass procedures for severe aortoiliac occlusive disease-A cohort study. Vascular 2024:17085381241236558. [PMID: 38407000 DOI: 10.1177/17085381241236558] [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: 02/27/2024]
Abstract
OBJECTIVES Extra-anatomic bypass (ExAB) grafting has been questioned due its inferior durability compared to anatomic bypass for aortoiliac occlusive disease (AIOD). This study aims to present early and late outcomes of patients treated with ExAB as well as to evaluate potential prognostic factors. METHODS This is a retrospective cohort study presenting a series of patients treated with ExAB for AIOD. All patients were treated between 2005 and 2022 within the Vascular Surgery Unit of a University Surgery Clinic. Both early (30-day) and late outcomes were evaluated. Univariate and multivariate analyses were conducted for potential predictors. Kaplan-Meier curve was produced for long-term patency. RESULTS A total of 41 patients were treated (85.3% males; mean age: 76.3 ± 4.2 years). Indication for treatment included severe claudication or critical limb ischemia (Rutherford stages III-VI). The following procedures were recorded: Femorofemoral bypass (FFB; n = 21) and axillofemoral bypass (AxFB; n = 20). All procedures were conducted using synthetic grafts with external rings. Early outcomes included no death, no myocardial infarction, no major bleeding, no graft infection, and no major amputation. Regarding late outcomes, 14.6% patients were lost after the first month. For the rest of patients (n = 35), five-year primary patency was 88.6%, primary-assisted patency was 94.3%, and secondary patency was also 94.3%. Limb salvage was 100% within follow-up. Endarterectomy at the distal anastomosis was the only independent predictor associated with worse patency in the long-term (OR = 5.356; 95% CI (1.012-185.562); p = .041). CONCLUSIONS FFB and AxFB is a safe and durable strategy for treating patients with severe AIOD where no other option is feasible. Regarding predictors, only endarterectomy at the distal anastomosis site was associated with an increased risk for graft failure.
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Affiliation(s)
- George Galyfos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Charalampopoulos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Chamzin
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Triantafillou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Victoria Michalopoulou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Intzes
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Kimpizi
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Zarmakoupis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Frangiska Sigala
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Filis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Management of Extensive Aorto-Iliac Disease: A Systematic Review and Meta-Analysis of 9319 Patients. Cardiovasc Intervent Radiol 2021; 44:1518-1535. [PMID: 34279686 DOI: 10.1007/s00270-021-02785-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Despite advances in endovascular management of aorto-iliac occlusive disease (AIOD) including covered endovascular reconstruction of aortic bifurcation (CERAB) techniques, guidelines for management of symptomatic Trans-Atlantic Inter-Society Consensus (TASC II) type C/D lesions favour open surgical revascularisation. This meta-analysis investigates outcomes in patients with TASC II C/D lesions treated with open bypass procedures (OS), standard endovascular treatments (SEV) or CERAB. METHODS Multiple databases (MEDLINE, EMBASE and the Cochrane database) were searched to identify studies reporting endovascular and open treatment of extensive AIOD. Studies were independently assessed. Outcomes reported included 30-day morbidity/mortality and patency rates. RESULTS A total of 9319 patients undergoing intervention for extensive AIOD were identified from 66 studies. Median patient age was 64 years (n = 3204) for SEV, 58 years (n = 240) for CERAB and 59 years for OS (n = 5875). Pooled meta-analysis for 30-day morbidity in patients undergoing SEV, CERAB and OS was 9, 10 and 15%, respectively. Thirty-day mortality rate was 0.79, 0 and 3% in the SEV, CERAB and OS groups, respectively. In these groups, one-year primary and secondary patency was 90, 88, 96 and 96, 97, and 97% whilst three-year primary and secondary patency was 78, 82, 93 and 93, 97, 97% respectively. Five-year primary and secondary patency was 71 and 89% for SEV and 88 and 95% for OS, respectively. CERAB data were only available to 3 years. CONCLUSIONS This meta-analysis shows that thirty-day morbidity and mortality favours endovascular techniques. Primary patency remains better with OS in both early and midterms;; however, secondary patency is comparable in all groups. These findings suggest that SEV/CERAB may be considered as an alternative to OS in higher-risk patients.
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Teveris V, Columbo J, Bartline P, Goodney P, Stone D, Suckow B. Selective Use of Anticoagulation or Dual Antiplatelet Therapy for Patients with Extra-anatomic Bypasses. Ann Vasc Surg 2020; 66:272-281.e1. [PMID: 31931126 DOI: 10.1016/j.avsg.2020.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/01/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The benefit of long-term anticoagulation or dual antiplatelet therapy (DAPT) for patients with extra-anatomic bypasses to the lower extremity remains poorly defined. Our study analyzed the real-world use of antithrombotic therapy in patients with extra-anatomic bypass grafts to the lower extremity and compared graft and patient outcomes by antithrombotic regimen. METHODS We studied patients who underwent axillofemoral or femoral-femoral bypass within the Vascular Quality Initiative with one-year follow-up data. Primary exposures were anticoagulation and DAPT, at the time of index procedure and one-year follow-up. Primary outcomes were major adverse limb events (MALE) defined as reintervention or above-ankle amputation, and primary patency. Secondary outcomes included perioperative blood transfusion requirements and the need for reoperation specifically for bleeding. We analyzed outcomes using the Kaplan-Meier estimation and examined factors associated with choice of antithrombotic therapy via logistic regression. RESULTS Our cohort included 2,760 patients (axillofemoral bypass, n = 857; femoral-femoral bypass, n = 1,903) across 168 centers from 2009 to 2018. Mean age was 66.5 ± 10.5 years and 59% were male. Patients were infrequently prescribed long-term anticoagulation (19%) or DAPT (22%). One-year primary patency was 86% and was similar by anticoagulation (log-rank P = 0.12) and DAPT status (log-rank P = 0.26). Freedom from MALE was 87% at 1 year and was slightly inferior for patients on anticoagulation (88 vs. 83%, log-rank P = 0.001) but was similar by DAPT (log-rank P = 0.19). Transfusion was more common in patients who were anticoagulated than those who were not (30 vs. 25%, P < 0.01), but there was no increase in reoperation because of bleeding (anticoagulation 0.8 vs. 0.8, P = 0.98). Anticoagulation was more commonly prescribed according to disease severity, such as rest pain (adjusted odds ratio (OR): 1.6 (95% confidence interval (CI): 1.20-2.20), tissue loss (OR: 1.9, CI: 1.28-2.73), or acute limb ischemia (OR: 1.9, CI: 1.35-2.71) or prior bypass graft (OR: 2.6, CI: 2.07-3.35). Patients were more commonly prescribed DAPT according to comorbidities, including hypertension (OR: 1.4, CI: 1.04-1.94) and coronary artery disease (OR: 1.6, CI 1.26-1.95). CONCLUSIONS Antithrombotics are selectively used in patients with extra-anatomic bypass to the lower extremity, the selection of which appears associated with disease severity for anticoagulants and patient comorbidities for DAPT. Primary patency and MALE rates are similar with focused utilization of anticoagulants or DAPT. Blood transfusions are more common among patients on antithrombotics without a difference in the need for reoperation for bleeding.
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Affiliation(s)
- Victoria Teveris
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Jesse Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Philip Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Manvar-Singh P, Segal M, Etkin Y, Dodla R, Landis G, Krishnasastry KV, Frankini L. A rare complication of testicular infarction after femorofemoral bypass highlighting the importance of surgical technique. J Surg Case Rep 2019; 2019:rjz271. [PMID: 31737243 PMCID: PMC6847100 DOI: 10.1093/jscr/rjz271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/02/2019] [Indexed: 11/21/2022] Open
Abstract
We present an interesting case of a 66-year-old male who had acute testicular infarction following a right common femoral artery to left profunda femoris artery bypass with advanced symptoms of claudication. Angiography in the preoperative period demonstrated the extent of peripheral arterial disease present, revealing a calcified aorta, partially occluded left hypogastric artery, occluded left external iliac, common femoral and superficial femoral arteries and an occluded right hypogastric artery. A bypass was performed without any initial complications and subsequent relief of symptoms of claudication and rest pain. Postoperative scrotal pain and follow-up duplex demonstrated lack of perfusion of the testicle necessitating orchiectomy. This case serves to illustrate the importance of preserving collateral vessels as a technical consideration, as well as presenting a rare potential complication.
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Affiliation(s)
- Pallavi Manvar-Singh
- Division of Vascular Surgery, Department of Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Michael Segal
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Yana Etkin
- Division of Vascular Surgery, Department of Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Ranjith Dodla
- Division of Vascular Surgery, Department of Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Gregg Landis
- Division of Vascular Surgery, Department of Surgery, Northwell Health, New Hyde Park, NY, USA
| | | | - Larry Frankini
- Division of Vascular Surgery, Department of Surgery, Northwell Health, New Hyde Park, NY, USA
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Saadeddin ZM, Rybin DV, Doros G, Siracuse JJ, Farber A, Eslami MH. Comparison of Early and Late Post-operative Outcomes after Supra-inguinal Bypass for Aortoiliac Occlusive Disease. Eur J Vasc Endovasc Surg 2019; 58:529-537. [DOI: 10.1016/j.ejvs.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/12/2019] [Indexed: 10/26/2022]
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Affiliation(s)
- Alik Farber
- From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston
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8
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Venous Conduits Have Superior Patency Compared with Prosthetic Grafts for Femorofemoral Bypass. Ann Vasc Surg 2018; 52:126-137. [PMID: 29783030 DOI: 10.1016/j.avsg.2018.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The objective of the study was to compare the outcomes of externally supported polytetrafluoroethylene (PTFE) grafts and femoral vein as conduits for femorofemoral crossover grafts. METHODS This is a retrospective review of consecutive femorofemoral crossover grafts at our institution between January 2005 and March 2016. Patient demographics, indications, complication rates, patency rates, and survival rates were compared between femorofemoral grafts created with either PTFE or femoral vein conduits, autogenous or cryopreserved. RESULTS One hundred nineteen femorofemoral crossover bypasses (89 PTFE, 30 vein [18 autogenous and 12 cryopreserved femoral veins]) were performed. Most patients underwent isolated femorofemoral bypass alone (76% isolated femorofemoral bypass versus 24% axillobifemoral bypass). A greater proportion of patients who received vein grafts were female (PTFE 37% vs. vein 60%, P = 0.028) and had prior bypasses (PTFE 33% vs. vein 73%, P < 0.001). PTFE bypasses were performed primarily for chronic limb ischemia (61.8%), while most venous bypasses were for infections (80%, P < 0.001). Femoral vein conduits were used in cases of infected aortic or extra-anatomical grafts (N = 20) or groin infection (N = 5). The 30-day complication rate was 38.7% and was not different between groups (36% for PTFE, 44.4% for autologous vein grafts and 50% for cryovein, P = 0.33) with wound complications being most frequent (18% PTFE, 27.8% autologous vein, 16.7% cryovein, P = 0.25). Patients receiving vein grafts were more likely to receive blood transfusion (34.8% PTFE vs. 70% vein, P = 0.001). Overall, median follow-up was 9.8 months (range 0-107). Primary patency rates at 1, 2, and 3 years were 83.7 %, 73.7% and 69.8%, respectively, for PTFE bypasses, and 100% for all time points for venous grafts, respectively (log rank, P = 0.03). Primary-assisted and secondary patency rates were not significantly different between the 2 groups (log rank, P = 0.16). Survival rates at 1, 2, and 3 years were 82%, 76.4% and 69.7%, respectively, for patients with PTFE grafts versus 76.7%, 73.3%, and 55%, respectively, for patients with vein grafts, respectively (log rank, P = 0.17). CONCLUSIONS While the indications for procedure differed in this series, femoral veins in femorofemoral bypasses have overall superior primary patency and similar complication rates compared with PTFE grafts. Based on this series, femoral vein, either autologous or cryopreserved, appears to be a suitable conduit for femorofemoral bypasses, and in some cases, it may be the preferred conduit.
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Comparison of Direct and Less Invasive Techniques for the Treatment of Severe Aorto-Iliac Occlusive Disease. Ann Vasc Surg 2017; 46:226-233. [PMID: 28739459 DOI: 10.1016/j.avsg.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 06/19/2017] [Accepted: 07/16/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Severe aorto-iliac occlusive disease (AIOD) is traditionally treated with aorto-bifemoral bypass (ABF) or aorto-unifemoral bypass (AUF). However, cross-femoral bypass (CFB) and hybrid femoral endarterectomy and patch angioplasty with iliac stenting (EPS) have gained popularity as less invasive options. We sought to compare 1-year survival, primary patency, and major amputation rates between open surgical (ABF and AUF) and 2 less invasive reconstruction techniques (CFB and EPS) using a large, multicenter cohort. STUDY DESIGN This is a retrospective cohort study of patients who underwent either ABF/AUF or CFB/EPS for AIOD between 2006 and 2013 in the Society for Vascular Surgery Vascular Quality Initiative registry. Baseline patient and periprocedural variables were compared. Propensity score matching (PSM) was performed to predict the likelihood of more invasive repair. Kaplan-Meier analysis and Cox models were performed for 1-year survival, primary patency, and major amputation. RESULTS 1872 patients underwent procedures for AIOD, including 1,133 ABF/AUF and 739 CFB/EPS, during the study period. Indication was critical limb ischemia in 47.3% (n = 886). Median follow-up time was 305 days (range, 10-406). After PSM, the matched cohort included 1,094 ABF/AUF and 711 CFB/EPS patients. Multivariate analysis revealed that patient factors and procedure indication were significant predictors of 1-year mortality and major amputation, but not procedure type. ABF/AUF was associated with improved primary patency over CFB/EPS at 1 year (94.1% ± 1.1% vs. 92.3% ± 1.5%, hazard ratio 0.65, 95% confidence interval 0.45-0.94; P = 0.02). CONCLUSIONS In a propensity-matched cohort from a multicenter vascular surgery registry, a direct approach to AIOD (ABF/AUF) demonstrated better 1-year primary patency than commonly used less invasive strategies. However, treatment approach was not a predictor of 1-year survival or limb salvage, suggesting that patient factors and procedure indication have a greater impact on outcome.
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Park KM, Park YJ, Kim YW, Hyun D, Park KB, Do YS, Kim DI. Long Term Outcomes of Femorofemoral Crossover Bypass Grafts. Vasc Specialist Int 2017; 33:55-58. [PMID: 28690996 PMCID: PMC5493187 DOI: 10.5758/vsi.2017.33.2.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/05/2017] [Accepted: 04/03/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. MATERIALS AND METHODS Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. RESULTS The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The one-year primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. CONCLUSION Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.
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Affiliation(s)
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shen CY, Liu YF, Li QL, Zhang YB, Jiao Y, Krokidis ME, Zhang XM. Open and Endovascular Treatment of Trans-Atlantic Inter-Society Consensus II D Aortoiliac Occlusive Lesions: What Determines the Rate of Restenosis? Chin Med J (Engl) 2016; 128:3035-42. [PMID: 26608983 PMCID: PMC4795256 DOI: 10.4103/0366-6999.169053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus (TASC) II guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors of restenosis after open and endovascular reconstruction of symptomatic TASC II D aortoiliac occlusive lesions (AIOLs). Methods: Fifty-six patients (82 limbs) who underwent open repair and endovascular treatment (ET) for symptomatic TASC ΙΙ D AIOLs between March 2005 and December 2012 were retrospectively reviewed. Baseline characteristics, preoperative and postoperative imaging, and operation procedure reports were reviewed and analyzed. Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency. Results: The mean duration of follow-up was 42.8 ± 23.5 months (ranging from 3 to 90 months). Primary patency rates at 1-, 3-, 5-, and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively. Restenosis after revascularization occurred in 11 limbs. Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5th and concurrent femoropopliteal TASC II type C/D lesions were significantly related to the duration of primary patency. According to the result of Cox regression, diabetes and femoropopliteal TASC ΙΙ type C/D lesions were identified as the risk factors for restenosis after revascularization. Conclusion: This study demonstrated that diabetes and femoropopliteal TASC ΙΙ type C/D lesions are risk factors associated with restenosis after open and ET of TASC II D AIOLs.
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Affiliation(s)
- Chen-Yang Shen
- Department of Vascular Surgery, Peking University People's Hospital, Beijing 100044, China
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12
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Jaff MR, Dorros G, Kumar K, Caballero G, Tector A. Endovascular Repair of an Ascending Aorta-to-Left Common Femoral Artery Graft with Aneurysmal Degeneration. J Endovasc Ther 2016. [DOI: 10.1177/152660289500200213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the use of endovascular grafting to repair degenerative aneurysmal changes in an extra-anatomic bypass graft. Methods: A 14-year-old extra-anatomic ascending aorta-to-left common femoral bypass graft (“ventral aorta”) had undergone aneurysmal degeneration, producing symptoms of progressive claudication and local abdominal swelling. The aneurysmal graft dilatation began within the thoracic cavity and extended through the entire extraperitoneal abdominal segment. The option for minimally invasive repair using a customized stent-graft device was offered to the patient as an alternative to standard reoperation. Results: An 8-mm × 42-cm endovascular graft was constructed of polytetrafluoroethylene with 30-mm Palmaz stents sutured to each end. With balloon occlusion of antegrade and retrograde blood flow, the stent-graft was delivered retrograde through an incision in the distal end of the existing bypass graft. The device was successfully positioned and deployed with complete exclusion of the aneurysm. No complications occurred, and the patient's symptoms abated. Follow-up arteriography at 1 month showed a pseudoaneurysm at the distal graft incision site; surgical repair was necessary. At 6 months, angiography demonstrated continued patency of the extra-anatomic bypass graft. Conclusions: Intraluminal aneurysm exclusion techniques in degenerated extra-anatomic bypass grafts may evolve into a viable therapeutic alternative to complex reoperative surgery.
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Affiliation(s)
- Michael R. Jaff
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., St. Luke's Medical Center, and the Milwaukee Heart and Vascular Clinic, SC, Milwaukee, Wisconsin, USA
| | - Gerald Dorros
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., St. Luke's Medical Center, and the Milwaukee Heart and Vascular Clinic, SC, Milwaukee, Wisconsin, USA
| | - Krishna Kumar
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., St. Luke's Medical Center, and the Milwaukee Heart and Vascular Clinic, SC, Milwaukee, Wisconsin, USA
| | - Gerardo Caballero
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., St. Luke's Medical Center, and the Milwaukee Heart and Vascular Clinic, SC, Milwaukee, Wisconsin, USA
| | - Alfred Tector
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., St. Luke's Medical Center, and the Milwaukee Heart and Vascular Clinic, SC, Milwaukee, Wisconsin, USA
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13
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Lipsitz EC, Ohki T, Veith FJ, Rhee SJ, Gargiulo NJ, Suggs WD, Wain RA. Patency Rates of Femorofemoral Bypasses Associated with Endovascular Aneurysm Repair Surpass Those Performed for Occlusive Disease. J Endovasc Ther 2016; 10:1061-5. [PMID: 14723569 DOI: 10.1177/152660280301000606] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate the patency rates of femorofemoral grafts performed in conjunction with aortomonoiliac or aortomonofemoral (AMI/F) endografts. Methods: Over the past 8 years, 110 patients (98 men; mean age 77 ± 7 years, range 57–90) underwent aortoiliac aneurysm repair with an AMI/F endograft. Follow-up data in these patients were prospectively collected for a mean 2.3 years (range 1–68 months). Results: There were 2 early (<7 days) AMI/F endograft thromboses with secondary femorofemoral graft occlusion. In both patients, patency of all grafts was restored by thrombectomy plus stenting of the endograft. Three late (4, 5, and 10 months) AMI/F endograft thromboses led to femorofemoral graft failure; 2 were successfully treated, but the third patient refused further intervention. No femorofemoral bypass failed in the absence of AMI/F endograft thrombosis. There were no femorofemoral graft infections. Four-year life-table primary and secondary patency rates were 95% and 99%, respectively. Conclusions: Femorofemoral bypasses with AMI/F endografts for aneurysmal disease are durable procedures and have better patency than femorofemoral grafts used to treat occlusive disease. Femorofemoral bypass patency rates alone are not a disadvantage of aortomonoiliac endografts.
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Affiliation(s)
- Evan C Lipsitz
- Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Abstract
The prevalence of peripheral arterial disease (PAD) is increasing worldwide, with recent global estimates exceeding 200 million people. Advanced PAD leads to a decline in ambulatory function and diminished quality of life. In its most severe form, critical limb ischemia, rest pain, and tissue necrosis are associated with high rates of limb loss, morbidity, and mortality. Revascularization of the limb plays a central role in the management of symptomatic PAD. Concomitant with advances in the pathogenesis, genetics, and medical management of PAD during the last 20 years, there has been an ongoing evolution of revascularization options. The increasing application of endovascular techniques has resulted in dramatic changes in practice patterns and has refocused the question of which patients should be offered surgical revascularization. Nonetheless, surgical therapy remains a cornerstone of management for advanced PAD, providing versatile and durable solutions to challenging patterns of disease. Although there is little high-quality comparative effectiveness data to guide patient selection, existing evidence suggests that outcomes are dependent on definable patient factors such as distribution of disease, status of the limb, comorbid conditions, and conduit availability. As it stands, surgical revascularization remains the standard against which emerging percutaneous techniques are compared. This review summarizes the principles of surgical revascularization, patient selection, and expected outcomes, while highlighting areas in need of further research and technological advancement.
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Affiliation(s)
- Shant M. Vartanian
- From the Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco
| | - Michael S. Conte
- From the Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco
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Clinical application and early outcomes of the aortouni-iliac configuration for endovascular aneurysm repair. J Vasc Surg 2014; 60:1452-9. [DOI: 10.1016/j.jvs.2014.08.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/07/2014] [Indexed: 11/21/2022]
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Reentry device aided endovascular aneurysm repair in patients with abdominal aortic aneurysm and unilateral iliac artery occlusion. Ann Vasc Surg 2014; 28:1800.e1-7. [PMID: 24911810 DOI: 10.1016/j.avsg.2014.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/09/2014] [Accepted: 05/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND We report 2 cases of patients undergoing endovascular aneurysm repair (EVAR) using reentry devices to recanalize unilateral iliac artery occlusions and complete a bifurcated endovascular repair. METHODS Patient 1 is a 70-year-old male with an enlarging 6.5-cm abdominal aortic aneurysm (AAA) and disabling left leg claudication with L external iliac occlusion with patent common and internal iliac arteries. Patient 2 is a 67-year-old male with an asymptomatic 4.0-cm AAA and L iliac chronic total occlusion (CTO) and disabling claudication. Both patients were poor operative candidates for open repair. RESULTS Both patients underwent elective percutaneous EVAR along with left iliac artery revascularization. Initial angiography in both cases showed a blind ending of the left common iliac artery. Retrograde subintimal dissection through the occluded iliac segment was attempted but in both cases the wire was unable to traverse back into the true aortic lumen. Using either the Outback LTD or Pioneer reentry catheter, direct visualization of the true aortic lumen was obtained to re-enter the true lumen. The subintimal iliac tract was then predilated to facilitate routine EVAR in both cases. Both patients were discharged the following day and 1-year and 6-month follow-up imaging revealed aneurysm exclusion, no endoleak, and patent bilateral common iliac arteries with resolution of claudication symptoms and normal ankle-brachial indexes. The previously patent internal iliac artery was preserved. CONCLUSIONS While not always technically possible, reentry device aided EVAR is safe, feasible, and durable in the mid-term and avoids the morbidity and mortality related to aortouniiliac/femoral-femoral bypass and open repair. This technique should be considered in patients with iliac artery CTO and concurrent AAA to allow total endovascular repair.
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Kim YS, Yun WS, Park K. Long-term outcome of crossover femoro-femoro-popliteal bypass using side-to-side anastomosis in ilio-femoral occlusive disease. Ann Surg Treat Res 2014; 86:91-4. [PMID: 24761414 PMCID: PMC3994596 DOI: 10.4174/astr.2014.86.2.91] [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: 07/24/2013] [Revised: 10/13/2013] [Accepted: 10/24/2013] [Indexed: 11/30/2022] Open
Abstract
Purpose During crossover femoro-femoro-popliteal sequential bypass (CFFPB) surgery in ilio-femoral occlusive disease, proximal anastomosis of the femoro-popliteal bypass is usually performed distal to the distal anastomosis of the crossover femoro-femoral bypass. If not, it is done with a piggyback configuration. Another method is a side-to-side anastomosis. Its benefit is that this is the only anastomosis made. And it is less bulky compared with the piggyback configuration. This study was aimed to investigate the long-term outcome of CFFPB using side-to-side anastomosis. Methods From Sep 2006 to Aug 2012, 21 patients who underwent CFFPB using side-to-side anastomosis were enrolled. Externally supported polytetrafluoroethylene graft was used as a conduit in all patients. Patient demographic data and procedure details were investigated. Primary graft patency was calculated using the Kaplan-Meier method. Results The mean age of patients was 79 years (range, 62-81 years) and males were 17 (81%). Fifteen patients (71%) had critical limb ischemia. Inflow arteries comprised of 16 common femoral artery (CFA), 4 superficial femoral artery (SFA), and 1 deep femoral artery (DFA). Side-to-side anastomosis was performed on the CFA in 11, SFA in 2, and DFA in 8 patients. During the mean follow-up period of 21 months (1-60 months), 8 patients died. The 1-, 3-, and 5-year primary patency rates were 76%, 63%, and 63%. Conclusion Long-term patency of CFFPB using side-to-side anastomosis was acceptable. It can be one of the treatment options for patients with ilio-femoral occlusive disease.
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Affiliation(s)
- Yoon-Sub Kim
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Woo-Sung Yun
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kihyuk Park
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K, Sosa JA. Clinical Outcomes of 5358 Patients Undergoing Direct Open Bypass or Endovascular Treatment for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. J Endovasc Ther 2013; 20:443-55. [DOI: 10.1583/13-4242.1] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vallabhaneni R, Sorial EE, Jordan WD, Minion DJ, Farber MA. Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair. J Vasc Surg 2012; 56:1549-54; discussion 1554. [DOI: 10.1016/j.jvs.2012.05.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/22/2012] [Accepted: 05/23/2012] [Indexed: 11/29/2022]
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Huded CP, Goodney PP, Powell RJ, Nolan BW, Rzucidlo EM, Simone ST, Walsh DB, Stone DH. The impact of adjunctive iliac stenting on femoral-femoral bypass in contemporary practice. J Vasc Surg 2012; 55:739-45; discussion 744-5. [PMID: 22226183 DOI: 10.1016/j.jvs.2011.10.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Most reports of femoral-femoral bypass (FFB) were published before the era of endovascular intervention. This study examines the utilization and impact of adjunctive endovascular intervention on FFB in contemporary practice. METHODS We reviewed 253 FFB performed in 247 patients between 1984 and 2010. Primary endpoints, including graft patency, primary-assisted patency, limb salvage, and survival, were assessed using Kaplan-Meier life-table analysis. Univariate and multivariate analyses were performed to determine predictors of primary endpoints. RESULTS The indication for FFB included claudication (27%; n = 69) and critical limb ischemia (72%; n = 184). Forty-eight patients (19%) were treated urgently for acute ischemia. Mean follow-up was 5.6 ± 5.5 years. Over the study interval, adjunctive iliac percutaneous transluminal angioplasty (PTA)/stent placement increased significantly from 0% to 54% (P trend < .001), while the rate of axillofemoral bypass or no inflow procedure decreased from 100% to 46% (P trend < .001). Despite increased utilization, iliac PTA/stenting was associated with decreased 5-year primary graft patency of 44% compared with 74% for axillofemoral bypass patients and 71% in patients with no adjunctive inflow procedure (P = .004). Patients with inflow iliac PTA/stents also had diminished 5-year assisted primary patency of 61% compared with 85% for axillofemoral bypass patients and 87% in patients without inflow revascularization (P = .002). Adjunctive iliac PTA/stenting did not impact limb salvage or overall survival. Five-year primary patency among claudicants and critical leg ischemia patients was 65% and 68%, respectively. CONCLUSIONS The incidence of iliac PTA/stent placement in conjunction with FFB has increased significantly over time in contemporary practice. Reliance on iliac stent placement for FFB inflow is paradoxically associated with both diminished primary and assisted primary graft patency when compared with historical controls. These findings highlight the importance of patient selection and inflow consideration when performing FFB.
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Rinckenbach S, Guelle N, Lillaz J, Al Sayed M, Ritucci V, Camelot G. Femorofemoral bypass as an alternative to a direct aortic approach in daily practice: appraisal of its current indications and midterm results. Ann Vasc Surg 2011; 26:359-64. [PMID: 22050878 DOI: 10.1016/j.avsg.2011.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/18/2011] [Accepted: 04/03/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND To assess our current practice concerning the indications and the immediate and midterm results of femorofemoral bypass. METHODS We retrospectively included all patients, from 1997 to 2008, operated on for aortoiliac occlusive disease using an extra-anatomical bypass from a donor iliac artery or a femoral artery to the contralateral femoral artery (common or profunda artery). Demographic data, initial clinical status, characteristics of the interventions, and short- and midterm results were collected. Elective surgery was distinguished from urgent surgery (critical limb ischemia, acute ischemia, vascular infection). RESULTS One hundred twenty-four femorofemoral bypasses were performed (103 male), mean age 68 (±12) years. Indications were critical limb ischemia (47.1%), intermittent claudication (38.8%), acute ischemia (12.1%), and vascular infections (1.7%). Perioperative outcomes were 5.6% mortality (elective surgery 0.0%, urgent surgery 9.7%, P = 0.02) and 27.4% morbidity without any secondary graft infections (elective surgery 22.5%, urgent surgery 31.9%, P = 0.17). Mean follow-up period was 3 years, and overall survival was 69.4% (elective surgery 88.7%, urgent surgery 56.7%, P = 0.08). At 3 years, primary patency was 81.8% and secondary patency was 89.3% (elective surgery 96.4%, urgent surgery 84.2%, P = 0.68). No significant risk factors for immediate and secondary thromboses were found. CONCLUSION In our current practice, femorofemoral bypasses are applied mainly for urgent procedures when avoiding a direct aortic approach is mandatory, with good midterm results. Although indications are limited for good-fit patients, femorofemoral bypass has confirmed safety (no perioperative deaths, no infections) and high durability (good secondary patency).
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Affiliation(s)
- Simon Rinckenbach
- Vascular Surgery Unit, University Hospital of Besancon, Besancon, France.
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The Current Management of Aortic, Common Iliac, and External Iliac Artery Disease: Basic Data Underlying Clinical Decision Making. Ann Vasc Surg 2011; 25:990-1003. [DOI: 10.1016/j.avsg.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/26/2011] [Accepted: 05/15/2011] [Indexed: 10/17/2022]
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Mwipatayi BP, Thomas S, Wong J, Temple SEL, Vijayan V, Jackson M, Burrows SA. A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease. J Vasc Surg 2011; 54:1561-70. [PMID: 21906903 DOI: 10.1016/j.jvs.2011.06.097] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This trial was conducted to determine if covered stents offer a patency advantage over bare-metal stents in the treatment of aortoiliac arterial occlusive disease. METHODS The Covered Versus Balloon Expandable Stent Trial (COBEST), a prospective, multicenter, randomized controlled trial, was performed involving 168 iliac arteries in 125 patients with severe aortoiliac occlusive disease who were randomly assigned to receive a covered balloon-expandable stent or bare-metal stent. Patient demographic data, clinical signs and symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and preprocedure and postprocedure ankle-brachial index measurements were recorded. The primary end points included freedom from binary restenosis and stent occlusion of the treated area, as determined by ultrasound imaging or quantitative visual angiography, or both. Postprocedural follow-up was at 1, 6, 12, and 18 months. RESULTS Aortoiliac lesions treated with a covered stent were significantly more likely to remain free from binary restenosis than those that were treated with a bare-metal stent (hazard ratio [HR], 0.35; 95% confidence interval (CI), 0.15-0.82; P = .02). Freedom from occlusion was also higher in lesions treated with covered stents than in those treated with a bare-metal stent (HR, 0.28; 95% CI, 0.07-1.09); however, this did not reach statistical significance (P = .07). Subgroup analyses demonstrated a significant difference in freedom from binary restenosis for covered stents in TASC C and D lesions compared with a bare stent (HR, 0.136; 95% CI, 0.042-0.442). This difference was not demonstrated for TASC B lesions (HR, 0.748; 95% CI, 0.235-2.386). CONCLUSIONS COBEST demonstrates covered and bare-metal stents produce similar and acceptable results for TASC B lesions. However, covered stents perform better for TASC C and D lesions than bare stents in longer-term patency and clinical outcome.
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Affiliation(s)
- Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
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Shin YT, Son BK, Joo YS, Park KH. Cross Pubic Femoro-femoral Artery Bypass with Great Saphenous Vein. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.2.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yong Tae Shin
- Division of Vascular Surgery, Department of General Surgery, Daegu Catholic Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Bog Kyung Son
- Division of Vascular Surgery, Department of General Surgery, Daegu Catholic Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Yoon Seung Joo
- Division of Vascular Surgery, Department of General Surgery, Daegu Catholic Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ki Hyuk Park
- Division of Vascular Surgery, Department of General Surgery, Daegu Catholic Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Seymour KA, Sadowitz B, Amankwah KS, Gahtan V. Outcome of lower extremity revascularization for peripheral artery occlusive disease: is there a difference between men and women? Vascular 2011; 19:59-67. [DOI: 10.1258/vasc.2010.ra0042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incidence of peripheral arterial occlusive disease (PAD) increases with age. Women represent a growing percentage of the elderly population who present with PAD. While speculation exists that gender affects outcome after revascularization procedures, the literature is confusing and often conflicting. This review compares outcomes by gender after open surgical and endovascular lower extremity revascularization (LER) procedures including: demographic differences, patency rates, limb salvage rates, long-term survival, perioperative complications and 30-day mortality. This review summarizes the existing data and discusses current influences on outcome after LER.
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Affiliation(s)
- Keri A Seymour
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, 750 East Adams Street
- Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, 800 Irving Avenue, Syracuse, NY 13210, USA
| | - Benjamin Sadowitz
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, 750 East Adams Street
- Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, 800 Irving Avenue, Syracuse, NY 13210, USA
| | - Kwame S Amankwah
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, 750 East Adams Street
- Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, 800 Irving Avenue, Syracuse, NY 13210, USA
| | - Vivian Gahtan
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, 750 East Adams Street
- Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, 800 Irving Avenue, Syracuse, NY 13210, USA
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Successful treatment of an abdominal aortic aneurysm by endovascular graft placement through a previously placed prosthetic graft: Report of a case. Surg Today 2010; 40:1169-72. [PMID: 21110163 DOI: 10.1007/s00595-009-4184-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/05/2009] [Indexed: 10/18/2022]
Abstract
A 77-year-old man with an infrarenal abdominal aortic aneurysm was referred with a complex medical history including pancreatitis, chronic renal failure, atrial fibrillation, and a cerebral infarction. He also had a history of atherosclerosis obliterans, treated with a vascular bypass using an 8-mm prosthetic graft 9 years previously. His complicated anatomy, including a small access route and a large common iliac artery, suggested usage of Powerlink, a bifurcated stent graft through the previously placed graft, as an access route. The patient was discharged from the hospital with a type III endoleak, which was completely resolved 5 months after discharge.
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Thomas BG, Sanchez LA, Geraghty PJ, Rubin BG, Money SR, Sicard GA. A comparative analysis of the outcomes of aortic cuffs and converters for endovascular graft migration. J Vasc Surg 2010; 51:1373-80. [DOI: 10.1016/j.jvs.2010.01.081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 01/18/2010] [Accepted: 01/25/2010] [Indexed: 11/29/2022]
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Chiu K, Davies R, Nightingale P, Bradbury A, Adam D. Review of Direct Anatomical Open Surgical Management of Atherosclerotic Aorto-Iliac Occlusive Disease. Eur J Vasc Endovasc Surg 2010; 39:460-71. [DOI: 10.1016/j.ejvs.2009.12.014] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 12/13/2009] [Indexed: 11/26/2022]
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Jean-Baptiste E, Batt M, Azzaoui R, Koussa M, Hassen-Khodja R, Haulon S. A Comparison of the Mid-term Results Following the use of Bifurcated and Aorto-uni-iliac Devices in the Treatment of Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2009; 38:298-304. [DOI: 10.1016/j.ejvs.2009.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 06/06/2009] [Indexed: 10/20/2022]
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Heredero AF, Stefanov S, del Moral LR, Leblic I, Nistal MG, Mendieta C, de Cubas LR. Long-term Results of Femoro-Femoral Crossover Bypass After Endovascular Aortouniiliac Repair of Abdominal Aortic and Aortoiliac Aneurysms. Vasc Endovascular Surg 2008; 42:420-6. [DOI: 10.1177/1538574408318008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortouniiliac stent grafts allow the endovascular treatment of complex anatomy aortoiliac aneurysms. The main drawback is the need for femoro-femoral crossover bypass, with its complications and its patency limitations. However, some authors have shown good results of femoro-femoral crossover bypass in aneurysmal disease. In this article, initial and long-term results of our experience in femoro-femoral crossover bypass revascularization after endovascular aortouniiliac stent grafts repair of aortoiliac aneurysms is reported. Prospective collection, intention-to-treat, and retrospective analysis maintained database. Femoro-femoral crossover bypass patency assessment of all patients treated between January 1999 and September 2002, compared patients with or without associated occlusive arterial disease. Urgent indications were excluded. In total of 52 patients, with a mean age 72.6 years, 30.8% of patients were identified with associated occlusive arterial disease. Initial systemic and local, access site, complications were 7.7% and 7.7%, respectively, no early thrombosis or death is reported. Primary patency was 90.9% at 54 months, 66 months assisted primary and secondary patency were 97.7% and 100%, respectively. The 48-month survival rate was 84.2%. No significant differences between patients with or without associated occlusive arterial disease were found. Femoro-femoral crossover bypass after aortouniiliac stent grafts treatment of aortoiliac aneurysms shows excellent initial and long-term patency and low complication rate.
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Affiliation(s)
- Alvaro F. Heredero
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain,
| | - Stefan Stefanov
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - L. Riera del Moral
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Israel Leblic
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Marta G. Nistal
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Covadonga Mendieta
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - L. Riera de Cubas
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
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Thuijls G, van Laake L, Lemson M, Kitslaar P. Usefulness and Applicability of Femorofemoral Crossover Bypass Grafting. Ann Vasc Surg 2008; 22:663-7. [DOI: 10.1016/j.avsg.2008.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 02/25/2008] [Accepted: 04/28/2008] [Indexed: 11/26/2022]
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Ricco JB, Probst H. Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease. J Vasc Surg 2008; 47:45-53; discussion 53-4. [PMID: 17997269 DOI: 10.1016/j.jvs.2007.08.050] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/21/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
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Hertzer NR, Bena JF, Karafa MT. A personal experience with direct reconstruction and extra-anatomic bypass for aortoiliofemoral occlusive disease. J Vasc Surg 2007; 45:527-535; discussion 535. [PMID: 17321340 DOI: 10.1016/j.jvs.2006.09.065] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 11/21/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was conducted to investigate factors influencing the outcome of all open operations for aortoiliofemoral (AIF) revascularization performed by a single surgeon at a tertiary referral center. METHODS The series included 355 direct reconstructions and 181 extra-anatomic bypass (EAB) grafts in 339 men (63%) and 197 women, with median ages of 61 and 62 years, respectively. These procedures were done for claudication alone in 267 patients (50%), for advanced ischemia in 258 (48%), and to facilitate other interventions in 11 (2.0%). Simultaneous infrainguinal bypass was necessary in 36 patients (6.7%). Survival and patency analyses were performed using logistic regression, Kaplan-Meier estimations, and proportional hazards models. RESULTS Patients receiving EAB were older (P < .001) and were more likely to have advanced preoperative limb ischemia (P < .001), superficial femoral artery occlusions (P < .001), a history of previous lower extremity inflow operations (P < .001), elevated serum creatinine (P = .017), and clinically severe chronic obstructive pulmonary disease (P = .016). On multivariable analysis, EAB resulted in a higher incidence of postoperative death (8.8% vs 2.3%, P = .005) or graft thrombosis (8.8% vs 2.8%, P = .006) than direct reconstruction. Women were more likely to sustain graft thrombosis (P = .006) or require major amputation (P = .050), or both, during the early postoperative period. Overall late survival rates were 87% +/- 3% at 1 year, 64% +/- 5% at 5 years, 39% +/- 5% at 10 years, and 20% +/- 4% at 15 years. Late survival rates were significantly lower (P = .026) after EAB and also were unfavorably associated with advanced preoperative ischemia (P = .046) as well as with several medical comorbidities (P < .001). Primary limb-based patency rates were 95% +/- 2% at 1 year, 85% +/- 3% at 5 years, 77% +/- 5% at 10 years, and 69% +/- 7% at 15 years. Late occlusions occurred more frequently in patients who had undergone previous inflow procedures (P = .028) and were especially common after EAB (P < .001). Patients >65 years had higher early and late mortality rates than younger patients (P < .001), but younger patients had lower long-term patency rates (P < .001). CONCLUSIONS The worse operative mortality and late survival rates for EAB in this series largely were preordained by the frequent selection of EAB for patients who represented poor medical risks for direct AIF reconstruction. However, the durability of aortofemoral, aortoiliac, or iliofemoral bypass compared with either femorofemoral or axillofemoral bypass makes direct reconstruction clearly superior for average or low-risk patients. Direct reconstruction should be used preferentially in such cases, especially in women and for younger patients of either gender.
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Affiliation(s)
- Norman R Hertzer
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, Ohio 44195, USA.
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Park KB, Do YS, Kim DI, Kim DK, Kim YW, Shin SW, Cho SK, Choo SW, Choe YH, Choo IW. The TransAtlantic InterSociety Consensus (TASC) Classification System in Iliac Arterial Stent Placement: Long-term Patency and Clinical Limitations. J Vasc Interv Radiol 2007; 18:193-201. [PMID: 17327551 DOI: 10.1016/j.jvir.2006.12.726] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the long-term patency of iliac arterial stent placement according to individual TransAtlantic Intersociety Consensus (TASC) stages and demonstrate the limitations of TASC classification for iliac arterial disease. MATERIALS AND METHODS Retrospective analysis of 218 patients who underwent iliac arterial stent placement revealed 295 stents were placed in 260 limbs. Iliac lesions of patients were classified according to the TASC classification on initial angiography but patients having bilateral different staged lesion were classified with limb based TASC classification. Analysis was performed based on the number of treated limbs not on the number of patients. Stent patency of individual TASC stages was analyzed by Kaplan-Meier methods and were compared by the log rank test. RESULTS The technical success rate was 99%. 171 patients (80%) were classified under a single TASC category, however, 44 patients (20%) with bilateral iliac lesions could not be classified under a single TASC stage. The number of patients and limbs in each TASC group was: TASC A (88/97), TASC B (91/97), TASC C (32/48), and TASC D (16/18). The 1, 3 and 5 year primary patencies of the iliac arterial stent for TASC A were 96%, 84%, and 81%; TASC B were 95%, 85%, and 85%; TASC C were 94%, 94%, and 78%; and TASC D were 93%, 74%, and 74%, respectively. Four TASC groups were not statistically different for primary patency rates (P < .03). CONCLUSION The patency of iliac arterial stents did not show statistically significant difference among TASC stages. TASC system is limited for patient classification with bilateral iliac arterial disease [corrected]
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Affiliation(s)
- Kwang Bo Park
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam gu, Seoul, 135-710, Korea
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Abstract
PURPOSE To report the recanalization of an occluded common iliac artery (CIA) to allow endovascular repair of an abdominal aortic aneurysm (AAA) with a bifurcated stent-graft. CASE REPORT A 76-year-old man with a 75-mm infrarenal AAA and an occluded right CIA was successfully treated with a Zenith bifurcated stent-graft. The right CIA was recanalized allowing access, delivery, and deployment of the stent-graft. Follow-up computed tomography at 9 months showed no evidence of endoleak; maximum aneurysm diameter was reduced to 72 mm, and the iliac vessels were patent. CONCLUSION Bifurcated stent-graft repair of an AAA can be performed following recanalization of an occluded CIA. This option may be preferable to an open repair or an aortomonoiliac stent-graft with extra-anatomical bypass in some patients. Long-term surveillance will be necessary to ensure freedom from iliac-related secondary intervention.
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Affiliation(s)
- James Scurr
- Regional Vascular Unit, Royal Liverpool University Hospital, Liverpool, UK
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Eiberg JP, Røder O, Stahl-Madsen M, Eldrup N, Qvarfordt P, Laursen A, Greve M, Flörenes T, Nielsen OM, Seidelin C, Vestergaard-Andersen T, Schroeder TV. Fluoropolymer-coated Dacron Versus PTFE Grafts for Femorofemoral Crossover Bypass: Randomised Trial. Eur J Vasc Endovasc Surg 2006; 32:431-8. [PMID: 16807001 DOI: 10.1016/j.ejvs.2006.04.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 04/06/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate whether patency of a thin walled 8 mm fluoropassivated Dacron graft was similar to that of a standard 8mm PTFE graft for femorofemoral crossover bypass surgery. DESIGN A randomised multicentre clinical trial comparing two vascular grafts with participation of 10 departments of vascular surgery in Denmark, Sweden and Norway. PATIENTS AND METHODS 198 patients were randomised to PTFE (n=107) or fluoropolymer-coated Dacron grafts (n=91), 63% underwent surgery for claudication, 27% for ischaemic rest pain and 10% for tissue loss. The median follow-up time was 24 months (IQR 19-26 months). RESULTS The primary patency rate of the two grafts was similar (log rank test: p=0.35). The primary patency rates (95% CI) for coated Dacron and PTFE grafts were 92% (86-98) and 94% (89-99) at 12 months and 87% (74-95) and 93% (87-99) at 24 months, respectively. CONCLUSION In patients with unilateral iliac artery disease not amenable to angioplasty, the femoral-femoral bypass is durable and effective. No difference in patency was found between the two graft materials (fluoropolymer coated Dacron and PTFE).
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Affiliation(s)
- J P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
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Park KB, Do YS, Kim JH, Han YH, Kim DI, Kim DK, Kim YW, Shin SW, Cho SK, Choo SW, Choe YH, Choo IW. Stent placement for chronic iliac arterial occlusive disease: the results of 10 years experience in a single institution. Korean J Radiol 2006; 6:256-66. [PMID: 16374084 PMCID: PMC2684973 DOI: 10.3348/kjr.2005.6.4.256] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective We wanted to retrospectively evaluate the long-term therapeutic results of iliac arterial stent placement that was done in a single institution for 10 years. Materials and Methods From May 1994 to April 2004, 206 patients who underwent iliac arterial stent placement (mean age; 64±8.8) were followed up for evaluating the long term stent patency. Combined or subsequent bypass surgery was performed in 72 patients. The follow up period ranged from one month to 120 months (mean; 31±25.2 months). The factors that were analyzed for their effect on the patency of stents were age, the stent type and diameter, the lesion site, lesion shape, lesion length, the Society of Cardiovascular and Interventinal Radiology criteria, the total run off scores, the Fontaine stage and the cardiovascular risk factors (diabetes mellitus, hypertension and smoking). Follow-up included angiography and/or CT angiography, color Doppler sonography and clinical evaluation with the ankle-brachial index. Results Two hundred and eighty-four stents were placed in 249 limbs of 203 patients. The technical success rate was 98% (203/206). The primary patency rates of the stents at 3, 5, 7 and 10 year were 87%, 83%, 61% and 49%, respectively. One hundred seventy-seven patients maintained the primary stent patency until the final follow up and 26 patients showed stenosis or obstruction during the follow up. Secondary intervention was performed in thirteen patients. Lesions in the external iliac artery (EIA) or lesions in both the common iliac artery (CIA) and EIA were a poor prognostic factor for stent patency. The run off score and stent diameter also showed statistically significant influence on stent patency. The overall complication rate was 6%. Conclusion Iliac arterial stent placement is a safe treatment with favorable long term patency. Lesions in the EIA or lesions in both the EIA and CIA, poor run off vessels and a stent having the same or a larger diameter than 10 mm were the poor prognostic factors for long term stent patency.
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Affiliation(s)
- Kwang Bo Park
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young Soo Do
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jae Hyung Kim
- Department of Radiology, Paik Hospital, Sangye, College of Medicine, Inje University, Korea
| | - Yoon Hee Han
- Department of Radiology, Paik Hospital, Ilsan, College of Medicine, Inje University, Korea
| | - Dong Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Duk Kyung Kim
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Sung Wook Shin
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Sung Ki Cho
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Sung Wook Choo
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Yeon Hyeon Choe
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In-Wook Choo
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.02.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Menard MT, Belkin M. Reconstructive Surgery. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Kim YW, Lee JH, Kim HG, Huh S. Factors Affecting the Long-term Patency of Crossover Femorofemoral Bypass Graft. Eur J Vasc Endovasc Surg 2005; 30:376-80. [PMID: 15890541 DOI: 10.1016/j.ejvs.2005.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Accepted: 04/06/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the factors affecting long-term patency of crossover femorofemoral bypass (FFB) graft. DESIGN A retrospective clinical study of a prospectively registered database. MATERIALS Two hundred and sixteen FFBs performed for 192 patients with atherosclerotic iliac occlusive disease. METHODS The clinical and surgical variables influencing graft patency were assessed with log-rank test and Cox's proportional hazard analysis. RESULTS The primary patency rates of all FFB grafts at 3 and 5 years were 73+/-4 and 65+/-5%, respectively. By multivariate analysis, hypertension (Odds ratio 2.8, P=0.002) and critical ischemia (Odds ratio 0.42, P=0.01) significantly (P<.05) influenced long-term patency of FFB grafts. CONCLUSION The long-term patency of FFB grafts was not affected by procedural modifications. Graft patency was inferior in patients with severe lower limb ischemia but superior in patients with hypertension. Further study is required to clarify the mechanism of an unexpected beneficial effect of hypertension on FFB graft patency.
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Affiliation(s)
- Y W Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center (SMC), Sungkyunkwan University School of Medicine, Seoul, South Korea.
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D'Addio V, Ali A, Timaran C, Siragusa T, Valentine J, Arko F, Modrall JG, Clagett GP. Femorofemoral bypass with femoral popliteal vein. J Vasc Surg 2005; 42:35-9. [PMID: 16012449 DOI: 10.1016/j.jvs.2005.03.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The femoropopliteal vein (FPV) has been used successfully for vascular reconstructions at multiple sites. To date, there have been no studies documenting patency of the FPV graft in the femorofemoral position. Our goal was to assess long-term patency of the FPV graft used for femorofemoral bypass (FFBP). METHODS Patients undergoing FFBP over a 10-year period were studied. Those in whom the FPV was used as a conduit were analyzed for runoff resistance score to assess how patients with poor runoff fared. Poor runoff was defined as a runoff resistance score of > or =7 (1 = normal runoff, 10 = total occlusion of all runoff vessels). RESULTS Fifty-four patients underwent FPV FFBP as a sole procedure (n = 16, 30%) or as a portion of an aortofemoral reconstruction with a FFBP component (n = 38, 70%). Mean (+/- SD) follow-up was 47 +/- 33 months. The 1-, 3-, and 5-year primary patencies were 97%, 93%, and 76%. The 5-year assisted primary and secondary patency rates were 85% and 90%. Among 27 patients with poor runoff (runoff resistance score of > or =7), the cumulative 40 month patency rate was 90%. Among patients in whom FPV FFBP was performed as a primary procedure (no aortofemoral component), there were no graft failures. CONCLUSIONS FFBP performed with FPV has excellent 1-, 3, and 5-year patency rates. FPV has sustained patency for FFBP in patients with poor runoff.
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Affiliation(s)
- Victor D'Addio
- University of Texas Southwestern Medical Center, Dallas, 75390, USA
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42
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Saratzis N, Melas N, Lazaridis J, Ginis G, Antonitsis P, Lykopoulos D, Lioupis A, Gitas C, Kiskinis D. Endovascular AAA Repair With the Aortomonoiliac EndoFit Stent-Graft: Two Years' Experience. J Endovasc Ther 2005; 12:280-7. [PMID: 15943502 DOI: 10.1583/04-1474.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the feasibility and efficacy of a specific aortomonoiliac endograft and the durability of the femorofemoral bypass for treatment of abdominal aortic aneurysm (AAA). METHODS From 2002 to 2004, 39 high-risk (ASA III/IV) patients (36 men; median age 74 years, range 63-84) with AAA (n = 33) or AAA and common iliac artery aneurysm (n = 6) were treated with an EndoFit aortomonoiliac endograft and femorofemoral crossover bypass. The contralateral iliac axis was obstructed with an endoluminal occluder. Patients were followed with contrast-enhanced computed tomography at 1, 6, 12, and 24 months. RESULTS EndoFit AMI stent-grafts were implanted successfully in all patients. Perioperative mortality was zero. Endoleak occurred in 3 (7.7%) cases. A proximal type I endoleak was identified at 1 month and was treated with a proximal cuff. Two type II endoleaks are under surveillance because the aneurysm sac shows no enlargement. Thrombosis of the femorofemoral graft occurred in 1 case during the immediate postoperative period due to insufficient inflow from a residual stenosis of the endograft (primary patency 97.5%). The deficit was treated successfully (secondary patency 100%). Two (5.1%) tunnel hematomas were treated conventionally. Median follow-up was 14 months (range 6-30). All patients are alive. None of the aneurysms has ruptured or been converted to an open procedure. Graft migration, serious infection, paraplegia, distal embolization, or any other serious complication has not been observed. CONCLUSIONS In high surgical risk patients with complex iliac anatomy, aortomonoiliac endograft with femorofemoral crossover bypass is feasible and efficacious. Moreover, the midterm patency of the extra-anatomic bypass appears quite satisfactory.
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Affiliation(s)
- Nikolaos Saratzis
- First Department of Surgery, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece.
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43
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Pursell R, Sideso E, Magee TR, Galland RB. Critical appraisal of femorofemoral crossover grafts. Br J Surg 2005; 92:565-9. [PMID: 15810055 DOI: 10.1002/bjs.4880] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The aim of this study was to determine how often femorofemoral crossover grafting for critical ischaemia or intermittent claudication gives an ideal result. An ideal result is an uncomplicated operation with primary wound healing, relief of ischaemic symptoms without recurrence and no need for further intervention.
Methods
All patients undergoing primary femorofemoral crossover grafting between January 1988 and December 2003 were studied.
Results
Some 144 operations were analysed; 51 patients had critical ischaemia and 93 claudication. There was one postoperative death (0·7 per cent). Complications occurred within 30 days in 32 patients (22·2 per cent), including graft occlusion in three (2·1 per cent); six patients (4·2 per cent) required early reoperation. Primary patency for patients with critical ischaemia was 88, 82 and 74 per cent at 1, 3 and 5 years respectively. Respective figures for those who presented with claudication were 93, 92 and 90 per cent (P = 0·034). Late symptoms included graft occlusion (20 patients), disease progression (25), ongoing ulceration (six), graft infection (nine), false aneurysm formation (two) and late donor-site stenosis (two).
Conclusion
When obtaining informed consent, simply describing patency and limb salvage rates does not provide an accurate picture of the outcome of femorofemoral grafting.
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Affiliation(s)
- R Pursell
- Department of Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
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Murphy TP, Ariaratnam NS, Carney WI, Marcaccio EJ, Slaiby JM, Soares GM, Kim HM. Aortoiliac Insufficiency: Long-term Experience with Stent Placement for Treatment. Radiology 2004; 231:243-9. [PMID: 15068949 DOI: 10.1148/radiol.2311030408] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To establish and report the authors' experience with the long-term outcomes of aortoiliac stent placement for treatment of chronic lower-extremity ischemia. MATERIALS AND METHODS Stents were placed in 505 arterial segment lesions in 365 patients who presented with symptoms of chronic leg ischemia between February 1992 and March 2001. The 505 treated lesions were 88 occlusions and 417 stenoses. Indications for stent placement were claudication in 312 (62%), rest pain in 107 (21%), ulcer in 67 (13%), and gangrene in 19 (4%) arterial segments. Patients were followed up for up to 105 months (mean, 33 months +/- 27 [SD]). RESULTS Hemodynamic success was achieved in 484 (98%) of the 496 limbs for which postprocedural translesion pressure gradients were available. Mean ankle-brachial indexes improved from 0.53 +/- 0.25 to 0.79 +/- 0.23 (P <.001). Major complications were seen in 24 (7%) patients. Two patients (0.5%) died within 30 days after stent placement. Twenty (6%) of 355 patients underwent aortic or iliac bypass surgery during the follow-up period. Eight years after stent placement, primary patency was 74%; primary assisted patency, 81%; and secondary patency, 84%. Variables associated with better patency included stenosis (rather than occlusion), shorter lesion length, older age, and limb-threatening ischemia. At the last follow-up examination, 74% of the 466 limbs for which follow-up clinical status data were available were asymptomatic, 22% were associated with claudication, 3% were associated with rest pain, and 1% were associated with ischemic tissue loss. Five patients underwent amputation on the ipsilateral side after stent placement. CONCLUSION Findings from long-term experience with aortoiliac stent placement for treatment of chronic lower-extremity ischemia confirmed the procedure to be a durable, low-risk revascularization option.
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Affiliation(s)
- Timothy P Murphy
- Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA
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Lipsitz EC, Ohki T, Veith FJ, Rhee SJ, Gargiulo NJ, Suggs WD, Wain RA. Patency Rates of Femorofemoral Bypasses Associated With Endovascular Aneurysm Repair Surpass Those Performed for Occlusive Disease. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<1061:profba>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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46
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Hinchliffe RJ, Alric P, Wenham PW, Hopkinson BR. Durability of femorofemoral bypass grafting after aortouniiliac endovascular aneurysm repair. J Vasc Surg 2003; 38:498-503. [PMID: 12947267 DOI: 10.1016/s0741-5214(03)00415-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Endovascular aneurysm repair (EVAR) with aortouniiliac prostheses extends the morphologic range of aneurysms that can be treated and is potentially a more rapid and simple operation than bifurcated endovascular repair. It may, however, be limited by durability of the femorofemoral extra-anatomic bypass graft required to revascularize the contralateral lower limb. Previous studies of femorofemoral bypass grafts were performed almost exclusively in patients with occlusive disease. An 8-year single center experience with use of the femorofemoral bypass graft in aneurysmal disease is reported. METHODS All patients undergoing EVAR with an aortouniiliac endovascular stent graft over eight years (1994-2002) at a single institution were included in a retrospective study. Patient data were collected from a prospectively maintained local endovascular database. All patients gave informed consent and were part of an endovascular program approved by the local ethics committee. RESULTS Over the 8 years, 231 patients underwent EVAR with an aortouniiliac endovascular stent-graft. Median follow-up was 22 months. Localized wound complications were observed in 25 patients (11%). Cumulative 3-year patency rate for the femorofemoral bypass graft was 91%. At the end of 5 years 83% of grafts remained patent. CONCLUSIONS The femorofemoral bypass graft used during EVAR with aortouniliac stent grafts offers encouraging medium and long-term patency. When graft occlusion occurs, it is usually directly attributable to inadequate inflow from the endovascular stent graft itself or to endoluminal damage of the external iliac artery. Awareness and early detection of stent-graft distortion or complications in the external iliac artery may result in improved patency rates.
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Affiliation(s)
- Robert J Hinchliffe
- Department of Vascular and Endovascular Surgery, University Hospital, England.
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Abstract
The choice of prosthetic graft material for cross-femoral bypass has been evolving in the past two decades. Expanded polytetrafluoroethylene (ePTFE) has become our preferred graft material since 1995. However, few studies have looked into the optimal graft material in this procedure. Justification for the preferential use of ePTFE graft in lower limb revascularization remains unknown. The aim of the present study was to compare the long-term outcomes of Dacron and ePTFE grafts in femorofemoral bypass. The records of 61 consecutive patients who underwent femorofemoral bypass at the University of Hong Kong Medical Center from 1981 to 1998 were retrospectively reviewed. Dacron grafts were used in 27 patients and 34 patients had ePTFE grafts. The demographic features, patency, and limb salvage rates of the two groups of patients were compared. The 3-year primary patency rates of Dacron and ePTFE grafts were 85% (SE = 9.5%) and 66% (SE = 14.5%), respectively. The difference was not statistically significant. The limb salvage rates of Dacron and ePTFE grafts were 91% and 83% at 3 years, respectively (p = 0.27). The long-term outcomes of Dacron and ePTFE grafts in femorofemoral bypass were equivalent. The preferential use of ePTFE graft in femorofemoral bypass is not evidence based. Selection of an appropriate prosthetic graft for femorofemoral bypass should be based on the cost and its handling characteristics.
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Affiliation(s)
- H Lau
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China.
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Mellière D, Blancas AE, Desgranges P, Becquemin JP. The underestimated advantages of iliofemoral endarterectomy. Ann Vasc Surg 2000; 14:343-9. [PMID: 10943785 DOI: 10.1007/s100169910068] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Iliofemoral endarterectomy was invented 50 years ago, but it is seldom practiced today for two reasons. The first is that it is technically challenging and the second is that outcome in early series was poor. Our preliminary experience having been more encouraging, we have continued to perform iliofemoral endarterectomy for the past 20 years. The purpose of this retrospective study was to evaluate our results and compare them with results of alternative techniques described in recent literature. We have performed a total of 176 iliofemoral endarterectomies in patients with normal or nearly normal aortas. The procedure involved the entire network including the common iliac artery, external iliac artery, and common femoral artery in 108 cases (group I), the common iliac artery with or without the external iliac artery in 40 cases (group II), and the external iliac arteries and the common femoral artery with or without the deep femoral artery in 28 cases (group III). From our results we conclude that iliofemoral endarterectomy should be used as a first-choice modality in patients with normal or nearly normal aortas who present with iliac lesions that are either too long for balloon angioplasty or impossible to recanalize. It eliminates the risk of graft infection and false aneurysm. Restenosis can be treated by balloon angioplasty. It also saves the cost of a prosthesis.
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Affiliation(s)
- D Mellière
- Service de Chirurgie Vasculaire, Hôpital Henri Mondor, Créteil, France
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49
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Introduction to interventional treatment for critical limb ischaemia. Eur J Vasc Endovasc Surg 2000. [DOI: 10.1016/s1078-5884(00)80034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Rehring TF, Brewster DC, Cambria RP, Kaufman JA, Geller SC, Fan CM, Gertler JP, Lamuraglia GM, Abbott WM. Utility and reliability of endovascular aortouniiliac with femorofemoral crossover graft for aortoiliac aneurysmal disease. J Vasc Surg 2000; 31:1135-41. [PMID: 10842150 DOI: 10.1067/mva.2000.107120] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the early efficacy of endovascular aortouniiliac stent grafts with femorofemoral bypass graft in the treatment of aortoiliac aneurysmal disease. METHODS We analyzed 51 consecutive patients from January 1997 to March 1999 with a mean follow-up of 15.8 months. Patients ranged in age from 44 to 93 years (mean, 75 years) with a mean aortic aneurysm diameter of 6.2 cm. Technical success was achieved in 50 patients; one patient required conversion to open repair intraoperatively. We placed 28 custom-made and 22 commercial devices. The mean operative time was 223 minutes. The endograft was extended to the external iliac artery in 42% of cases. The contralateral common iliac artery was occluded using either a closed covered stent or intraluminal coils. RESULTS The median hospital stay was 4 days with an average intensive care unit stay of 0.25 days. There were no operative mortalities. Two patients died during follow-up from unrelated conditions. Endoleaks occurred in 11 patients (22%); seven patients (14%) required intervention (four catheter based, three operative). Other complications occurred in 38% of patients but were largely remote or wound related. One femorofemoral bypass graft occluded immediately postoperatively as a result of an intraprocedural external iliac dissection yielding a 98% primary patency and 100% secondary patency. Clinical success was achieved in 88% of patients. CONCLUSIONS These data suggest that this strategy represents a reliable method of repair of aortoiliac aneurysmal disease and extends the capability of an endoluminal approach to patients with complex iliac anatomy.
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Affiliation(s)
- T F Rehring
- Division of Vascular Surgery, Massachusetts General Hospital and Departments of Surgery and Radiology, Harvard Medical School, Boston, USA
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