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Rassam S, Coscas R. Percutaneous Endovascular Reconstruction of the Common Femoral Artery and Its Bifurcation. J Clin Med 2024; 13:3169. [PMID: 38892880 PMCID: PMC11173178 DOI: 10.3390/jcm13113169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Occlusive lesions of the common femoral artery (CFA) and its bifurcation have traditionally been treated with open surgery. Although long-term patency rates after open surgery are excellent, such repairs are associated with substantial local and general morbidity. In recent years, different treatment options have emerged within percutaneous endovascular repair. We hereby present a narrative review on endovascular treatment modalities and a treatment algorithm for endovascular revascularisation of the CFA and its bifurcation. Lesion analysis, access issues, vessel preparation tools, and types of repairs with or without the involvement of the bifurcation are described. Based on current data, an interventional approach can result in high technical success and acceptable mid-term patency rates. Further comparative evidence with open surgery and/or between the different types of endovascular repairs is required to improve the current treatment algorithm.
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Affiliation(s)
- Stephanie Rassam
- Division of Vascular and Endovascular Surgery, Department of Heart, Vascular and Endovascular Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Raphaël Coscas
- Department of Vascular Surgery, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique Hôpitaux de Paris (AP-HP), 92104 Boulogne-Billancourt cedex, France
- UMR 1018, Inserm-Paris11—CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France
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2
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Fataliev GB, Arakelyan VS, Shubin AA. [Choice of hybrid interventions for iliac-femoral arterial lesions]. Khirurgiia (Mosk) 2024:21-28. [PMID: 38477240 DOI: 10.17116/hirurgia202403121] [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: 03/14/2024]
Abstract
OBJECTIVE To compare the short-term and long-term outcomes of hybrid interventions after various infrainguinal reconstructions (restoration of blood flow through superficial femoral artery and pulsatile blood flow through deep femoral artery) in patients with iliac-femoral arterial disease. MATERIAL AND METHODS A retrospective analysis included patients after hybrid iliac-femoral interventions between 2014 and 2018. These interventions included stenting of iliac arteries and various open infrainguinal reconstructions. The first group (n=41) consisted of patients who underwent reconstruction of superficial femoral artery, the second group (n=88) - restoration of pulsatile blood flow in deep femoral artery. We analyzed the Rutherford score, perioperative complications, primary patency rates and limb salvage rates after 12 months in both groups. RESULTS Significant improvement (Rutherford score +3) was achieved in 28 (70%) and 14 (15.9%) patients, respectively (p<0.05). There were no significant between-group differences in the number of postoperative complications. Surgery time was longer in the first group (median 160 and 130 min, respectively, p<0.05). However, intraoperative blood loss was similar. Primary patency rates after 12 months were 82.4% and 95.1%, respectively (p=0.054). Limb salvage rates after 12 months were 94.7% and 100%, respectively (p<0.05). CONCLUSION This study highlights the potential advantages of restoring pulsatile blood flow through the deep femoral artery in hybrid interventions. Higher primary patency and limb salvage rates in the second group indicate better long-term outcomes after restoration of blood flow through the deep femoral artery. Further prospective studies are needed to confirm these results and determine the underlying mechanisms of differences.
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Affiliation(s)
| | - V S Arakelyan
- Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia
| | - A A Shubin
- Botkin City Clinical Hospital, Moscow, Russia
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Noronen K, Söderström M, Kouhia S, Venermo M. Bovine pericardial patch: A good alternative in femoral angioplasty. J Vasc Surg 2023; 77:225-230. [PMID: 35987464 DOI: 10.1016/j.jvs.2022.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two methods are scarce. In this retrospective study, we aimed to discover the differences between BPP and AVP closure in long-term durability. METHODS This study consisted of all femoral endarterectomies with BPP closure performed in Helsinki University Hospital from January 1, 2014, to December 31, 2017. For comparison, the same number of consecutive patients who underwent femoral endarterectomy with AVP closure from January 1, 2014, to October 16, 2016, were reviewed. Follow-up ended December 31, 2020. The mean follow-up was 19 months (range, 0-74 months) in the BPP group and 22 months (range, 0-79 months) in the AVP group. The primary endpoint was primary patency. Secondary endpoints were restenosis at patch site detected by imaging or perioperatively, patch rupture, and deep surgical wound infection. Propensity score analysis was performed for adjustment of differences between the AVP and BPP groups. RESULTS Overall primary patency was superior in the AVP group compared with the BPP group: at 1 year, 96.5% vs 85.0% and at 5 years, 83.0% vs 72.3% (P = .04). In propensity score-matched pairs (n = 92), no difference was found between the groups in primary patency: 95.7% and 95.7% at 1 year and 92.5% and 78.6% at 5 years (P = .861) or in freedom from restenosis: 100% and 100% at 1 year and 89.1% and 84.0% at 5 years (P = .057). Deep wound infections occurred slightly more often after BPP closure (8%) than after AVP closure (4%), but the difference was not statistically significant (P = .144). There were no patch ruptures in the BPP group, but in the AVP group, there were five ruptures (3.5%) (P = .024). CONCLUSIONS BPP is compatible to AVP in femoral endarterectomy in patency and can be regarded as the safer choice considering the risk of patch rupture.
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Affiliation(s)
- Katariina Noronen
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
| | - Maria Söderström
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Sanna Kouhia
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
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4
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Kaneta G, Husain S, Musto L, Hamakarim T, Elsharkawi A, Littlejohn S, Helm J, Saratzis A, Zayed H. Editor's Choice - Eligibility of Common Femoral Artery Atherosclerotic Disease for Endovascular Treatment - the CONFESS Study. Eur J Vasc Endovasc Surg 2022; 64:684-691. [PMID: 36075540 DOI: 10.1016/j.ejvs.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Advances in endovascular technologies have allowed the treatment of common femoral artery (CFA) steno-occlusive disease by minimally invasive means; however, the proportion of lesions treated with common femoral artery endarterectomy (CFAE) which would be amenable to endovascular treatment is unknown. This observational study aimed to describe the morphology and composition of CFA lesions treated with CFAE and report the proportion that would be amenable to endovascular treatment with modern technologies. METHODS Patients presenting with symptomatic peripheral artery disease who underwent CFAE from January 2014 to December 2018 in two tertiary NHS hospitals were included. Extensive data relating to patient demographics, risk factors, clinical outcomes, as well as anatomical and morphological characteristics of the CFA atherosclerotic lesions, were collected which included detailed plaque analysis using 3D reconstruction of pre-operative computed tomography angiograms. CFA lesions were considered suitable for endovascular treatment if presented with patent iliac inflow, at least one patent outflow vessel (superficial femoral artery [SFA] or profunda femoral artery [PFA]), and stenotic rather than occluded CFA. RESULTS A total of 829 CFAs in 737 consecutive patients who underwent CFAE were included (mean age 71 ± 10 years; 526 males, 71%); 451 (62%) presented with chronic limb threatening ischaemia. Overall, 35% of CFAs had a localised lesion (no bifurcation disease) that could possibly be treated endovascularly. In total, 376 (45%) target vessels did not feature severe calcium load, with a patent CFA, PFA, and proximal SFA and therefore would have been amenable to endovascular treatment; while 271 CFAs (33%) featured a significant calcium load which would have potentially required stenting. CONCLUSION A significant proportion of patients with atherosclerotic CFA lesions who undergo surgery could potentially be candidates for endovascular treatment. A randomised trial comparing CFAE and new endovascular techniques in this clinical context is required.
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Affiliation(s)
| | | | - Liam Musto
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | | | - Sofia Littlejohn
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jessica Helm
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Hany Zayed
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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5
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Long-Term Outcomes following Common Femoral Endarterectomy. J Clin Med 2022; 11:jcm11226873. [PMID: 36431350 PMCID: PMC9697575 DOI: 10.3390/jcm11226873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Thromboendarterectomy of the common femoral artery (CFA) for occlusive disease is a crucial procedure in vascular surgery. As an outcome reference for emerging endovascular procedures and new devices, we need more robust evidence of the outcome of this gold standard technique. The purpose of this study was to report 10-year results after femoral endarterectomy (FEA). A retrospective review of medical records at our institution identified eighty consecutive patients (91 limbs) who underwent FEA for CFA lesions. Indications for FEA included 50 limbs (55%) for intermittent claudication (IC) and 39 limbs (43%) with chronic limb-threatening ischemia (CLTI). Two limbs (2%) underwent FEA to prevent hemodynamic steal during extra-anatomical bypass. Adjunctive procedures included endovascular therapy in 32%. CFAs were closed with patch angioplasty in 44%. With a mean follow-up period of 39 months, the survival rates at 3 and 8 years were 85% and 77%, respectively. Limb salvage rates were 92% and 87%. Primary patencies were 98% and 84%. Freedom from target lesion revascularization was 95% at 3 years and 91% at 8 years. Our findings support the durability of FEA, with comparable long-term procedural results in CLTI patients as well as IC patients. Since the FEA is a gate maneuver for hybrid revascularization in CLTI patients, our findings support a strategy combining open and endovascular approaches. Femoral endarterectomy remains a durable solution for common femoral occlusive disease in IC and CLTI in the era of endovascular therapy.
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Sutter W, Hentgen B, Mercier L, Delattre M, Ouldsalek E, Bensaid B, Renard R, Fallouh A, Feito B, Cheysson E, Davaine JM. Surgical treatment of femoral artery bifurcation without material. Technique and follow up. Ann Vasc Surg 2022; 86:190-198. [PMID: 35513126 DOI: 10.1016/j.avsg.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Complete eversion of the femoral tripod is interesting to reduce clinical consequences of wound infection, in particular for patients at high risk (eg: obese, diabetics, cancer). Experience and follow up of this technique are scarce. The different technical possibilities and results are reported here. METHODS Single center prospective study including patients operated on for femoral occlusive lesions using eversion of the common femoral artery and its bifurcation. Clinical and imaging preoperative data, surgical technique and follow up are detailed. RESULTS Thirty-five patients (37 limbs) have been included between June 2014 and April 2016. Mean Rutherford index was 3.6 and 65% of the patients were claudicants. Lesions were limited to the common femoral artery in 14 (38%) of the cases and spread to the superficial femoral artery in 2 (7%) and to the three branches in 21 (57%) of the cases, respectively. Postoperatively, one death, one major amputation and 3 reinterventions were noted, resulting in a 8% rate of major complications. The mean follow up was 37 months. At this time, 11 MACE, 9 deaths and no additional major amputation were noted. The mean Rutherford index was 1.7 (P<.001) and 3 reinterventions were necessary (1 for septic occlusion at 3 months and 2 for restenosis at 12 and 42 months), translating into a primary and secondary patency rates of 93.3% and 96.1%. CONCLUSION This work further confirms that eversion of the femoral tripod is safe and effective. This experience adds to the existing body of the literature and describe alternative techniques of eversion. The technique should be considered when treating patients at high risk of postoperative infection.
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Affiliation(s)
- W Sutter
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Hentgen
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris
| | - L Mercier
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris
| | - M Delattre
- Clinical Research Unit, Centre Hospitalier René Dubos, Pontoise, France
| | - E Ouldsalek
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Bensaid
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - R Renard
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - A Fallouh
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Feito
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - E Cheysson
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - J M Davaine
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris.
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Simons MV, Groen MHA, de Borst GJ, Leiner T, Doevendans PAF, Ebbini E, Slieker FJB, van Es R, Hazenberg CEVB. Safety and feasibility study of non-invasive robot-assisted high-intensity focused ultrasound therapy for the treatment of atherosclerotic plaques in the femoral artery: protocol for a pilot study. BMJ Open 2022; 12:e058418. [PMID: 35501090 PMCID: PMC9062820 DOI: 10.1136/bmjopen-2021-058418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is an atherosclerotic disease leading to stenosis and/or occlusion of the arterial circulation of the lower extremities. The currently available revascularisation methods have an acceptable initial success rate, but the long-term patency is limited, while surgical revascularisation is associated with a relatively high perioperative risk. This urges the need for development of less invasive and more effective treatment modalities. This protocol article describes a study investigating a new non-invasive technique that uses robot assisted high-intensity focused ultrasound (HIFU) to treat atherosclerosis in the femoral artery. METHODS AND ANALYSIS A pilot study is currently performed in 15 symptomatic patients with PAD with a significant stenosis in the common femoral and/or proximal superficial femoral artery. All patients will be treated with the dual-mode ultrasound array system to deliver imaging-guided HIFU to the atherosclerotic plaque. Safety and feasibility are the primary objectives assessed by the technical feasibility of this therapy and the 30-day major complication rate as primary endpoints. Secondary endpoints are angiographic and clinical success and quality of life. ETHICS AND DISSEMINATION Ethical approval for this study was obtained in 2019 from the Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands. Data will be presented at national and international conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NL7564.
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Affiliation(s)
- Michelle V Simons
- Department of Vascular Medicine, University Medical Centre, Utrecht, The Netherlands
| | - Marijn H A Groen
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Gert J de Borst
- Vascular Surgery, University Medical Centre Speciality Surgery, Utrecht, The Netherlands
| | - Tim Leiner
- Radiology, University Medical Center Imaging Division, Utrecht, The Netherlands
| | - Pieter A F Doevendans
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
- Netherlands Heart Institue, Utrecht, The Netherlands
| | - Emad Ebbini
- Electrical and Computer Engineering, University of Minnesota College of Science and Engineering, Minneapolis, Minnesota, USA
| | - Fons J B Slieker
- Department of Oral Surgery, University Medical Centre, Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
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Antegrade dissection of external iliac artery after failed attempt of common femoral artery chronic total occlusion angioplasty. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210218106t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction. Endovascular treatment of chronic total occlusion (CTO) represents a true challenge even for experienced interventional radiologists. We are presenting a case of hidden antegrade dissection of the external iliac artery (EIA) after a failed attempt to recanalize CTO of the common femoral artery (CFA). Case outline. A 52-year-old male patient was admitted for multidetector computed tomography (CT) angiography. Left common iliac artery (CIA) stenting was performed, followed by ?crossover? attempt of recanalization of right CFA CTO that failed. The next day, left femoral superficial artery angioplasty was performed and after one month, angioplasty of the left popliteal and the bellow-knee arteries. A month later, the patient was readmitted for surgical reconstruction of the CFA. After desobstruction, excellent inflow was obtained and a Dacron graft was inserted. A few hours postoperatively, Fogarty catheter thrombectomy was performed. The next morning, pulsations were weakened again and CT angiography showed antegrade dissection of the EIA. Stenting of the EIA was performed with two stents and a favorable outcome was achieved. After a detailed analysis of the CT, hidden thrombosed antegrade dissection of the EIA was noted in the lateral view, which was not seen in the posterior/anterior view and was presented as fibrous plaque with mural thrombosis. Dissection occurred after failed attempt of CFA recanalization and was clinically silent until flow was established triggering opening of the false lumen and the release of thrombotic masses. Conclusion. In patients with failed angioplasty of CTO of the CFA and CT characteristics of fibrous plaque proximal to the site of attempted angioplasty, thrombosed antegrade dissection should be considered.
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9
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Fataliev GB, Arakelian VS, Shubin AA. [Hybrid operations in treatment of patients with multi-level lesions of lower limb arteries]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:173-179. [PMID: 34528603 DOI: 10.33529/angiq2021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound. Also discussed herein are the problems of terminology, indications for, techniques and results of treatment, providing a historical background, followed by analysing problem spots of using this technique and trends of development.
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Affiliation(s)
- G B Fataliev
- Municipal Clinical Hospital named after S.P. Botkin of the Moscow Healthcare Department, Moscow, Russia
| | - V S Arakelian
- A.N.Bakulev National Medical Research Center of Cardiovascular Surgery of the RF Ministry of Public Health, Moscow, Russia
| | - A A Shubin
- Municipal Clinical Hospital named after S.P. Botkin of the Moscow Healthcare Department, Moscow, Russia
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Giusti JCG, Cury MVM, Rossi FH, Soares SP, Trento AF, Tartarotti SP, Brochado-Neto FC. Eversion Endarterectomy of the External Iliac Artery in Treating Chronic Limb-Threatening Ischemia in TASC II C and D Iliofemoral Occlusive Disease. Ann Vasc Surg 2021; 75:162-170. [PMID: 33556512 DOI: 10.1016/j.avsg.2021.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endovascular treatment of iliofemoral occlusive disease is a challenging approach, especially for TransAtlantic Inter-Society C and D lesions. Therefore, the revascularization procedure in such situations is preferably performed by bypass graft surgery with synthetic materials. The purpose of this study is to report the feasibility and mid-term results of eversion endarterectomy of the external iliac artery (EEEIA), as an alternative autologous option. METHODS Retrospective study with 18 EEEIA performed between September 2015 and February 2020, exclusively for chronic limb-threatening ischemia treatment in patients with increased risk of postoperative surgical infection and inadvisable for endovascular treatment. Demographic, clinical variables and outcomes were collected from a prospective database. The main end points are: amputation-free survival (AFS) and 30-day mortality. Secondary end points include: primary patency (PP), cumulative patency (CP), overall survival (OS), and postoperative surgical complication. Kaplan-Meier analysis was used to estimate cumulative time of outcomes. RESULTS The mean age was 64.8 ± 8.3 years, with predominance of men. The median follow-up period was 1012 days, 95% confidence interval [119, 1365] days. Most had Rutherford 5 (n = 13, 72.2%) and mean ankle brachial index was 0.38 ± 0.22. The PP, CP, AFS, and OS in 730 days were 81%, 92%, 80%, and 88%, respectively. There was no 30-day mortality or postoperative surgical infection. CONCLUSIONS Iliofemoral reconstruction through EEEIA is an effective surgical procedure with good patency rates, AFS and OS. In addition, it can be considered an useful and safe option, especially in cases in which a prosthesis should be avoided.
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Affiliation(s)
- Júlio César Gomes Giusti
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil.
| | - Marcus Vinícius Martins Cury
- Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
| | - Fábio Henrique Rossi
- Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | - Samara Pontes Soares
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil
| | - André Felipe Trento
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil
| | - Sabrina Payne Tartarotti
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil
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Esposito A, Menna D, Baiano A, Benedetto P, Di Leo F, Cappiello AP. Eversion Endarterectomy of the Femoral Bifurcation: Technique, Results and Potential Advantages. Ann Vasc Surg 2020; 66:580-585. [DOI: 10.1016/j.avsg.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022]
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12
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Massard-Combe P, Verscheure D, Jayet J, Couture T, Chiche L, Koskas F. Lower Limb Discrepancy Secondary to Post-traumatic Femoral Lesion: A Case Report. Ann Vasc Surg 2020; 68:571.e5-571.e7. [PMID: 32417286 DOI: 10.1016/j.avsg.2020.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Abstract
We report the case of a young man who developed a lower limb claudication associated to a lower limb discrepancy secondary to a closed traumatism during childhood that had never been explored. Fifteen years later, we managed to get the young man get rid of his crippling claudication, but it was unfortunately too late to correct the lower limb asymmetry.
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Affiliation(s)
| | - Dorian Verscheure
- Department of Vascular Surgery, Pitié-Salpétrière Hospital, Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Pitié-Salpétrière Hospital, Paris, France
| | - Thibault Couture
- Department of Vascular Surgery, Pitié-Salpétrière Hospital, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, Pitié-Salpétrière Hospital, Paris, France
| | - Fabien Koskas
- Department of Vascular Surgery, Pitié-Salpétrière Hospital, Paris, France
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13
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Uhl C, Götzke H, Zeman F, Woronowicz S, Betz T, Töpel I, Steinbauer M. Long-Term Outcome of Common Femoral Artery Endarterectomy In Octogenarians and Non-Octogenarians. Scand J Surg 2020; 110:400-406. [PMID: 32098583 DOI: 10.1177/1457496920907733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Arteriosclerotic disease of the common femoral artery can be treated by surgical or endovascular intervention. Elderly patients are said to have a worse outcome if treated by surgical means; however, data to support this theory are missing. METHODS Retrospective analysis of all patients who underwent common femoral artery endarterectomy between March 2007 and July 2018 in our clinic. Group 1 included all patients <80 years and Group 2 included all patients ⩾80 years. Endpoints were patency rates, limb salvage, and overall survival. RESULTS During this time period, 977 common femoral artery endarterectomies were performed. Indication was claudication in 61.5% and critical limb ischemia in 38.5%. Group 1 included 805 cases (82.4%) and Group 2 included 172 cases (17.6%). Thirty-day mortality was 2.7% (Group 1 = 1.6% versus Group 2 = 7.6%; p < 0.001) and 30-day major amputation was 1.1% (Group 1 = 0.7% versus Group 2 = 2.9%; p = .043). Primary patency and secondary patency were 84.2% and 96.8%, respectively, after 7 years. Limb salvage (93.7%, Group 1 = 94.1% versus Group 2 = 91.8%; p = .088) and overall survival (52.0%, Group 1 = 59.1% versus Group 2 = 15.7%; p = .006) were significantly different after the same time period. Multivariable analysis showed female gender to be a risk factor for loss of primary patency. Age ⩾ 80 years and ulcer or gangrene were risk factors for death. Statin use was beneficial to survival. CONCLUSIONS Common femoral artery endarterectomy is a safe procedure with excellent long-term results. Octogenarians have an increased risk for perioperative mortality and major amputation.
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Affiliation(s)
- Christian Uhl
- Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Pruefeningerstrasse 81, Regensburg, 93049, Germany
| | - Hannah Götzke
- Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Sandra Woronowicz
- Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Thomas Betz
- Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Ingolf Töpel
- Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Markus Steinbauer
- Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
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14
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A Hybrid Technique to Treat Iliofemoral Lesions Using a Covered Stent Associated with Open Femoral Repair. Ann Vasc Surg 2019; 66:601-608. [PMID: 31866550 DOI: 10.1016/j.avsg.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND To describe a hybrid approach for complex iliofemoral lesions and report short-term and mid-term results. METHODS In this single-center retrospective study, all consecutive patients (n = 32, 36 limbs) who underwent hybrid repair of complex iliofemoral lesions between 2012 and 2017 using a conformable self-expandable covered stent for external iliac artery lesions and open repair of the common femoral artery were included. Lesions were responsible for claudication in 13 (36%) limbs, rest pain in 13 (36%) limbs and tissue loss in 10 (28%) limbs. Over a wire crossing the iliac lesion, the covered stent was deployed, externalized through the femoral arteriotomy, and cut at the iliofemoral junction in such a way that no untreated transition zone remained between the stent and the open reconstruction of the femoral artery. RESULTS Two elderly patients with critical limb ischemia died during the postoperative course, giving in-hospital mortality of 6.2%. Four (12.5%) presented with moderate to severe complications, including one transtibial amputation in a patient who presented with tissue loss at admission. The median follow-up period was 24.1 months (range: 0.8-64 months). One-year and two-year Kaplan-Meier estimates of overall survival were 91% (95% CI: 97-74) and 76% (95% CI: 89-53). One-year and two-year estimates of freedom from major amputation were 96% (95% CI: 99-76) and 91% (95% CI: 97-66). Estimates of primary patency, assisted primary patency, and secondary patency were: 93.7 (95% CI: 77.1-98.4) at 1 year, and 93.7 (95% CI: 77.1-98.4) at 2 years; 96.7% (95% CI: 78.6-99.6) at 1 year, and 96.7% (95% CI: 78.6-99.6) at 2 years; 96.7% (95% CI: 78.6-99.6) at 1 year and 96.7% (95% CI: 78.6-99.6) at 2 years, respectively. CONCLUSIONS Our hybrid approach for iliofemoral lesions provided acceptable mortality and good mid-term patency rates. Further studies with long-term followup are needed to evaluate the safety and durability of this technique.
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15
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Jia X, Sun ZD, Patel JV, Flood K, Stocken DD, Scott DJA. Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease. Br J Surg 2018; 106:13-22. [DOI: 10.1002/bjs.11026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 01/09/2023]
Abstract
Abstract
Background
Endovascular intervention has emerged as a potential alternative to open surgery in treating common femoral artery (CFA) atherosclerotic disease. The aim of this systematic review was to assess the safety and efficacy of both techniques.
Methods
Thirteen electronic databases from 1980 to 3 January 2018 were searched. Study quality was assessed using the National Institute for Health and Care Excellence Interventional Procedure Programme quality assessment tool. Safety and efficacy outcome measures were analysed.
Results
Thirty-one studies reporting 813 endovascular procedures and 3835 endarterectomies were included. Only two small RCTs have been reported. The methodological quality of available studies was generally low and follow-up short. Safety endpoint assessment revealed a similar risk of wound haematoma for endovascular intervention and endarterectomy (5·5 (95 per cent c.i. 0·2 to 17·2) versus 3·9 (1·7 to 6·9) per cent respectively), a lower risk of wound infection with endovascular procedures (0 versus 5·9 (3·4 to 9·0) per cent) and a lower risk of wound lymph leakage (0 versus 5·7 (3·3 to 8·6) per cent). Efficacy endpoint assessment at 1 year identified that endovascular intervention had a lower primary patency rate than endarterectomy (78·8 (73·3 to 83·8) versus 96·0 (92·2 to 98·6) per cent respectively), a higher revascularization rate (16·0 (6·1 to 29·4) versus 5·8 (1·0 to 14·2) per cent) and a similar amputation rate (2·7 (1·2 to 4·8) versus 1·9 (0·7 to 3·8) per cent).
Conclusion
Endovascular intervention of CFA disease appears to reduce the risk of wound complications but is associated with a lower patency rate and increased rates of subsequent revascularization procedures. Standardization of the endovascular technique and quantification of the proportions of patients suitable for either technique are required.
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Affiliation(s)
- X Jia
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Z D Sun
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - J V Patel
- Radiology Department, Leeds General Infirmary, Leeds, UK
| | - K Flood
- Radiology Department, Leeds General Infirmary, Leeds, UK
| | - D D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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16
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Kawarada O, Zen K, Hozawa K, Ayabe S, Huang HL, Choi D, Kim SH, Kim J, Kato T, Tsubakimoto Y, Nakama T, Ichihashi S, Fujimura N, Higashimori A, Fujihara M, Sato T, Yan BPY, Pang SYC, Wongwanit C, Leong YP, Chua B, George RK, Yokoi Y, Motomura H, Obara H. Contemporary critical limb ischemia: Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care. Cardiovasc Interv Ther 2018; 33:297-312. [PMID: 29654408 PMCID: PMC6153892 DOI: 10.1007/s12928-018-0523-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
The burden of peripheral artery disease (PAD) and diabetes in Asia is projected to increase. Asia also has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world. Therefore, most Asian patients with PAD might have diabetic PAD or ESRD-related PAD. Given these pandemic conditions, critical limb ischemia (CLI) with diabetes or ESRD, the most advanced and challenging subset of PAD, is an emerging public health issue in Asian countries. Given that diabetic and ESRD-related CLI have complex pathophysiology that involve arterial insufficiency, bacterial infection, neuropathy, and foot deformity, a coordinated approach that involves endovascular therapy and wound care is vital. Recently, there is increasing interaction among cardiologists, vascular surgeons, radiologists, orthopedic surgeons, and plastic surgeons beyond specialty and country boundaries in Asia. This article is intended to share practical Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care for CLI.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Japan.
- Department of Cardiovascular Medicine, Ikuwakai Memorial Hospital, Osaka, Japan.
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Shinobu Ayabe
- Department of Plastic Surgery, Yao Tokushukai General Hospital, Yao, Japan
| | - Hsuan-Li Huang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Hong Kim
- Department of Cardiology, Busan Veterans Hospital, Busan, South Korea
| | - Jiyoun Kim
- Department of Orthopedic Surgery, Busan Veterans Hospital, Busan, South Korea
| | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | | | - Tasuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tomoyasu Sato
- Department of Radiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Bryan Ping-Yen Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Skyi Yin-Chun Pang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | | | - Yew Pung Leong
- Department of Vascular Surgery, Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Benjamin Chua
- Department of Vascular Surgery, Vascular and Interventional Centre Singapore, Mount Elizabeth Novena Specialist Centre, The Farrer Park Hospital, Singapore, Singapore
| | - Robbie K George
- Department of Vascular Surgery, Narayana Hrudayalaya and Mazumdar Shaw Medical Centre, Bengaluru, India
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Osaka City University, Osaka, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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