scholarly journals Application of relay puncture technique in treating patients with complicated lower extremity arterial diseases

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6345
Author(s):  
Chengzhi Li ◽  
Huimin You ◽  
Hong Zhang ◽  
Yulong Liu ◽  
Wanghai Li ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Brachial Artery ◽  
Ankle Brachial Index ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Technical Success Rate ◽  
Percutaneous Transluminal ◽  
Puncture Technique

Objective This study aimed to introduce and evaluate the safety and efficacy of the relay puncture technique in patients with complicated lower extremity arterial diseases. Methods A total of 21 patients (16 male and five female patients; median age: 68.5 years old), who had suffered from lower extremity arterial diseases between December 2014 and July 2017, were retrospectively collected. For all patients, the contralateral femoral artery was not available for puncture access, and the length of the devices was too short for the brachial artery approach. Therefore, the relay puncture technique, in which the first puncture was performed on the brachial artery, followed by an antegrade puncture on the femoral artery, was used to accomplish the endovascular therapy. Percutaneous transluminal angioplasty and/or percutaneous transluminal stenting were/was used to assess the efficacy of the relay puncture technique. The ankle–brachial index (ABI) and Rutherford clinical classification were used to evaluate the improvement of symptoms after treatment. Patients were followed up for 1, 3, 6, and 12 months, and annually (mean: 16.6 months) after discharge. Results The relay puncture treatment had a 100% technical success rate, and immediately decreased the ischemic symptoms of patients after the procedure. The ABI significantly increased from 0.33 ± 0.18 to 0.75 ± 0.21 at the 1-year follow-up time point (P < 0.05). No serious complications occurred during the follow-up period. The 1-year primary patency rate was 71.43%. Conclusion The relay puncture technique is a feasible technique in the hands of experienced and skilled equipment operators for the treatment of lower extremity arterial diseases, when the contralateral femoral artery is not available for puncture, and the length of the device is too short to treat the distal lesion of the femoral artery and popliteal artery through the brachial artery approach.

Magnetresonanzphasenkontrastgeschwindigkeitsmessungen als noninvasive Nachbeobachtungsmaßnahme nach perkutaner transluminaler Angioplastie

VASA ◽  
2002 ◽  
Vol 31 (4) ◽  
pp. 235-240 ◽  
Author(s):  
Heverhagen ◽  
Wagner ◽  
Bandorski ◽  
Hoppe ◽  
Alfke
Keyword(s):  
Phase Contrast ◽  
Ankle Brachial Index ◽  
Transluminal Angioplasty ◽  
Walking Distance ◽  
Slice Thickness ◽  
Non Invasive ◽  
The Mean ◽  
Percutaneous Transluminal ◽  
Phase Contrast Sequence

Background: The aim of this study was to evaluate magnetic resonance phase contrast velocimetry (MRVL) as a non-invasive follow up tool to assess restenosis after percutaneous transluminal angioplasty (PTA). Patients and methods: We prospectively investigated 51 consecutive patients who underwent PTA of the femoropopliteal region. MRVL was conducted prior, one day, six weeks, twelve weeks and 24 weeks after PTA using a circular polarized extremity coil and a gradient echo sequence (TR/TE 600/6 ms, flip angle 30°, slice thickness 10 mm). Hemodynamic data, derived from the MR phase contrast sequence, allowed to calculate the degree of area stenosis of the lesion treated with PTA. These data were correlated with clinical hemodynamic parameters (ankle-brachial index and walking distance). Results: The mean grade of area stenosis was 69% ± 27% before PTA, 30% ± 20% one day, 29% ± 23% six weeks, 39% ± 17% twelve weeks and 42% ± 18% 24 weeks after PTA and correlated well with clinical data and the post angioplasty clinical course of the patients. Conclusions: Follow up measurements using MRVL are suitable to assess restenosis after PTA and allow quantifying the grade of recurrent stenosis as well as the hemodynamic consequences.

scholarly journals Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

2012 ◽  
Vol 97 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Junjie Zou ◽  
Yongxiang Xia ◽  
Hongyu Yang ◽  
Hao Ma ◽  
Xiwei Zhang
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Ankle Brachial Index ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Primary Patency ◽  
Secondary Patency ◽  
Hybrid Procedures ◽  
Lower Extremity Arterial Disease ◽  
Group 3

Abstract The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and ankle-brachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P  =  0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.

The deep femoral artery, a readily available inflow vessel for lower limb revascularization: a single-center experience

Vascular ◽  
2013 ◽  
Vol 21 (2) ◽  
pp. 75-78 ◽  
Author(s):  
Daniel Silverberg ◽  
Basheer Sheick-Yousif ◽  
Dmitry Yakubovitch ◽  
Moshe Halak ◽  
Jacob Schneiderman
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Lower Limb ◽  
Bypass Graft ◽  
Graft Patency ◽  
Primary Patency ◽  
Single Center ◽  
Deep Femoral Artery ◽  
Single Center Experience

The deep femoral artery (DFA) offers several advantages as an inflow vessel in lower-extremity bypasses. We report a single-center experience using the DFA as an inflow artery for lower-extremity revascularization. We reviewed all patients who underwent a lower-extremity bypass utilizing the DFA as the inflow vessel. Demographics, indications for surgery, indication for use of the DFA, type of conduits and target vessels were recorded. Follow-up data included resolution of symptoms, bypass graft patency, major amputations and survival. Over 2.5 years, 23 patients were treated with a DFA-inflow bypass. Eighteen (78%) suffered from wounds and five (22%) from rest pain. The proximal, middle and distal DFA was used in 8, 14 and 1 patients, respectively. Indications for using the DFA were limited vein conduit (16) and a hostile groin (5). All patients experienced initial resolution of their ischemic symptoms. The primary patency at two years was 93%. The survival rate was 83%. In conclusion, the DFA is an excellent and underutilized alternative inflow artery in patients requiring lower limb revascularization. It offers excellent patency rates and should be considered in patients with hostile groins or insufficient lengths of a vein conduit.

Comparison of the Results of Percutaneous Transluminal Angioplasty and Stenting with Medical Treatment for Claudicants Who Have Superficial Femoral Artery Occlusive Disease

Vascular ◽  
2006 ◽  
Vol 14 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Samuel Wilson ◽  
Dmitri Gelfand ◽  
Juan Jimenez ◽  
Ian Gordon
Keyword(s):  
Medical Treatment ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Transluminal Angioplasty ◽  
Walking Distance ◽  
Control Group ◽  
Early Results ◽  
Percutaneous Transluminal

The outcomes of medical management of peripheral vascular disease localized to the superficial femoral artery (SFA) were compared with those obtained by percutaneous transluminal angioplasty (PTA) with or without stenting in a review of selected studies. The natural history of localized SFA disease is favorable, with major amputation rates less than 10% and revascularization in only 18% of patients over a 10-year interval. Conservative treatment of claudicants shows increases (150%) in walking distance if the ankle brachial index (ABI) is over 0.6 and patients stop smoking. Analysis of 10 trials (882 patients) of PTA with or without stenting found that the overall primary patency rates at 12 months were 71.1% for PTA plus stenting and 58.3% for PTA alone. Technical success with PTA with or without stenting is over 90%, and early results at 6 months are superior to those with exercise. In three randomized controlled trials, however, the difference between PTA and medical treatment at 2 years, whether measured by walking distance or ABI, was not significant, nor was the quality of life. For long-term improvement in walking distance (> 1 year) in the claudicant, intervention is not superior to medical treatment and a monitored exercise program. Consideration should be given to including a nonintervention control group and 2-year outcomes in the evaluation of new SFA stents.

Comparison of drug-eluting balloon angioplasty with self-expanding interwoven nitinol stent deployment in patients with complex femoropopliteal lesions

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Burak Teymen ◽  
Suleyman Akturk ◽  
Ulku Akturk ◽  
Muhammed Tdjani
Keyword(s):  
Ankle Brachial Index ◽  
Primary Patency ◽  
Stent Deployment ◽  
Nitinol Stent ◽  
Technical Success Rate ◽  
Before And After ◽  
Drug Eluting ◽  
Drug Eluting Balloon ◽  
One Year

Objective The aim of this study was to compare the drug-eluting balloon with self-expanding interwoven nitinol stent deployment in patients with complex femoropopliteal lesions. Methods We retrospectively identified patients at our clinic with complex femoropopliteal artery lesions treated either with self-expanding interwoven nitinol stent or drug-eluting balloon. All patients had ankle-brachial index measured before and after the intervention, and regular clinical follow-up with Doppler ultrasonography was performed at six months and one year. Patients underwent peripheral angiography if needed. Results From April 2012 to July 2015, 107 patients with complex femoropopliteal lesions treated with using self-expanding interwoven nitinol stent ( N = 49, mean length 143.5 mm, mean follow-up of 14.1 ± 3.7 months) or drug-eluting balloon ( N = 58, mean length 140.6 mm, mean follow-up of 13.8 ± 4.1 months). The technical success rate was 100% in Supera® and 96.6% in drug-eluting balloon group. There were seven restenosis in self-expanding interwoven nitinol stent (SUS) group (84.8% patency) and 11 restenosis in drug-eluting balloon group (79.2% patency). A significant increase in the ankle-brachial index in both groups after intervention demonstrated a hemodynamic success (SUS group 0.45 ± 0.06, drug-eluting balloon group 0.43 ± 0.07). The mean Rutherford Becker Class significantly decreased in both groups after a follow-up of 12 months (SUS group 0.70 ± 0.73, drug-eluting balloon group 0.74 ± 0.75). Conclusion Deploying drug-eluting balloon or self-expanding interwoven nitinol stent in patients with complex femoropopliteal lesions are both safe and effective with high patency rates with no statistical difference for one-year primary patency rates between them.

Stenting as a bail-out option after failed percutaneous transluminal angioplasty in infrainguinal vein bypass grafts

Vascular ◽  
2016 ◽  
Vol 24 (4) ◽  
pp. 383-389 ◽  
Author(s):  
K Mathur ◽  
MK Ayyappan ◽  
J Hodson ◽  
J Hopkins ◽  
MJ Duddy ◽  
...  
Keyword(s):  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Covered Stents ◽  
Bypass Grafts ◽  
Technical Success Rate ◽  
Vein Grafts ◽  
Graft Rupture ◽  
Vein Bypass ◽  
Percutaneous Transluminal ◽  
Bail Out

Objectives To study the safety and efficacy of bare and covered stents in infrainguinal vein grafts after failure of PTA for treating graft stenoses. Methods An analysis of a prospective database of all patients who underwent stenting of infrainguinal vein bypass grafts at this institution between 1 January 2008 and 31 December 2012 was carried out. The main outcome considered was primary patency, which was reported at 1, 6 and 12 months. Results A total of 18 patients with a mean age of 73 years (range: 56 to 86) were included. The indications for stent placement were significant recoil (7, 39%), graft rupture (6, 33%), residual vein cusps (3, 17%) and aneurysmal degeneration (2, 11%). There was a high overall technical success rate of 94% (17/18) and arrest of haemorrhage was achieved in all cases of graft rupture. The primary patency at 1, 6 and 12 months was 89%, 71% and 59%, respectively. Conclusion The use of bare and covered stents in infrainguinal vein grafts appears safe and effective. They are an excellent bail-out option for the treatment of graft rupture and give acceptable short-term results.

scholarly journals Mid-term results and predictors of restenosis in patients undergoing endovascular therapy for isolated popliteal artery steno-occlusive disease

Imaging ◽  
2021 ◽  
Author(s):  
Dat Tin Nguyen ◽  
Patrik Bayerle ◽  
Miklós Vértes ◽  
Ákos Bérczi ◽  
Edit Dósa
Keyword(s):  
Popliteal Artery ◽  
Cox Regression ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Cox Regression Analysis ◽  
Stent Restenosis ◽  
Percutaneous Transluminal ◽  
Mid Term Results ◽  
Crural Arteries

AbstractBackground and aimThere is only a limited number of major publications on the outcome of interventions for isolated popliteal artery stenosis. The purpose of this study was to report our results on mid-term patency and predictors of restenosis.Patients and methodsThis single-center retrospective study included 61 symptomatic patients (males, N = 33; median age, 65.1 years [IQR, 60.7–71.9 years]; Rutherford grade 4–6, N = 14) with at least two patent crural arteries, whose atherosclerotic stenoses/occlusions were treated with percutaneous transluminal angioplasty (PTA) or stenting (using self-expanding bare-metal Astron Pulsar stents) between 2011 and 2018.ResultsTwenty-six patients had PTA, while 35 underwent stenting. The median follow-up was 29 months (IQR, 10–47 months). The primary patency rates were not significantly different (P = 0.629) between PTA and stenting groups. Restenosis developed in nine patients (34.6%) in the PTA group, and in 12 (34.3%) in the stenting group. Restenotic lesions required re-intervention in nine cases (100%) in the PTA group, and in eight (66.7%) in the stenting group. Restenosis developed significantly less frequently (P = 0.010) in patients with a popliteal/P1 stent; the primary patency rates were also significantly better (P = 0.018) in patients with a popliteal/P1 stent when compared to popliteal/P2 plus multi-segment stents. Cox regression analysis identified lesion location as a predictor of in-stent restenosis (HR, 2.5; 95% CI, 1.2–5.5; P = 0.019).ConclusionStenting was not superior when compared to PTA (if selective stenting was not considered as loss of patency). Follow-up should be more thorough in patients undergoing popliteal/P2 or multi-segment stenting.

Balloon Angioplasty Versus Bailout Stenting for Isolated Chronic Total Occlusions in the Popliteal Artery

2018 ◽  
Vol 53 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Maxime Elens ◽  
Robert Verhelst ◽  
Stefano Mastrobuoni ◽  
Michel J. Bosiers ◽  
Julien Possoz ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Popliteal Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Technical Success ◽  
Chronic Total Occlusions ◽  
Significant Difference ◽  
Percutaneous Transluminal

Aims: Stenting of the popliteal artery (PA) is generally considered inappropriate due to the high mechanical stress and bending of the artery during knee flexion. Nevertheless, vessel recoil remains problematic following angioplasty procedure for chronic total occlusions (CTOs) and adjunctive stenting may be required. The purpose of this study is to compare balloon angioplasty alone versus bailout stenting for isolated CTO of the PA. Materials and Methods: Between March 2012 and October 2016, 43 patients were treated with percutaneous transluminal angioplasty with balloon alone (PTA, n = 16) or bailout stenting percutaneous transluminal angioplasty and stenting (PTAS, n = 27) for de novo CTO of PA. There was no statistically significant difference between both groups with regard to patient demographics and lesions characteristics (calcification severity and lesion length). The median lesion lengths were 67 mm (39.5-78.5) in the PTA group and 94 mm (50-114) in the PTAS group ( p = 0.14). The primary outcome measure was primary patency; secondary outcomes were technical success, primary assisted patency, major amputation, and increased Rutherford classification. Results: Technical success rate was 37% and 96.3% in the PTA and PTAS groups, respectively. There was no statistical difference in 12-month primary patency rate (65.8% versus 58.7%; p = 0.15) and primary assisted patency at 12 months (75.2 versus 69.2; p = 0.47) between the 2 groups. Freedom from target lesion revascularization at 12 months was not significantly different, with 85.7% and 81.6% ( p = 0.2) in the PTA and PTAS groups, respectively. One amputation occurred in the PTA group. Conclusion: This small cohort suggests that stenting as a bailout procedure in CTO of the PA provides similar results to successful balloon angioplasty. Stenting should only be performed after suboptimal balloon angioplasty with vessel recoil. Due to the large lost to follow-up, strong evidence of a therapy over the other cannot be formulated. Larger studies with longer and stronger follow-up are needed to confirm those results.

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