In the Patient with Profunda Artery Disease, Is Open Revascularization Superior to Endovascular Repair for Improving Rest Pain?

Abstract: We reported a case of 56 years old man with critical limb ischemia. Diagnosis was made based on anamnesis, signs and clinical symptoms, as well as investigations that included the presence of rest pain in the left leg. Patient also had a history of diabetes mellitus. Echo- doppler and angiographic investigations supported the diagnosis of critical limb ischemia. In this patient, medicamentous treatment has been administered consisted of antiplatelet and cilostazol, blood sugar control by using insulin. The patient also underwent endovascular revascularization.Keywords: critical limb ischemia, peripheral artery diseaseAbstrak: Telah dilaporkan kasus critical limb ischemia pada seorang laki-laki berusia 56 tahun dengan keluhan nyeri seperti terbakar pada kaki kiri bahkan saat istirahat dengan riwayat diabetes melitus. Hasil pemeriksaan penunjang echo-doppler dan angiografi menyokong terdapatnya critical limb ischemia. Diagnosis ditegakkan berdasarkan anamnesis, tanda dan gejala klinis, serta pemeriksaan penunjang. Pada pasien ini, diberikan penatalaksanaan terapi medikamentosa yaitu antiplatelet dan cilostazol, kontrol gula darah dengan menggunakan insulin, dan dilakukan tindakan revaskularisasi endovaskular.Kata kunci: critical limb ischemia, peripheral artery disease

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Antegrade Hybrid Chimney TEVAR Endograft in a Patient with Blunt Aortic Injury: A Challenging Case with Technical Success but Unfavorable Result

Case Reports in Vascular Medicine ◽

10.1155/2021/6380428 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Fotios Eforakopoulos ◽

Maria Giovani ◽

Petros Zampakis ◽

Christina Kalogeropoulou ◽

Fotini Fligou ◽

...

Keyword(s):

Endovascular Repair ◽

Aortic Injury ◽

Ascending Aorta ◽

Hybrid Technique ◽

Stent Grafts ◽

Landing Zone ◽

Advantages And Disadvantages ◽

Blunt Aortic Injury ◽

Artery Disease ◽

Hypothermic Arrest

Thoracic Endovascular Aortic Repair (TEVAR) has modified aortic medicine, particularly in patients with traumatic aortic injury (TAI). Conventional repair of TAI in the aortic arch is technically demanding as it requires cardiopulmonary bypass and deep hypothermic arrest with still a significant number of complications. Despite recent improvements in endovascular techniques, many patients have been excluded from endovascular repair due to unfavorable anatomy. To increase the feasibility of endovascular repair, adjunctive open extra-anatomical bypasses may be required to provide an adequate proximal landing zone. Several methods, for instance, chimney technique, hybrid technique, and fenestrated or branched stent-grafts, have been proposed as options to preserve the supra-aortic branches, each with its own advantages and disadvantages. We herein present a patient with complex anatomical features and blunt aortic injury, who underwent antegrade chimney stent-graft deployment through the ascending aorta, not otherwise amenable to standard retrograde delivery because of severe peripheral artery disease. The remarkable aspect, in this case, is that both stents were placed antegrade, through the ascending aorta.

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Surgical treatment of acquired heart diseases combined with endovascular repair of coronary artery disease

Kardiologiya i serdechno-sosudistaya khirurgiya ◽

10.17116/kardio201811471 ◽

2018 ◽

Vol 11 (4) ◽

pp. 71

Author(s):

I. I. Scopin ◽

Kh. V. Paronyan ◽

P. V. Kakhktsyan ◽

A. M. Otarov ◽

G. G. Aleksanyan

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Surgical Treatment ◽

Endovascular Repair ◽

Heart Diseases ◽

Artery Disease

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P3971Clinical outcomes of patients with abdominal aortic aneurysm after endovascular repair according to combined presence of coronary or peripheral artery disease

European Heart Journal ◽

10.1093/eurheartj/ehx504.p3971 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

O.H. Lee ◽

Y.G. Ko ◽

C.M. Ahn ◽

J.S. Kim ◽

D.H. Shin ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Peripheral Artery Disease ◽

Endovascular Repair ◽

Peripheral Artery ◽

Abdominal Aortic ◽

Artery Disease

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Systematic review of inframalleolar endovascular interventions and rates of limb salvage, wound healing, restenosis, rest pain, reintervention and complications

Vascular ◽

10.1177/17085381211004246 ◽

2021 ◽

pp. 170853812110042

Author(s):

M Machin ◽

HC Younan ◽

AM Guéroult ◽

S Onida ◽

J Shalhoub ◽

...

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Limb Salvage ◽

Peripheral Artery Disease ◽

Critical Limb Ischaemia ◽

Rest Pain ◽

Peripheral Artery ◽

Single Study ◽

Artery Disease

Objectives Peripheral artery disease is estimated to affect 237 million individuals worldwide. Critical limb ischaemia, also known as chronic limb threatening ischaemia is a consequence of the progression of peripheral artery disease which occurs in ∼21% of patients over a five-year period. The aim of this systematic review is to assess the use of additional below-the-ankle angioplasty in comparison to the use of above-the-ankle angioplasty alone, and the subsequent rates of amputation, wound healing, restenosis, rest pain, reintervention and complications. Methods This systematic review was undertaken in accordance with PRISMA guidelines following a registered protocol (CRD42019154893). Online databases were searched using a search strategy of 20 keywords. Included articles reported the outcome for inframalleolar (pedal artery, pedal arch, plantar arteries) angioplasty with additional proximal angioplasty in comparison to proximal angioplasty alone. GRADE assessment was applied to assess the quality of the evidence. Results After screening 1089 articles, 10 articles met the inclusion criteria. Comparative performance assessment of below-the-ankle with above-the-ankle versus above-the-ankle angioplasty alone was undertaken in 3 articles, with the remaining 7 articles reporting outcomes of below-the-ankle with above-the-ankle angioplasty with no distinct comparator group. Significant decrease in major lower limb amputation at the last follow-up in the below-the-ankle group when compared with the above-the-ankle angioplasty alone group was observed in a single study (3.45% vs. 14.9%, p < 0.05). Improved wound healing rate at follow-up in the below-the-ankle group versus above-the-ankle angioplasty alone group was also reported in a single study (59.3% vs. 38.1%, p < 0.05). Subsequent rate of amputation after below-the-ankle angioplasty has been estimated as 23.5%. Conclusion To date, there is a lack of studies assessing inframalleolar interventions and their use in improving limb salvage, wound healing and symptomatology. Prospective RCTs should be undertaken with adequate participant numbers to be sufficiently powered and report clinically important end-points.

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Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

Journal of Endovascular Therapy ◽

10.1177/1526602819892557 ◽

2019 ◽

Vol 27 (2) ◽

pp. 231-236 ◽

Cited By ~ 1

Author(s):

Ahmed Eleshra ◽

Konstantinos Spanos ◽

Giuseppe Panuccio ◽

Catharina Gronert ◽

Fiona Rohlffs ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Thoracoabdominal Aortic Aneurysm ◽

Covered Stent ◽

Covered Stents ◽

Femoral Access ◽

Type Iv ◽

Custom Made ◽

Artery Disease

Purpose: To present a case of endovascular repair using a custom-made 7-branch stent-graft for a thoracoabdominal aortic aneurysm (TAAA) in a patient with variations in the renovisceral artery anatomy. Case Report: A 70-year-old asymptomatic man presented with a 60-mm-diameter type IV TAAA. Due to severe coronary artery disease, an endovascular approach was elected. In the preoperative computed tomography angiography (CTA) scans, variations in the renovisceral artery anatomy included the common hepatic and splenic arteries deriving separately from the aorta and bilateral double renal arteries (RAs). A custom-made 7-branch stent-graft was manufactured to preserve all renovisceral arteries. The 7 branches were catheterized and connected with a steerable sheath from a femoral access. All branches were bridged to the target vessel (TV) with a self-expanding covered stent; 4 TVs also had balloon-expandable covered stents implanted. Final angiography and predischarge CTA showed patency of all 7 target vessels and corresponding visceral organs, with no endoleak. The patient was discharged on postoperative day 8 without complications. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 7 target vessels. Conclusion: Successful treatment of a TAAA in a patient with multiple variant renovisceral arteries was feasible with a custom-made 7-branch stent-graft, achieving a good early outcome.

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Clinical outcomes from profundoplasty performed as a sole procedure for revascularization in critically ischaemic limbs

Vascular ◽

10.1177/1708538120963901 ◽

2020 ◽

pp. 170853812096390

Author(s):

Mohamed Elsharkawi ◽

Mohammed Elkassaby ◽

Niall McVeigh ◽

Joseph Dowdall ◽

Mary Barry ◽

...

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Artery Occlusion ◽

Tissue Loss ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Rest Pain ◽

Pain Group ◽

Femoral Artery Occlusion ◽

Artery Disease

Objectives The aim of this study is to investigate the durability and clinical efficacy of profundoplasty as a sole procedure in patients presenting with critical limb ischaemia associated with profunda femoral artery disease and superficial femoral artery occlusion. Methods Retrospective analysis of outcomes from all patients who underwent surgical profundoplasty in a single tertiary referral centre was performed. Patients who presented with either rest pain or tissue loss and had combined profunda femoral artery disease and superficial femoral artery occlusion were included in the study. Outcomes were compared between the rest pain and the tissue loss groups. Results Between 2009 and 2019, 51 procedures were performed in 49 patients; 27 (53%) procedures were performed for rest pain and 24 (47%) for tissue loss. Technical success was 100% in both groups. Procedure success was significantly better in the rest pain group owing to lower procedure-related complications ( p = 0.037). Incidence of major adverse cardiovascular events was higher in the tissue loss group with five reported cases compared to only one in the rest pain group ( p = .05); 85.2% of patients with rest pain experienced clinical improvement compared to only 33.3% in the tissue loss group ( p < .001). Higher rates of re-intervention were recorded in the tissue loss group, but this was not statistically significant. Amputation-free survival at 3, 6 and 12 months was 96%, 96% and 92% in the rest pain group, respectively, compared to 77%, 67% and 54% in the tissue loss group ( p = .004). At one-year, freedom from major adverse limb events was lower in patients with tissue loss at 43% compared to 81% in patients with rest pain ( p = .009). Conclusions Profundoplasty performed as a sole procedure for revascularisation of the critically ischaemic limb is a viable straightforward option. However, our results suggest that it may be more effective in the treatment of rest pain rather than in the setting of tissue loss when a combined superficial femoral artery angioplasty or distal bypass may be required.

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Elevated level of circulatory sTLT1 induces inflammation through SYK/MEK/ERK signalling in coronary artery disease

Clinical Science ◽

10.1042/cs20190999 ◽

2019 ◽

Vol 133 (22) ◽

pp. 2283-2299

Author(s):

Apabrita Ayan Das ◽

Devasmita Chakravarty ◽

Debmalya Bhunia ◽

Surajit Ghosh ◽

Prakash C. Mandal ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Chronic Inflammation ◽

Ex Vivo ◽

Human Subjects ◽

Critical Role ◽

Atherosclerotic Cardiovascular Disease ◽

Tnf Α ◽

Artery Disease

Abstract The role of inflammation in all phases of atherosclerotic process is well established and soluble TREM-like transcript 1 (sTLT1) is reported to be associated with chronic inflammation. Yet, no information is available about the involvement of sTLT1 in atherosclerotic cardiovascular disease. Present study was undertaken to determine the pathophysiological significance of sTLT1 in atherosclerosis by employing an observational study on human subjects (n=117) followed by experiments in human macrophages and atherosclerotic apolipoprotein E (apoE)−/− mice. Plasma level of sTLT1 was found to be significantly (P<0.05) higher in clinical (2342 ± 184 pg/ml) and subclinical cases (1773 ± 118 pg/ml) than healthy controls (461 ± 57 pg/ml). Moreover, statistical analyses further indicated that sTLT1 was not only associated with common risk factors for Coronary Artery Disease (CAD) in both clinical and subclinical groups but also strongly correlated with disease severity. Ex vivo studies on macrophages showed that sTLT1 interacts with Fcɣ receptor I (FcɣRI) to activate spleen tyrosine kinase (SYK)-mediated downstream MAP kinase signalling cascade to activate nuclear factor-κ B (NF-kB). Activation of NF-kB induces secretion of tumour necrosis factor-α (TNF-α) from macrophage cells that plays pivotal role in governing the persistence of chronic inflammation. Atherosclerotic apoE−/− mice also showed high levels of sTLT1 and TNF-α in nearly occluded aortic stage indicating the contribution of sTLT1 in inflammation. Our results clearly demonstrate that sTLT1 is clinically related to the risk factors of CAD. We also showed that binding of sTLT1 with macrophage membrane receptor, FcɣR1 initiates inflammatory signals in macrophages suggesting its critical role in thrombus development and atherosclerosis.

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