The Role of Drug-Coated Balloon for the Treatment of Native Below-the-Knee Arteries

2019 ◽  
pp. 181-188
Author(s):  
Roberto Nerla ◽  
Fausto Castriota ◽  
Alberto Cremonesi ◽  
Antonio Micari
Keyword(s):  
Below The Knee ◽  
Drug Coated Balloon

Recurrent varicose veins below the knee after varicose vein surgery

Phlebologie ◽  
2007 ◽  
Vol 36 (03) ◽  
pp. 132-136
Author(s):  
M. W. de Haan ◽  
J. C. J. M. Veraart ◽  
H. A. M. Neumann ◽  
P. A. F. A. van Neer
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Varicose Vein Surgery ◽  
Proximal Point ◽  
Perforating Veins ◽  
Recurrent Varicose Veins ◽  
Below The Knee ◽  
Duplex Imaging ◽  
Additional Value

SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.

Role of Atherectomy in Below-the-Knee Vessels in Critical Limb Ischemia

2014 ◽  
pp. 331-337
Author(s):  
Jihad A. Mustapha ◽  
Larry J. Diaz-Sandoval ◽  
Fadi A. Saab
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Below The Knee

The Role of Revascularization in Transmetatarsal Amputations

2001 ◽  
Vol 91 (10) ◽  
pp. 533-535 ◽  
Author(s):  
Javier La Fontaine ◽  
Alex Reyzelman ◽  
Gary Rothenberg ◽  
Khalid Husain ◽  
Lawrence B. Harkless
Keyword(s):  
Lower Extremity ◽  
Diabetes Duration ◽  
Amputation Level ◽  
Knee Amputation ◽  
Below The Knee ◽  
Transmetatarsal Amputation ◽  
The Mean ◽  
Lower Extremity Revascularization

Data from 37 patients who underwent a transmetatarsal amputation from January 1993 to April 1996 were reviewed. The mean age and diabetes duration of the subjects were 54.9 (± 13.2) years and 16.6 (± 8.9) years, respectively. The follow-up period averaged 42.1 (± 11.2) months. At the time of follow-up, 29 (78.4%) of the 37 patients still had foot salvage, 8 (21.6%) had progressed to below-the-knee amputation, and 15 (40.5%) had undergone lower-extremity revascularization. Twelve (80%) of the 15 revascularized patients preserved their transmetatarsal amputation level at a follow-up of 36.4 months. The authors concluded that at a maximum of 3 years follow-up after initial amputation, transmetatarsal amputation was a successful amputation level. (J Am Podiatr Med Assoc 91(10): 533-535, 2001)

The Role of Drug-coated Balloons in Infrapopliteal Intervention

2012 ◽  
Vol 9 (2) ◽  
pp. 112-114
Author(s):  
Gary M Ansel ◽  
Peter A Schneider
Keyword(s):  
Endovascular Therapy ◽  
Metal Stents ◽  
Below The Knee ◽  
Straight Line ◽  
Improved Outcomes ◽  
Line Flow ◽  
Drug Eluting ◽  
One Year

The goal of infrapopliteal endovascular therapy is the re-establishment of straight-line flow to the foot with adequate perfusion of tissue. This treatment should be the first method in properly selected patients to relieve ischemic rest pain, heal ulcers and prevent limb loss, improving quality of life. Percutaneous angioplasty (PTA) continues to be the cornerstone of infrapopliteal therapy. Metal stents are reserved for suboptimal PTA. Although data are accumulating that may eventually guide the use of alternative devices such as lasers, excisional, and rotational atherectomy, drug-eluting stents or drug-coated balloons, we currently lack adequate evidence demonstrating improved outcomes. Endovascular therapy has expanded to include patients with severe co-morbidities such as renal failure and complex occlusive disease. Despite advances in below-the-knee (BTK) angioplasty balloons and a focus on angioplasty technique, current PTA results demonstrate one-year restenosis rates up to 80 %, depending on lesion complexity. Drug-coated balloons have demonstrated superior patency in the superficial femoral artery and it is yet to be determined if this technology can achieve improved patency and the clinical outcomes in the infrapopliteal region.

Echo-Anatomy of Long Saphenous Vein in the Knee Region: Proposal for a Classification in Five Anatomical Patterns

2002 ◽  
Vol 16 (3) ◽  
pp. 111-116 ◽  
Author(s):  
S. Ricci ◽  
A. Cavezzi
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Medial Gastrocnemius ◽  
Long Saphenous Vein ◽  
Type D ◽  
Below The Knee ◽  
Duplex Imaging ◽  
Anatomical Classification ◽  
O 15

Objective: Ultrasonography of the anatomical course of the long saphenous vein (LSV) and its tributaries to produce and verify an anatomical classification (five types). Methods: Four hundred and ninety-three limbs (293 healthy; 200 with varicose veins, VV) were investigated by ultrasonic duplex imaging by the two authors independently, identifying the LSV as the vessel in the (ultrasonic) saphenous fascial ‘eye’ compartment (SFEC), in the thigh, and within two fascial layers between tibia and medial gastrocnemius muscle, below the knee. Results: Type A: LSV runs entirely in the SFEC without relevant tributaries: overall (O) 112 (23%), limbs with vv (V) 13, normal limbs (N) 99. Type B: LSV runs in the SFEC with one or more relevant tributaries below the knee: O 133 (27%), V 70, N 63. Type C: LSV runs in the SFEC with a relevant tributary above the knee: O 89 (18%), V 28, N 61. Type D: LSV runs in the SFEC from the foot upwards, continuing at the middle third of the leg in a large side vein with the calibre and role of the LSV but in a more superficial location. LSV stem is absent (or hypoplasic) in the para-tibial position. At the thigh level the tributary re-enters the true LSV: O 72 (14.5%), V 42, N 30. type E: similar to type D but the LSV is absent only at the knee level: O 72 (14.5%), V 38, N 34. Unclassified: O 15 (3%), V 9, N 6. Conclusions: We found a good reproducibility and clinical utility of the suggested classification. Remarks: (a) the absence (or hypoplasia) of LSV at the knee level with prevalence of a tributary in almost 30% of the limbs is of importance for arterial bypass and saphenous sparing management; (b) there is a low rate of LSV complete incompetence (6%); (c) there is a correlation between absent LSV (or presence of a relevant tributary) and the incidence of VV.

scholarly journals Case Report: Combination of Pressure Guidewire and Optical Coherence Tomography-Guided Drug-Coated Balloon Revascularization for Renal Artery Fibromuscular Dysplasia

2022 ◽  
Vol 8 ◽  
Author(s):  
Yuxi Li ◽  
Xinyan Wen ◽  
Bo Zheng ◽  
Ming Chen ◽  
Wei Ma ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Renovascular Hypertension ◽  
Fibromuscular Dysplasia ◽  
Optical Coherence ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Drug Coated Balloon ◽  
Selection Of

Fibromuscular dysplasia (FMD) is the second common cause of renovascular hypertension. With the advent of endovascular therapy, angiography has become a diagnostic gold standard for FMD. Optical coherence tomography (OCT) by reflecting in vivo histology may improve diagnostic and classification accuracy. Renal fractional flow reserve (rFFR), measured by pressure guidewire, may distinguish the patients who may benefit from revascularization by identifying physiologically significant stenoses. However, the role of usage of both OCT and rFFR is not well-studied. We herein report a 17-year-old male with renovascular hypertension due to FMD. Angioplasty of drug-coated balloon (DCB) guided by OCT and FFR favorably achieved blood pressure (BP) control. In conclusion, the utility of both OCT and FFR may be useful for the appropriate selection of patients with renal FMD.

scholarly journals A Retrospective Evaluation of the Burden of Diabetes in Grenada

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Peripheral Neuropathy ◽  
Gender Disparity ◽  
Retrospective Evaluation ◽  
Below The Knee ◽  
And Gender ◽  
National Significance ◽  
Preventative Interventions ◽  
Gender Discrepancies

Objective: To analyze the burden of diabetes in Grenada and to understand the local/national significance of interventions implemented to combat this burden. Methods: Through analysis in trends of incidence, amputation procedures and gender discrepancies over the period 2008 – 2012. Results: There were no statistically significant differences or trends (relationships) found between number of amputations and incidences of diabetes with respect to time respectively. There was also no statistically significant gender disparity with the incidence of diabetes. Most of the amputations performed in Grenada during 2008 - 2012 were below the knee and peripheral neuropathy, associated with type 2 diabetes, was found to be the leading reason for amputation. Conclusion: While there was no definite trend found for the burden of diabetes in Grenada, the global incidence of chronic disease cannot be ignored. National preventative interventions to decrease the incidence of amputations should be focused on the role of peripheral neuropathy; which is what the Ipswich Touch Toe Test specifically targets.

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