Endovascular Intervention for Foot Necrosis Caused by an Inadvertent Intraarterial Injection

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

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In-Hospital Outcomes and Trends of Endovascular Intervention vs Surgical Revascularization in Octogenarians With Peripheral Artery Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.02.010 ◽

2021 ◽

Vol 73 (5) ◽

pp. 1831

Author(s):

H.M. Pacha ◽

Y. Al-Khadra ◽

F. Darmoch ◽

M. Soud ◽

C.S. Kwok ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Endovascular Intervention ◽

Peripheral Artery ◽

Surgical Revascularization ◽

Hospital Outcomes ◽

Artery Disease

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Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011653 ◽

2015 ◽

Vol 8 (7) ◽

pp. 722-728 ◽

Cited By ~ 22

Author(s):

Grzegorz Brzezicki ◽

Dennis J Rivet ◽

John Reavey-Cantwell

Keyword(s):

Skull Base ◽

Treatment Option ◽

Case Series ◽

Endovascular Intervention ◽

Long Term Results ◽

Complete Revascularization ◽

Intraoperative Complication ◽

Pipeline Embolization Device ◽

High Cervical

BackgroundMost cervical dissections are treated with anticoagulation or antiplatelet agents with very good results; however, some patients may benefit from endovascular intervention. High cervical and skull base dissections are often more challenging to treat because of the distal location and tortuous anatomy. The Pipeline Embolization Device (PED) may be a reasonable treatment option for this indication.ObjectivesTo report a case series of patients treated with the PED for high cervical and skull base dissections, focusing on their presentation, indications for treatment, dissection revascularization success, and pseudoaneurysm obliteration evaluated by imaging, and to review available pertinent literature.MethodsWe retrospectively reviewed all cases of high cervical and skull base dissections treated with a PED at our institution. Patient clinical characteristics, presentation, procedural and follow-up imaging, and clinical course were analyzed to evaluate for procedure complications, dissection revascularization success, pseudoaneurysm obliteration, and clinical outcome.ResultsThis is a retrospective case series including 11 patients with 13 carotid dissections treated in our center. There were nine traumatic and four spontaneous dissections. The most common presentation was cerebrovascular accident/transient ischemic attack (CVA/TIA; 5 patients) and headache/face pain (4 patients). Eleven dissections were associated with pseudoaneurysms. Three patients failed medical management with anticoagulation, although flow-limiting stenosis was the main indication for endovascular intervention. Up to three PEDs per vessel were deployed. Angioplasty was used in 10 cases. Complete revascularization (<10% residual stenosis) was achieved in 91% of vessels and 50% of pseudoaneurysms were completely or near completely obliterated immediately after PED(s) deployment. Proximal iatrogenic dissection was the only intraoperative complication. Follow-up imaging was available for nine treated vessels and demonstrated patent PEDs without significant in-stent stenosis up to 9 months after intervention. 75% of pseudoaneurysms were completely obliterated at follow-up. One PED partially collapsed but had no neurological consequences. There were no new CVA/TIAs.ConclusionsOur initial experience with treatment of high cervical and skull base dissections with the PED appears to show that this technique may be a safe and viable treatment option. However, long-term results are needed to fully evaluate the efficacy of such treatment.

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The value of duplex surveillance after endovascular intervention for femoropopliteal obstructive disease

European Journal of Vascular and Endovascular Surgery ◽

10.1016/s1078-5884(96)80099-2 ◽

1996 ◽

Vol 12 (2) ◽

pp. 145-150 ◽

Cited By ~ 24

Author(s):

A.V. Tielbeek ◽

E. Rietjens ◽

J. Buth ◽

D. Vroegindeweij ◽

F.P.G. Schol

Keyword(s):

Endovascular Intervention ◽

Obstructive Disease

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Decision-Making in the Scheduling of Endovascular Treatment after Brain Arteriovenous Malformation Haemorrhage: A Retrospective Single Centre Study

The Neuroradiology Journal ◽

10.1177/197140091102400609 ◽

2011 ◽

Vol 24 (6) ◽

pp. 879-885 ◽

Cited By ~ 2

Author(s):

J.J. Downer ◽

M. Cellerini ◽

R.A. Corkill ◽

S. Lalloo ◽

W. Küker ◽

...

Keyword(s):

Early Intervention ◽

High Risk ◽

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Complication Rate ◽

Injury Severity ◽

Endovascular Intervention ◽

Brain Arteriovenous Malformation ◽

Single Centre ◽

Significant Difference

The appropriate timing for endovascular intervention after brain arteriovenous malformation (bAVM) rupture is not known. This paper aims to determine factors that lead to early endovascular intervention and to investigate whether early intervention has the same complication rate as late intervention in a single centre. All patients who underwent endovascular treatment for a ruptured bAVM at our institution in the period January 2007 and July 2010 were included in this retrospective observational study. Of 50 patients, 33 had early endovascular intervention, defined as within 30 days of haemorrhage and the remaining 17 patients had endovascular treatment at day 30 or beyond. A greater proportion of patients treated within the first 30 days were in neurointensive care preoperatively (51.5% vs. 23.5%, p=0.07). A ‘high-risk’ angioarchitectural feature was identified in more patients who had acute intervention (78.8% vs. 11.8%, p<0.0001) and targeted embolization was also more frequent in this group (48.5% vs. 5.9%, p=0.004). Nidal aneurysms, venous varices and impaired venous outflow (venous stenosis) were the principal ‘high risk’ features. Clinically apparent complications occurred in 10.8% of procedures with permanent neurological deficit in 3.6%. There was no directly procedure-related mortality. There was no statistically significant difference in the complication rate of early procedures compared with delayed interventions (12.5% vs. 7.4%, p=0.71). Greater initial injury severity and the presence of high-risk lesion characteristics are the factors that lead to early endovascular intervention. Early intervention is associated with a higher complication rate, but this difference is not statistically significant.

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