Distal embolization during lower extremity endovascular interventions

Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

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The Value of Screening for HPR in Patients Undergoing Lower Extremity Arterial Endovascular Interventions

Case Medical Research ◽

10.31525/ct1-nct04007055 ◽

2019 ◽

Author(s):

Keyword(s):

Lower Extremity ◽

Endovascular Interventions

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Embolic Protection in Complex Femoropopliteal Interventions: Safety, Efficacy and Predictors of Filter Macroembolization

CardioVascular and Interventional Radiology ◽

10.1007/s00270-020-02717-w ◽

2020 ◽

Author(s):

Michael Czihal ◽

Zeynep Findik ◽

Christoph Bernau ◽

Max Seidensticker ◽

Jens Ricke ◽

...

Keyword(s):

Risk Factors ◽

Balloon Angioplasty ◽

Critical Limb Ischaemia ◽

Lesion Length ◽

Limb Ischaemia ◽

Distal Embolization ◽

Embolic Protection ◽

Endovascular Interventions ◽

Directional Atherectomy ◽

Peripheral Embolization

Abstract Objectives To evaluate the safety and efficacy of a filter embolic protection device (FEPD) in endovascular interventions of the femoropopliteal arteries. Methods Patients who underwent endovascular interventions of the femoropopliteal arteries between 2008 and 2016 and in whom the SpiderFXTM FEPD was applied were included in this retrospective study. Clinical and angiographic characteristics, filter macroembolization (FME), device-related complications, distal embolization, as well as the early clinical and hemodynamic outcome, were assessed. Potential risk factors for FME were evaluated by multivariate analysis. Results A total of 244 cases were identified (203 patients, claudication 60.4%, critical limb ischaemia 39.6%, mean lesion length 13.2 ± 12.9 cm, complete occlusions in 72.7%). Balloon angioplasty ± stenting (BAP), directional atherectomy ± balloon angioplasty ± stenting (DA) and rotational thrombectomy ± balloon angioplasty ± stenting (RT) were performed in 141, 61 and 42 cases, respectively. FEPD placement and retrieval were successful in all but one case each. Permanent filter-related vessel damage was not observed. The rate of FME was 37.3% (BAP 36.2%, DA 32.8%, RT 47.7%). Risk factors for FME in the BAP- and DA-group were total occlusion, lesion length > 19 cm, visible thrombus and diabetes mellitus. The distal embolization rate despite filter protection was 4.1 % (BAP 4.9%, DA 1.6%, RT 4.8%) and was higher in cases with FME compared with those without FME (8.7% vs. 1.5%, p = 0.02). Conclusion The Spider FXTM device is safe and effective in capturing embolic debris during femoropopliteal interventions. A residual risk of peripheral embolization remains. Level of Evidence III, Cohort study

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Open Surgical Secondary Interventions Are More Durable Than Endovascular Interventions for Lower Extremity Bypass Stenosis or Occlusion

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.06.037 ◽

2019 ◽

Vol 70 (2) ◽

pp. e32-e33

Author(s):

Mikayla N. Lowenkamp ◽

Abhisekh Mohapatra ◽

Efthymios D. Avgerinos ◽

Eric S. Hager ◽

Michael C. Madigan

Keyword(s):

Lower Extremity ◽

Secondary Interventions ◽

Endovascular Interventions ◽

Bypass Stenosis

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Preventing Lower Extremity Distal Embolization Using Embolic Filter Protection:Results of the PROTECT Registry

Journal of Endovascular Therapy ◽

10.1583/08-2397.1 ◽

2008 ◽

Vol 15 (3) ◽

pp. 270-276 ◽

Cited By ~ 91

Author(s):

Nicolas W. Shammas ◽

Eric J. Dippel ◽

Denise Coiner ◽

Gail A. Shammas ◽

Michael Jerin ◽

...

Keyword(s):

Lower Extremity ◽

Distal Embolization

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Practice patterns of dual antiplatelet therapy after lower extremity endovascular interventions

Vascular Medicine ◽

10.1177/1358863x19880602 ◽

2019 ◽

Vol 24 (6) ◽

pp. 528-535 ◽

Cited By ~ 2

Author(s):

Tanner I Kim ◽

Julia F Chen ◽

Kristine C Orion

Keyword(s):

Lower Extremity ◽

New England ◽

Antiplatelet Therapy ◽

Practice Patterns ◽

Dual Antiplatelet Therapy ◽

Endovascular Intervention ◽

Endovascular Interventions ◽

Vascular Bypass ◽

Artery Disease

Antiplatelet therapy is commonly prescribed following endovascular interventions. However, there is limited data regarding the regimen and duration of antiplatelet therapy following lower extremity endovascular interventions. The aim of this study was to investigate the practice patterns of dual antiplatelet therapy (DAPT) after lower extremity endovascular interventions. We identified all patients who received an endovascular intervention in the Vascular Study Group of New England (VSGNE) registry from 2010 through 2018. The antiplatelet regimen was examined at the time of discharge and follow-up. Variables predicting discharge antiplatelet therapy and duration of antiplatelet therapy were investigated. There were 13,510 (57.69%) patients discharged on DAPT, 8618 (36.80%) patients discharged on single antiplatelet therapy, and 1292 (5.51%) patients discharged without antiplatelet therapy. Patients with coronary artery disease (CAD), prior vascular bypass and endovascular intervention, preoperative statin use, stent placement compared with angioplasty, and femoropopliteal and tibial treatment were associated with higher odds of being discharged with DAPT compared with no antiplatelet therapy and single antiplatelet therapy. Of the patients discharged on DAPT who were followed up at 9–12 months and 21–24 months, 56.49% and 49.63% remained on DAPT, respectively. Only a narrow margin of the patient majority undergoing endovascular interventions was discharged with DAPT, suggesting that only a small proportion of patients undergoing endovascular intervention remain on DAPT long-term. As the number of peripheral vascular interventions continues to grow, further studies are crucial to identify the optimal duration of DAPT.

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Lower-Extremity Endovascular Interventions for Medicare Beneficiaries: Comparative Effectiveness as a Function of Provider Specialty

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.06.065 ◽

2012 ◽

Vol 56 (2) ◽

pp. 573

Author(s):

A.M. Zafar ◽

R. Dhangana ◽

T.P. Murphy

Keyword(s):

Lower Extremity ◽

Comparative Effectiveness ◽

Medicare Beneficiaries ◽

Endovascular Interventions

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Duplex Evaluation Following Femoropopliteal Angioplasty and Stenting: Criteria and Utility of Surveillance

Vascular and Endovascular Surgery ◽

10.1177/1538574412448684 ◽

2012 ◽

Vol 46 (5) ◽

pp. 353-357 ◽

Cited By ~ 11

Author(s):

Donald T. Baril ◽

Luke K. Marone

Keyword(s):

Lower Extremity ◽

Velocity Ratio ◽

Peak Systolic Velocity ◽

Duplex Ultrasound ◽

Standard Of Care ◽

Endovascular Interventions ◽

Routine Surveillance ◽

Angioplasty And Stenting ◽

Aneurysm Repair ◽

Stent Stenosis

Surveillance following lower extremity bypass, carotid endarterectomy, and endovascular aortic aneurysm repair has become the standard of care at most institutions. Conversely, surveillance following lower extremity endovascular interventions is performed somewhat sporadically in part because the duplex criteria for recurrent stenoses have been ill defined. It appears that duplex surveillance after peripheral endovascular interventions, as with conventional bypass, is beneficial in identifying recurrent lesions which may preclude failure and occlusion. In-stent stenosis following superficial femoral artery angioplasty and stenting can be predicted by both peak systolic velocity and velocity ratio data as measured by duplex ultrasound. Duplex criteria have been defined to determine both ≥50% in-stent stenosis and ≥80% in-stent stenosis. Although not yet well studied, it appears that applying these criteria during routine surveillance may assist in preventing failure of endovascular interventions.

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