scholarly journals Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Ahmed Amro ◽  
Alaa Gabi ◽  
Adee Elhamdani ◽  
Naveed Iqbal ◽  
Mehiar El-Hamdani
Keyword(s):  
Limb Salvage ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Posterior Tibial Artery ◽  
Covered Stent ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Bail Out

Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI) patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA) intervention complications.Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent.Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation.

scholarly journals Endovascular Distal Plantar Vein Arterialization in Dialysis Patients With No-Option Critical Limb Ischemia and Posterior Tibial Artery Occlusion: A Technique for Limb Salvage in a Challenging Patient Subset

2017 ◽  
Vol 25 (1) ◽  
pp. 127-132 ◽  
Author(s):  
Roberto Gandini ◽  
Stefano Merolla ◽  
Jacopo Scaggiante ◽  
Marco Meloni ◽  
Laura Giurato ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Venous Access ◽  
Posterior Tibial Artery ◽  
Percutaneous Technique ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Esrd Patients

Purpose: To detail a percutaneous technique for distal plantar venous arterialization in diabetic, end-stage renal disease (ESRD) patients with no-option critical limb ischemia (CLI). Technique: After failure of standard intraluminal recanalization attempts, a subintimal approach through the posterior tibial artery (PTA) is begun using a 0.014-inch, 190- or 300-cm-long guidewire supported by a 2-×20-mm, low-profile balloon catheter positioned a short distance behind the narrow “U-shaped” loop in the guidewire. Typically, heavy calcification in the distal tortuous segment of the PTA prevents reentry to the arterial true lumen; however, an entry in the distal lateral or medial plantar vein from a subintimal channel in the plantar artery can be intentionally pursued as a bailout technique, pointing the tip of the guidewire opposite to the arterial wall calcifications. Venous access is confirmed by contrast injection through the balloon catheter. Once the guidewire is advanced in the distal lateral or medial plantar vein and a plantar arteriovenous fistula (AVF) has been created, the AV anastomosis and the occluded PTA segment are dilated with 0.014-inch balloon catheters. The technique has been attempted in 9 consecutive diabetic, ESRD patients (mean age 69 years; 5 men) with no-option CLI; an AVF was created between the PTA and plantar vein in 7 patients. The mean TcPO2 at 1 month was 30±17 mm Hg (vs 7.3±2.2 at baseline). Six ulcers healed over an average of 21±4 weeks. Three of the 9 patients had below-knee amputations. Conclusion: Although further investigations are required, distal plantar venous arterialization may represent a promising technique to improve recanalization rates and limb salvage in diabetic ESRD patients with extremely calcified PTA occlusions.

Precise Retrograde Supera Stenting of the Ostium (PRESTO) of the Superficial Femoral Artery for Complex Femoropopliteal Occlusions: The PRESTO Technique

2018 ◽  
Vol 25 (5) ◽  
pp. 588-591 ◽  
Author(s):  
Luis M. Palena ◽  
Larry J. Diaz-Sandoval ◽  
Laiq M. Raja ◽  
Luis Morelli ◽  
Marco Manzi
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Posterior Tibial Artery ◽  
Anterior Tibial Artery ◽  
Access Site ◽  
Total Occlusion ◽  
Arterial Access ◽  
Tibial Artery ◽  
Anterior Tibial

Purpose: To describe a novel technique designed to safely and precisely deploy the Supera stent accurately at the ostium of the proximal superficial femoral artery (SFA) without compromising the profunda and common femoral arteries. Technique: After antegrade crossing of the chronic total occlusion (CTO) at the SFA ostium and accurate predilation of the entire SFA lesion, a retrograde arterial access is obtained. The Supera stent is navigated in retrograde fashion to position the first crown to be released just at the SFA ostium. Antegrade dilation is performed across the retrograde access site to obtain adequate hemostasis. The technique has been applied successfully in 21 patients (mean age 78.1±8.2 years; 13 men) with critical limb ischemia using retrograde Supera stenting from the proximal anterior tibial artery (n=6), the posterior tibial artery (n=2), retrograde stent puncture in the mid to distal SFA (n=2), the native distal SFA/proximal popliteal segment (n=6), and the distal anterior tibial artery (n=5). No complications were observed. Conclusion: Distal retrograde Supera stent passage and reverse deployment allow precise and safe Supera stenting at the SFA ostium.

scholarly journals Endovascular Recanalization of Chronic Total Occlusions of the Native Superficial Femoral Artery After Failed Femoropopliteal Bypass in Patients with Critical Limb Ischemia.

2021 ◽  
Author(s):  
Roberto Minici ◽  
Michele Ammendola ◽  
Marisa Talarico ◽  
Maria Luposella ◽  
Marco Minici ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Secondary Patency ◽  
Femoropopliteal Bypass ◽  
Technical Success ◽  
Clinical Prognosis ◽  
Chronic Total Occlusions ◽  
Endovascular Recanalization

Abstract Background: The femoropopliteal bypass occlusion in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery remains a significant problem, that hardly challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, although it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. Advanced age, lack of a good great saphenous vein, anastomosis’ pseudoaneurysms and high surgical risks make surgical approach not always suitable. Over the past few years, angioplasty has been commonly used, with the development in endovascular technologies, to treat chronic total occlusions of the native SFA, with a good technical success rate and clinical prognosis. Hence, the idea to recanalize the native SFA chronic total occlusions, in patients with critical limb ischemia (CLI) and femoro-popliteal bypass failure, has been born, limited to those patients unfit for surgery or refusing surgical reconstruction. Data regarding long-term outcomes of this approach in femoro-popliteal bypass failure are limited to few case-series studies.Results: Technical success was achieved in 51 (94.4%) of 54 limbs. Angiographically, 77.8% of the lesions were TASC II category D, while 22.2% TASC II category C. The average length of the native SFA lesions was 26.8 cm. Clinical success, with improved Rutherford classification staging, followed each case of technical success. The median follow-up value was 5.75 years (IQR, 1.5 – 7). By Kaplan-Meier survival analysis, primary patency rates were 61% (±0.07 SE) at 1 year and 46% (±0.07 SE) at 5 years. Secondary patency rates were 93% (±0.04 SE) at 1 year and 61% (±0.07 SE) at 5 years. Limb salvage rates were 94% (±0.03 SE) at 1 year and 88% (±0.05 SE) at 5 years.Conclusions: The endovascular recanalization of chronic total occlusions (CTO) of the native superficial femoral artery (SFA) after failed femoropopliteal bypass is a safe and effective therapeutic option in patients unfit for surgery with critical limb ischemia.

scholarly journals POOR PROGNOSTIC DETERMINANTS FOR PATIENTS UNDERGOING SUPERFICIAL FEMORAL ARTERY ANGIOPLASTY

2020 ◽  
Vol 8 (11) ◽  
pp. 828-831
Author(s):  
S. Maruthu Thurai ◽  
◽  
P. Mohan Raja ◽  
M. Murali ◽  
◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Superficial Femoral Artery ◽  
Lower Limb ◽  
Prospective Observational Study ◽  
Negative Impact ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
The Poor

Introduction: Aim is to study the poor prognostic determinants for patients undergoing superficial femoral artery angioplasty . Material and Methods: It is a Prospective observational study done in fifty patients who has undergone superficial femoral artery angioplasty for lower limb ischemia. Results: 22% had reocclusion of lesion, 10% required reintervention and 8% underwent major limb amputation .These three were considered major negative impact conditions. These were found in majority of patients with renal insufficiency, critical limb ischemia, smoker and drug defaulters. Conclusion: Thus poor prognostic determinants in the study were renal insufficiency, critical limb ischemia , smoker and drug defaulters.

scholarly journals Alternative Combined Retrograde–Antegrade Use of a Re-entry Device in the Revascularization of a Surgically Ligated Superficial Femoral Artery Occlusion

2021 ◽  
Vol 5 (01) ◽  
pp. 62-65
Author(s):  
Roberto Gandini ◽  
Armando Raso ◽  
Arezia Di Martino ◽  
Fabio Salimei ◽  
Daniele Morosetti
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Covered Stent ◽  
Foot Ulcers ◽  
Surgical Closure ◽  
Femoral Artery Occlusion ◽  
The Right ◽  
Occluded Segment

AbstractWe report a case of a diabetic patient with critical limb ischemia, who previously underwent thromboendarterectomy at the right lower extremity, resulting in surgical ligation at the proximal third of the right superficial femoral artery (SFA). Twenty months later, the patient developed foot ulcers; endovascular treatment was therefore performed. After obtaining a retrograde right SFA subintimal access, directly puncturing the occluded segment of the artery, a re-entry intravascular ultrasound-guided catheter was used to gain proximal re-entry. Then, the same device was used again, in antegrade fashion, to obtain re-entry into the patent popliteal artery. A covered stent was deployed in the site of the surgical closure. In the following 3 months, foot ulcers healed.

scholarly journals Dealing with Superficial Femoral Artery Disease: An Ongoing Debate—Open vs. Endovascular Treatment—Preliminary Results

2020 ◽  
Vol 2020 (1) ◽  
pp. 1
Author(s):  
Andreea Luciana Rață ◽  
Sorin Barac ◽  
Roxana Ramona Onofrei ◽  
Adela Dumitrașcu ◽  
Mihai Ionac
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Superficial Femoral Artery ◽  
Treatment Strategies ◽  
Limb Ischemia ◽  
Public Infrastructure ◽  
Free Survival ◽  
The Public ◽  
Major Cardiovascular Events ◽  
Artery Disease

(1) Background: Both open surgery and endovascular strategies are accepted methods for the treatment of critical limb ischemia (CLI) due to superficial femoral artery disease (SFA). There is currently only one randomized trial results (BASIL-1) that compared open vs. endo procedures for SFA treatment. In this study, we wanted to compare two treatment strategies for superficial femoral artery vascular disease. (2) Material and methods: A study was conducted on 235 patients (part of a national project—“Development of the public infrastructure research and development and creation of new infrastructure”) in which the open vs. endovascular strategy was compared in patients with critical limb ischemia and SFA disease. (3) Results: Primary outcomes are the time elapsed until major events related to the index leg or death. Secondary outcomes are amputation-free survival rate, reintervention on the index leg, major cardiovascular events and postoperative complications. (4) Conclusion: After 6 months, we had an overall mortality rate of 7.23% and an amputation-free survival of 89.36%.

Sign in / Sign up

Export Citation Format

Share Document