scholarly journals Kissing Balloon Technique for Angioplasty of Tibioperoneal Arteries Bifurcation Using Pedal Arterial Retrograde Revascularization

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ahmed Amro ◽  
Obadah Aqtash ◽  
Adee Elhamdani ◽  
Mehiar El-Hamdani
Keyword(s):  
Femoral Artery ◽  
Clinical Success ◽  
Common Femoral Artery ◽  
Severity Index ◽  
Femoral Access ◽  
Infrapopliteal Artery ◽  
Kissing Balloon Technique ◽  
Balloon Technique ◽  
Bifurcation Lesions ◽  
Procedural Success

Background. Kissing Balloon Technique using retrograde pedal approach together with anterograde common femoral artery (CFA) approach could be the treatment of choice in patients with diseased infrapopliteal artery bifurcation. We report seven cases where the KBT was utilized for the treatment of diseased infrapopliteal artery bifurcation using retrograde pedal access in conjunction with the conventional common femoral artery (CFA) access. Methods. We reviewed all seven cases that underwent KBT with the combination of pedal and common femoral access in a single-center study from 2014 to 2015 utilizing Rutherford classification severity index; all cases were deemed stage 3 (severe claudication) to stage 6 (severe ischemic ulcers or frank gangrene). With the exception of two cases, contralateral femoral access was obtained, with sheath sizes varying from 4 to 6 French for both CFA and pedal access. Ultrasound was utilized for ipsilateral pedal access in all seven cases. Results. Arterial revascularization was successfully achieved by the KBT in all patients without any complications. All patients achieved procedural success, which is defined as residual stenosis of less than 30% with no dissection or thrombosis and clinical success that is defined as resolution of symptoms (absence of intermittent claudication and healing of the ulcer) as well as improvement in the arterial brachial index (ABI). During follow-up, out of the seven cases, repeat angiogram was performed for one case, which showed patent arteries with no residual lesions. Conclusions. In patients with popliteal and tibioperoneal trunk bifurcation lesions, Kissing Balloon Technique using retrograde pedal access in conjunction with the conventional anterograde access appeared to be successful, safe, and effective technique with lower access site complications and shorter procedure time.

scholarly journals Determinants of Success and Early Complications in Common Femoral Artery Endarterectomy: A Retrospective Study

Surgeries ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 180-189
Author(s):  
Marcel Libertus Johannes Quax ◽  
Daniël Eefting ◽  
Herman Joseph Smeets
Keyword(s):  
Retrospective Study ◽  
Femoral Artery ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Emergency Operation ◽  
Common Femoral Artery ◽  
Walking Distance ◽  
Safe Procedure ◽  
Hybrid Procedures ◽  
Significant Difference

Introduction: Common femoral artery endarterectomy (CFE) is considered a relatively simple, successful and safe procedure in the literature, but major complications can occur. This retrospective study was performed in order to define characteristics contributing to success or failure after common femoral artery endarterectomy, either performed as a single or hybrid procedure. Methods: A total of 298 patients who underwent CFE in our hospital between 1 January 2011 and 1 January 2017 were included. After exclusion, 227 patients were analyzed. Patient characteristics and outcomes were derived from the patient records. Follow-up was 30 days postoperatively. Outcomes were analyzed by the chi-square test and regression analysis. Clinical success was defined as a combination of technical success, improvement in the ankle-brachial index, increased walking distance and “no complications.” Results: The procedure was clinically successful in 74.4% of the patients, and in 25.6%, a complication occurred. The Rutherford class improved in 65.1% of the patients with 1.6 (SD 1.3) class points. The ankle-brachial index improved in 44.8% of the cases, with an average of 116.6%. The most contributing factors for complications such as death, unplanned amputation, surgical site infection, thrombosis and longer hospital admission were emergency operation and a higher ASA classification. Significantly more complications also occurred in patients with renal failure, congestive heart disease, a high Rutherford classification and previous groin incision. A higher Rutherford class was the only factor correlating with an increase in the ankle-brachial index. When single CFE (48.9% of cases) and hybrid procedures (51.1%) were compared, no significant difference in success or failure was found. Conclusion: Limb ischemia requiring emergency operation and preoperative comorbidity were identified as the most important factors predictive for complications following femoral artery endarterectomy. Combining femoral endarterectomy with an endovascular intervention does not seem to increase the risk of a postoperative complication.

Use of a Steerable Sheath for Retrograde Access to Antegrade Branches in Branched Stent-Graft Repair of Complex Aortic Aneurysms

2018 ◽  
Vol 25 (5) ◽  
pp. 566-570 ◽  
Author(s):  
Vladimir Makaloski ◽  
Nikolaos Tsilimparis ◽  
Fiona Rohlffs ◽  
Konstantinos Spanos ◽  
E. Sebastian Debus ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Stent Graft ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Aortic Aneurysms ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Stent Graft Repair ◽  
The Common ◽  
Steerable Sheath

Purpose: To describe how to use a steerable sheath from a femoral access to catheterize antegrade branches in a branched aortic stent-graft. Technique: Following femoral cutdown, a stent-graft with antegrade branches destined for renovisceral target vessels was deployed in the desired position. A steerable sheath with a tip that rotates up to 180° was introduced from the common femoral artery and navigated to the antegrade branches for consecutive catheterization of the target vessels and deployment of one or more bridging stents per branch. The technique is demonstrated in 4 patients who underwent successful complex abdominal and thoracoabdominal branched endovascular repairs with 1, 2, and 4 antegrade branches. Conclusion: Retrograde access for complex aortic endografts with antegrade branches using a steerable sheath appears feasible and effective and may serve as an alternative to upper extremity access.

scholarly journals Initial experience with the AXERA 2 Femoral Access System in neurovascular procedures

2015 ◽  
Vol 21 (3) ◽  
pp. 412-417 ◽  
Author(s):  
Ramesh Grandhi ◽  
Nathan T Zwagerman ◽  
Xiaoran Zhang ◽  
Stephanie H Chen ◽  
Ashutosh P Jadhav ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Manual Compression ◽  
Femoral Access ◽  
Device Failure ◽  
Arterial Access ◽  
Access System ◽  
Small Series ◽  
Vascular Closure Devices ◽  
Groin Hematoma

Introduction Conventional cerebral angiography is a commonly performed procedure in medicine. Vascular closure devices have been developed as alternatives to manual compression at the arteriotomy site and prolonged bed rest. The risks of using these devices include arterial dissection, groin hematoma, and device failure. Herein, we describe our experience with the use of a novel device used for arterial access and closure, the AXERA 2 Access System. Methods A total of 13 patients underwent vascular access and closure with the AXERA 2 Access System. Results Arterial access using the AXERA 2 Access System was achieved in 11 of 13 patients. Amongst the patients with successful access, one patient experienced a groin hematoma requiring manual compression and two patients suffered occlusions of the common femoral artery due to dissections, with both patients requiring femoral artery thromboendarterectomies. Conclusions This small series highlights a heretofore underreported serious complication rate of the AXERA 2 Access System. Additional studies are warranted to provide further insight into risk factors for device failure and complication development.

scholarly journals A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions

2020 ◽  
pp. 83-93
Author(s):  
Mohamed Ahmed Khalil ◽  
Fatehia Ahmed Elsheshtawy ◽  
Medhat Mohamed Ashmawy ◽  
Samiah Mahmoud Sharaf El-Din ◽  
Ayman Mohamed Elsaeed
Keyword(s):  
Clinical Outcome ◽  
Side Branch ◽  
Balloon Inflation ◽  
Short Term ◽  
Coronary Bifurcation Lesions ◽  
Main Vessel ◽  
Kissing Balloon Technique ◽  
Balloon Technique ◽  
Bifurcation Lesions

Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies. Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions. Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group - PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group – RFKBI). Results: 1- Dissection of side branch and conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4- MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months. Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes.

scholarly journals Localization of the femoral artery bifurcation: hips don't lie – in at least 97% of cases

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Uehlein ◽  
S Smolka ◽  
M Arnold ◽  
M Marwan ◽  
S Achenbach
Keyword(s):  
Femoral Head ◽  
Femoral Artery ◽  
Hip Replacement ◽  
Age Groups ◽  
Vascular Complications ◽  
Common Femoral Artery ◽  
Femoral Access ◽  
Funding Sources ◽  
Transcatheter Aortic Valve ◽  
Upper Third

Abstract Background The most common vascular access for structural cardiac interventions such as transcatheter aortic valve implantation (TAVI) is the common femoral artery (CFA). Depending on the procedure CFA puncture has to be performed not only unilaterally, but also bilaterally. Since incorrect localization of femoral access can lead to severe vascular complications, specific knowledge about the exact position of the CFA bifuraction is helpful. Such information might be systematically obtained from pre-TAVI CT scans. Methods We performed a retroperspective analysis of consecutive contrast-enhanced pre-TAVI CT angiography data sets (n=1000) to determine the CFA bifurcation localization relative to the femoral head and the correlation to contralateral CFA bifurcation location. Results The site of the CFA bifurcation was in 67.2% below the femoral head (−−), in 24.3% within the lower third of the femoral head (−), in 7.4% in the mid (0) and in 1.2% within the upper third (+) of the femoral head. Bifurcations above (++) the femoral head were not detected. CFA bifurcations below the femoral head showed the highest prevalence within men and women in all age groups (50–59, 60–69, 70–79, 80–89, 90–99 years). Bilateral agreement of CFA bifurcations was observed in only 69.3% and was independent of one-sided hip replacement (agreement 72.7%) or two-sided hip replacement (agreement 78.7%). A congruent contralateral left CFA bifurcation below the femoral head could be predicted in 80.6%, whereas CFA bifurcations within the lower and upper margins of the femoral head were congruent in only 65.7% (of these, 49.2% for the lower third, 29.7% for the mid and 36.4% for the upper third). Conclusion In conclusion, punctures within the upper third of the femoral head will provide an ideal puncture site in at least 97% of cases, independent of age, sex, or previous hip replacement. FUNDunding Acknowledgement Type of funding sources: None.

Femoral Vascular Access – Approaches and Available Devices

2012 ◽  
Vol 7 (2) ◽  
pp. 108
Author(s):  
Benjamin H Holland ◽  
Robert J Applegate ◽  
◽  
Keyword(s):  
Vascular Access ◽  
Femoral Artery ◽  
Healthcare Costs ◽  
Common Femoral Artery ◽  
Delivery Systems ◽  
Manual Compression ◽  
Femoral Access ◽  
Cardiac Procedures ◽  
The Common

Femoral access remains a vital route for many cardiac and non-cardiac procedures, including those involving the use of large delivery systems. In the common femoral artery access is extremely important to minimise complications and optimise use of closure devices. Dissatisfaction with haemostasis achieved by manual compression stimulated development of VCDs that provide quick and effective haemostasis after sheath removal. Despite shortening time to haemostasis and ambulation, a debate still rages regarding their overall contribution to reducing complications and healthcare costs.

scholarly journals Catheter-based local antiproliferative therapy in kissing balloon technique for in-stent stenosis of coronary artery bifurcation lesions

2008 ◽  
Vol 24 (4) ◽  
pp. 309-311 ◽  
Author(s):  
Christian Herdeg ◽  
Tobias Geisler ◽  
Katrin Goehring-Frischholz ◽  
Christine Zuern ◽  
Ulrike Hartmann ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kissing Balloon Technique ◽  
Balloon Technique ◽  
Bifurcation Lesions ◽  
Stent Stenosis
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