Diagnostic Value of CT Value of Arterial Angiography in Femoral Artery Obstructive Disease

2020 ◽  
Vol 10 (4) ◽  
pp. 954-960
Author(s):  
Wenming Huang ◽  
Haiyang Zhi ◽  
Haidong Ye
Keyword(s):  
Radial Artery ◽  
Femoral Artery ◽  
Collateral Circulation ◽  
High Specificity ◽  
Partial Occlusion ◽  
Total Occlusion ◽  
Blocking Group ◽  
Complete Occlusion ◽  
Ct Value ◽  
Chronic Occlusion

Objective: To compare the changes of CT values of distal femoral artery and radial artery obstructive lesions and whether CTA showed the diagnosis of complete occlusion of lower extremity arteries by CT angiography and DSA. Materials and Methods: A total of 50 consecutive patients with femoral artery and radial artery occlusion were enrolled and retrospectively studied, aged 32–83 years, mean 68.5 ± 8.7 years old; 35 males and 15 females, reverse descending The sign was defined as the contrast fill gradient in the distal lumen of the vascular occlusion site, which was characterized by a progressive increase in the CT value of the distal lumen of the obstructed lesion from proximal to distal. DSA was used as the criterion to statistically analyze the incidence of CT angiographic inverse descending signs and collateral circulation in chronic complete obstructive lesions and partial obstructive lesions of the femoral artery and radial artery, and statistical analysis was performed. Results: The rates of reversed CT values in the chronic total occlusion group and the partial occlusion group were 76.9% (20/26) and 20.8% (5/24), respectively. The signs of reverse degeneration were significantly more common in the chronic complete occlusion group (X2 = 13.1). P < 0.05). The incidence of peripheral collateral circulation in the chronic occlusion group and partial obstruction group was 80.8% (21/26) and 29.2% (7/24), respectively. The incidence of collateral circulation in the chronic complete occlusion group was significantly higher than that in the partial occlusion group. Blocking group (X2 = 13.5, P < 0.05). The sensitivity of CT and angiographic collateral signs for the diagnosis of chronic complete occlusion of the femoral artery and radial artery was 92.3%, and the specificity was 70.8%. Conclusions: The inverse degeneration of CT values and the signs of CTA collateral circulation have a high specificity for the diagnosis of chronic complete occlusion of the femoral artery and radial artery, and help to identify partial occlusion of the femoral artery and radial artery and chronic complete occlusion.

scholarly journals Pancreaticoduodenectomy following total occlusion of the superior mesenteric artery: a case report and literature review

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Reo Ohtsuka ◽  
Hodaka Amano ◽  
Michiyo Hashimoto ◽  
Toshiyasu Iwao
Keyword(s):  
Bile Duct ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Collateral Circulation ◽  
Bile Duct Carcinoma ◽  
Three Dimensional ◽  
Celiac Artery ◽  
Total Occlusion ◽  
Duct Carcinoma ◽  
Chronic Occlusion

Abstract Background Patients with chronic occlusion of the celiac artery and superior mesenteric artery (SMA) are often asymptomatic, and occlusion may be caused by arteriosclerosis or median arcuate ligament compression. Pancreaticoduodenectomy (PD) is occasionally performed for patients with celiac artery occlusion; however, reports on patients with SMA occlusion are rare. We report a patient with cholangiocarcinoma and total atherosclerotic occlusion of the SMA without preoperative stenting or bypass. Case presentation A 73-year-old man suspected to have lower bile duct carcinoma was admitted to our hospital for further treatment. Three-dimensional computed tomography (3DCT) showed a common bile duct tumor and total occlusion of the SMA with collateral circulation of the gastroduodenal artery (GDA) and inferior mesenteric artery (IMA). We performed a PD. During the operation, we used test clamping of the GDA, which revealed no bowel ischemia. The postoperative course was uneventful, and the patient was discharged on postoperative day (POD) 30. 3DCT on POD 98 and POD 307 showed development of collateral circulation between the IMA and SMA. Conclusion Here, we report the case of a patient with total occlusion of the SMA who subsequently underwent PD. 3DCT was instrumental in gathering vascular collateral information and thus we conclude that the assessment of collateral circulation before surgery is important.

scholarly journals Successful case of direct puncture of a prosthetic bypass graft in endovascular treatment for long superficial artery chronic total occlusion: a case report

2020 ◽  
Author(s):  
Makoto Sugihara ◽  
Yoko Ueda ◽  
Yuiko Yano ◽  
Shin-Ichiro Miura
Keyword(s):  
Femoral Artery ◽  
Chronic Total Occlusion ◽  
Bypass Graft ◽  
Common Femoral Artery ◽  
Critical Limb Ischaemia ◽  
Complete Revascularization ◽  
Anastomotic Site ◽  
Graft Occlusion ◽  
Total Occlusion ◽  
Direct Puncture

Abstract Background The access site for endovascular therapy (EVT) is often limited because of multi-vascular diseases. Prior lower limb bypass can potentially limit the availability of common femoral artery access when EVT is required. Case summary An 88-year-old woman who presented with non-healing ulceration in the dorsalis pedis of the left foot despite treatment for several months was admitted to our hospital. She had undergone axillo-bilateral femoral bypass surgery for right critical limb ischaemia 3 years previously. Ultrasound and contrast computed tomography demonstrated bypass graft occlusion, left superficial femoral artery (SFA)-popliteal artery long chronic total occlusion from the origin with severe calcification and severe stenosis in the bilateral common femoral artery close to the anastomotic site. EVT for the left SFA occlusion was necessary to save the left foot, but access sites for EVT were limited. We decided to puncture an occluded axillo-femoral prosthetic bypass graft. It is difficult to cross the wire with only an antegrade approach. Therefore, it was necessary to use a bi-directional approach with dorsalis pedis artery puncture and the Rendez-vous technique. Finally, angiogram demonstrated improved blood flow to the wound site, and haemostasis at the puncture site could be achieved by manual compression. The ulceration healed within a month. Discussion Direct puncture of a prosthetic bypass graft and additional techniques resulted in complete revascularization. Thus, direct puncture of a bypass graft could be a useful EVT strategy for patients with complex and extremely long chronic total occlusion.

Scoring Balloon Reduces the Severity of Dissection and Stent Implantation Rate in Superficial Femoral Artery Angioplasty Compared to Plain Balloon

2020 ◽  
pp. 153857442096897
Author(s):  
Hanbee Hong ◽  
Ui Jun Park ◽  
Young Nam Roh ◽  
Hyoung Tae Kim
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Stent Implantation ◽  
Implantation Rate ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Total Occlusion ◽  
Scoring Balloon ◽  
Significant Difference ◽  
The Difference

Purpose: The knowledge regarding the benefits of the scoring balloon (SB) in comparison to the plain balloon (PB) is limited. This study aims to elucidate the difference in efficacy between SB and PB as pre-balloon in superficial femoral artery angioplasty. Methods: We retrospectively analyzed angiographic images of 113 lesions in 98 patients treated with endovascular surgery. 37 lesions were prepared by SB and 76 lesions by PB. Lesions without significant residual stenosis nor a flow-limiting dissection were treated by drug-coated balloon and the others by drug-eluting stent. Severity of dissection was evaluated by Kobayashi dissection grade and NHLBI classification. The rate of stent implantation was compared between the 2 groups. Kaplan-Meier analysis estimated freedom from target lesion revascularization (TLR) rate at 12 months. Results: Severe dissections (>1/3 of lumen) occurred less frequently in the SB group (SB 40.5% vs. PB 75.0%, P = 0.001). Overall stent implantation rate was lower in the SB group (SB 27.0% vs. PB 55.3%, P = 0.005). In subgroup analysis for the complex lesions, the SB group had lower rate of severe dissection(>1/3 of lumen) in patients with long lesions(>15 cm) (SB 51.7% vs. PB 76.9%, P = 0.020) and lesions of calcium grade ≥2 (SB 43.8% vs. PB 72.5%, P = 0.009). SB group had lower stent implantation rate in patients with long lesions (SB 34.5% vs. PB 59.6%, P = 0.030), lesions of calcium grade ≥2 (SB 31.3% vs. PB 56.9%, P = 0.023), and total occlusion (SB 30.8% vs. PB 80.0%, P = 0.002). There were no procedure-related complications in either group except 1 case of puncture-site hematoma. There was no significant difference in TLR rate between both groups at 12 months (P = 0.509). Conclusion: SB reduces the incidence of severe dissection (>1/3 of lumen) and rate of overall stent implantation in comparison with PB. The use of SB is a safe and effective method of lesion preparation in SFA angioplasty.

Effects of exercise on collateral development in myocardial ischemia in pigs

1984 ◽  
Vol 56 (3) ◽  
pp. 656-665 ◽  
Author(s):  
C. M. Bloor ◽  
F. C. White ◽  
T. M. Sanders
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Exercise Training ◽  
Collateral Circulation ◽  
Coronary Artery Stenosis ◽  
Arterial Stenosis ◽  
Collateral Flow ◽  
Circumflex Coronary Artery ◽  
Complete Occlusion ◽  
Collateral Development

To study the effects of exercise on collateral development in myocardial ischemia, we induced coronary arterial stenosis of the left circumflex coronary artery (LCCA) in 18 of 30 pigs. During that surgery, we identified the coronary bed at risk. Nine of these pigs were then subjected to 5 mo of exercise training on a treadmill. After exercise training, we determined regional collateral and myocardial blood flow using radiolabeled microspheres. At autopsy, all animals had complete occlusion of the LCCA. Infarct size in the exercise-trained pigs was significantly less than in the sedentary pigs (5.9 +/- 1.0 vs. 11.7 +/- 1.0% of the left ventricle). The exercise-trained animals had a greater increase in collateral flow, 35.1 +/- 3.0 vs. 28.7 +/- 4.1 ml X min-1 X 100 g-1, in the noninfarcted jeopardized zone of the LCCA bed. The major findings of the study were the following: 1) chronic coronary artery stenosis progressing to occlusion stimulated development of the collateral circulation and salvaged tissue in the jeopardized myocardium of an animal model with sparse collaterals; 2) development of the collateral circulation and tissue salvage is increased by exercise training; 3) collaterals develop primarily in or near the ischemic zone; and 4) all collateral beds develop a circumferential flow gradient following occlusion.

scholarly journals Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diversion ◽  
Total Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Radiological Features ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

scholarly journals Endovascular therapy for severely calcified plaque at the superficial femoral artery using myocardial biopsy forceps

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Shigeru Nakamura ◽  
Takanori Ikeda
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Calcium Score ◽  
Biopsy Forceps ◽  
Myocardial Biopsy ◽  
Deep Femoral Artery ◽  
Total Occlusion ◽  
Stent Expansion ◽  
Calcified Plaque ◽  
The Right

Abstract Background Currently, the success rate of EVT for treating CTO of the SFA is high; however, EVT is still found to be insufficient in treating CTOs with severely calcified lesions. Even if the guidewire crosses the lesion, the calcifications may still cause difficulties during stent expansion. Main text A 78-year-old male had been reported to have intermittent claudication with chronic total occlusion (CTO) of the right superficial femoral artery (SFA). Angiography revealed severely calcified plaque (Angiographic calcium score: Group4a [1]) at the ostium of the SFA. Stenting posed a risk of underexpansion, causing the plaque to shift to the deep femoral artery. we decided to remove the calcified plaque using biopsy forceps. After removing the extended calcified plaque, the guidewire could cross easily, and the self-expandable stent was well dilated without causing the plaque to shift to the DFA. Conclusions Biopsy forceps may be used in some endovascular cases to remove severely calcified lesions. To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it.

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