Remote Superficial Femoral Artery Endarterectomy and Distal Vein Bypass for Limb Salvage: Initial Experience

2003 ◽  
Vol 10 (1) ◽  
pp. 121-125 ◽  
Author(s):  
David Rosenthal ◽  
Eric D. Wellons ◽  
John H. Matsuura ◽  
Mark Ghegan ◽  
Frederick W. Shuler ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Patency Rate ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Atheromatous Plaque ◽  
Color Flow ◽  
The Mean

Purpose: To examine the results of remote superficial femoral artery endarterectomy (RSFAE) performed through a small groin incision in conjunction with distal saphenous vein (SV) bypass for limb salvage. Methods: A retrospective study was conducted of 21 patients (14 men; mean age 68.5 years, range 47–78) who underwent RSFAE and distal SV bypass between May 1998 and September 2001 for limb salvage. Thirteen had gangrene and 8 had rest pain. RSFAE was performed with the MollRing Cutter device through a femoral arteriotomy; the distal atheromatous plaque was “tacked up” with a stent. Distal SV bypass from the proximal popliteal artery was performed in situ in 7, from a transposed harvested vein in 8, or from a reversed graft in 6. All patients underwent follow-up examination with serial color-flow ultrasound scans. Results: The mean length of the endarterectomized SFA was 26.5 cm (range 12–40). There were no deaths, only 2 wound complications, and the mean hospital length of stay was 3.1 ± 0.6 days. The primary cumulative patency rate by life-table analysis was 71.4% with follow-up extending to an average of 12.4 months (range 1–18). There were 2 amputations for gangrene and 6 percutaneous procedures in 4 (19.1%) patients to maintain bypass patency, producing an assisted primary patency rate of 81.5%. The locations of the restenoses were evenly distributed along the endarterectomized SFA and SV graft. Conclusions: When adequate SV is not available, RSFAE with residual SV bypass is a safe and moderately durable procedure that may prove to be a useful adjunct for limb salvage, especially in the presence of foot infection, where an autogenous tissue bypass is preferred.

Cryopreserved saphenous vein allograft for infragenicular bypass in the presence of foot infection

Vascular ◽  
2013 ◽  
Vol 21 (4) ◽  
pp. 221-223 ◽  
Author(s):  
Walaya Methodius-Rayford ◽  
James M Combs ◽  
Eric D Wellons ◽  
James M Poindexter ◽  
David Rosenthal
Keyword(s):  
Risk Factors ◽  
Limb Salvage ◽  
Saphenous Vein ◽  
Patency Rate ◽  
Recurrent Infections ◽  
Limb Salvage Rate ◽  
The Mean ◽  
Salvage Rate ◽  
Vein Allograft

We report our distal bypass experience with cryopreserved saphenous vein allograft (CSVA) in 12 patients presenting with infection and no autologous saphenous vein available. Twelve patients underwent 13 arterial reconstructions. The mean age of the cohort was 68.4 years. Ninety-two percent (92%) of the patients presented with Rutherford Class 5 or 6 disease which required wide debridement and copious irrigation of all infected tissue beds. All distal anastomoses were to infragenicular vessels. Two patients died with patent grafts during follow-up for an 83% survival rate. Three grafts failed during follow-up between one and 36.3 months, of which two underwent amputation for an 82% limb salvage rate. The primary and primary assisted patency rate was 40% and 60% at 18 months follow-up, respectively, and no recurrent infections. In patients who have complex risk factors and the presence of infection, CSVA appears to be a reasonable option for limb salvage.

scholarly journals Preprocedural Mean Platelet Volume Level Is a Predictor of In-Stent Restenosis of the Superficial Femoral Artery Stents in Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Kurtulus Karauzum ◽  
Ulas Bildirici ◽  
Emir Dervis ◽  
Irem Karauzum ◽  
Canan Baydemir
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Mean Platelet Volume ◽  
Strong Predictor ◽  
Platelet Volume ◽  
Roc Curve Analysis ◽  
Stent Restenosis ◽  
The Mean ◽  
In Stent Restenosis

Background. The mean platelet volume (MPV), the most commonly used measure of the platelet size, is a cheap and easy-to-use marker of the platelet activation. We aimed to evaluate the relationship between preprocedural MPV and other hematologic blood count parameters and in-stent restenosis in patients with superficial femoral artery (SFA) stenting.Methods and Results. The consecutive 118 patients who successfully underwent endovascular stenting of the SFA were enrolled retrospectively in the study. The mean follow-up was 23 ± 12 months. The in-stent restenosis was observed in 42 patients (35.6%). There were no statistically significant differences between the restenosis group and no-restenosis group in terms of age, gender, and smoking (p=0.116,p=0.924, andp=0.428, resp.). In the restenosis group, the MPV level was markedly higher than that in the no-restenosis group, and it was statistically significant (p<0.001). According to the ROC curve analysis, the optimal cutoff value of the MPV to determine the restenosis was >8.7 fL, and the level of the MPV >8.7 fL was a strong predictor of the restenosis (p<0.001) in logistic regression analysis.Conclusions. The measurement of the preprocedural MPV levels may help to identify high-risk patients for development of the in-stent restenosis. These patients may benefit from an aggresive antiplatelet therapy and close follow-up.

scholarly journals Application of Combined Superficial Femoral Artery Stenting and Deep Femoral Artery Profundoplasty in Chinese Patients With Lower Extremity Artery Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Guoqing Chi ◽  
Mingchao Ding
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Patency Rate ◽  
Chinese Patients ◽  
Deep Femoral Artery ◽  
Hybrid Operation ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Objective: Lower extremity artery disease (LEAD) increases sharply with age and results in severe burden in individuals and in society. This study aimed to compare the efficiency of simple superficial femoral artery stenting (SFAS) and the hybrid operation, such as combined SFAS and deep femoral artery profundoplasty (DFAP), in the treatment of Chinese patients with LEAD, classified as Rutherford grades 3–5.Methods: There were 200 patients with LEAD classified as Rutherford grades 3–5 included in the simple SFAS group (n = 100) and the combined SFAS and DFAP group (n = 100).Results: All the patients had median age of 71 years, and there were 143 males (71.5%). Not only the increase rate of ankle brachial index (ABI), but also reduction rate of Rutherford grade, were significantly higher after surgery in the combined SFAS and DFAP group than in the simple SFAS group (P &lt; 0.05 for all). The patency rate of patients in the combined SFAS and DFAP group was significantly higher than that of patients in the simple SFAS group during the follow-up (P &lt; 0.05). Proportion of amputation and claudication distance &lt;200 m had no significant difference between the two groups during the 2-year follow-up (P &gt; 0.05 for all).Conclusion: This study demonstrated that, compared with SFAS, combined SFAS and DFAP improved not only the ABI and the Rutherford grade after surgery but also the patency rate during the follow-up in Chinese patients with LEAD. Hybrid operation has significant value in alleviating clinical symptoms after surgery, and, thereby, improving vascular prognosis in Chinese patients.

Drug-eluting stents for treatment of focal infrapopliteal lesions

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Rastan ◽  
Noory ◽  
Zeller
Keyword(s):  
Limb Salvage ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Target Lesion Revascularisation ◽  
Randomized Studies ◽  
Drug Eluting ◽  
The Mean

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis

2021 ◽  
Vol 50 (4) ◽  
pp. E7
Author(s):  
Arvid Frostell ◽  
Maryam Haghighi ◽  
Jiri Bartek ◽  
Ulrika Sandvik ◽  
Bengt Gustavsson ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Cranial Vault ◽  
Hospital Length Of Stay ◽  
Cephalic Index ◽  
Sagittal Synostosis ◽  
The Mean ◽  
Cranial Vault Remodeling

OBJECTIVE Isolated nonsyndromic sagittal synostosis (SS) is the most common form of craniosynostosis in children, accounting for approximately 60% of all craniosynostoses. The typical cranial measurement used to define and follow SS is the cephalic index (CI). Several surgical techniques have been suggested, but agreement on type and timing of surgery is lacking. This study aimed to evaluate the authors’ institutional experience of surgically treating SS using a modified subtotal cranial vault remodeling technique in a population-based cohort. Special attention was directed toward the effect of patient age at time of surgery on long-term CI outcome. METHODS A retrospective analysis was conducted on all patients with isolated nonsyndromic SS who were surgically treated from 2003 to 2011. Data from electronic medical records were gathered. Eighty-two patients with SS were identified, 77 fulfilled inclusion criteria, and 72 had sufficient follow-up data and were included. CI during follow-up after surgery was investigated with ANOVA and a linear mixed model. RESULTS In total, 72 patients were analyzed, consisting of 16 females (22%) and 56 males (78%). The mean ± SD age at surgery was 4.1 ± 3.1 months. Blood transfusions were received by 81% of patients (26% intraoperatively, 64% postoperatively, 9% both). The mean ± SD time in the pediatric ICU was 1.1 ± 0.25 days, and the mean ± SD total hospital length of stay was 4.6 ± 2.0 days. No patient required reoperation. The mean ± SD CI increased from 69 ± 3 to 87 ± 5 for patients who underwent surgery before 45 days of age. Surgery resulted in a larger increase in CI for patients who underwent surgery at a younger age compared with older patients (p < 0.05, Tukey’s HSD test). In the comparison of patients who underwent surgery before 45 days of age with patients who underwent surgery at 45–90, 90–180, and more than 180 days of age, the linear mixed model estimated a long-term loss of CI of 3.0, 5.5, and 7.4 points, respectively. CONCLUSIONS The modified subtotal cranial vault remodeling technique used in this study significantly improved CI in patients with SS. The best results were achieved when surgery was performed early in life.

scholarly journals Percutaneous Treatment of Superficial Femoral Artery Total Occlusions: Single Center Experience

Acta Medica ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 30-35
Author(s):  
AHMET HAKAN ATEŞ ◽  
AYSU BAŞAK ÖZBALCI ◽  
SELİM KUL ◽  
MUSTAFA YENERÇAĞ ◽  
Metin Okşul ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Treatment Strategy ◽  
Percutaneous Treatment ◽  
Arterial Disease ◽  
Complication Rates ◽  
Total Occlusion ◽  
First Choice ◽  
Stenting Procedure

Objectives Superficial femoral artery (SFA) is the most commonly effected vessel in peripheral arterial disease (PAD) and SFA total occlusions constitute the 50% of PAD patients presenting with symptoms. In this study, we investigated our patients with SFA total occlusions who were treated with percutaneous treatment strategy.   Methods In this study, we included ambulatory patients who were admitted to our clinics due to symptomatic severe SFA total occlusion and underwent PTA or PTA + stenting procedure.The demographic findings of the patients, procedure details, complications and follow-up results were noted. Results Out of 67 patients, 62 (92.5%) underwent PTA or PTA + stenting procedure successfully for SFA total occlusions. Only one serious complication, acute renal failure resulting in death developed during hospitalization. The mean follow-up time after the procedure was 11.1±7.2 months. During this follow-up time 36 (58.1%) were asymptomatic.  Out of 26 patients who were symptomatic, only 6 of them underwent reintervention and 3 were recommended surgical intervention.   Conclusion Peripheral interventions for SFA total occlusions are being performed successfully in experienced centers with low complication rates as the first treatment strategy in PAD. Herein,we have presented our patients who underwent successful PTA and/or stenting procedure with   high success and low complication rates. Peripheral interventions should be the first choice for SFA total occlusions in experienced centers.  

scholarly journals Sustained drug retention after paclitaxel-coated balloon angioplasty for superficial femoral artery disease: Follow-up intravascular imaging

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090782
Author(s):  
Norihiro Kobayashi ◽  
Keisuke Hirano ◽  
Masahiro Yamawaki ◽  
Motoharu Araki ◽  
Tsuyoshi Sakai ◽  
...  
Keyword(s):  
Frequency Domain ◽  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Superficial Femoral Artery ◽  
Optical Frequency ◽  
Optical Frequency Domain Imaging ◽  
Drug Retention ◽  
Artery Disease ◽  
The Right

A 63 year-old woman with claudication underwent endovascular therapy for diffuse stenosis of the right superficial femoral artery in our hospital. We performed paclitaxel-coated balloon angioplasty using the IN.PACT™ Admiral™ and achieved acceptable results. After 42 days, we performed follow-up optical frequency domain imaging for the right superficial femoral artery lesion treated with paclitaxel-coated balloon and observed several high-intensity regions with attenuation on the lumen surface. Sustained drug availability is a notable characteristic of paclitaxel-coated balloon. To the best of our knowledge, this is the first report on the visualization of sustained drug retention on the lumen surface using follow-up optical frequency domain imaging after paclitaxel-coated balloon angioplasty in a human patient with superficial femoral artery disease.

Vascularized fibular epiphyseal transfer for proximal humeral reconstruction in children with a primary sarcoma of bone

2018 ◽  
Vol 100-B (4) ◽  
pp. 535-541 ◽  
Author(s):  
J. D. Stevenson ◽  
R. Doxey ◽  
A. Abudu ◽  
M. Parry ◽  
S. Evans ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Avascular Necrosis ◽  
Proximal Humerus ◽  
Bone Tumour ◽  
Limb Salvage Surgery ◽  
Primary Sarcoma ◽  
Toronto Extremity Salvage Score ◽  
The Mean ◽  
One Year

Aims Preserving growth following limb-salvage surgery of the upper limb in children remains a challenge. Vascularized autografts may provide rapid biological incorporation with the potential for growth and longevity. In this study, we aimed to describe the outcomes following proximal humeral reconstruction with a vascularized fibular epiphyseal transfer in children with a primary sarcoma of bone. We also aimed to quantify the hypertrophy of the graft and the annual growth, and to determine the functional outcomes of the neoglenofibular joint. Patients and Methods We retrospectively analyzed 11 patients who underwent this procedure for a primary bone tumour of the proximal humerus between 2004 and 2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean age at the time of surgery was five years (two to eight). The mean follow-up was 5.2 years (1 to 12.2). Results The overall survival at five and ten years was 91% (confidence interval (CI) 95% 75% to 100%). At the time of the final review, ten patients were alive. One with local recurrence and metastasis died one-year post-operatively. Complications included seven fractures, four transient nerve palsies, and two patients developed avascular necrosis of the graft. All the fractures presented within the first postoperative year and united with conservative management. One patient had two further operations for a slipped fibular epiphysis of the autograft, and a hemi-epiphysiodesis for lateral tibial physeal arrest. Hypertrophy and axial growth were evident in nine patients who did not have avascular necrosis of the graft. The mean hypertrophy index was 65% (55% to 82%), and the mean growth was 4.6 mm per annum (2.4 to 7.6) in these nine grafts. At final follow-up, the mean modified functional Musculoskeletal Tumour Society score was 77% (63% to 83%) and the mean Toronto Extremity Salvage Score (TESS) was 84% (65% to 94%). Conclusion Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535–41.

scholarly journals The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987401
Author(s):  
Fasheng Wang ◽  
Tianyi David Luo ◽  
Chunyong Chen ◽  
Yun Xie ◽  
Zhangxiong Lin ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Tension Band ◽  
High Rate ◽  
Wound Complications ◽  
Functional Rehabilitation ◽  
Postoperative Function ◽  
Patella Fractures ◽  
The Mean ◽  
Patellar Fractures

Purpose: The purpose of this study was to assess the outcomes in a series of patients, who underwent cerclage and figure-of-eight tension band wiring using a single titanium cable for comminuted patellar fractures. Methods: We describe a modified tension band technique using a single titanium cable to create an ellipsoidal cap structure that combines the circumferential and figure-of-eight wrapping in the fixation of closed Association for the Study of Internal Fixation/Orthopaedic Trauma Association 34C2 and 34C3 patellar fractures. We retrospectively reviewed 25 patients (16 males and 9 females, mean age 54 years) who underwent the described fixation technique between 2015 and 2017. Postoperative function was evaluated using the Böstman score. Results: At the mean follow-up of 25 months (range 17–39 months), the mean Böstman score was 27.3 ± 2.6 points (range 23–30). Eighteen patients (72%) had excellent results (score ≥28); seven patients (28%) had good results (score 20–27); and no patients had an unsatisfactory result (score < 20). All surgical incisions healed without major wound complications. Two patients reported minor complications (soft tissue irritation, cellulitis). No patients demonstrated loss of reduction or implant failure during the follow-up period. Conclusion: The modified anterior ellipsoidal cap tension band using a single titanium cable created an effective tension band structure in the treatment of comminuted patella fractures. It is a simple operative technique that produced a stable fixation construct, which allowed early functional rehabilitation and weight-bearing with a high rate of excellent outcomes at 2 years after surgery.

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