Complete Revascularization of Acute Limb Ischemia With Distal Pedal Access

Acute limb ischemia (ALI) is an abrupt decrease of blood flow to a limb, resulting in a potential threat to that body part. In ALI, which is commonly caused by embolism or traumatic occlusion, symptoms appear quickly due to a lack of collateral blood flow and extension of the thrombus to arterial outflow. In cases with ALI presentation, urgent evaluation and management are necessary. Here, we report 3 cases with ALI due to thromboembolism. Conventional open thromboembolectomy was performed with a femoral artery cutdown and antegrade passage of the embolectomy catheter. Further, distal access was created in the dorsalis pedis artery and/or posterior tibial artery at the ankle level. After the retrograde passage of the guidewire and antegrade insertion of the embolectomy catheter, the embolus was completely removed.

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Retrograde Surgical Cut-down Direct Thrombectomy as a Salvage Procedure for Acute Limb Ischemia With Below the Knee Thrombotic Occlusion: a Case Series

10.21203/rs.3.rs-739661/v1 ◽

2021 ◽

Author(s):

Ying-Sheng Li ◽

Ying-Ching Li

Keyword(s):

Limb Ischemia ◽

Posterior Tibial Artery ◽

Complete Revascularization ◽

Acute Limb Ischemia ◽

Salvage Procedure ◽

Posterior Tibial ◽

Tibial Artery ◽

Dorsalis Pedis Artery ◽

Below The Knee ◽

Surgical Thrombectomy

Abstract Background: Acute limb ischemia is a serious condition even in an era of highly comprehensive medical treatment. Despite the development of conservative and endovascular treatment, complete removal of the thrombus with antegrade thrombectomy via the femoral approach, especially in below-the-knee arteries, is still not possible. In addition, distal embolization of dislodged debris or thrombus during the procedure is another concern as this might cause severe complications, including amputation. Given the above-mentioned issues, retrograde surgical cut-down direct thrombectomy from the dorsalis pedis artery and posterior tibial artery could be an optimal option for complete revascularization in below-the-knee arteries. Case presentation: We present five cases where the limbs were preserved after retrograde surgical thrombectomy. The standard antegrade thrombectomy procedure with a conventional surgical approach from the common femoral artery was performed. All five patients underwent an intraoperative assessment of indications for dorsalis pedis artery and posterior tibial artery retrograde thrombectomy by the surgical cut-down method. After retrograde thrombectomy, direct evaluation of blood flow was the strongest evidence of revascularization. A retrograde angiogram showed revascularization of below-the-knee arteries. All five patients had successful salvage procedures that prevented major limb amputation. Conclusion: Retrograde surgical thrombectomy could be a salvage procedure for incomplete antegrade thrombectomy.

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Effects of Enhanced External Counterpulsation With Different Sequential Levels on Lower Extremity Hemodynamics

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.795697 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yahui Zhang ◽

Yujia Zhang ◽

Yinfen Wang ◽

Xiuli Xu ◽

Jing Jin ◽

...

Keyword(s):

Blood Flow ◽

Flow Velocity ◽

Posterior Tibial Artery ◽

Anterior Tibial Artery ◽

Posterior Tibial ◽

Tibial Artery ◽

Dorsalis Pedis Artery ◽

Level Sequence ◽

Anterior Tibial ◽

Enhanced External Counterpulsation

Objective: This study aimed to investigate acute hemodynamics of lower extremities during enhanced external counterpulsation with a three-level sequence at the hips, thighs, and calves (EECP-3), two-level sequence at the hips and thighs (EECP-2), and single leg three-level sequence (EECP-1).Methods: Twenty healthy volunteers were recruited in this study to receive a 45-min EECP intervention. Blood flow spectrums in the anterior tibial artery, posterior tibial artery, and dorsalis pedis artery were imaged by Color Doppler ultrasound. Mean flow rate (FR), area, pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), and systolic maximum acceleration (CCAs) were sequentially measured and calculated at baseline during EECP-3, EECP-1, and EECP-2.Results: During EECP-3, PI, PSV, and MV in the anterior tibial artery were significantly higher, while EDV was markedly lower during EECP-1, EECP-2, and baseline (all P < 0.05). Additionally, ACCs were significantly elevated during EECP-3 compared with baseline. Moreover, FR in the anterior tibial artery was significantly increased during EECP-3 compared with baseline (P = 0.048). During EECP-2, PI and MV in the dorsalis pedis artery were significantly higher and lower than those at baseline, (both P < 0.05). In addition, FR was markedly reduced during EECP-2 compared with baseline (P = 0.028). During EECP-1, the area was significantly lower, while EDV was markedly higher in the posterior tibial artery than during EECP-1, EECP-2, and baseline (all P < 0.05). Meanwhile, FR of the posterior tibial artery was significantly reduced compared with baseline (P = 0.014).Conclusion: Enhanced external counterpulsation with three-level sequence (EECP-3), EECP-2, and EECP-1 induced different hemodynamic responses in the anterior tibial artery, dorsalis pedis artery, and posterior tibial artery, respectively. EECP-3 acutely improved the blood flow, blood flow velocity, and ACCs of the anterior tibial artery. In addition, EECP-1 and EECP-2 significantly increased the blood flow velocity and peripheral resistance of the inferior knee artery, whereas they markedly reduced blood flow in the posterior tibial artery.

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A Rare Case of Bilateral Posterior Tibial Artery Aneurysm Presenting as Unilateral Acute Limb Ischemia

Case Reports in Vascular Medicine ◽

10.1155/2019/5647380 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Andrew T. Hattam ◽

Mayur Krishnaswamy

Keyword(s):

Artery Aneurysm ◽

Limb Ischemia ◽

Posterior Tibial Artery ◽

Acute Limb Ischemia ◽

Surgical Decision ◽

Posterior Tibial ◽

Tibial Artery ◽

Tibial Arteries ◽

Aneurysm Thrombosis ◽

Patient Presentation

True aneurysms of the tibial arteries are extremely rare. Of the few previously described tibial artery aneurysms, there are scant reports of isolated true aneurysms of the posterior tibial artery (PTA). In this report, we describe the second documented case of bilateral true PTA aneurysms. Unique aspects of this case are that the aneurysmal PTA were the only patent tibial arteries bilaterally, the aneurysms were degenerative in nature, and initial patient presentation was due to aneurysm thrombosis causing acute foot ischemia. The clinical and radiological features of this case, as well as surgical decision making and management, are discussed.

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Cardiovascular responses to head-stand posture

Journal of Applied Physiology ◽

10.1152/jappl.1963.18.5.987 ◽

1963 ◽

Vol 18 (5) ◽

pp. 987-990 ◽

Cited By ~ 4

Author(s):

Shanker Rao

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

High Pressure ◽

Blood Flow ◽

Arterial Pressure ◽

Skin Temperature ◽

Cardiovascular Responses ◽

Posterior Tibial Artery ◽

Nervous Control ◽

Posterior Tibial

Reports of cardiovascular responses to head-stand posture are lacking in literature. The results of the various responses, respectively, to the supine, erect, and head-stand posture, are as follows: heart rate/min 67, 84, and 69; brachial arterial pressure mm Hg 92, 90, and 108; posterior tibial arterial pressure mm Hg 98, 196, and 10; finger blood flow ml/100 ml min 4.5, 4.4, and 5.2; toe blood flow ml/100 ml min 7.1, 8.1, and 3.4; forehead skin temperature C 34.4, 34.0 and 34.3; dorsum foot skin temperature C 28.6, 28.2, and 28.2. It is inferred that the high-pressure-capacity vessels between the heart level and posterior tibial artery have little nervous control. The high-pressure baroreceptors take active part in postural adjustments of circulation. The blood pressure equating mechanism is not as efficient when vital tissues are pooled with blood as when blood supply to them is reduced. man; heart rate; blood flow; skin temperature Submitted on January 3, 1963

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Modified Recipient Blood Flow-Preserved Cross-Leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

10.21203/rs.3.rs-411666/v2 ◽

2021 ◽

Author(s):

Hong-Xiang Zhou ◽

Liang He ◽

Dong Yin ◽

Yang Niu ◽

Zhe Jin ◽

...

Keyword(s):

Blood Flow ◽

Lower Limb ◽

Posterior Tibial Artery ◽

Anterolateral Thigh Flap ◽

Posterior Tibial ◽

Thickness Skin ◽

Anterolateral Thigh ◽

Flap Procedure ◽

Tissue Defects

Abstract Background Complex lower limb reconstruction following severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy. Methods Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injuries underwent modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the contralateral posterior tibial artery in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the defects. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The vascular pedicle was divided 4 weeks after vascular anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the recipient posterior tibial artery during postoperative follow-up. Results All 22 flaps survived. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. Eighteen flaps were designed in a single fashion, and four flaps were bilobed. Twenty patients underwent fasciocutaneous flap transplantation, and two underwent musculocutaneous flap transplantation. Two cases developed local lysis of the flap, and the wound healed after further debridement. Direct suture of the donor-site incision was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients with severe tibia bone defects. Blood flow of recipient posterior tibial arteries was confirmed during follow-up. All flaps recovered sensation at the final follow-up. The postoperative follow-up ranged from 18 to 84 months, and no long-term complications were observed. Conclusions The modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair large tissue defects without sacrificing the major artery of the uninjured lower limb.

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Korelasi antara Gambaran Spektral Doppler Arteri Tibialis Posterior dan Arteri Dorsalis Pedis dengan Skor PEDIS pada Penderita Ulkus Kaki Diabetik

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.10.2.2018.20087 ◽

2018 ◽

Vol 10 (2) ◽

Author(s):

Leise Limpeleh ◽

Richard Sumangkut ◽

Djoni E. Tjandra

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Posterior Tibial Artery ◽

Foot Ulcers ◽

Tibialis Posterior ◽

Diabetic Foot Ulcers ◽

Doppler Examination ◽

Posterior Tibial ◽

Dorsalis Pedis Artery

Abstract: Diabetic foot ulcer is still a major health problem worldwide due to its increasing prevalence. This study was aimed to prove the correlation between PEDIS score and vascular Doppler examination performed on dorsalis pedis and posterior tibial arteries of patients with diabetic foot ulcers. This was an observational study with a cross sectional design. The results showed that during the period of August 2017 until January 2018, there were 62 patients with diabetic foot ulcers at the wards of Surgery Department and Internal Medicine Department of Prof. Dr. R. D. Kandou Hospital Manado. Most patients were in the age group of 60-69 years, had leukocytosis (74.1%), poor blood sugar control (70.9%), and hypoalbuminemia (98.3%). Moreover, smoking history in 20.9% of patients; hypertension in 35.4% of patients; and dyslipidemia in 20.9% of patients. The Doppler examination resulted in biphasic waveform in posterior tibial artery (40.3%) as well as in dorsalis pedis artery (41.9%). Perfusion score showed 50% of subjects had PAD. Most subjects (90.3%) had ulcers of >3 cm2 and were infected superficially in the subcutaneous area (56.4%). Most subjects (58%) suffered from severe infection with high leucocyte counts, however, only 29% of subjects had lost of sensoric ability. The correlation Spearman test obtained r = -0.486 and P = 0.000 in the posterior tibial artery; and r = -0.281 and P = 0.0027 in the dorsalis pedis artery. Conclusion: There was a significant correlation between vascular Doppler result and PEDIS score. The higher the PEDIS score, the worse the vascular Doppler result.Keywords: diabetic foot ulcer, PEDIS score, vascular DopplerAbstrak: Ulkus kaki diabetik masih merupakan masalah kesehatan utama sedunia dengan prevalensi yang terus meningkat. Penelitian ini bertujuan untuk membuktikan apakah terdapat hubungan antara skor PEDIS dan pemeriksaan spektral Doppler vaskuler pada arteri poplitea, dorsalis pedis, dan tibialis posterior pada pasien dengan ulkus kaki diabetik. Jenis penelitian ialah observasional dengan desain potong lintang. Hasil penelitian mendapatkan 62 pasien dengan ulkus kaki diabetik di bangsal Bagian Bedah dan Penyakit Dalam RSUP Prof. Dr. R. D. Kandou Manado selama periode Agustus 2017 sampai Januari 2018. Ukus diabetik tersering ditemukan pada kelompok usia 60-69 tahun dengan rerata usia 58,5 tahun. Sebagian besar pasien mengalami leukositosis (74,1%), kontrol gula darah buruk (70,9%), dan hipoalbuminemia (98,3%). Riwayat merokok didapatkan sebesar 20,9%; hipertensi 35,4%; dan dislipidemia 20,9%. Hasil pemeriksaan Doppler bifasik pada arteri tibialis posterior (40,3%) dan arteri dorsalis pedis (41,9%). Skor perfusi menunjukkan 50% subyek mengalami penyakit arteri perifer (PAD). Sebagian besar (90,3%) subjek memiliki ulkus >3 cm2 luas area. Infeksi sebagian besar superfisial di subkutan (56,4%), selebihnya menderita infeksi hingga fasia, otot, dan tendon. Sebagian besar subyek penelitian menderita infeksi berat (58%) dengan angka leukosit tinggi. Hanya 29% dari subjek penelitian mengalami kehilangan kemampuan sensorik. Hasil uji korelasi Spearman mendapatkan pada arteri tibialis posterior: r = -0,486 dengan P = 0,000 dan pada arteri dorsalis pedis: r = -0,281 dengan P = 0,0027. Simpulan: Terdapat hubungan bermakna antara hasil pemeriksaan spektral Doppler dan skor PEDIS. Semakin tinggi skor PEDIS semakin buruk hasil spektral Doppler.Kata kunci: ulkus kaki diabetik, skor PEDIS, Doppler spektral vaskular

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“Silent” thrombosis of an abdominal aortic aneurysm not producing acute limb ischemia

VASA ◽

10.1024/0301-1526/a000040 ◽

2010 ◽

Vol 39 (3) ◽

pp. 265-267 ◽

Cited By ~ 2

Author(s):

Moulakakis ◽

Maras ◽

Bountouris ◽

Pomoni ◽

Georgakis ◽

...

Keyword(s):

Blood Flow ◽

Abdominal Aortic Aneurysm ◽

Mortality Rate ◽

Aortic Aneurysm ◽

Acute Pain ◽

Limb Ischemia ◽

Lower Limbs ◽

Acute Limb Ischemia ◽

Abdominal Aortic ◽

Flow Through

Thrombosis of an abdominal aortic aneurysm is a rare devastating complication with an estimated mortality rate of 50%. Simultaneous acute pain, pallor and coldness of the lower limbs, mottling from the level of iliac crests or umbilicus, paraplegia and absence of femoral pulses are all manifestations of a sudden and acute interruption of blood flow through the aneurysmatic aorta. We report a case of an occlusion of an abdominal aortic aneurysm during hospitalization which was not manifested with symptoms of limb ischemia. In this case we feature the rare and unusually “silent” presentation of the event.

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A Study of the Semeiological Reliability of Dorsalis Pedis Artery and Posterior Tibial Artery in the Diagnosis of Lower Limb Arterial Occlusive Disease

Angiology ◽

10.1177/000331978403501203 ◽

1984 ◽

Vol 35 (12) ◽

pp. 767-772 ◽

Cited By ~ 3

Author(s):

Giuseppe Nuzzaci ◽

Giovanni Giuliano ◽

Daniele Righi ◽

Tiziana Baroncelli ◽

Alessandro Lotti ◽

...

Keyword(s):

Lower Limb ◽

Posterior Tibial Artery ◽

Arterial Occlusive Disease ◽

Occlusive Disease ◽

Posterior Tibial ◽

Tibial Artery ◽

Dorsalis Pedis Artery

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

Case Reports in Vascular Medicine ◽

10.1155/2016/7519748 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

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.

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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

Journal of Endovascular Therapy ◽

10.1177/1526602817750211 ◽

2017 ◽

Vol 25 (1) ◽

pp. 127-132 ◽

Cited By ~ 16

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.

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