Rendezvous technique for recanalization of long-segmental chronic total occlusion above the knee following unsuccessful standard angioplasty

Purpose To assess the technical feasibility and efficacy of the rendezvous technique, a type of subintimal retrograde wiring, for the treatment of long-segmental chronic total occlusions above the knee following unsuccessful standard angioplasty. Methods The rendezvous technique was attempted in eight limbs of eight patients with chronic total occlusions above the knee after standard angioplasty failed. The clinical symptoms and ankle-brachial index were compared before and after the procedure. At follow-up, pain relief, wound healing, limb salvage, and the presence of restenosis of the target vessels were evaluated. Results The rendezvous technique was performed successfully in seven patients (87.5%) and failed in one patient (12.5%). Foot pain improved in all seven patients who underwent successful treatment, with ankle-brachial indexes improving from 0.23 ± 0.13 before to 0.71 ± 0.09 after the procedure ( P < 0.001). At the end of the follow-up period, the visual analogue scale improved from 6.86 ± 1.57 to 1.57 ± 1.27 ( P < 0.001). Non-healing ulcers in three patients either healed (n = 2) or improved (n = 1). No major amputation was necessary. Kaplan–Meier analyses revealed that stenosis-free rate was 83.3% at six months and 41.7% at 12 months. Conclusion The rendezvous technique is a feasible and effective treatment for chronic total occlusions above the knee when standard angioplasty fails.

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Retrograde Popliteal Access to Percutaneous Peripheral Intervention for Chronic Total Occlusion of Superficial Femoral Arteries

Vascular and Endovascular Surgery ◽

10.1177/1538574417698902 ◽

2017 ◽

Vol 51 (5) ◽

pp. 240-246 ◽

Cited By ~ 3

Author(s):

Mert Dumantepe

Keyword(s):

Popliteal Artery ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Stent Fracture ◽

Secondary Patency ◽

Total Occlusion ◽

Chronic Total Occlusions ◽

Type D ◽

Secondary Patency Rate

Objective: The aim of this study is to present our initial experience with the use of the retrograde popliteal artery access in patients with chronic total occlusions of superficial femoral artery (SFA). Method: From July 2012 to May 2014, a total of 28 patients (20 men, mean age 61.2 ± 11.5 years) with total occlusion of the SFA and good distal runoff were treated with percutaneous atherectomy, balloon angioplasty, and stenting (mean length 165.3 ± 57.5 mm, range 72-336 mm). All patients had severe claudication or critical limb ischemia, and most of the lesions were TransAtlantic Inter-Society Consensus classification type D (n = 21). Results: Technical success was achieved in all cases. In majority (26, 92.8%) of the patients, endoluminal recanalization was possible from the popliteal access; SFA recanalization in the other 2 cases was obtained through the subintimal space. During a mean follow-up of 12.9 ± 2.5 months, claudication, severity, rest pain, and toe ulcers improved significantly. Ankle–brachial index changed from 0.54 ± 0.11 to 0.91 ± 0.2 at 1 year after intervention ( P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 92.8%, and 85.7%, respectively. One pseudoaneurysm and 1 arteriovenous fistula were found in the popliteal region on duplex examinations. There were 2 in-stent restenosis and 3 occlusions during the 12-month follow-up. These occlusions were treated with reendovascular procedures. Our secondary patency rate was 96.4%. No stent fracture was observed. Conclusion: The retrograde popliteal artery approach under duplex guidance can be considered as safe, efficient, and the primary SFA recanalization strategy in carefully selected patients, with competitive immediate and mid-term results.

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Abstract 13533: 1-Year Results of Paclitaxel-Coating Nitinol Stent Placement for Chronic Total Occlusion in the Femoropopliteal Artey

Circulation ◽

10.1161/circ.130.suppl_2.13533 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Naotaka Murata ◽

Yoshimitu Soga ◽

Yusuke Tomoi ◽

Seiichi Hiramori ◽

Yohei Kobayashi ◽

...

Keyword(s):

Chronic Total Occlusion ◽

Ankle Brachial Index ◽

Primary Patency ◽

Lesion Length ◽

Total Occlusion ◽

Femoropopliteal Artery ◽

Nitinol Stent ◽

Kaplan Meier ◽

Zilver Ptx

Introduction: The mid-term outcomes of paclitaxel-coating nitinol stent (Zilver PTx) placement for chronic total occlusion (CTO) in the femoropopliteal artery have not been assessed. Hypothesis: Zilver PTx placement for CTO in the femoropopliteal artey is reliable. Methods: All patients enrolled in this prospective, single center study underwent Zilver PTx placement for de novo or restenotic CTO and non-CTO in the superficial femoral and/or popliteal artery. Baseline and follow-up Rutherford classification and Ankle-brachial index (ABI) measurements were obtained. Follow-up was completed at 3, 6, 12 months. Results: There were 61 of CTO and 58 of non-CTO treated. Mean age was 74 ± 8 years and male was 82 % in overall. Patients characteristics and degree of lesion calcification was not different significantly between two groups. CTO group had a longer mean lesion length than non-CTO group (209 mm ± 93 mm vs 131 mm ± 87 mm, P < .0001). Procedural success in both treatments was over 98 %. The operative complications were 3 cases in CTO group and 2 cases in non-CTO group. The primary patency of CTO group was significantly lower than non-CTO group in Kaplan-Meier estimate curves at 12 months (75 % vs 82 %, Log-rank P < 0.05). There were no significant differences in event-free survival or freedom from target lesion revascularization in Kaplan-Meier estimate curves at 12 months (68 % vs 70 %; Log-rank P = 0.82, 63 % vs 65 %; Log-rank P = 0.47, respectively). Both groups experienced a significant improvement in Rutherford classification and ABI after treatment, and these improvements were sustained to 12-months follow-up. Based on multivariate analysis, CTO was the negative predictor for primary patency at 12 months (HR 2.37, 95 % CI 1.02 to 5.9, adjusted P < 0.05). Conclusions: CTO influences negatively the primary patency of Zilver PTx placed in the femoropopliteal artery. However, Improvement of Rutherford classification and ABI at 12-months after CTO- intervention is sustained.

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Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

Chinese Neurosurgical Journal ◽

10.1186/s41016-020-00222-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Xiaorong Yan ◽

Huiqing Wang ◽

Cai Li ◽

Yuanxiang Lin ◽

Lin Lin ◽

...

Keyword(s):

Surgical Technique ◽

Spinal Deformity ◽

Tumor Recurrence ◽

Clinical Symptoms ◽

Short Term ◽

Before And After ◽

Intradural Extramedullary ◽

Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

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Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Vascular ◽

10.1177/17085381211029819 ◽

2021 ◽

pp. 170853812110298

Author(s):

Görkem Yiğit

Keyword(s):

Critical Limb Ischemia ◽

Bypass Graft ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Rotational Atherectomy ◽

Total Occlusion ◽

The Mean ◽

Knee Pathology ◽

Drug Coated Balloon

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.

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Endoscopically-controlled surgery with open hemi-laminectomy for the treatment of intradural extramedullary tumors: An operative technique and short-term outcomes of 20 consecutive cases

10.21203/rs.3.rs-28089/v1 ◽

2020 ◽

Author(s):

Xiaorong Yan ◽

Huiqing Wang ◽

Cai Li ◽

Yuanxiang Lin ◽

Lin Lin ◽

...

Keyword(s):

Surgical Technique ◽

Spinal Deformity ◽

Tumor Recurrence ◽

Clinical Symptoms ◽

Short Term ◽

Before And After ◽

Intradural Extramedullary ◽

Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically-controlled surgery with open hemi-laminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically-controlled surgery with open hemi-laminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically-controlled surgery with open hemi-laminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

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Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy

Circulation ◽

10.1161/circ.132.suppl_3.14293 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Grant W Reed ◽

Negar Salehi ◽

Pejman Raeisi-Giglou ◽

Umair Malik ◽

Rami Kafa ◽

...

Keyword(s):

Wound Healing ◽

Endovascular Therapy ◽

Critical Limb Ischemia ◽

Proportional Hazards ◽

Limb Ischemia ◽

Major Amputation ◽

Cox Proportional Hazards ◽

Time Dependent ◽

Kaplan Meier

Introduction: There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy. Methods: In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis. Results: A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005). Conclusions: A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.

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Percutaneous Femoropopliteal Bypass: 2-Year Results of the DETOUR System

Journal of Endovascular Therapy ◽

10.1177/15266028211034862 ◽

2021 ◽

pp. 152660282110348

Author(s):

Grzegorz Halena ◽

Dainis K. Krievins ◽

Dierk Scheinert ◽

Janis Savlovskis ◽

Piotr Szopiński ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Major Amputation ◽

Primary Patency ◽

Lesion Length ◽

Secondary Patency ◽

Femoropopliteal Bypass ◽

Chronic Total Occlusions ◽

Target Vessel Revascularization ◽

Kaplan Meier

Purpose: This study investigated the 2-year safety and effectiveness of the PQ Bypass DETOUR system as a percutaneous femoropopliteal bypass. Materials and Methods: Seventy-eight patients with 82 long-segment femoropopliteal lesions were enrolled in this prospective, single-arm, multicenter study. The DETOUR system deployed Torus stent grafts directed through a transvenous route. Eligible patients included those with lesions of >10 cm and average of 371±55 mm. Key safety endpoints included major adverse events (MAEs) and symptomatic deep venous thrombosis in the target limb. Effectiveness endpoints included primary patency defined as freedom from ≥50% stenosis, occlusion, or clinically-driven target vessel revascularization (CD-TVR), primary assisted, and secondary patency. Results: Chronic total occlusions and severe calcium occurred in 96% and 67% of lesions, respectively. Core laboratory-assessed total lesion length averaged 371±51 mm with a mean occlusion length of 159±88 mm. The rates of technical and procedural success were 96%, with satisfactory delivery and deployment of the device without in-hospital MAEs in 79/82 limbs. The MAE rate was 22.0%, with 3 unrelated deaths (4%), 12 CD-TVRs (16%), and 1 major amputation (1%). Deep venous thrombosis developed in 2.8% of target limbs, and there were no reported pulmonary emboli. Primary, assisted primary, and secondary patency rates by the Kaplan–Meier analysis were 79±5%, 79±5%, and 86±4%, respectively. Conclusions: The PQ Bypass DETOUR system is a safe and effective percutaneous alternative to femoropopliteal open bypass with favorable results through 2 years. The DETOUR system provides a durable alternative to conventional endovascular modalities and open surgery for patients with long, severely calcified, or occluded femoropopliteal lesions.

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Prognostic significance of occlusion length in recanalized chronic total occlusion lesion: a retrospective cohort study with 5-year follow-up

BMJ Open ◽

10.1136/bmjopen-2020-038302 ◽

2020 ◽

Vol 10 (7) ◽

pp. e038302

Author(s):

Tao Tian ◽

Changdong Guan ◽

Lijian Gao ◽

Lei Song ◽

Jiansong Yuan ◽

...

Keyword(s):

Cohort Study ◽

Primary Endpoint ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Chronic Total Occlusion ◽

Secondary Outcome ◽

Total Occlusion ◽

Risk Of Death ◽

Kaplan Meier

ObjectivesThis study sought to investigate the relationship between occlusion length and long-term outcomes of patients with recanalised chronic total occlusion (CTO) lesion.DesignA retrospective cohort study.SettingFuwai Hospital, National Center for Cardiovascular Disease, Beijing, ChinaParticipantsConsecutive patients with successfully recanalised CTO were included from January 2010 to December 2013.Primary and secondary outcome measuresThe primary endpoint of the present study was a composite event of all-cause death and myocardial infarction (MI). The secondary endpoints included target lesion revascularisation (TLR) and target vessel revascularisation (TVR).ResultsA total of 1987 patients were included and 1801 (90.6%) subjects completed 5-year follow-up in this study. Based on occlusion length, the patients were divided equally into two groups: short (length <15 mm, n=957) and long (length ≥15 mm, n=1030) CTO group. Kaplan-Meier survival curve showed no significant difference in the risk of the composite primary endpoint between short and long CTO groups (p=0.242). Receiver operating characteristic curve analysis also established occlusion length ≥15 mm as a cut-off value for predicting TLR and TVR, with an area under the curve of 0.604 (95% CI: 0.569 to 0.638, p<0.001) and 0.605 (95% CI: 0.572 to 0.638; p<0.001). Kaplan-Meier analysis revealed that the risks for TLR (p=0.002) and TVR (p=0.002) were higher in a patient with long CTO lesion. Multivariate Cox analysis also identified long CTO lesion as an independent predictor of TLR (HR: 1.539, 95% CI: 1.033 to 2.293; p=0.034) and TVR (HR: 1.476, 95% CI: 1.012 to 2.151; p=0.043).ConclusionPatients with long CTO lesion did not show a higher risk of death and MI after recanalisation, but had higher risks of TLR and TVR. Lesion with occlusion length ≥15 mm should be under close surveillance for restenosis after recanalisation.

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Chronic venous leg ulcers: Effects of foam sclerotherapy on healing and recurrence

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514557854 ◽

2014 ◽

Vol 31 (1) ◽

pp. 34-41 ◽

Cited By ~ 16

Author(s):

G Grover ◽

A Tanase ◽

A Elstone ◽

S Ashley

Keyword(s):

Ulcer Recurrence ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Invasive Treatment ◽

Recurrence Rates ◽

Venous Ulceration ◽

Kaplan Meier ◽

Before And After ◽

One Year

Introduction Ultrasound-guided foam sclerotherapy is a minimally invasive treatment option used for ablation of axial and perforator reflux for chronic venous ulceration. Active ulceration presents a significant health burden in both the primary and secondary care setting. The objective of this study is to determine ulcer healing rates at 24 weeks and 12 months, and ulcer recurrence rates at one year for chronic venous ulcers after ultrasound-guided foam sclerotherapy. Methods Between 2007 and 2012, 54 patients underwent ultrasound-guided foam sclerotherapy for clinical, aetiological, anatomical and pathological C6 ulcers. All patients were followed up clinically, and venous duplex was performed on all legs before and after treatment. A prospectively maintained database was analysed to determine venous truncal occlusion rates, 24-week and 12-month healing and recurrence rates (using Kaplan–Meier survival analysis). Results Fifty-seven ulcerated legs, 39 primary and 18 with recurrent superficial venous reflux were analysed. Median time of active ulceration at presentation was 15.2 months (range 5 months to 17 years). At a median follow-up of 2.7 months, 90% (51 legs) achieved full truncal occlusion after one session, 4% (2) short segment occlusion and 5% (3) failed to occlude and one patient died and was lost to follow-up; 13/57 (23%) required a second session of treatment for completion of treatment, recanalisations and to treat perforator disease, 88% (50/57) ulcers healed at a median of 5.3 months (interquartile range 2.9–8.4 months) following their first ultrasound-guided foam sclerotherapy treatment. The 24-week and 12-month estimated healing rates were 53% and 72%, respectively. The estimated 12-month recurrence rate was 9.2%. There were no reported incidences of deep venous thrombosis or neurological symptoms. Conclusion This study affirms the role of ultrasound-guided foam sclerotherapy as a safe and effective option for abolition of superficial reflux.

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Infrared Thermography Follow-Up After Lower Limb Revascularization

Journal of Diabetes Science and Technology ◽

10.1177/1932296820912311 ◽

2020 ◽

pp. 193229682091231

Author(s):

Arjaleena Ilo ◽

Pekka Romsi ◽

Matti Pokela ◽

Jussi Mäkelä

Keyword(s):

Skin Temperature ◽

Infrared Thermography ◽

Lower Limb ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Clear Correlation ◽

Before And After ◽

Patients With Diabetes ◽

The Mean

Background: The purpose of this study was with a simple clinical setting to compare skin temperature changes in the feet before and after revascularization and to identify possible correlation between ankle brachial index (ABI) and toe pressure (TP) values and foot skin temperature patient with and without diabetes. Methods: Forty outpatient clinic patients were measured ABI, TP, and the skin temperature using infrared thermography (IRT) at the foot before and after revascularization. Patients in the revascularization group were divided into subgroups depending on whether they had diabetes or not and a wound or not. Results: There were clear correlation between increase of ABI and TP and increase of the mean skin temperature on the feet after revascularization. The temperature was higher and the temperature change was greater among patients with diabetes. Side-to-side temperature difference between the revascularized feet and contralateral feet decreased after treatment. The mean temperature was higher in the feet with wound whether patient had diabetes mellitus or not. Conclusion: The simple, prompt, and noninvasive IRT procedure showed its potential as a follow-up tool among patients with diabetes or peripheral arterial disease and previous lower limb revascularization.

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