Patient doses in endovascular and hybrid revascularization of aortoiliac segment

2021 ◽  
Author(s):  
Stefan Stanev ◽  
Desislava Kostova-Lefterova ◽  
Svetla Dineva
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Skin Dose ◽  
Aortoiliac Occlusive Disease ◽  
Modifying Factors ◽  
Current Survey ◽  
Hybrid Revascularization ◽  
Radiation Induced ◽  
Patient Doses ◽  
Lower Morbidity

Objectives: Constantly increasing number of procedures performed – endovascular or hybrid in patients with aortoiliac occlusive disease during the last decades finds its explanation in the lower morbidity and mortality rates, compared to bypass surgery. The purpose of the current survey was to estimate patients’ radiation exposure in aortoiliac segment after endovascular or hybrid revascularization and to study the main factors which have direct contribution. Methods: A retrospective study of 285 procedures conducted with the help of a mobile C-arm system in 223 patients was performed. Procedures were grouped according to criteria such as: type of intervention, vascular access, level of complexity and operating team. Different analyses were performed within the groups and dose values. Results: The median values of kerma–air product (KAP), the number of series and the peak skin dose (PSD) significantly increase with the increasing number of vascular accesses: for one access (16.68 Gy.cm2, 6 and 336 mGy), for two (56.93 Gy.cm2, 11 and 545 mGy), and for three (102.28 Gy.cm2, 15 and 781 mGy). Significant dependence was observed in the case of single access site between the type of access and the dose values: hybrid and retrograde common femoral artery/superficial femoral artery (CFA/SFA) endovascular accesses, 10.06 Gy.cm2/301 mGy and 13.23 Gy.cm2/318 mGy respectively, in contrast with the contralateral CFA and left brachial access, 33 Gy.cm2/421 mGy and 38.33 Gy.cm2/448 mGy respectively. Conclusion: The results demonstrate that the most important factors increasing the dose values are number and type of vascular accesses, followed by the combination and number of implanted stents with the complexity of the procedure. The PSD values for a single procedure were between 2 and 12 times lower than those IAEA proposed as trigger levels for radiation-induced erythema. This study shows that trigger levels were not reached even for patients with repeated procedures in the same segment in 1-year period. Advances in knowledge: The study gives important understanding and clarity on the growing awareness for dose-modifying factors during endovascular and hybrid revascularization of aortoiliac segment.

scholarly journals A Case of Hybrid Revascularization from Abdominal Aorta to Common Femoral Artery for Extensive Calcified Lesions

2016 ◽  
Vol 77 (5) ◽  
pp. 1053-1057
Author(s):  
Akihito IDETSU ◽  
Masahiro MATSUSHITA ◽  
Yuichi MACHIKI ◽  
Takashi HIROMATSU ◽  
Daisuke TAKARA
Keyword(s):  
Abdominal Aorta ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Hybrid Revascularization

scholarly journals Patient doses in endovascular and hybrid revascularization of the lower extremities

2018 ◽  
Vol 91 (1091) ◽  
pp. 20180176
Author(s):  
Desislava D Kostova-Lefterova ◽  
Nadelin N Nikolov ◽  
Stefan S Stanev ◽  
Boyka B Stoyanova
Keyword(s):  
Vascular Access ◽  
Brachial Artery ◽  
Lower Extremities ◽  
Skin Dose ◽  
Hybrid Surgery ◽  
Skin Injuries ◽  
Surgical Methods ◽  
Hybrid Revascularization ◽  
Radiation Induced ◽  
Peak Skin Dose

Objective:Hybrid surgical methods such as remote endarterectomy and endovascular revascularization are fluoroscopy-guided procedures successfully replacing conventional open surgery for treatment of peripheral artery disease (PAD). The aim of this study was to: (1) evaluate the dose parameters describing exposure of patients undergoing endovascular or hybrid revascularization of the lower limb (below the inguinal ligament); (2) compare the data available in the literature with the evaluations of patients’ dose values and related factors for patients undergoing such procedures; (3) examine the correlation of doses with certain parameters; (4) estimate the peak skin dose and assess the potential for radiation-induced skin injuries during the procedures.Methods:Data for 259 patients were extracted retrospectively and analyzed. The procedures were grouped by type of intervention, vascular approach, and level of complexity. The analyses included the correlation of dose values with the operating team.Results:The air kerma-area product (KAP) and fluoroscopy time (FT) values greatly varied depending on the procedure type but also among patients undergoing the same procedure. The type of vascular access has the largest impact on patients’ doses. The KAP and FT values for brachial artery were: 347 Gy.cm2and FT: NA; for contralateral common femoral artery (CFA) approach: 207 Gy.cm2and 153 s; e.g. significantly higher than for ipsilateral CFA: 96 Gy.cm2and 78 s; for hybrid surgery: 77 Gy.cm2and 41 s; and for ipsilateral retrograde popliteal approach: 61 Gy.cm2and 53 s. The same tendency is observed for the peak skin dose (PSD) values: the highest are for brachial artery (2053 mGy) and contralateral CFA (1325 mGy) approach, followed by the ipsilateral CFA (748 mGy), hybrid surgery (649 mGy), and ipsilateral retrograde popliteal approach (566 mGy).Conclusion:Registered dose values and FT for the different procedures do not exceed the International Atomic Energy Agency (IAEA) proposed trigger values for patients’ follow-up for radiation-induced skin injuries. The type of vascular access has the highest negative impact on radiation dose levels and resultant KAP, PSD, and FT values. There is a significant increase of the dose values with increase of the number of inserted stents and the level of complexity. This should be considered in planning, especially for patients who undergo multiple diagnostic and therapeutic procedures.Advances in knowledge:This study gives a systematic understanding for patient radiation exposure in endovascular and hybrid revascularization of the lower extremities, thus far absent in the literature.

Double Uncture fo Single Common Femoral Artery for CT Hepatic Arteriography and CT Arterial Portography

1998 ◽  
Vol 39 (5) ◽  
pp. 927
Author(s):  
Ho Kyoung Lee ◽  
Yun Hwan Kim ◽  
Hyoung Rae Kim ◽  
Chang Ho Kang ◽  
Hong Won Kim ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Hepatic Arteriography ◽  
Arterial Portography ◽  
Ct Hepatic Arteriography

Endovascular Repair of an Ascending Aorta-to-Left Common Femoral Artery Graft with Aneurysmal Degeneration

1995 ◽  
Vol 2 (2) ◽  
pp. 189-195 ◽  
Author(s):  
Michael R. Jaff ◽  
Gerald Dorros ◽  
Krishna Kumar ◽  
Gerardo Caballero ◽  
Alfred Tector
Keyword(s):  
Femoral Artery ◽  
Endovascular Repair ◽  
Common Femoral Artery ◽  
Ascending Aorta ◽  
Artery Graft

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.

scholarly journals Early Detection of Post-Endarterectomy Complication by Point-of-Care Ultrasound

Reports ◽  
2021 ◽  
Vol 4 (3) ◽  
pp. 21
Author(s):  
Bo-Ku Chen ◽  
Po-Wei Chiu ◽  
Chih-Hao Lin
Keyword(s):  
Femoral Artery ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Atheromatous Plaque ◽  
Point Of Care Ultrasound ◽  
Related Complication ◽  
Contrast Extravasation ◽  
The Right

Endarterectomy is an effective intervention to remove the atheromatous plaque in the inner lining of the artery, aiming to revascularize the occluded/stenosed vessel in patients with peripheral arterial occlusive disease (PAOD). The most common wound-related complication is postoperative bleeding, followed by infection, hematoma, and seroma. However, hematoma complications with air surrounded have rarely been reported in clinical cases. Case presentation: A 90-year-old female patient visited our emergency department because of a rapidly growing hematoma with pulsatile bleeding over her right groin area. She had received bilateral percutaneous transluminal angioplasty with endarterectomy for PAOD one month prior. A point-of-care ultrasound revealed a large hypoechoic mass, with a dirty shadow on the right groin area. Computed tomography angiography showed a hematoma over her right femoral region, with free air surrounding the right femoral artery. Angiography revealed an irregular shaped lesion on the right femoral artery without contrast extravasation. The patient was diagnosed with right-femoral post-endarterectomy infection with infected hematoma, with the inclusion of air. She underwent urgent excision and repair of the right femoral artery infectious lesion, debridement of the infectious hematoma and stenting of the right external iliac artery, common femoral artery and superficial femoral artery.

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