scholarly journals Direct Bare Metal Needle Puncture and Balloon Angioplasty in Calcified Plaques of the Common Femoral Artery Guided by Angiography (“BAMBOO SPEAR”)

2021 ◽  
Author(s):  
Naoki Hayakawa ◽  
Satoshi Kodera ◽  
Masataka Arakawa ◽  
Satoshi Hirano ◽  
Sandeep Shakya ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Common Femoral Artery ◽  
Lower Limbs ◽  
Bare Metal ◽  
Needle Puncture ◽  
Total Occlusion ◽  
Calcified Plaque ◽  
The Common ◽  
Metal Needle

Abstract BackgroundSurgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique “direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography” or “BAMBOO SPEAR.” Main textThis report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique ‘‘direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography” (BAMBOO SPEAR).ConclusionsThe BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.

scholarly journals Direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography (“BAMBOO SPEAR”)

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Naoki Hayakawa ◽  
Satoshi Kodera ◽  
Masataka Arakawa ◽  
Satoshi Hirano ◽  
Sandeep Shakya ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Common Femoral Artery ◽  
Lower Limbs ◽  
Bare Metal ◽  
Needle Puncture ◽  
Total Occlusion ◽  
Calcified Plaque ◽  
The Common ◽  
Metal Needle

Abstract Background Surgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique “direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography” or “BAMBOO SPEAR.” Main text This report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique “direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography” (BAMBOO SPEAR). Conclusions The BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.

scholarly journals The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Takuya Haraguchi ◽  
Tsutomu Fujita ◽  
Yoshifumi Kashima ◽  
Masanaga Tsujimoto ◽  
Tsuyoshi Takeuchi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Common Femoral Artery ◽  
Hydraulic Pressure ◽  
Lumen Area ◽  
Minimal Lumen Area ◽  
Calcified Plaque ◽  
The Common

Abstract Background The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the “no stenting zone”, is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA patency provide the better clinical outcomes than standard balloon angioplasty. Atherectomy devices, which focus on the modification of superficial calcifications, contribute to the improvement of clinical outcomes. However, deep calcifications resist vessel expansion such that luminal gain is not easily achieved. Main text We propose a novel calcified plaque modification technique, named the “fracking technique” (FT). The term fracking refers to how a rock is fractured by the high hydraulic pressure. In this technique, deep calcifications are cracked with hydraulic pressure via a balloon indeflator through an 18-gauge needle, which punctures calcifications to achieve greater acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in the right CFA. Conventional balloon angioplasty for the lesion yielded a suboptimal minimal lumen area (MLA), which increased from 6.2 to 10.7-mm2 on intravascular ultrasound (IVUS). The FT was implemented to obtain a larger MLA. After the FT was repeated at three locations at up to 8-atm, a greater MLA of 27.1-mm2 was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis due to diabetes mellitus who presented with ischemic pain in his right limbs at rest due to severe stenosis with eccentric calcification in the distal CFA. The MLA on IVUS before and after balloon angioplasty was 10.0-mm2 and 13.1-mm2, respectively, and this result was still suboptimal. The FT was attempted and successfully yielded a greater MLA of 28.9-mm2 without complications. Restenosis has not been detected for 2 years follow-up period. Conclusions The FT is an effective option for treating calcified CFA lesions to achieve a larger lumen area. Long-term follow-up studies are necessary.

Endovascular treatment of calcific lesions of the common femoral artery using atherectomy device associated with scoring balloon angioplasty in diabetic patients with high “major amputation” risk

Vascular ◽  
2021 ◽  
pp. 170853812110192
Author(s):  
Daniele Morosetti ◽  
Marcello Chiocchi ◽  
Renato Argirò ◽  
Fabio Salimei ◽  
Marco Nezzo ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Patency Rate ◽  
Common Femoral Artery ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Scoring Balloon ◽  
The Common ◽  
Ulcerative Lesions

Objectives To investigate the outcomes of patients with calcific lesions in the common femoral artery undergoing endovascular procedures with atherectomy device and scoring balloon angioplasty combined with treatment of steno-occlusive disease of the remaining arterial districts of the lower limb. Methods Between January 2015 and December 2018, 11 diabetic patients at high risk for “major amputation”, with calcific lesions of the common femoral artery and ischemic ulcers requiring endovascular treatment were retrospectively evaluated. Technical success was defined as revascularization of the common femoral artery with a residual stenosis lower than 30%. Primary endpoints were an immediate increase of perilesional transcutaneous oxygen pressure (TCPO2) > 40 mmHg, ulcerative lesions improvement up to healing or skin flaps re-epithelialization after minor amputation, limb rescue with rejected major amputation, and resolution of rest pain if present. Results The success rate of the revascularization procedures was 100%. No patient underwent surgical conversion. One case of peri-operative bleeding at the brachial access site was observed. There were no cases of arterial dissection or undesired distal embolization. The average baseline value of perilesional TCPO2 was 21.8 ± 9.2 mmHg. The mean TCPO2 value was 57.4 ± 7.2 mmHg three days after the procedure ( P < 0.05), and 51.2 ± 9.8 mmHg 15 days after ( P < 0.05). Minor amputations were performed in five patients with advanced ulcerative lesions. No major amputations were performed in the follow-up period. At 14 months follow-up, one patient developed new occlusion of the CFA for extension from the external iliac artery and underwent a new endovascular procedure. We observed an overall primary patency rate of 91% and a primary assisted patency rate of 100% in our 18-month follow-up. Conclusions Endovascular approach for severely calcified atherosclerotic lesions of the common femoral artery seems to represent a valid therapeutic option associated with promising results in terms of clinical outcome and low complication rates.

scholarly journals Fracking Technique: The Novel Approach To Crack Deep Calcified Plaque In Common Femoral Artery With Hydraulic Pressure.

2021 ◽  
Author(s):  
Takuya Haraguchi ◽  
Tsutomu Fujita ◽  
Yoshifumi Kashima ◽  
Masanaga Tsujimoto ◽  
Tsuyoshi Takeuchi ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Common Femoral Artery ◽  
Hydraulic Pressure ◽  
Lumen Area ◽  
Novel Approach ◽  
Minimal Lumen Area ◽  
Calcified Plaque ◽  
Before And After ◽  
Modification Technique

Abstract Background:The patency of conventional peripheral intervention for atherosclerotic lesions in common femoral artery (CFA), called “no stenting zone”, are not superior to surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA provide the better clinical outcome compared to standard balloon angioplasty. Atherectomy devices, which focus on modification of superficial calcification, contribute to the improvement of clinical outcomes. However, deep calcium resists vessel expansion so that luminal gain is not easily achieved. Main text:We propose a novel calcified plaque modification technique, named the” Fracking technique”. The term fracking refers to how a rock is fractured apart by the high hydraulic pressure. This technique is to crack deep calcification with hydraulic pressure with a balloon indeflator through 18-gauge needle, which punctures into calcification in order to obtain larger acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in right CFA. Conventional balloon angioplasty for the lesion provided the suboptimal minimal lumen area (MLA) from 6.2 to 10.7mm2 with intravascular ultrasound (IVUS) measurement. Fracking technique was implemented to obtain the larger MLA. After fracking was repeated three times until there were no more Fracking points, a much larger MLA of 27.1mm2 was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis presented with ischemic rest pain of his right limbs due to severe stenosis with eccentric calcification in distal CFA to proximal superficial femoral artery. MLAs with IVUS before and after ballooning were 10.0mm2, 13.1mm2, respectively. None of the results of MLA lived up to our expectation. Fracking technique was attempted, and MLA of 28.9mm2 was successfully obtained after this technique. No complications observed. Conclusions:Fracking technique was effective for severe calcified lesion in CFA to obtain significantly larger lumen area which will lead to long-term patency superior to conventional peripheral intervention.

scholarly journals A case of picking calcified plaque in the common femoral artery with a long needle: the “calc-pick technique”

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Yoshihiro Iwasaki ◽  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Tomoko Kobayashi ◽  
Takanori Ikeda ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intermittent Claudication ◽  
Femoral Artery ◽  
Balloon Dilatation ◽  
Common Femoral Artery ◽  
Contralateral Approach ◽  
Calcified Plaque ◽  
The Common ◽  
Stiff Guidewire

AbstractAn 88-year-old man had intermittent claudication of his right leg. Angiography revealed severely calcified plaque in the common femoral artery. Endovascular treatment was performed by contralateral approach. We attempted to penetrate the center of the calcified plaque and perform balloon dilatation. However, a 0.014-inch stiff guidewire could not enter the center of the lesion. Thus, we used an inner cylinder of 15-cm 20G long needle directly through the retrograde femoral sheath and successfully introduced the guidewire into the calcified plaque. Crosser and balloon dilatation resulted in 50 % stenosis. To cross the center of calcified plaque, it is important to obtain sufficient lumen gain at the non-stenting zone.

scholarly journals RARE VERSION OF TOPOGRAPHY OF DEEP FEMORAL ARTERY

2020 ◽  
Vol 8 (4) ◽  
pp. 591-598
Author(s):  
R.E. Kalinin ◽  
◽  
I.A. Suchkov ◽  
E.A. Klimentova ◽  
I.N. Shanaev ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Femoral Vein ◽  
Coronary Vessels ◽  
Common Femoral Artery ◽  
Lower Limbs ◽  
Deep Femoral Artery ◽  
Lower Trunk ◽  
Endovascular Interventions ◽  
The Common ◽  
Angiographic Examination

The deep femoral artery is a large branch of the common femoral artery that is of much interest for vascular and endovascular surgeons due to the role it plays in collateral circulation between the vessels of the small pelvis and arteries of the popliteal-tibial segment. In most cases, the deep femoral artery branches off from the posterolateral or posterior surface of the common femoral artery. At the same time, anomalies of development of the deep femoral vessels may become the cause for iatrogenic damages in implementation of the open or endovascular interventions. In the article, a clinical case of a patient referred for a planned ultrasound examination of vessels of the lower limbs before angiographic examination of the vessels of the heart and of the lower limbs, is described that revealed atypical topography of branching of the two trunks of the deep femoral artery from the common femoral artery. The upper trunk of the deep femoral artery branched off from the anteromedial surface of the common femoral artery and in the initial part was positioned above the common femoral vein. The lower trunk of the deep femoral artery sepa-rated from the anterolateral surface of the common femoral artery. Preoperative identification of the variant anatomy of the vessels of the femoral triangle permitted to perform angiographic examination of the coronary vessels through the femoral artery on the contralateral limb without complications.

scholarly journals A Case of Picking Calcified Plaque In The Common Femoral Artery With A Long Needle: The “Calc-Pick Technique”

2021 ◽  
Author(s):  
Yoshihiro Iwasaki ◽  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Tomoko Kobayashi ◽  
Shigeru Nakamura ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intermittent Claudication ◽  
Femoral Artery ◽  
Balloon Dilatation ◽  
Common Femoral Artery ◽  
Contralateral Approach ◽  
Calcified Plaque ◽  
The Common ◽  
Stiff Guidewire

Abstract An 88-year-old male had intermittent claudication of his right leg. Angiography revealed severely calcified plaque in the common femoral artery. Endovascular treatment was performed by contralateral approach. We attempted to penetrate the center of the calcified plaque and perform balloon dilatation. However, a 0.014-inch stiff guidewire could not enter center of the lesion. Thus, we used a inner cylinder of 15-cm 20G long needle directly through the retrograde femoral sheath and successfully introduce the guidewire into the calcified plaque. Crosser and balloon dilatation resulted 50% stenosis. To cross the center of calcified plaque is important to get sufficient lumen gain at the nonstenting zone.

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.

Initial Experience with Percutaneous Angioplasty of the Common Femoral Artery in De Novo Stenotic Lesions

2015 ◽  
Vol 29 (8) ◽  
pp. 1493-1500 ◽  
Author(s):  
Romain de Blic ◽  
Jean-François Deux ◽  
Hicham Kobeiter ◽  
Pascal Desgranges ◽  
Jean-Pierre Becquemin ◽  
...  
Keyword(s):  
Femoral Artery ◽  
De Novo ◽  
Common Femoral Artery ◽  
Initial Experience ◽  
Percutaneous Angioplasty ◽  
The Common ◽  
Stenotic Lesions

Anomalous High Bifurcation of the Common Femoral Artery at the Groin: Management of Gsv Incompetence with Endovenous Laser Ablation

2012 ◽  
Vol 28 (5) ◽  
pp. 264-267 ◽  
Author(s):  
C Lekich ◽  
W Campbell ◽  
S Walton ◽  
P Hannah
Keyword(s):  
Laser Ablation ◽  
Femoral Artery ◽  
Vascular Complications ◽  
Common Femoral Artery ◽  
Vascular Anomalies ◽  
Endovenous Laser Ablation ◽  
Safe Treatment ◽  
Complications Of Surgery ◽  
The Common ◽  
Saphenofemoral Junction

Objectives: To discuss safety of EVLA in anomalies of the GSV anatomy. To review and discuss complications of surgery involving anomalous anatomy. Method: We report a case of high bifurcation of the common femoral artery wrapping around the saphenofemoral junction. Results: Successful ablation was achieved with no adverse consequences. Conclusion: EVLA is a safe treatment for SFJ/GSV incompetence in the presence of vascular anomalies that have historically resulted in serious vascular complications from surgery.

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