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

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.

Complete Revascularization of Acute Limb Ischemia With Distal Pedal Access

2019 ◽  
Vol 54 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Sungsin Cho ◽  
Seung Hwan Lee ◽  
Jin Hyun Joh
Keyword(s):  
Blood Flow ◽  
Limb Ischemia ◽  
Body Part ◽  
Posterior Tibial Artery ◽  
Complete Revascularization ◽  
Acute Limb Ischemia ◽  
Potential Threat ◽  
Abrupt Decrease ◽  
Posterior Tibial ◽  
Dorsalis Pedis Artery

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.

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

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.

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

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.

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

Angiology ◽  
1984 ◽  
Vol 35 (12) ◽  
pp. 767-772 ◽  
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

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

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
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.

scholarly journals 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

2017 ◽  
Vol 25 (1) ◽  
pp. 127-132 ◽  
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.

scholarly journals Correlation of Ankle-Brachial Index and Ultrasound Findings on Dorsalis Pedis Artery and Posterior Tibial Artery in Patients with Diabetic Foot Ulcer

2020 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Dedy Pratama ◽  
Mulawardi Mulawardi ◽  
Patrianef Darwis
Keyword(s):  
Diabetic Foot ◽  
Ankle Brachial Index ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Posterior Tibial Artery ◽  
Test Results ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Dorsalis Pedis Artery ◽  
Insignificant Correlation

Introduction: In patients with diabetic foot ulcers, atherosclerosis, and endothelial dysfunction can worsen the patient’s vascular condition. Atherosclerosis is one of which is assessed by the ankle-brachial index (ABI). The occurrence of endothelial dysfunction can be identified indirectly from the examination of flow-mediated dilatation (FMD) via doppler ultrasound. This study was conducted to determine whether there is a correlation between the ankle-brachial index examination with ultrasound examinations of the dorsalis pedis artery and posterior tibial arteries in diabetic foot sufferers. Method: The study design was a cross-sectional prospective conducted on 11th November – 15th December 2014 at Cipto Mangungkusumo National Hospital, Fatmawati National Hospital, and Tangerang Hospital. The inclusion criteria used were diabetics and allow for ABI examination and ultrasonography. Patients who did not have a precise diagnosis and had undergone a major amputation of the leg examined were excluded from the study. Results: From the Spearman non-parametric correlation analysis test results obtained significant results on the correlation between ABI and posterior tibial artery volume flow (VF) (p=0.021). In contrast, insignificant results were obtained on the correlation between peak systolic velocity (PSV) dorsalis pedis artery with ABI (p=0.561), as well as an insignificant correlation between VF of dorsalis pedis artery with ABI (p=0.143), as well as insignificant correlation on PSV of posterior tibial artery with ABI (p=0.231) The results of Spearman’s non-parametric correlation analysis test results obtained significant results on the correlation between ABI and ABI spectral picture (p=0,000) in the diabetic foot. Conclusion: There was a significant correlation between the posterior tibial artery VF with ABI and the Doppler ultrasound spectral picture with ABI. Keywords: ultrasound doppler, ankle-brachial index, diabetic foot ulcer, dorsalis pedis artery, popliteal artery

scholarly journals Surgical thrombectomy versus conservative treatment in cases of acute limb ischemia with COVID-19 pneumonia

2021 ◽  
Vol 20 (4) ◽  
pp. 2885
Author(s):  
A. M. Fahad ◽  
H. A. Alkhalidi ◽  
Y. Q. M. Altimimi
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Conservative Treatment ◽  
Distress Syndrome ◽  
Limb Ischemia ◽  
Causative Factor ◽  
Acute Limb Ischemia ◽  
Single Center ◽  
Below The Knee ◽  
Intravascular Thrombosis ◽  
Surgical Thrombectomy

COVID-19 infection is a major cause for acute respiratory distress syndrome, multi-organ dysfunction, coagulopathy, and intravascular thrombosis; therefore, it is the main causative factor for acute limb ischemia.Aim. To compare the treatment outcome of two limb ischemic groups post COVID-19 infection in a single center and detect at least which is better for the patients in the period of COVID-19 pandemic.Material and methods. Here, in this study, we collect 26 patients and divided them into two groups, G1 (14) patients treated conservatively and G2 (12) patients treated with surgical thrombectomy. Data were analyzed to look for the outcome of groups after 24 hours and 30 days.Results. The successful rate of conservative treatment was 85,72% in G1, while it was 75% in G2. There were two amputations below the knee joint in each group. Three patients died in both groups.Conclusion. In conclusion, both conservative treatment and surgical thrombectomy have a comparable successful rate in the selected group of COVID-19 patients.

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