Could prior endovascular interventions affect the results of lower extremity below the knee autologous vein bypasses?

Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

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The Value of Screening for HPR in Patients Undergoing Lower Extremity Arterial Endovascular Interventions

Case Medical Research ◽

10.31525/ct1-nct04007055 ◽

2019 ◽

Author(s):

Keyword(s):

Lower Extremity ◽

Endovascular Interventions

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Lower Extremity Amputation for Ischemia

DeckerMed Surgery ◽

10.2310/surg.2115 ◽

2018 ◽

Author(s):

William C. Pevec

Keyword(s):

Lower Extremity ◽

Chronically Ill ◽

Major Amputation ◽

Postoperative Management ◽

Functional Mobility ◽

Knee Amputation ◽

Below The Knee ◽

Psychological Harm ◽

Independent Ambulation ◽

Chronic Arterial Occlusive Disease

Major amputations (proximal to the ankle) of the lower extremity are the manifestations of end-stage, nonreconstructable chronic arterial occlusive disease. A well-performed amputation provides the patient with the best prognosis for return to functional mobility. However, an amputation that fails to heal primarily may cause substantial physical and psychological harm to an already chronically ill patient. Minor amputations (at the toe or forefoot level) are not technically complex, but poor patient selection or technical imperfection can result in major amputation and loss of independent ambulation. In this chapter, selection of the level of amputation is reviewed; the methods to perform digital, forefoot, transtibial, and transfemoral amputations are presented; and postoperative management and potential complications are discussed. Key Words: above-the-knee amputation, below-the-knee amputation, Guillotine amputation, ray amputation, transmetatarsal amputation, transphalangeal amputation This review contains 10 figures, 1 table and 22 references

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Open Surgical Secondary Interventions Are More Durable Than Endovascular Interventions for Lower Extremity Bypass Stenosis or Occlusion

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.06.037 ◽

2019 ◽

Vol 70 (2) ◽

pp. e32-e33

Author(s):

Mikayla N. Lowenkamp ◽

Abhisekh Mohapatra ◽

Efthymios D. Avgerinos ◽

Eric S. Hager ◽

Michael C. Madigan

Keyword(s):

Lower Extremity ◽

Secondary Interventions ◽

Endovascular Interventions ◽

Bypass Stenosis

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The Role of Revascularization in Transmetatarsal Amputations

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-91-10-533 ◽

2001 ◽

Vol 91 (10) ◽

pp. 533-535 ◽

Cited By ~ 22

Author(s):

Javier La Fontaine ◽

Alex Reyzelman ◽

Gary Rothenberg ◽

Khalid Husain ◽

Lawrence B. Harkless

Keyword(s):

Lower Extremity ◽

Diabetes Duration ◽

Amputation Level ◽

Knee Amputation ◽

Below The Knee ◽

Transmetatarsal Amputation ◽

The Mean ◽

Lower Extremity Revascularization

Data from 37 patients who underwent a transmetatarsal amputation from January 1993 to April 1996 were reviewed. The mean age and diabetes duration of the subjects were 54.9 (± 13.2) years and 16.6 (± 8.9) years, respectively. The follow-up period averaged 42.1 (± 11.2) months. At the time of follow-up, 29 (78.4%) of the 37 patients still had foot salvage, 8 (21.6%) had progressed to below-the-knee amputation, and 15 (40.5%) had undergone lower-extremity revascularization. Twelve (80%) of the 15 revascularized patients preserved their transmetatarsal amputation level at a follow-up of 36.4 months. The authors concluded that at a maximum of 3 years follow-up after initial amputation, transmetatarsal amputation was a successful amputation level. (J Am Podiatr Med Assoc 91(10): 533-535, 2001)

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Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

Vascular Medicine ◽

10.1177/1358863x16676901 ◽

2016 ◽

Vol 22 (1) ◽

pp. 28-34 ◽

Cited By ~ 10

Author(s):

Caitlin W Hicks ◽

Alireza Najafian ◽

Alik Farber ◽

Matthew T Menard ◽

Mahmoud B Malas ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Multivariable Analysis ◽

Limb Ischemia ◽

Major Amputation ◽

Primary Patency ◽

Tissue Loss ◽

Vascular Intervention ◽

Below The Knee ◽

Endovascular Interventions ◽

One Year

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

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Practice patterns of dual antiplatelet therapy after lower extremity endovascular interventions

Vascular Medicine ◽

10.1177/1358863x19880602 ◽

2019 ◽

Vol 24 (6) ◽

pp. 528-535 ◽

Cited By ~ 2

Author(s):

Tanner I Kim ◽

Julia F Chen ◽

Kristine C Orion

Keyword(s):

Lower Extremity ◽

New England ◽

Antiplatelet Therapy ◽

Practice Patterns ◽

Dual Antiplatelet Therapy ◽

Endovascular Intervention ◽

Endovascular Interventions ◽

Vascular Bypass ◽

Artery Disease

Antiplatelet therapy is commonly prescribed following endovascular interventions. However, there is limited data regarding the regimen and duration of antiplatelet therapy following lower extremity endovascular interventions. The aim of this study was to investigate the practice patterns of dual antiplatelet therapy (DAPT) after lower extremity endovascular interventions. We identified all patients who received an endovascular intervention in the Vascular Study Group of New England (VSGNE) registry from 2010 through 2018. The antiplatelet regimen was examined at the time of discharge and follow-up. Variables predicting discharge antiplatelet therapy and duration of antiplatelet therapy were investigated. There were 13,510 (57.69%) patients discharged on DAPT, 8618 (36.80%) patients discharged on single antiplatelet therapy, and 1292 (5.51%) patients discharged without antiplatelet therapy. Patients with coronary artery disease (CAD), prior vascular bypass and endovascular intervention, preoperative statin use, stent placement compared with angioplasty, and femoropopliteal and tibial treatment were associated with higher odds of being discharged with DAPT compared with no antiplatelet therapy and single antiplatelet therapy. Of the patients discharged on DAPT who were followed up at 9–12 months and 21–24 months, 56.49% and 49.63% remained on DAPT, respectively. Only a narrow margin of the patient majority undergoing endovascular interventions was discharged with DAPT, suggesting that only a small proportion of patients undergoing endovascular intervention remain on DAPT long-term. As the number of peripheral vascular interventions continues to grow, further studies are crucial to identify the optimal duration of DAPT.

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Lower-Extremity Endovascular Interventions for Medicare Beneficiaries: Comparative Effectiveness as a Function of Provider Specialty

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.06.065 ◽

2012 ◽

Vol 56 (2) ◽

pp. 573

Author(s):

A.M. Zafar ◽

R. Dhangana ◽

T.P. Murphy

Keyword(s):

Lower Extremity ◽

Comparative Effectiveness ◽

Medicare Beneficiaries ◽

Endovascular Interventions

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Duplex Evaluation Following Femoropopliteal Angioplasty and Stenting: Criteria and Utility of Surveillance

Vascular and Endovascular Surgery ◽

10.1177/1538574412448684 ◽

2012 ◽

Vol 46 (5) ◽

pp. 353-357 ◽

Cited By ~ 11

Author(s):

Donald T. Baril ◽

Luke K. Marone

Keyword(s):

Lower Extremity ◽

Velocity Ratio ◽

Peak Systolic Velocity ◽

Duplex Ultrasound ◽

Standard Of Care ◽

Endovascular Interventions ◽

Routine Surveillance ◽

Angioplasty And Stenting ◽

Aneurysm Repair ◽

Stent Stenosis

Surveillance following lower extremity bypass, carotid endarterectomy, and endovascular aortic aneurysm repair has become the standard of care at most institutions. Conversely, surveillance following lower extremity endovascular interventions is performed somewhat sporadically in part because the duplex criteria for recurrent stenoses have been ill defined. It appears that duplex surveillance after peripheral endovascular interventions, as with conventional bypass, is beneficial in identifying recurrent lesions which may preclude failure and occlusion. In-stent stenosis following superficial femoral artery angioplasty and stenting can be predicted by both peak systolic velocity and velocity ratio data as measured by duplex ultrasound. Duplex criteria have been defined to determine both ≥50% in-stent stenosis and ≥80% in-stent stenosis. Although not yet well studied, it appears that applying these criteria during routine surveillance may assist in preventing failure of endovascular interventions.

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