Ilio-Deep Femoral Bypass – an Alternative Treatment Strategy to Critical Limb Ischemia (CLI)

2021 ◽  
Vol 6 (2) ◽  
pp. 108-111
Author(s):  
Vasile Adrian Muresan ◽  
Mircea Catalin Cosarca ◽  
Eliza Russu ◽  
Raluca Niculescu ◽  
Mihai Soimu
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
High Morbidity ◽  
Deep Femoral Artery ◽  
Femoral Arteries ◽  
Alternative Treatment Strategy ◽  
Management Of Complications ◽  
The Common ◽  
The Right

Abstract Background: Critical limb ischemia is considered the most severe form of peripheral artery disease. High morbidity and mortality rates are associated with this pathology due to poor economic management of complications. Case summary: A 68-year-old female patient underwent a routine Doppler ultrasound which revealed the obstruction of both the common and superficial right femoral arteries, as well as the right deep femoral artery. In this case, an iliofemoral bypass was performed using the right deep femoral artery as the outflow artery. Conclusion: Revascularization of the deep femoral artery has a reasonable chance of preserving the ischemic lower limb whenever the common and superficial femoral arteries suffer major atherosclerotic blockages.

Does Deep Femoral Artery Revascularization as an Isolated Procedure Play a Role in Chronic Critical Limb Ischemia?

2004 ◽  
Vol 11 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Nicolas Diehm ◽  
Hannu Savolainen ◽  
Felix Mahler ◽  
Jürg Schmidli ◽  
Do-Dai Do ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Deep Femoral Artery ◽  
Chronic Critical Limb Ischemia

Kissing Stents in the Common Femoral Artery Bifurcation for Critical Limb Ischemia: Technical Description and Report of Three Cases

Vascular ◽  
2007 ◽  
Vol 15 (4) ◽  
pp. 211-214 ◽  
Author(s):  
Sven Ross Mathisen ◽  
Michael Åkesson ◽  
Mats Lindh ◽  
Krassi Ivancev ◽  
Timothy A. Resch
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Short Term ◽  
Number Of Patients ◽  
The Common ◽  
Kissing Stent ◽  
Patch Plasty

The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5–8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography–verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.

scholarly journals Common Femoral Artery Diameters Determined by Doppler Ultrasonography

2019 ◽  
Vol 25 (1) ◽  
pp. 1-5
Author(s):  
Prună Ion Irina ◽  
Ciufu Carmen ◽  
Bordei Petru
Keyword(s):  
Femoral Artery ◽  
Doppler Ultrasonography ◽  
Common Femoral Artery ◽  
General Electric ◽  
Femoral Arteries ◽  
Diameter Range ◽  
Left Femoral Artery ◽  
Left And Right ◽  
The Common ◽  
The Right

Abstract Common femoral arteries diameters (left and right) were studied, on a number of 60 cases (26 women and 34 men) with a General Electric – Voluson 730 Expert ultrasonograph. The diameters of the common femoral arteries, left and right, were measured in three points: proximal, middle and inferior, in 60 cases as it follows: 26 cases on women (43,33%) and 34 cases on men (56,70%). Regarding the proximal third of the right common femoral artery, the diameter range was found between 6,1 and 8,9mm, in women being between 6,2-7,9mm, and in men between 6,1-8,9mm. The diameter of the middle third had values between 5,8-9,7mm, in women ranging from 6,1 to 7,8mm, and in men from 5,8 to 9,7mm. At the level of the inferior third, the femoral artery had a diameter between 6,8-12,7mm, in women ranging from 6,5 to 9,8mm, and in men from 6,3 to 12,7mm. The common left femoral artery, in its proximal third had a diameter with values between 5,7 – 9,9mm, in women from 6,2 to 8,0mm, and in men being between 5,7-9,9mm. In the middle third the values were found between 6,1-9,8mm, in women being from 6,6 to 7,9mm, and in men from 6,1 to 9,8mm. Regarding the inferior third, the diameters had values between 7,0-12,5mm, in women ranging from 7,1 to 10,5mm, and in men, from 6,8 to 12,5mm.

scholarly journals Increased collateral flow by rescue femorofemoral bypass dissolved residual thrombus in implanted iliofemoral artery stents: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tatsuo Haraki ◽  
Taichi Kondo ◽  
Izaya Kamei ◽  
Takahiro Tanabe
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Femoropopliteal Bypass ◽  
Bypass Grafts ◽  
Deep Femoral Artery ◽  
The Right ◽  
Femorofemoral Bypass

Abstract Background Failed aortofemoral and femoropopliteal bypass grafts in the lower extremity artery usually result in acute limb ischemia. Endovascular treatment and surgical revascularization have been reported for limb salvage. Case presentation A 72-year-old Japanese man was admitted with acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Endovascular treatment with balloon angioplasty, thrombectomy, and stent implantation in the long chronic total occlusion from the right common iliac artery to the superficial femoral artery did not result in efficient flow due to thrombus transfer from a failed aortofemoral bypass graft. However, a rescue femorofemoral bypass (the left femoral to the right deep femoral artery) improved his symptoms, and implanted in-stent flow was gradually recovered. Lower extremity angiography performed 5 months later confirmed the patency of the iliofemoral in-stent flow. However, the femorofemoral bypass graft was unfortunately occluded due to the progression of left external iliac artery stenosis. The patency of the iliofemoral in-stent flow was confirmed at 1 year by ultrasonography. Conclusions Improvement of the deep femoral artery flow plays an important role in the treatment of acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Thus, increased collateral circulation to the periphery through the deep femoral artery dissolved the remaining in-stent thrombus in the iliofemoral artery.

scholarly journals Comparative analysis of mouse bone marrow and adipose tissue mesenchymal stem cells for critical limb ischemia cell therapy

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Pegah Nammian ◽  
Seyedeh-Leili Asadi-Yousefabad ◽  
Sajad Daneshi ◽  
Mohammad Hasan Sheikhha ◽  
Seyed Mohammad Bagher Tabei ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Mesenchymal Stem Cells ◽  
Adipose Tissue ◽  
Cell Therapy ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia

Abstract Introduction Critical limb ischemia (CLI) is the most advanced form of peripheral arterial disease (PAD) characterized by ischemic rest pain and non-healing ulcers. Currently, the standard therapy for CLI is the surgical reconstruction and endovascular therapy or limb amputation for patients with no treatment options. Neovasculogenesis induced by mesenchymal stem cells (MSCs) therapy is a promising approach to improve CLI. Owing to their angiogenic and immunomodulatory potential, MSCs are perfect candidates for the treatment of CLI. The purpose of this study was to determine and compare the in vitro and in vivo effects of allogeneic bone marrow mesenchymal stem cells (BM-MSCs) and adipose tissue mesenchymal stem cells (AT-MSCs) on CLI treatment. Methods For the first step, BM-MSCs and AT-MSCs were isolated and characterized for the characteristic MSC phenotypes. Then, femoral artery ligation and total excision of the femoral artery were performed on C57BL/6 mice to create a CLI model. The cells were evaluated for their in vitro and in vivo biological characteristics for CLI cell therapy. In order to determine these characteristics, the following tests were performed: morphology, flow cytometry, differentiation to osteocyte and adipocyte, wound healing assay, and behavioral tests including Tarlov, Ischemia, Modified ischemia, Function and the grade of limb necrosis scores, donor cell survival assay, and histological analysis. Results Our cellular and functional tests indicated that during 28 days after cell transplantation, BM-MSCs had a great effect on endothelial cell migration, muscle restructure, functional improvements, and neovascularization in ischemic tissues compared with AT-MSCs and control groups. Conclusions Allogeneic BM-MSC transplantation resulted in a more effective recovery from critical limb ischemia compared to AT-MSCs transplantation. In fact, BM-MSC transplantation could be considered as a promising therapy for diseases with insufficient angiogenesis including hindlimb ischemia.

Isolated femoral artery revascularisation with or without iliac inflow improvement – a less invasive surgical option in critical limb ischemia

VASA ◽  
2021 ◽  
pp. 1-7
Author(s):  
Andreas S. Peters ◽  
Katrin Meisenbacher ◽  
Dorothea Weber ◽  
Theodosios Bisdas ◽  
Giovanni Torsello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Negative Impact ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lesion Length ◽  
Vascular Intervention ◽  
Selection Of Variables ◽  
Surgical Option

Summary: Background: Isolated femoral artery revascularisation (iFAR) represents a well-established surgical method in the treatment of peripheral arterial disease (PAD) involving common femoral artery disease. Data for iFAR in multilevel PAD are inconsistent, particularly in patients with critical limb ischemia (CLI). The aim of the study was to evaluate the outcome of iFAR in CLI regarding major amputation and reintervention and to identify associated risk factors for this outcome. Patients and methods: The data used have been derived from the German Registry of Firstline Treatment in Critical Limb Ischemia (CRITISCH). A total of 1200 patients were enrolled in 27 vascular centres. This sub-analysis included patients, which were treated with iFAR with/without concomitant iliac intervention. For detection of risk factors for the combined endpoint of major amputation and/or reintervention, selection of variables for multiple regression was conducted using stepwise forward/backward selection by Akaike’s information criterion. Results: 95 patients were included (mean age: 72 years ± 10.82; 64.2% male). Of those, 32 (33.7%) participants reached the combined endpoint. Risk factor analysis revealed continued tobacco use (odds ratio [OR] 2.316, confidence interval [CI] 0.832–6.674), TASC D-lesion (OR: 2.293, CI: 0.869–6.261) and previous vascular intervention in the trial leg (OR: 2.720, CI: 1.037–7.381) to be associated with reaching the combined endpoint. Conclusions: iFAR provides a reasonable, surgical option to treat CLI. Lesion length (TASC D) seems to have a negative impact on outcome. Further research is required to better define the future role of iFAR for combined femoro-popliteal lesions in CLI – best in terms of a randomised controlled trial.

scholarly journals Endovascular therapy for severely calcified plaque at the superficial femoral artery using myocardial biopsy forceps

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Shigeru Nakamura ◽  
Takanori Ikeda
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Calcium Score ◽  
Biopsy Forceps ◽  
Myocardial Biopsy ◽  
Deep Femoral Artery ◽  
Total Occlusion ◽  
Stent Expansion ◽  
Calcified Plaque ◽  
The Right

Abstract Background Currently, the success rate of EVT for treating CTO of the SFA is high; however, EVT is still found to be insufficient in treating CTOs with severely calcified lesions. Even if the guidewire crosses the lesion, the calcifications may still cause difficulties during stent expansion. Main text A 78-year-old male had been reported to have intermittent claudication with chronic total occlusion (CTO) of the right superficial femoral artery (SFA). Angiography revealed severely calcified plaque (Angiographic calcium score: Group4a [1]) at the ostium of the SFA. Stenting posed a risk of underexpansion, causing the plaque to shift to the deep femoral artery. we decided to remove the calcified plaque using biopsy forceps. After removing the extended calcified plaque, the guidewire could cross easily, and the self-expandable stent was well dilated without causing the plaque to shift to the DFA. Conclusions Biopsy forceps may be used in some endovascular cases to remove severely calcified lesions. To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it.

Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia

2017 ◽  
Vol 24 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Yukun Li ◽  
Ali Esmail ◽  
Konstantinos P. Donas ◽  
Georgios Pitoulias ◽  
Giovanni Torsello ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Success Rate ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Technical Success ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Below The Knee ◽  
Antegrade Approach

Purpose: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI). Methods: Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups. Results: Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047). Conclusion: The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.

Femoral Balloon-Oriented Puncture for True Lumen Reentry in the Common Femoral Artery After Subintimal Retrograde Recanalization of Superficial Femoral Artery Ostial Occlusion: The FORLEE Technique

2019 ◽  
Vol 26 (4) ◽  
pp. 490-495 ◽  
Author(s):  
Gabriele Testi ◽  
Tanja Ceccacci ◽  
Mauro Cevolani ◽  
Francesco Giacchi ◽  
Fabio Tarantino ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Balloon Catheter ◽  
Duplex Ultrasound ◽  
Cost Effective ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Anterior Tibial Artery ◽  
True Lumen ◽  
The Common

Purpose: To report a new technique to reenter the common femoral artery (CFA) true lumen after retrograde recanalization of a superficial femoral artery (SFA) with flush ostial occlusion. Technique: The technique is demonstrated in a 76-year-old woman with critical limb ischemia previously submitted to several surgical revascularizations. A duplex ultrasound showed flush ostial occlusion of the SFA and patency of the anterior tibial artery at the ankle as the sole outflow vessel. After unsuccessful antegrade attempts to recanalize the SFA, a retrograde guidewire was advanced subintimally up to the CFA, without gaining reentry. A balloon catheter was inflated in the subintimal plane across the SFA ostial occlusion. Antegrade access to the distal CFA was achieved with a 20-G needle, which was used to puncture the balloon. A guidewire was advanced into the balloon and pushed forward while the collapsed balloon was pulled back to the mid SFA. The antegrade guidewire was externalized through a retrograde catheter, which was pushed in the CFA true lumen. A retrograde guidewire was advanced and externalized through the femoral sheath, establishing a flossing wire. The procedure was completed in antegrade fashion. Conclusion: The FORLEE technique is a cost-effective option to gain the CFA true lumen after subintimal retrograde recanalization of an ostial SFA occlusion.

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