scholarly journals Application of Combined Superficial Femoral Artery Stenting and Deep Femoral Artery Profundoplasty in Chinese Patients With Lower Extremity Artery Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Guoqing Chi ◽  
Mingchao Ding
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Patency Rate ◽  
Chinese Patients ◽  
Deep Femoral Artery ◽  
Hybrid Operation ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Objective: Lower extremity artery disease (LEAD) increases sharply with age and results in severe burden in individuals and in society. This study aimed to compare the efficiency of simple superficial femoral artery stenting (SFAS) and the hybrid operation, such as combined SFAS and deep femoral artery profundoplasty (DFAP), in the treatment of Chinese patients with LEAD, classified as Rutherford grades 3–5.Methods: There were 200 patients with LEAD classified as Rutherford grades 3–5 included in the simple SFAS group (n = 100) and the combined SFAS and DFAP group (n = 100).Results: All the patients had median age of 71 years, and there were 143 males (71.5%). Not only the increase rate of ankle brachial index (ABI), but also reduction rate of Rutherford grade, were significantly higher after surgery in the combined SFAS and DFAP group than in the simple SFAS group (P < 0.05 for all). The patency rate of patients in the combined SFAS and DFAP group was significantly higher than that of patients in the simple SFAS group during the follow-up (P < 0.05). Proportion of amputation and claudication distance <200 m had no significant difference between the two groups during the 2-year follow-up (P > 0.05 for all).Conclusion: This study demonstrated that, compared with SFAS, combined SFAS and DFAP improved not only the ABI and the Rutherford grade after surgery but also the patency rate during the follow-up in Chinese patients with LEAD. Hybrid operation has significant value in alleviating clinical symptoms after surgery, and, thereby, improving vascular prognosis in Chinese patients.

scholarly journals Osteoid Metaplasia in Femoral Artery Plaques Is Associated With the Clinical Severity of Lower Extremity Artery Disease in Men

2020 ◽  
Vol 7 ◽  
Author(s):  
Mirjami Laivuori ◽  
Johanna Tolva ◽  
A. Inkeri Lokki ◽  
Nina Linder ◽  
Johan Lundin ◽  
...  
Keyword(s):  
Image Analysis ◽  
Deep Learning ◽  
Lower Extremity ◽  
Femoral Artery ◽  
Analysis Algorithm ◽  
Image Analysis Algorithm ◽  
Artery Disease ◽  
Area Percentage ◽  
Lower Extremity Artery Disease ◽  
Whole Slide Images

Lamellar metaplastic bone, osteoid metaplasia (OM), is found in atherosclerotic plaques, especially in the femoral arteries. In the carotid arteries, OM has been documented to be associated with plaque stability. This study investigated the clinical impact of OM load in femoral artery plaques of patients with lower extremity artery disease (LEAD) by using a deep learning-based image analysis algorithm. Plaques from 90 patients undergoing endarterectomy of the common femoral artery were collected and analyzed. After decalcification and fixation, 4-μm-thick longitudinal sections were stained with hematoxylin and eosin, digitized, and uploaded as whole-slide images on a cloud-based platform. A deep learning-based image analysis algorithm was trained to analyze the area percentage of OM in whole-slide images. Clinical data were extracted from electronic patient records, and the association with OM was analyzed. Fifty-one (56.7%) sections had OM. Females with diabetes had a higher area percentage of OM than females without diabetes. In male patients, the area percentage of OM inversely correlated with toe pressure and was significantly associated with severe symptoms of LEAD including rest pain, ulcer, or gangrene. According to our results, OM is a typical feature of femoral artery plaques and can be quantified using a deep learning-based image analysis method. The association of OM load with clinical features of LEAD appears to differ between male and female patients, highlighting the need for a gender-specific approach in the study of the mechanisms of atherosclerotic disease. In addition, the role of plaque characteristics in the treatment of atherosclerotic lesions warrants further consideration in the future.

scholarly journals Sustained drug retention after paclitaxel-coated balloon angioplasty for superficial femoral artery disease: Follow-up intravascular imaging

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090782
Author(s):  
Norihiro Kobayashi ◽  
Keisuke Hirano ◽  
Masahiro Yamawaki ◽  
Motoharu Araki ◽  
Tsuyoshi Sakai ◽  
...  
Keyword(s):  
Frequency Domain ◽  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Superficial Femoral Artery ◽  
Optical Frequency ◽  
Optical Frequency Domain Imaging ◽  
Drug Retention ◽  
Artery Disease ◽  
The Right

A 63 year-old woman with claudication underwent endovascular therapy for diffuse stenosis of the right superficial femoral artery in our hospital. We performed paclitaxel-coated balloon angioplasty using the IN.PACT™ Admiral™ and achieved acceptable results. After 42 days, we performed follow-up optical frequency domain imaging for the right superficial femoral artery lesion treated with paclitaxel-coated balloon and observed several high-intensity regions with attenuation on the lumen surface. Sustained drug availability is a notable characteristic of paclitaxel-coated balloon. To the best of our knowledge, this is the first report on the visualization of sustained drug retention on the lumen surface using follow-up optical frequency domain imaging after paclitaxel-coated balloon angioplasty in a human patient with superficial femoral artery disease.

Endovascular Stent-Grafts for Superficial Femoral Artery Disease: Results of 1-year Follow-up

1999 ◽  
Vol 10 (3) ◽  
pp. 289-296 ◽  
Author(s):  
David O. Kessel ◽  
Lasantha D. Wijesinghe ◽  
Lain Robertson ◽  
David J.A. Scott ◽  
Henricus Raat ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Endovascular Stent ◽  
Stent Grafts ◽  
Artery Disease

Impact of angiotensin receptor blockers on mortality after hospitalization for symptomatic lower extremity artery disease

2020 ◽  
Author(s):  
François-Xavier Lapébie ◽  
Alessandra Bura-Rivière ◽  
Philippe Lacroix ◽  
Joël Constans ◽  
Carine Boulon ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Cox Model ◽  
Angiotensin Receptor Blockers ◽  
Incidence Rates ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Abstract Aims The objective was to assess the association between angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) prescription at discharge in patients hospitalized for symptomatic lower extremity artery disease (LEAD) and 1-year mortality. Methods and results The COPART registry is a multicentre, prospective, observational, cohort study which includes consecutive patients hospitalized for symptomatic LEAD in four French academic centres. All-cause mortality during a 1-year follow-up after hospital discharge was compared between patients with ARB, patients with ACEI and patients without ARB or ACEI. Analyses were performed using Cox models. As a sensitivity analysis, a propensity score (PS)-matching analysis was carried out. Among 1981 patients, 421 had ARB (21.3%), 766 ACEI (38.7%), and 794 no ACEI/ARB (40.1%) at discharge. During the 1-year follow-up, incidence rates for mortality were 12.6/100 person-years [95% confidence interval (CI) 9.7–16.1] for patients with ARB, 15.8/100 person-years (95% CI 13.4–18.6) for patients with ACEI and 19.8/100 person-years for patients without ACEI/ARB (95% CI 17.2–22.8). In a multivariate Cox model, ARB at discharge was associated with decreased mortality compared with no ACEI/ARB, hazard ratio (HR) 0.68 (95% CI 0.49–0.95), and with ACEI, HR 0.69 (95% CI 0.49–0.97). These results are consistent with those obtained by the Cox analyses in the PS-matched sample: HR 0.68 (95% CI 0.47–0.98) for patients with ARB compared with no ARB. Conclusion Angiotensin receptor blockers at discharge after hospitalization for symptomatic LEAD is associated with a better survival compared with ACEI or no ACEI/ARB.

The deep femoral artery, a readily available inflow vessel for lower limb revascularization: a single-center experience

Vascular ◽  
2013 ◽  
Vol 21 (2) ◽  
pp. 75-78 ◽  
Author(s):  
Daniel Silverberg ◽  
Basheer Sheick-Yousif ◽  
Dmitry Yakubovitch ◽  
Moshe Halak ◽  
Jacob Schneiderman
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Lower Limb ◽  
Bypass Graft ◽  
Graft Patency ◽  
Primary Patency ◽  
Single Center ◽  
Deep Femoral Artery ◽  
Single Center Experience

The deep femoral artery (DFA) offers several advantages as an inflow vessel in lower-extremity bypasses. We report a single-center experience using the DFA as an inflow artery for lower-extremity revascularization. We reviewed all patients who underwent a lower-extremity bypass utilizing the DFA as the inflow vessel. Demographics, indications for surgery, indication for use of the DFA, type of conduits and target vessels were recorded. Follow-up data included resolution of symptoms, bypass graft patency, major amputations and survival. Over 2.5 years, 23 patients were treated with a DFA-inflow bypass. Eighteen (78%) suffered from wounds and five (22%) from rest pain. The proximal, middle and distal DFA was used in 8, 14 and 1 patients, respectively. Indications for using the DFA were limited vein conduit (16) and a hostile groin (5). All patients experienced initial resolution of their ischemic symptoms. The primary patency at two years was 93%. The survival rate was 83%. In conclusion, the DFA is an excellent and underutilized alternative inflow artery in patients requiring lower limb revascularization. It offers excellent patency rates and should be considered in patients with hostile groins or insufficient lengths of a vein conduit.

scholarly journals “Low Echoic Area” around stent after bare and drug-coated stenting or stent graft placement for superficial femoral artery disease

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110145
Author(s):  
Yoshimitsu Soga ◽  
Kenji Ando
Keyword(s):  
Stent Graft ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Drug Eluting Stent ◽  
Drug Eluting ◽  
Cook Medical ◽  
Artery Disease ◽  
Zilver Ptx ◽  
Cordis Corporation

Restenosis after stent implantation in femoropopliteal lesions is still big issue. However, restenosis has been reduced by the recent new drug-eluting stent “Eluvia” (Boston Scientific, Marlborough, MA, USA). However, it was reported that “low echoic area (LEA)” finding around stent by ultrasound that they called “aneurysmal degeneration,” but no blood flow was identified outside the stent was confirmed after Eluvia implantation. In this report, we describe the similar findings that were observed after other types of stents (S.M.A.R.T. bare-nitinol stent (Cordis Corporation, Hialeah, FL, USA), Zilver PTX drug-coated stent (Cook Medical, Bloomington, IN, USA), and Viabahn stent graft (W. L. Gore & Associates, Newark, Delaware, USA)) for superficial femoral artery disease. These findings did not change to “aneurysmal change” during the follow-up.

Remote Superficial Femoral Artery Endarterectomy and Distal Vein Bypass for Limb Salvage: Initial Experience

2003 ◽  
Vol 10 (1) ◽  
pp. 121-125 ◽  
Author(s):  
David Rosenthal ◽  
Eric D. Wellons ◽  
John H. Matsuura ◽  
Mark Ghegan ◽  
Frederick W. Shuler ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Patency Rate ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Atheromatous Plaque ◽  
Color Flow ◽  
The Mean

Purpose: To examine the results of remote superficial femoral artery endarterectomy (RSFAE) performed through a small groin incision in conjunction with distal saphenous vein (SV) bypass for limb salvage. Methods: A retrospective study was conducted of 21 patients (14 men; mean age 68.5 years, range 47–78) who underwent RSFAE and distal SV bypass between May 1998 and September 2001 for limb salvage. Thirteen had gangrene and 8 had rest pain. RSFAE was performed with the MollRing Cutter device through a femoral arteriotomy; the distal atheromatous plaque was “tacked up” with a stent. Distal SV bypass from the proximal popliteal artery was performed in situ in 7, from a transposed harvested vein in 8, or from a reversed graft in 6. All patients underwent follow-up examination with serial color-flow ultrasound scans. Results: The mean length of the endarterectomized SFA was 26.5 cm (range 12–40). There were no deaths, only 2 wound complications, and the mean hospital length of stay was 3.1 ± 0.6 days. The primary cumulative patency rate by life-table analysis was 71.4% with follow-up extending to an average of 12.4 months (range 1–18). There were 2 amputations for gangrene and 6 percutaneous procedures in 4 (19.1%) patients to maintain bypass patency, producing an assisted primary patency rate of 81.5%. The locations of the restenoses were evenly distributed along the endarterectomized SFA and SV graft. Conclusions: When adequate SV is not available, RSFAE with residual SV bypass is a safe and moderately durable procedure that may prove to be a useful adjunct for limb salvage, especially in the presence of foot infection, where an autogenous tissue bypass is preferred.

Nonoperative treatment of superficial femoral artery disease: Long-term follow-up

1993 ◽  
Vol 17 (1) ◽  
pp. 172-182 ◽  
Author(s):  
Robert J. Lusby ◽  
Geoffrey S. Cox ◽  
Norman R. Hertzer ◽  
Jess R. Young ◽  
Patrick J. O'Hara ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Nonoperative Treatment ◽  
Long Term Follow Up ◽  
Artery Disease

scholarly journals Nonoperative treatment of superficial femoral artery disease: Long-term follow-up

1993 ◽  
Vol 17 (1) ◽  
pp. 172-182 ◽  
Author(s):  
Geoffrey S. Cox ◽  
Norman R. Hertzer ◽  
Jess R. Young ◽  
Patrick J. O'Hara ◽  
Leonard P. Krajewski ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Nonoperative Treatment ◽  
Long Term Follow Up ◽  
Artery Disease

Antithrombotic Therapy in Lower Extremity Artery Disease

2020 ◽  
Vol 18 (3) ◽  
pp. 215-222 ◽  
Author(s):  
Mislav Vrsalovic ◽  
Victor Aboyans
Keyword(s):  
Lower Extremity ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Cardiovascular Outcomes ◽  
Lower Limbs ◽  
Stent Type ◽  
Increased Risk ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Lower extremity artery disease (LEAD) is a marker of a more advanced atherosclerotic process often affecting multiple vascular beds beyond the lower limbs, with a consequent increased risk for all-cause and cardiovascular mortality. Antithrombotic therapy is the cornerstone of management of these patients to prevent ischaemic cardiovascular and limb events and death. In patients with symptomatic LEAD, the efficacy of aspirin has been established long ago for the prevention of cardiovascular events. In the current guidelines, clopidogrel may be preferred over aspirin following its incremental ability to prevent cardiovascular events, while ticagrelor is not superior to clopidogrel in reducing cardiovascular outcomes. Dual antiplatelet therapy (DAPT, aspirin with clopidogrel) is currently recommended for at least 1 month after endovascular interventions irrespective of the stent type. Antiplatelet monotherapy is recommended after infra-inguinal bypass surgery, and DAPT may be considered in below-the-knee bypass with a prosthetic graft. In symptomatic LEAD, the addition of anticoagulant (vitamin K antagonists) to antiplatelet therapy increased the risk of major and life-threatening bleeding without benefit regarding cardiovascular outcomes. In a recent trial, low dose of direct oral anticoagulant rivaroxaban plus aspirin showed promising results, not only to reduce death and major cardiovascular events, but also major limb events including amputation. Yet, this option should be considered especially in very high risk patients, after considering also the bleeding risk. Despite all the evidence accumulated since >40 years, many patients with LEAD remain undertreated and deserve close attention and implementation of guidelines advocating the use of antithrombotic therapies, tailored according to their level of risk.

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