scholarly journals A 5.5 years observational follow-up study of patients with critical limb ischaemia treated efficiently by endovascular approach

2020 ◽  
Vol 30 (2) ◽  
pp. 236-240
Author(s):  
Dan F. Filip ◽  
Gabriela Kozma ◽  
Calin F. Pop
Keyword(s):  
Endovascular Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Artery ◽  
Arterial Segment ◽  
Final Treatment ◽  
Endovascular Approach ◽  
The Mean ◽  
Peripheral Artery Diseases

Objectives – The aim of this study was to describe our experience with endovascular treatment in critical limb ischaemia and to bring new follow-up data about these patients with initial successfully revascularization. Methods – A retrospective study of 181 patients with critical limb ischaemia, with successful endovascular treatment in our institution was performed. We followed death, reintervention and amputation rates during a mean period of 55.1 ± 8.2 months. Results – The mean age of the patients was 65.2±11.6 years. Of these patients, 66.3% were males, 38.1% diabetics, 51.4% active smokers, 21% with chronic kidney disease, 32.6% with other clinical forms of peripheral artery diseases. The final treatment was stenting in 31.5% of cases and balloon angioplasty alone in the rest of the cases. Treated arteries were in the femoral-popliteal segment – 55.6%, aorto-iliac segment – 31.4% and infrapopliteal segment – 13%. 27.6% of the patients underwent procedures on more than one arterial segment. During follow up 11 deaths occurred (6.1%), 27 patients (14.9%) underwent reinterventions for revascularization (endovascular or surgical) and 31 patients (17.1%) suffered further amputations. Conclusions – Despite a certain rate of death, amputation and reintervention, our results suggest that endovascular approach in critical limb ischaemia can be an effi cient and feasible treatment option if its results are optimal at the time of implementation.

scholarly journals The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives

2019 ◽  
Vol 2 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Grigorios Korosoglou ◽  
Sorin Giusca ◽  
Martin Andrassy ◽  
Michael Lichtenberg
Keyword(s):  
Endovascular Treatment ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischaemia ◽  
Current Evidence ◽  
Limb Ischaemia ◽  
Ageing Population ◽  
Peripheral Artery ◽  
Directional Atherectomy ◽  
First Choice ◽  
Artery Disease

An ageing population and the increasing prevalence of cardiovascular risk factors have aggravated the burden of peripheral artery disease (PAD). Despite advances in the pharmacological treatment of atherosclerosis, many patients with symptomatic PAD require invasive procedures to reduce the symptoms of claudication, salvage tissue and prevent amputation and subsequent disability in those with critical limb ischaemia. After significant advances in endovascular treatment over the past two decades, these techniques are widely accepted as first-choice treatment in the majority of patients with PAD. However, in patients with severely calcified lesions, standard endovascular treatment such as plain or drug-coated balloon (DCB) angioplasty may fail due to vessel recoil or severe dissection in the acute setting, and intimal hyperplasia in the long term. With the use of percutaneous plaque modification and debulking techniques based on atherectomy, such calcified lesions can be tackled more easily after removal or fragmentation of atherosclerotic plaque. More homogeneous balloon expansion at lower pressures can be achieved after atherectomy, which reduces barotrauma while allowing better drug delivery to the vessel wall during DCB angioplasty avoids the need for stent placement. There are four principal methods of direct atherectomy available at the present time: directional atherectomy, rotational atherectomy, orbital atherectomy and hybrid atherectomy. In this article, we provide a short overview of these techniques and the current evidence from clinical trials to support their use.

Important Factors for a Combined Neurovascular Team to Consider in Selecting a Treatment Modality for Patients with Previously Clipped Residual and Recurrent Intracranial Aneurysms

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 732-739 ◽  
Author(s):  
Brian L. Hoh ◽  
Bob S. Carter ◽  
Christopher M. Putman ◽  
Christopher S. Ogilvy
Keyword(s):  
Endovascular Treatment ◽  
Treatment Modality ◽  
Posterior Circulation ◽  
Neurological Deficits ◽  
Parent Vessel ◽  
Surgical Risk ◽  
Fatal Hemorrhage ◽  
The Mean ◽  
Selection Of

Abstract OBJECTIVE Intracranial residual and recurrent aneurysms can occur after surgical clipping, with risks of growth and rupture. In the past, surgical reoperation, which can be associated with higher risk than the initial operation, was the only available treatment. A combined neurovascular team that uses both surgical and endovascular therapies could maximize efficacy and outcomes while minimizing risks in these difficult cases. The indications for which surgical or endovascular treatment should be used to treat patients with residual or recurrent aneurysms, however, have not been elucidated well. We have reviewed the 10-year experience of our combined neurovascular team to determine in a retrospective manner which factors were important to treatment modality selection for patients with these residual and recurrent lesions. METHODS From 1991 to 2001, the combined neurovascular unit at the Massachusetts General Hospital treated 25 residual and recurrent previously clipped aneurysms (15 had been clipped at other centers). Only patients in whom a clip had been placed were included in the study; patients who did not have a clip placed or whose aneurysms were wrapped or coated were excluded. The radiographic studies and clinical data were reviewed retrospectively to determine the efficacy, outcomes, and factors important to the selection of treatment strategy in these patients. RESULTS The patients' clinical presentations were radiographic follow-up, 17 patients; rehemorrhage, 3; mass effect, 3; and thromboembolism, 2. The mean aneurysm recurrence or residual size was 11 mm (range, 4–26 mm). The mean interval until representation was 6.6 years (range, 1 wk–25 yr). Treatment consisted of: coiling, 11 patients; reclipping, 8; proximal parent vessel balloon occlusion, 2; extracranial-intracranial bypass with coil occlusion of aneurysm and parent vessel, 2; extracranial-intracranial bypass with clip trapping, 1; and extracranial-intracranial bypass with proximal clip occlusion of parent vessel, 1. The mean radiographic follow-up period was 11 months. Complete angiographic occlusion was found in 19 aneurysms (76%), at least 90% occlusion was found in 4 aneurysms (16%), intentional partial coil obliteration was found in 1 fusiform lesion (4%), and intentional retrograde flow was found in 1 fusiform lesion (4%). Clinical outcomes were excellent or good in 19 patients (76%). Twenty-one patients (84%) were neurologically the same after retreatment (13 remained neurologically intact, and 8 had preexisting neurological deficits that did not change). Three patients (12%) had new neurological deficits after retreatment, and one patient (4%) died. There were four complications of retreatment (16%), one of which was a fatal hemorrhage in a patient 1 month after intentional partial coil obliteration of a fusiform vertebrobasilar junction aneurysm. Factors important to the selection of treatment modality were recurrence or residual location (all posterior circulation lesions were treated endovascularly), lesion size (lesions larger than 10 mm were treated endovascularly or with the use of combined techniques), and aneurysm morphology (fusiform and wide-necked lesions were treated endovascularly or with the use of combined techniques). CONCLUSION The proper selection of surgical or endovascular treatment for residual and recurrent previously clipped aneurysms can achieve excellent radiographic efficacy with low mortality. Factors important to the selection of treatment by this combined neurovascular team were posterior circulation location, aneurysm size larger than 10 mm, and fusiform morphology, which were treated endovascularly or with the use of combined techniques because of the higher surgical risk associated with these factors. For aneurysms with lower surgical risk, such as some anterior circulation aneurysms and aneurysms smaller than 10 mm, we prefer to perform a reoperation because of superior radiographic cure without compromising the outcome.

Bifurcated bypass in severe chronic limb threatening ischaemia

Vascular ◽  
2021 ◽  
pp. 170853812199985
Author(s):  
Daniele Adami ◽  
Michele Marconi ◽  
Alberto Piaggesi ◽  
Davide M Mocellin ◽  
Raffaella N Berchiolli ◽  
...  
Keyword(s):  
Survival Rates ◽  
Primary Patency ◽  
Free Survival ◽  
Mortality And Morbidity ◽  
Bypass Patency ◽  
Stage 4 ◽  
Endovascular Approach ◽  
The Mean ◽  
Clinical Records

Objectives Revascularization according to the angiosome concept is of proven importance for limb salvage in chronic limb threatening ischaemia but it is not always practicable. Bifurcated bypasses could be considered as an option when an endovascular approach is not feasible or has already failed and a single bypass would not allow direct revascularization of the ischaemic area. Bifurcated bypasses are characterized by landing on two different arteries, the main artery (in direct continuity with the foot vessels) and the secondary one (perfusing the angiosome district). The aim of this study is to evaluate the safety and effectiveness of bifurcated bypass in chronic limb threatening ischaemia. Methods Thirty-five patients were consecutively treated with a bifurcated bypass for chronic limb threatening ischaemia from January 2014 to December 2019 in a single vascular surgery centre. Data from clinical records and operative registers were collected prospectively in an electronic database and retrospectively analysed. Primary and primary assisted bypass patency, amputation-free survival, morbidity and mortality rates at 12 and 24 months were analysed. Results Mean follow-up period was 25.1 months (range 2–72 months). Thirty-six bifurcated bypasses were performed on 35 patients (age 75.3 ± 7.2 years; 69.4% were male). According to Wound, Ischemia, foot Infection classification 22.2% belonged to stage 3 and 77.8% to stage 4 and the mean Rutherford’s class was 5.1 ± 0.7. Immediate technical success was 100%. Early mortality and morbidity rates were respectively 5.5%, and 33.3%; foot surgery was performed in 50% of cases with wound healing in all patients. Primary patency and primary assisted bypass patency were 96.7% and 100% at 6 months; 85.2% and 92% at 12 months, 59.9% and 73.4% at 24 months, respectively. Amputation-free survival at 12 and 24 months was, respectively, 95.6% and 78.8%. Overall survival rates at 12 and 24 months were respectively 94.4% and 91.6%. Conclusions Bifurcates bypass can provide good results in patients with chronic limb threatening ischaemia without endovascular option, especially in diabetic ones. Bifurcated bypass is a complex surgical solution, both to be planned and performed, and it is quite invasive for frail patients that should be accurately selected.

The endovascular management of splenic artery aneurysms and pseudoaneurysms

Vascular ◽  
2011 ◽  
Vol 19 (5) ◽  
pp. 257-261 ◽  
Author(s):  
Jia Xin ◽  
Liu Xiao-ping ◽  
Guo Wei ◽  
Xiong Jiang ◽  
Zhang Hong-peng ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Splenic Artery ◽  
Endovascular Procedures ◽  
Endovascular Management ◽  
Total Procedure Time ◽  
The Mean ◽  
Postembolization Syndrome ◽  
Mid Term Results ◽  
Total Procedure

The purpose of this study was to evaluate outcomes of the endovascular treatment of splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPAs). From April 2003 to December 2009, 12 patients (mean age 46.8 years, range 29–58) with SAAs ( n = 9) or SAPAs ( n = 3) underwent endovascular treatment. Four patients were asymptomatic and three had ruptured aneurysms. Lesions were in the proximal splenic artery ( n = 3), intermediate splenic artery ( n = 3) and distal splenic artery ( n = 6). Endovascular procedures included embolization by sac packing ( n = 5), sandwich occlusion of the splenic artery ( n = 4) or stent graft deployment ( n = 3). Computed tomography (CT) was done before the operation, 3 and 12 months after the operation, then yearly. Endovascular treatment was successful at the first attempt in all 12 (100%) patients, with complete angiographic exclusion of the aneurysm at the end of the operation. The mean amount of contrast medium used was 165 mL (range 100–230), and the mean total procedure time was 92 minutes (range 55–160). No major complications occurred. Postoperational CT scans showed splenic multisegmental infarcts in eight patients (66.7%, 8/12) and among them postembolization syndrome developed in six patients, manifesting as abdominal pain and fever. The mean follow-up was 32 months (range 9–51). No patient demonstrated gross evidence of aneurysm sac growth, and no significant decrease in aneurysm sac size postintervention was noted on follow-up. The endovascular management of SAAs and SAPAs is safe and effective and may induce less mortality than open surgery. Regardless of the etiology, endovascular treatment can provide excellent mid-term results.

scholarly journals Endovascular Treatment of Common Femoral Artery Atherosclerotic Disease

2018 ◽  
Vol 1 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Omar Jawaid ◽  
Ehrin Armstrong
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Long Term Outcomes ◽  
Patch Angioplasty ◽  
The Common ◽  
Artery Disease

Common femoral artery atherosclerosis is a common cause of claudication and critical limb ischaemia. Surgical endarterectomy with or without patch angioplasty has been considered the gold standard for the treatment of common femoral peripheral artery disease. Endovascular intervention to the common femoral artery has gained popularity in recent years as devices and technical skills have advanced. A systematic review of the literature from 1987 to 2018 for endovascular treatment of common femoral artery disease was conducted. This article summarises the data on acute and long-term outcomes for endovascular treatment of common femoral artery disease.

Abstract 3319: Autologous Transplantation of Peripheral Blood Mononuclear Cells for Patients with Peripheral Artery Diseases; Long Term Outcomes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kaoru Tateno ◽  
Junji Moriya ◽  
Tohru Minamino ◽  
Kentaro Miura ◽  
Naomi Shimizu ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Early Phase ◽  
Rest Pain ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Ischemic Ulcer ◽  
Long Term Follow Up ◽  
Peripheral Artery Diseases

Mononuclear cell (MNC) transplantation for peripheral artery diseases (PAD) has become prevalent. However, long-term outcomes of this novel therapeutic strategy have not been documented in details. We had extended the observation period following peripheral blood (PB) MNC transplantation for severe PAD, and obtained clinical data suggesting beneficial yet caution requiring effect of therapeutic neovascularization. Indications for intervention were severe rest pain (36/42, 86%), ischemic ulcer of lower limbs (30/42, 71%), or severe intermittent claudication compromising their ADL (6/42, 14%). Altogether, 42 patients (34 men, 8 women; average age 61 +/− 14 years) underwent 94 transplantations. Sixty seven percents (28/42) of the patients were diagnosed as arteriosclerosis obliterans (ASO), and the remainders were thromboangiitis obliterans (TAO). Co-morbidities included diabetes (21/42 50%) and chronic renal insufficiency treated by dialysis (19/42 45%). Early phase (~6 months) success, defined by improvement in either rest pain, ischemic ulcer, or walking distance, was achieved in 76% (32/42) of the patients. During the long-term follow up (average 30+/− 10 months range 6 –50 months), 85% (17/20) of the responding patients were safe from the relapse of ischemic ulcers, and 89% (23/26) were maintained rest pain free. Limb salvage was 91 % (4/42) at early phase, and 97 % (33/34) during the late follow up period. While there were no major adverse events seen in the TAO patients, 32% (9/28) of the ASO patients had suffered the progression of atherosclerosis in their long term follow-up. There were 11 deaths among 28 ASO patients (39%) in the same period, which were notably associated with the presence of renal insufficiency. In the group of patients undergoing hemo-dialyses, responses to the treatment seemed to correlate with their prognosis, suggesting that improved QOL by the cell therapy may have some good contribution on their survival. In conclusion, PBMNC transplantation for severe PAD is a safe and durable intervention for non-ASO patients without renal failure. However, careful and discrete case selection, in company with stringent follow up of atherosclerosis, is critically advisable for ASO patients with severe renal insufficiency.

scholarly journals The role of endovascular treatment in unruptured basilar tip aneurysms

2016 ◽  
Vol 23 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Huijian Ge ◽  
Xianli Lv ◽  
Hengwei Jin ◽  
Zhihua Tian ◽  
Youxiang Li ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Endovascular Treatment ◽  
Potential Risk ◽  
Complete Occlusion ◽  
Delayed Hemorrhage ◽  
Hemorrhagic Events ◽  
Occlusion Rate ◽  
The Mean ◽  
Incomplete Occlusion

Objective This study was to evaluate the safety and efficiency of endovascular treatment of unruptured basilar tip aneurysms. Methods We retrospectively reviewed consecutive 79 cases of unruptured basilar tip aneurysms in our center between 2009 and 2014. The patients’ clinical and imaging information were recorded. Complications, initial occlusion rate, clinical outcomes and the predictors were retrospectively analyzed. Results Thirty-five cases received conservative treatment and 44 cases were treated by endovascular embolization. In the conservative treatment group, six (19.4%) of 31 basilar tip aneurysms ruptured and resulted in five deaths (16.1%) during the mean 18.1-month follow-up (range from 1 to 60 months). Among the endovascularly treated cases, 24 (54.5%) achieved initial complete occlusion and no delayed hemorrhagic events occurred during the mean 33.6-month follow-up (range from 10 to 68 months). For 20 (45.5%) incompletely occluded cases, five postoperative or delayed hemorrhagic events and two mass effect events resulted in six deaths. There were no statistical significant differences in hemorrhagic events ( p = 0.732) and mortality ( p = 0.502) between the incomplete occlusion group and untreated group. Large aneurysm size (≥10 mm) was an independent predictor for incomplete occlusion ( p = 0.002), which had a potential risk of postoperative or delayed hemorrhage. On univariate analysis, initial occlusion rate and aneurysm size were found to be associated with clinical outcomes ( p = 0.042 and 0.015). Conclusion Complete occlusion for unruptured basilar tip aneurysm proved to be a safe and effective therapeutic method that could eliminate the potential risk of postoperative or delayed hemorrhage.

scholarly journals An observational study into the management of arteriomegaly: a call for a revised classification system

2012 ◽  
Vol 94 (4) ◽  
pp. 250-255 ◽  
Author(s):  
JV Barandiaran ◽  
TC Hall ◽  
I Glaves ◽  
N El-Barghouti ◽  
EP Perry
Keyword(s):  
Observational Study ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Cerebrovascular Events ◽  
Progression Of Disease ◽  
Artery Disease

INTRODUCTION Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution. METHODS Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed. RESULTS Arteriomegaly was identified in 1.3% of patients (n=69) undergoing lower limb angiography in the study period. Of these, the majority (n=67) were men. The mean age was 74 years (range: 60–89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Fortynine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hoi lier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6–146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up. CONCLUSIONS This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier’s classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity.

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