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Title: Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage

Abstract

We report a novel application of balloon angioplasty to recanalise a chronically occluded remote endarterectomy superficial femoral artery. This patient previously had two occluded surgical bypass grafts in an attempt to revascularise the limb and presented with critical limb ischaemia and necrotic foot ulcerations. Following the angioplasty, the patient showed significant improvement in rest pain and healing of the ulcerations. This technique may be useful for limb salvage in patients where surgical options have been exhausted.

Authors:
 [1]; ;  [2];  [1]
  1. King’s College Hospital, Department of Radiology (United Kingdom)
  2. King’s College Hospital, Department of Vascular Surgery (United Kingdom)
Publication Date:
OSTI Identifier:
22645330
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 2; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; BALLOONS; BYPASSES; FEET; GRAFTS; HEALING; PAIN; PATIENTS; SURGERY

Citation Formats

Husainy, Mohammad Ali, E-mail: m.husainy@nhs.net, Slim, Hani, Rashid, Hisham, and Huang, Dean Y. Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage. United States: N. p., 2017. Web. doi:10.1007/S00270-016-1499-7.
Husainy, Mohammad Ali, E-mail: m.husainy@nhs.net, Slim, Hani, Rashid, Hisham, & Huang, Dean Y. Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage. United States. doi:10.1007/S00270-016-1499-7.
Husainy, Mohammad Ali, E-mail: m.husainy@nhs.net, Slim, Hani, Rashid, Hisham, and Huang, Dean Y. Wed . "Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage". United States. doi:10.1007/S00270-016-1499-7.
@article{osti_22645330,
title = {Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage},
author = {Husainy, Mohammad Ali, E-mail: m.husainy@nhs.net and Slim, Hani and Rashid, Hisham and Huang, Dean Y.},
abstractNote = {We report a novel application of balloon angioplasty to recanalise a chronically occluded remote endarterectomy superficial femoral artery. This patient previously had two occluded surgical bypass grafts in an attempt to revascularise the limb and presented with critical limb ischaemia and necrotic foot ulcerations. Following the angioplasty, the patient showed significant improvement in rest pain and healing of the ulcerations. This technique may be useful for limb salvage in patients where surgical options have been exhausted.},
doi = {10.1007/S00270-016-1499-7},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 40,
place = {United States},
year = {Wed Feb 15 00:00:00 EST 2017},
month = {Wed Feb 15 00:00:00 EST 2017}
}
  • Purpose: To evaluate the treatments of a short-segment atherosclerotic stenosis in the superficial femoral arteries with the cutting balloon angioplasty (CBA) versus conventional balloon angioplasty [percutaneous transluminal angioplasty (PTA)] in a randomized controlled trial. Material and Methods: The study group comprised 60 patients (33 men, 27 women; average age 64 years) with a short ({<=}5 cm) focal SFA de novo atherosclerotic stenosis associated with a history of intermittent claudication or rest pain. The primary end point of this study was the rate of binary restenosis in the treated segment 12 months after the intervention. All patients were evenly randomized tomore » either the PTA or CBA treatment arms. Follow-up angiograms and ankle-brachial index (ABI) measurements were performed after 12 months. The evaluation of the restenosis rates and factors influencing its occurrence were calculated by logistic regression analysis. Results: In the intention-to-treat analysis, restenosis rates after 2-month follow-up were 9 of 30 (30 %) in the PTA group and 4 of 30 (13 %) in the CBA group (p = 0.117). In the actual treatment analysis, after exclusion of patients who required nitinol stent placement for a suboptimal result after angioplasty alone (5 patients in the PTA group and none in the CBA group), restenosis rates were 9 of 25 (36 %) and 4 of 30 (13 %), respectively (p = 0.049). In the intention-to-treat analysis there were also significant differences in ABI values between the PTA and CBA groups at 0.77 {+-} 0.11 versus 0.82 {+-} 0.12, respectively (p = 0.039), at 12 months. Conclusion: Based on the presented results of the trial, CBA seems to be a safer and more effective than PTA for treatment of short atherosclerotic lesions in the superior femoral artery.« less
  • No abstract prepared.
  • In-stent re-stenosis is a frequent complication of endovascular stents, especially in the superficial femoral artery (SFA). Endovascular re-intervention of in- or peri-stent occlusive disease consists of recanilization through the occluded stent. In our case report, we describe the endovascular treatment of a previously placed stent in the SFA. We unintentionally passed the affected stent subintimally, in a double barrel fashion next to the first stent. The procedure was without any complications and with a successful angiographic result. At one year follow-up the patient still has no complaints and the stent is still patent.
  • Purpose: To evaluate the safety and long-term results after laser angioplasty of short occlusions of the superficial femoral artery (SFA). Methods: In a prospective trial in 312 patients with short occlusions of the SFA excimer laser angioplasty for recanalization was applied. The average occlusion length of the SFA was 7.5 cm (range 1-10 cm). The recanalization attempt was done using either a cross-over technique from the contralateral femoral artery(278 patients), antegrade technique (16 patients) or transpopliteal technique(18 patients). Results: Percutaneous transluminal laser angioplasty (PTLA) produced successful recanalization of the SFA in 286 of 312 patients (91.7%). In 26 patients (8.3%)more » recanalization was not possible.The reason for the unsuccessful PTLAs was obstructing calcified material n = 8) which was resistant to laser application. In nine cases obstructing calcifications resulted in positioning of the laser catheter in subintimal tissue or perforation of the SFA. In another four patients there was an aberrant anatomy of the SFA which resulted in a direct vessel injury after advancing the laser catheter. In five patients subintimalrecanalization failed. After a follow-up period of 36 months there was a primary, primary assisted and secondary patency rate of 49.2%, 76.5% and 86.3%.Conclusion:Excimer laser angioplasty of short occlusions of the SFA is a feasible procedure with a low failure rate.Long-term results are promising but additional interventions are required inmost patients to achieve a patency rate of 86.3% after 3 years. Further studies are needed to compare the clinical outcome of PTLA and PTA in short occlusions of the SFA.« less
  • We report the successful angioplasty of an acute arterial narrowing after suture-mediated closure (SMC) of a femoral arterial puncture. A 75-year-old woman underwent a cerebral arteriogramvia a right common femoral artery puncture. The arteriotomy site was closed with a SMC device. Four days after placement the patient complained of pain in her right calf after walking. An arteriogram 7 days after SMC showed a severe focal stenosis at the origin of the superficial femoral artery involving the presumed puncture site. The lesion was successfully treated with balloon angioplasty. The patient at 6 months was asymptomatic.