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Dubosq M, Renard R, Jayet J, Mercier L, Javerliat I, Castier Y, Coggia M, Coscas R. Single Primary Retrograde Access to Treat Femoro-Popliteal Occlusive Lesions. J Endovasc Ther 2023:15266028231188868. [PMID: 37515490 DOI: 10.1177/15266028231188868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
INTRODUCTION The retrograde puncture of a distal artery is considered a bailout procedure in case of anterograde approach failure for peripheral artery disease (PAD) treatment. A single primary retrograde access has been suggested as an efficient and safe option. As scant data are available, we present our results using this approach. MATERIAL AND METHODS Between August 2019 and October 2022, we performed this technique in selected patients with femoro-popliteal PAD. Chronic total occlusions (CTOs) were selected on the basis of the CTOP classification. An ultrasound-guided retrograde puncture of a tibial artery at the ankle level was performed, followed by the preferential use of 4F materials. Hemostasis of the puncture site was obtained using manual compression. Postoperative duplex scan examination systematically included an evaluation of the punctured artery. Demographics, intraoperative, and follow-up data were collected retrospectively. The results are expressed as means with standard deviations and numbers with percentages when appropriate. RESULTS In total, 55 procedures were performed in 46 patients (9 bilateral). Of these, 57% (N=26) were considered at risk for femoral puncture (obesity, history of groin surgery, challenging crossover approach) and 54% (N=25) presented with critical limb-threatening ischemia (CLTI). The TASC-II femoro-popliteal classification was generally B (60%) and also C (33%) or D (7%). Mean lesion length was 105.6±49.4 mm and 65% were CTOs. Most patients were operated in an outpatient setting (N=25; 54%) under potentialized local anesthesia (N=41, 89%). The punctured site was the posterior tibial artery in 73% (N=40). The procedure time was 65.1±25.7 minutes, and the fluoroscopy time was 10.7±8.5 minutes. The technical success rate was 100%. There were no intraoperative complications. All patients could walk the same day. One CLTI patient presented an erysipelas related to the puncture in postoperative period. At 30 days, the primary patency of the treated and the punctured arteries were 98% and 100%, respectively. CONCLUSION A single primary retrograde access can be used safely to treat femoro-popliteal PAD. It represents a valuable alternative to the femoral puncture and allows fast ambulation. Prospective and long-term studies on larger populations are necessary to confirm our results. CLINICAL IMPACT This study demonstrates that a single primary retrograde access can be used safely without damaging the punctured artery to treat femoro-popliteal lesions, especially in claudicant patients. Chronic total occlusions can be treated successfully using this technique. This approach represents a valuable alternative to the femoral puncture and allows fast ambulation without risk of major bleeding.
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Affiliation(s)
- Maxime Dubosq
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Régis Renard
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Mercier
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Huici-Sanchez M, Martí-Mestre FJ, Martinez-Rico C, Espinar-Garcia E, Jiménez-Guiu X, Romera-Villegas A, Vila-Coll R. Usefulness of ultrasound-guided tibio-pedal access in patients with critical limb ischemia. Cir Esp 2022; 100:431-436. [PMID: 35523416 DOI: 10.1016/j.cireng.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 04/06/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Retrograde access performed guided by fluoroscopy or ultrasound. We aimed to analyze the usefulness of ultrasound in retrograde access in patients with critical limb ischemia. METHODS Observational analytical study. From December 2013 to June 2019. We included all retrograde accesses that were guided by ultrasound. Our register assesses demographic and clinical data, the vessel used as retrograde access, the procedure performed, the amount of contrast agent used and time of fluoroscopy, access failure, and local complications. RESULTS On 715 procedures performed, was used ultrasound-guided retrograde access in 25 patients (64% men). The mean age was 74.8 years (45-90), with 92% of diabetics and 32% of chronic renal failure. Two patients with Rutherford stage 4 and 23 with stage 5-6. In 24 (96%) patients the ultrasound-guided puncture was successful, while in one (4%) of them, it was not possible to enter the target vessel. After the punch, was achieved the technical success of revascularization in 19 (79.2%) patients, with 5 (20.8%) in whom did not the arterial injury was not overcome. The arteries used as retrograde access were: anterior tibial 11, posterior tibial 10, and peroneal in 4. The mean of contrast used was 63 mL (9-100 mL) with an average time of 43 min (15-76 min). Complications related did not observe in retrograde access. CONCLUSIONS Ultrasound-guided retrograde distal access is an effective method that may use as a bailout method in those endovascular procedures in which it is not possible to cross the lesion anterogradely.
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Affiliation(s)
- Malka Huici-Sanchez
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain.
| | - Francisco Javier Martí-Mestre
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain
| | - Carlos Martinez-Rico
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain
| | - Emma Espinar-Garcia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain
| | - Xavier Jiménez-Guiu
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain
| | - Antonio Romera-Villegas
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain
| | - Ramón Vila-Coll
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain
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Feldman ZM, Mohapatra A. Endovascular Management of Complex Tibial Lesions. Semin Vasc Surg 2022; 35:190-199. [DOI: 10.1053/j.semvascsurg.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022]
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Martin G, Covani M, Saab F, Mustapha J, Malina M, Patrone L. A systematic review of the ipsilateral retrograde approach to the treatment of femoropopliteal arterial lesions. J Vasc Surg 2021; 74:1394-1405.e4. [PMID: 34019987 DOI: 10.1016/j.jvs.2021.04.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The endovascular treatment of femoropopliteal lesions is an integral part of managing peripheral arterial disease. The antegrade approach is the most widely used technique with good evidence for its safety and efficacy. However, crossing a lesion, particularly chronic total occlusions (CTO), can be technically challenging and so the retrograde approach is increasingly used to maximize the chances of procedural success. The objective of this systematic review was, therefore, to assess the safety and effectiveness of the ipsilateral retrograde approach to femoropopliteal lesions. METHODS A systematic review conforming to the PRISMA standards was undertaken. MEDLINE, EMBASE, and The Cochrane Register were searched between January 1, 1988, and January 1, 2020. Full-text, English-language, peer-reviewed articles pertaining to peripheral arterial disease, endovascular intervention and access site were included. RESULTS A total of 8599 articles were screened, of which 38, involving 1940 patients undergoing 2184 retrograde procedures, were included. The mean number of patients per study was 51.1, with three studies including fewer than 10 and four more than 100 patients. The reported follow-up ranged from 30 days to 3 years, and six articles did not report any long-term outcome data. A retrograde approach was used as the primary access route in 45.% of procedures (648/1438) with relevant data. Primary technical success was achieved in 88% (1920/2184; 64%-100%) with a reported complication rate of 11% (235/2117; 0%-27%). Overall, the quality of evidence was poor, with just seven articles deemed to be of high quality with a low risk of bias. A meta-analysis was not deemed appropriate owing to heterogeneity of data. CONCLUSIONS An ipsilateral retrograde approach to femoropopliteal lesions has good primary technical success and a low rate of complications. It has a promising role as a bailout, or even a primary access technique, in complex lesions. Patient positioning, puncture site and technique, lesion anatomy, and the size of catheters and devices used are important considerations to achieve the best outcomes. There remains a paucity of robust evidence for its superiority over traditional antegrade approaches, and further work is required to identify the optimal technique and those patients who would benefit most from the approach.
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Affiliation(s)
- Guy Martin
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Marco Covani
- Faculty of Medicine, University of Messina, Messina, Italy
| | - Fadi Saab
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Mich
| | - Jihad Mustapha
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Mich
| | - Martin Malina
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Lorenzo Patrone
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom
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Stern JR, Connolly PH, Meltzer AJ. Retrograde Endovascular With Intimal Re-Entry Through Endarterectomy: The REWIRE Technique. Ann Vasc Surg 2021; 76:218-221. [PMID: 34004322 DOI: 10.1016/j.avsg.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hybrid lower extremity revascularization has been well described, typically consisting of common femoral endarterectomy (CFE) followed by direct patch puncture and endovascular treatment of any distal disease. We describe a modified technique that obviates the need for endovascular re-entry and simplifies treatment at the proximal and distal endpoints. METHODS The REWIRE technique begins with retrograde arterial access via a patent tibial, pedal or femoropopliteal vessel. The diseased segment is crossed in the subintimal plane. Once the wire reaches the common femoral artery (CFA), the vessel is surgically exposed. Arteriotomy is performed and the wire is externalized during standard CFE. With through-wire access achieved, a sheath is inserted and the distal disease is treated. The proximal extent of the endovascular revascularization is incorporated into a standard CFE with patch angioplasty. RESULTS Seven patients with chronic limb-threatening ischemia were treated with this approach, all with long segment occlusions of the SFA and significant CFA disease. The SFA disease was stented and bovine pericardial patch was used for CFE in all. Technical success was achieved in all patients. There were no complications related to the retrograde puncture site, which was controlled with manual pressure (4) or excluded with a covered stent (3). Thirty-Day freedom from major adverse limb events was 100%. CONCLUSIONS The REWIRE technique is an effective approach to hybrid revascularization involving the CFA. By crossing the occluded segment in a retrograde fashion and surgically externalizing the wire during CFE, the proximal and distal endpoints can be addressed with ease, the profunda femoris is protected under direct visualization, and the need for endovascular re-entry is eliminated.
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Affiliation(s)
| | - Peter H Connolly
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
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Huici-Sanchez M, Martí-Mestre FJ, Martinez-Rico C, Espinar-Garcia E, Jiménez-Guiu X, Romera-Villegas A, Vila-Coll R. Usefulness of ultrasound-guided tibio-pedal access in patients with critical limb ischemia. Cir Esp 2021; 100:S0009-739X(21)00133-0. [PMID: 33972063 DOI: 10.1016/j.ciresp.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 03/20/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Retrograde access performed guided by fluoroscopy or ultrasound. We aimed to analyze the usefulness of ultrasound in retrograde access in patients with critical limb ischemia. METHODS Observational analytical study. From December 2013 to June 2019. We included all retrograde accesses that were guided by ultrasound. Our register assesses demographic and clinical data, the vessel used as retrograde access, the procedure performed, the amount of contrast agent used and time of fluoroscopy, access failure, and local complications. RESULTS On 715 procedures performed, was used ultrasound-guided retrograde access in 25 patients (64% men). The mean age was 74.8 years (45-90), with 92% of diabetics and 32% of chronic renal failure. Two patients with Rutherford stage 4 and 23 with stage 5-6. In 24 (96%) patients the ultrasound-guided puncture was successful, while in one (4%) of them, it was not possible to enter the target vessel. After the punch, was achieved the technical success of revascularization in 19 (79.2%) patients, with 5(20.8%) in whom did not the arterial injury was not overcome. The arteries used as retrograde access were: anterior tibial 11, posterior tibial 10, and peroneal in 4. The mean of contrast used was 63 mL (9-100 ml) with an average time of 43 minutes (15- 76 min). Complications related did not observe in retrograde access. CONCLUSIONS Ultrasound- guided retrograde distal access is an effective method that may use as a bailout method in those endovascular procedures in which it is not possible to cross the lesion anterogradely.
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Affiliation(s)
- Malka Huici-Sanchez
- Servicio de angiología y cirugía vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, España.
| | - Francisco Javier Martí-Mestre
- Servicio de angiología y cirugía vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, España
| | - Carlos Martinez-Rico
- Servicio de angiología y cirugía vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, España
| | - Emma Espinar-Garcia
- Servicio de angiología y cirugía vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, España
| | - Xavier Jiménez-Guiu
- Servicio de angiología y cirugía vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, España
| | - Antonio Romera-Villegas
- Servicio de angiología y cirugía vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, España
| | - Ramón Vila-Coll
- Servicio de angiología y cirugía vascular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Llobregat, España
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Giannopoulos S, Palena LM, Armstrong EJ. Technical Success and Complication Rates of Retrograde Arterial Access for Endovascular Therapy for Critical Limb Ischaemia: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2020; 61:270-279. [PMID: 33358346 DOI: 10.1016/j.ejvs.2020.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Antegrade crossing techniques via transfemoral access are often challenging and may be associated with technical and clinical failure when treating patients with critical limb ischaemia (CLI). The objective of this study was to summarise all available literature regarding retrograde endovascular treatment of patients with CLI and to investigate the technical success and complication rate of retrograde access. METHODS A systematic literature search was performed in PubMed, Scopus, and Cochrane Central until May 2020. A meta-analysis of 31 observational studies (29 retrospective and two prospective; 26 and five studies with low and moderate risk of bias, respectively) was conducted with random effects modelling. The incidence of adverse events peri-procedurally and during follow up were calculated. RESULTS The 31 studies enrolled 1 910 patients who were treated endovascularly for femoropopliteal and/or infrapopliteal lesions causing CLI. Most of the patients had diabetes while more than half of the overall population had coronary artery disease and dyslipidaemia. All lesions were located in the infra-inguinal segment and most were chronic total occlusions (96%; 95% CI 85%-100%). Seven studies reported moderate or severe calcification in approximately half of the cases (45%; 95% CI 30%-60%). The overall technical success of the retrograde approach was 96% (18 studies; 95% CI 92%-100%). Perforation, flow limiting dissection, distal embolisation, and local haematoma at the retrograde access site were infrequent and observed in 2.1%, 0.6%, 0.1%, and 1.3% of the patients, respectively. The six month primary patency rate was 78% (five studies; 95% CI 46%-99%), the six month limb salvage rate was 77% (four studies; 95% CI 70%-84%). CONCLUSION The results indicated that the retrograde or bidirectional antegrade/retrograde approach is safe and effective and facilitates angioplasty when antegrade treatment fails. However, prospective studies with standardised wound care and surveillance protocols are needed to investigate retrograde techniques in patients with CLI who failed antegrade revascularisation, to improve long term limb salvage and survival.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Centre, University of Colorado, Denver, CO, USA
| | - Luis M Palena
- Endovascular Surgery Unit, Endovascular Interventions & Research, Foot & Ankle Clinic, Maria Cecilia Hospital, Cotignola, Italy
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Centre, University of Colorado, Denver, CO, USA.
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Retrograde Pedal Access via Occluded Arteries in Endovascular Treatment of Critical Limb Ischemia. J Vasc Interv Radiol 2020; 32:164-172. [PMID: 33248916 DOI: 10.1016/j.jvir.2020.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the feasibility and technical outcomes of retrograde access via occluded pedal arteries in endovascular treatment of critical limb ischemia (CLI) when the conventional antegrade approach fails. MATERIALS AND METHODS One hundred fifty-one patients with CLI (age 69 y ± 10.5; 116 men) who were not surgical candidates and were treated via retrograde pedal access between January 2016 and January 2018 were evaluated retrospectively. Seventy patients in whom retrograde access was performed through occluded arteries constituted the occluded group, and 81 patients who were treated via retrograde access from patent arteries constituted the nonoccluded group. Pedal access success, lesion crossing success, angiographic success, overall technical success, and procedure-related complications were evaluated and compared between groups. RESULTS Pedal access success (74 of 78 vs 83 of 87 attempts; P = .873) and lesion crossing success (64 of 78 vs 77 of 87 lesions; P = .340) were comparable between subgroups. Angiographic success (54 of 78 vs 77 of 87 lesions; P = .012) and overall technical success (48 of 70 vs 72 of 81 patients; P = .004) rates were lower in the occluded group. Procedure-related complications were similar between groups (P = .096). CONCLUSIONS Retrograde pedal access from occluded pedal arteries is a feasible option when an antegrade approach fails in endovascular treatment of CLI. Although it has lower technical success, its use enables angiosome-directed therapy and has the potential to improve the outcomes of the procedure.
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Kuserli Y, Kavala AA. Retrograde Popliteal Access and Balloon Dilatation of Chronic Total Occlusion of Superficial Femoral Arteries. Ann Vasc Surg 2019; 64:253-262. [PMID: 31634601 DOI: 10.1016/j.avsg.2019.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the effectiveness of retrograde popliteal access in subjects with chronic total occlusion of the superficial femoral artery. METHODS A retrospective review of subjects who underwent balloon dilatation via retrograde popliteal access (RPA) is included. Age, gender, tobacco use, comorbid diseases, body mass index, ejection fraction, claudication distance (0 to 50 meters, 50 to 100 meters and 100 to 150 meters), preoperative Rutherford scale, and Ankle-brachial index (ABI) are noted for each subject. A duplex ultrasound (DUS) was performed preoperatively. The localization side of the lesion (right-left), the length of the atherosclerotic segment, and the localization of the diseased segment (proximal superficial femoral artery [SFA], mid-SFA, distal SFA, popliteal-above the knee) were noted. Subjects were followed for at least one year after the procedure. Subjects were reevaluated in the first, 6th, and 12th months after the procedure. In control subjects, Rutherford class and ABI were noted. A DUS was performed to detect restenosis. The subjects' preoperative Rutherford class and ABI and restenosis degree were compared with their postoperative values. RESULTS A total of 93 subjects (75.3% male, 24.7% female; mean age 68.57 ± 8.70 years old) were evaluated. In all 93 (100%) subjects, successful RPA was achieved. Overall, balloon dilatation via RPA was successful in 86 (92.47%) of the 93 subjects. The procedural success rate was 92.47%. The occluded segment was on the right side in 49.5% of the subjects (n = 46) and on the left side in 50.5% (n = 47) of the subjects. The mean length of the lesion was 10.77 ± 2.21 cm, and the average stenosis degree was 95.9 ± 5.05%. The localization of the occluded segment was in the proximal SFA, mid SFA, distal SFA and popliteal above the knee in 45.2%, 50.5%, 25.8% and 10.8% of the patients, respectively.When comparing the successful and unsuccessful groups, target lesion length (10.48 ± 2.01 vs. 14.43 ± 0.79, P < 0.001), mid-SFA localization (n = 40 vs. n = 7, P = 0,012) and claudication distance in the first 50 meters (P = 0,003) were significantly higher in subjects with failed balloon dilatation via RPA. When the Rutherford scale was examined, the mild, moderate, and severe claudication ratios were 23.7%, 29%, and 47.3%, respectively. After the procedure, 61.3% of the cases were asymptomatic, and 38.7% had mild claudication. The change in the Rutherford scale was statistically significant (P < 0,001). When the ABI measurements were examined before procedure, it increased from 0.63 ± 0.08 before to 0.90 ± 0.06 after the procedure, indicating a statistically significant difference (P < 0,001). When Doppler findings were examined, in the successful RPA group, the no-stenosis percentages were 82.6%, 72.1%, and 65.1 at the first, 6th, and 12th month follow-up, respectively. The mean disease-free survival time was 9.80 ± 0.39 months. In the first year, subjects were divided according to stenosis degree. Subjects with less than 50% stenosis were compared with subjects with more than 50% stenosis to detect the preprocedural characteristics that affect the restenosis degree. Tobacco use, chronic obstructive pulmonary disease, hyperlipidemia, chronical renal insufficiency, and popliteal above the knee localization were significantly higher in subjects who had more than 50% stenosis 1 year after the procedure (P = 0.009, P = 0.015, P = 0.044, P = 0.001, and P = 0.017, respectively). CONCLUSIONS RPA under DUS guidance is an effective method. RPA has high procedural success rate with low morbidity. Longer target lesion length, mid-SFA localization, and claudication distance in first 50 meters found to be related factors with RPA balloon dilatation failure. Restenosis rates after 12 months of follow-up is low and comparable with literature.
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Affiliation(s)
- Yusuf Kuserli
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Aycan Kavala
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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