1
|
Mukhamadeev IS, Oborin AA, Danilov VN, Vronskiĭ AS. [Results of loop endarterectomy and femoropopliteal bypass grafting in TASC C and D lesions]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:107-112. [PMID: 33825736 DOI: 10.33529/angio2021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The aim of our investigation was to analyse the results of treatment of patients with atherosclerotic lesions of the femoropopliteal segment by means of femoropopliteal bypass grafting or loop endarterectomy within the framework of a single-centre retrospective study. PATIENTS AND METHODS The study included a total of 177 patients who were divided into two groups. Group One was composed of 108 patients subjected to loop endarterectomy from the arteries of the femoropopliteal segment, and Group Two comprised 69 patients who endured femoropopliteal bypass surgery using a synthetic graft. RESULTS Thoroughly analysed were the clinical, demographic, anatomical and perioperative data, as well as intra- and perioperative complications, followed by assessment of primary and secondary patency, with no statistically significant differences in these parameters revealed. Secondary patency was somewhat better in the group of loop endarterectomy. Also determined and examined were specific complications such as insufficient extraction of the plaque, perforation of the artery with the loop, thinning of the wall, detachment of the calcified plaque. This is followed by discussing variants of correction of similar events. In the group of loop endarterectomy, there were no severe complications, such as myocardial infarction, stroke, amputation in the early postoperative period. CONCLUSION Loop endarterectomy is an acceptable alternative to femoropopliteal bypass grafting with a synthetic prosthesis. Taking into account all specific complications, it is possible to achieve minimization of unsuccessful outcomes.
Collapse
Affiliation(s)
- I S Mukhamadeev
- Department of Cardiovascular Surgery, Perm Regional Clinical Hospital, Perm, Russia
| | - A A Oborin
- Chair of Cardiovascular Surgery, Perm State Medical University named after Academician E.A. Wagner under the RF Ministry of Public Health, Perm, Russia
| | - V N Danilov
- Department of Cardiovascular Surgery, Perm Regional Clinical Hospital, Perm, Russia
| | - A S Vronskiĭ
- Department of Hospital Surgery, Perm State Medical University named after Academician E.A. Wagner under the RF Ministry of Public Health, Perm, Russia
| |
Collapse
|
2
|
Mukhamadeev IS, Oborin AA. [Efficacy of using loop endarterectomy]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:182-188. [PMID: 30994626 DOI: 10.33529/angio2019125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endarterectomy is considered to be the most physiological technique of correcting arterial blood flow, since it does not require implantation of a synthetic material, with blood flow restored through its own bed. However, surgeons have long sought to work out the most effective modification of endarterectomy, which eventually resulted in creation of a method known as loop endarterectomy. Mention should be made that some researchers report patency which may be comparable to that of autovenous bypass grafting, while others report negative results of using loop endarterectomy. Such ambiguous findings have impelled the authors to carry out a scrupulous study of the data available in scientific literature. The presented review discusses advantages and shortcomings of loop endarterectomy, also analysing possible complications in loop endarterectomy (causes, probability of occurrence, etc.). Also discussed herein is the problem concerning a combination of loop endarterectomy and roentgen-endovascular stenting.
Collapse
Affiliation(s)
- I S Mukhamadeev
- Department of Cardiovascular Surgery, Perm Regional Clinical Hospital, Perm, Russia
| | - A A Oborin
- Perm State Medical University named after Academician E.A. Wagner, Perm, Russia
| |
Collapse
|
3
|
Creation of an Extraluminal Arterial Bypass Graft Using a Commercially Available Self-Expanding Stent Graft: Feasibility Study in a Porcine Model. Cardiovasc Intervent Radiol 2017; 40:1447-1453. [PMID: 28474113 DOI: 10.1007/s00270-017-1672-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to assess the technical feasibility of ultrasound-guided endovascular creation of a percutaneous extraluminal arterial bypass graft without a surgically created arterial anastomosis. MATERIALS AND METHODS Nine swine were utilized for this IACUC-approved study using a carotid bypass model in swine. Using sonographic guidance, percutaneous access was obtained to the proximal and distal common carotid artery. A self-expanding stent graft was advanced through the proximal carotid access site, tunneled subcutaneously, then advanced through the distal carotid access site, and deployed. The stent grafts were monitored weekly for patency using ultrasound. Angiography was performed at 4 weeks to evaluate for graft patency. Gross pathologic analysis was performed on the explanted stent grafts. RESULTS In eight out of the nine swine (89%), percutaneous extraluminal bypass graft creation was technically successful, with brisk flow through the stent graft to the distal circulation, complete exclusion of the bypassed segment of carotid artery, and no extravasation. The technical failure was due to stent graft maldeployment. Of the six swine evaluated for patency, four grafts were patent at the 4-week end point. Both occluded stent grafts were due to extraluminal extrusion of one end, likely related to neck movement and growth in neck length. CONCLUSION The percutaneous arterial bypass technique had a high technical success rate and a graft patency rate of 67% at 4 weeks, with early occlusions possibly related to limitations of the animal model.
Collapse
|
4
|
Karathanos C, Spanos K, Saleptsis V, Antoniou GA, Koutsias S, Giannoukas AD. Single-Center Experience With Remote Endarterectomy for the Treatment of Long-Segment Superficial Femoral Artery Occlusion: Long-Term Results. Vasc Endovascular Surg 2015; 49:250-5. [PMID: 26647429 DOI: 10.1177/1538574415617555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Remote endarterectomy (RE) is a relatively minimally invasive procedure as an alternative to femoropopliteal above-knee bypass for the treatment of long-segment superficial femoral artery (SFA) occlusion. The objective of this study was to report our experience and to evaluate the long-term outcome. DESIGN Single-center nonrandomized retrospective study with prospective collection of patients' data. METHODS Twelve patients (11 men; mean age 72 years, range 55-81 years) with long (>10 cm) SFA occlusion underwent RE followed by stent (aSpire) placement at the distal end of the endarterectomy. All patients had at least 2 tibial vessels outflow. Indications were severe claudication in 9 (75%), rest pain in 1(8%), and gangrene in 2 (17%) cases. Technical, hemodynamic success rates and clinical improvement were recorded. Assessment of patency and limb loss was made at a mean follow-up of 50 months (range 12-66 months). RESULTS Technical success rate was 100%. Immediate hemodynamic and clinical improvement were 92% and 75%, respectively. The mean increase in the Ankle-Brachial pressure index was 0.24. The primary, primary-assisted, and secondary patency rates were 50%, 83%, and 100%, respectively. The perioperative mortality rate was 8% (one death due to myocardial infarction). There was no early (30-day) reocclusion. During the follow-up, 5 (41.6%) cases underwent 7 reinterventions, all by endovascular means. The amputation rate was 16% (2 of 12). CONCLUSIONS The RE for long SFA occlusion is a feasible procedure with acceptable short- and long-term outcomes in the presence of distal arterial outflow. Good long-term patency and limb salvage can be achieved with close surveillance and with the compensation of endovascular reintervention procedures.
Collapse
Affiliation(s)
- Christos Karathanos
- Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Vassileios Saleptsis
- Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Georgios A Antoniou
- Royal Liverpool University Hospital, Liverpool Vascular and Endovascular Service, Liverpool, United Kingdom
| | - Stylianos Koutsias
- Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| |
Collapse
|
5
|
Antoniou GA, Koutsias S, Antoniou SA, Giannoukas AD. Remote endarterectomy for long segment superficial femoral artery occlusive disease. A systematic review. Eur J Vasc Endovasc Surg 2008; 36:310-8. [PMID: 18538596 DOI: 10.1016/j.ejvs.2008.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 04/10/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Remote endarterectomy is a minimally invasive procedure which combines open and endovascular surgery for the treatment of long segment superficial femoral artery (SFA) occlusive disease. We conducted a systematic review of the medical literature to analyze the indications, technical limitations and the outcome of remote SFA endarterectomy (RSFAE). METHODS The English literature was searched using the MEDLINE electronic database up to February 2008. We considered studies comprising at least 10 patients treated with RSFAE and reporting on the primary and/or secondary patency rates. Average primary and secondary patency rates were obtained by weighting the data of each study by the number of limbs treated. RESULTS Our search identified 19 retrospective or prospective case series; no randomized controlled trials comparing RSFAE with another treatment modality were identified. The average technical success rate was 94% and the procedure-related complication rate was 14.7%. The weighted mean cumulative primary patency rates were 60%, 57% and 35% at 1, 2 and 5 years, respectively. The weighted mean assisted primary patency rates were 75%, 77% and 50% at 1, 2 and 5 years, respectively. The weighted mean secondary patency rates were 88% and 62% at 1 and 2 years, respectively. CONCLUSIONS RSFAE has acceptable short-, medium- and long-term results but patients should undergo intensive surveillance postoperatively. Randomized controlled trials are needed to assess the durability of this procedure as compared to conventional open bypass surgery.
Collapse
Affiliation(s)
- G A Antoniou
- Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, Larissa, Greece
| | | | | | | |
Collapse
|
6
|
Pokrovsky AV, Savrasov GV, Danilin EI, Chepelenko GV, Antusevas AF, Kavaliauskiene Z. Ultrasonic endarterectomy for long superficial femoral artery atherosclerotic occlusive disease. Eur J Vasc Endovasc Surg 2006; 32:657-62. [PMID: 16935533 DOI: 10.1016/j.ejvs.2006.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Accepted: 07/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To report the long term results of ultrasonic superficial femoral artery endarterectomy (USFAE). DESIGN Retrospective study. PATIENTS AND METHODS From January 1998 to June 2004 218 USFAE were performed in 202 selected patients (178 males, 192 procedures) with a median age of 65 years (46-87 years). Indications for operation were disabling intermittent claudication in 137 procedures (68%), rest pain in 24 procedures (12%), and limb salvage in 41 procedures (20%). The new medical technology of ultrasonic endarterectomy is based on the application of the mechanical vibrations in the range of low frequency ultrasound. The ultrasonic device consists of the ultrasonic generator, acoustic unit and the flexible wave concentrators with special working tips in the shape of a ring. Follow up consisted of clinical evaluation, ankle-brachial index measurements and duplex scanning. RESULTS The mean follow-up time was 30.1 months. The mean length of the endarterectomised SFAs was 29 cm (range, 15-43 cm). The five year cumulative primary patency rate by means of life table analysis was 45.8 +/- 4.4% (SE). Percutaneous transluminal balloon angioplasty and surgical re-interventions were performed in thirty three and five patients respectively resulting in a primary assisted patency rate of 57.5 +/- 4.1%. The five year secondary patency rate was 65.6 +/- 3.8%. Limb salvage was achieved in 35 of the 41 patients with gangrene. CONCLUSIONS The long term results of ultrasonic SFA endarterectomy suggest this is an effective technique.
Collapse
Affiliation(s)
- A V Pokrovsky
- Department of Vascular Surgery A. Vishnevsky Institute of Surgery, Moscow, Russia
| | | | | | | | | | | |
Collapse
|
7
|
Knight JS, Smeets L, Morris GE, Moll FL. Multi Centre Study to Assess the Feasibility of a New Covered Stent and Delivery System in Combination with Remote Superficial Femoral Artery Endarterectomy (RSFAE). Eur J Vasc Endovasc Surg 2005; 29:287-94. [PMID: 15694803 DOI: 10.1016/j.ejvs.2004.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the feasibility and efficacy of an innovative new covered stent and adjustable deployment system (aSpire Covered Stent, Vascular Architects Inc., San Jose, CA, USA) in combination with remote superficial femoral artery endarterectomy (RSFAE) for the treatment of long segment femoropopliteal occlusive disease. DESIGN Prospective multi-centre trial. MATERIALS AND METHODS Sixty-two limbs in 61 patients (41 men; median age 69 years, range 40-88) with severe disabling claudication (n=56) or critical limb ischaemia (n=6) were treated in five European centres with aSpire stenting after RSFAE for long segment occlusions (mean length 25 cm). Follow-up was by duplex scanning at 1-, 6-, 12- and 18-months. Primary, primary-assisted and secondary patency rates were analysed. RESULTS The median follow-up was 17 (range 2-34) months. A mean of 1.3 stents (range 1-3) were deployed with a median stent diameter of 7 mm (range 6-9). There were one early and 24 late failures. At 18-months the cumulative primary, primary-assisted and secondary patency rates were 60, 70 and 72%, respectively. There were no device related adverse events, such as kinking or fracturing and no stent migrations. CONCLUSIONS The aSpire stent and the delivery system are both safe and feasible in combination with RSFAE. The mid term follow-up appears favourable in view of the long segment occlusions treated. Further follow-up is required to compare the mid- and long-term outcomes with current stents and conventional femoropopliteal bypass.
Collapse
Affiliation(s)
- J S Knight
- Department of Vascular Surgery, Southampton General Hospital, Southampton, UK
| | | | | | | |
Collapse
|
8
|
Smeets L, Ho GH, Hagenaars T, van den Berg JC, Teijink JAW, Moll FL. Remote endarterectomy: first choice in surgical treatment of long segmental SFA occlusive disease? Eur J Vasc Endovasc Surg 2003; 25:583-9. [PMID: 12787704 DOI: 10.1053/ejvs.2002.1921] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to report the long term results of remote superficial femoral artery endarterectomy (RSFAE) with the MollRing Cutter for the treatment of long segmental SFA occlusive disease. DESIGN retrospective open study. PATIENTS AND METHODS from March 1994 to August 2000 183 RSFAEs were performed in 164 selected patients (105 males, 120 procedures) with a median age of 63 years (43-84 years). Indications for operation were disabling intermittent claudication in 129 procedures (70%), rest pain in 20 procedures (11%), and limb salvage in 34 procedures (19%). Follow up consisted of clinical evaluation, ankle-brachial index measurements and duplex scanning. RESULTS the mean follow-up time was 29.3 months. The mean length of the endarterectomised SFAs was 31 cm (range, 17-45cm). The five year cumulative primary patency rate by means of life table analysis was 37.8+/-6.67% (SE). Percutaneous transluminal balloon angioplasty and surgical re-intervention were performed in twenty-nine and four patients respectively resulting in a primary assisted patency rate of 47.9+/-6.27%. Limb salvage was achieved in 30 of the 34 patients. Females had a statistically significant lower primary patency rate, i.e., 26 vs 45% (p -value=0.01). CONCLUSIONS the long term results of remote SFA endarterectomy show that it is a safe, effective and durable, minimally invasive procedure. It also leaves open all other options for conventional bypass procedures. The five-year primary patency rate is at least similar to prosthetic above-knee bypass surgery.
Collapse
Affiliation(s)
- L Smeets
- Department of Vascular Surgery, Atrium Hospital, Heerlen, The Netherlands
| | | | | | | | | | | |
Collapse
|
9
|
Giudice R, Scoccianti M. Simple technique to decrease total clamping time during combined iliac and femoral endovascular procedures. J Endovasc Ther 2003; 10:126-9. [PMID: 12751943 DOI: 10.1177/152660280301000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe an alternative method of gaining vascular access while preserving blood flow to the profunda femoral artery during combined iliac and superficial femoral artery (SFA) recanalization. TECHNIQUE A sheath is introduced through the occluded SFA to reduce the total ischemic time when both the external iliac artery and SFA are obstructed. After iliac stenting and remote endarterectomy of the SFA with stent-graft deployment, blood flow to the profunda is interrupted only briefly when the proximal anastomosis of the femoral endobypass is completed. CONCLUSIONS Sheath insertion into the proximal portion of an occluded SFA can be an effective option in reducing ischemic time when dealing with combined iliac and femoral endovascular procedures.
Collapse
Affiliation(s)
- Rocco Giudice
- Division of Vascular Surgery, Endovascular Surgery Unit, S. Giovanni-Addolorata Hospital Complex, Rome, Italy
| | | |
Collapse
|
10
|
Giudice R, Scoccianti M. Simple Technique to Decrease Total Clamping Time During Combined Iliac and Femoral Endovascular Procedures. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0126:sttdtc>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|