The SAFARI technique or Subintimal Arterial Flossing with Antegrade-Retrograde Intervention is an endovascular procedure that allows recanalization of Chronic Total Occlusive (CTO) lesions when conventional subintimal angioplasty is unsuccessful. Retrograde access is usually obtained through the popliteal, anterior tibial, dorsalis pedis artery, or posterior tibial arteries and may potentially provide more options for endovascular interventions in limb salvage. The case of an 81-year-old man with a history of uncontrolled hypertension, diabetes mellitus, and dyslipidemia is presented. He presented with a cutaneous ulcer on the right lower limb with torpid evolution and poor healing. The Doppler ultrasound and arteriographic study revealed a CTO lesion of the popliteal artery that was not a candidate for antegrade endovascular revascularization, but was successfully treated using the SAFARI technique. The patient had no perioperative complications, the wound showed better healing, and he was discharged with an indication of daily dressings and control by an external outpatient clinic.
Esta obra está bajo una Licencia Creative CommonsAtribución 4.0 Internacional.
Introduction There is currently no universal and uniform pattern of peripheral arterial disease (PAD) in the lower limbs; however, it is influenced by various cardiovascular factors of the individual. The objective of this study was to identify the arteriographic patterns of PAD in the lower limbs according to cardiovascular factors in a Peruvian cohort of patients. Methods This is an analytical, observational, and retrospective study. The arteriographic patterns of PAD in the aortoiliac segment were analyzed with the TransAtlantic InterSociety Consensus (TASC-II) score and the Global Anatomic Staging System (GLASS) for the femoropopliteal (FP), infraopopliteal (IP), and pedial (P) segments in a Peruvian cohort from January 2018 to May 2021. Results 595 patients (833 extremities) were analyzed with a mean age of 67.54 ± 16.39 years, and the main cardiovascular factor was diabetes (65.04%). The patients older than 65 years with GLASS FP 4 (p = 0.042), IP 0 (p = 0.004), and P2 ( p = 0.047) presented significant findings: in men and women with GLASS IP 4 ( p = 0.031) and P 2 ( p = 0.045); diabetes with TASC-II A ( p = 0.031), GLASS FP 4 ( p = 0.038), IP 4 ( p = 0.009), and P2 ( p = 0.003); dyslipidemia with TASC-II D ( p = 0.027), GLASS FP 4 ( p = 0.038), IP 0 ( p = 0.009), and P0 ( p = 0.003); smoking with TASC-II D ( p = 0.001), GLASS FP 4 ( p = 0.049) and IP 0 ( p = 0.008); chronic coronary disease with GLASS IP 4 ( p = 0.049) and P2 ( p = 0.037); chronic kidney disease with GLASS FP 4 ( p=0.047), IP 4 ( p = 0.004), and P2 ( p = 0.016); and previous amputation history with GLASS IP 4 ( p = 0.015) and P2 ( p = 0.039). The most frequent arteriographic pattern of PAD in the lower limbs of our cohort was TASC-II A, GLASS FP 0 and 4, IP 0, and P2 ( p = 0.047). Conclusion Our work will allow the limb salvage teams to understand the behavior of PAD affectation in the population of our environment, allowing a timely control of cardiovascular risk factors, adequate revascularization planning, and a significant reduction in the risk of loss of limb.
Esta obra está bajo una Licencia Creative CommonsAtribución 4.0 Internacional.
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