Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease

Chang, Robert W.; Goodney, Philip P.; Baek, Jennie H.; Nolan, Brian; Rzucidlo, Eva M.; Powell, Richard J.

doi:10.1016/j.jvs.2008.03.042

Cited by 174 publications

(123 citation statements)

References 26 publications

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“…Surgical procedures were as reported in the literature. 7,13,14,33 Most of the procedures (71%) occurred under local anesthesia, and the remaining under general anesthesia. Because of concern of perioperative bleeding complications caused by the use of anticoagulant drugs it is recommended that the use of epidural or spinal anesthesia be avoided.…”

mentioning

confidence: 99%

“…Recently, several investigators have published results on several types of combined treatments for various patterns of iliac, femoral, and infrapopliteal diseases with promising outcomes. [7][8][9][10][11][12][13][14] Most reports discussed hybrid bypass surgery and endovascular surgery. [7][8][9][10][11]13 Although few reported femoral artery endarterectomy combined with iliac artery endovascular therapy, 12,14 which did not include the infrainguinal lesions.…”

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confidence: 99%

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Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Zou

Xia

Yang

et al. 2012

International Surgery

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The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and anklebrachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P = 0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.Key words: Endarterectomy -Interventional radiography -Arteriosclerosis obliteransFemoral artery T he indications for the endovascular treatment of peripheral arterial disease have rapidly increased since the introduction of percutaneous transluminal angioplasty (PTA) and stenting. 1,2 The advantages of the endovascular approach include lower periprocedural morbidity and mortality. Short-term data from Bypass versus Angioplasty trials in Severe Ischemia of the Leg (BASIL) have confirmed this, with similar clinical outcome for the surgical and endovascular approach. Considerable progress has also been made in the endovascular treatment of infrapopliteal arterial occlusion. One study has demonstrated that infrapopliteal angioplasty is a reasonable primary treatment for critical limb ischemia patients with TransAtlantic InterSociety Consensus (TASC) A, B, or C lesions. 4 Due to the multilevel nature of peripheral arterial disease, iliac or femoral lesions accompanied by the femoral artery bifurcation (FB) disease are frequently observed. 5,6 Endovascular surgery is poorly suited to treating lesions in the FB because they are bulky and eccentric. In addition, the location of the lesions makes ipsilateral access difficult and stent placement impossible. As with the common femoral artery, the deep femoral artery is not generally favorable for endovascular surgery because it usually has either an orifice lesion involving the FB or a diffuse lesion along the length of the artery, which is often into its secondary and tertiary branches.Simultaneous hybrid endovascular and open lower extremity arterial reconstructive procedures have the advantage of eliminating the need for major surgery and avoiding separate staged interventions and their associated morbidity. Recently, several investigators have published results on several types of combined treatments for various patterns of iliac, femoral, and infrapopliteal diseases with promising outcomes.7-14 Mos...

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confidence: 99%

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confidence: 99%

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Zou

Xia

Yang

et al. 2012

International Surgery

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“…Сердечно-сосудистые заболевания / Cardiovascular medicine В настоящее время во всем мире для лечения ате-росклеротических поражений подвздошных арте-рий все шире применяются эндоваскулярные вме-шательства, включающие баллонную дилятацию и стентирование [1,2,3,4,5,6,7,8,9,10,11,12]. Однако наряду с ними существует другой малотравматич-ный способ лечения, приобретающий все большую популярность -эндартерэктомия при помощи раз-личных петель и колец (ПЭАЭ).…”

Section: том 4 №5 / 2017unclassified

“…ПЭАЭ возможно выполнять не только при ограниченных окклюзиях и стенозах артерий, но и при продленных. А так же данное вмешательство более радикально, чем эндо-васкулярные операции [1,6,9,10,12].…”

Section: том 4 №5 / 2017unclassified

Surgical Treatment of Atherosclerotic Lesion of Iliac Arteries by Method of Loop Endarterectomy

Gusinskiy¹,

Шломин²,

Rakhmatillaev³

et al. 2017

Transl. med. (Print)

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ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ АТЕРОСКЛЕРОТИЧЕСКИХ ПОРАЖЕНИЙ ПОДВЗДОШНЫХ АРТЕРИЙ МЕТОДОМ ПЕТЛЕВОЙ ЭНДАРТЕРЭКТОМИИ РезюмеАктуальность: петлевая эндартерэктомия (ПЭАЭ) является одним из малотравматичных способов современного лечения атеросклероза артерий нижних конечностей.Цель исследования: определение преимуществ и недостатков эндартерэктомии (ПЭАЭ) подвздошных артерий для более успешного внедрения ее как компонента гибридных технологий.Материалы и методы: изучению подверглись результаты лечения 131 пациента, страдающего облитерирующим атеросклерозом артерий нижних конечностей с преимущественным поражением подвздошных артерий. В раннем и позднем (до 5-7 лет) послеоперационных периодах пациентов изучали при помощи анкетного опроса и ультразвукового ангиосканирования, 23 больным выполнена аортоартериография, 68 -СКТ в режиме «ангио».Результаты: в 107 (81,3%) случаях вмешательство удалось осуществить только из бедренного доступа. Дополнительный доступ в забрюшинное пространство потребовался при выполнении 24 (18,3%) операций. Противопоказания для выполнения ПЭАЭ: выраженный кальциноз с поражением всех слоев сосудистой стенки, гипоплазия, извитость или аневризматические расширения подвздошных артерий, высокая окклюзия брюшной аорты. У этих пациентов шунтирование синтетическим протезом является вмешательством выбора. В раннем послеоперационном периоде произошел тромбоз 5 (3,8%) подвергшихся ПЭАЭ подвздошных артерий. Послеоперационный койко-день составил 8+-2 дня. Пятилетняя выживаемость после ПЭАЭ составила 77,1%.Выводы: 1) Проведенное исследование показало, что ПЭАЭ является перспективным, а может быть и приоритетным вмешательством на подвздошных артериях.2) Отдаленные результаты проходимости подвздошных артерий после ПЭАЭ достоверно выше, чем у синтетических шунтов, установленных в аорто-бедренную позицию.3) Отказ от применения синтетических заменителей или сведение их использования до минимума (только в качестве заплаты) значительно уменьшает опасность инфекционных осложнений.Ключевые слова: облитерирующий атеросклероз артерий нижних конечностей, поражение аорто-бедренного сегмента, хирургическое лечение, ранние и отдаленные результаты, полузакрытая петлевая эндартерэктомия.

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“…It has been suggested that covered stents may be useful for lesions involving the distal aorta and for iliac arteries that are being treated with kissing stents [32,33]. The disadvantage of ePTFE covered stents is the difficult deliverability due to their stiffness, which often requires larger sheaths and may predispose patients to access site complications.…”

Section: Covered Stentsmentioning

confidence: 99%

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

Klein

Feldman

Aronow

et al. 2014

Cathet Cardio Intervent

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Aorto‐iliac arterial occlusive disease is common and may cause a spectrum of chronic symptoms from intermittent claudication to critical limb ischemia. Treatment is indicated for symptoms that have failed lifestyle and medical therapies or occasionally to facilitate other interventional procedures such as TAVR and/or placement of hemodynamic assist devices. It is widely accepted that TASC A, B, and C lesions are best managed with endovascular intervention. In experienced hands, most TASC D lesions may be treated by endovascular methods, and with the development of chronic total occlusion devices, many aorto‐iliac occlusions may be recanalized safely by endovascular means. Interventional cardiologists should be well versed in the anatomy, as well as the treatment of aorto‐iliac disease, given their need to traverse these vessels during transfemoral procedures. Overall, aorto‐iliac occlusive disease is more commonly being treated with an endovascular‐first approach, using open surgery as a secondary option. This document was developed to guide physicians in the clinical decision‐making related to the contemporary application of endovascular intervention among patients with aorto‐iliac arterial disease. © 2014 Wiley Periodicals, Inc.

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Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease

Abstract: Combined CFA endarterectomy with iliac intervention yield acceptable long-term results. The use of stent grafts compared with bare stents is associated with improved primary patency.

Cited by 174 publications

References 26 publications

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Surgical Treatment of Atherosclerotic Lesion of Iliac Arteries by Method of Loop Endarterectomy

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

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