Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia

Soares, Rafael de Athayde; Matielo, Marcelo Fernando; Neto, Francisco Cardoso Brochado; Cury, Marcus Vinícius Martins; Marques, Régis Campos; Sacilotto, Roberto

doi:10.1016/j.jvs.2016.04.020

Cited by 23 publications

(14 citation statements)

References 20 publications

(21 reference statements)

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“…These findings differ from those of a previous study undertaken in our department, in which de Athayde Soares et al. 11 investigated whether the number of infrapopliteal arteries undergoing endovascular treatment was associated with the limb salvage rate in patients with critical limb ischemia. The conclusion drawn was that it is not necessary to treat the largest number of arteries possible in these patients.…”

Section: Discussioncontrasting

confidence: 99%

Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease

Soares

Matielo

Neto

et al. 2019

JRSM Cardiovascular Disease

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ObjectivesIn this paper, we report the long-term outcomes of the endovascular treatment of femoropopliteal occlusive disease, focusing on the importance of calcification and runoff outflow on limb salvage and patency, and the factors associated with these outcomes at a single center.MethodsThis retrospective cohort study included consecutive patients with femoropopliteal occlusive who underwent femoropopliteal angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between January 2015 and July 2017.ResultsIn total, 86 femoropopliteal occlusive angioplasties were performed in 86 patients, with an initial technical success rate of 95.34%. The mean ± standard deviation follow-up time was 880 ± 68.84 days. The analysis was performed at 720 days. Technical failure occurred in four patients, who were excluded from the analysis, leaving 82 patients and 82 femoropopliteal occlusive angioplasties. The estimated primary patency, secondary patency, limb salvage, and overall survival rates at 720 days were 60%, 96%, 90%, and 82.5%, respectively. In univariate and multivariate analyses, Cox regression showed worse primary patency rates in patients with one tibial vessel or isolated popliteal artery runoff (p = 0.005), calcification grade 4 (p = 0.019), calcification grade > 2 (p = 0.017), small vessel diameter < 4 mm (p = 0.03) or primary angioplasty without stenting (p = 0.021). A univariate analysis showed worse limb salvage in patients with one tibial vessel or isolated popliteal artery runoff (p = 0.039).ConclusionsIn this study, the main factors associated with worse outcomes in the endovascular treatment of femoropopliteal occlusive in terms of loss of primary patency were one tibial vessel or isolated popliteal artery runoff, calcification grade 4, or calcification grade > 2, small vessel diameter < 4 mm, and no stents use. One tibial vessel or isolated popliteal artery runoff was also associated with limb loss in a univariate Cox regression analysis.

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Section: Discussioncontrasting

confidence: 99%

Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease

Soares

Matielo

Neto

et al. 2019

JRSM Cardiovascular Disease

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“…23 These findings were confirmed by other authors. 47,48 Kobayashi et al, in a retrospective study on 137 limbs in 123 CLTI patients with lesions in both the anterior and the posterior tibial arteries, compared clinical outcomes in single versus dual tibial arteries endovascular treatment. They found that in the group of double tibial arteries treatment, the wound healing rate was significantly higher, the time to wound healing was shorter, and the repeat peripheral vascular intervention rate was lower.…”

Section: Single or Multivessel Infrapopliteal Revascularization: Whatmentioning

confidence: 99%

“…51,52 On the other hand, despite the potential benefit of achieving a complete revascularization, it is suspected that the procedure may carry a higher risk of renal impairment due the use of a greater contrast volume, longer procedure time, radiation exposure, and potential complications. 47,48,51 The GVGs assert that multivessel (tibial) revascularization may be reasonable in selected patients with advanced limb-threatening lesions (eg, WIfI stages 3 and 4) undergoing endovascular therapy if it can be safely accomplished without risking loss of a bypass target or compromising runoff to the foot. 14…”

Section: Single or Multivessel Infrapopliteal Revascularization: Whatmentioning

confidence: 99%

Foot Angiosomes: Instructions for Use

Ferraresi

Clerici

Casini

et al. 2020

The International Journal of Lower Extremity Wounds

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In the last 15 years an abundance of literature has demonstrated that angiosome-targeted revascularization, either endovascular or open, can lead to better clinical results in patients with chronic limb-threatening ischemia. According to this literature, the angiosome concept should guide our treatment strategy in every chronic limb-threatening ischemia patient. However, in our daily practice, its application is often difficult or impossible. Most foot wounds spread over multiple angiosomes and, moreover, the value of an angiosome-guided revascularization approach can vary according to vascular anatomy, collateral vessel network, type of revascularization, and wound. The aim of this article is to explore values and limits of the angiosome concept, and to propose some “instructions for use” regarding its application in our daily practice.

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“…In this case report, the patient had prior peripheral arterial occlusive disease and was admitted via the emergency room with critical limb ischemia at high risk of limb loss, and underwent endovascular treatment with recanalization of femoropopliteal and peroneal arteries. 22 The worsening of the ulcer on the left external malleolus and the severity of the patient’s clinical condition may be related to those thrombotic events. However, no further investigations regarding thromboembolic events were conducted due to multiple organ failure and the severity of the patient’s clinical condition, caused by SARS-Cov-2 complications.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 diagnosis in a patient with critical limb ischemia: complications and clinical outcomes

Soares¹,

Vedovello²,

Medeiros³

et al. 2020

J. vasc. bras.

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A 67-year-old male diabetic patient with systemic arterial hypertension was admitted to the emergency department with a necrotic ulcer in the left external malleolus and no palpable popliteal or pedal pulses. Arterial Duplex ultrasound identified femoropopliteal occlusion, with popliteal refilling below the knee and a patent peroneal artery. An endovascular procedure was performed, requiring retrograde access to the popliteal artery to re-establish blood flow and deploy a popliteal stent. Technical success was achieved and the patient underwent debridement of the wound. Two days later, about 48 hours after the operation, the patient began to exhibit respiratory symptoms, with coughing and dyspnea. He immediately underwent a chest CT that identified ground glass opacities, the crazy-paving pattern, and bilateral air bronchogram in the lungs. A reverse transcription – polymerase chain reaction (RT-PCR) test was positive for SARS-Cov-2. The patient was moved to an intensive care unit and put on mechanical ventilation. Both hydroxychloroquine and azithromycin were administered. Despite appropriate treatment, the patient died 4 days after he was diagnosed with COVID-19.

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Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia

Abstract: Our results suggest that it is not necessary to treat the largest number of arteries possible in CLI patients. Instead, the most amenable artery for endovascular procedures should be treated to improve limb salvage and secondary patency rates.

Cited by 23 publications

References 20 publications

Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease

Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease

Foot Angiosomes: Instructions for Use

COVID-19 diagnosis in a patient with critical limb ischemia: complications and clinical outcomes

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