Patency Results of Percutaneous and Surgical Revascularization for Femoropopliteal Arterial Disease

Hunink, M. G. Myriam; Wong, John B.; Donaldson, Magruder C.; Meyerovitz, Michael F.; Harrington, Donald P.

doi:10.1177/0272989x9401400109

Cited by 163 publications

(100 citation statements)

References 31 publications

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“…13,14 Most graft occlusions occur during the early postoperative period: when considering synthetic vascular graft, the rate of occlusions is 53 cases/1,000 patients/month in the first 3 postoperative months; the corresponding figures at 6 and 12 months are 21 cases/1,000 patients/ month, whereas in following years the rate decreases to 10 cases/1,000 patients/month. 15 Starting from these data, several studies have tried to identify the ideal vascular graft for peripheral revascularizations that is highly biocompatible and thrombosis-resistant.…”

Section: Discussionmentioning

confidence: 99%

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

Dorigo

Carlo

Troisi

et al. 2008

Annals of Vascular Surgery

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The aim of the study was to evaluate the immediate and long-term results of femoropopliteal bypasses performed with a new bioactive heparin-treated expanded polytetrafluoroethylene (ePTFE) graft in a single-center experience. From March 2002 to April 2006, 51 patients underwent lower limb revascularization with a new bioactive ePTFE prosthetic graft with covalent endpoint attachment of heparin to the graft surface. Data concerning preoperative assessment, intraoperative strategy, drug administration, and follow-up surveillance program were prospectively collected in a dedicated database; early results were analyzed in terms of graft patency, amputation rate, and deaths. Follow-up consisted of clinical and duplex scan examination at 1, 6, and 12 months and yearly thereafter. Midterm results in terms of primary and secondary patency, limb salvage, and survival were analyzed. Patients were predominantly male (35 patients, 71%), with a mean age of 71 years (SD ¼ 9.05). Indications for surgical revascularization were critical limb ischemia in 36 patients and severe intermittent claudication in 15 patients. Interventions were performed for occlusion of a native vessel in 35 cases, whereas 12 patients had late thrombosis of a femoropopliteal bypass; the remaining four patients were operated on for an occluded popliteal artery aneurysm. Intervention consisted of below-knee bypass in 34 patients, while the other 17 had an above-knee revascularization. No perioperative deaths occurred. Cumulative 30-day graft patency was 88%, with an amputation rate of 4% (two cases). Results were similar in above-and below-knee revascularizatons. Mean duration of follow-up was 18 months (SD ¼ 7). Cumulative estimated 24-month survival and primary patency rates were 97% and 80.2%, respectively; the corresponding limb salvage rate was 85.7%. Long-term results did not significantly differ in above-and below-knee revascularizatons. In our experience, the use of a modified ePTFE graft with covalent end-point linkage of heparin molecules on the graft surface provides good early and midterm results, with low rates of graft thrombosis and amputation.

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Section: Discussionmentioning

confidence: 99%

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

Dorigo

Carlo

Troisi

et al. 2008

Annals of Vascular Surgery

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“…The intraluminal recanalization in the treatment of a femoral occlusion longer than 5 cm is poor (45-55% at 12-24 months) [17][18][19], compared with the vein graft patency of 82% at 1 year [9] or 66-81% at 5 years [19][20][21][22]. The subintimal procedure is therefore preferable.…”

Section: Discussionmentioning

confidence: 99%

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Gandini

Pipitone

Stefanini

et al. 2007

Cardiovasc Intervent Radiol

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The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.

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“…21 The patency rates in this series were superior to those in the meta-analyses for iliac 11 and femoropopliteal disease. 12,13 In the current series, the only factor associated with a poorer post-angioplasty patency was the indication for angioplasty, with critical ischaemia being associated with a poorer outcome. although a formal quality-of-life assessment tool was not used, 70% undergoing a technically successful procedure reported a significantly improved claudication distance following angioplasty.…”

Section: -14mentioning

confidence: 67%

“…The proportion of patients undergoing angioplasty for critical ischaemia in the current study (52%) was greater than in reported meta-analyses of angioplasty for iliac 11 and femoropopliteal disease. 12,13 The majority of angioplasties were performed for stenotic lesions, this being the case in most of the published literature. [11][12][13][14] However, almost a third of those with stenoses had more than one lesion treated by angioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 The majority of angioplasties were performed for stenotic lesions, this being the case in most of the published literature. [11][12][13][14] However, almost a third of those with stenoses had more than one lesion treated by angioplasty. Furthermore, even though occlusive lesions accounted for only 20% of cases, a third had more than one occlusion.…”

Section: Discussionmentioning

confidence: 99%

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Long-term clinical outcome following lower limb arterial angioplasty

Morris‐Stiff

Moawad

Appleton

et al. 2011

annals

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INTRODUCTION The aim of this study was to determine the clinical outcome of lower limb arterial angioplasty in a busy district general hospital practice. PATIENTS AND METHODS All angioplasties performed from January 1999 to December 2004 were identified and data collected included cardiovascular risk factors, indications for and complications of angioplasty, limb salvage and patient survival rates, and clinically significant re-stenoses. RESULTS 471 interventions were performed in 385 patients (231 men, 154 women). The median age was 67.9 years (range: 39-93 years). Indications for angioplasty were critical ischaemia (n=247, 52%) and lifestyle-limiting intermittent claudication (n=224, 48%). Stenotic lesions accounted for 378 (80%) cases and occlusion for 93 (20%). Radiological success was obtained in 417 (88.5%), improving to 93.6% if only those in whom access was achieved were included. Post-angioplasty complications were observed in 42/471 (9.1%) of interventions. The actual patient survival at 1,2, and 3 years was 87.4%, 85.1% and 83.2% respectively. Indication for angioplasty and the number of lesions present were identified as risk factors for outcome on multivariate analysis. The cumulative post-angioplasty patency rates at 1, 2 and 3 years were 86.0%, 83.1% and 81.6% respectively. The only factor associated with patency was the mode of presentation. CONCLUSIONS Angioplasty for lower limb peripheral vascular disease can be performed safely and efficaciously with a high technical success rate and a low complication rate. The patient survival and post-angioplasty patency data reflect the progressive and multi-site nature of the underlying disease process.

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Patency Results of Percutaneous and Surgical Revascularization for Femoropopliteal Arterial Disease

Cited by 163 publications

References 31 publications

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Long-term clinical outcome following lower limb arterial angioplasty

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