Abstract:These data suggest that percutaneous profundaplasty is safe, effective, and may be considered as an alternative to surgical therapy in patients with anatomically suitable lesions.
“…12–40 Twenty of these reports were included after final review by the authors. 12–16,18,19,21,22,25–28,31,33,35–37,39,40 After reviewing the full paper, data regarding patient numbers and demographics, indications, pre- and post-intervention ankle-brachial index (ABI), site of intervention, and patency of SFA, technical success, type of endovascular approach, complications, patency and mortality rates were extracted and analyzed (Table 1). Figure 1.Flow diagram for inclusion and exclusion of relevant clinical reports.…”
Endovascular interventions to the common femoral artery and common femoral artery can be performed safely with high technical success. Endovascular therapy may be a favored approach over endarterectomy for highly selected patients of poor surgical risk, with limited life expectancy and those with wound-healing considerations such as re-operative fields or prone to infection.
“…12–40 Twenty of these reports were included after final review by the authors. 12–16,18,19,21,22,25–28,31,33,35–37,39,40 After reviewing the full paper, data regarding patient numbers and demographics, indications, pre- and post-intervention ankle-brachial index (ABI), site of intervention, and patency of SFA, technical success, type of endovascular approach, complications, patency and mortality rates were extracted and analyzed (Table 1). Figure 1.Flow diagram for inclusion and exclusion of relevant clinical reports.…”
Endovascular interventions to the common femoral artery and common femoral artery can be performed safely with high technical success. Endovascular therapy may be a favored approach over endarterectomy for highly selected patients of poor surgical risk, with limited life expectancy and those with wound-healing considerations such as re-operative fields or prone to infection.
“…We reported the results of a consecutive series of patients with severe lower-extremity ischemia in whom PTA of the profunda femoris artery was performed alone or in combination with an additional (inflow) percutaneous revascularization procedure ( Figure 6). 48 Clinical success was obtained in 91% (29 of 32 limbs) by use of a combination of provisional stent placement with or without thrombolytic therapy for thrombotic occlusions. The only procedural complications were groin hematomas in 2 patients.…”
Section: Common and Deep Femoral Artery Diseasementioning
Abstract-Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. (Figure 1). 1,2 It is important to remember the significant association of coincident coronary artery disease and cerebrovascular disease in these patients, because it represents the major cause of major morbidity and mortality in the PAD population. 3 Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed by Charles Dotter 4 and advanced by Andreas Gruentzig, who employed then newly developed inflatable balloon catheters that could dilate vascular stenoses. 5 The availability of stents, more than any other advance, has fueled the growth of catheterbased procedures by improving the safety, durability, and predictability of percutaneous revascularization.Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. 6,7 It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. 8 The recognition of an unmet need for a trained cadre of clinicians to care for patients with PAD prompted the development of a core curriculum document (COCATS-11) 9 and a multispecialty societal competency statement. 10 The American Heart Association and American College of Cardiology have published guidelines and recommendations for the diagnosis and treatment of PAD. 2 Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD.
Diagnostic Evaluation Noninvasive AssessmentThe initial assessment should include a physical examination, with the patient's shoes and socks removed, to look for signs of acute or chronic peripheral ischemia and distal embolization and to determine the status of the peripheral pulses. The abdomen is examined for evidence of an aortic aneurysm, and blood pressure should be meas...
“…As in other vascular beds, there are many different endovascular options available for the treatment of a stenotic diseased femoral bifurcation. Simple single‐balloon PTA is the first option for both DFA and CFA lesions [4, 9–21]. As dilation of ostial DFA or SFA lesions with single balloons can cause dissection or shifting of the plaque and can lead to an occlusion of the other vessel, the kissing balloon technique might be preferred [22].…”
Section: Endovascular Approachmentioning
confidence: 99%
“…The retrospective studies report procedural success rates ranging from 77 to 100%. Follow‐up results are often lacking and if available difficult to compare due to the variety in reported patency definitions and follow‐up times (Table I) [4, 9–18, 20, 21].…”
Arterial occlusive disease at the level of the femoral bifurcation mostly occurs in combination with inflow and/or outflow lesions. Surgical endarterectomy of the femoral bifurcation is a well-proven low-risk and easy surgical intervention with known durable success, while, although proven to be safe, evidence is lacking about the durability of the endovascular approach. Based on the evidence at hand, the surgical approach should be recommended for the vast majority of patients and the endovascular approach should only be indicated as the first strategy in selected cases presenting with factors that might compromise the outcome of surgery in the groin. If feasible, the hybrid approach with endarterectomy at the level of the bifurcation and endovascular repair of the inflow and outflow lesions is preferred in patients with multilevel disease.
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