Retrograde Popliteal Access and Balloon Dilatation of Chronic Total Occlusion of Superficial Femoral Arteries

Kuserli, Yusuf; Kavala, Ali Aycan

doi:10.1016/j.avsg.2019.09.030

Cited by 7 publications

(19 citation statements)

References 18 publications

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“…Compared with the diameter at T2, the diameter of the expanded vascular lumen at T3 was reduced by 21% and 13%, and the distribution was uniform; the rebound rate of proximal and distal vascular lumen was about −10% and −15%, respectively. It showed that balloon expansion could improve the lumen diameter of narrowed blood vessels to a certain extent [ 19 ]. However, the diameter of the vascular lumen after expansion was slightly smaller than the standard diameter of the expansion balloons due to the rebound effect of blood vessels.…”

Section: Results and Analysismentioning

confidence: 99%

Virtual Reality-Assisted Percutaneous Transluminal Angioplasty for Interventional Treatment of Lower-Extremity Arteriosclerosis Obliterans

Zhou

Zhai

Yin

et al. 2021

Journal of Healthcare Engineering

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This study was to evaluate the biomechanical characteristics of the vascular wall during virtual reality- (VR-) assisted percutaneous transluminal angioplasty (PTA) and its effect on the treatment of lower-extremity arteriosclerosis obliterans (LEAO). In this study, a three-dimensional (3D) model and a finite-element model of arteries were constructed first, and various fluid mechanics were analyzed. Then, the virtual expansion simulation (VES) of individualized PTA was performed based on the ABAQUS/Explicit module to analyze the interaction between the balloon and the blood vessel at different times and the changes in the vascular shape and structural stress distribution. Finally, an LEAO animal model was constructed. Based on conventional PTA (PTA group) and VR-assisted PTA (VR-PTA) treatment, the morphological changes of vascular lumen of the two animal models were evaluated. The results showed that the normal, stenotic blood vessels and blood models were successfully constructed; the pressure of the stenotic blood vessel at the stenosis decreased obviously and the shear stress of blood vessel wall increased compared with that of the normal blood vessels, and there may be a blood reflux area in the poststenosis stage. The simulation results of the VES showed that the maximum principal stress value at 3 mm of the marginal vessel was much lower than that at 5 mm (about 10% lower), so the maximum principal stress change within 2 mm of the balloon-expanded vessel was the most obvious. The treatment results of the animal model showed that the VR-PTA group showed an obvious increase in the diameter of the vascular lumen, a decrease in the intima and media area, and a decrease in the thickness of the vessel wall in contrast to the PTA group P < 0.05 , which had an important effect on the reconstruction and expansion of the vascular lumen. The VR-PTA treatment on LEAO was realized in this study, which provided critical reference for the follow-up application of VR technology in the evaluation of surgical plan and research on biomechanical mechanisms of restenosis after PTA.

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Section: Results and Analysismentioning

confidence: 99%

Virtual Reality-Assisted Percutaneous Transluminal Angioplasty for Interventional Treatment of Lower-Extremity Arteriosclerosis Obliterans

Zhou

Zhai

Yin

et al. 2021

Journal of Healthcare Engineering

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“…The low complication rate seen in the POA access cohort, including an no access site complications, is within the reported 0% to 15.7% range found in the literature. 9,12,16,19 In contrast, UEA access site complications occurred in 4.3% of our cohort, including 6 hematomas (3.2%) and 2 pseudoaneurysms (1.1%). These rates are in line with what has been previously reported in the recent literature, which cited complication rates from 1.3% to 10.6%.…”

Section: Discussionmentioning

confidence: 67%

“…7,10,14,17,18 The 84.5% POA technical success rate was also similar to that of other studies, which reported a range between 80% and 100%. 9,12,15,16,19 This large range in POA technical success can be partly attributed to the wide variability in technique, which has included prone and/or supine patient positioning and differing usage of duplex guidance. 9,11,12,16,19 Although our study did not observe a statistically significant association between dialysis and technical success, dialysis was included as a forced variable in the multivariate regression model for technical failure due to its established association with inferior endovascular outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…9,[11][12][13]15 Recent improvements in technique have also decreased the rates of complications associated with early POA attempts. 9,16 However, the lack of a standardized POA protocol; inherent risks associated with the prone position; and difficulties associated with accessing a flexed leg, compressing the vessel after sheath removal, and obesity complicate the POA approach. 9,11,16 Given the current lack of comparisons in the literature, we aimed to compare the technical success and complication rate of UEA and POA for the treatment of isolated SFA occlusive disease to help guide selection of the preferred alternative access site.…”

Section: Introductionmentioning

confidence: 99%

“…9,16 However, the lack of a standardized POA protocol; inherent risks associated with the prone position; and difficulties associated with accessing a flexed leg, compressing the vessel after sheath removal, and obesity complicate the POA approach. 9,11,16 Given the current lack of comparisons in the literature, we aimed to compare the technical success and complication rate of UEA and POA for the treatment of isolated SFA occlusive disease to help guide selection of the preferred alternative access site. We hypothesize that POA for isolated SFA occlusive disease results in a higher degree of technical success and a lower complication rate.…”

Section: Introductionmentioning

confidence: 99%

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Periprocedural Outcomes of Popliteal vs Upper Extremity Access in the Treatment of Superficial Femoral Artery Occlusive Disease

et al. 2021

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Purpose: Percutaneous lower extremity revascularization is being performed via upper extremity, pedal, or popliteal access with increasing frequency. This study aimed to compare periprocedural outcomes of popliteal (POA) and upper extremity (UEA) access for the treatment of isolated superficial femoral artery (SFA) occlusive disease. Materials and Methods: A retrospective cohort study compared the outcomes of patients undergoing primary percutaneous intervention of SFA occlusive disease with POA or UEA using the Vascular Quality Initiative database from December 2010 to June 2019. Our primary endpoint was technical success. Secondary endpoints included factors associated with perioperative complications. Results: A total of 349 patients underwent isolated SFA intervention through the popliteal, radial, or brachial artery. UEA was performed in 188 (53.9%) patients and POA in 161 (46.1%). Technical success with TASC A lesions was 95.8% and with TASC D lesions, 65.0%. POA had a higher proportion of TASC D lesions (24.8% vs 10.6%, p<0.001), and larger (≥7 Fr) sheath size (14.3% vs 2.7%, p<0.001). UEA had a higher proportion of no calcification (27.1% vs 11.2%, p<0.001), and smaller (4–5 Fr) sheath size (46.8% vs 34.8%, p=0.023). There was no difference in technical success between UEA and POA (88.8% vs 84.5%, p=0.230), which was also seen on multivariable analysis (p=0.985). Univariate analysis revealed technical failure was associated with TASC D lesions (45.7% vs 12.9%, p<0.001) and the presence of severe calcifications (39.1% vs 17.5%, p=0.002). Multivariable analysis confirmed technical failure was associated with degree of calcification (OR, 2.4; 95% CI, 1.18 to 4.89; p=0.016) and TASC D lesions (OR, 5.01; 95% CI, 2.45 to 10.24; p<0.001). Postoperative complications were associated with UEA on univariate (p=0.041) and multivariate analysis (OR, 2.08; 95% CI, 0.80 to 5.37; p=0.016). Access site complications were also associated with UEA compared to POA (4.3% vs 0.0%, p=0.027). Conclusions: There is no difference in technical success between UEA and POA when treating isolated SFA occlusive disease, and UEA is associated with a higher complication rate. Technical success is dependent on calcification and TASC II classification. Based on similar technical success rates and low complication rates, POA should be considered as a viable alternative to UEA when planning endovascular interventions.

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Efficacy and Safety of Angiography-Guided Retrograde Posterior Popliteal Puncture Technique in the Supine Position

Hayakawa

Kodera

Sandeep

et al. 2021

Annals of Vascular Surgery

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Retrograde Popliteal Access and Balloon Dilatation of Chronic Total Occlusion of Superficial Femoral Arteries

Cited by 7 publications

References 18 publications

Virtual Reality-Assisted Percutaneous Transluminal Angioplasty for Interventional Treatment of Lower-Extremity Arteriosclerosis Obliterans

Virtual Reality-Assisted Percutaneous Transluminal Angioplasty for Interventional Treatment of Lower-Extremity Arteriosclerosis Obliterans

Periprocedural Outcomes of Popliteal vs Upper Extremity Access in the Treatment of Superficial Femoral Artery Occlusive Disease

Efficacy and Safety of Angiography-Guided Retrograde Posterior Popliteal Puncture Technique in the Supine Position

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