Shifting Paradigms in the Treatment of Lower Extremity Vascular Disease

DeRubertis, Brian G.; Faries, Peter L.; McKinsey, James F.; Chaer, Rabih A.; Pierce, Matthew; Karwowski, John K.; Weinberg, Alan; Nowygrod, Roman; Morrissey, Nicholas J.; Bush, Harry L.; Kent, K. Craig

doi:10.1097/sla.0b013e31814699a2

Cited by 163 publications

(60 citation statements)

References 44 publications

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“…7,13 Recent studies have shown that BA access can be a safe and effective alternative to femoral access, with complication rates of between 1.3% and 3.4% reported. 2,3,10,14 The complication rate in our patients requiring intervention or admission was 1.9%. Our low complication rate can be attributed to the routine use of ultrasound guidance, 4F micropuncture kits, and dedicated hold team nurses who are specially trained to hold BA access sites.…”

Section: Discussionmentioning

confidence: 93%

“…[2][3][4][5]13 Failure of access can be attributed to multiple prior procedures on the artery, arterial spasm, and arterial dissection. 7 BA access offers a full range of interventions to all clinically relevant arterial regions.…”

Section: Discussionmentioning

confidence: 98%

“…1 Endovascular access for treatment of PVD is typically performed through a common femoral artery (CFA) puncture. [2][3][4] Relative contraindications to CFA puncture include absent femoral pulses, recent intervention to the femoral artery, severe aortoiliac-femoral occlusive disease, femoral aneurysms or pseudoaneurysm, groin hematomas, and the presence of a bypass graft. [5][6][7][8][9] A reliable alternative access site is a necessity for a complete array of endovascular strategies.…”

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confidence: 99%

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Treatment of peripheral arterial disease via percutaneous brachial artery access

Franz

Tanga

Herrmann

2017

Journal of Vascular Surgery

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Brachial access is a reliable and effective option for treatment of peripheral vascular disease and should be considered when femoral access is difficult or contraindicated and when a bypass graft is present in the femoral region. In addition, bilateral lesions may be approached easily through one brachial artery access site, making this approach advantageous when bilateral lesions are expected. The complication rate is similar to femoral access and can be minimized with ultrasound-guided access distally over the humerus, micropuncture access, and a dedicated postprocedure "hold team."

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Treatment of peripheral arterial disease via percutaneous brachial artery access

Franz

Tanga

Herrmann

2017

Journal of Vascular Surgery

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“…8 A number of studies have reported hypercholesterolemia as an independent predictor of poor outcome after a patient undergoes revascularization for PAD. [9][10][11] Apolipoprotein E (ApoE) is a glycoprotein synthesized by the liver and macrophages and is a constituent of plasma lipoproteins. 12,13 It serves as a ligand for the cell-surface lipoprotein receptors and therefore is important in clearing lipoprotein remnants from the circulation.…”

mentioning

confidence: 99%

Apolipoprotein E–/– mice have delayed skeletal muscle healing after hind limb ischemia–reperfusion

Kang

Albadawi

Patel

et al. 2008

Journal of Vascular Surgery

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Although there was no difference between the injured muscle of Wt and ApoE(-/-) mice during the acute phase of reperfusion, ApoE(-/-) mice showed delay in skeletal muscle healing during the chronic phase of reperfusion. This lag in muscle regeneration was associated with lower levels of myogenin at 7DR and an increased level of MCP-1 at 14DR in the ApoE(-/-) mice. The delay in skeletal muscle healing in the ApoE(-/-) mice may have broader implications for poor tissue healing and functional recovery in elderly patients who have vascular risk factors such as hypercholesterolemia.

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“…Previous studies have suggested favorable EVT outcomes for CLI, [13][14][15][16] but at the same time they have revealed contradictory results about the relative benefit of EVT in comparison with bypass surgery. Although the Bypass versus Angioplasty in Severe Ischemia of the Leg trial showed better long-term amputation-free survival outcomes after bypass surgery on autologous veins compared with EVT, 17 a major amputation has been reported to be necessary in ≈10% of patients with ischemic ulcers of the lower limbs despite a patent bypass.…”

Section: Discussionmentioning

confidence: 98%

Vascular Flow Reserve Immediately After Infrapopliteal Intervention as a Predictor of Wound Healing in Patients With Foot Tissue Loss

Fukunaga¹,

Fujii²,

Kawasaki³

et al. 2015

Circ: Cardiovascular Interventions

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Background-The purpose of this study was to verify whether the concept of coronary blood flow reserve can be applied to patients with critical limb ischemia who are undergoing endovascular treatment (EVT) for isolated infrapopliteal lesions. Methods and Results-Forty patients diagnosed with critical limb ischemia (Rutherford category 5) who were undergoing EVT for isolated infrapopliteal lesions were prospectively enrolled. All lesions were treated with conventional balloon angioplasty without stent placement. After successful EVT, a pressure/temperature sensor-tipped guidewire was positioned in the proximal popliteal artery. Using the thermodilution technique, the mean transit time (Tmn) was determined after bolus injections of 3-mL saline at baseline and at the onset of intra-arterial papaverine induced maximum hyperemia. Vascular flow reserve (VFR) was calculated as resting Tmn divided by hyperemic Tmn. Complete epithelialization of the reference wound (wound healing) was completely closed by either surgical or secondary intervention within 3 months after EVT. Wound healing was achieved in 22 patients after EVT (healing group) but was not achieved in 18 patients (nonhealing group). Postprocedural VFR was significantly lower in the nonhealing group than in the healing group (2.40; interquartile range, 2.00-3.08 versus 4.05; interquartile range, 3.60-4.60; P<0.0001). Receiver operating characteristic analysis revealed postprocedural VFR >3.6 as the best threshold value for complete wound healing after EVT. Univariate analysis revealed that postprocedural VFR >3.6 was a predictor of wound healing (P=0.0002). Conclusions-Advanced lower limb clinical setting may be caused by a poor capability of microvasculature. VFR, which is easily assessable, is useful in clinical risk stratification for patients with critical limb ischemia after EVT in the catheterization laboratory. Clinical Trial Registration

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Shifting Paradigms in the Treatment of Lower Extremity Vascular Disease

Cited by 163 publications

References 44 publications

Treatment of peripheral arterial disease via percutaneous brachial artery access

Treatment of peripheral arterial disease via percutaneous brachial artery access

Apolipoprotein E–/– mice have delayed skeletal muscle healing after hind limb ischemia–reperfusion

Vascular Flow Reserve Immediately After Infrapopliteal Intervention as a Predictor of Wound Healing in Patients With Foot Tissue Loss

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