Subintimal Angioplasty of Long Superficial Femoral Artery Occlusions

Yılmaz, Saim; Sindel, Timur; Yeğin, Arif; Lüleci, Ersin

doi:10.1097/01.rvi.000008261.05622.b8

Cited by 70 publications

(85 citation statements)

References 22 publications

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“…The subintimal procedure is therefore preferable. However, as previously reported [3], the subintimal recanalization alone is associated with a high percentage of technical failure (13-24%) that too often leads to amputation and death. The first cause of failure is the difficulty to precisely guide the dissection into the best distal runoff vessel.…”

Section: Discussionmentioning

confidence: 55%

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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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Section: Discussionmentioning

confidence: 55%

“…The percutaneous endovascular recanalization approach, consisting of the intraluminal or the subintimal technique, represents a valid alternative to the surgical bypass in patients at risk of limb loss and not suitable for surgery [3][4][5].…”

mentioning

confidence: 99%

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Gandini

Pipitone

Stefanini

et al. 2007

Cardiovasc Intervent Radiol

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“…A stent is finally deployed to secure the result. A prototype device was used successfully in a few patients, but to date the current mature device has been investigated only in peripheral total occlusions, with a technical success rate ranging from 78% to 92% with an acceptable safety profile [87][88][89]. Similarly, the Lumend Outback catheter utilizes a needle-based reentry system that is positioned toward the true lumen under fluoroscopy rather than intravascular ultrasound.…”

Section: Novel Approaches To Ctos Under Active Investigationmentioning

confidence: 97%

“…Similarly, the Lumend Outback catheter utilizes a needle-based reentry system that is positioned toward the true lumen under fluoroscopy rather than intravascular ultrasound. However, chronic patency rates with subintimal angioplasty and stenting have been disappointing [89], necessitating further long-term investigation. Catheter profile must also be reduced and flexibility and imaging accuracy improved if these devices are to be used for coronary occlusions.…”

Section: Novel Approaches To Ctos Under Active Investigationmentioning

confidence: 97%

Percutaneous recanalization of chronically occluded coronary arteries: Procedural techniques, devices, and results

Stone

Colombo

Teirstein

et al. 2005

Cathet. Cardiovasc. Intervent.

118

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“…G. S. Treiman su kolegomis teigia, kad aspirino ir galbūt netiesioginio veikimo antikoaguliantų ar trombocitų agregaciją slopinančių medikamentų vartojimas galėtų pagerinti subintiminės angioplastikos techninę sėkmę ir rezultatus (22). S. Yilmaz teigia, kad varfarinas statistiškai reikš-mingai prailgina subintiminės angioplastikos hemodinaminį poveikį (7). Mūsų duomenimis, kraujo krešė-jimą veikiantys medikamentai neturėjo reikšmingo poveikio hemodinaminiam poveikiui.…”

Section: Kulkšnies-žasto Indeksasunclassified

The influence of various factors on results of subintimal angioplasty of superficial femoral artery occlusions

Aleksynas¹,

Kaupas

2007

Medicina

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Kardiologijos instituto Invazinės kardiologijos laboratorija Raktažodžiai ĮvadasKraujagyslių chirurgija ir intervencinė radiologijasparčiai progresuojančios medicinos sritys. Nuolat tobulinami seni ir sukuriami nauji, dažniausiai mažiau invaziniai periferinių arterijų okliuzinės ligos gydymo metodai. Arterijų užakimams ir susiaurėjimams gydyti atliekama balioninė angioplastika ir lazerinė rekanalizacija, arterijų stentavimas ir endoprotezavimas, operuojama naudojant autologines venas, kriohomovenas ar įvairius sintetinius kraujagyslių protezus. Šių metodų daugėja, nes didėja žmonių amžiaus vidurkis, o dėl jų sveikatos būklės dažnai negalima atlikti atvirų operacijų, arba ligoniai jau neturi arterijų rekonstrukcijoms reikalingų autovenų (1). Subintiminė angioplastika yra vienas iš mažai invazinių metodų, kuriuo galima atkurti arterijų praeinamumą.Procedūra atliekama per antegradinę bendrosios šlaunies arterijos punkciją. Dažniausiai naudojamas 6F diametro introdiuseris ir universalios konfigūraci-jos, 5F diametro, trumpas kateteris su rentgenokontrastiniu galiuku. Kateteriui nukreipti reikalinga 0,035¢¢ diametro, 180-260 cm ilgio viela, padengta hidrofiline danga. Į ekstraspindinį tarpą kontroliuojant rentgenu kišamas tik kateteris arba kateteris su vielos kilpa. Kateterio įkišimas į ekstraspindinį tarpą vadinamas subintimine disekacija. Ekstraspindiniame tarpe nukreipiančioji viela turi įgauti didelės kilpos, besisukančios spirale aplink okliuduotą spindį, formą. Ši kilpa kartu su kateteriu stumiama tolyn, kur per kolaterales vėl kontrastuojasi arterijos spindis. Kartais dėl kalcifikacijų tenka atitraukti nukreipiančiąją vielą, perstatyti kateterio galą nauja kryptimi ir formuoti kilpą iš naujo. Svarbu, kad nukreipiančioji viela per daug nesilenktų ar neslystų tolyn visiškai išsitiesinusi prieš patekdama į spindį distalinėje dalyje. Jeigu išsi-tiesinusi nukreipiančioji viela lengvai slenka į šoną,

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Subintimal Angioplasty of Long Superficial Femoral Artery Occlusions

Cited by 70 publications

References 22 publications

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Percutaneous recanalization of chronically occluded coronary arteries: Procedural techniques, devices, and results

The influence of various factors on results of subintimal angioplasty of superficial femoral artery occlusions

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