Tunneled Ipsilateral Sheath: A Novel Technique in Endovascular Management of Superficial Femoral Artery Ostial Lesions

El-Maadawy, Mohamed; Balboula, Ahmed M.; Zaghloul, Hossam

doi:10.1177/1538574418823593

Cited by 2 publications

(4 citation statements)

References 7 publications

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“…To overcome these limitations, we adopted the strategy of tunneled ipsilateral sheath that is modified from the one described by El-Maadawy et al 11 In their technique, two skin punctures are made, one is located directly over the CFA (standard puncture) where the guidewire is passed through the needle into the PFA, while the second skin puncture is made few centimeters proximal to the first one. The second puncture needle is advanced subcutaneously towards to the first puncture site so the guidewire of the first puncture site can be flossed into the tip of the second needle to exit from the second puncture site.…”

Section: Discussionmentioning

confidence: 99%

“…9 The major limitations of ipsilateral antegrade puncture of CFA in the presence of flush SFA occlusion are the partially inserted sheath that can be easily slipped from the artery and the close proximity to the lesion which does not give enough space for the guide wire manipulation during lesion recanalization. 10 To overcome these limitations, we adopted the strategy of tunneled ipsilateral sheath that is modified from the one described by El-Maadawy et al 11 In their technique, two skin punctures are made, one is located directly over the CFA (standard puncture) where the guidewire is passed through the needle into the PFA, while the second skin puncture is made few centimeters proximal to the first one. The second puncture needle is advanced subcutaneously towards to the first puncture site so the guidewire of the first puncture site can be flossed into the tip of the second needle to exit from the second puncture site.…”

Section: Discussionmentioning

confidence: 99%

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Duplex-Guided Ipsilateral Antegrade Approach for Flush Superficial Femoral Artery Occlusion

Saleh

Ali

Gamal

et al. 2023

Vasc Endovascular Surg

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Objective Recanalization of flush ostial superficial femoral artery (SFA) occlusion is a very challenging procedure. Using the ipsilateral antegrade approach in such lesions has some difficulties. This study aimed to assess the feasibility, efficacy, and outcomes of duplex-guided ipsilateral antegrade access for endovascular treatment of atherosclerotic flush occlusion of the SFA. Methods This is a prospective two-center study that included chronic lower extremity ischemia patients with flush occlusion of SFA who underwent duplex-guided ipsilateral antegrade endovascular revascularization due to unfeasible contralateral femoral approach. Flush occlusions were preoperatively documented by duplex ultrasound and computed tomography angiography in all patients. The outcome measures were technical success, patency rates, perioperative morbidity and mortality, limb salvage, and amputation free survival rates. Results Between April 2019 and March 2021, 49 patients were enrolled in the current study with a mean age of 63.7 ± 5.7 years. Diabetes was the most common risk factor and was found in 40 (81.6%) patients. Associated popliteal lesions were found in seven (14.3%) patients, while 10 (20.4%) patients had combined tibial disease. Selective stenting was done in nine (18.4%) patients. Technical success was achieved in 43 (87.8%) patients. All failures were due to inability to cross the lesion rather than failure to access the common femoral artery. All complications were minor and occurred in seven (14.3%) patients. Primary, assisted primary, and secondary patency rates were 63.9% ± 7.1%, 82.8% ± 5.6%, and 93.5% ± 3.7% at 12 months, respectively. The overall 12-month limb salvage and amputation free survival rates were 91.8% and 83.3% ± 5.4%, respectively. Conclusion Duplex-guided ipsilateral antegrade femoral access is a feasible, safe, and effective endovascular treatment option for flush SFA occlusion when contralateral femoral access is not possible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Duplex-Guided Ipsilateral Antegrade Approach for Flush Superficial Femoral Artery Occlusion

Saleh

Ali

Gamal

et al. 2023

Vasc Endovascular Surg

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“…In addition, if there is substantial PFA disease, endovascular "profundoplasty" might be done at the completion of the operation.. 5 Another procedure reported is inserting 2 to 3 cm of the sheath into the common femoral artery and leaving the rest of the sheath in a fashioned subcutaneous tunnel of the lower most abdomen, securing and shielding the sheath against unintended dislodgement. 7 Except for the necessity for careful identification of both radiological and anatomical landmarks, the technical demands are similar to those for performing established antegrade punctures. Furthermore, the procedure does not need the use of any extra instruments.…”

Section: Introductionmentioning

confidence: 99%

“…Limitations to using the suggested procedure include the PFA's inability to be cannulated and/or the CFA's high bifurcation. 7 Aim of the work was to assess the feasibility, adequacy, safety, as well as complications of an ipsilateral antegrade procedure in patients with persistent lower limb ischemia who had superficial femoral artery ostial lesions.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Ipsilateral Antegrade Techniques for Endovascular Treatment of Ostial Superficial Femoral Artery Lesions

AlBealy

Eweda²,

Abdelhafez³

2022

Al-Azhar International Medical Journal

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Background:The most prevalent cause of intermittent claudication is peripheral arterial disease (PAD) of the superficial femoral artery (SFA).The SFA is a target of atherosclerotic disease predominantly in the distal section in the region of Hunter's canal where the adductor muscles tend to compress the artery and in the proximal section near the bifurcation to the deep femoral artery. Aim of the study: In patients with persistent lower limb ischemia, to determine the feasibility, adequacy, safety, and consequences of an ipsilateral antegrade approach in the event of superficial femoral artery ostial lesions. Patients and Methods: Between August 2019 and August 2021, 30 patients with peripheral arterial occlusive disease were included in this prospective cohort research at Al-Azhar University Hospitals (Al-Hussain and Bab-Alsheryah) (affecting ostium of the superficial femoral artery). Results: The most frequent extension of the lesion was SFA CTO total length till the adductor canal (36.7%), followed by proximal 1/3 SFA tight stenosis extending into middle 1/3 of SFA (26.7%), proximal SFA CTO extending into middle 1/3 of SFA (20%), and proximal 1/3 SFA tight stenosis (16.7%). Most patients showed technical success (80%), and most of them (79.2%) had endo-luminal wire passage. The most frequent type of passage in failure cases was contralateral antegrade (50%), followed by trans brachial antegrade (33.3%) and popliteal ipsilateral retrograde (16.7%). Conclusion: Endovascular therapy (EVT) in ostial and near ostial SFA occlusive lesions with ipsilateral antegrade access through common femoral artery puncture is a feasible and effective approach.

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Tunneled Ipsilateral Sheath: A Novel Technique in Endovascular Management of Superficial Femoral Artery Ostial Lesions

Cited by 2 publications

References 7 publications

Duplex-Guided Ipsilateral Antegrade Approach for Flush Superficial Femoral Artery Occlusion

Duplex-Guided Ipsilateral Antegrade Approach for Flush Superficial Femoral Artery Occlusion

Evaluation of Ipsilateral Antegrade Techniques for Endovascular Treatment of Ostial Superficial Femoral Artery Lesions

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