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Bare nitinol stent enabled recanalization of long segment chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia
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Abstracts / Cardiovascular Revascularization Medicine 10 (2009) 259–276
Conclusions: Transfemoral administration of UABM might constitute a feasible, well-tolerated, and safe procedure in patients suffering from peripheral arterial disease without option of revascularization. Although the number of patients is low, the procedure shows potential therapeutic efficacy, which warrants further studies with a larger number of patients. doi:10.1016/j.carrev.2009.04.088
Value of duplex scanning in differentiating embolic occlusion on atherosclerosed artery from thrombotic occlusion in acute limb ischemia Mahmoud F. Elmahdy, Waleed Ammaar, Hussein Heshmat, Karim Said, Essam Baligh, Soliman Ghareeb Cairo University, Cairo, Egypt Background: Management of acute limb ischemia is largely based on the etiology of arterial occlusion (embolic vs. thrombotic). Patients with embolic occlusion on atherosclerosed artery usually have the same clinical history and predisposing factors of atherosclerosis. It is usually difficult to differentiate between them using contrast-enhanced magnetic resonance angiography or catheter-based angiography. Purpose: To determine the ability of duplex scanning in differentiating acute embolic occlusion on atherosclerosed artery from thrombotic occlusion. Methods: We prospectively recruited 77 patients (65.3±5.7 years; 65% males) with 87 nontraumatic acute limb ischemia in native arteries. All patients underwent surgical revascularization. Preoperative duplex scan detected arterial occlusion in the following arteries: iliac (6), femoral (34), popliteal (34), infrapopliteal (2), subclavian (4), axillary (1), brachial (4), and forearm arteries (2). We measured the arterial diameters at the site of occlusion (doccl) and at the corresponding contralateral healthy side (dcontra). The difference (Δ) between the two diameters was calculated as (doccl−dcontra). According to surgical findings, limbs were classified into embolic on atherosclerosed artery (E group=limbs) and thrombotic (T group=limbs) groups. Results: Both groups were comparable regarding age, diabetes, hypertension, smoking, atrial fibrillation, and time of presentation. Δ in the E group was 0.85±0.82 mm vs. −0.13±1.02 mm in the T group (Pb.001). A value of ≥0.5 mm for Δ had 82% sensitivity and 79% specificity for the diagnosis of embolic occlusion on atherosclerosed artery (CI 0.72–0.90, Pb.001), whereas a value of ≤−0.5 mm for Δ had 82% sensitivity and 79% specificity for thrombotic occlusion (CI 0.72–0.90, Pb.001). Conclusion: Duplex scanning can accurately and easily differentiate acute embolic occlusion on atherosclerosed artery from thrombotic occlusion, where ≥0.5 mm dilatation or diminution in the occluded artery diameter is a useful duplex sign for diagnosing embolic occlusion on atherosclerosed artery or thrombotic occlusion, respectively. doi:10.1016/j.carrev.2009.04.089
Bare nitinol stent enabled recanalization of long segment chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia Manish Taneja, Atul Dewan, Mathew Sebastian, Shanker Pasupathy, Kiang Hiong Tay, Sheuh En Lin, Terence Teo, Richard Lo, Seck Guan Tan, Bien Soo Tan Singapore General Hospital, Singapore, Singapore Objective: To evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long-length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients. Methods: A total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective review was done of diabetic patients undergoing recanalization of long-length SFA/ adjacent PPA (N10 cm) occlusions with self-expanding bare nitinol stents evaluating their impact on limb salvage.
Results: A total of 44 patients (mean age 65.2 years; M/F 25:19) underwent 49 long length (N10 cm) SFA/PPA stenting procedures over a period of 26 months. Diabetics comprised 66% of patients (n=29; mean age 63.7 years; M/F 19:10). The infrapopliteal distal run-off in this diabetic subgroup comprised one vessel (n=14/29, 48%), two vessels (n=12/29, 41%), and three vessels (n=3/29, 10%). The spectrum of critical limb ischemia included rest pain (n=8), ulcer (n=7), and gangrene (n=14). The length of occlusions recanalized was 10 to 39 cm. A total of 58 stents (individual length 10 to 17 cm, average diameter 6 mm, mean of two stents per patient) were placed with the average length of stented segment being 23.8 cm. Four patients had stents placed through ipsilateral popliteal artery approach with the rest placed through the femoral artery approach. Significant complications of the procedure included distal embolization (n=3) successfully managed with thrombolysis and popliteal arteriovenous fistula in one patient undergoing recanalization through the popliteal approach managed with covered stent placement. No procedure-related mortality occurred during 30-day follow-up period. All were followed up over an average duration of 12 months postprocedure. Three patients died due to associated medical conditions during this period. The following amputations were done on follow-up: three toe amputations; five forefoot amputations; three below knee amputations; two above knee amputations. The overall limb salvage rate was 79%. Conclusion: Our study shows the beneficial result of SFA/PPA stent placement in diabetic occlusions with significant concomitant infrapopliteal disease. doi:10.1016/j.carrev.2009.04.090
Using duplex scanning as an alternative to conventional arteriography in differentiating embolic from thrombotic arterial occlusion in acute limb ischemia Mahmoud F. Elmahdy, Waleed Ammaar, Hussein Heshmat, Karim Said, Essam Baligh, Soliman Ghareeb Cairo University, Cairo, Egypt Background: Management of acute limb ischemia (ALI) is largely based on the etiology of arterial occlusion (embolic vs. thrombotic). Conventional arteriography (CA) allows a distinction to be made between embolus and thrombus; however, there is always the fear of contrast media harming an acutely ischemic leg, causing renal damage, allergy, and vascular complication. Purpose: To determine the feasibility of using duplex scanning as an alternative to conventional angiography in acute limb ischemia to differentiate embolic from thrombotic arterial occlusion. Methods: We prospectively recruited 80 patients (50.3±19.7 years; 55% males) with 90 nontraumatic acute limb ischemia in native arteries. All patients underwent surgical revascularization. The patients were divided into two groups (Group A and Group B).Group A underwent preoperative duplex scanning, while Group B underwent preoperative CA. In both groups, site of occlusion and cause of occlusion (embolic vs. thrombotic) were detected preoperatively and were compared with the final operation performed which was used as the gold standard. Results: Both groups were comparable regarding age, diabetes, hypertension, smoking, atrial fibrillation, time of presentation, and sites of occlusion. The mean time of the duplex scanning was 33±15.2 min, while the mean time of CA was 30±12.3 min (P=.45). Thrombotic occlusion was detected in 25 limbs in Group A and 29 limbs in Group B, while embolic occlusion was detected in 20 limbs in Group A and 16 limbs in Group B. The sites of occlusion were accurately detected in 95.5% (43/45) and 97.7% (44/45) of limbs by duplex scanning and CA, respectively (P=.25). Cause of occlusion was correctly detected in 84.44% (38/45) and 88.88% (40/45) of limbs by duplex scanning and CA, respectively (P=.47). The overall results obtained by duplex scanning were comparable to that obtained by CA (P=.68, relative risk 0.74, 95% confidence interval 0.18–2.99).
Abstracts / Cardiovascular Revascularization Medicine 10 (2009) 259–276
Conclusions: Transfemoral administration of UABM might constitute a feasible, well-tolerated, and safe procedure in patients suffering from peripheral arterial disease without option of revascularization. Although the number of patients is low, the procedure shows potential therapeutic efficacy, which warrants further studies with a larger number of patients. doi:10.1016/j.carrev.2009.04.088
Value of duplex scanning in differentiating embolic occlusion on atherosclerosed artery from thrombotic occlusion in acute limb ischemia Mahmoud F. Elmahdy, Waleed Ammaar, Hussein Heshmat, Karim Said, Essam Baligh, Soliman Ghareeb Cairo University, Cairo, Egypt Background: Management of acute limb ischemia is largely based on the etiology of arterial occlusion (embolic vs. thrombotic). Patients with embolic occlusion on atherosclerosed artery usually have the same clinical history and predisposing factors of atherosclerosis. It is usually difficult to differentiate between them using contrast-enhanced magnetic resonance angiography or catheter-based angiography. Purpose: To determine the ability of duplex scanning in differentiating acute embolic occlusion on atherosclerosed artery from thrombotic occlusion. Methods: We prospectively recruited 77 patients (65.3±5.7 years; 65% males) with 87 nontraumatic acute limb ischemia in native arteries. All patients underwent surgical revascularization. Preoperative duplex scan detected arterial occlusion in the following arteries: iliac (6), femoral (34), popliteal (34), infrapopliteal (2), subclavian (4), axillary (1), brachial (4), and forearm arteries (2). We measured the arterial diameters at the site of occlusion (doccl) and at the corresponding contralateral healthy side (dcontra). The difference (Δ) between the two diameters was calculated as (doccl−dcontra). According to surgical findings, limbs were classified into embolic on atherosclerosed artery (E group=limbs) and thrombotic (T group=limbs) groups. Results: Both groups were comparable regarding age, diabetes, hypertension, smoking, atrial fibrillation, and time of presentation. Δ in the E group was 0.85±0.82 mm vs. −0.13±1.02 mm in the T group (Pb.001). A value of ≥0.5 mm for Δ had 82% sensitivity and 79% specificity for the diagnosis of embolic occlusion on atherosclerosed artery (CI 0.72–0.90, Pb.001), whereas a value of ≤−0.5 mm for Δ had 82% sensitivity and 79% specificity for thrombotic occlusion (CI 0.72–0.90, Pb.001). Conclusion: Duplex scanning can accurately and easily differentiate acute embolic occlusion on atherosclerosed artery from thrombotic occlusion, where ≥0.5 mm dilatation or diminution in the occluded artery diameter is a useful duplex sign for diagnosing embolic occlusion on atherosclerosed artery or thrombotic occlusion, respectively. doi:10.1016/j.carrev.2009.04.089
Bare nitinol stent enabled recanalization of long segment chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia Manish Taneja, Atul Dewan, Mathew Sebastian, Shanker Pasupathy, Kiang Hiong Tay, Sheuh En Lin, Terence Teo, Richard Lo, Seck Guan Tan, Bien Soo Tan Singapore General Hospital, Singapore, Singapore Objective: To evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long-length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients. Methods: A total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective review was done of diabetic patients undergoing recanalization of long-length SFA/ adjacent PPA (N10 cm) occlusions with self-expanding bare nitinol stents evaluating their impact on limb salvage.
Results: A total of 44 patients (mean age 65.2 years; M/F 25:19) underwent 49 long length (N10 cm) SFA/PPA stenting procedures over a period of 26 months. Diabetics comprised 66% of patients (n=29; mean age 63.7 years; M/F 19:10). The infrapopliteal distal run-off in this diabetic subgroup comprised one vessel (n=14/29, 48%), two vessels (n=12/29, 41%), and three vessels (n=3/29, 10%). The spectrum of critical limb ischemia included rest pain (n=8), ulcer (n=7), and gangrene (n=14). The length of occlusions recanalized was 10 to 39 cm. A total of 58 stents (individual length 10 to 17 cm, average diameter 6 mm, mean of two stents per patient) were placed with the average length of stented segment being 23.8 cm. Four patients had stents placed through ipsilateral popliteal artery approach with the rest placed through the femoral artery approach. Significant complications of the procedure included distal embolization (n=3) successfully managed with thrombolysis and popliteal arteriovenous fistula in one patient undergoing recanalization through the popliteal approach managed with covered stent placement. No procedure-related mortality occurred during 30-day follow-up period. All were followed up over an average duration of 12 months postprocedure. Three patients died due to associated medical conditions during this period. The following amputations were done on follow-up: three toe amputations; five forefoot amputations; three below knee amputations; two above knee amputations. The overall limb salvage rate was 79%. Conclusion: Our study shows the beneficial result of SFA/PPA stent placement in diabetic occlusions with significant concomitant infrapopliteal disease. doi:10.1016/j.carrev.2009.04.090
Using duplex scanning as an alternative to conventional arteriography in differentiating embolic from thrombotic arterial occlusion in acute limb ischemia Mahmoud F. Elmahdy, Waleed Ammaar, Hussein Heshmat, Karim Said, Essam Baligh, Soliman Ghareeb Cairo University, Cairo, Egypt Background: Management of acute limb ischemia (ALI) is largely based on the etiology of arterial occlusion (embolic vs. thrombotic). Conventional arteriography (CA) allows a distinction to be made between embolus and thrombus; however, there is always the fear of contrast media harming an acutely ischemic leg, causing renal damage, allergy, and vascular complication. Purpose: To determine the feasibility of using duplex scanning as an alternative to conventional angiography in acute limb ischemia to differentiate embolic from thrombotic arterial occlusion. Methods: We prospectively recruited 80 patients (50.3±19.7 years; 55% males) with 90 nontraumatic acute limb ischemia in native arteries. All patients underwent surgical revascularization. The patients were divided into two groups (Group A and Group B).Group A underwent preoperative duplex scanning, while Group B underwent preoperative CA. In both groups, site of occlusion and cause of occlusion (embolic vs. thrombotic) were detected preoperatively and were compared with the final operation performed which was used as the gold standard. Results: Both groups were comparable regarding age, diabetes, hypertension, smoking, atrial fibrillation, time of presentation, and sites of occlusion. The mean time of the duplex scanning was 33±15.2 min, while the mean time of CA was 30±12.3 min (P=.45). Thrombotic occlusion was detected in 25 limbs in Group A and 29 limbs in Group B, while embolic occlusion was detected in 20 limbs in Group A and 16 limbs in Group B. The sites of occlusion were accurately detected in 95.5% (43/45) and 97.7% (44/45) of limbs by duplex scanning and CA, respectively (P=.25). Cause of occlusion was correctly detected in 84.44% (38/45) and 88.88% (40/45) of limbs by duplex scanning and CA, respectively (P=.47). The overall results obtained by duplex scanning were comparable to that obtained by CA (P=.68, relative risk 0.74, 95% confidence interval 0.18–2.99).