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IF13. Catheter-Directed Thrombolysis and Percutaneous Mechanical Thrombectomy Followed by Nitinol Stent Implant in Acute Ileofemoral Deep Vein Thrombosis
JOURNAL OF VASCULAR SURGERY June Supplement 2015
38S Abstracts
branch open (P ¼ .02), with a significant improvement in wound healing. Overall survival was 65% 6 12% at 2 years. Only 74 wounds (56%) could be assigned to a single peroneal angiosome, and 34 wounds (25%) were located on the border of two angiosomes. In multivariate analysis with matched propensity score, patency of both peroneal branches was a significant predictor for wound healing (odds ratio, 2.7; 95% confidence interval, 1.7-8.9) but not angiosome direct revascularization. Conclusions: Our results suggest that patency of both peroneal branches provides better wound healing irrespective of the wound primary angiosome. Direct revascularization to wound angiosomes by a peroneal bypass was possible in only half of the patients with tissue loss and did not improve wound healing significantly. Author Disclosures: M. Gargiulo: Cook, consulting fee; Medtronic, speakers bureau; F. M. Schneider: Nothing to disclose; A. Stella: Nothing to disclose; M. Abualhin: Nothing to disclose; M. Desvergnes: Nothing to disclose; J. Ricco: Nothing to disclose. IF12. Endovascular Intervention of Native Lower Extremity Chronic Total Occlusions in Critical Limb Ischemia Patients With Intermediate-to-Late Graft Failure MinYi Yin, Xintian Huang, Xinwu Lu, Mier Jiang. Shanghai Ninth People’s Hospital, Shanghai Jiaotong University, Shanghai, China Objectives: The study evaluated the feasibility, safety, and outcome of endovascular intervention of native lower extremity chronic total occlusions (CTO) in critical limb ischemia (CLI) patients with intermediate-to-late ($30 days after surgery) bypass graft failure. Methods: A retrospective review of CLI patients with a failed lower limb graft who underwent recanalization of native CTO was conducted in two institutions from January 2010 to June 2014. The current study included 28 patients (28 limbs) with limited surgical revascularization options in all cases. Demographics, procedural data, complications, and technical success, vessel patency, limb salvage, survival rates were followed-up. Results: The mean follow-up period was 12.8 months. Technical success was achieved in 26 of 28 limbs (92.9%), with additional retrograde subintimal recanalization in nine limbs (32.1%). Periprocedural (<30 days) major complications included two myocardial infarctions (7.1%) and two stent thromboses (7.1%), resulting in one early amputation. Ankle-brachial index (ABI) before discharge was significantly improved after intervention (0.78 6 0.08 vs 0.31 6 0.10, P < .01). The primary, assisted primary, and secondary patency rates at 12 months were 52.2%, 65.8%, and 82.2%, respectively. Limb salvage rates at 12 and 24 months were 91.6% and 86.5%, and amputationfree survival rates were 87.0% and 76.7%, respectively. Conclusions: Endovascular intervention of native CTO in patients with CLI related to graft failure is a feasible, safe, and effective procedure, with reasonable technical success, vessel patency, and limb salvage rates. Such attempt should be made before amputation in patients with limited realistic surgical redo options.
Author Disclosures: M. Yin: Nothing to disclose; X. Huang: Nothing to disclose; X. Lu: Nothing to disclose; M. Jiang: Nothing to disclose. IF13. Catheter-Directed Thrombolysis and Percutaneous Mechanical Thrombectomy Followed by Nitinol Stent Implant in Acute Ileofemoral Deep Vein Thrombosis Guilherme Napp1, Carolina M. Stapenhorst1, Renan R. Onzi1, Luiz F. Costa2, Nubia S. Franzon3, Ernesto Bettio1. 1Hospital Mãe de Deus, Vascular Surgery, Porto Alegre, Brazil; 2Centro Clinico Mãe de deus, Porto Alegre, NJ, Brazil; 3Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil Objectives: We reviewed our experience with catheterdirected thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT), followed by nitinol stent implant, in patients with acute or acute on chronic ileofemoral deep venous thrombosis (DVT). Methods: We retrospectively reviewed our database of patients with acute or acute-on-chronic ileofemoral DVT, treated with CDT or PMT, followed by nitinol stent implant, between 2007 and 2014. We excluded patients with acute thrombosis of previously implanted stents for chronic DVT. Results: We treated 20 patients (15 women), mean age 37 years, with 18 on the left side. Fourteen had an acute DVT and six had a recurrent DVT. Seventeen patients were treated with CDT, two with PMT, and one with both. All patients received at least one nitinol stent. Nine patients had grade III lysis, 9 had grade II lysis, and 3 patients had grade I lysis. There were five minor bleedings, no major bleedings, and no deaths related to the procedure. One early thrombosis was treated with repeat CDT, with a good result, and one late thrombosis was managed conservatively. One stent restenosis was treated with a different type of stent implantation (braided, self-expanding). On long-term we have two patients with acute DVT who developed post-thrombotic syndrome, one of which had a venous ulcer that healed with compression. Conclusions: Transcatheter therapy for ileofemoral DVT, followed by nitinol stent implantation, is a safe treatment option, with good long-term patency. Author Disclosures: G. Napp: Nothing to disclose; C. Stapenhorst: Nothing to disclose; R. R. Onzi: Nothing to disclose; L. F. Costa: Nothing to disclose; N. Franzon: Nothing to disclose; E. Bettio: Nothing to disclose. IF14. Ratio of Apolipoprotein A-II/B Improves Lipoprotein-Associated Risk Prediction of Postoperative Survival in Carotid Surgery Nikolaus Duschek1, Afshin Assadian2, Jelena Basic1. 1 Department of Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria; 2KAV Vienna, Vienna, Austria Objectives: Despite successful lowering of low-density lipoprotein cholesterol (LDL-C), a significant risk of atherosclerotic cardiovascular disease (ASCVD) remains,
38S Abstracts
branch open (P ¼ .02), with a significant improvement in wound healing. Overall survival was 65% 6 12% at 2 years. Only 74 wounds (56%) could be assigned to a single peroneal angiosome, and 34 wounds (25%) were located on the border of two angiosomes. In multivariate analysis with matched propensity score, patency of both peroneal branches was a significant predictor for wound healing (odds ratio, 2.7; 95% confidence interval, 1.7-8.9) but not angiosome direct revascularization. Conclusions: Our results suggest that patency of both peroneal branches provides better wound healing irrespective of the wound primary angiosome. Direct revascularization to wound angiosomes by a peroneal bypass was possible in only half of the patients with tissue loss and did not improve wound healing significantly. Author Disclosures: M. Gargiulo: Cook, consulting fee; Medtronic, speakers bureau; F. M. Schneider: Nothing to disclose; A. Stella: Nothing to disclose; M. Abualhin: Nothing to disclose; M. Desvergnes: Nothing to disclose; J. Ricco: Nothing to disclose. IF12. Endovascular Intervention of Native Lower Extremity Chronic Total Occlusions in Critical Limb Ischemia Patients With Intermediate-to-Late Graft Failure MinYi Yin, Xintian Huang, Xinwu Lu, Mier Jiang. Shanghai Ninth People’s Hospital, Shanghai Jiaotong University, Shanghai, China Objectives: The study evaluated the feasibility, safety, and outcome of endovascular intervention of native lower extremity chronic total occlusions (CTO) in critical limb ischemia (CLI) patients with intermediate-to-late ($30 days after surgery) bypass graft failure. Methods: A retrospective review of CLI patients with a failed lower limb graft who underwent recanalization of native CTO was conducted in two institutions from January 2010 to June 2014. The current study included 28 patients (28 limbs) with limited surgical revascularization options in all cases. Demographics, procedural data, complications, and technical success, vessel patency, limb salvage, survival rates were followed-up. Results: The mean follow-up period was 12.8 months. Technical success was achieved in 26 of 28 limbs (92.9%), with additional retrograde subintimal recanalization in nine limbs (32.1%). Periprocedural (<30 days) major complications included two myocardial infarctions (7.1%) and two stent thromboses (7.1%), resulting in one early amputation. Ankle-brachial index (ABI) before discharge was significantly improved after intervention (0.78 6 0.08 vs 0.31 6 0.10, P < .01). The primary, assisted primary, and secondary patency rates at 12 months were 52.2%, 65.8%, and 82.2%, respectively. Limb salvage rates at 12 and 24 months were 91.6% and 86.5%, and amputationfree survival rates were 87.0% and 76.7%, respectively. Conclusions: Endovascular intervention of native CTO in patients with CLI related to graft failure is a feasible, safe, and effective procedure, with reasonable technical success, vessel patency, and limb salvage rates. Such attempt should be made before amputation in patients with limited realistic surgical redo options.
Author Disclosures: M. Yin: Nothing to disclose; X. Huang: Nothing to disclose; X. Lu: Nothing to disclose; M. Jiang: Nothing to disclose. IF13. Catheter-Directed Thrombolysis and Percutaneous Mechanical Thrombectomy Followed by Nitinol Stent Implant in Acute Ileofemoral Deep Vein Thrombosis Guilherme Napp1, Carolina M. Stapenhorst1, Renan R. Onzi1, Luiz F. Costa2, Nubia S. Franzon3, Ernesto Bettio1. 1Hospital Mãe de Deus, Vascular Surgery, Porto Alegre, Brazil; 2Centro Clinico Mãe de deus, Porto Alegre, NJ, Brazil; 3Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil Objectives: We reviewed our experience with catheterdirected thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT), followed by nitinol stent implant, in patients with acute or acute on chronic ileofemoral deep venous thrombosis (DVT). Methods: We retrospectively reviewed our database of patients with acute or acute-on-chronic ileofemoral DVT, treated with CDT or PMT, followed by nitinol stent implant, between 2007 and 2014. We excluded patients with acute thrombosis of previously implanted stents for chronic DVT. Results: We treated 20 patients (15 women), mean age 37 years, with 18 on the left side. Fourteen had an acute DVT and six had a recurrent DVT. Seventeen patients were treated with CDT, two with PMT, and one with both. All patients received at least one nitinol stent. Nine patients had grade III lysis, 9 had grade II lysis, and 3 patients had grade I lysis. There were five minor bleedings, no major bleedings, and no deaths related to the procedure. One early thrombosis was treated with repeat CDT, with a good result, and one late thrombosis was managed conservatively. One stent restenosis was treated with a different type of stent implantation (braided, self-expanding). On long-term we have two patients with acute DVT who developed post-thrombotic syndrome, one of which had a venous ulcer that healed with compression. Conclusions: Transcatheter therapy for ileofemoral DVT, followed by nitinol stent implantation, is a safe treatment option, with good long-term patency. Author Disclosures: G. Napp: Nothing to disclose; C. Stapenhorst: Nothing to disclose; R. R. Onzi: Nothing to disclose; L. F. Costa: Nothing to disclose; N. Franzon: Nothing to disclose; E. Bettio: Nothing to disclose. IF14. Ratio of Apolipoprotein A-II/B Improves Lipoprotein-Associated Risk Prediction of Postoperative Survival in Carotid Surgery Nikolaus Duschek1, Afshin Assadian2, Jelena Basic1. 1 Department of Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria; 2KAV Vienna, Vienna, Austria Objectives: Despite successful lowering of low-density lipoprotein cholesterol (LDL-C), a significant risk of atherosclerotic cardiovascular disease (ASCVD) remains,