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Interventional therapy of femoropopliteal and tibial arteries in critical ischemia
Endovascular Techniques the stenotic group and 86% in the occlusive group (observation period: 3-33 months; mean 18 ± 10 months). CONCLUSION: The atherectomy catheter was effective in protecting the arterial wall and decreasing arterial stenosis. This new technique might have further clinical application, with improvements of the initial and long-term patency rates, and widening the indications for severe occlusive lesions by its combined use with laser angioplasty.
of stents in each patient were as follows: 1 stent: 23 patients; 2:14; 3:16; 4:4; 6:4. CONCLUSION: lilac artery stenosis can be successfully treated by endovascular Palmaz stent under local anesthesia with shortened hospitalization and low morbidity. A multicenter prospective randomized study between conventional bypass and stenting of the lilac artery is required to study the long-term differences between longevity of the procedure, cost effectiveness, failure and the re-intervention rate during a given patient's lifetime.
1.7
Interventional Therapy of Femoropopliteal and Tibial Arteries in Critical Ischemia ~. MARZELLE, F. CORMIER, J.M. FICHELLE, D. G UEZ and J.M. CORMIER, Paris, France Less invasive catheter-mediated interventional treatment procedures were performed on 168 patients (178 limbs) when standard surgery was not possible and/or represented an undue risk. All patients had critical ischemia. Gangrene was present in 58.4%, rest pain in 25.8%, non-healing ulcer in 11.2%, and complications from a previous surgical procedure were present in 4.5%. The number and type of catheter mediated procedures and vessels involved will be presented. Immediate angiographic success was achieved in 77.5% of procedures. Mean follow up was 17.4 < 14.3 months. The cumulative patency rate expressed by life table analysis was 76% at one month, 72% at 6 months, 58% at 12 months, and 55% at 24 months. The limb salvage rate was 91% at one month, 88% at 6 months, and 85% at 12 and 24 months. CONCLUSIONS: Contrary to current belief, cathetermediated therapy is useful in the management of critical ischemia. Patients with critical ischemia but with no standard surgical option available have a 2-year primary patency rate of 55% and a 2-year limb salvage rate of 85%.
1.8 Analysis Of lilac Artery Palmaz Stents In 59 Patients M.R. BALAJI, A.P. VERSTREA TE, T.A. RIZK and J.]. SVOBODA, Rochester, New York, USA METHODS: Between August 1992 and December 1994, 59 consecutive patients underwent primary iliac or aortoiliac endovascular Palmaz stent placement by a vascular surgeon. Stents were used for 51 unilateral and 8 bilateral lesions. These patients were prospectively followed by serial non-invasive and/or clinical evaluation at 1-, 3-, 6- and 12-month postoperative intervals and semi-annually. 51 patients (81%) were treated solely under local anesthesia, 47 of whom were hospitalized for less than three days. Two patients whose stenosis could not be crossed with any guide wire for stem placement were excluded. RESULTS: Two patients (3.4%) had early occlusion had early occlusion, one of which was re-opened with thrombolysis. Two patients (3.4%) had occlusion beyond 30 days. Three patients (5%) had a restenotic lesion protruding through the open stent and underwent successful balloon angioplasty, for an overall revision rate of 11.8%. None had arterial perforation or same day unscheduled surgery. Three patients had outflow procedures during same hospitalization. The number
CARDIOVASCULAR SURGERY SEPTEMBER 1995
1.9
Endovascular Recanalization of Iliac Thrombosis: A Surgical Experience ].M. CARDON, A. CARDON, A. JOYEUX, D. NOBLET, V. VIDAL and J. GA UTHIER, Nirnes, France If the immediate and long-term results of classical surgery for iliac thrombosis are now well known, this is not true for endovascular techniques. We conducted a 36-month prospective study of all symptomatic patients presenting with an iliac thrombosis and answering to the inclusion criteria. The originality of this study is that it has been conducted by a vascular surgeon skilled in endovascular techniques in the operating room. Without any previous thrombolysis, the occlusion was traversed with a hydrophilic guide followed by balloon angioplasty, and in every case one or several Palmaz's balloon expandable stents were inserted. All patients were followed-up for at least 6 months. The semestrial control included ABI at rest and after exercise and color duplex scanning of the recanalized artery. Angiography was performed in cases of failure and systematically for all patients in June 94. The primary patency was defined following the ad hoc committee on reporting standards of SVS/ ISCVS. We called secondary patency all patients reopened by a simple PTA. Thirty-eight out of 46 patients (82.6%) were successfully recanalized. However, one retroperitoneal haemorrhage and two distal emboli required emergency surgery, leading to an immediate success rate of 76.1%. Secondary failures were two secondary thromboses requiring surgery and four restenoses of more than 50%, treated by PTA. The actuarial patency (Kaplan-Meier) is 58 ± 0.14 for secondary patency. This experience suggests that the endovascular approach can be proposed at the first step. The potential hazard of this method is restenosis, which can be easily corrected by an angioplasty. In the case of immediate failure, classical surgery is realized by the endovascular surgeon himself during the same anesthesia.
1.10
Hemodialysis-Associated Axillary and Subclavian Vein Stenosis: The Failure of Percutaneous Angioplasty A.B. LUMSDEN, R.C. ALLEN, M.J. MACDONALD, D.K. KIKERI and E.C. HALL, Atlanta, Georgia, USA Venous outflow stenosis is the primary etiology of chronic hemodialysis access graft failure. Central vein stenosis is a common predisposing factor to graft failure in this patient
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of stents in each patient were as follows: 1 stent: 23 patients; 2:14; 3:16; 4:4; 6:4. CONCLUSION: lilac artery stenosis can be successfully treated by endovascular Palmaz stent under local anesthesia with shortened hospitalization and low morbidity. A multicenter prospective randomized study between conventional bypass and stenting of the lilac artery is required to study the long-term differences between longevity of the procedure, cost effectiveness, failure and the re-intervention rate during a given patient's lifetime.
1.7
Interventional Therapy of Femoropopliteal and Tibial Arteries in Critical Ischemia ~. MARZELLE, F. CORMIER, J.M. FICHELLE, D. G UEZ and J.M. CORMIER, Paris, France Less invasive catheter-mediated interventional treatment procedures were performed on 168 patients (178 limbs) when standard surgery was not possible and/or represented an undue risk. All patients had critical ischemia. Gangrene was present in 58.4%, rest pain in 25.8%, non-healing ulcer in 11.2%, and complications from a previous surgical procedure were present in 4.5%. The number and type of catheter mediated procedures and vessels involved will be presented. Immediate angiographic success was achieved in 77.5% of procedures. Mean follow up was 17.4 < 14.3 months. The cumulative patency rate expressed by life table analysis was 76% at one month, 72% at 6 months, 58% at 12 months, and 55% at 24 months. The limb salvage rate was 91% at one month, 88% at 6 months, and 85% at 12 and 24 months. CONCLUSIONS: Contrary to current belief, cathetermediated therapy is useful in the management of critical ischemia. Patients with critical ischemia but with no standard surgical option available have a 2-year primary patency rate of 55% and a 2-year limb salvage rate of 85%.
1.8 Analysis Of lilac Artery Palmaz Stents In 59 Patients M.R. BALAJI, A.P. VERSTREA TE, T.A. RIZK and J.]. SVOBODA, Rochester, New York, USA METHODS: Between August 1992 and December 1994, 59 consecutive patients underwent primary iliac or aortoiliac endovascular Palmaz stent placement by a vascular surgeon. Stents were used for 51 unilateral and 8 bilateral lesions. These patients were prospectively followed by serial non-invasive and/or clinical evaluation at 1-, 3-, 6- and 12-month postoperative intervals and semi-annually. 51 patients (81%) were treated solely under local anesthesia, 47 of whom were hospitalized for less than three days. Two patients whose stenosis could not be crossed with any guide wire for stem placement were excluded. RESULTS: Two patients (3.4%) had early occlusion had early occlusion, one of which was re-opened with thrombolysis. Two patients (3.4%) had occlusion beyond 30 days. Three patients (5%) had a restenotic lesion protruding through the open stent and underwent successful balloon angioplasty, for an overall revision rate of 11.8%. None had arterial perforation or same day unscheduled surgery. Three patients had outflow procedures during same hospitalization. The number
CARDIOVASCULAR SURGERY SEPTEMBER 1995
1.9
Endovascular Recanalization of Iliac Thrombosis: A Surgical Experience ].M. CARDON, A. CARDON, A. JOYEUX, D. NOBLET, V. VIDAL and J. GA UTHIER, Nirnes, France If the immediate and long-term results of classical surgery for iliac thrombosis are now well known, this is not true for endovascular techniques. We conducted a 36-month prospective study of all symptomatic patients presenting with an iliac thrombosis and answering to the inclusion criteria. The originality of this study is that it has been conducted by a vascular surgeon skilled in endovascular techniques in the operating room. Without any previous thrombolysis, the occlusion was traversed with a hydrophilic guide followed by balloon angioplasty, and in every case one or several Palmaz's balloon expandable stents were inserted. All patients were followed-up for at least 6 months. The semestrial control included ABI at rest and after exercise and color duplex scanning of the recanalized artery. Angiography was performed in cases of failure and systematically for all patients in June 94. The primary patency was defined following the ad hoc committee on reporting standards of SVS/ ISCVS. We called secondary patency all patients reopened by a simple PTA. Thirty-eight out of 46 patients (82.6%) were successfully recanalized. However, one retroperitoneal haemorrhage and two distal emboli required emergency surgery, leading to an immediate success rate of 76.1%. Secondary failures were two secondary thromboses requiring surgery and four restenoses of more than 50%, treated by PTA. The actuarial patency (Kaplan-Meier) is 58 ± 0.14 for secondary patency. This experience suggests that the endovascular approach can be proposed at the first step. The potential hazard of this method is restenosis, which can be easily corrected by an angioplasty. In the case of immediate failure, classical surgery is realized by the endovascular surgeon himself during the same anesthesia.
1.10
Hemodialysis-Associated Axillary and Subclavian Vein Stenosis: The Failure of Percutaneous Angioplasty A.B. LUMSDEN, R.C. ALLEN, M.J. MACDONALD, D.K. KIKERI and E.C. HALL, Atlanta, Georgia, USA Venous outflow stenosis is the primary etiology of chronic hemodialysis access graft failure. Central vein stenosis is a common predisposing factor to graft failure in this patient
3