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Outcomes of Native Superficial Femoral Artery Chronic Total Occlusion Recanalization After Failed Femoropopliteal Bypass: Should We Shift the Redo Paradigm?
JOURNAL OF VASCULAR SURGERY Volume 62, Number 3
Abstracts 795
Conclusions: In a high-risk cohort, bypass is superior to native CTO recannulization after failure of a femoropopliteal bypass. Shifting the paradigm offers no patient benefit. Author Disclosures: M. G. Davies: None; H. ElSayed: None. Acute Limb Ischemia After Cardiothoracic Surgery Is Associated With High Rates of Amputation and Mortality Angelina S. June, Adriana Laser, Donald G. Harris, Angela M. Crawford, James S. Gammie, Bradley Taylor, Rajabrata Sarkar, Robert S. Crawford This abstract has been published in the Abstracts of the 2015 Vascular Annual Meeting: The Society for Vascular Surgery. DOI: http://dx.doi. org/10.1016/j.jvs2015.04.261. Common Carotid Web: A Rare Cause of Stroke John Phair, MD1, Eric Trestman, MD1, Chetra Yean, BS2, Evan C. Lipsitz, MD1. 1Montefiore Medical Center, Bronx, NY; 2Albert Einstein College of Medicine, Bronx, NY Fig. Major amputation rates between the standard vein bypass (SVB) group and hybrid procedure (HP) group.
Author Disclosures: G. McFarland: None; B. J. Pearce: None; M. A. Patterson: None; Z. Novak: None; M. A. Passman: None; T. C. Matthews: None; W. D. Jordan: None. Outcomes of Native Superficial Femoral Artery Chronic Total Occlusion Recanalization After Failed Femoropopliteal Bypass: Should We Shift the Redo Paradigm? Mark G. Davies, MD, PhD1, Hosam ElSayed, MD2. 1University of Texas Health Science Center at San Antonio, San Antonio, Tex; 2Ohio State University, Columbus, Ohio
Objectives: We report a symptomatic carotid web successfully treated with carotid endarterectomy. Methods: A literature search was performed using the PubMed database. Three citations contained the search term “carotid web.” Two of these reports described symptomatic internal carotid web lesions. There are no reports in the current literature describing a common carotid web. Results: A 43-year-old woman presented with acute-onset left-sided weakness. Her medical history consisted only of chronic headaches. Carotid web was evident on computed tomography angiography (Fig) as a focal filling defect in the right common carotid artery. This right common carotid web extending into the internal carotid artery created an eddy resulting in turbulent flow. Subsequent acute embolus formation led to an emboli to the right distal M1 artery seen on cerebrovascular angiography. Thrombolysis was performed with recanalization of the right M1 artery. The patient underwent carotid endarterectomy without patch angioplasty of the diseased segment. Surgery was well tolerated, and the patient suffered no additional neurologic sequelae.
Objectives: Failure of a femoropopliteal bypass often necessitates redo lower extremity surgery and is associated with increased mortality and morbidity. An alternative strategy is to perform endovascular revascularization of the superficial femoral artery (SFA) and avoid catheter-directed lysis or open surgery. The purpose of this retrospective study was to examine the outcomes of native SFA chronic total occlusion (CTO) recanalization compared with bypass after failed femoropopliteal bypass. Methods: Patients presenting with a symptomatic failed femoropopliteal bypass who underwent attempted CTO recannulization of the native SFA or a redo femoropopliteal bypass from 2000 to 2014 were included. Patients undergoing catheter-directed thrombolysis were excluded. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. Results: A total of 104 patients (69% male, average age 65 years) underwent native CTO recannulization (n ¼ 40) or redo bypass (n ¼ 64) after presentation with symptomatic occlusion of a previous femoropopliteal bypass graft (rest pain in 84% and life style-limiting claudication in 16%, 79% to the aboveknee popliteal), 81% of the lesions being TASC-II category D and 19% TASC-II category C. Tibial runoff was one tibial vessel in most patients (79%) and two-vessel runoff in the remainder. Lesions treated endovascularly underwent primary stenting with a median of three stents used. Sixty-nine percent of the bypasses were to the below-knee popliteal and remainder to the proximal tibials (68% of the patients has venous conduit). Overall, 30-day major adverse cardiac events were 5.6% and all-cause morbidity was 6.3%. 30-day major adverse limb events was 17% and 30-day amputation rate was 8% (Table). Overall amputation-free survival was 43% 6 9% and freedom from major adverse limb events was 28% 6 7% at 3 years (Table). Critical ischemia, TASC-II lesion (D), and onevessel tibial runoff were significant predictors of failure. Table. Outcomes Outcome 30-day MACE 30-day MALE 30-day Amputation Amputation-free survival Freedom from MALE
Endovascular, % 2.5 25 7.5 33 6 9 19 6 8
Bypass, %
P value
8.3% 10.9 7.8 56 6 8 46 6 7
.4 .0001 1.00 .02 .04
MACE, Major adverse cardiac event; MALE, major adverse limb event.
Fig. Computed tomography angiogram of carotid artery demonstrates carotid web.
Abstracts 795
Conclusions: In a high-risk cohort, bypass is superior to native CTO recannulization after failure of a femoropopliteal bypass. Shifting the paradigm offers no patient benefit. Author Disclosures: M. G. Davies: None; H. ElSayed: None. Acute Limb Ischemia After Cardiothoracic Surgery Is Associated With High Rates of Amputation and Mortality Angelina S. June, Adriana Laser, Donald G. Harris, Angela M. Crawford, James S. Gammie, Bradley Taylor, Rajabrata Sarkar, Robert S. Crawford This abstract has been published in the Abstracts of the 2015 Vascular Annual Meeting: The Society for Vascular Surgery. DOI: http://dx.doi. org/10.1016/j.jvs2015.04.261. Common Carotid Web: A Rare Cause of Stroke John Phair, MD1, Eric Trestman, MD1, Chetra Yean, BS2, Evan C. Lipsitz, MD1. 1Montefiore Medical Center, Bronx, NY; 2Albert Einstein College of Medicine, Bronx, NY Fig. Major amputation rates between the standard vein bypass (SVB) group and hybrid procedure (HP) group.
Author Disclosures: G. McFarland: None; B. J. Pearce: None; M. A. Patterson: None; Z. Novak: None; M. A. Passman: None; T. C. Matthews: None; W. D. Jordan: None. Outcomes of Native Superficial Femoral Artery Chronic Total Occlusion Recanalization After Failed Femoropopliteal Bypass: Should We Shift the Redo Paradigm? Mark G. Davies, MD, PhD1, Hosam ElSayed, MD2. 1University of Texas Health Science Center at San Antonio, San Antonio, Tex; 2Ohio State University, Columbus, Ohio
Objectives: We report a symptomatic carotid web successfully treated with carotid endarterectomy. Methods: A literature search was performed using the PubMed database. Three citations contained the search term “carotid web.” Two of these reports described symptomatic internal carotid web lesions. There are no reports in the current literature describing a common carotid web. Results: A 43-year-old woman presented with acute-onset left-sided weakness. Her medical history consisted only of chronic headaches. Carotid web was evident on computed tomography angiography (Fig) as a focal filling defect in the right common carotid artery. This right common carotid web extending into the internal carotid artery created an eddy resulting in turbulent flow. Subsequent acute embolus formation led to an emboli to the right distal M1 artery seen on cerebrovascular angiography. Thrombolysis was performed with recanalization of the right M1 artery. The patient underwent carotid endarterectomy without patch angioplasty of the diseased segment. Surgery was well tolerated, and the patient suffered no additional neurologic sequelae.
Objectives: Failure of a femoropopliteal bypass often necessitates redo lower extremity surgery and is associated with increased mortality and morbidity. An alternative strategy is to perform endovascular revascularization of the superficial femoral artery (SFA) and avoid catheter-directed lysis or open surgery. The purpose of this retrospective study was to examine the outcomes of native SFA chronic total occlusion (CTO) recanalization compared with bypass after failed femoropopliteal bypass. Methods: Patients presenting with a symptomatic failed femoropopliteal bypass who underwent attempted CTO recannulization of the native SFA or a redo femoropopliteal bypass from 2000 to 2014 were included. Patients undergoing catheter-directed thrombolysis were excluded. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. Results: A total of 104 patients (69% male, average age 65 years) underwent native CTO recannulization (n ¼ 40) or redo bypass (n ¼ 64) after presentation with symptomatic occlusion of a previous femoropopliteal bypass graft (rest pain in 84% and life style-limiting claudication in 16%, 79% to the aboveknee popliteal), 81% of the lesions being TASC-II category D and 19% TASC-II category C. Tibial runoff was one tibial vessel in most patients (79%) and two-vessel runoff in the remainder. Lesions treated endovascularly underwent primary stenting with a median of three stents used. Sixty-nine percent of the bypasses were to the below-knee popliteal and remainder to the proximal tibials (68% of the patients has venous conduit). Overall, 30-day major adverse cardiac events were 5.6% and all-cause morbidity was 6.3%. 30-day major adverse limb events was 17% and 30-day amputation rate was 8% (Table). Overall amputation-free survival was 43% 6 9% and freedom from major adverse limb events was 28% 6 7% at 3 years (Table). Critical ischemia, TASC-II lesion (D), and onevessel tibial runoff were significant predictors of failure. Table. Outcomes Outcome 30-day MACE 30-day MALE 30-day Amputation Amputation-free survival Freedom from MALE
Endovascular, % 2.5 25 7.5 33 6 9 19 6 8
Bypass, %
P value
8.3% 10.9 7.8 56 6 8 46 6 7
.4 .0001 1.00 .02 .04
MACE, Major adverse cardiac event; MALE, major adverse limb event.
Fig. Computed tomography angiogram of carotid artery demonstrates carotid web.