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1.

Objective

When a bypass fails, the options are lysis, redo bypass, or endovascular intervention. If lysis of the original bypass is not considered an option, which is better—redo bypass or attempts at endovascular recanalization of the native system? This retrospective study examined the outcomes of native superficial femoral artery (SFA) chronic total occlusion (CTO) recanalization compared with redo bypass after failed femoropopliteal bypass.

Methods

Patients presenting with a symptomatic failed femoropopliteal bypass that underwent attempted CTO endovascular (EV) recanalization of the native SFA or a redo femoropopliteal bypass (BP) from 2000 to 2015 were analyzed. Patients undergoing catheter-directed thrombolysis were excluded. Time-dependent outcomes were assessed with life-table analyses. 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 EV (n = 40) or BP (n = 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 above-knee popliteal, 81% prosthetic). According to the TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease classification, 91% of the lesions were category D and 19% were category C. Tibial runoff was one tibial vessel in 79% of the patients and two or more runoff vessels in the remainder. Lesions treated endovascularly underwent primary stenting with a median of 3 stents used. Of the bypasses performed, 69% were to the below knee popliteal and remainder were to the proximal tibials (68% of the patients had a venous conduit). At 30 days in EV vs BP, major adverse cardiovascular events were 3% and 8% (P = .24), major adverse limb events were 25% and 11% (P = .01), and the amputation rate was 8% and 8% (P = .96), respectively. Amputation-free survival was 33% ± 9% and 56% ± 8% (P = .02) and freedom from major adverse limb event was 19% ± 8% and 46% ± 7% (P = .04) at 3 years for EV vs BP, respectively.

Conclusions

In a high-risk cohort when thrombolysis is excluded, BP is superior to EV after failure of a femoropopliteal bypass.  相似文献   

2.
目的观察TASCⅡ C、D型股腘动脉闭塞腔内治疗的临床疗效,分析影响治疗效果的可能因素与操作技巧。方法 2009年1月～2010年6月,89例(113条患肢)TASCⅡ C、D型股腘动脉闭塞患者接受腔内治疗。对患者术后3、6和12个月时的临床症状、踝肱指数(ABI)、并发症发生率和累计通畅率进行分析。结果成功开通病变肢体共106条,技术成功率93.8%。36条(34.0%)患肢出现并发症。75例患者(共92条下肢)获得随访,随访率为86.8%。平均随访时间12.5个月。术后3、6和12个月时的平均ABI分别为0.74±0.39、0.68±0.38和0.66±0.31,与术前比较(0.43±0.39),差异均有统计学意义(P<0.01)。术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为64.6%、72.4%和81.5%。结论 TASCⅡ C、D型股腘动脉闭塞腔内治疗是一种安全有效的方法。熟练的腔内操作技术和规范的术后指导是提高技术成功率和维持动脉早中期通畅的关键。  相似文献   

3.
BACKGROUND: Percutaneous endovascular therapy is becoming a primary option for managing infrainguinal occlusive disease. This study examined the results of femoropopliteal percutaneous transluminal angioplasty (PTA) with intermediate (mean, 24 months) follow-up in a contemporary series of patients presenting with critical limb ischemia or claudication. METHODS: Femoropopliteal PTA was performed on 238 consecutive limbs (208 patients) from January 2002 to July 2004. Study end points, including primary patency, assisted patency, and limb salvage (Society of Vascular Surgery reporting standards), were assessed by Kaplan-Meier life-table analysis, and factors predictive of hemodynamic or clinical failure, or both, were evaluated by univariate and multivariate methods. RESULTS: Clinical and demographic features included a mean age, 72 years; male (62%); critical limb ischemia (46%); diabetes mellitus (49%); and renal insufficiency (creatinine >or= 1.5 mg/dL) (29%). Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) A (11%), B (43%), C (41%), and D (5%). PTA was confined to the femoropopliteal segment in 77 patients (33%), and 161 (67%) underwent concurrent interventions in other anatomic locations. Femoropopliteal interventions included angioplasty only in 183 (78%), and the remaining 53 (22%) received at least one stent. Technical success was achieved in 97% of patients, with no deaths and a major morbidity rate of 3%. The 36-month actuarial primary patency was 54.3%, and assisted patency was 92.6% (37 peripheral reinterventions), resulting in a limb preservation rate of 95.4% in all patients regardless of clinical presentation. Interval conversion to bypass surgery occurred in 19 patients (8%). Comparison between critical limb ischemia and claudication revealed a primary patency of 40.8% vs 64.8%, assisted patency of 93.8% vs 92.6%, and limb salvage of 89.7% vs 100%, respectively. Negative predictors of primary patency determined by multivariate analysis included history of congestive heart failure (P = .02) and TASC C/D (P = .02). However, further evaluation of TASC C/D vs A/B revealed an assisted patency of 89.7% vs 94.3% (P = .37) and limb salvage of 94.3% vs 96.4% (P = .58). CONCLUSIONS: Femoropopliteal PTA can be performed with a low perioperative morbidity and mortality. Intermediate primary patency is directly related to TASC classification. Although secondary intervention is often necessary to maintain patency in TASC C/D lesions, these data suggest that it would be appropriate to use PTA as initial therapy for chronic femoropopliteal occlusive disease regardless of clinical classification at presentation or TASC category of lesion severity.  相似文献   

4.

Objective

The peroneal artery is a well-established target for bypass in patients with critical limb ischemia (CLI). The objective of this study was to evaluate the outcomes of peroneal artery revascularization in terms of wound healing and limb salvage in patients with CLI.

Methods

Patients presenting between 2006 and 2013 with CLI (Rutherford 4-6) and isolated peroneal runoff were included in the study. They were divided into patients who underwent bypass to the peroneal artery and those who underwent endovascular peroneal artery intervention. Demographics, comorbidities, and follow-up data were recorded. Wounds were classified by Wound, Ischemia, foot Infection (WIfI) score. The primary outcome was wound healing; secondary outcomes included mortality, major amputation, and patency.

Results

There were 200 limbs with peroneal bypass and 138 limbs with endovascular peroneal intervention included, with mean follow-up of 24.0 ± 26.3 and 14.5 ± 19.1 months, respectively (P = .0001). The two groups were comparable in comorbidities, with the exception of the endovascular group's having more patients with cardiac and renal disease and diabetes mellitus but fewer patients with smoking history. Based on WIfI criteria, ischemia scores were worse in bypass patients, but wound and foot infection scores were worse in endovascular patients. Perioperatively, bypass patients had higher rates of myocardial infarction (4.5% vs 0%; P = .012) and incisional complications (13.0% vs 4.4%; P = .008). At 12 months, the bypass group compared with the endovascular group had better primary patency (47.9% vs 23.4%; P = .002) and primary assisted patency (63.6% vs 42.2%; P = .003) and a trend toward better secondary patency (74.2% vs 63.5%; P = .11). There were no differences in the rate of wound healing (52.6% vs 37.7% at 1 year; P = .09) or freedom from major amputation (81.5% vs 74.7% at 1 year; P = .37). In a multivariate analysis, neuropathy was associated with improved wound healing, whereas WIfI wound score, cancer, chronic renal insufficiency, and smoking were associated with decreased wound healing. Treatment modality was not a significant predictor (P = .15).

Conclusions

Endovascular peroneal artery intervention results in poorer primary and primary assisted patency rates than surgical bypass to the peroneal artery but provides similar wound healing and limb salvage rates with a lower rate of complications. In appropriately selected patients, endovascular intervention to treat the peroneal artery is a low-risk intervention that may be sufficient to heal ischemic foot wounds.  相似文献   

5.

Background

Our aim was to compare intraoperative combined versus traditional surgical procedures at the aorto-iliac level during long-term follow-up.

Methods

From 1991 to 1999 a total of 42 aortic or iliac stents were placed in 34 patients. In 76.4%, there was a high preoperative risk (ASA-score III and IV). Stent placement was performed only in iliac TASC type A stenosis and combined with femoral patchplasty (n=10), ipsilateral (n=2) and cross-over bypass (n=22).

Results

The technical success of stent placement was 100%. Two cases of stent associated stenosis were treated successfully with PTA, bypass occlusion in five patients with successful thrombectomy in two cases. A single perioperative death (2.9%) occurred. In one patient, major amputation was necessary. The primary (secondary) patency rate after 1, 2, 5 and 7 years was 85%, 81%, 81% and 81% (91%, 85%, 85% und 85%).

Conclusions

Intraoperative combined procedures had a patency rate comparable to traditional aorto-iliac reconstructions while showing lower morbidity and mortality. The endovascular procedure can be performed safely and successfully by vascular surgeons.  相似文献   

6.

Background

Existing endovascular therapies for failing infrainguinal bypass grafts are associated with modest patency rates. The use of everolimus drug-eluting stents (eDESs) for endovascular bypass graft revision has not yet been reported. The objective of this study was to describe and to compare clinical outcomes of eDESs vs percutaneous cutting balloons (PCBs) vs percutaneous transluminal angioplasty (PTA) for the treatment of infrainguinal bypass graft stenoses.

Methods

A multicenter, single-institution retrospective analysis of patients with infrainguinal bypass graft stenoses treated by endovascular intervention (August 2010-December 2017) was conducted. The primary study outcome was primary patency of the treated lesion. The secondary outcome was limb salvage. Outcomes are described overall and stratified by endovascular treatment modality using Kaplan-Meier curves and log-rank tests.

Results

During the 7-year study period, 43 patients with 78 infrainguinal bypass stenoses were treated by endovascular intervention (eDES, 15; PCB, 23; PTA, 40). Mean age was 63.3 ± 1.7 years, 53.5% were male, and 55.8% were black. The majority of patients were diabetic (60.5%) with a history of smoking (74.4%), and nearly all (83.7%) had two or more comorbidities. Half (48.7%) of bypasses treated were femoral-popliteal bypasses, followed by popliteal-distal (25.6%) and femoral-tibial (25.6%) configurations. The location of revision was the proximal anastomosis in 37.2%, midbypass in 25.6%, and distal anastomosis in 37.2%. There were no significant differences in baseline characteristics, bypass configuration, or revision location between treatment groups (P ≥ .19). Technical success for endovascular bypass intervention was 100%. At 2 years after intervention, primary patency was significantly better for patients treated with eDES (81.8%) compared with PCB (54.7%) or PTA (33.2%; log-rank, P = .03). Limb salvage was achieved in 93.6% of patients, including 86.7%, 91.3%, and 97.5% for eDES, PCB, and PTA, respectively (P = .30).

Conclusions

This is the first study reporting the results of eDESs for the treatment of infrainguinal bypass graft stenoses. Use of eDESs for endovascular bypass graft revision not only is feasible but may have better primary patency than other endovascular therapies. These data suggest that eDESs may be considered a safe and efficacious endovascular technique in the armamentarium for treatment of infrainguinal bypass graft stenoses.  相似文献   

7.
OBJECTIVE: Endovascular therapy for moderate femoropopliteal arterial occlusive disease remains controversial. This study reviewed our experience with endovascular therapy for TransAtlantic InterSociety Consensus (TASC) type B disease, which is defined as multiple stenoses less than 3 cm in diameter or a single stenosis or occlusion 3 to 5 cm in diameter. Stenosis-free patency was used as an objective end point to evaluate the hemodynamic outcome. METHODS: A retrospective review was performed of all patients who had undergone endovascular treatment of TASC type B lesions between 1997 and 2002 at two referral centers. Balloon angioplasty was performed in all patients. Stenting was used selectively as an adjunct in patients with suboptimal angioplasty results. The treated sites were examined with duplex ultrasound scanning at 6-month to 12-month intervals. Stenosis-free patency was defined as the absence of stenosis greater than 50% diameter in the treated arterial segment with standard duplex criteria. RESULTS: One hundred fifteen limbs in 98 patients were studied. The indication for treatment was claudication in 92 patients (80%) and ischemic rest pain or gangrene in the remaining patients (20%). Multiple lesions greater than 3 cm were treated in 89 limbs (77%), and a single lesion 3 to 5 cm long was treated in 26 limbs (23%). Balloon angioplasty alone was performed in 74 limbs (65%), and angioplasty and adjunctive stenting was performed in 41 limbs (35%). Endovascular therapy was technically successful in all but one patient (99%), and there was no perioperative mortality or limb loss. During follow-up recurrent stenosis was detected in 46 limbs (40%), and reocclusion occurred in 11 limbs (10%). Seven patients (6%) underwent surgical bypass after endovascular treatment failure. The aggregate 1-year stenosis-free patency rate at life table analysis was 55.1%. The 1-year stenosis-free patency for angioplasty alone was 58%, compared with 51% (NS) for angioplasty and adjunctive stenting. Univariate regression analysis failed to demonstrate a difference in stenosis-free patency for demographic variables, medical comorbidities, and anatomic characteristics (multiple vs single lesions; number of angioplasty procedures). CONCLUSIONS: Endovascular therapy for TASC type B femoropopliteal lesions is safe and technically feasible. However, the length of time that a treated arterial segment remains free of stenosis is limited, and is not improved with adjunctive stenting. Recurrent stenosis, not occlusion, was the most common study end point, and few patients subsequently required surgical bypass. Predictors of outcome after endovascular therapy for TASC type B lesions were not identified in this study.  相似文献   

8.
目的观察TASCⅡC、D型股胭动脉慢性长段闭塞腔内治疗的临床疗效,总结腔内治疗相关并发症和防治方法。方法2009年1月至2010年12月,134例（172条下肢）TASCⅡC、D型股胴动脉闭塞患者接受腔内治疗。回顾性分析技术成功率、患肢术后临床症状、踝肱指数（ankle brachial index,ABI）变化、并发症发生率和通畅率。结果技术成功率90．7％。43条患肢（83条次）出现并发症（27．6％）。其中动脉夹层29条（34．9％）,动脉穿孔11条（13．3％）,动脉栓塞8条（9．6％）,穿刺部位血肿16条（19．3％）,穿刺点假性动脉瘤5条（6．0％）,急性动脉血栓形成3条（3．6％）,造影剂过敏反应3条（3．6％）,尿路出血2条（2．4％）和心脑血管意外6条（7．2％）。平均随访13．1个月。术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为61．1％、70．2％、81．7％。结论TASCⅡC、D型股胭动脉闭塞腔内治疗是一种安全有效的方法。熟练的腔内操作技术,及时正确的并发症处理和规范的术后随访是提高治疗成功率和维持动脉长期通畅的关键。  相似文献   

9.
目的探讨对泛大西洋协作组织(TASC)C、D级髂股动脉闭塞老年患者行腔内治疗的疗效。方法 104例老年TASC C、D级髂股动脉闭塞患者接受微创腔内介入手术,其中TASC C型73例、TASC D型31例,闭塞长度4.25~17.61cm,平均(13.46±1.24)cm。对腔内介入治疗的临床疗效、并发症、术后随访等情况进行分析。结果 94例成功开通闭塞动脉,技术成功率90.38%(94/104),其中单纯球囊扩张12例、联合支架植入92例。围手术期发生并发症8例,并发症发生率为7.69%(8/104),包括急性动脉血栓2例、穿刺处假性动脉瘤形成1例、心功能衰竭4例、对比剂肾病1例。术后7天踝肱指数由术前的0.32±0.12增至0.81±0.11(P0.01)。术后6个月、12个月各随访78例和53例患者,通畅率分别为88.46%(69/78)、81.13%(43/53)。结论对老年TASC C、D级髂股动脉闭塞患者,微创腔内介入治疗手术成功率高,并发症少,可取得满意的临床疗效。  相似文献   

10.

Objective

Common femoral artery (CFA) occlusive disease remains a debatable site for endovascular therapy, and the outcome of drug-eluting balloon (DEB) angioplasty in treating CFA occlusive disease is largely unknown. This study compared the efficacy, safety, and short-term patency rate of DEB angioplasty and femoral endarterectomy for treatment of CFA occlusive disease.

Methods

From March 2013 to June 2016, there were 100 patients with symptomatic CFA occlusive disease who were retrospectively reviewed. Forty patients were treated with DEB angioplasty and 60 were treated with femoral endarterectomy. Each patient received regular follow-up. Patency rate, ankle-brachial index, target lesion revascularization, and adverse events were assessed.

Results

Technical success was 100% in all patients. The DEB group had a lower 1-year primary patency rate (75.0% vs 96.7%; P = .003), but the secondary patency rate was similar between the two groups (97.5% vs 98.3%; P = 1.000). At 2-year follow-up, the primary patency was lower in the DEB group (57.1%) than in the endarterectomy group (94.1%; P = .001), whereas the secondary patency rate had no significant difference (90.5% vs 97.1%; P = 1.000). Both groups had significant improvement in ankle-brachial index. Freedom from target lesion revascularization was lower in the DEB group both at 1 year (75.0% vs 96.7%; P = .003) and at 2 years (57.1% vs 94.1%; P = .001). There was no significant difference in the incidence of complications and adverse events.

Conclusions

Femoral endarterectomy has a better primary patency rate compared with DEB angioplasty in treating CFA occlusive disease without significant increase in complications. In patients not suitable for endarterectomy, DEB angioplasty provides a similar secondary patency rate and could be considered an alternative treatment.  相似文献   

11.
Percutaneous angioplasty and stenting of the superficial femoral artery   总被引：10，自引：0，他引：10  
OBJECTIVES: The objectives of this study were to examine factors predictive of success or failure after percutaneous angioplasty (PTA) and stenting (S) of the superficial femoral artery (SFA) and to compare the results of PTA/S with a contemporary group of patients treated with femoropopliteal bypass. METHODS: A database of patients undergoing PTA and/or S of the SFA between 1986 and 2004 was maintained. Intention-to-treat analysis was performed. Patients underwent duplex scanning follow-up at 1, 3, and every 6 months after the intervention. Angiograms were reviewed in all cases to assess lesion characteristics and preprocedure and postprocedure runoff. Results were standardized to current TransAtlantic Inter-Society Consensus (TASC) and Society for Vascular Surgery (SVS) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Cox proportional hazard analyses were performed to assess factors associated with patient survival and treatment efficacy. RESULTS: Three hundred eighty total limbs underwent PTA/S in 329 patients (67% male, 33% female; average age, 65 years). Mean follow-up was 1.8 years from the date of initial intervention. Indications for intervention were claudication in 66%, rest pain in 16%, and tissue loss in 18%. Runoff at the tibial level was 2.1 +/- 0.8 patent vessels. Mean SVS ischemia grade was 3.1 (range, 1 to 5). TASC lesion grades were A (48%), B (18%), C (22%), and D (12%). Angioplasty alone was used in 63% of cases. Primary treatment failure (inability to cross lesion) was seen in 7% of patients. There was one periprocedural death. Primary patency rates were 86% at 3 months, 80% at 6 months, 75% at 12 months, 66% at 24 months, 60% at 36 months, 58% at 48 months, and 52% at 60 months. Assisted primary patency rates were slightly higher ( P = not significant). By Cox proportional hazards analysis, patency of PTA/S was associated with higher preoperative ankle/brachial index ( P = .016) and the performance of angioplasty only ( P = .011). Failed or occluded PTA/S was associated with TASC C ( P < .0001) and TASC D lesions ( P < .0001). Patient death was associated with the presence of congestive heart failure ( P = .003). Subgroup analysis revealed that primary patency rates are highly dependent on lesion type (A > B > C > D, P < .0001). PTA/S patency for TASC A and B lesions compared favorably to prosthetic and venous femoropopliteal bypass. Surgical bypass was superior to PTA/S for TASC C and D lesions. CONCLUSIONS: PTA and stenting of the SFA can be performed safely with excellent procedural success rates. Improved patency of these interventions was seen with increased ankle/brachial index and the performance of angioplasty only. Worse patency was seen with TASC C and TASC D lesions. Patency rates were strongly dependent on lesion type, and the results of angioplasty and stenting compared favorably with surgical bypass for TASC A and B lesions.  相似文献   

12.

Objective

The aim of this study was to retrospectively compare early and late results of aortobifemoral bypass and endovascular recanalization with the kissing stent technique in the management of TransAtlantic Inter-Society Consensus II (TASC II) C and D lesions in the aortoiliac district in a multicenter study.

Methods

From January 2006 to December 2013, 210 open and endovascular interventions for TASC II class C and D aortoiliac obstructive lesions were performed at three Italian teaching hospitals. In all the cases, the intervention was performed for aortic and bilateral iliac involvement. An aortobifemoral bypass was performed in 82 patients (group 1); in the remaining 128, an endovascular recanalization with the kissing stent technique was carried out (group 2). Early results in the two groups were compared with the χ2 test. Follow-up results were analyzed with Kaplan-Meier curves and compared with log-rank test. Univariate and multivariate (forward Cox regression) analysis to identify potentially significant predictors of primary patency in the whole study group was performed.

Results

Patients in group 2 were more frequently female and more frequently had diabetes and arterial hypertension than patients in group 1. The indication for surgical intervention was the presence of critical limb ischemia in 29 cases in group 1 (35%) and in 31 cases in group 2 (24%; P = .07). Technical success in group 2 was 98.5%; two patients required immediate conversion to open surgery for iliac rupture. There was one perioperative death in group 1 (mortality rate, 1%; P = .2 in comparison with group 2). Four perioperative thromboses occurred, two in group 1 and two in group 2 (in one case requiring conversion to open surgical intervention), and no amputations at 30 days were recorded. Cumulative postoperative local and systemic complications occurred in 17 patients in group 1 (20.5%) and in 9 patients in group 2 (7%; P < .001). Mean duration of follow-up was 38 months (range, 1-96 months). Survival rates at 6 years were 65.5% (standard error [SE], 0.08) in group 1 and 83.5% (SE, 0.08) in group 2 (P = .08; log-rank, 2.2). At the same time interval, primary, assisted primary, and secondary patency rates were similar; reintervention rates were 6% in group 1 (SE, 0.05) and 11% in group 2 (SE, 0.04; P = .3; log-rank, 0.8). Univariate and multivariate analysis showed that only the presence of critical limb ischemia was independently associated with poorer primary patency during follow-up (hazard ratio, 2.4; 95% confidence interval, 0.9-6.4; P = .05).

Conclusions

In this multicenter experience, endovascular repair of aortoiliac complex lesions with the kissing stent technique provided similar satisfactory early and late results to those obtained with open surgery.  相似文献   

13.

Background

In Leriche syndrome, postoperative graft thrombosis remains one of the most significant clinical challenges.

Methods

We reviewed 51 patients who underwent surgery for aortoiliac occlusive disease at our hospital from January 2007 to December 2014. The factors associated with graft patency were determined using the Cox proportional hazard model.

Results

The 2-year prosthetic graft patency rate was 72.5%. Younger age (p = 0.017, Odd ratio (OR) = 1.112), postoperative uncontrolled hypertension (p = 0.044, OR = 3.797), and associated Trans Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease II (TASC II) D femoropopliteal lesion (p = 0.008, OR = 11.139) were significantly related factors for prosthetic graft patency after surgical repair. The existing comorbidities of the patients that indicated the need for axillo-bifemoral bypass seemed to be related to lower graft patency or other complications.

Conclusions

For better graft patency after an open surgical repair of Leriche syndrome, strict postoperative hypertension control and distal run-off resolution are necessary.  相似文献   

14.
This clinical review of 70 polytetrafluoroethylene femoropopliteal and femoral-distal (tibial or peroneal) bypasses for limb salvage analyzes factors that influence graft patency. Patients with “good” angiographic run-off (n = 26) had a significantly better (P < 0.01) cumulative patency rate when compared to patients with “poor” (n = 43) angiographic run-off. Other factors which had a significant influence on graft patency over the 2-year follow-up included site of distal anastomosis (femoropopliteal versus femoral-distal), and previously failed femoropopliteal bypass. Patients with a preoperative ankle/brachial Doppler pressure index of less than 0.2 had a 67% occlusion rate during the first postoperative month. Thrombectomy and distal revisions (patch or jump graft) following graft occlusion did not significantly prolong graft patency.  相似文献   

15.

Objective

Aortobifemoral bypass has been the gold standard treatment for extensive aortoiliac occlusive disease. Endovascular therapy and stenting of aortic and iliac occlusive lesions has proven to be efficacious, especially when dealing with short segment lesions. Endovascular treatment of TransAtlantic Inter-Society Consensus II (TASC) D aortoiliac occlusive lesions remains a challenge, but a valuable treatment option in poor surgical candidates. We present our operative technique and midterm results in treating TASC D aortoiliac occlusive disease using unibody bifurcated endografts.

Methods

We performed a retrospective review of patients with TASC D aortoiliac occlusive disease who underwent transfemoral endovascular revascularization with the Endologix Powerlink unibody bifurcated endograft (Endologix, Irvine, Calif). Demographic data, operative details, and outcomes were collected. Paired t-tests were performed to compare preoperative and postoperative ankle brachial indexes.

Results

Between March 2009 and July 2011, 10 high-risk patients (8 male and 2 female) for a traditional aortobifemoral bypass were treated using this endovascular technique. The mean age was 59 ± 6 years (range, 50-69 years). All patients presented with rest pain, and four with tissue loss. Technical success was 100%, with two patients requiring brachial access and eight patients requiring additional stent placement. Postoperatively, all patients reported clinical improvement with resolution of ischemic symptoms. Mean improvement ankle brachial index was 0.50 ± 0.08 (P = .028) and 0.50 ± 0.01 (P = .034) in the left and right legs, respectively. Mean follow-up time was 40 ± 24 months (range, 4-81 months). The primary and secondary patency rates were 80% and 100%, respectively. Complications requiring early reintervention occurred in two patients and included one expanding hematoma from the percutaneous access site and one acute iliac artery thrombosis. Additionally, one patient underwent repeat angioplasty/stenting for threatened endograft limbs at 4 months. One patient expired during follow-up from an unrelated cardiac cause 19 weeks postoperatively.

Conclusions

This series demonstrates that endovascular repair using a unibody bifurcated endograft for TASC D aortoiliac occlusive disease is feasible, effective, and has excellent midterm patency. It should be considered an effective treatment option when the disease process involves the aorta, in particular if the patient is surgically unfit for a traditional aortobifemoral bypass. The unibody configuration preserves the anatomic aortic bifurcation, which is particularly important in patients with peripheral occlusive disease who are deemed to undergo subsequent endovascular interventions.  相似文献   

16.
目的：探讨TASC II C、D型股腘动脉闭塞的治疗效果。方法：将TASC II C、D型股腘动脉闭塞性病变178例患者回顾性分为观察组82例（开放手术组）和对照组96例（腔内治疗组）,对其疗效和并发症进行评估。结果：术后1周、3个月,观察组通畅率及踝肱指数（ABI）略高于对照组（P〉0.05）;术后6、12、24个月,观察组通畅率及ABI明显高于对照组（P〈0.05）;观察组心脑血管不良事发生率高于对照组（P〈0.01）。结论：TASC II C、D型股腘动脉慢性闭塞性病变,开放手术治疗后ABI改善情况及中远期通畅率高于腔内治疗组。  相似文献   

17.

Background

Subintimal endovascular intervention has been used widely in the treatment of symptomatic superficial femoral artery (SFA) occlusion. The relative effectiveness of subintimal placement of a covered stent (CS) versus balloon-only subintimal angioplasty (SIA) remains uncertain.

Methods

We performed a retrospective cohort study of consecutive patients with symptomatic SFA occlusions (>15 cm) who underwent subintimal endovascular intervention, either CS or SIA, in a single institution. Primary patency was the primary outcome. Secondary outcomes included complication rates, freedom from re-intervention, and limb salvage rates. Patency was ascertained with followup duplex or clinically.

Results

We evaluated 57 patients in the SIA group and 31 patients in the CS group. At 1 year the SFA primary patency for the SIA and CS groups was 28% versus 75% (P < .001), whereas the primary assisted patency was 37% versus 84% (P < .001), respectively. Need for bypass was 13% versus 0% (P = .05) in the SIA and CS groups, respectively.

Conclusions

Placement of a covered stent improves patency after subintimal intervention for long SFA occlusion.  相似文献   

18.
Purpose: The purpose of this study was to evaluate the early results of a newly developed endovascular technique for the treatment of superficial femoral artery occlusion.Methods: Fifty-five patients with total occlusion of the superficial femoral artery with patent popliteal artery were treated and evaluated over a 21-month period. The endovascular treatment was performed through a groin incision and consisted of a recanalization of the occluded femoral artery, balloon dilatation, and intraluminal placement of a 3-mm polytetrafluoroethylene graft, distal fixation with a stent, dilation of the graft, and proximal suture anastomosis in the common femoral artery.Results: At a 1-year follow-up the Kaplan-Meier method revealed a primary patency rate of 73.1% (95% confidence limits: 59.6 to 86.6) and a secondary patency rate of 86.3% (range 75.8% to 96.9%). The procedure morbidity rate was 3.6%; the mortality and amputation rate at 12 months was nil.Conclusions: The early 1-year results of this endovascular study support the concept that femoropopliteal endobypass for atherosclerotic occlusive disease may be an acceptable alternative to classic direct femoropopliteal bypass operations. Further study is necessary. (J Vasc Surg 1996;24:647-54.)  相似文献   

19.

Objective

The urgency with which salvage of thrombosed vascular accesses for dialysis should be attempted remains unknown. We examined the effect of a timely thrombectomy approach on vascular access outcomes for dialysis.

Methods

A before-and-after study was conducted with patients on hemodialysis who had undergone endovascular thrombectomy. A timely thrombectomy initiative (ie, salvage within 24 hours of thrombosis diagnosis) was started in July 2015 at our institution. Data about thrombectomy procedures, performed within 1 year before and after the initiative was introduced, were abstracted from an electronic database. Immediate outcomes and patency outcomes were compared between the preinitiative (control) and postinitiative (intervention) groups.

Results

During the study period, 329 patients were enrolled, including 165 cases before and 164 cases after the initiative. The intervention group had more thrombectomy procedures performed within 24 hours (93% vs 55%; P < .01) and within 48 hours (97% vs 79%; P < .01) than the control group. No between-group differences in procedural success or clinical success rates were found. At 3 months, the intervention group had a higher postintervention primary patency rate than the control group, although this did not reach statistical significance (58% vs 48%; P = .06). After stratification into native or graft accesses, the patency benefit was observed in the native access group (68% vs 50%; P = .03) but not in the graft access group (50% vs 46%; P = .65). After adjusting for potential confounders, timely thrombectomy remained an independent predictor of postintervention primary patency (hazard ratio, 0.449; 95% confidence interval, 0.224-0.900; P = .02) for native dialysis accesses.

Conclusions

Our results suggest that a timely thrombectomy approach, in which salvage is attempted within 24 hours of thrombosis diagnosis, improves postintervention primary patency of native but not graft accesses for dialysis.  相似文献   

20.
目的探讨糖尿病对下肢动脉硬化闭塞症（股胭动脉节段）腔内治疗效果的影响。方法2009年1月1日～2012年8月1日,对我院接受股、胭动脉腔内介入治疗的患者按是否合并糖尿病,分为糖尿病组与非糖尿病组,其中糖尿病组94例（109条肢体）,非糖尿病组84例（94条肢体）。比较2组患者围手术期情况、一期通畅率,应用Kaplan—Meier方法计算一期通畅率,COX回归分析影响预后的相关危险因素。结果糖尿病组与非糖尿病组围手术期局部并发症发生率[3．7％（4／109）vs．3．2％（3／94）,P=1．000]、系统并发症发生率[3．9％（4／103）vs．3．4％（3／88）,P=1．000]均无明显差异。糖尿病组3、6、12、24、36个月的一期通畅率分别为（93．8±2．5）％,（80．7±4．2）％,（71．7±5．1）％,（66．0±5．7）％,（66。0±5．7）％;非糖尿病组3、6、12、24、36个月的一期通畅率分别为（97．6±1．6）％,（89．1±3．4）％,（84．5±4．2）％,（79．8±5．1）％,（75．6±6．4）％,2组比较无统计学差异（10g—rank检验,z。=3．052,P=0．081）。COX回归分析显示,2型糖尿病（RR=2．182,95％们：1．13～4．22）、高脂血症（RR=1．904,95％叫：1．02～3．56）及TASCⅡC、D级病变（RR=2．322,95％C1：1．20～4．49）是影响一期通畅率的危险因素。结论对于合并糖尿病的股胭动脉硬化闭塞症患者,腔内介入治疗是一种安全、有效的治疗方法。糖尿病是影响股、胭动脉腔内介入治疗一期通畅率的危险因素,其他影响一期通畅率的危险因素包括TASCⅡC、D级病变及高脂血症。  相似文献   

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