HYBRID REVASCULARIZATION OF CHRONIC LIMB-THREATENING ISCHEMIA USING POPLITEAL BELOW-KNEE AND TIBIAL TRIFURCATION OPEN ENDARTERECTOMY DISTALLY PLUS INTER-WOVEN NITINOL STENTING PROXIMALLY

2021 ◽  
Author(s):  
Luis J. García Domínguez ◽  
Irene Ramos Moreno ◽  
Laura Gálvez Núñez ◽  
Manuel Miralles Hernández
Keyword(s):  
Hybrid Revascularization

An asymptomatic Lima dissection after a programmed hybrid revascularization procedure turned to nightmare

2021 ◽  
pp. 1-3
Author(s):  
Sotirios Marinakis ◽  
Jacques Lalmand ◽  
Serge Cappeliez ◽  
Yasmine De Bruyne ◽  
Claire Viste ◽  
...  
Keyword(s):  
Revascularization Procedure ◽  
Hybrid Revascularization

MINI OPCAB Operation: Surgical Technique

2021 ◽  
Author(s):  
Federico Benetti ◽  
Natalia Scialacomo ◽  
Gustavo Mazzolino
Keyword(s):  
Surgical Technique ◽  
Large Scale ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Revascularization ◽  
Pump Coronary Artery Bypass ◽  
The Right

Introduction: We describe how to perform left internal mammary artery (LIMA) bypass to the left anterior descending (LAD) artery, the so-called MINI Off-pump Coronary Artery Bypass (MINI OPCAB). Materials and Methods: We included patients with a demonstrated predominant ischemia related to the LAD territory. Of 70 patients who were operated upon at the Benetti Foundation, 10 received hybrid revascularization. Surgical Technique: The patient is prepared as for a standard coronary bypass operation through sternotomy. The sternum is opened to the 3rd or 4th intercostal space depending on the anatomy, and a retractor is put in place. The left mammary artery is generally dissected to about 8 cm and isolated without the veins. Importantly, the angle of the superior part, where the mammary artery is attached to the sternum, needs to be below 20% to avoid any potential kinking. The pericardium is cleaned to identify the area of the pulmonary artery. The pericardium is opened to the apex and towards the right to around 5 to 6 cm initially. In most cases, the area of the LAD can be seen and the potential area of the anastomosis is defined. The patient is heparinized and the LAD is occluded with 5-0 Proline. A mechanical stabilizer is put in place and the anastomosis is performed. When the bypass is finished, and before sutures are tied, the stitches of 5-0 polypropylene around the artery are released, along with the clamp of the mammary artery; the anastomosis is then tied. The mechanical stabilizer is removed, the stitches of the pericardium are released and the flow of the graft is measured, while ensuring that there is no kinking. If the flow and Pulsatility and Resistance (PR) are acceptable, the mammary is fixed with 2 stitches of 7-0 polypropylene on both sides around 1 cm from the anastomosis. The heparin is reverted with protamine and a drain is put in place, while taking care to avoid any chance of touching the mammary artery or the anastomosis. The sternum is closed with 1 or 2 wires. Results: Operative mortality in this series was 0%; one patient was converted to sternotomy off-pump (1.4%). None of the grafts were revised after measurement with a Medistim system (Medistim ASA, Oslo, Norway). Fifty five patients (79%) were extubated in the operating room The average hospitalization stay was 60 hours (SD 17, 95% CI). Sixteen patients who underwent the LIMA-to-LAD procedure were restudied, with 100% patency. At 144 months, 82% of the patients were alive and 68% were asymptomatic. Conclusion: Additional clinical experience is required to be able to reproduce this operation on a large scale and expand the MINI OPCAB operation in hybrid revascularization.

scholarly journals Case of successful hybrid revascularization and limb salvage in patient with CLI after multiply ABF thrombosis and absence of outflow arteries

2020 ◽  
pp. 130-142
Author(s):  
A. F. Kharazov ◽  
V. M. Luchkin ◽  
N. M. Basirova ◽  
V. A. Kulbak ◽  
A. I. Maslov
Keyword(s):  
Femoral Artery ◽  
Mechanical Recanalization ◽  
Main Obstacle ◽  
Femoral Arteries ◽  
The Third ◽  
Chronic Occlusion ◽  
First Case ◽  
Anterior Tibial ◽  
Hybrid Revascularization ◽  
Revascularization Procedures

Patients with CLI often present multilevel disease. They underwent multiply revascularization procedures aiming to save thelimb. The main obstacle is absence or poor outflow arteries. Inability to restore bloodflow usuallyleads to ischemia progression and consequent amputation. We describe two cases of successful treatment of patient with CLI after multiply ABF thrombosis and absence of outflow arteries.The first 63 years old patient developed the third case of ABF thrombosis as a result of profunda and superficial femoral arteries chronic occlusion. We performed mechanical recanalization and angioplasty of anterior tibial, popliteal, subintimal recanalization and angioplasty of superficial femoral arteries. After that the ABFleg was sutured to subintimal space of femoral artery. The next case was another 63 years old patient with total chronic occlusion of iliac, femoral, popliteal and tibioperoneal trunk. We performed mechanical recanalization and angioplasty of anterior tibial, popliteal, subintimal recanalization and angioplasty of superficial femoral arteries. And then extra anatomy femoro-femoral autovenous bypass, distal anastomosis was performed by using subintimal artery space also. Thelong term period was 27 months for the first case and 20 months - for the second one. All bypasses were patient.Therefore this described above approach of hybrid open and endovascular surgery could give additional chance forlowlimb revascularization in this so-called hopeless group with criticallimb ischemia.

Patient doses in endovascular and hybrid revascularization of aortoiliac segment

2021 ◽  
Author(s):  
Stefan Stanev ◽  
Desislava Kostova-Lefterova ◽  
Svetla Dineva
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Skin Dose ◽  
Aortoiliac Occlusive Disease ◽  
Modifying Factors ◽  
Current Survey ◽  
Hybrid Revascularization ◽  
Radiation Induced ◽  
Patient Doses ◽  
Lower Morbidity

Objectives: Constantly increasing number of procedures performed – endovascular or hybrid in patients with aortoiliac occlusive disease during the last decades finds its explanation in the lower morbidity and mortality rates, compared to bypass surgery. The purpose of the current survey was to estimate patients’ radiation exposure in aortoiliac segment after endovascular or hybrid revascularization and to study the main factors which have direct contribution. Methods: A retrospective study of 285 procedures conducted with the help of a mobile C-arm system in 223 patients was performed. Procedures were grouped according to criteria such as: type of intervention, vascular access, level of complexity and operating team. Different analyses were performed within the groups and dose values. Results: The median values of kerma–air product (KAP), the number of series and the peak skin dose (PSD) significantly increase with the increasing number of vascular accesses: for one access (16.68 Gy.cm2, 6 and 336 mGy), for two (56.93 Gy.cm2, 11 and 545 mGy), and for three (102.28 Gy.cm2, 15 and 781 mGy). Significant dependence was observed in the case of single access site between the type of access and the dose values: hybrid and retrograde common femoral artery/superficial femoral artery (CFA/SFA) endovascular accesses, 10.06 Gy.cm2/301 mGy and 13.23 Gy.cm2/318 mGy respectively, in contrast with the contralateral CFA and left brachial access, 33 Gy.cm2/421 mGy and 38.33 Gy.cm2/448 mGy respectively. Conclusion: The results demonstrate that the most important factors increasing the dose values are number and type of vascular accesses, followed by the combination and number of implanted stents with the complexity of the procedure. The PSD values for a single procedure were between 2 and 12 times lower than those IAEA proposed as trigger levels for radiation-induced erythema. This study shows that trigger levels were not reached even for patients with repeated procedures in the same segment in 1-year period. Advances in knowledge: The study gives important understanding and clarity on the growing awareness for dose-modifying factors during endovascular and hybrid revascularization of aortoiliac segment.

Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up

2002 ◽  
Vol 73 (6) ◽  
pp. 1849-1855 ◽  
Author(s):  
Friedrich-Christian Riess ◽  
Ralf Bader ◽  
Peter Kremer ◽  
Clemens Kühn ◽  
Joachim Kormann ◽  
...  
Keyword(s):  
Hybrid Revascularization

scholarly journals Current landscape of hybrid revascularization: A report from the NCDR CathPCI Registry

2019 ◽  
Vol 215 ◽  
pp. 167-177 ◽  
Author(s):  
Angela Lowenstern ◽  
Jingjing Wu ◽  
Steven M. Bradley ◽  
Alexander C. Fanaroff ◽  
James E. Tcheng ◽  
...  
Keyword(s):  
Hybrid Revascularization
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