TCTAP C-192 Rescue Lower Limbs by Fogerty and Endovascular Treatment for Subacute Severe Limb Ischemia Which Occluded from External Iliac to Below the Knee Artery

Purpose: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI). Methods: Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups. Results: Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047). Conclusion: The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.

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Prognostic Factors in Hemodialysis Patients Undergoing Endovascular Treatment for Critical Limb Ischemia due to Isolated Below-the-Knee Disease

Journal of Atherosclerosis and Thrombosis ◽

10.5551/jat.25056 ◽

2015 ◽

Vol 22 (4) ◽

pp. 404-414 ◽

Cited By ~ 7

Author(s):

Nobuhiro Suematsu ◽

Osamu Iida ◽

Mitsuyoshi Takahara ◽

Yasutaka Yamauchi ◽

Yoshimitsu Soga ◽

...

Keyword(s):

Prognostic Factors ◽

Endovascular Treatment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Hemodialysis Patients ◽

Below The Knee

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Complex Endovascular Treatment for Critical Limb Ischemia in Poor Surgical Candidates: A Pilot Study

Journal of Endovascular Therapy ◽

10.1177/152660280200900509 ◽

2002 ◽

Vol 9 (5) ◽

pp. 599-604 ◽

Cited By ~ 29

Author(s):

Bruce H. Gray ◽

John R. Laird ◽

Gary M. Ansel ◽

John W. Shuck

Keyword(s):

Endovascular Treatment ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Lower Limbs ◽

Intention To Treat ◽

Area Reduction ◽

Tibial Arteries ◽

Table Analysis ◽

A Prospective Study

Purpose: To evaluate the effectiveness of complex endovascular treatment for limb salvage in patients with critical limb ischemia. Methods: In a prospective study, 23 patients (13 men; mean age 70 ± 11 years, range 44–87) with ischemic ulceration or gangrene of 25 lower limbs were enrolled at 4 sites to evaluate treatment with excimer laser recanalization followed by balloon angioplasty with optional stenting in the superficial femoral, popliteal, and/or tibial arteries. Results: Multiple lesions (mean 3.1, range 1–8) were treated in most cases. Reduction of stenosis/occlusion to <50% was achieved in 22 (88%) limbs. Individual cases of vessel perforation, inability to cross the lesion, and excessive residual stenosis accounted for the 3 failures. Over a 6-month period, 4 patients died of cardiac comorbidity and 1 was lost to follow-up. Adverse events included 4 minor and 2 below-knee amputations, 4 secondary angioplasties, and 4 femorodistal bypasses. The mean wound area reduction was 70% at 3 months, increasing to 89% at 6 months. According to life table analysis, the limb salvage rate was 90% with bypass and 69% without in the successfully treated patients (corresponding intention-to-treat rates were 79% and 61%). Conclusions: Complex endovascular treatment combining laser debulking and angioplasty/stenting offers an alternative for patients with critical limb ischemia who lack good surgical options.

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Rationale and Design of a Prospective, Multicenter, Single-Arm Clinical Trial to Investigate the Safety and Effectiveness of Rotablator Atherectomy System as an Adjunctive Device for Endovascular Treatment of Occlusive Atherosclerotic Lesions in Below-the-Knee Arteries With Critical Limb Ischemia (RESCUE-BTK)

Circulation Reports ◽

10.1253/circrep.cr-20-0024 ◽

2020 ◽

Vol 2 (8) ◽

pp. 449-454

Author(s):

Takeshi Yagyu ◽

Shin Ito ◽

Osami Kawarada ◽

Mitsuyo Mizuseki ◽

Haruko Yamamoto ◽

...

Keyword(s):

Clinical Trial ◽

Endovascular Treatment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Below The Knee ◽

Atherosclerotic Lesions

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Differences in patterns of peripheral arterial occlusive disease and eligibility for endovascular treatment

VASA ◽

10.1024/0301-1526/a000233 ◽

2012 ◽

Vol 41 (6) ◽

pp. 432-439 ◽

Cited By ~ 6

Author(s):

Zimmermann ◽

Arzt ◽

Wildgruber ◽

Schuster ◽

Wendorff ◽

...

Keyword(s):

Endovascular Treatment ◽

Morphological Changes ◽

Multivariable Analysis ◽

Lower Extremities ◽

Limb Ischemia ◽

Below The Knee ◽

Run Off ◽

Logistic Regressions ◽

Peripheral Arterial ◽

Lesion Localization

Background: To analyze differences in morphological changes in the vascular tree among patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). In addition, suitability for endovascular treatment was evaluated. Patients and methods: Our study included 690 lower extremities with IC or CLI in 500 consecutive patients who were assessed by magnetic resonance angiography (MRA) according to the TASC II classification and in terms of the below the knee run-off status. Multivariable logistic regressions models adjusted for cardiovascular risk factors were used to evaluate differences in arteriosclerotic lesion patterns and eligibility for endovascular treatment. Results: Multivariable analysis showed that compared with IC extremities, CLI extremities have significantly more severe arteriosclerotic lesions at the aortoiliac (p < 0.001), femoropopliteal (p < 0.001), and crural levels (p < 0.001), with a greater risk of multilevel disease (odds ratio [OR], 1.71; 95 % confidence interval [CI] 1.10 - 2.66; p = 0.018). More than 80 % of extremities with IC and more than 50 % of extremities with CLI appeared to be eligible for endovascular treatment in an isolated evaluation of the aortoiliac and femoropopliteal axis. For combined evaluation of the aortoiliac and femoropopliteal axis, the proportion of endovascular suitability (TASC A+B lesions) decreased to 65 % (IC) and 41 % (CLI). For TASC A+B+C lesions, the proportions were 79 % (IC) and 41 % (CLI). Conclusions: Lower extremities with IC and CLI significantly differ in terms of arteriosclerotic lesion morphology and patterns of lesion localization. The majority of IC and CLI extremities appear to be eligible for endovascular treatment. Because of further improvement in endovascular equipment, even more patients will be eligible for treatment.

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LONG-TERM EFFICACY OF ENDOVASCULAR TREATMENT FOR PATIENTS WITH CRITICAL LIMB ISCHEMIA DUE TO ISOLATED BELOW THE KNEE LESIONS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)62049-x ◽

2012 ◽

Vol 59 (13) ◽

pp. E2048 ◽

Cited By ~ 1

Author(s):

Kiyonori Nanto ◽

Osamu iida ◽

Yoshimitsu Soga ◽

Kenji Suzuki ◽

Terutoshi Yamaoka ◽

...

Keyword(s):

Endovascular Treatment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Term Efficacy ◽

Below The Knee

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Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽

10.1024/0301-1526/a000786 ◽

2019 ◽

Vol 48 (4) ◽

pp. 321-329

Author(s):

Mariya Kronlage ◽

Erwin Blessing ◽

Oliver J. Müller ◽

Britta Heilmeier ◽

Hugo A. Katus ◽

...

Keyword(s):

Endovascular Treatment ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Limb Ischemia ◽

Bleeding Complications ◽

Severe Bleeding ◽

Short Term ◽

Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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