Comparison between antegrade common femoral artery access and superficial femoral artery access in infrainguinal endovascular interventions

Author(s):  
Luisa Ciucci Biagioni ◽  
Leticia Pereira ◽  
Felipe Nasser ◽  
Rodrigo Bruno Biagioni ◽  
Marcelo Calil Burihan ◽  
...  
2019 ◽  
Vol 26 (4) ◽  
pp. 490-495 ◽  
Author(s):  
Gabriele Testi ◽  
Tanja Ceccacci ◽  
Mauro Cevolani ◽  
Francesco Giacchi ◽  
Fabio Tarantino ◽  
...  

Purpose: To report a new technique to reenter the common femoral artery (CFA) true lumen after retrograde recanalization of a superficial femoral artery (SFA) with flush ostial occlusion. Technique: The technique is demonstrated in a 76-year-old woman with critical limb ischemia previously submitted to several surgical revascularizations. A duplex ultrasound showed flush ostial occlusion of the SFA and patency of the anterior tibial artery at the ankle as the sole outflow vessel. After unsuccessful antegrade attempts to recanalize the SFA, a retrograde guidewire was advanced subintimally up to the CFA, without gaining reentry. A balloon catheter was inflated in the subintimal plane across the SFA ostial occlusion. Antegrade access to the distal CFA was achieved with a 20-G needle, which was used to puncture the balloon. A guidewire was advanced into the balloon and pushed forward while the collapsed balloon was pulled back to the mid SFA. The antegrade guidewire was externalized through a retrograde catheter, which was pushed in the CFA true lumen. A retrograde guidewire was advanced and externalized through the femoral sheath, establishing a flossing wire. The procedure was completed in antegrade fashion. Conclusion: The FORLEE technique is a cost-effective option to gain the CFA true lumen after subintimal retrograde recanalization of an ostial SFA occlusion.


VASA ◽  
2009 ◽  
Vol 38 (4) ◽  
pp. 334-337 ◽  
Author(s):  
Pontón ◽  
Negueruela ◽  
Bernal ◽  
García ◽  
Arnáiz ◽  
...  

Background: Despite the theoretical effectiveness of the Angio-Seal closure device to control bleeding after arterial puncture it can increase the risk of ischemia. Objectives: To describe arterial lesions caused by the device, surgical techniques needed to repair those lesions and surgical outcome in patients who underwent surgery for arterial ischemia after heart catheterization. Patients and methods: Seven patients underwent surgery over a period of 12 months at our institution. Five patients underwent emergency surgery and two a delayed procedure. The cause of ischemia was dissection of an atheroma plaque at the puncture site in four cases, dissection of the superficial femoral artery in one case, thrombosis of the common femoral artery in one case, and plication of the posterior arterial wall in one case. Arterial repair in these patients required the insertion of a vascular graft in three cases, endarterectomy plus angioplasty in two cases, endarterectomy plus graft interposition plus thrombectomy of the superficial femoral artery in one case and endarterectomy plus femoropopliteal bypass in one case. Results: Treatment was successful in all patients. Mean follow up was 7.6 months (range 5-11 months). During the study period one patient died due to cardiopathy. No patients had to be re-operated and no limb losses were recorded. All the patients were asymptomatic from a vascular point of view with normal active lives for their age. Conclusions: Surgical repair is effective, although, generally, it is not restricted to a simple thrombectomy, requiring the use of different arterial repair techniques


2012 ◽  
Vol 56 (3) ◽  
pp. 880-881
Author(s):  
Javier E. Anaya-Ayala ◽  
Christopher J. Smolock ◽  
Matthew K. Adams ◽  
Mitul S. Patel ◽  
Cassidy Duran ◽  
...  

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 722-730
Author(s):  
Kenneth Tran ◽  
Vy T Ho ◽  
Nathan K Itoga ◽  
Jordan R Stern

Objectives The superficial femoral artery can be used as inflow for infra-geniculate bypass, but progressive proximal occlusive disease may affect graft durability. We sought to evaluate the effect of superficial femoral artery versus common femoral artery inflow on infra-geniculate bypass patency within a large contemporary multicenter registry. Methods The vascular quality initiative was queried from 2013 to 2019 to identify patients with >30-day patency follow-up, Rutherford chronic limb ischemia stage 1–6, and an infra-geniculate bypass, excluding those with prior ipsilateral bypass. The cohort was stratified by inflow vessel, with primary, primary-assisted, and secondary patency serving as the primary outcome variables. Multivariate Cox-proportional hazard models and radius-based propensity-score matching were performed to reduce treatment-selection bias due to clinical covariates. Results A total of 11,190 bypass procedures were performed (8378 common femoral artery inflow, 2812 superficial femoral artery) on 10,110 patients, with a mean follow-up of 12.8 months (range 1–98). Patients receiving superficial femoral artery inflow bypasses were more commonly male ( p = 0.002), obese ( p < 0.0001) and had chronic, limb threatening ischemia ( p < 0.0001), whereas those with common femoral artery inflow were older ( p < 0.0004), and had higher baseline comorbidities including smoking ( p < 0.0001), coronary disease ( p < 0.0001), and pulmonary disease ( p < 0.0001). On life-table analysis, there was no significant difference in three year estimated primary (32.1 vs 30.1%, p = 0.928), primary assisted (60.5 vs 65.8%, p = 0.191), or secondary patency (62.5 vs 66.7%, p = 0.139) between superficial femoral artery and common femoral artery inflow groups, respectively. A multivariate Cox model found no significant association between inflow vessel and primary patency (0.96 [0.88–1.04], HR [95%CI]), primary-assisted (1.07 [0.95–1.20], HR [95%CI]), or secondary patency (1.08 [0.96–1.22]). In a propensity-matched cohort ( n = 11,151), there were small but statistically significant differences in primary, primary-assisted, and secondary patency at latest follow-up (non-time-to-event data) between groups. The largest difference was observed when evaluating secondary patency, with common femoral artery inflow having a marginally higher secondary patency of 88.1% compared to 85.6% for those with superficial femoral artery inflow at latest follow-up ( p = 0.009). Conclusions Within the vascular quality initiative, there is no significant difference in life-table determined three-year primary, primary-assisted, and secondary patency between infra-geniculate bypasses using common femoral artery inflow compared to superficial femoral artery inflow. Small, statistically significant differences exist in primary, primary-assisted, and secondary patency favoring common femoral artery inflow after propensity score matching. Long-term follow-up data are required in the vascular quality initiative to better evaluate bypass graft durability as this study was limited by a mean follow-up of one year.


2011 ◽  
Vol 54 (6) ◽  
pp. 1866
Author(s):  
Christopher J. Smolock ◽  
Javier E. Anaya-Ayala ◽  
Charudatta S. Bavare ◽  
Mitul S. Patel ◽  
Jean Bismuth ◽  
...  

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