Ostial lesions of the superficial femoral artery preclude the use of ipsilateral common femoral artery antegrade approach. Access via either the contralateral common femoral or the brachial arteries are the 2 alternative classical approaches. Conversely, using an ipsilateral antegrade approach, through a partially inserted sheath, usually leaves the sheath insecure and frequently hits ostial lesion itself during insertion. Dislodgment from the artery frequently occurs, resulting in loss of access. We describe a technique whereby we insert 2 to 3 cm of the sheath into the common femoral artery and the remaining part of the sheath resides in a fashioned subcutaneous tunnel of the lowermost abdomen. Technical details are provided as well as the results of using this technique on 37 patients. The technique is safe, easy to perform, and reproducible.
Background: Though uncommon, complications of endovascular angioplasty and stenting may have devastating outcomes that can threaten limb and life. Adequate awareness of these complications will allow to achieve excellent clinical outcomes. Results: Endovascular intervention was successful in treatment of most of distal SFA complications with limited use in flush ostial complications; residual stenosis ≥ 30%, flow-limiting dissection, perforation or rupture; 100% in group (2) vs 50% in group (1) but thrombosis; 75% of distal SFA lesions were treated endovascularly vs 40% of flush ostial lesions; X 2 = 12.7, P = 0.02. Emergency surgery as a bailout was used for most ostial lesion complications: residual stenosis ≥ 30%, flow-limiting dissection, and perforation or rupture; 50% in group (1) vs 0% in group (2); X 2 = 20.1, P = 0.01. Conclusion: Bailout procedures are procedures used to save the limb or the patient. Evolving endovascular strategies embrace new technologies in an attempt to improve the safety and efficacy of revascularization procedures for lower extremity arterial occlusive disease.
This study aims to review contemporary lines of endovasular management of Aortic aneurysm in bechet’s disease illustrating the pros and cons of each treatment modality. This is a retrospective cohort study of all consecutive Aortic aneurysms in patients diagnosed bechet’s disease treated between 2018-2021. The aim of this study is to evaluate efficacy &outcome of endovascular stent graft implantation for the treatment of Aortic aneurysm in Bechet’s disease. From feb 2018 to august 2021, 11 Aortic aneurysms were diagnosed in 10 patients with Bechet’s disease. All patients were male. The patients ranged in age from 33 to 66 years (median ,41 years). There were three infrarenal abdominal aortic aneurysm, two supra celiac aneurysm, three descending thoracic, one Aortic arch aneurysm, and one patient had both pararenal &descending thoracic aneurysm. All patients received immunosuppressive therapy before intervention to induce remission. After hospital discharge, all patients were followed up regularly at 3 months intervals. The mean duration of follow-up was 22.6 months (range ,1-39 months). A straight tube graft was implanted in nine patients and a bifurcated graft in one patient. Two stage procedures (debranching before endovascular therapy) were performed in three patients.
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