Early evaluation of the infrainguinal revascularization strategy selection tool of the Global Vascular Guidelines for chronic limb-threatening ischemia patients

Haga, Makoto; Shindo, Shunya; Motohashi, Shinya; Nishiyama, Ayako; Kimura, Mitsuhiro; Inoue, Hidenori; Akasaka, Junetsu

doi:10.1016/j.jvs.2021.04.034

Cited by 10 publications

(4 citation statements)

References 21 publications

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“…Haga et al assessed outcomes for 117 patients undergoing open or endovascular intervention for CLTI stratified by GLASS and WIFI scoring. 15 Their results found ITF of 29.5% for the 17 GLASS III patients undergoing endovascular intervention. 15 In comparison, the results of our OPERAS patients are cautiously optimistic with an ITF of 0% and LBP of 67% at 1 year.…”

Section: Discussionmentioning

confidence: 93%

“…15 Their results found ITF of 29.5% for the 17 GLASS III patients undergoing endovascular intervention. 15 In comparison, the results of our OPERAS patients are cautiously optimistic with an ITF of 0% and LBP of 67% at 1 year.…”

Section: Discussionmentioning

confidence: 93%

“…LBP was defined as freedom from occlusion, critical stenosis, reintervention affecting the targeted arterial path (TAP) to in-line flow distally, decrease in ABI > . 15, decrease in TBI > .1, unresolved symptoms such as rest pain, and worsening or persistent tissue loss.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Revascularization can be complicated by the presence chronic total occlusion (CTO) lesions which are associated with a more severe degree of disease in multiple grading systems. 3,6,15 This is particularly the case when endovascular intervention is required and has resulted in the development of ancillary devices and technically complex maneuvers. For example, devices can attempt to disrupt the CTO cap from within the lumen using mechanical vibration, blunt microdissection, rotation, and ultraviolet ablation.…”

Section: Discussionmentioning

confidence: 99%

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Open Proximal Endarterectomy with Retrograde Access and Stenting: A Novel Technique for Lower Extremity Revascularization

Blitzer

Rolle

Abdou

et al. 2022

Vasc Endovascular Surg

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Background: Treatment of chronic limb threatening ischemia (CLTI) poses a significant clinical challenge despite recent medical advancements. Chronic total occlusion (CTO) lesions make endovascular approaches to CLTI particularly challenging. Open proximal exposure with retrograde access and stenting (OPERAS) aims to solve this challenge through retrograde subintimal crossing of a CTO with direct visualization of proximal re-entry into the true lumen. We describe this novel technique and present its efficacy in eight patients. Methods: We conducted a retrospective case series at a single tertiary academic center. Data for patients who received OPERAS intervention included demographics, peri-operative details, and follow-up information. Statistical analysis was performed on length of stay, major post-operative complications, further intervention, clinical progression at 1 year, and amputation-free survival at 1 year. Immediate technical failure (ITF) and limb-based patency (LBP) at 1 year were calculated. Results: Nine limbs underwent OPERAS between January 2019 and March 2020. Inflow was achieved with common femoral artery endarterectomy. All limbs underwent balloon angioplasty and stenting of the SFA, and seven underwent the same procedure in the popliteal artery. ITF was 0% for all nine cases. There were no major post-operative complications, and ankle-brachial index significantly improved pre-and post-operatively ( P < .001). Eight limbs (88.9%) sustained amputation-free survival at 1 year, and overall LBP was 67% at 1 year. Conclusion: Our study presents a hybrid revascularization option to address severe, anatomically complex limbs (GLASS III) that lack a single autogenous conduit for open surgical revascularization. OPERAS addresses a main point of technical failure of subintimal techniques by directly visualizing the wire in the true lumen. Our data suggest that OPERAS can be effective to: (1) improve technical success of luminal re-entry following a subintimal approach; (2) address inflow concurrently with severe femoropopliteal disease; and (3) can be utilized when distal tissue loss is involved.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Open Proximal Endarterectomy with Retrograde Access and Stenting: A Novel Technique for Lower Extremity Revascularization

Blitzer

Rolle

Abdou

et al. 2022

Vasc Endovascular Surg

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Anatomical and clinical factors associated with infrapopliteal arterial bypass outcomes in patients with chronic limb-threatening ischemia

Haga,

Shindo,

Nitta

et al. 2024

Heart Vessels

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The aim of this study was to identify anatomical and clinical factors associated with limb-based patency (LBP) loss, major adverse limb events (MALEs), and poor amputation-free survival (AFS) after an infrapopliteal arterial bypass (IAB) surgery according to the Global Limb Anatomic Staging System. A retrospective analysis of patients undergoing IAB surgery between January 2010 and December 2021 at a single institution was performed. Two-year AFS, freedom from LBP loss, and freedom from MALEs were assessed using the Kaplan–Meier method. Anatomical and clinical predictors were assessed using multivariate analysis. The total number of risk factors was used to calculate risk scores for subsequent categorization into low-, moderate-, and high-risk groups. IABs were performed on 103 patients. The rates of two-year freedom from LBP loss, freedom from MALEs, and AFS were 71.3%, 76.1%, and 77.0%, respectively. The multivariate analysis showed that poor run-off beyond the ankle and a bypass vein caliber of < 3 mm were significantly associated with LBP loss and MALEs. Moreover, end-stage renal disease, non-ambulatory status, and a body mass index of < 18.5 were significantly associated with poor AFS. The rates of freedom from LBP loss and MALEs and the AFS rate were significantly lower in the high-risk group than in the other two groups (12-month low-risk rates: 92.2%, 94.8%, and 94.4%, respectively; 12-month moderate-risk rates: 58.6%, 84.6%, and 78.3%, respectively; 12-month high-risk rates: 11.1%, 17.6%, and 56.2%, respectively; p < 0.001, p < 0.001, and p < 0.001, respectively). IAB is associated with poor clinical outcomes in terms of LBP, MALEs, and AFS in high-risk patients. Risk stratification based on these predictors is useful for long-term prognosis.

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Validity of the Global Vascular Guidelines in Predicting Outcomes Based on First-Time Revascularization Strategy

Lou

Dossabhoy

Tran

et al. 2023

Annals of Vascular Surgery

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Early evaluation of the infrainguinal revascularization strategy selection tool of the Global Vascular Guidelines for chronic limb-threatening ischemia patients

Cited by 10 publications

References 21 publications

Open Proximal Endarterectomy with Retrograde Access and Stenting: A Novel Technique for Lower Extremity Revascularization

Open Proximal Endarterectomy with Retrograde Access and Stenting: A Novel Technique for Lower Extremity Revascularization

Anatomical and clinical factors associated with infrapopliteal arterial bypass outcomes in patients with chronic limb-threatening ischemia

Validity of the Global Vascular Guidelines in Predicting Outcomes Based on First-Time Revascularization Strategy

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