Endovascular recanalization of chronic total occlusions of the native superficial femoral artery after failed femoropopliteal bypass in patients with critical limb ischemia

Abstract

Background Femoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, although it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. Over the past few years, angioplasty has been commonly used, with the development in endovascular technologies, to treat chronic total occlusions of the native superficial femoral artery, with a good technical success rate and clinical prognosis. The purpose of the study is to assess the outcome of endovascular recanalization of chronic total occlusions of the native superficial femoral artery, in patients unfit for surgery with critical limb ischemia after failed femoropopliteal bypass. Results A total of 54 patients were treated. 77.8 % of the conduits were PTFE grafts; the remainder were single-segment great saphenous veins. The most common clinical presentation was rest pain. Technical success was achieved in 51 (94.4 %) of 54 limbs. Angiographically, 77.8 % of the lesions were TASC II category D, while 22.2 % were TASC II category C. The average length of the native SFA lesions was 26.8 cm. Clinical success, with improved Rutherford classification staging, followed each case of technical success. The median follow-up value was 5.75 years (IQR, 1.5–7). By Kaplan-Meier survival analysis, primary patency rates were 61 % (± 0.07 SE) at 1 year and 46 % (± 0.07 SE) at 5 years. Secondary patency rates were 93 % (± 0.04 SE) at 1 year and 61 % (± 0.07 SE) at 5 years. Limb salvage rates were 94 % (± 0.03 SE) at 1 year and 88 % (± 0.05 SE) at 5 years. Conclusions The endovascular recanalization of chronic total occlusions (CTO) of the native superficial femoral artery (SFA) after a failed femoropopliteal bypass is a safe and effective therapeutic option in patients unfit for surgery with critical limb ischemia.

Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver

“…According to both the CTCAE and the CIRSE classification systems, patients experienced a global rate of adverse events after chemoembolization that is comparable to previous data on cTACE, DSM-TACE, or DEB-TACE, performed with conventional femoral or radial accesses [19,20,39,[54][55][56], and on other procedures in the endovascular fields [57][58][59]. Finally, in our investigation, we did not observe significant differences in terms of safety endpoints between the group undergoing DEB-TACE with femoral access and the group undergoing DEB-TACE with distal radial access.…”

“…The rate of vascular access site complications (VASCs) was comparable to other published studies in the endovascular field, whether it is femoral or radial access [35,40,41,44,[48][49][50]. Two cases of access site hematoma in high-risk patients with a platelet count lower than 100,000 per microliter of blood were observed.…”

Endovascular treatment of femoro‐popliteal occlusions with retrograde tibial access after failure of the antegrade approach

“…35 Possibly, a complex interventional procedure such as CART and SAFARI can be performed in those cases where the simple retrograde approach is not sufficient to treat the target lesion. 13,37 Despite these advantages and the growing evidence and indications in support of endovascular treatment also for complex femoro-popliteal TASC C or D lesions, 6,7,38,39 limited data are currently available to evaluate the retrograde crossing of femoropopliteal occlusions with tibial access. Other options as retrograde vascular access sites include the distal SFA, popliteal and pedal artery.…”

“…Despite these advantages and the growing evidence and indications in support of endovascular treatment also for complex femoro‐popliteal TASC C or D lesions, 6,7,38,39 limited data are currently available to evaluate the retrograde crossing of femoro‐popliteal occlusions with tibial access. Other options as retrograde vascular access sites include the distal SFA, popliteal and pedal artery.…”

Efficacy and Safety of Axiostat® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers

“…It provides easy antegrade access to the ipsilateral lower extremity and retrograde access to the remaining arterial tree, thus enabling numerous endovascular procedures aimed at restoring vessel caliber, removing a thrombus, occluding a vessel, retrieving foreign bodies, or delivering drugs or medical devices. Arterial introducer sheaths ranging in size from 4 to 8 Fr are used in most interventional radiology procedures [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. After the removal of the introducer sheath, achieving hemostasis of the vascular access site by manual compression (MC) or a vascular closure device (VCD) is critical to the safe completion of any endovascular procedure [ 13 ].…”