Safety and Outcomes of Ipsilateral Antegrade Angioplasty for Femoropopliteal Disease

Abstract

stent deployment) compared to peaking several days postoperatively after CEA. This large retrospective cohort study found that the risk of ICH was significantly higher after CAS (0.85%) than CEA (0.42%). However, this difference may not be clinically significant. This discrepancy in ICH was not due to differences in preprocedure antiplatelet or anticoagulant. Many factors were not assessed, such as the degree of contralateral disease, plaque characteristics, and, most importantly, postprocedure dual antiplatelet therapy, which the authors agree was almost certainly higher in stented patients. A review of patients who underwent CEA in the Vascular Quality Initiative showed that dual therapy with aspirin and clopidogrel was associated with increased reoperation for bleeding (P ¼ .003), but the risk of ICH was not addressed. 1 Nonetheless, use of dual therapy was associated with decreased risk of perioperative stroke compared to aspirin alone (P ¼ .03) and the overall stroke risk was very low. There may not be much interventionalists can do to reduce the risk of this devastating complication after CAS, which may be due to the required use of clopidogrel before and after this intervention.

Antegrade common femoral artery closure device use is associated with decreased complications

“…Cragg et al 21 reported in a prospective study of 556 patients undergoing femoropopliteal angioplasty that compared with femoral RA, AA did not have a significantly higher rate of access site complications (AA, 3.7% vs RA, 1.1%; P ¼ .186), which were defined as retroperitoneal hematoma, pseudoaneurysm, hematoma requiring transfusion, arteriovenous fistula formation, acute thrombosis, and need for surgical repair. Although not statistically significant, Cragg et al 21 complications, including hematoma, between femoral RA and AA, although this study did not report on the use of CDs.…”

Resuscitative endovascular balloon occlusion of the aorta for retroperitoneal hemorrhage and shock after ipsilateral antegrade angioplasty with vascular closure device

“…AA scores over RA by avoiding difficult inflow anatomy and reducing the contrast agent and radiation dose (1,3). However, AA is more likely to be associated with procedure-induced complications, such as retroperitoneal hematoma in cases with a high puncture site in the EIA (1,2). Therefore, ultrasound-guided CFA puncture is recommended.…”

“…Surgery is indicated even in hemodynamically stable patients in the event of endovascular treatment failure or in patients in whom an appropriate graft is unavailable. However, identification of the bleeding site is often challenging, and surgery is usually associated with significant morbidity and mortality (1,6). Therefore, aortic occlusion is an acceptable alternative for hemostasis to achieve temporary hemodynamic stabilization and restore blood pressure in patients with hemorrhagic shock secondary to RPH.…”

“…Percutaneous intervention is widely used to treat peripheral vascular disease using ipsilateral antegrade femoral arterial access and vascular closure device (VCD) (1)(2)(3). However, it is associated with vascular complications and significant morbidity and mortality secondary to retroperitoneal hemorrhage (1,2,4). Herein, we describe a case report with hemorrhagic shock to technical errors, who was successfully treated by resuscitative endovascular balloon occlusion of the aorta (REBOA), which is the first case to show a beneficial role as damage control surgery.…”

“…Percutaneous intervention is widely used to treat peripheral vascular disease using ipsilateral antegrade femoral arterial access and vascular closure device (VCD) (1)(2)(3). However, it is associated with vascular complications and significant morbidity and mortality secondary to retroperitoneal hemorrhage (1,2,4).…”