Superficial Femoral Artery Access for Infrainguinal Antegrade Endovascular Interventions in the Hostile Groin: A Prospective Randomized Study

Zenunaj, Gladiol; Traina, Luca; Acciarri, Pierfilippo; Mucignat, Marianna; Scian, Sabrina; Alesiani, Francesca; Serra, Raffaele; Gasbarro, Vincenzo

doi:10.1016/j.avsg.2022.04.017

Cited by 5 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is an expected outcome considering that most of the procedures are performed under local anaesthesia and percutaneously or by the femoral artery cutdown technique, which has been demonstrated to be a safe and less invasive approach that results in less postoperative pain and faster mobilisation. 8 For these reasons, this minimally invasive approach is advantageous, especially in the elderly and frail patients as in our case series. However, in the present study, we did not notice any statistical differences in mid- and long-term survival or MACE rates between the two groups.…”

Section: Discussionmentioning

confidence: 80%

Treatment of true superficial femoral artery aneurysms: the 15-year experience of a single centre

Zenunaj,

Baldazzi,

Acciarri

et al. 2024

annals

View full text Add to dashboard Cite

Objective True superficial femoral artery aneurysms (SFAAs) are rare and traditionally treated by open repair. However, the endovascular approach excluding the aneurysm sac with a covered stent may be an alternative. This study aimed to compare the outcomes of the open and endovascular repair of SFAAs. Methods This is a retrospective, observational, monocentric study. The main endpoints were: technical success, limb salvage and primary patency rate, and hospitalisation time. Results We identified 49 SFAAs in 40 patients; the mean age was 73.3±10.1 years, the mean diameter of SFAAs was 5.41±3.64cm, and 61.2% were symptomatic for ischaemic or compression-related signs. The indication for open repair was given mainly for complex SFAAs involving the distal third of the superficial femoral artery and with an ipsilateral popliteal aneurysm. Among the 36 open-repair patients, 33 underwent ligation and revascularisation via bypass or graft interposition, and 3 patients underwent simple ligation without revascularisation. The endovascular approach was adopted mainly for aneurysms located in the medial third of the SFAA, which underwent covered stenting in 12 patients and coil embolisation in 1 patient. The technical success was 100% in all cases. There were no statistical differences in terms of primary patency and limb salvage rate between groups at two and four years. The mean hospitalisation time was 10±4 and 3±1 days after open and endovascular treatment, respectively. Conclusions The endovascular approach may be a valid alternative for isolating SFAAs offering good results and shorter hospitalisation. Open repair remains a valid approach, particularly in complex aneurysms.

show abstract

Section: Discussionmentioning

confidence: 80%

Treatment of true superficial femoral artery aneurysms: the 15-year experience of a single centre

Zenunaj,

Baldazzi,

Acciarri

et al. 2024

annals

View full text Add to dashboard Cite

show abstract

“…Vascular access was achieved in the remaining cases using the femoral cut-down technique. Two different approaches were used in the endovascular group because of randomisation in another study, which evaluated the outcomes between the two vascular accesses [ 11 ]. The length of the target lesion was 200 mm + −15 mm SD.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, in our study, the endovascular approach was beneficial in terms of vascular access management and complications rate. In this aspect, percutaneous procedures—especially those supported by ultrasound guidance during arterial puncturing and use of a percutaneous closure device to perform haemostasis—significantly favoured the endovascular choice, even in hostile groins [ 11 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Revascularisation versus Open Surgery with Prosthetic Bypass for Femoro-Popliteal Lesions in Patients with Peripheral Arterial Disease

Zenunaj,

Acciarri,

Baldazzi

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

Aim: Complex atherosclerotic femoro-popliteal lesions have traditionally been treated with bypass surgery. A prosthetic graft is used to save the vein graft for more distal revascularisations or when a vein graft is unavailable. The endovascular approach has gained popularity and is offered as a first-line strategy for complex lesions. This study aimed to evaluate whether endovascular procedures can be used as a first-line treatment strategy for complex native femoro-popliteal lesions over open surgery with prosthetic bypass in patients with peripheral arterial disease (PAD). Methods: This single-centre retrospective observational study was conducted between 2013 and 2021; it included patients with symptomatic PAD who required limb revascularisation at the femoro-popliteal segment and who had complex lesions. The primary endpoints analysed were technical success, primary patency, freedom from clinically driven target lesion revascularisation (cdTLR), freedom from major adverse limb and cardiovascular events (MALE and MACE, respectively), freedom from limb loss, and survival. The secondary endpoints were length of in-hospital stay, and duration and costs of the procedure. Results: We identified 185 limbs among 174 suitable candidates for comparison, wherein 105 were treated with an endovascular procedure and 80 with a femoro-popliteal prosthetic bypass. Most patients in both groups presented with chronic limb-threatening ischaemia, and >90% of them had an American Society of Anesthesiologists (ASA) physical status classification of >3. The endovascular group had more octogenarians (p = 0.02) and patients with coronary disease (p = 0.004). The median follow-up was 30 months. The technical failure rate for endovascular procedures was 4.7%, versus 0% in the open group (p = 0.047). Freedom from MACE was similar in both groups. The endovascular group showed superior primary patency (p < 0.0001), cdTLR (p < 0.0001), MALE (p < 0.0001), and freedom from limb loss (p = 0.0018) at 24 and 48 months. Further analysis performed for the open above-the-knee sub-group showed that the aforementioned endpoints were similar between the groups at 12 months and were better in the endovascular group at 24 and 48 months. Procedural time and in-hospital stay were longer in the open group than in the endovascular group (p < 0.0001 and p < 0.001, respectively). The procedural cost in the endovascular group was 10-fold lower than that in the prosthetic bypass group. Conclusions: Endovascular procedures are safe for treating complex femoro-popliteal lesions in patients at a high risk for surgery and show better outcomes at 24 months than prosthetic bypasses do. The latter may be considered as an alternative should endovascular treatment fail.

show abstract

Arterial Revascularization

Ali,

Arslan,

Beasley

et al. 2023

Limb Preservation for the Vascular Specialist

View full text Add to dashboard Cite

Superficial Femoral Artery Access for Infrainguinal Antegrade Endovascular Interventions in the Hostile Groin: A Prospective Randomized Study

Cited by 5 publications

References 13 publications

Treatment of true superficial femoral artery aneurysms: the 15-year experience of a single centre

Treatment of true superficial femoral artery aneurysms: the 15-year experience of a single centre

Endovascular Revascularisation versus Open Surgery with Prosthetic Bypass for Femoro-Popliteal Lesions in Patients with Peripheral Arterial Disease

Arterial Revascularization

Contact Info

Product

Resources

About