Abstract:
:Patients with severe tibioperoneal disease are poor candidates for a distal bypass. Absence of a distal target, lack of conduit, or multiple medical problems can make these patients a prohibitive risk for revascularization. Acute on chronic ischemia in this group poses a greater challenge. Thrombolytic therapy for acute ischemia can be prolonged and carries a significant risk of bleeding if continued beyond 24 hours. However, if the ischemic limbs can be isolated from the systemic circulation, a higher dose of the lytic agent can be given with lower risk. These are the initial results of a series of 10 patients who underwent percutaneous isolated limb perfusion with a high dose of thrombolytics for severe ischemia. Ten patients (lower extremity 8 and upper extremity 2) presented with severe limb-threatening ischemia. Mean ankle/brachial index (ABI) was 0.15 for the lower extremity, and there were no recordable digital pressures in patients with upper extremity ischemia. No distal target was visible on the initial arteriogram. These patients were then taken to the operating room, and under anesthesia, catheters were placed in an antegrade fashion via femoral approach in the popliteal artery and vein percutaneously. For upper extremity, the catheters were placed in the brachial artery and vein. A proximal tourniquet was then applied. This isolated the limb from the systemic circulation. Heparinized saline was infused through the arterial catheter while the venous catheter was left open. A closed loop or an isolated limb perfusion was confirmed when effluent became clear coming out of the venous port. A high dose of thrombolytic agent (urokinase 500,000 to 1,000,000 U) was infused into the isolated limb via the arterial catheter and drained out of the venous catheter. After 45 minutes, arterial flow was reestablished. In 4 patients, Reopro((R)) was used in addition to thrombolytics. Postprocedure angiograms showed minimal changes, but patients exhibited marked clinical improvement. The ABI changed from 0.15 to 0.5 in the lower extremity and near-normal digital pressures in upper extremity ischemia. Limb salvage and symptomatic relief at 6 months was 90%. All patients except one were kept on anticoagulation postoperatively. No bleeding complications were observed from the procedure. Percutaneous isolated limb perfusion brought symptomatic relief to patients presenting with acute on chronic limb ischemia. This can be an alternate option for patients facing amputation with no revascularization options.
journal_name
Vasc Endovascular Surgjournal_title
Vascular and endovascular surgeryauthors
Ali AT,Kalapatapu VR,Bledsoe S,Moursi MM,Eidt JFdoi
10.1177/153857440503900605keywords:
subject
Has Abstractpub_date
2005-11-01 00:00:00pages
491-7issue
6eissn
1538-5744issn
1938-9116journal_volume
39pub_type
杂志文章abstract::Although the radial artery has proven to be a reliable conduit for arterial bypass procedures in cardiac surgery, its use in lower extremity revascularization has been limited due to its length. In patients who have undergone multiple cardiovascular procedures, venous conduit options can be limited, and infrapopliteal...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574407299807
更新日期:2007-08-01 00:00:00
abstract::Angiogenic therapies for critical limb ischemia were tested in a mouse model. The mice were anesthetized and their femoral arteries were ligated. The animals were treated with bone marrow mononuclear cells (BMMCs) alone, BMMCs combined with plasmid vector encoding granulocyte macrophage colony-stimulating factor (GM-C...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574413518119
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:Radial artery access is widely utilized in coronary angiography with reported lower rates of vascular complications and better patient comfort. There is limited data in the literature regarding radial access in peripheral endovascular procedures. We hypothesize that radial access is safe and feasible for per...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574420906942
更新日期:2020-05-01 00:00:00
abstract::The objective was to evaluate our results on functional outcome for both through-knee amputations and above-knee amputations. Functional outcome was measured using the Special Interest Group in Amputee Medicine score, which focuses on walking distance and use of prosthesis. From 1997 to 2006, 39 through-knee amputatio...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574408316914
更新日期:2008-10-01 00:00:00
abstract:PURPOSE:To describe a hybrid approach for the treatment of a ruptured juxta-innominate artery saccular aneurysm. CASE REPORT:A 68-year-old smoker male with poor exercise tolerance sustained a contained ruptured saccular aneurysm at the origin of the innominate artery. Although under the femoral-axillary bypass to allo...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574412470739
更新日期:2013-02-01 00:00:00
abstract:INTRODUCTION:Despite advances of endovascular interventions, bypass surgery remains the gold standard for treatment of long and complex arterial occlusions in the lower limb. Autologous vein is regarded superior to other options. As the graft of first choice, the great saphenous vein (GSV) is often not available due to...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574420980610
更新日期:2021-01-22 00:00:00
abstract:OBJECTIVE:To evaluate the immediate and long-term clinical outcomes after carotid artery stenting (CAS) with and without protection devices (PDs), compared with carotid endarterectomy (CEA). METHODS:A total of 116 patients with symptomatic carotid stenosis underwent CAS; 56 patients (48.3%) underwent CAS-PD; and 137 p...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574412457471
更新日期:2012-10-01 00:00:00
abstract::A 26-year-old male soldier was clinically characterized by transient fever, persistent right upper quadrant pain, hypertension, and elevated inflammatory biomarkers associated with bacterial infection. On the fifteenth day after the onset of symptoms, he had typical CT findings in polyarteritis nodosa involving only t...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574420968682
更新日期:2020-10-21 00:00:00
abstract:BACKGROUND:Hybrid procedures for thoracoabdominal aortic aneurysms (TAAA) have been previously described as an attractive alternative to open reconstruction. PATIENTS AND METHODS:Between 1999 and 2009, 16 patients with a median age of 67years underwent hybrid repair of a TAAA (Crawford type I: 3, type II: 3, type III:...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574409347390
更新日期:2010-02-01 00:00:00
abstract:PURPOSE:To present a case of aortic sac occlusion using an Amplatzer vascular plug II (AVP). CASE REPORT:A patient with sigmoid malignancy and an infrarenal aortic aneurysm ultimately required an axillobifemoral graft for acute limb ischemia. The sac was ligated at subsequent laparotomy. Persistent filling of the sac ...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574411433297
更新日期:2012-02-01 00:00:00
abstract:PURPOSE:The snorkel technique is commonly used to preserve renal arteries in juxta renal aneurysm during endovascular repair. Herein, we present a patient who underwent bifurcated endograft implantation with snorkel technique for inferior mesenteric artery (IMA) in order to preserve the major source of bowel circulatio...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574418758597
更新日期:2018-04-01 00:00:00
abstract::This study evaluated the learning curve for a second-year general surgery resident and compared 2 totally laparoscopic aortic surgery techniques in 10 pigs: the transretroperitoneal apron approach and the transperitoneal retrocolic approach. Five end points were compared: success rate, percentage of conversion, time r...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574407299800
更新日期:2007-06-01 00:00:00
abstract::Leiomyosarcoma of the vascular origin is a rare malignant tumor. It originates from the smooth muscle cells of the media with intra- or extraluminal growth, and in most cases it arises in the inferior vena cava. The diagnosis is often delayed because the clinical symptoms of this disease are often nonspecific. Accurat...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574416637445
更新日期:2016-04-01 00:00:00
abstract::Recent reports have established the feasibility and safety of percutaneous transluminal angioplasty and stent placement in the treatment of innominate artery occlusive disease. Although the long-term durability of these endovascular approaches has not been clearly established, they are particularly attractive in patie...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/153857440303700407
更新日期:2003-07-01 00:00:00
abstract::Symptomatic internal carotid artery (ICA) occlusion with hemodynamic impairment remains a dismal disease when untreated. In this prospective, single-center, controlled study, we investigated the feasibility, safety, and long-term outcome of stenting by endovascular recanalization for patients with chronic ICA occlusio...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574414525863
更新日期:2014-05-01 00:00:00
abstract::Since the outbreak of the COVID-19 pandemic, increasing evidence suggests that infected patients present a high incidence of thrombotic complications. We report a 67-year-old-woman admitted for severe acute respiratory syndrome coronavirus 2 infection. Chest CT images showed bilateral ground glass opacities, bilateral...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574420966106
更新日期:2020-10-09 00:00:00
abstract::This study evaluated the efficacy of an exercise program after arterial bypass surgery. Patients undergoing bypass surgery were randomized to a control group (group I), with standard preoperative and postoperative care, or the intervention group (group II) with a supervised exercise program of twice-weekly treadmill a...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章,随机对照试验
doi:10.1177/1538574406296209
更新日期:2007-02-01 00:00:00
abstract::Recent reports have documented poor long-term results following endovascular aneurysm repair (EVAR) of large abdominal aortic aneurysms (AAA). EVAR of small AAAs may result in improved long-term results compared to large AAAs. It is not known whether the frequency of anatomic suitability for EVAR is increased for smal...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/153857440503900502
更新日期:2005-09-01 00:00:00
abstract::Moyamoya disease is a rare cerebrovascular disorder that is characterized by progressive stenosis of the distal portion of the internal carotid artery and its main branches. Here the authors present the first case of spontaneous recanalization of an occluded middle cerebral artery in a woman with moyamoya who had not ...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574413495463
更新日期:2013-08-01 00:00:00
abstract::Inadvertent complications of jugular vein catheterization are not uncommon, however, a persistent symptomatic carotid-jugular fistula has been rarely reported. A 72-year-old male with infected surgical wound after coxofemoral disarticulation for sarcoma presented with symptoms of acute right heart failure. A fistula b...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574416675675
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:The baroreceptor at the carotid body plays an important role in hemodynamic autoregulation. Manipulation of the baroreceptor during carotid endarterectomy (CEA) or radial force from carotid artery angioplasty and/or stenting (CAS) may cause both intraoperative and postoperative hemodynamic instability. The pu...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574419828088
更新日期:2019-05-01 00:00:00
abstract::Acute arterial disruptions of the thoracic aorta are rare and often lethal. They are most often due to blunt trauma and occur most commonly just distal to the left subclavian artery origin in the setting of multisystem injuries. The very proximal nature of the lesion in survivors makes open surgical repair hazardous, ...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/153857440403800404
更新日期:2004-07-01 00:00:00
abstract::Patients with chronic occlusion of iliac veins may present with symptoms ranging from mild discomfort to severe disability, including limb swelling, venous claudication, and ulceration. Endovascular treatment has emerged as first line of interventional therapy. Surgical venous-venous bypasses for the management of the...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574412454584
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Diminished endothelial activity (EA) has been associated with an increased risk of incident cardiovascular disease (CAD) events. METHODS:Vasodilatory responses (EA and relative distensibility [RD]) were evaluated noninvasively using iontophoresis of acetylcholine (ACH) and sodium nitroprusside (SNP) and rec...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574413508229
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:The systemic nature of atherosclerosis compromises medium-term survival following major vascular surgery. Neutrophil-lymphocyte ratio (NLR) is a simple index of systemic inflammatory burden which correlates with survival following percutaneous coronary intervention. METHODS:Patients undergoing elective majo...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1177/1538574410396590
更新日期:2011-04-01 00:00:00
abstract::The prevalence of upper extremity deep vein thrombosis (UEDVT) has shown a dramatic increase with the use of central venous catheters (CVCs) for patient care. The objective of this study was to identify risk factors and clinical outcomes in patients diagnosed with UEDVT at an academic medical center over a 1-year peri...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574411432145
更新日期:2012-02-01 00:00:00
abstract::Nail-patella syndrome (NPS) is a rare disorder characterized by abnormal development of ectodermal and mesodermal tissues. Classically, NPS presents as a triad of nail dysplasia, dysplastic patellae, and bony exostoses of the ilia known as "iliac horns." Apart from dermatological and skeletal abnormalities, patients m...
journal_title:Vascular and endovascular surgery
pub_type:
doi:10.1177/1538574419888345
更新日期:2020-02-01 00:00:00
abstract:AIM:The aim of the study is to determine whether presentation and outcomes of inflammatory abdominal aortic aneurysms (IAAA) have changed over the last five decades. METHODS:Comparison of current outcomes (January 2001 to December 2007) with results of the earliest report from our unit in 1972. RESULTS:In contemporar...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/1538574409335915
更新日期:2009-08-01 00:00:00
abstract::Iliac vein aneurysms are an exceedingly uncommon problem faced by vascular specialists. We report a case of a healthy 32 year old woman who had large asymptomatic bilateral external iliac vein aneurysms found incidentally on CT scan. They may present with thromboembolism, spontaneous rupture, or they may be asymptomat...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章,评审
doi:10.1177/1538574410366488
更新日期:2010-10-01 00:00:00
abstract::Left recurrent laryngeal nerve paralysis was first described in 1897 by Ortner in a patient with mitral valve disease. However, this paralysis has also been attributed to other cardiovascular pathologies, such as thoracic aortic aneurysms. In 1971, Parodi introduced the endoluminal technique by inserting endovascular ...
journal_title:Vascular and endovascular surgery
pub_type: 杂志文章
doi:10.1177/153857440604000111
更新日期:2006-01-01 00:00:00