Abstract:
OBJECTIVE:The objective of this study was to evaluate the safety and efficacy of a retrograde tibial approach in revascularization of lower extremities for treatment of ischemia in anatomically challenging patients. METHODS:This is a retrospective study of 57 procedures performed between 2012 and 2016 using the retrograde approach to treat patients with flush occlusion, inability to cross the lesion, failed bypass, or hostile groin. Demographic data, Rutherford classes, vessels treated, and approach were noted. Type of procedure, complications, amputations, deaths, and patency of access tibial vessels and treated vessels were recorded. Ultrasound-guided tibial access was achieved through the anterior tibial artery, posterior tibial artery, or peroneal artery. Technical success was defined as residual stenosis of <30%. Restenosis was defined as two times increase in velocity at the site of treatment. In follow-up, access vessel patency and treated vessel patency were evaluated by physical examination and ultrasound. Kaplan-Meier survival curves were used to assess proportional hazards before using the marginal Cox model to determine statistical significance in risk of postintervention occlusion. RESULTS:In 53 patients (32 men) with an average age of 67 ± 10.6 years, Rutherford categories were as follows: class 2, n = 1; class 3, n = 37; class 4, n = 5; class 5, n = 12; and class 6, n = 2. Tibial arteries were successfully accessed in all limbs. Lesions were crossed in 56 of 57 limbs. One procedure was terminated because of local arterial dissection. Revascularization was achieved in 55 of 57 limbs. Within 30 days of the procedure, 2 of 2 Rutherford class 6 patients and 1 of 12 class 5 patients needed major amputation because of pre-existing disease. There was no 30-day mortality. Of 103 vessels treated, technical success was achieved in 97 (94%). Secondary patency for 103 vessels was 79% with mean follow-up of 6.66 ± 5.4 months. The primary patency was 90% compared with a primary assisted patency of 51%. There was no statistically significant difference in access vessel primary patency in follow-up: 86% (30/35) for anterior tibial artery, 80% (16/20) for posterior tibial artery, and 100% (2/2) for peroneal artery. In addition, in follow-up, there was no significant difference in incidence of occlusion of target vessels based on choice of access vessel used (P = .109). CONCLUSIONS:In this group of anatomically challenging patients, a retrograde tibial approach was safely used. Accessing the tibial artery does not usually cause access vessel occlusion and resulted in no adverse outcomes. The majority of access vessels remained patent for future bypass if necessary.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Lai SH,Fenlon J,Roush BB,Munn J,Rummel M,Johnston D,Longton C,Jain KMdoi
10.1016/j.jvs.2018.10.114subject
Has Abstractpub_date
2019-07-01 00:00:00pages
157-165issue
1eissn
0741-5214issn
1097-6809pii
S0741-5214(18)32663-6journal_volume
70pub_type
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journal_title:Journal of vascular surgery
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更新日期:2005-08-01 00:00:00
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.02.004
更新日期:2015-07-01 00:00:00
abstract::Two hundred forty-three bypasses to paramalleolar arteries were performed in 224 extremities of 208 patients since 1971; 166 were implanted in men (68%) and 77 in women (32%). The median age was 73 years. Gangrene (61%), nonhealing ulcer (15%), rest pain (22%), and trauma (2%) were the indications for bypass. Usual ri...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1988.avs0070785
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abstract::Aortoesophageal fistula is a rare, frequently fatal cause of upper gastrointestinal bleeding. Although several causes have been described, it appears that the most common cause is rupture of a thoracic aortic aneurysm into the esophagus, occurring in approximately 12% of thoracic aneurysm ruptures. Although the entity...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:
更新日期:1992-07-01 00:00:00
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.05.043
更新日期:2016-10-01 00:00:00
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journal_title:Journal of vascular surgery
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更新日期:1996-04-01 00:00:00
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
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更新日期:2019-12-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2004.04.005
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journal_title:Journal of vascular surgery
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更新日期:2009-05-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.04.030
更新日期:2008-09-01 00:00:00
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journal_title:Journal of vascular surgery
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doi:10.1016/j.jvs.2006.08.017
更新日期:2006-12-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70209-5
更新日期:1998-07-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00
abstract::Abdominal aortic aneurysm with spontaneous aorto-left renal vein fistula is a rare but well-described clinical entity usually with abdominal pain, hematuria, and a nonfunctioning left kidney. This report describes a 44-year-old man with left-sided groin pain and varicocele who was treated with conservative measures on...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2000.102330
更新日期:2000-04-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.11.056
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1988.avs0080064
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
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doi:
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/0741-5214(94)90014-0
更新日期:1994-08-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.05.079
更新日期:2020-07-15 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.121817
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVE:Current long-term surveillance after endovascular abdominal aortic aneurysm repair (EVAR) is based on high-resolution contrast-enhanced computed tomography (CT) scans at scheduled, lifelong intervals. The cancer and nephrotoxicity risks of interval CT scanning and prolonged radiation exposure are concerning. ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.06.019
更新日期:2010-11-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.117144
更新日期:2001-09-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2007.02.061
更新日期:2007-06-01 00:00:00
abstract::Secondary vascular procedures to below-knee vessels for lower extremity ischemia present a challenge to the vascular surgeon. Autogenous vein is often unavailable and failure of the previous bypass often limits the choice of distal vessels suitable for revascularization. This dilemma raises the question of amputation ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1988.avs0080137
更新日期:1988-08-01 00:00:00
abstract:OBJECTIVE:To assess the long-term results of elective abdominal aortic aneurysm (AAA) repair with a single stent graft system. METHODS:Patients undergoing elective, infrarenal endovascular aneurysm repair (EVAR) with a single-stent graft system between 1998 and 2012 were analyzed retrospectively registering pre-, intr...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.09.061
更新日期:2020-08-01 00:00:00