Percutaneous intentional extraluminal recanalization in patients with chronic critical limb ischemia.


PURPOSE:To review percutaneous intentional extraluminal recanalization (PIER) for treatment of patients who are poor candidates for infrainguinal arterial bypass surgery (IABS) and have arterial occlusions and chronic critical limb ischemia (CCLI). MATERIALS AND METHODS:Patients with CCLI who were poor candidates for IABS were candidates for PIER. PIER was performed to create continuous arterial flow to the foot for limb salvage. PIER was attempted in 40 patients (22 men, 18 women; median age, 69 years; age range, 44-87 years). Of these patients, 24 (60%) had diabetes, 17 (42%) had renal disease, and 26 (66%) had coronary artery disease. Wound healing was evaluated at follow-up. Kaplan-Meier curves were constructed to evaluate limb salvage, survival, and amputation-free survival. RESULTS:Fifty procedures were attempted in 44 limbs. Tissue loss was present in 40 (91%) limbs, and rest pain was present in four (9%); technical success occurred in 38 (86%). Thirty-seven (84%) of 44 limbs treated with PIER involved tibial vessels (tibial vessels only, n = 15; tibial and superior femoral artery [SFA] and/or popliteal vessels, n = 22). Sixty-six infrainguinal arterial vessel segments (SFA, n = 29; tibial, n = 37) in 38 limbs (1.7 segments per limb) were successfully treated with PIER. Thirty-five (95%) of 37 tibial occlusions and 24 (83%) of 29 SFA and/or popliteal occlusions were longer than 10 cm. Median run-off scores were 5.3 (range, 3-8) and 6.6 (range, 3-9) for patients with tibial occlusions and SFA and/or popliteal occlusions, respectively, as scored with modified Rutherford weighting of run-off arteries. Median follow-up was 7.8 months (range, 1-24 months). Twelve months after PIER, Kaplan-Meier analysis showed limb salvage rate was 66%, survival rate was 71%, and amputation-free survival rate was 48% in these patients. The 30-day mortality rate was 2.5%. Major complications occurred in four (10%) patients, and minor complications occurred in an additional four (10%). CONCLUSION:PIER is a useful percutaneous technique for limb salvage in patients with CCLI.






Spinosa DJ,Leung DA,Matsumoto AH,Bissonette EA,Cage D,Harthun NL,Kern JA,Angle JF,Hagspiel KD,Crosby IK,Wellons HA Jr,Tribble CG,Hartwell GD




Has Abstract


2004-08-01 00:00:00














  • Clinical course of patients with squamous cell carcinoma of the upper respiratory and digestive tracts with no evidence of disease 5 years after initial treatment.

    abstract::Eleven hundred sixty-three patients with squamous cell carcinoma of the upper respiratory and digestive tracts, treated from January 1948 through December 1965, had no evidence of disease five years after the initial treatment and no other manifestation of squamous cell carcinoma within the first five years. After fiv...


    pub_type: 杂志文章


    authors: Kogelnik HD,Fletcher GH,Jesse RH

    更新日期:1975-05-01 00:00:00

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    authors: Mathieu D,Ladeb MF,Guigui B,Rousseau M,Vasile N

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  • Rectal biopsy as a cause of rectal ulceration.

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    pub_type: 杂志文章


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  • Texture Analysis with 3.0-T MRI for Association of Response to Neoadjuvant Chemotherapy in Breast Cancer.

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    pub_type: 杂志文章


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    pub_type: 杂志文章


    authors: Spring DB,Salvatierra O Jr,Palubinskas AJ,Amend WJ Jr,Vincenti FG,Feduska NJ

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    authors: Niederau C,Sonnenberg A

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    pub_type: 杂志文章


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    authors: Amparo EG,Higgins CB,Hricak H,Sollitto R

    更新日期:1985-05-01 00:00:00

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    pub_type: 临床试验,杂志文章,随机对照试验


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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    更新日期:1999-06-01 00:00:00