Purpose:
To directly compare the clinical outcomes of aortobifemoral bypass surgery (ABF) and endovascular treatment (EVT) for chronic total occlusion (CTO) of the infrarenal abdominal aorta (IAA).
...Materials and Methods:
In this retrospective, multicenter study, we used an international database of 436 patients who underwent revascularization for CTO of the IAA between 2007 and 2017 at 30 Asian cardiovascular centers. After excluding 52 patients who underwent axillobifemoral bypass surgery, 384 patients (139 ABFs and 245 EVTs) were included in the analysis. Propensity score-matched analysis was performed to compare clinical results in the periprocedural period and the long-term.
Results:
Propensity score matching extracted 88 pairs. Procedure time (ABF; 288 240–345 minutes vs EVT; 159 100–205 minutes, p<0.001) and length of hospital stay (17 12–23 days vs 5 4–13 days, p<0.001) were significantly shorter in the EVT group than in the ABF group, while the proportions of procedural success (98.9% versus 96.6%, p=0.620), complications (9.1% versus 12.3%, p=0.550), and mortality (2.3% versus 3.8%, p=1.000) were not different between the groups. At 1 months, ABI significantly increased more in the ABF group for both in a limb with the lower (0.56 versus 0.50, p=0.018) and the higher (0.49 versus 0.34, p=0.001) baseline ABI, while the change of the Rutherford category was not significantly different between the groups (p=0.590). At 5 years, compared with the EVT group, the ABF group had significantly better primary patency (89.4±4.3% versus 74.8±4.3%, p=0.035) and survival rates (86.9±4.5% versus 66.2±7.5%, p=0.007). However, there was no significant difference between the groups for secondary patency (100.0%±0.0% versus 93.5%±3.9%, p=0.160) and freedom from target lesion revascularization (TLR) (89.3±4.3% vs 77.3±7.3%, p=0.096).
Conclusion:
Even with recent advancements in EVT, primary patency was still significantly better for ABF in CTO of the IAA. However, there was no difference between the groups in terms of secondary patency and freedom from TLR at 5 years. Furthermore, there was no difference in procedural success, complications, mortality, and improvement in the Rutherford classification during the periprocedural period, with significantly shorter procedure time and hospital stay in the EVT group.
Purpose:
To report use of a retrograde 3-F popliteal approach performed in a supine patient by lifting the heel after failed antegrade angioplasty for chronic total occlusion (CTO) in the superficial ...femoral artery (SFA).
Case Report:
During subintimal angioplasty for a calcified 10-cm CTO in the distal left SFA of 65-year-old man with digital tissue loss, inability to re-enter the true lumen prompted us to place a 3-F sheath in a retrograde popliteal approach by lifting the heel so the patient could remain supine. The occlusive lesion was crossed retrogradely using a 0.014-inch floppy guidewire and serially dilated with a 4.0times40-mm monorail balloon through the 3-F popliteal sheath. Subsequent procedures (stenting and postdilation) were performed in an antegrade manner facilitated by a through-and-through wire. After the successful procedure, the 3-F sheath was removed in the catheterization laboratory, and a hemostasis device was left in place for 30 minutes, achieving hemostasis without any complication. During the 9-month follow-up, the patient remained asymptomatic and without evidence of restenosis.
Conclusion:
A retrograde 3-F popliteal approach without the need for patient position change could be a convenient option for failed antegrade angioplasty of chronic SFA occlusions.
Infrapopliteal arterial disease is a significant cause of critical limb ischemia (CLI), whether single-segment or multisegment disease. The collaboration between the tremendous advancements in ...endovascular technology and the refinement of endovascular techniques has renewed the classic infrapopliteal interventions during the past decade. With this paradigm shift in the treatment of CLI, the role of a comprehensive approach of different disciplines for tissue loss is becoming greater. Given the increasing global burden of CLI, we review the cutting-edge diagnostic and endovascular approaches to infrapopliteal artery disease, and the importance of wound management in optimizing clinical outcomes. (Circ J 2014; 78: 1540–1549)
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