Femoral Angioplasty Research Articles

Sweet Syndrome Presenting with Features of Cellulitis Shortly after Femoral Angioplasty.

Sweet syndrome, a rare skin condition related to neutrophil infiltration, may be triggered by angioplasty.Sweet syndrome is easily misdiagnosed as infectious conditions such as cellulitis.

Bovine pericardial patch - a good alternative in femoral angioplasty.

Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two methods are scarce. In this retrospective study, we aimed to discover the differences between BPP and AVP closure in long-term durability. This study consisted of all femoral endarterectomies with BPP closure performed in Helsinki University Hospital from January 1, 2014, to December 31, 2017. For comparison, the same number of consecutive patients who underwent femoral endarterectomy with AVP closure from January 1, 2014, to October 16, 2016, were reviewed. Follow-up ended December 31, 2020. The mean follow-up was 19months (range, 0-74months) in the BPP group and 22months (range, 0-79months) in the AVP group. The primary endpoint was primary patency. Secondary endpoints were restenosis at patch site detected by imaging or perioperatively, patch rupture, and deep surgical wound infection. Propensity score analysis was performed for adjustment of differences between the AVP and BPP groups. Overall primary patency was superior in the AVP group compared with the BPP group: at 1year, 96.5% vs 85.0% and at 5years, 83.0% vs 72.3% (P= .04). In propensity score-matched pairs (n= 92), no difference was found between the groups in primary patency: 95.7% and 95.7% at 1year and 92.5% and 78.6% at 5years (P= .861) or in freedom from restenosis: 100% and 100% at 1year and 89.1% and 84.0% at 5years (P= .057). Deep wound infections occurred slightly more often after BPP closure (8%) than after AVP closure (4%), but the difference was not statistically significant (P= .144). There were no patch ruptures in the BPP group, but in the AVP group, there were five ruptures (3.5%) (P= .024). BPP is compatible to AVP in femoral endarterectomy in patency and can be regarded as the safer choice considering the risk of patch rupture.

Outcome of Femoral Angioplasty/Stenting Procedures in Different Ethnic Groups in England: A Retrospective Analysis of Hospital Episode Statistics and Review of Literature

Purpose Various studies, mainly from North America, report worse outcomes in ethnic minority populations submitted to revascularization for peripheral arterial disease (PAD). Limited nationwide data in relation to ethnicity are available from Europe. Objective The objective of the study is to compare the outcomes of femoral angioplasty/stenting procedures among different ethnic groups in England during the 10-year period from 2006 to 2015. Materials and Methods The “Hospital Episode Statistics” database has been searched using International Classification of Diseases, Tenth Revision (ICD-10) codes to identify all cases of femoral angioplasty or stenting from English NHS Hospitals between January 1, 2006, and December 31, 2015. Subsequent mortality, second open or endovascular infrainguinal procedures, and major amputations on the same side within 2 years after the first procedure have been recorded. Patients were broadly categorized according to ethnicity as whites, Asians, and blacks. Chi-square test was used to demonstrate significant differences among ethnic groups and odds ratios (ORs) were calculated using white ethnic group as reference. Results A total number of 70 887 femoral endovascular procedures were recorded in patients from the 3 ethnic groups. Two-year mortality in whites, Asians, and blacks was 18.3%, 22.1%, and 19.5% (p<0.001); rates of second endovascular procedure were 12.1%, 13.1%, and 13.5% (p=0.24); rates of open infrainguinal procedure were 5.6%, 4.5%, and 8.0% (p<0.001); and rates of major amputation were 4.8%, 4.1%, and 7.0% (p<0.001), respectively. Mortality was higher in Asians (OR=1.26, 95% confidence interval [CI]=1.10-1.45, p<0.01) compared with whites. On the contrary, blacks underwent more open arterial operations (OR=1.48, 95% CI=1.19-1.83, p<0.01) and more amputations (OR=1.49, 95% CI=1.18-1.87, p<0.01). There were no significant differences in the rates of second endovascular procedures. Conclusion Two-year mortality after femoral angioplasty/stenting is higher in Asians, whereas risk of limb loss is higher in blacks compared with whites. Reasons of these ethnic differences in outcomes following femoral endovascular procedures for PAD merit further study.

Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia.

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported. Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months. Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively. Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.

The Effect of Simultaneous Sand-Ice Bag Application on Hemorrhage and Hematoma after Percutaneous Coronary Intervention: A Randomized Clinical Trial

Introduction: Angioplasty is widely used as a selective treatment for acute coronary syndromes. The complications of this procedure often lead to an increase in the length of the patients’ stay and hospital costs. Therefore, this study aimed to determine the effect of using sand and ice bags on hematoma and hemorrhage after percutaneous coronary intervention (PCI).Methods: In this randomized clinical trial, study was completed with participation of 60 patients with femoral angioplasty candidate, referring to Imam Reza hospital in Mashhad, were randomly divided into control and intervention groups. In the control group, a sand bag was placed on the location for up to 4 hours. In the intervention group, the ice bag and the sand bag were used simultaneously for 15 minutes, and then for 45 minutes, with the pressure of the sand bag only. This cycle was repeated four times. Hemorrhage (volume and weight) and hematoma (area and lump) were checked four times. The data were analyzed using SPSS software version 22.Results: The rate of hemorrhage after intervention was significantly reduced in the intervention group compared to the control group. Although the incidence of hematoma in the intervention group decreased from control to 20% to 6.7%, but the statistical test was not significant.Conclusion: According to the results of the present study, the simultaneous sand-ice bag application can reduce post-PCI’ hemorrhage (and hematoma rate, though insignificantly) through compression and vasoconstriction.

Bovine Pericardial Patch – A Good Alternative in Femoral Angioplasty

Introduction - This study investigates the results of bovine pericardial patch closure in femoral endarterectomies. The main focuses are immediate as well as later complications such as infections, stenosis at the patch site and patch ruptures. Methods - This retrospective study consists of all the femoral endarterectomies with bovine pericardial patch closure (Peri-Guard Supple® or Xenosure®) performed in Helsinki University Hospital (HUH) from January 1 2010 to July 31 2017. Patient data was collected retrospectively from the prospectively maintained Husvasc-registry and from the prosthesis registry in the operating room. Primary endpoints are restenosis at the patch site, patch ruptures and patch infections. Secondary endpoints are restenosis and infections at the entire surgical site. Results - During the study period 1160 femoral endartectomies including angioplasty took place in HUH. In 167 (14.4%) bovine pericardial patch closure was used. The indications for operations were claudication (28%), ischemic wound (22.6%) and rest pain (21.4%). Of the operations 51.8% were hybrid procedures including endovascular treatment either proximally (51.7%), distally (32.2%) or in both directions (16.1%). Median follow up time was 2.6 years, during which five (2.4.%) restenosis at the patch site were detected, four with ischemic symptoms and one found incidentally. If proximal and distal restenoses are included there were altogether 11 (6.5%) restenosis. Infections at the whole surgical site appeared in 23 (13.7%) patients, majority (n=20) detected within 30 days. Deep infections affecting also the patch occurred in 11 (6.5%) patients. There were no patch ruptures during the follow up. Eight (4.8%) patients had the patch removed due to infection (n=2), stenosis (n=5) and reoperation technique (n=1). Conclusion - Bovine pericardial patch provides a safe choice in femoral angioplasty with reasonably good patency results and relatively small risk for complications and can be considered comparable to autologous vein patch.

Human Infant Pants for Postoperative Protection during Social Housing of New Zealand White Rabbits (Oryctolagus cuniculus).

Elizabethan collars (E-collars) are commonly used in various species to safeguard healing wounds. However, E-collars inadvertently restrict the expression of normal species-typical behaviors, including coprophagy, self-grooming, and social housing. To maintain social housing in accordance with recommendations in the 8th edition of the Guide for the Care and Use of Laboratory Animals, we implemented the use of human infant pants instead of E-collars for postsurgical protection. We retrospectively reviewed the medical records of 154 intact male New Zealand white rabbits (age, 2 to 3 mo) regarding the use of E-collars (group 1; n = 72) compared with human infant pants (group 2; n = 82) for postoperative protection after 308 femoral angioplasty procedures. Maintenance of social pairs throughout the postoperative phase, replacement rate of infant pants, and self-mutilation rates were measured. Our findings indicate that using infant pants for postoperative protection was most successful in maintaining social housing, offers a more cost-effective option to E-collars, and does not increase the rate of self-mutilation in intact male New Zealand white rabbits.

Early ambulation after femoral percutaneous transluminal angioplasty - report of 02 cases

INTRODUCTION: In Brazil and around the world, there is still an abundance of hospital services that restrict exercise in individuals undergoing percutaneous coronary interventions (PCI), in the immediate postoperative period, for fear of complications. It is important to demonstrate that cardiovascular physical therapy can be performed in this population. OBJECTIVE: To verify the adverse effects in the performance of early ambulation after PCI, with the use of a mechanical device of arterial closure in the femoral puncture. POPULATION AND METHODS: Two cases (68-years-old man and 57-years-old woman) submitted to a single-vessel coronary artery (right coronary artery and diagonal branch, respectively) that had their femoral puncture associated with the device Angio-Seal - St. Jude Medical©, who were discharged from the hospital six hours after the intervention. Before PCI, patients had stable angina and cardiovascular risk factors (dyslipidemia, hypertension, and others). After the PCI, the patients were evaluated by the Heart Team, who monitored intercurrences during hospitalization (chest pain, ventilatory discomfort, electrocardiogram, cardiac enzymes and others). The gait of the individuals was verified, in order to evaluate the tolerance of the individuals to the same, after five hours of the PCI. Individuals were advised to walk in a light rhythm (modified Borg 1-3) for five minutes in a corridor of approximately 15 meters, in round-trip movements, and were evaluated after ambulation for hematoma at the puncture site, pain or any complications that might arise. On the first postoperative day, a telephone call was made for a second complication check. RESULTS: Both patients tolerated the five-minute walk and were released from the hospital after six hours, wandering uneventfully. One of the patients reported low-intensity headache during hospitalization. The same patient reported low-intensity pain at the puncture site the next day. There were no clinically relevant changes in cardiovascular or ventilatory parameters during the six hours postoperative hospitalization or during ambulation. CONCLUSION: Early ambulation within six hours after PCI was well tolerated in the two cases studied, even with the femoral artery access site. The use of a mechanical device for arterial closure was important so that the ambulation could be carried out in this population.

Endovascular iliac and femoral angioplasty followed by contralateral femoropopliteal bypass in a patient with chronic lower extremity ischemia: case report

Endovascular iliac and femoral angioplasty followed by contralateral femoropopliteal bypass in a patient with chronic lower extremity ischemia: case report

Managing soft tissues in severe lower limb trauma in an ageing population

PurposeWith an ageing population, the incidence of trauma in those aged over 65 years is increasing. Strategies for dealing with these patients must be developed. At present the standard management of open tibial fractures in the UK is described by the BOAST4 guidelines (from the British Orthopaedic Association and British Association of Plastic & Aesthetic Surgeons). It is not clear to what extent these are appropriate for older patients. We describe our experience of managing elderly patients presenting with open tibial fractures. MethodPatients were identified via prospectively collected national and departmental databases. These data were supplemented by review of the patient records and radiographs. Data collated included patient demographics, injury details, orthopaedic and plastic surgery operative details, and long-term outcomes. ResultsBetween January 2013 and June 2016, 74 patients aged over 65 years were admitted with open lower limb fractures. 54 of these were open tibial fractures and these patients formed the study group. 19 patients required soft-tissue reconstruction for Gustilo and Anderson IIIB tibial fractures (age range, 67–95 years). In these patients, there were 7 midshaft (AO 42), 1 proximal (AO 41), and 11 distal (AO 43) fractures. 13 patients were treated with internal fixation and 6 with circular frames. The median length of hospital stay was 27 days (range, 4–85). 14 patients received loco-regional flaps and 5 underwent free tissue transfer with one requiring preoperative femoral angioplasty. There were no flap losses. Four patients had fasciocutaneous flaps, 3 tibialis anterior transposition, 2 an extensor digitorum brevis flap, 1 a hemisoleus flap, and 4 were skin grafted. All patients went on to unite and return to their premorbid weight-bearing status (4 using walking frames, 3 using sticks, and 12 walking independently). ConclusionAlthough the literature suggests a significantly higher complication rate in elderly patients with open fractures, we have demonstrated comparable rates of flap survival and bony union to those observed in younger patients. Challenges are presented in terms of patient physiology and these must be carefully managed pre- and postoperatively. These challenges are reflected in prolonged hospital stays.

A Case Report of Duplex-Guided Femoral Angioplasty in a Patient with Severe Renal Insufficiency Still an Option to Consider

1.1 Introduction One of the main concern of percutaneous transluminal angioplasty (PTA) is the risk of renal injury in nephropathic patients. A valid alternative is represented by CO2 angiography, which is however contraindicated in patients with chronic obstructive pulmonary disease and is not always available in hospitals. In these cases, the role of duplex guided balloon angioplasty (Du-PTA) should be reassessed. 1.2 Case presentation We describe the case of a 75 years-old nephropathic Caucasian male patient who underwent a duplex-guided percutaneous transluminal angioplasty (Du-PTA) for a 10-cm occlusion of his right femoral superficial artery causing rest pain. A review of the literature about the use of duplex ultrasound for the endovascular treatment of infrainguinal vascular disease in selected high-risk nephropathic patients was also performed. 1.3 Conclusion In well selected patients who present with critical limb ischemia and are at high risk for contrast-induced nephropathy, and when CO2 angiography cannot be performed, Du-PTA of femoral-popliteal district can still be a safe and effective alternative to conventional PTA and should be taken into account.

Phlegmasia Cerulea Dolens and May–Thurner Syndrome in the first trimester of Pregnancy

Background Venous thromboembolism in pregnancy remains one of the leading causes of morbidity and mortality. Case A young, gravid patient presented with a cyanotic, edematous left lower extremity with no distal pulses palpable. She was emergently taken to the operating room and was found to have extensive iliofemoral thrombosis requiring femoral angioplasty and embolectomy with 43.7-rad intraoperative radiation exposure. Phlegmasia cerulea dolens and May–Thurner syndrome were diagnosed. Conclusion Timely diagnosis and prompt surgical management are necessary due to the limb-threatening nature of this condition. Despite maternal radiation exposure, the nature and extent of fetal effects depends upon radiation dose and gestational age.

Surgical treatment of patients with critical ischemia of lower limbs originating from aortoiliac lesions and concomitant coronary artery disease

The study focuses on the outcomes of surgical treatment of 236 patients with critical ischemia of lower limbs originating from aortoiliac lesions and concomitant coronary artery disease. All patients first underwent vascular surgery, with 158 of them having aortobifemoral bypass surgery and 78 - hybrid vascular procedures on the aortoiliac segment: open surgical revascularization of femoral arteries and angioplasty and stenting of iliac arteries. Critical limb ischemia was successfully treated in all patients. One patient died after aortobifemoral bypass surgery; no fatal outcomes were registered after hybrid procedures.

Abstract 201: Adventitial Nab-Rapamycin Injection Reduces Porcine Femoral Artery Luminal Stenosis Induced by Balloon Angioplasty via Inhibition of Medial Proliferation and Adventitial Inflammation

Introduction: Balloon angioplasty of peripheral arteries induces a substantial inflammatory response and has a high rate of restenosis. Our hypothesis was that peri-adventitial injection of the antiproliferative, immunosuppressant drug rapamycin would reduce luminal stenosis in a porcine femoral artery model of balloon angioplasty injury. Methods: 16 male crossbred swine had a balloon angioplasty overstretch injury of the femoral artery followed by peri-adventitial injection of saline or 500μg of nanoparticle albumin-bound (nab) rapamycin with an intraluminal microinfusion catheter. Qualitative and quantitative assessments of the femoral arteries, including histomorphometric measurements, were performed on H&amp;E, Masson’s trichrome or immunohistochemistry stained sections. Blood and tissue rapamycin concentration were assessed by liquid chromatography and mass spectrometry at 1h, 3d, 8d and 28d. Results: There was 100% procedural success with periadventitial injection. At 28 days, femoral arteries treated with nab-rapamycin had a 42% reduction in luminal stenosis, 19.5 ± 3.3% vs 11.4 ± 0.84%, p=0.01 t-test (figure). Nab-rapamycin also significantly reduced medial fibrosis by qualitative analysis, p&lt;0.0001 t-test, and media cell proliferation by Ki-67 staining, p=0.02 t-test. There were significantly fewer adventitial leukocytes at 3 days, p=0.03 t-test, but no difference at 28 days. One hour after injection, the perivascular concentration of nab-rapamycin was 1500-times higher than serum and rapamycin persisted in the tissue for at least 8 days. Rapamycin was not detectable in serum or tissue at 28 days. There was no difference in endothelial coverage or regeneration by Factor VII and H&amp;E staining at 3, 8 or 28 days. Conclusions: A single periadventitial dose of nab-rapamycin significantly reduced luminal stenosis in a porcine model of femoral artery balloon angioplasty injury. The observed reduction in early adventitial infiltration by leukocytes and decrease in medial cell proliferation and fibrosis at 28 days suggests a mechanism by which nab-rapamycin may have an effect. Adventitial injection with an intraluminal microinfusion catheter is safe and efficient and represents an alternative to stent- or balloon-based local drug delivery.

Superior Mesenteric Vein Aneurysm

A 46-year-old female was found to have a saccular superior mesenteric vein (SMV) aneurysm on computed tomography (CT) scan during workup for abdominal pain. It measured 3.5 cm in diameter. The SMV aneurysm was successfully resected, and the SMV was repaired with femoral vein patch angioplasty. She was placed on coumadin for 3 months. At follow-up, the vein patch repair was patent and the patient was doing well with complete resolution of her abdominal pain.

Trends and outcomes after surgical lower limb revascularization in England

The aim was to analyse contemporary data on the number of surgical revascularization procedures performed each year in England, and their outcome. Hospital Episode Statistics and Office for National Statistics data were used to quantify numbers and identify factors associated with outcome after all femoropopliteal and femorodistal bypass procedures performed between 2002 and 2006. Outcome measures were repeat bypass, major amputation, death and a composite measure. Single-level multivariable logistic regression modelling was used to quantify the effect of these variables on outcome. A total of 21,675 femoropopliteal and 3458 femorodistal bypass procedures were performed. Mean in-hospital mortality rates were 6·7 and 8·0 per cent respectively. One-year survival rates were 82·8 and 79·1 per cent; both increased over the study interval. The mean 1-year major amputation rate after femoropopliteal bypass was 10·4 per cent, which decreased significantly over the 5 years (P < 0·001); after distal bypass the rate of 20·8 per cent remained unchanged (P = 0·456). Diabetes mellitus and chronic kidney disease were significant predictors of adverse outcome for both procedures: odds ratio (OR) at 1 year 1·56 (95 per cent confidence interval 1·46 to 1·67; P < 0·001) and 2·15 (1·88 to 2·45; P < 0·001) respectively for femoropopliteal bypass. Previous femoral angioplasty was associated with an increased rate of major amputation 1 year after proximal bypass (OR 1·18, 1·05 to 1·33; P = 0·004). Although all mortality rates are improving, the major amputation rate remains high after femorodistal bypass. Adverse events occurred after 37·6 per cent of femoropopliteal and 49·7 per cent of femorodistal bypasses; diabetes and chronic renal failure were the main predictors of poor outcome.

External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

Extended deep femoral angioplasty: An alternative to femoropopliteal bypass

The results of extended deep femoral angioplasty (EDFA) have been alaysed for 74 legs in 72 patients. In 69 per cent a femoropopliteal bypass would have been possible, so DEFA is considered here as an alternative operation. The success rate was 66-9 per cent, the failure rate 25-6 per cent and no effect was achieved in 7-5 per cent. Diabetes adversely affected the results. Of the failures, 45 per cent were diabetic, while the incidence of diabetes was only 14 per cent in the group where the operation was successful. The long term results of the operation were reasonable, 75 per cent being successful for 10-39 months. Age had no bearing on success or failure. The effects of EDFA were most dramatic on intermittent claudication. In 52 per cent it was abolished and in 92 per cent claudication distance was increased to over 200 yards. Good results were achieved after failed lumbar sympathectomy and failed femoropopliteal bypass. Successful results of EDFA could be predicted best by inspection of angiograms. Success or failure could have been predicted from the state of the run-off in 81 per cent of the cases. Claudication and rest pain were the most relieved by EDFA, followed by isachaemic ulceration of the leg. Gangrene of digits was helped but less than had been hoped. We conclude that the indications for femoropopliteal bypass are limited to cases of digital gangrene where angiography shows that bypass is possible or where an EDFA operation has failed.

Doppler ultrasound in the functional assessment of extended deep femoral angioplasty.

Twelve patients who have had an extended deep femoral angioplasty (EFDA) for severe lower limb ischaemia have been assessed. The patients underwent a standard exercise ankle pressure test before operation and 6 months after operation. The test included the measurement of resting brachial and ankle pressures, walking distance on a treadmill and the post-exercise pressure response. A limb ischaemic score was derived from these measurements; 8 patients showed an improved score, 3 patients exhibited no change and 1 was worse. The mean improvement in walking distance of the successful cases was 182 per cent (s.d. 96 per cent). There were no amputation during the period of study.

Retrograde femoral angioplasty: A new technique

Percutaneous transluminal angioplasty cannot be used for lesions of the superficial femoral artery when the origin of the vessel is occluded. A new technique, retrograde femoral angioplasty, is described in which angioplasty is performed from below via the exposed popliteal artery. In four out of six patients retrograde femoral angioplasty was successfully completed, and three of the four vessels remain patent up to 1 year later. The method provides an alternative to the femoropopliteal bypass graft in some patients.