Femoral Angioplasty Research Articles

Study of Peripheral Flow During Successful Aortoiliac and Aortofemoral Prosthetic Reconstructions by Intraoperative Above-Ankle Pressure Index Monitoring

Doppler above-ankle pressure index (API) was monitored during 368 consec utive bilateral aortoiliac or aortofemoral graft reconstructions performed for aneurysmal or occlusive disease. The aim of this study was to investigate the variations of peripheral pressure, during and just after completion of the proce dure, either when followed by immediate and definitive success or when an intraoperative correction or an early postoperative reoperation was necessary owing to postreconstructive ischemia. For this purpose the API courses were subdivided into three groups: A (705 limbs), which underwent immediately suc cessful reconstructions; B (22 limbs), which needed intraoperative correction; C (9 limbs), which required early reoperation. All 736 limbs were studied individ ually as monolateral reconstructions and classified into six subgroups: 1, pervi ous iliac, pervious femoral artery; 2, occluded iliac, pervious femoral; 3, pervi ous iliac, stenotic femoral (i.e, stenosis > 75% of the superficial femoral artery); 4, occluded iliac, stenotic femoral; 5, pervious iliac, occluded femoral; 6, oc cluded iliac, occluded femoral. APIs were monitored before the operation (PRE), at the completion of the distal anastomosis (DEC), and five, fifteen, thirty, and forty-five minutes after. Data were statistically analyzed by multivariate analysis in regards to 705 immediately successful limbs (group A) and by comparison of all corrected or reoperated cases (groups B and C) with the lower bound of the fifth centiles of group A. The results in group A show that: API-PRE is different in the six subgroups (p < 0.001); API-DEC is lower than API-PRE in the patent iliac artery sub groups (1,3, and 5) and higher than API-PRE in the occluded iliac artery sub groups (2,4, and 6) (p always < 0.001). From declamping time to the forty-five- minutes observation, the mean courses turn out parallel and rising but on dif ferent levels (p < 0.001): pervious femoral, stenotic femoral, occluded femoral. API-forty-five minutes is higher than API-PRE in occluded iliac artery subgroups (2, 4, and 6) (p < 0.001), whereas in the patent iliac artery subgroups only the fifth subgroups reveals a slight but significant rise (p < 0.01), probably owing to the high rate of profunda femoral endarterectomy or angioplasty asso ciated with aortofemoral reconstructions. APIs values of 31 cases in groups B and C, compared with the lower bound of the fifth centile of group A, show that 8/31 cases (26%) remain above that bound, while 23/31 cases (74%) fall below it.

The use of double guidewires through a single vascular sheath for obtaining profunda femoris arterial access: Technical note

We describe a double guidewire/single vascular sheath technique that facilitates dilatation of stenotic lesions within both the superficial femoral and profunda femoris arteries following a single antegrade common femoral arterial puncture. Such a technique prevents inadvertent loss of vascular access during maneuvers to catheterize the profunda femoris artery or the superficial femoral artery. Angioplasty within the superficial femoral artery with simultaneous safety-wire placement within the profunda femoris artery has been described previously, but we present, in this technical note, successful profunda femoral angioplasty with the safety wire within the superficial femoral artery.

Bilateral Common Femoral Artery Stenosis Mimicking Aortic Stenosis—Case Report

Isolated bilateral common femoral artery stenoses or occlusions are an ex tremely rare arterial lesion and have not been previously reported. Herein the authors report 2 patients with this lesion with remarkable similarities. Both are similarly aged women, diabetic, hypertensive, and cigarette smokers. Both pa tients had thigh and calf claudication, diminished or absent femoral pulses, and diminished Doppler pressures from the thigh down. Common femoral endar terectomy and patch angioplasty with and without distal bypass was successful in the management of these 2 patients. The signs and symptoms of this lesion are identical to those of patients with aortic stenosis or bilateral iliac artery stenoses.

Emergency Surgery in Late Occlusion of Aortobifemoral Bypass Reconstructions

Personal experience of 66 late reoperations following occlusion of aortofe moral bypass procedures of patients operated for occlusive arterial disease of the lower extremities emphasizes that two possibilities exist: either a situation of compensation allowing a deferred evaluation of the problem (55 cases) or an emergency situation (11 cases) due to: 1) acute ischemia of the lower limbs (6 cases); 2) possibility of intestinal infarction (3 cases); 3) ascending thrombosis of the abdominal aorta (2 cases). The aim of the reoperation is to restore a good runoff usually with an endar terectomy of the profunda femoral artery (PFA) and angioplasty of this vessel or, when the profunda femoral artery does not give good reliability, with a fe moropopliteal or femorotibial bypass. Moreover, adequate blood flow must always be guaranteed in at least one of the hypogastric arteries by retrograde flow, reimplantation of the internal iliac artery or, as a last resort, by reimplantation of the inferior mesenteric artery (IMA) . It is necessary to underline that in a patient with occlusion of one graft limb, who had been conservatively treated for unremarkable subjective symp tomatology, the occlusion of the contralateral branch usually requires reopera tion with revascularization of at least one external iliac artery.

Per-operative haemodynamic assessment of lower limb arterial surgery Part 1: Hydraulic impedance measurement

Hydraulic impedance measurements have been made during surgery on 32 patients undergoing reconstructive arterial surgery. The reconstructive procedures included aorto-iliac, femoro-popliteal and axillo-femoral bypass, and extended deep femoral angioplasty. It was found that in aorto-iliac reconstruction the phase curves provide the means of assessing success, but that in other cases the impedance measurements though showing a similar trend are unable unequivocally to differentiate between success or failure.

Saphenous neuralgia: a complication of vascular reconstructions below the inguinal ligament.

Although relatively frequent in our experience saphenous neuralgia (SN) is not usually reported as a complication of vascular operations below the inguinal ligament. In 55 patients undergoing extended deep femoral angioplasty (EDFA, n = 28) and femoropopliteal bypass graft (FPBG, n = 27) special attention was paid to incidence and severity of postoperative SN. Severe early postoperative SN was seen in 8/28 patients with EDFA and in 6/27 with FPBG. Milder SN was seen in 10 more patients with EDFA, and 3 other developed SN many months after surgery. The milder forms of SN and late SN were not encountered after FPBG. SN usually improved with the passage of time, and at last follow-up averaging 18 months for EDFA and 33 months for FPBG there remained only 23 patients with mild SN (15 after EDFA and 8 after FPBG). The etiology of SN appears to be trauma to the nerve sustained during operation. Age, sex, diabetes, or the addition of lumbar sympathectomy to the vascular operation did not affect the risk of sustaining early postoperative SN. Increased awareness of this complication may help to understand its pathophysiology better, and possibly to decrease its incidence.

Percutaneous Transluminal Angioplasty with the Grüntzig Balloon Catheter

The results of an ongoing five-year study of percutaneous transluminal angioplasty for the treatment of peripheral vascular disease are presented. A balloon catheter was used for iliac and superficial femoral and popliteal artery dilatation. Forty out of 43 procedures performed were considered to have initial success, with iliac angioplasty showing a greater success rate (96%) than superficial femoral angioplasty (90%). Complications requiring surgical intervention occurred in only 3 patients. Advantages of this technique include local anesthesia, early ambulation, reduced hospital stay, and reproducibility.

Reversed autogenous saphenous vein by-pass from the common to the deep femoral (profunda femoris) artery.

Abstract Extended deep femoral angioplasty is an invaluable method of saving a limb especially where a femoro-popliteal vein by-pass is not possible because of a poor run-off. Atherosclerosis in the deep femoral artery often extends for more than 10 cm. In such cases we have preferred to perform a short vein by-pass than an extensive endarterectomy and patch graft. Our experience is described of 6 such cases, in 5 of whom amputation was avoided.

Extended deep femoral angioplasty.

At present reconstructive arterial surgery for atherosclerotic disease below the level of the inguinal ligament is restricted to femoropopliteal bypass grafts. We have found a new operation, which we call extended deep femoral angioplasty, to be effective not only in some cases where bypass is possible but also in many cases where it is impossible because of a poor run-off, lack of a suitable vein, or even when a bypass has failed. In a consecutively treated group of 34 patients operative reconstruction was limited to the deep femoral artery and a success rate of 65% was achieved. Most gratifying was the saving of a leg in eight patients in whom bypass was impossible.