Femoral Artery Occlusion Research Articles

Research on application of totally endoscopic surgery with Three- Dimensional system for congenital heart surgery in children

Objective: to evaluate the feasibility and results of implementing 3D total endoscopic surgery for congenital heart surgery in children. Abstract: Minimally invasive surgery is currently a widespread tendency in open heart surgery and particularly in congenital heart surgery. In particular, total endoscopic surgery with a 3D system has been applied to adult patients, bringing many benefits such as thoroughly resolving heart lesions, fast post-operative recovery and especially high aesthetic value with small surgical scars. The application of 3D endoscopic surgery for children still has many limitations due to their small body size. Therefore, we conducted this study to evaluate the feasibility and results of implementing this technique in children. Subjects and methods: From January 2018 to March 2024, patients weighing over 15 kilograms were operated using 3D total endoscopic methods. Total 127 patients included: 62 cases of atrial septal defect, 42 cases of ventricular septal defect, 18 cases of partial atrioventricular septal defect and 5 cases of partial anomalous pulmonary venous return. Average age: 8.73 years (3-15). Average weight: 21.34 kg (15-51). Results: All patients were established with peripheral extracorporeal circulation, no patient had to undergo sternotomy. The time of cardiopulmonary bypass for atrial septal defect, ventricular septal defect, partial atrioventricular septal defect, and partial anomalous pulmonary venous return were: 78 minutes, 115 minutes, 140 minutes, 91 minutes, respectively. Aortic clamping time for ventricular septal defect: 82 minutes; partial atrioventricular septal defect: 88 minutes; partial anomalous pulmonary venous return: 62 minutes. For the disease of atrial septal defect, the heart was left beating during the surgical process. No cases of fatality after surgery. Postoperative echocardiography demonstrates promising results. Postoperative complications included 1 patient with femoral artery occlusion at the site of arterial cannulation, this patient then underwent emergency femoral artery angioplasty; 1 patient with external iliac artery stenosis required reoperate after 3 months. The average postoperative follow-up time was 29 months (2 - 59), no fatality, no complications, stable echocardiography results, no patient needed to be reoperated during the follow-up period. Conclusion: 3D total endoscopic surgery can be performed routinely on children weighing over 15 kg, offering excellent early and long-term outcomes and evident cosmetic benefits.

COMPARATIVE EVALUATION OF METHODS OF R EVASCULARIZATION OF ARTERIAL BLOOD FLOW I N PATIENTS WITH MULTI-LEVEL OCCLUSIVE-STENOTIC LESIONS OF MAIN ARTERIES IN OBLITERATING ATHEROSCLEROSIS OF THE LOWER EXTREMITIES

Abstract. In Ukraine, from 3 to 10% of the population suffers from occlusive diseases of the arteries of the lower extremities. It is important, that the cause of lower limb ischemia in 45-50% of patients is an atherosclerotic impression. The aim: to study the results of the treatment of multi-level occlusive-stenotic lesions of the main arteries of the lower extremities by choosing the optimal method of surgical revascularization in obliterating atherosclerosis. Materials and methods: the research is based on the results of examination and treatment of 267 patients with critical ischemia of the lower extremity III, IV degrees according to Fontaine. The results. In the case of a combination of occlusion of the superficial femoral artery with stenotic-occlusive lesion of the arteries of the popliteal segment against the background of obliterating atherosclerosis, the use of simultaneous revascularization of the two layers of the lesion allows to expand the indications for revascularization of the arteries in this category of patients and improve the results of treatment. Conclusions: postoperative thrombosis of the reconstruction area in patients, who underwent complex restoration of the patency of the iliac-popliteal arterial segment in various combinations in order to correct the phenomena of critical ischemia occur in 10.5%, and in patients, who underwent restoration of the patency of the iliac-popliteal arterial segment without intervention on arteries of the distal channel – in 27.8%.

Abstract 4120854: Case Report: Elevated HDL in Familial Hyper-Alpha-Lipoproteinemia: Atheroprotective or Atherogenic?

Introduction: Familial hyper-alpha-lipoproteinemia (HALP) is a heterogenous genetic lipid disorder that is found in only 8% of the population and manifests as elevated HDL levels above the 90 th percentile. HALP is due to mutations in various genes including cholesteryl ester transfer protein (CETP), hepatic lipase, or apolipoprotein C-III (APOC3). While epidemiological studies have noted an inverse relationship between high HDL and the development of coronary artery disease, recent data have shown a lack of causal atheroprotective effects. We present a case of a patient with significantly elevated HDL and peripheral vascular disease. Case Description: Patient is a 64-year-old female with past medical history of peripheral artery disease with occlusion of the left femoral artery and popliteal arteries status post angioplasty, hypertension, type 2 diabetes, alcohol use, and CKD Stage 4 who presented to the advanced lipid clinic for management of elevated lipoproteins. Patient’s laboratory data was significant for total cholesterol (TC) of 375 mg/dL, a high-density lipoprotein (HDL) of >200 mg/dL, triglycerides (TG) of 66 mg/dL, and a low-density lipoprotein (LDL) of 175 mg/dL. Further testing revealed elevated apolipoprotein A-I of 231 mg/dL. Patient was subsequently initiated on a high intensity statin with improvement in her lipid panel with a TC of 247 mg/dL, HDL of 133 mg/dL, TG of 50 mg/dL, and LDL of 106 mg/dL, with plan for further uptitration of lipid therapy to target LDL <70 mg/dL. Discussion: CETP exchanges cholesteryl esters from HDL for TG, making HDL smaller and more TG-rich. Studies have shown that in vitro addition of CETP and hepatic lipase, which hydrolyzes phospholipids and TG, into CETP-deficient patients led to the development of very small HDL particles that were able to remove cholesterol from lipid laden macrophages. Conversely, larger HDL molecules seen in CETP-deficient patients did not have such anti-atherogenic properties. In addition to recognizing HALP in the setting of elevated HDL, it is also important to exclude secondary causes of elevated HDL, such as primary biliary cirrhosis and high-dose niacin. Genetic testing should also be considered.

Abstract 080: Challenges Associated with The Embolic Protection Device (epd) And Perioperative Events Between Those Who Did and Did Not Receive Epd During Carotid Artery Stenting

Background In CREST trial 96.1% of the patient in carotid artery stenting (CAS) group had EPD and with a 4.1± 0.6 incidence of stroke. Despite the use of EPD, CAS has more cerebral ischemic events (CIE) compared to CEA. Additionally, the challenges associated with EPD device was not described and underreported. Objective of this study is to describe the challenges associated with EPD and compare the perioperative events between those with EP and without embolic protection. Additionally, to describe the unintentional strategies utilized for the EP. Methods From a prospectively maintained data base, Consecutive patient who underwent CAS for ≥ 70% stenosis based on NASCET criteria were collected and retrospectively analyzed from January 2012 to December 2020. Patients demographics, procedural techniques and perioperative events were captured. Outcome was measured using modified ranking scale (mRS). Our patients received acute loading doses of dual antiplatelets on the day prior to CAS. Results A total of 177 patients with baseline mRS 0.511±1.02 and 71% symptomatic, 29% asymptomatic underwent CAS in two community based tertiary care facilities. Patients received conscious sedation except one who underwent general anesthesia. Median age 69 (39‐91) female 39.55%. EPD was used in 69% and 41% didn't receive EPD due to the tortuosity or critical stenosis prevented DPD to cross the lesion. Stent couldn't be deployed in one because of non‐cooperation and underwent CEA. EPD associated challenges observed in 12 patients (9.8%). EPD couldn't be deployed in 3 required additional 3 devices and use of intraarterial eptifibatide (integrilin). EPD induced spasm developed in 5 required IA verapamil. Severe challenges were observed in 3 during retrieval of the capture device requiring multiple unintentional balloon angioplasties, patients head manipulations and IA intermittent delivery eptifibatide (5 mg at least 10 minutes interval maximum 2 doses). Unexpected EPD related events increased procedure time and have created significant stresses to the team and to the operators. Perioperative events without death, stroke and MI in 7 cases 3.9%. CEI in 2 cases (1.2%), one in an 88‐year‐old man without EPD and one in a 66‐year‐old man with EPD. Carotid artery asymptomatic dissection in one with EPD. Groin complications in 4 (2.3%). Anterior small hematoma in 3, had no impacts in hospital stay and outcomes. Closure device related femoral artery occlusion in 1, required emergent repair and achieved mRS 0. All asymptomatic patients achieved their baseline mRS and had no events. 30 days and 90 days mRS were 0.405 ±0.96 and 0.402 ± 0.95 respectively. Conclusions We observed significant challenges associated with EPD and unintentional interventions such as use of additional devices, vessels spasm, delivery of spasmolytic, balloon angioplasties and IA eptifibatide, especially during the retrieval of EPD. If the EPD couldn't be retrieved in our 3 cases, which might have potentially led to a life‐threatening stroke. We observed no added benefits in the prevention of embolic events between those who received or didn't receive EPD during CAS. A prospective randomized controlled trial is deemed necessary.

Platelet membrane coated r-SAK to improve thrombolytic efficacy by targeting thrombus

Abstract Background Thrombolytic therapy is one of the most effective treatments to achieve rapid thrombus clearance and recanalization of blocked vessels in thrombotic diseases. However, the application of thrombolytic strategy has been limited due to unsatisfied thrombolytic efficacy, relatively higher bleeding complications, and consequently restricted indications.[1] With the development of nanotechnology and biotechnology, platelet membrane nanoparticles have been developed to enable the targeted delivery of thrombolytic agents to local thrombus sites.[2] Recombinant staphylokinase (r-SAK) is a third-generation thrombolytic agent produced by genetic engineering technology. In this study, platelet membrane coated r-SAK (PLT-r-SAK) was constructed, and its thrombolytic efficacy was evaluated in in-vitro and in-vivo experiments. Purpose We aimed to construct a thrombus-targeting agent of PLT-r-SAK and investigate its thrombolytic efficacy. Methods PLT-r-SAK was prepared by encapsulating r-SAK into platelet membrane vesicles using a membrane extrusion method. An in-vitro thrombolytic experiment was performed to examine the thrombolytic efficacy of PLT-r-SAK, and a totally occluded femoral artery thrombosis model of rabbit was developed to evaluate the in-vivo thrombolytic efficacy of PLT-r-SAK. The changes in femoral artery pressure were adopted to assess the vessel opening status. Besides, the effect of the antiplatelet drugs on the thrombolytic efficacy of PLT-r-SAK was explored. Finally, near-infrared fluorescence imaging system was used to verify the thrombus-targeting effect of PLT-r-SAK. Results PLT-r-SAK was firstly constructed, which exhibited a uniformly dispersed spherical morphology with a diameter of 185.8 ± 1.5 nm and a zeta potential of -26.1 ± 0.8 mV. In the in-vitro animal experiment, the thrombolysis rate of PLT-r-SAK was significantly higher than that of the same (low) dose and 4-fold (high) dose r-SAK (Figure 1a, 1b). In the in-vivo experiment, the initial recanalization time of PLT-r-SAK was significantly shorter than that of the low dose and high dose r-SAK, and the duration of the reperfusion time of PLT-r-SAK was prolonged compared to low dose and high dose r-SAK (Figure 1c). Another in-vitro experiment showed that the increased thrombolysis rate of PLT-r-SAK could be inhibited by platelet poor plasma (PPP) from aspirin- and ticagrelor-treated patients. Finally, both the in-vitro and in-vivo near-infrared fluorescence imaging showed significantly higher radiant efficiency in the PLT-r-SAK group as compared to the NS group (Figure 2). Conclusions Platelet membrane coating significantly improves the thrombolytic efficacy of r-SAK, which is related to the thrombus-targeting activity of the platelet membrane and can be inhibited by aspirin- and ticagrelor-treated plasma.Thrombolytic efficacy of PLT-r-SAKThrombus-targeting evidence of PLT-r-SAK

Acute lower limb ischemia caused by repeat deployment of vascular closure device.

Vascular closure devices are used to facilitate faster hemostasis and earlier ambulation, improve patient comfort, and reduce length of hospital stay after percutaneous endovascular procedures. However, their use may rarely be associated with limb ischemia due to endothelial damage and arterial thrombosis. This report illustrates the case of a patient who experienced acute lower limb ischemia due to superficial femoral artery occlusion caused by repeat closure with Angio-Seal vascular closure device within 30 days in a small-caliber superficial femoral artery. The patient was surgically treated by vascular repair with a synthetic graft, and remains symptom-free in 3-year follow-up. Repeat deployment of vascular closure devices in the same access site within a period of 30 days may cause acute limb ischemia due to arterial thrombosis, especially in patients with small-caliber arteries, even in the absence of evident risk factors.

Popliteal access for iliofemoral occlusive disease in the office-based catheter laboratory

ObjectivePopliteal access as an alternative to conventional femoral access has not been reported in the office-based catheter laboratory setting (OBL) and may be perceived to have higher risks. The purpose of this study was to evaluate the safety and efficacy of popliteal access for the endovascular treatment of iliofemoral arterial occlusive disease in an OBL setting. MethodsFrom October 2018 to October 2023, a total of 1408 interventions for peripheral artery disease were performed in our OBL. A cohort of 27 popliteal access consecutive procedures for femoral and iliac artery occlusions were studied. All interventions were done using a micropuncture needle under ultrasound guidance. All patients were discharged 1 hour after completion of the procedure. Indications for popliteal access were presence of aortoiliac stent grafts, aortobifemoral or aortoiliac bypasses, difficult contralateral or antegrade femoral access, and flush superficial femoral artery occlusions. Procedures were determined to be successful upon complete resolution of the target lesions and safety was measured perioperatively and at 90 days. Patency was determined clinically, by arterial duplex examination, and by need for reintervention for ≤2 years. ResultsWe performed 27 popliteal access procedures in 25 patients (21 complete femoral artery occlusions, 6 severe stenosis). Iliac disease was present in nine. Indications for popliteal access were existing aortoiliac stent graft in 11, aortobifemiliac bypass in 4, noncrossable iliac occlusions in 3, failed antegrade femoral access in 4, flush superficial femoral artery occlusion in 3, and bilateral common femoral artery disease precluding access in 2. Trans-Atlantic Inter-Society Consensus classification preoperatively was B, 4; C, 4; and D, 19. Treatments included atherectomy/balloon angioplasty and stent in 12, balloon angioplasty and stenting in 4, atherectomy/balloon angioplasty in 5, and balloon angioplasty alone in 6. Successful opening of occlusions occurred in 25 of 27 patients (92.5%). No complications or major adverse cardiac events occurred, except one asymptomatic small popliteal arteriovenous fistula. Of the 25 successful procedures, the duplex patency at 3, 6, and 12 months was 19/20 (95%), 11/15 (69.3%), and 11/13 (61%). Rutherford Classification improved from a preoperative value of >4 in 24 of 27 (89%) to a postoperative value of <2 at 1 month in 23 of 23 (100%), at 3 months in 19 of 20 (95%), at 6 months in 11 of 15 (69.3%), and at 12 months in 11 of 13 (61%). Freedom from reintervention at 3 months occurred in 19 of 20 (95%), at 6 months in 13 of 15 (86%), and at 12 months in 12 of 13 (79%). ConclusionsPopliteal artery access for complex iliofemoral disease is safe and effective and should be considered as a valid alternative option in the OBL setting.

Femoropopliteal Bypass Surgery for Total Calcification of the Iliofemoral Segment

Calcification of the lower extremities arteries is an unfavorable factor for vascular surgery. Extensive lesions of the femoral segment are an indication for femoropopliteal bypass surgery. Calcification of the femoral arteries complicates the construction of a proximal anastomosis because it precludes clamping the arteries. In addition to technical difficulties in the construction of an anastomosis, significant calcification increases the risks of bleeding and embolic complications and the duration of surgery. In cases of total calcification of the femoral and iliac arteries, balloon occlusion during the construction of an anastomosis makes it possible to occlude the arteries without clamping, which reduces the risks of perioperative complications. We report a case of femoropopliteal bypass surgery in a patient with total calcification of the iliofemoral segment and occlusion of the superficial femoral artery.

Remote Endarterectomy Facilitated With a Flexible Ureteroscope System for Treating Superficial Femoral Artery Occlusion.

Remote Endarterectomy Facilitated With a Flexible Ureteroscope System for Treating Superficial Femoral Artery Occlusion.

Outpatient regenerative therapy of a chronic diabetic foot ulcer with exposed bone surface

BACKGROUND: Treatment of deep chronic wounds with the bone tissue involvement against the background of lower limb atherosclerosis and diabetic foot syndrome does not fit any reasonable hospital stay duration and at the same time has no effective outpatient methods. Therapy with conditioned medium derived from human mesenchymal stem cells (CM-MSC) may be a solution for this problem. CLINICAL CASE DESCRIPTION: Patient F., 77-year-old, arrived for an outpatient treatment of local necrosis in the area of the 1st toe of the left foot in April, 2022. The main diagnosis: Peripheral arterial disease of the lower extremities. Multifocal atherosclerosis. Occlusion of the superficial femoral and popliteal arteries, diffuse lesions of the lower leg arteries on the left. Chronic arterial insufficiency of the 4th degree. Attempts of revascularisation of the left lower limb. Limited gangrene (Wagner IV) of the 1st toe of the left foot. Associated diseases: insulin-dependent type 2 diabetes mellitus (for more than 30 years). Diabetic polyneuropathy. Diabetic foot syndrome, neurotrophic form. Local treatment was performed by the microsurgical debridement of the affected surface in combination with the method of multilayered dressings, according to the previously patented technology. The microsurgical treatment of the bone surface in the wound area was carried out with the use of CM-MSC. Positive dynamics in the form of a partial closure of the bone fragment with soft tissue was observed on the sixth month of therapy. The complete closure of the open bone fragment was observed in 12 months from the beginning of the outpatient treatment. CONCLUSION: The developed method of treatment using CM-MSC can be effective for chronic wounds with open bone surfaces.

A latent bleeding complication in ipsilateral common femoral puncture involving delayed diagnosis: a case report

BackgroundThe trans femoral ipsilateral approach is often adopted for endovascular treatment (EVT) for better steerability of guidewires or better device deliverability. However, contrary to the trans femoral contralateral approach, ipsilateral antegrade puncture sometimes causes peculiar bleeding complications.Case presentationA 76-year-old female underwent EVT for chronic occlusion of the left superficial femoral artery (SFA) via the ipsilateral antegrade approach. After guidewire passage, we inflated the drug-coated balloons, but angiography showed blood flow stasis at the mid segment of the SFA. We also ensured prolonged balloon inflation, which resulted in favorable blood flow. While trying to ensure hemostasis, the blood pressure remained decreased, but neither bleeding nor superficial hematoma were observed at the puncture site. After hemostasis was achieved, we removed the surgical drape and noticed a swelling in the mid-portion of the thigh, distant from the puncture point. We then approached the left common femoral artery (CFA) contralaterally. Angiography showed continuous bleeding from a little bit distally to the sheath insertion point that was spreading through an intramuscular space. We stopped the bleeding with balloon tamponade inside the CFA. Angiography after hemostasis demonstrated blood flow stasis at the mid-segment of the SFA, similarly as that seen before. We confirmed compression of the SFA by a large hematoma using both intra- and extra- vascular ultrasound. Therefore, we deployed a self-expandable stent at the compressed SFA position. Finally, we achieved favorable blood flow on angiography.ConclusionWe encountered a case that latent bleeding unrecognized in the surgical field persisted while prolonged inflation of DCB was conducted at just proximal SFA. We could have avoided bailout stenting by noticing the bleeding incident in a timely manner. Prediction and prevention are essential for all kinds of procedural complications in EVT.

Modeling of rabbit femoral artery occlusion by high-intensity focused ultrasound

One of the effective methods of artery and vein occlusion used in experimental studies and in clinical practice for certain diseases is local exposure of vessels to high-intensity focused ultrasound (HIFU). The wide use of this method in our country is limited by the lack of appropriate domestic equipment. At the Peter the Great St. Petersburg Polytechnic University, in the Laboratory of Ultrasound Technologies of the Center for Advanced Research, a stand for HIFU effects on various biological objects has been developed. There is no experience in using this device in angiology yet. The purpose of our research was to study the possibility of using Medusa 008, a high-tech mobile medical device designed for ultrasound diagnosis and personalized HIFU therapy, to model vascular occlusion and stop blood flow during irradiation. Materials and methods. The object of the study is the femoral artery of a rabbit. The source of HIFU is Medusa 008, the high-tech mobile medical device designed for ultrasound diagnostics and personalized HIFU-therapy with radiation frequency of 2 MHz (prototype). The following irradiation modes were used in the research: irradiation duration - 50 ms, pause between exposures – 10 ms, number of pulses – 20, 30, 40. The following energy values corresponded to these modes: 58 J, 87 J, 116 J. Irradiation of the femoral artery of an anesthetized rabbit was performed percutaneously. We used ultrasound to visualize the arteries and measure the blood flow velocity. According to ultrasound data, after HIFU irradiation, blood flow in the artery stopped. The factor contributing to arterial occlusion is the cessation of blood flow during irradiation. A histological examination of the area of the irradiated artery revealed structural changes in all layers of the vascular wall. Results. HIFU irradiation with intensity of 87 and 116 J has a significant dose-dependent destructive effect on the muscular arterial wall. The more intense damaging irradiation (116 J) causes smooth muscle cell necrosis. The time of direct influence on the vessel wall structures did not exceed 3 sec. During the experiment, we found that HIFU in the used modes causes temperature increase up to 45–60 оC, which is enough for thermal damage of cells in the irradiation zone. Conclusion. Thus, as a result of the above experiments, it was shown that Medusa 008, the high-tech mobile medical device designed for ultrasound diagnostics and personalized HIFU-therapy can be used to simulate vascular occlusion.

Advantages of the hybrid revascularization technique in the treatment of extended occlusions of the superficial femoral artery and multilevel lesions of the lower extremity arteries

Introduction. Atherosclerotic lesions of the lower extremity arteries often have a multilevel character, the consequence of which is the disability of the population up to the development of post-ischemic necrosis. Conventional methods of surgical treatment of occlusion of the superficial femoral artery (SFA) and multilevel arterial lesions, however, are characterized by high traumatism causing an increase in mortality in this cohort of patients. Overcoming the above disadvantages required the development of alternative approaches, particularly hybrid revascularization. Objective. To analyze our own experience of the above-mentioned intervention in order to further evaluate its benefits. Material and methods. The study included 80 patients suffering from chronic limb-threatening ischemia (CLTI) with occlusion of the femoral-popliteal segment arteries &gt;20 cm long. The subjects were divided into two equal groups depending on the type of surgery performed – autovenous femoral-popliteal bypass with endovascular correction of outflow channels (hybrid bypass) or autologous femoral-tibial bypass (FTB). We analyzed the clinical and demographic characteristics of the patients, technical features of interventions, as well as their direct and long-term effects. The assessment of the shunt patency was carried out using Kaplan-Meyer tables. The differences in indicators between groups were determined using the logarithmic criterion. Results. Thirty-day mortality among patients in the hybrid bypass group was 2.5% versus 4.3% in the second group (p&gt;0.05). The frequency of graft failure is 5% versus 13%, respectively. A year after the operation, the primary shunt patency reached 77.7% (95% CI 61.7-93.7) in the first group. In the second group, this indicator was 57.1% (95% CI 42.9-71.3). One-year survival without amputation was 82.1% (95% CI 66.8-97.4) versus 69.6% (95% CI 56.1-83.1), respectively. The frequency of angiosomal revascularization in patients who underwent hybrid bypass surgery reached 90.0%. In the other group, the indicator was lower and amounted to 69.2% (p=0.006). Conclusions. The presented information proves the high efficiency of the investigated method of treatment.

Bedside ultrasonography in diagnosing bilateral femoral arterial occlusion in an elderly patient with acute limb ischemia

Non-traumatic acute limb ischemia is a critical vascular emergency that can lead to limb loss or life-threatening complications1. It is predominantly caused by arterial occlusions due to thrombi or emboli. Our report highlights the pivotal role of bedside ultrasonography in the emergency diagnosis of acute limb ischemia, exemplified by a case of bilateral femoral arterial occlusion. An 83-year-old woman with a medical history of atrial fibrillation, not on anticoagulation therapy, presented to the emergency department with increased right knee pain and dizziness. Initial examination revealed palpable peripheral pulses and sensitivity on knee palpation without overt signs of ischemia. However, subsequent systemic examination, prompted by the patient’s worsening agitation and pain, revealed coldness, pallor, and weakened pulses in both lower extremities. Bedside ultrasonography confirmed the presence of thrombi in both femoral arteries. The patient underwent successful emergency thrombectomy and was discharged with full recovery after appropriate management of atrial fibrillation. This case underscores the importance of vigilant systemic re-examination and the utility of bedside ultrasonography in the rapid diagnosis of acute arterial occlusion, particularly in patients with risk factors such as atrial fibrillation. Emergency physicians should consider acute limb ischemia in the differential diagnosis of patients presenting with non-specific symptoms like dizziness and localized pain, especially when coupled with a history of cardiovascular risk factors.

Successful Percutaneous Revascularization for Femoral Artery Occlusion After Catheter Intervention: Serial Case Report

Successful Percutaneous Revascularization for Femoral Artery Occlusion After Catheter Intervention: Serial Case Report

Recanalization of superficial femoral artery chronic total occlusion through retrograde popliteal approach recanalization of superficial femoral artery chronic total occlusion

PurposeThis retrospective study aims to evaluate the safety, practicality, and efficacy of the independent retrograde popliteal approach for recanalization superficial femoral artery (SFA) occlusions when the bilateral common femoral artery approach is unavailable, such as after endovascular aneurysm repair or common iliac artery stenting. MethodsThis treatment was considered for patients with contralateral iliac artery occlusion, severe iliac tortuosity, or those who had previously undergone endovascular aneurysm repair or common iliac stenting. Patients with SFA lesions extending into the P1–P2 segment of the popliteal artery or with calcification in the P3 segment were excluded. Angioplasty and stenting were conducted via the popliteal artery approach, with hemostasis at the puncture site achieved using an EXOSEAL vascular closure device. Patients were routinely followed up at 3, 6, and 12 months, and annually thereafter. ResultsForty-eight consecutive patients with SFA occlusion who underwent endovascular treatment via the retrograde popliteal artery approach were included in this study. Retrograde puncture of the popliteal artery was successful in all cases. Six-French sheaths were utilized in all procedures. The EXOSEAL vascular closure device was successfully applied in all 48 cases. No instances of pseudoaneurysms, arteriovenous fistulas, major bleeding, or embolic complications were observed. The technical success rate for SFA recanalization was 100 %. All patients experienced clinical improvement. The ankle-brachial index significantly increased from an initial 0.33 ± 0.11 at admission to 0.81 ± 0.19 at discharge (P < 0.001). The mean follow-up period was 25.1 ± 11.7 months. Kaplan-Meier analysis revealed primary patency rates of 82.5 % at 12 months and 71.8 % at 24 months. No patients required major amputation during the follow-up period. ConclusionThe endovascular treatment of SFA occlusions via the independent retrograde popliteal approach is a viable alternative, demonstrating a low incidence of puncture-related complications and a high success rate of recanalization.

The Effect of Cerium Oxide (CeO2) on Ischemia-Reperfusion Injury in Skeletal Muscle in Mice with Streptozocin-Induced Diabetes.

Objective: Lower extremity ischemia-reperfusion injury (IRI) may occur with trauma-related vascular injury and various vascular diseases, during the use of a tourniquet, in temporary clamping of the aorta in aortic surgery, or following acute or bilateral acute femoral artery occlusion. Mitochondrial dysfunction and increased basal oxidative stress in diabetes may cause an increase in the effects of increased reactive oxygen species (ROS) and mitochondrial dysfunction due to IRI. It is of great importance to examine therapeutic approaches that can minimize the effects of IRI, especially for patient groups under chronic oxidative stress such as DM. Cerium oxide (CeO2) nanoparticles mimic antioxidant enzymes and act as a catalyst that scavenges ROS. In this study, it was aimed to investigate whether CeO2 has protective effects on skeletal muscles in lower extremity IRI in mice with streptozocin-induced diabetes. Methods: A total of 38 Swiss albino mice were divided into six groups as follows: control group (group C, n = 6), diabetes group (group D, n = 8), diabetes-CeO2 (group DCO, n = 8), diabetes-ischemia/reperfusion (group DIR, n = 8), and diabetes-ischemia/reperfusion-CeO2 (group DIRCO, n = 8). The DCO and DIRCO groups were given doses of CeO2 of 0.5 mg/kg intraperitoneally 30 min before the IR procedure. A 120 min ischemia-120 min reperfusion period with 100% O2 was performed. At the end of the reperfusion period, muscle tissues were removed for histopathological and biochemical examinations. Results: Total antioxidant status (TAS) levels were found to be significantly lower in group DIR compared with group D (p = 0.047 and p = 0.022, respectively). In group DIRCO, total oxidant status (TOS) levels were found to be significantly higher than in group DIR (p < 0.001). The oxidative stress index (OSI) was found to be significantly lower in group DIR compared with group DCO (p < 0.001). Paraoxanase (PON) enzyme activity was found to be significantly increased in group DIR compared with group DCO (p < 0.001). The disorganization and degeneration score for muscle cells, inflammatory cell infiltration score, and total injury score in group DIRCO were found to be significantly lower than in group DIR (p = 0.002, p = 0.034, and p = 0.001, respectively). Conclusions: Our results confirm that CeO2, with its antioxidative properties, reduces skeletal muscle damage in lower extremity IRI in diabetic mice.

Successful Bail-Out With Vasodilator Injection Using Dilated Over-the-Wire Balloon for Slow-Flow Phenomenon After Drug-Coated Balloon for Superficial Femoral Artery Occlusion

Successful Bail-Out With Vasodilator Injection Using Dilated Over-the-Wire Balloon for Slow-Flow Phenomenon After Drug-Coated Balloon for Superficial Femoral Artery Occlusion

Endovascular Perclose ProGlide complication puncture site, treated successful by cutting balloon dilatation: A case report and literature review.

Perclose ProGlide were created as preferred for puncture site closure of femoral artery. Femoral artery occlusion is one of the serious device-related complications. This report presents a continuous endovascular technique combined with peripheral cutting balloon (PCB) treatment for a case of a 32s woman diagnosed with lower extremity ischaemia caused by right superficial femoral artery (SFA) occlusion following the use of the Perclose ProGlide system in minimally invasive cardiac surgery. During the primary operation, limb ischaemia symptoms were relieved with vessel perfusion and reconstruction after regular balloon dilatation. A secondary operation was conducted 6 weeks later, and the obstructive lesions were recanalised without residual stenosis after PCB dilatation. No vessel-related adverse events such as dissection, rupture or distal embolisation occurred during the perioperative period. The patient recovered uneventfully after the operation, with complete alleviation of symptoms. Follow-up computed tomography angiography 3 month post-operatively revealed an undeformed shape and excellent patency of the right SFA.

Superficial Femoral Artery Atherosclerosis Masquerading as Sciatica: Diagnosis and Conservative Management – A Case Report

BACKGROUND: Often misdiagnosed as sciatica, vascular disorders such as peripheral arterial disease (PAD) can lead to a decreased quality of life. CASE PRESENTATION: The patient was a 44-year-old female referred to physical therapy with diagnosis of right-sided sciatica and L5-S1 degenerative disc disease, reporting right hip pain radiating into the thigh and foot, and worsening calf cramping. Based on inconsistent exam findings with lumbar spine imaging, patient comorbidities, and medication review, there was suspicion of PAD. The patient was referred to vascular surgery with recommendation of arterial ultrasound evaluation per American College of Radiology imaging guidelines. OUTCOME AND FOLLOW-UP: Arterial duplex revealed moderate arterial insufficiency with right distal superficial femoral artery occlusion. Patient underwent a 12-week supervised exercise program using the Gardner-Skinner Protocol for conservative management. DISCUSSION: Recognizing clinical presentation of arterial pathology, knowledge of imaging guidelines, and interdisciplinary care are essential for optimal management of PAD, particularly in cases with atypical risk factors. JOSPT Cases 2024;4(1):22-29. Epub 8 January 2024. doi:10.2519/josptcases.2024.12102