Femoral Artery Occlusion Research Articles

A Modified Surgical Model of Hind Limb Ischemia in ApoE-/- Mice using a Miniature Incision.

The purpose of this study is to introduce and evaluate a modified surgical approach to induce acute ischemia in mice that can be implemented in most animal laboratories.Contrary to the conventional approach for double ligation of the femoral artery (DLFA), a smaller incision on the right inguinal region was made to expose the proximal femoral artery (FA) to perform DLFA. Then, using a 7-0 suture, the incision was dragged to the knee region to expose the distal FA. Magnetic resonance imaging (MRI) on bilateral hind limbs was used to detect FA occlusion after the surgery. At 0, 1, 3, 5, and 7 days after the surgery, functional recovery of the hind limbs was visually assessed and graded using the Tarlov scale. Histologic evaluation was performed after euthanizing the animals 7 days after DLFA. The procedures were successfully performed on the right leg in ten ApoE-/- mice, and no mice died during subsequent observation. The incision sizes in all 10 mice were less than 5 mm (4.2 ± 0.63 mm). MRI results showed that FA blood flow in the ischemic side was clearly blocked. The Tarlov scale results demonstrated that hind limb function significantly decreased after the procedure and slowly recovered over the following 7 days. Histologic evaluation showed a significant inflammatory response on the ischemic side and reduced microvascular density in the ischemic hind limb. In conclusion, this study introduces a modified technique using a miniature incision to perform hind limb ischemia (HLI) using DLFA.

ВЛИЯНИЕ КОРВИТИНА НА КИСЛОРОДТРАНСПОРТНУЮ ФУНКЦИЮ И ГАЗОТРАНСМИТТЕРЫ КРОВИ ПРИ ИШЕМИИ- РЕПЕРФУЗИИ НИЖНЕЙ КОНЕЧНОСТИ

Background. Ischemia-reperfusion of the lower limbs in atherosclerosis of their arteries is accompanied by impaired oxygen transport function (OTF) and the content gas transmitters (GT) of blood, which needs adequate correction. Purpose. To study the effect of corvitin on the parameters of OTF and GT of nitrogen monoxide and hydrogen sulfide in venous blood after revascularization of the lower limb in chronic atherosclerotic occlusion of the superficial femoral artery (SFA). Material and methods. Revascularization of the lower limbs in 103 patients was performed by loop endaterectomy from SFA. Patients of group I (n=52) received traditional medication support, II (n=51) - corvitin. The indices of OTFB and GT in the venous blood of the lower and upper limbs were determined before the operation, on the 3rd and 8th days after it. Results. The increase in the parameters of hyperoxemia, hypocapnemia and GT concentration in the postoperative period decreases with the use of corvitin. Conclusions. The use of corvitin reduces disturbances in OTFB and GT content during ischemia-reperfusion of the lower limbs.

Acute Occlusion of Right Femoral Artery Resulting in Gangrene of Right Leg Due to Essential Thrombocythemia and Atherosclerosis in COVID-19 era: A Case Report

Acute Occlusion of Right Femoral Artery Resulting in Gangrene of Right Leg Due to Essential Thrombocythemia and Atherosclerosis in COVID-19 era: A Case Report

Efficacy of navigating through the intraplaque route using AnteOwl WR intravascular ultrasound in femoropopliteal chronic total occlusion

BackgroundThere is no consensus on the optimal guidewire passage route for femoropopliteal (FP) chronic total occlusion (CTO). If intraplaque wiring can be performed, a stent-less strategy using a drug-coated balloon can be realized even with FP CTO, and there is a high possibility that good expansion can be obtained even when stent deployment is performed. AnteOwl WR (AnteOwl) is a novel intravascular ultrasound (IVUS) device useful for navigating the second guidewire into the intraplaque route under IVUS observation from the subintimal space. Here, we describe representative cases of FP CTO in which CTO-specific IVUS was extremely useful.Case presentationCase 1 involved a 79-year-old man with total occlusion of the left superficial femoral artery (SFA). We used a contralateral antegrade approach, but the guidewire was advanced into the subintimal space. We advanced AnteOwl into the CTO. By utilizing the asymmetric structure of the transducer and the IVUS wire, we were able to reflect the positional relationship among the IVUS transducer, IVUS wire, and target plaque onto the angiographic image. By aiming the wiring in that direction, we succeeded in traversing the center of the plaque and finally succeeded in obtaining good expansion using the drug-coated balloon. Case 2 involved a 76-year-old woman with total occlusion from the SFA to the popliteal artery. We used an ipsilateral antegrade approach. When AnteOwl was placed on the wire and advanced to the popliteal artery, the subintimal space in the middle of the SFA could be visualized. We employed an IVUS-guided parallel wiring technique and succeeded in passing through all intraplaque routes. Although the CTO was long, we could easily advance through the intraplaque route by reflecting the information obtained from AnteOwl in angiography.ConclusionsAnteOwl is an effective IVUS for FP CTO and facilitates a complex IVUS-guided procedure.

Heat treatment attenuates activities of ET‐1 signaling pathway and enhances the protective HSP72‐SOD2 in ischemic skeletal muscle of rats with peripheral artery disease

Background The arterial blood pressure (BP) response is augmented during walking in patients with peripheral artery disease (PAD) and in simulated PAD animal models during static exercise. The exercise pressor response (EPR) is a contributor to the exaggerated BP response and heating treatment is effective to attenuate exaggeration of the EPR. However, the underlying mechanisms leading to the inhibitory effects of heat treatment on the EPR, especially on the essential alteration originating within the ischemic skeletal muscles of PAD, is poorly understood. Aims We targeted if the repeated heat treatment protocol (~1.5oC muscle temperature evaluation, 30 minutes per time, twice per day in 72 hours after the femoral artery occlusion) alters some of the fundamental molecular mediators involved in ischemic insult and oxidative stress in the skeletal muscles of the hindlimb. Based on the existing literature, we determined the levels of endothelin-1 (ET-1), and the protein expression of heat shock protein 72 (HSP72) and superoxide dismutase 2 (SOD2) in the skeletal muscles of control rats and PAD rats with 72 hours of femoral artery occlusion. Methods The red and white components of the gastrocnemius muscles were obtained in groups of control, PAD and PAD + heat rats. ET-1 was measured by the method of colorimetric immunometric enzyme immunoassay. The expression of HSP 72 and SOD2 was measured by western blotting. To elevate the muscle temperature, a heating pad was placed locally on the hindlimb and the Tm was increased by ~1.5 °C. Then the Tm was stabilized and maintained for 30 min. One way ANOVA with LSD post-hoc test was applied to determine the difference among groups. Results Compared with control rats, in PAD rats a significant increase in ET-1 was observed in both of the red muscle (0.91±0.28 pg/ml/µg total protein in PAD/n=5 vs. 0.52±0.05 pg/ml/µg total protein in control/n=4; P<0.05); and the white muscle (0.71±0.14 pg/ml/µg total protein in PAD rats/n=5 vs. 0.47±0.09 pg/ml/µg total protein in control rats/n=4; P<0.05). Notably, following heat treatment the amplification of ET-1 in the skeletal muscle of PAD rats was significantly attenuated (red muscle: 0.53±0.08 pg/ml/µg total protein in PAD + heat rats n=5 vs. 0.91±0.28 pg/ml/µg total protein in PAD rats/n=5; P<0.05; white muscle: 0.52±0.10 pg/ml/µg total protein in PAD + heat rats n=5 vs. 0.71±0.14 pg/ml/µg total protein in PAD rats/n=5; P<0.05). Note that no significant difference in the ET-1 levels was seen in skeletal muscle of control rats and PAD + heat rats (P>0.05). In addition, heat treatment increased expression of HSP72 and SOD2 in the red muscle of PAD rats (HSP72: 1.22±0.39 in PAD + heat rats/n=4 vs. 0.68±0.27 in PAD rats/n=4, P<0.05; SOD2: 1.42±0.45 in PAD + heat rats/n=5 vs. 0.92±0.12 in PAD rats/n=4, P=0.062). Conclusion Heat treatment attenuates the activities of ET-1 signaling pathway and enhances the levels of HSP 72 and SOD2, potential protective mediators, in the skeletal muscle of PAD rats under ischemic situations.

The hypoxia sensitive metal transcription factor MTF-1 activates NCX1 brain promoter and participates in remote postconditioning neuroprotection in stroke

Remote limb ischemic postconditioning (RLIP) is an experimental strategy in which short femoral artery ischemia reduces brain damage induced by a previous harmful ischemic insult. Ionic homeostasis maintenance in the CNS seems to play a relevant role in mediating RLIP neuroprotection and among the effectors, the sodium-calcium exchanger 1 (NCX1) may give an important contribution, being expressed in all CNS cells involved in brain ischemic pathophysiology. The aim of this work was to investigate whether the metal responsive transcription factor 1 (MTF-1), an important hypoxia sensitive transcription factor, may (i) interact and regulate NCX1, and (ii) play a role in the neuroprotective effect mediated by RLIP through NCX1 activation. Here we demonstrated that in brain ischemia induced by transient middle cerebral occlusion (tMCAO), MTF-1 is triggered by a subsequent temporary femoral artery occlusion (FAO) and represents a mediator of endogenous neuroprotection. More importantly, we showed that MTF-1 translocates to the nucleus where it binds the metal responsive element (MRE) located at −23/−17 bp of Ncx1 brain promoter thus activating its transcription and inducing an upregulation of NCX1 that has been demonstrated to be neuroprotective. Furthermore, RLIP restored MTF-1 and NCX1 protein levels in the ischemic rat brain cortex and the silencing of MTF-1 prevented the increase of NCX1 observed in RLIP protected rats, thus demonstrating a direct regulation of NCX1 by MTF-1 in the ischemic cortex of rat exposed to tMCAO followed by FAO. Moreover, silencing of MTF-1 significantly reduced the neuroprotective effect elicited by RLIP as demonstrated by the enlargement of brain infarct volume observed in rats subjected to RLIP and treated with MTF-1 silencing. Overall, MTF-dependent activation of NCX1 and their upregulation elicited by RLIP, besides unraveling a new molecular pathway of neuroprotection during brain ischemia, might represent an additional mechanism to intervene in stroke pathophysiology.

Anjioplasti Sonrası Ana İliak Arterde Meydana Gelen Beklenmedik Okluzyonun Retrograd Popliteal Yaklaşımla Tedavisi: Vaka Sunumu

Treatment of the lesions located in the popliteal artery and superficial femoral artery are potentially clinical challenge because of the long length of lesions, high- calcium content in the vessel wall and inside the plaques, and individual dynamic forces found within these vessels. Intraluminal or subintimal recanalization of the vessel lumen is achieved mostly by ipsilateral antegrade or contralateral retrograde femoral approach in the treatment of total occlusion of the superficial femoral artery. In the event of failure, retrograde access into the popliteal artery is considered as an essentially different method. In our case report, we aimed to present rescue retrograde popliteal intervention following an unsuccessful antegrade approach which resulted in an unexpected atherothrombotic complication that occurred in the common iliac artery of the contralateral site.

Alternative Combined Retrograde–Antegrade Use of a Re-entry Device in the Revascularization of a Surgically Ligated Superficial Femoral Artery Occlusion

AbstractWe report a case of a diabetic patient with critical limb ischemia, who previously underwent thromboendarterectomy at the right lower extremity, resulting in surgical ligation at the proximal third of the right superficial femoral artery (SFA). Twenty months later, the patient developed foot ulcers; endovascular treatment was therefore performed. After obtaining a retrograde right SFA subintimal access, directly puncturing the occluded segment of the artery, a re-entry intravascular ultrasound-guided catheter was used to gain proximal re-entry. Then, the same device was used again, in antegrade fashion, to obtain re-entry into the patent popliteal artery. A covered stent was deployed in the site of the surgical closure. In the following 3 months, foot ulcers healed.

Aneurysmal Dilatation of the Superficial Femoral Artery After Endovascular Intervention

A patient with occlusion of the left superficial femoral artery (SFA) underwent endovascular intervention. Six-month follow-up angiography revealed aneurysmal dilatation of the previously stented artery. This finding may be a result of maladaptive vascular remodeling or arterial injury resulting in aneurysmal dilatation secondary to subintimal crossing, atherectomy, and paclitaxel therapies. (Level of Difficulty: Beginner.)

Endovascular foreign body removal of a MynxGrip polyethylene glycol (PEG) sealant embolus using a cerebral stent retriever

BackgroundThis is a rare case of removing an intra-arterial foreign body represented by MynxGrip polyethylene glycol (PEG) sealant as a rare complication of using the MynxGrip™ Vascular Closure Device (AccessClosure, Inc., Mountain View, CA) using a pRESET stent retriever (Phenox, Bochum, Germany) which is utilized mainly for treatment of endovascular stroke.Case presentationA 60-year-old female patient suffering from intermittent claudication in the right lower limb (stage IIb according to Fontaine) due to a peripheral arterial occlusive disease was presented for an elective revascularization using balloon angioplasty of a short chronic occlusion of the right superficial femoral artery. After a successful revascularization of the right superficial femoral artery using a retrograde femoral access from the left common femoral artery, the patient suffered from an acute limb ischemia in the left foot with distal popliteal embolization with involvement of BTK (below the knee) trifurcation. This is believed to be due to an intra-arterial foreign body embolism of MynxGrip polyethylene glycol sealant as a rare complication of using the MynxGrip™ Vascular Closure Device.ConclusionsStent retrievers have been used previously in removing dislocated coils especially in the cerebral vessels. This case report however proves a high efficacy and safety of using stent retrievers in removing different and rather unusual intra-arterial foreign bodies such as MynxGrip polyethylene glycol sealant.

Complications of femoral arterial lines in infants under 12 months

Background: The risks of femoral arterial line placement in young children have been incompletely defined. We hypothesized that a low complication rate would be associated with ultrasound use. Subjects and Methods: Infants aged 0–12 months undergoing placement of a femoral arterial line at our institution over a 3.5-year period were identified through billing data, and their records were reviewed. Events concerning each line were recorded individually. Patients were excluded if there was incomplete documentation or if the line was in place for under 24 h. Demographics, information about line placement, and complications were recorded. Results: Three hundred and sixty-four femoral arterial lines were included. Eighty percent of lines were placed in the operating room, with the rest placed in the cardiac intensive care unit (ICU) (11%), the cardiac catheterization lab (6%), or the pediatric ICU (3%). Femoral artery occlusion occurred with 16% of lines placed, and limb ischemia in 6%. One patient had tissue loss. Occlusion was associated with lower gestational age at birth (44 [40–57] vs. 50 [41–60], P = 0.04), lower weight (3.7 [3.1–5.7] vs. 4.3 kg [3.3–6.2], P = 0.05), left-sided lines (52% vs. 66%, P = 0.05), placement in interventional catheterization lab (odds ratio [OR]: 3.28, confidence interval [CI]: 1.24–8.67, P = 0.02), &gt;2 attempts (27% vs. 13%, P &lt; 0.01), and catheter diameter (OR: 2.86, CI: 1.18–6.92, P = 0.02). Conclusion: Femoral arterial catheter placement in infants younger than 12 months resulted in a 16% rate of arterial occlusion at our institution, which was associated with low gestational age, larger catheter size, and left-sided lines but not ultrasound use, line duration, catheter length, use of anticoagulation, physician specialty, or physician training level.

Safety and efficacy of Angio-Seal device for transfemoral neuroendovascular procedures: A systematic review and meta-analysis.

Angio-Seal is a commonly used device for femoral hemostasis in neuroendovascular procedures. This meta-analysis investigates of the safety and efficacy of Angio-Seal in patients undergoing endovascular neurointerventional procedures. A systematic review and meta-analysis on all studies evaluating the Angio-Seal device in neurointerventional procedures from inception through 2020 were performed. We studied rates of groin hematoma, retroperitoneal hematoma, pseudoaneurysm, ipsilateral DVT, and ischemic complications. Meta-analysis was performed using the random-effects model. 13 studies were included in our analysis. 2250 patients with 104 complications were found {4.5% (95% CI, 2.7%-6.3%)}. Of these complications, groin hematoma was the most common with a rate of 2.4% (95% CI, 1.1%-3.6%). Retroperitoneal hematoma {0.3% (95% CI, 0%-0.5%)}, pseudo-aneurysm {0.5% (95% CI, 0.2%-0.8%), and ipsilateral DVT {0.3% (95% CI, 0.1%-0.7%) were also not in negligible rate. The rate of other complications were as follows: vessel occlusion/stenosis; 0.2% (95% CI, 0%-0.4%), vascular surgery; 0.2% (95% CI, 0%-0.5%), and infection; 0.2% (95% CI, 0%-0.5%). One patient died as result of hemorrhagic complications {0.1% (95% CI, 0%-0.3%)}. Use of anticoagulant/antiplatelet therapy was found to be positively correlated with high risk of any groin complication and groin hematoma (p ≤ .05). Female gender was associated with high risk of ipsilateral DVT (p ≤ .05). Interestingly, large sheath size was associated with low risk of groin hematoma (p ≤ .05). The safety and efficacy rate of Angio-Seal was approximately 95%. The most common complication was groin hematoma. Serious complications including retroperitoneal hematoma and femoral artery occlusion were rare.

The neuroprotective role of SIRT1/PGC-1α signaling in limb postconditioning in cerebral ischemia/reperfusion injury

Limb ischemic postconditioning (LPostC) is an innovative treatment for ischemia/reperfusion injury (IRI). However, its mechanisms have not yet been elucidated. Herein, we assessed the importance of SIRT1/PGC-1α signaling in LPostC neuroprotection following cerebral I/R injury in rats. In this study, we used 40 male SD rats that were separated into sham, I/R, LPostC, and LPostC + EX-527 (SIRT1 inhibitor) groups (each with 10 rats), with a middle cerebral artery occlusion (MCAO) model used to induce IRI. LPostC was induced via three cycles of bilateral femoral artery occlusion and non-occlusion. At 24 h, we examined SIRT1 and PGC-1α protein levels by western blotting in ischemic areas. The mRNA levels of SIRT1, PGC-1α, NRF-1 and CytoC1 in the ischemic area were assessed by qRT-PCR. We also quantified neurological deficit scores and evaluated cerebral infarct volume by TTC staining. TUNEL staining was used to evaluate the apoptotic rates in neurons. In addition, antioxidant SOD activity and MDA levels were measured by the Microplate Reader. Our findings indicated that LPostC increased the protein and mRNA levels of SIRT1 and PGC-1α in cerebral ischemic tissue, then up-regulated the downstream protein NRF-1, down-regulated CytoC1, and improved mitochondrial function, thereby reducing brain damage. LPostC relieved cerebral IRI via reducing the size of the cerebral infarct, neuronal apoptosis, and neurological deficits. Meanwhile LPostC increased SOD activity and reduced MDA content in brain tissue. Treatment with EX-527 reversed the protection of LPostC after IRI (all P < 0.05). This suggests that LPosC may protect against cerebral IRI at least in part via up-regulating the SIRT1/PGC-1α signaling pathway, thereby increasing the individual’s ability to resist oxidative stress.

Percutaneous Implantation of Adult Sized Stents for Coarctation of the Aorta in Children ≤20 kg: A 12-Year Experience.

Stent implantation (SI) is more effective than balloon angioplasty for the treatment of coarctation of the aorta (CoA). Due to technical factors, balloon angioplasty is more commonly performed in small patients. We sought to evaluate outcomes of percutaneous adult sized SI for the treatment of CoA in small patients. A single-center retrospective review of all patients ≤20 kg who underwent percutaneous adult sized SI for native or recurrent CoA from 2004 to 2015 was performed. Thirty-nine patients (20 patients ≤10 kg) were identified, with 28 (71.8%) having recurrent CoA and 22 (56.4%) previously failed balloon angioplasty. At the time of SI, the median (range) patient age and weight were 1.1 (0.3-7.9) years and 10 (5.5-20.4) kg, respectively. SI resulted in significant improvements in the median gradient (26 mm Hg [interquartile range (IQR), 18-42] to 0 mm Hg [IQR, 0-2]; P< 0.05) and median minimum diameter (3.6 mm [IQR, 2.4-4.8] to 7.7 mm [IQR, 6.5-9.4]; P<0.05). Seven patients (18%) had procedural adverse events. Twenty-seven (69%) patients underwent elective reintervention at a median time of 49.3 (IQR, 26.5-63.2) months from SI, with 8 (21%) stents requiring repeat SI for stent fracture. Over a median follow-up of 67.2 (IQR, 33.8-116.1) months, 25 patients (69%) were without hypertension or blood pressure gradient. Three (11%) patients developed femoral arterial occlusion. Adult sized SI is an alternative to surgical intervention for small patients with CoA. SI carries a risk of access-related complications, which may improve with the development of lower profile stents with adult sized maximum diameters.

Endovascular treatment of chronic total occlusion of superficial femoral artery using retrograde approach from popliteal artery

An 55 years-old man with intermittent claudication was admitted to Hue central Hospital. Doppler ultrasound and digital subtraction angiography showed his left superficial femoral artery (SFA) was chronic total occlusion (CTO), and we performed endovascular treatment (EVT). We advanced a guide-wire by contralateral transfemoral approach, but guide-wire could not penetrate the occluded SFA lesion antegradely. Thus, we tried to approach the CTO lesion retrogradely. A guide-wire passed from popliteal artery to distal SFA. With a reverse-controlled antegrade and retrograde approach technique, we were able to pass the CTO lesion. Finally, two stents were implanted. We experienced a case in which retrograde approach via collateral channel from popliteal artery was effective to CTO of SFA.

Primary retrograde transpedal approach for revascularization of chronic total occlusions of the superficial femoral artery and re-route technique using percutaneous puncture for re-entry.

We aimed to demonstrate the safety and feasibility of revascularization of chronic total occlusion of the superficial femoral artery (SFA) using the transpedal approach and describe a new technique called "re-route". The study included all consecutive patients who had chronic total occlusions at the level of SFA and underwent retrograde treatment through a pedal artery intervention between September 2017 and October 2019. Balloon angioplasty was applied as the first treatment option. After angioplasty, bailout stenting was performed when necessary in patients with indications. If the common femoral artery lumen could not be reached from the SFA ostium, the re-route technique was used. Technical success was defined as revascularization with residual stenosis of less than 30%. Twenty-five SFAs were revascularized in 23 patients (17 males; mean age, 66±7.3 years) by angioplasty in 5 SFAs and angioplasty and stents in 20 SFAs. While the transpedal approach was applied after the failure of antegrade recanalization in three patients, it was used as the first treatment route in the remaining cases. The re-route technique was applied in 7 patients, with a 100% technical success rate. The mean follow-up was 15.3 months (range, 12-18 months). The primary patency rate was 78% at one year. The retrograde transpedal approach is a safe and successful technique for chronic total occlusion recanalization and carries a low risk of complications. In order to increase technical success, the re-route technique can be used as an alternative re-entry method.

Distal Re-Entry to Treat Lower Limb Chronic Total Occlusions Using a Novel Electrically Guided Re-Entry Catheter

IntroductionEndovascular treatment of challenging infra-inguinal peripheral vascular disease is increasingly common because of new techniques and improved tools. The use of a novel electrically guided 5 F re-entry catheter is presented. By emitting a minute electrical field, detected by a target wire inserted from an opposing access, the catheter's orientation is accurately displayed to the operator, allowing precise re-entry without the need for fluoroscopic alignment.ReportAn 84 year old man with tissue loss was treated for a long occlusion of the superficial femoral artery and tibial vessels. Successful subintimal recanalisation was achieved with the help of the ePATH re-entry catheter, restoring inline flow to the foot.ConclusionThis re-entry catheter benefits from an intuitive alignment method, smaller profile, and operator adjustable needle travel, making it a versatile tool for endovascular cases.

A Successful Case of Embolectomy for Acute Superficial Femoral Artery Occlusion Caused by Sloughed Intima from the External Iliac Artery after Thoracic Endovascular Aortic Repair

A Successful Case of Embolectomy for Acute Superficial Femoral Artery Occlusion Caused by Sloughed Intima from the External Iliac Artery after Thoracic Endovascular Aortic Repair

Three Cases of Hybrid Treatment Using Viabahn Stentgraft for Superficial Femoral Artery Occlusion with Common Femoral Artery Lesion

Three Cases of Hybrid Treatment Using Viabahn Stentgraft for Superficial Femoral Artery Occlusion with Common Femoral Artery Lesion

Persistent Sciatic Artery Presenting With Right Lower Limb Ischemia: A Potential Sonographic Pitfall

A case of persistent sciatic artery is reported in a patient with the lower limb ischaemia. Initial imaging dopplar sonography suggested a possible occlusion of the superficial femoral artery.