Femoropopliteal Bypass Operation Research Articles

Endovasküler Yöntemlerle Tedavi Ettiğimiz Akut Alt Ekstremite Emboli Deneyimlerimiz

Objectives: The study aims to retrospectively evaluate the 1-year results of endovascular treatment with rheolytic thrombectomy(TR) or catheter-directed thrombolytic(CDT) infusion therapy in acute femoro-popliteal bypass graft occlusion.
 Methods: The patients who had a history of femoro-popliteal by-pass operation and during their follow-up diagnosed with ipsilateral acute limb ischemia between 2016 and 2018 were included. The total of 13 patients were included and they were divided into two groups according to their treatment methods (RT, n=8 vs CDT, n=5).
 Results: There was no statistically significant difference between the two groups in terms of demographic data and Rutherford embolism classification. Reolitic thrombectomy and catheter-directed thromolytic infusion primary patency values were 87.5% and 80% for 6 months, 75% and 60% for 12 months, respectively. Secondary patency values were found to be 100% in both groups for 6 months, and 87.5% and 80% for 12 months, respectively. There was no significant difference between the two groups in terms of primer and sekonder patency.
 Conclusion:Endovascular therapy can be preferred in the treatment of acute femoro-popliteal by-pass graft occlusion in selected patient groups due to its less invasiveness, early mobilization, and low mortality and morbidity rates compared to surgery,

First Application of an Absorbable Skin Stapler in Peripheral Vascular Surgical Procedures

Abstract Objective: Appropriate skin closure is essential and several techniques are available such as dermal sutures and metal staples. Absorbable staples have promising qualities. Our aim was to lower the surgical site infection (SSI) rate with the use of subcuticular absorbable skin (Insorb™) staples. Design and Patients: A long-term (IDEAL) phase 4 historical comparative effectiveness trial was performed during a 2-year period from December 2012 to December 2014 in patients undergoing an infra-inguinal femoro-popliteal bypass operation. We compared closure of the skin by means of absorbable stapler with a cohort of patients treated with intracutaneous sutures. Primary outcome: number of SSI’s. Secondary outcome: other complications, duration of surgery and hospital length of stay. Main Results: 44 patients were enrolled in the study; 6 patients underwent skin closure with the absorbable staples. 4 of them had an SSI. Of 38 patients treated with intracutaneous sutures 7 had an SSI (risk difference: 0.48, 95% CI 0.09-0.88). Duration of surgery (p= 0.84) and length of stay (p= 0.15) were similar. Conclusion: Due to a large proportion of SSI’s in the absorbable stapler group the use of these subcuticular staples was discontinued in our facility. We consider the absorbable staples not strong enough for wound closure in peripheral vascular surgery.

Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance

The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion. A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation. Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty. Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.

A rare complication after axillofemoral bypass operation: disruption of the proximal anastomosis: single case after 12 years’ experience in extra-anatomic bypass surgery

Axillofemoral bypass operation is an alternative approach for patients at high risk for aortofemoral reconstruction and for patients with comorbid factors. Proximal anastomotic disruption, upper extremity thromboembolism, graft infection and seroma formation are known postoperative complications after axillofemoral bypass. Proximal anastomotic disruption is a severe complication in the early postoperative period and is usually secondary to technical errors in anastomosis, mechanical distress and infections. We performed a left axillofemoral bypass and left femoropopliteal bypass operation under general anesthesia by using an 8 mm full ringed polytetrafluoroethylene graft. On the seventh postoperative day, patient complained a sudden pain and swelling on left subclavian incision after a hyperabduction of the left arm. Patient was taken into operation theatre just after this complaint for suspicion of disruption of the proximal anastomosis. We report a case with proximal anastomotic disruption after axillofemoral bypass operation in accordance with literature data.

Duplex scanning allows selective use of arteriography in the management of patients with severe lower leg arterial disease

Purpose: Until April 1997 we routinely performed intra-arterial digital subtraction angiography (iaDSA) in all patients with severe lower leg ischemia requiring intervention. After a comparative study of duplex scanning (DS), pulsegenerated runoff, and iaDSA of the lower leg arteries, we postulated that management could be based on DS/pulse-generated runoff in 59% of patients. We prospectively evaluated the safety of such a noninvasive workup strategy. Methods: All consecutive patients referred with severe lower leg ischemia between April 1997 and September 1998 were eligible. Management was based on DS with iaDSA being performed only on indication. Complications within 30 days and 12- and 24-month patency, survival, and limb salvage rates were recorded and compared with historical controls. Results: A total of 125 limbs in 114 patients were evaluated (74% rest pain or tissue loss). In 97 (78%) of 125 limbs, management was based on DS. It comprised conservative treatment (n = 33, 0% after iaDSA), percutaneous transluminal angioplasty (n = 25, 16% iaDSA), femoropopliteal bypass graft (n = 29, 17% iaDSA), femorotibial bypass graft (n = 29, 62% iaDSA), and other surgical procedures (n = 8, 4% iaDSA). Overall, the mortality within 30 days was 4% (5/114), and 2-year survival was 83%. Two-year primary and secondary patency and limb salvage rates were 75%, 93%, and 93% after a femoropopliteal bypass operation, respectively. One-year primary and secondary patency and limb salvage rates were 35%, 73%, and 74%, respectively, after a femorocrural bypass operation. There were no differences in patient characteristics, indication for specific treatment, and immediate and intermediate term outcome between the study and reference population. Conclusion: In a vascular unit with wide expertise in DS of the lower leg arteries, management of patients with severe lower leg ischemia can be based on DS in most patients without negative effects on clinical outcome within 30 days and at 2-years' follow-up. (J Vasc Surg 2001;34:661-7.)

Study on plasma serotonin level during the femoro-popliteal bypass operation and also on the gene expression of serotonin-2A receptor in PAD

Study on plasma serotonin level during the femoro-popliteal bypass operation and also on the gene expression of serotonin-2A receptor in PAD

3.2 Effect of sarpogrelate hydrochloride on plasma serotonin level of arterial blood during femoropopliteal bypass operation

3.2 Effect of sarpogrelate hydrochloride on plasma serotonin level of arterial blood during femoropopliteal bypass operation

Pseudoaneurysm of Superficial Femoral Artery After Balloon Angioplasty

This paper presents 2 cases of pseudoaneurysm in the superficial femoral artery (SFA) at the site of dilatation after percutaneous transluminal angioplasty (PTA) in 2 claudicant patients. Localized and calcified tight stenoses in the lower third of the SFA were seen on angiogram. PTA was successful in the first patient, but in the second it failed to open the stenosed part of the artery, and no improvement of the clinical symptoms occurred. Oversized balloons were used in both cases. A localized false aneurysm was seen on angiography four months later in the first patient, and a pulsatile mass in the thigh, corresponding well to the site of the previous PTA, was clinically present three weeks later in the second patient. The diagnosis of pseudoaneurysm was made by intraarterial digital subtraction angiography in the first patient and by color flow duplex imaging (CFDI) in the second. The first patient has maintained a patent SFA with a stable localized false aneurysm at the site of angioplasty fourteen months after the PTA, experiencing only mild claudication, and the second patient underwent a femoropopliteal above-knee bypass operation resulting in relief of the symptoms.

A CASE OF PYOGENIC SPONDYLITIS OCCURRING AORTO-RIGHT FEMORO POPLITEAL BYPASS

A 69-year-old man underwent an aorto-right femoro-popliteal bypass operation for complete occulusion of the right common iliac artery. From the eighth to 16th postoperative day the patient ran a high fever over 38°C and an increase in inflammation reaction was confirmed. Various examinations were performed under a suspecion of postoperative infection, but the origin was unknown. On the 47th postoperative day and after he complained of lumber pain and was almost unable to take sitting posture or to move. With magnetic resonance imaging, bone scintigraphy and Ga-scintigraphy, pyogenic spondylitis was suspected. The patient was transferred to the department of orghopedics in our hospital. Surgicaltreatment was thought as a probable selection, but a long-term conservative therapy was employed, with a succssful outcome. The patient was discharged from the hospital.

ＡＳＯに対するＦ‐Ｐバイパスグラフト血流量と開存率の関係

ＡＳＯに対するＦ‐Ｐバイパスグラフト血流量と開存率の関係

A CASE OF BALLOON ANGIOPLASTY FOR THE STENOSIS OCCURRED AFTER FEMOROPOLITEAL BYPASS OPERATION

We experienced a rare case of arterial stenosis caused by bulldog forceps used in femoropopliteal bypass operahon. A 70-year-old female visited our department complaining of pain in the right lower extremity. Various examinations indicated that she was suffered from complete obstruction of the superficial femoral artery due to arteriosclerosis obliterans. Femoropopliteal bypass operation was performed. Postoperative roentgenography revealed a stenosis at a place beneath the graft anastomosis, namely, at a place where bulldog forceps appeard to be applied. Basic endoscopical findings also supported the stenosis caused by hemostat. She was treated with angioplasty by inserting a balloon through the resected artificial vessel, and her postoperative course was uneventful. Even a hemostat should be used with careful attention. Furthermore, intra-anginal endoscopy through the artificial vessel and balloon angioplasty are possible applicable diagnostic and therapeutic procedures to stenosis at the anastomosis.

How to quantify an arterial stenosis: a study on the femoral arteries of dog and man.

The blood supply to the femoral bed was studied in anaesthetised dogs before and after producing arterial stenoses. The blood supply system consisted of the vessels proximal to the site of measurement in the femoral artery and was characterised by a supply graph, which related mean perfusion pressure to mean flow. The different pressures and flows were obtained using an artificial periphery, the impedance of which was changed from beat to beat. The supply graph was approximated by a parabola with two parameters: the intercepts with the pressure and flow axes, the latter indicating the maximum mean flow. For constant aortic pressure the maximum mean flow appeared to be linearly related to the cross sectional area of the stenosed section (r = 0.98). Maximum mean flow was already considerably reduced before the stenosis became critical--that is, before physiological flow was measurably diminished. The change in maximum mean flow was therefore used to quantify the haemodynamic effects of stenoses that were less than critical. Blood supply graphs of the superficial femoral arteries were determined also in seven patients undergoing a femoropopliteal bypass operation. The maximum mean flow correlated well with the degree of obstruction determined from the preoperative angiograms (r = 0.90).

下し閉そく性動脈疾患に対するＦ‐Ｐ ｂｙｐａｓｓ術症例の検討

下し閉そく性動脈疾患に対するＦ‐Ｐ ｂｙｐａｓｓ術症例の検討

DELAYED RECOVERY OF SYMPATHETIC TRANSMISSION FOLLOWING TEN YEARS MONOAMINE OXIDASE INHIBITION. CASE REPORT

A 62-year-old lady who had taken pargylinc, a monoamine oxidase inhibitor, for ten years was admitted for a femoro-popliteal bypass operation. Despite discontinuing this therapy for three weeks prior to surgery she suffered a hypotensive crisis following induction of general anaesthesia and over-reacted to intravenous methylamphetamine 3 mg in the manner typical of patients under active monoamine oxidase inhibitor treatment. This group of drugs is discussed with respect to their therapeutic indications and dangers, modes of action, and the methods available for treatment of cardiovascular crises which may occur during anaesthesia.