Popliteal Lesions Research Articles

Comparative Study between Simple Percutaneous Transluminal Angioplasty and Drug-Coated Balloons in Chronic Total Occlusion of The Femoro-popliteal Artery

Background: Atherosclerotic peripheral artery disease (PAD) affects a growing number of patients in aging populations. Peripheral artery disease (PAD) accounts for a large proportion of cardiovascular disease (CVD) prevalence in most world regions. Objective: This study aims to evaluate and compare the patency, clinical outcome, and limb salvage rates between the simple percutaneous Transluminal angioplasty and the drug-coated balloons in chronic total occlusion of the femoropopliteal arterial segment on the short-term course. Patients and Method: A prospective randomized controlled comparative study was conducted in the vascular surgery department; Aswan University Hospital during the period from March 2018 to March 2020. In total, 30 patients with a well-established diagnosis of superficial femoral artery (SFA) and/or proximal popliteal lesions with symptoms of PAD. Results: The primary patency at 12-month following treatment with DCB was significantly better 100. %, 80.0%, 60.0% at 1, 6, 12 months compared with POBA 86.7 %, 66.7%, 46.7% at 1, 6, 12 months. The rate of clinically- driven TLR was the same in both groups (26.6%). The use of DCB was safe and did not increase the major adverse clinical events (death, myocardial infarction, and minor or major amputation) when compared with those seen with the use of the uncoated balloons). Conclusion: Use of DCBs is associated with improved vessel patency when compared to POBA in patients with FPD. There was no difference in clinically driven TLR between DCB and POBA in our study.

Comparative Study between Simple Percutaneous Transluminal Angioplasty and Drug-Coated Balloons in Chronic Total Occlusion of The Femoro-popliteal Artery

Background: Atherosclerotic peripheral artery disease (PAD) affects a growing number of patients in aging populations. Peripheral artery disease (PAD) accounts for a large proportion of cardiovascular disease (CVD) prevalence in most world regions. Objective: This study aims to evaluate and compare the patency, clinical outcome, and limb salvage rates between the simple percutaneous Transluminal angioplasty and the drug-coated balloons in chronic total occlusion of the femoropopliteal arterial segment on the short-term course. Patients and Method: A prospective randomized controlled comparative study was conducted in the vascular surgery department; Aswan University Hospital during the period from March 2018 to March 2020. In total, 30 patients with a well-established diagnosis of superficial femoral artery (SFA) and/or proximal popliteal lesions with symptoms of PAD. Results: The primary patency at 12-month following treatment with DCB was significantly better 100. %, 80.0%, 60.0% at 1, 6, 12 months compared with POBA 86.7 %, 66.7%, 46.7% at 1, 6, 12 months. The rate of clinically- driven TLR was the same in both groups (26.6%). The use of DCB was safe and did not increase the major adverse clinical events (death, myocardial infarction, and minor or major amputation) when compared with those seen with the use of the uncoated balloons). Conclusion: Use of DCBs is associated with improved vessel patency when compared to POBA in patients with FPD. There was no difference in clinically driven TLR between DCB and POBA in our study.

Stenting of Popliteal Lesions Improves Patency Compared to Drug-Coated Balloon Angioplasty

Popliteal artery stenting in patients with peripheral arterial disease remains controversial due to perceived risks of stent fracture and occlusion. Drug-coated balloons (DCBs) have been introduced as a better no-stent alternative while dedicated novel stents (NS) are increasingly used for treatment of popliteal lesions. Our aim was to compare midterm outcomes of stents to DCBs in the popliteal segment.

Use of Immunotherapy in the Treatment of Canine Visceral Leishmaniasis

Background: Canine visceral leishmaniasis is a worldwide zoonosis, with dogs being the main urban reservoirs. It is caused by a protozoan of the genus Leishmania spp. and is transmitted to mammals through a vector belonging to the phlebotomines family. Its treatment aims to reduce the parasitic load preventing these animals from being transmitters. Immunotherapy has been shown to be efficient in stimulating the patient's immune response, improving the general condition and preventing recurrence. This report describes the case of a dog diagnosed with canine visceral leishmaniasis submitted to immunotherapy and drug protocol, noting significant general improvement.Case: An 8-year-old female dog was treated with ulcerated lesions on the paw pads, nasal plane and lip region, onychogryphosis and ungeitis, in addition, hypertrophied popliteal lymph nodes and erosive lesions in the elbows, without improvement with previous treatments. Serological examination was then performed to diagnose leishmaniasis by the immunosorbent assay (ELISA) technique with negative results. In addition, was performed puncture of the popliteal lymph node, sample in which amastigote forms of Leishmania were observed and blood sample analysis by immunochromatographic rapid test showing reagent result, confirming the diagnosis of canine visceral leishmaniasis. The treatment protocol with marbofloxacin, allopurinol, prednisolone and domperidone was initiated. Thirty days later, there was a total improvement of the lesions and healing of the paw pads. Immunotherapy was then initiated by applying three double doses of recombinant vaccine against canine visceral leishmaniasis. The applications were made subcutaneously, with an interval of 21 days between them, still maintaining allopurinol. After six months a fourth double dose of the vaccine was applied and ten days later a new serological examination was performed using the Indirect Immunofluorescence Reaction (IIFR) technique with total dilution, with the result not reagent. Four months later, the patient was reevaluated and a new serological test was performed through the IIFR technique with total dilution and the result was reagent with high titration (1: 320). Then began the use of milteforan and domperidone. After two months, the patient received a new vaccination booster and the use of domperidone was discontinued. After ten days a new serological examination was performed using the IIIRF technique with total dilution, with reagent result, but with minimal titration (1:40).Discussion: Canine visceral leishmaniasis is a systemic zoonosis of major public health importance. The dog, due to its proximity to humans, is considered the main reservoir of the disease. Although clinical signs are nonspecific, skin lesions such as nasal hyperkeratosis, ulcers and hyperpigmentation, as well as clinical manifestations such as lymphadenopathy, fever, epistaxis and ophthalmic changes are frequently observed. In this case, the patient presented most of the lesions described in the literature. Laboratory abnormalities in blood count and serum biochemistry, commonly observed, were not observed in the animal. The ELISA serological test, despite being used as a screening test, due to its ability to detect low antibody titers, was negative in this case. The diagnosis was confirmed by lymph node cytology, described in the literature as a confirmatory test despite being considered invasive by most authors and positive result in rapid immunochromatography test. With the protocol used, the animal showed improvement, being observed negative results or with low titration of anti-leishmania antibodies in a serological test performed using the IFAT technique, indicating a decrease in parasitic load.

Comparison Between Interwoven Nitinol and Drug Eluting Stents for Endovascular Treatment of Femoropopliteal Artery Disease

Information on performance of different stent platforms in endovascular revascularisation of femoropopliteal lesions is controversial and scarce. Interwoven nitinol (INS, Supera) were compared with drug eluting (DES, Zilver PTx) stents with primary intervention for femoropopliteal lesions. The primary endpoint was time to clinically driven target lesion revascularisation (CD-TLR) within 12 months. Secondary endpoints were time to death, amputation and composite of death, amputation and CD-TLR. Due to the retrospective analysis, inverse probability treatment weighted (IPTW) Cox models were calculated to reach more similar patient populations with weights for the average treatment effect of the population. The two sensitivity analyses were propensity score matching and adjustment for covariates. At 12 months, the cumulative incidence of CD-TLR in the INS group (13%) and DES group (18%) did not differ (HR 1.36, 95% CI 0.56-3.31). A significant interaction between stents used and grade of calcification was observed (p=.006). HR for CD-TLR was 6.4 (95% CI 1.3-32.5) in none to mildly calcified favouring INS, and 0.3 (95% CI 0.1-1.3) for moderate to severely calcified lesions favouring DES. Stent efficiency did not differ comparing treatment of popliteal lesions (HR 0.80; 95% CI 0.21-3.13). Sensitivity analyses confirmed the primary efficacy outcome for either adjusted (HR 1.16; 95% CI 0.51-2.62) or matched analysis (HR 1.35; 95% CI 0.50-3.62)). Interaction of stents with calcification grade was lost for adjusted (HR 0.28; 95% CI 0.06-1.19) and matched analysis (HR 0.53; 95% CI 0.10-2.91). Both stents (INS and DES) showed comparable results regarding CD-TLR in femoropopliteal lesions, so that one stent could not be favoured over the other, even for calcified or popliteal artery lesions.

Young adult with varicosities and recurrent lower gastrointestinal bleeding

A 30 years gentleman presented with anaemia since last ten years due to recurrent rectal bleeding. He has had multiple admissions with transfusions in the preceding 10 years without a clear clinical diagnosis. His physical examination revealed gross pallor, prominent veins on the lateral side of the left lower limb with minimal hypertrophy and a hemangiomatous patch over the left buttock. Colonoscopy revealed a few dilated tortuous submucosal vessels in the rectum and sigmoid colon. A MR angiogram showed absent left popliteal vein and angiomatous lesions in the rectum and sigmoid colon. He was diagnosed to have Klippel-Trenaunay syndrome with hemangiomata of the lower gastrointestinal tract causing bleeding. He underwent a low anterior resection with stapled anastomosis, which has effectively controlled his bleeding. Adults with gastrointestinal bleeding due to congenital venous malformations commonly have visible external stigmata, which are often pointers of rare syndromes.

Incidence and Endovascular Treatment of Isolated Atherosclerotic Popliteal Artery Disease: Outcomes from the IPAD Multicenter Study.

To report the incidence and long-term outcomes following endovascular treatment of symptomatic, atherosclerotic isolated popliteal artery disease (IPAD). This retrospective, multicenter study included all patients who underwent endovascular treatment of IPAD between January 2010 and December 2016 because of intermittent claudication or critical limb ischemia (CLI), in three tertiary University Hospitals. In total, 4717 peripheral arterial disease (PAD) procedures were analyzed. The study's primary outcome measures were: IPAD incidence, binary restenosis rate and freedom from target lesion revascularization (TLR). Secondary outcome measures included technical success, limb salvage rate and the identification of predictors of outcomes. The incidence of IPAD was 0.98% (46/4717 PAD procedures). In total, 46 patients (38 male; mean age 73 ± 12years) underwent plain balloon (69.5%) or bail-out stenting (30.5%) procedures. Most patients suffered from CLI (65.2%). Mean lesion length was 52.5 ± 32.0mm and 45.6% of the cases were occlusions. Severe calcifications were noted in 26.1%. Technical success was 100%. Mean time follow-up was 32.6 ± 25.6months. According to Kaplan-Meier analysis, restenosis was 15.8, 40.9, 45.8% and TLR-free rate was 90.5, 79.0, 74.1%, at 1, 2 and 3years, respectively. Survival and limb salvage rates were 73.6 and 88.1%, at 5years, respectively. The major amputation rate for CLI patients was 10.0% (3/29 limbs), while no major amputations occurred in the claudication subgroup. Cox multivariable analysis detected baseline occlusion as an independent predictor of increased restenosis (HR 5.3; 95% CI 0.21-0.66, p = 0.02). Isolated popliteal lesions requiring treatment appear in nearly 1% of patients with PAD. Balloon angioplasty and bail-out stenting resulted in acceptable long-term clinical outcomes. Treatment of occlusions was correlated with increased restenosis rate.

The Sonographic Spectrum of Baker Cysts

Baker cysts are the most common pathologic finding in the sonography of the popliteal fossa. They have a wide range of sonographic appearances. Some of them may need to be recognized and differentiated from other popliteal lesions. Therefore, familiarity with their different imaging appearances is useful for clinical practice. This review summarized different presentations of Baker cysts. They are described in several categories, organized according to their shape and formation: typical Baker cysts and their mild variations, atypical small Baker cysts, ʎ-shaped Baker cysts and their related variations, Baker cysts with extension into nearby muscles, and Baker cysts with complications. The related differentiations are included in each category. The pathogenesis of Baker cysts is also discussed.

Stellarex Drug-Coated Balloon for Treatment of Femoropopliteal Disease: Twelve-Month Outcomes From the Randomized ILLUMENATE Pivotal and Pharmacokinetic Studies.

Drug-coated balloons (DCBs) are a predominant revascularization therapy for symptomatic femoropopliteal artery disease. Because of the differences in excipients, paclitaxel dose, and coating morphologies, varying clinical outcomes have been observed with different DCBs. We report the results of 2 studies investigating the pharmacokinetic and clinical outcomes of a new DCB to treat femoropopliteal disease. In the ILLUMENATE Pivotal Study (Prospective, Randomized, Single-Blind, U.S. Multi-Center Study to Evaluate Treatment of Obstructive Superficial Femoral Artery or Popliteal Lesions With A Novel Paclitaxel-Coated Percutaneous Angioplasty Balloon), 300 symptomatic patients (Rutherford class 2-4) were randomly assigned to DCB (n=200) or standard angioplasty (percutaneous transluminal angioplasty [PTA]) (n=100). The primary safety end point was freedom from device- and procedure-related death through 30 days, and freedom from target limb major amputation and clinically driven target lesion revascularization through 12 months. The primary effectiveness end point was primary patency through 12 months. In the ILLUMENATE PK study (Pharmacokinetic Study of the Stellarex Drug-Coated Angioplasty Balloon), paclitaxel plasma concentrations were measured after last DCB deployment and at prespecified times (at 1, 4, 24 hours and at 7 and 14 days postprocedure) until no longer detectable. In the ILLUMENATE Pivotal Study, baseline characteristics were similar between groups: 50% had diabetes mellitus, 41% were women, mean lesion length was 8.3 cm, and 44% were severely calcified. The primary safety end point was met (92.1% for DCB versus 83.2% for PTA, P=0.025 for superiority) and the primary patency rate was significantly higher with DCB (76.3% for DCB versus 57.6% for PTA, P=0.003). Primary patency per Kaplan-Meier estimates at day 365 was 82.3% for DCB versus 70.9% for PTA (P=0.002). The rate of clinically driven target lesion revascularization was significantly lower in the DCB cohort (7.9% versus 16.8%, P=0.023). Improvements in ankle-brachial index, Rutherford class, and quality of life were comparable, but the PTA cohort required twice as many revascularizations. Pharmacokinetic outcomes showed that all patients had detectable paclitaxel levels after DCB deployment that declined within the first hour (54.4±116.9 ng/mL to 1.4±1.0 ng/mL). The data demonstrate superior safety and effectiveness of the Stellarex DCB in comparison with PTA, and plasma levels of paclitaxel fall to low levels within 1 hour. URL: http://clinicaltrials.gov. Unique identifiers: NCT01858428 and NCT01912937.

Advances in Percutaneous Therapies for Peripheral Artery Disease: Drug-Coated Balloons.

This review paper provides a summary on the use of drug-coated balloons in peripheral artery disease. It covers the main drug-coated balloon (DCB) trials. It is divided into categories of lesions: superficial femoral artery and popliteal lesions, infra-popliteal lesions and in-stent restenosis. It also includes an overview of the future of DCBs, highlighting the main ongoing trials. The latest research on DCB focuses on newer types of DCBs, mainly paclitaxel-coated but with lower doses. Another area of latest DCB research is its use in superficial femoral artery and popliteal artery in-stent restenosis, with superior outcomes. Drug-coated balloons produce better outcomes than percutaneous transluminal angioplasty alone in de novo and in-stent restenosis lesions of superficial femoral artery and popliteal arteries. More data are needed to demonstrate efficacy and safety of DCBs in infrapopliteal disease. Newer DCBs and adjunctive therapy may provide improved outcomes for peripheral artery disease interventions.

Commentary: Endovascular Treatment of Popliteal Lesions Requires Advanced Physician Skills

Commentary: Endovascular Treatment of Popliteal Lesions Requires Advanced Physician Skills

Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions

Purpose: To report a single-center study comparing drug-coated balloon (DCB) angioplasty vs directional atherectomy with antirestenotic therapy (DAART) for isolated lesions of the popliteal artery. Methods: Seventy-two patients were treated with either DCB angioplasty alone (n=31) or with DAART (n=41) for isolated popliteal artery stenotic disease between October 2009 and December 2015. The majority of patients presented with lifestyle-limiting claudication (74% vs 86%, respectively). Vessel calcification (29% vs 29%, respectively), mean lesion length (47 vs 42 mm, respectively), and number of runoff vessels were comparable between the groups. The primary outcome measure was primary patency; secondary outcomes were technical success (<30% residual stenosis or bailout stenting), secondary patency, and freedom from clinically driven target lesion revascularization (TLR). Results: The technical success rate following DCB was 84% vs 93% (p=0.24) after DAART. The 12-month primary patency rate was significantly higher in the DAART group (65% vs 82%; hazard ratio 2.64, 95% confidence interval 1.09 to 6.37, p=0.021), while freedom from TLR did not differ between the 2 treatment strategies (82% vs 94%, p=0.072). Secondary patency at 12 months was identical for both groups (96% vs 96%). Although not statistically significant, bailout stenting was more common after DCB angioplasty (16% vs 5% for DAART, p=0.13) and aneurysmal degeneration of the popliteal artery was seen more often after DAART (7% vs 0% for DCB alone, p=0.25). Popliteal artery injury was observed in 2 patients treated using DAART (5% vs 0% for DCB alone, p=0.5), whereas distal embolization rates were comparable between the groups (3% for DCB alone vs 5% for DAART, p=0.99). Conclusion: In this study, the use of DAART was associated with a higher primary patency rate compared with DCB angioplasty for isolated popliteal lesions. Nonetheless, both treatment options were associated with excellent 12-month secondary patency. Aneurysmal degeneration of the popliteal artery and increased bailout stenting could compromise the outcomes of DAART and DCB, respectively.

Initial Experience With the Absorb Bioresorbable Vascular Scaffold Below the Knee

Purpose: To investigate a new bioresorbable vascular scaffold for the treatment of focal tibial and distal popliteal lesions. Methods: Tibial and distal popliteal angioplasty was performed in 15 limbs of 14 patients (9 men; median age 82 years) with critical limb ischemia (CLI, n=7) or severe claudication. The 18 lesions (mean length 22.2±14.0 mm) were implanted with 22 everolimus-eluting bioresorbable scaffolds (Absorb). Clinical and ultrasound follow-up was performed at 1, 3, 6, and 12 months to detect restenosis and evaluate safety, midterm restenosis rate, and clinical improvement. Results: Immediate technical success was 100%, although a single limb suffered 2 scaffold thromboses on the first day; it was salvaged with repeat endovascular intervention. All patients were available for surveillance examinations during a follow-up of 6.1±3.9 months; no patient died. Of the 15 limbs in the analysis, clinical improvement was present in 12 (4 of 7 CLI patients); there was no amputation, bypass surgery, or evidence of binary restenosis on follow-up sonographic examination. Conclusion: Midterm follow-up for this small pilot sample demonstrates acceptable safety and patency results, together with freedom from all major adverse limb events, using the Absorb bioresorbable vascular scaffold below the knee.

A single stent strategy in patients with lifestyle limiting claudication: 3-year results from the Durability II trial.

ObjectivesTo evaluate longer‐term safety and efficacy of a single self‐expanding stent up to 20 cm in length in patients with atherosclerotic disease of the superficial femoral (SFA) and proximal popliteal arteries.BackgroundAngioplasty and stenting are options for revascularization of symptomatic peripheral artery disease. While angioplasty alone is effective in short lesions, outcomes in longer lesions (i.e., mean 8.7 cm) show suboptimal patency rates of 33% at one year.MethodsTwo hundred eighty‐seven patients (mean age 68 years, 66% male) were treated with the EverFlex™ Self‐Expanding Peripheral Stent System. Patients were followed through 3 years with yearly core lab adjudicated duplex ultrasonography for patency, radiographic assessment of stent fractures, and resting ankle brachial indices.ResultsOverall freedom from loss of primary patency at 3 years was 60.0%. Patency was significantly higher for lesions ≤8 cm compared with lesions >8 cm (71.0 vs. 50.5%, P < 0.0001). There was no significant difference in patency between single‐stent and multistent recipients (60.4 vs. 52.4%, P = 0.343). The three‐year freedom from clinically driven target lesion revascularization was 70.0%. At 3 years, the overall stent fracture rate was 0.9%.ConclusionsDURABILITY II is the first investigational device exemption trial to report 3‐year duplex Doppler defined stent patency and CD‐TLR outcomes in long SFA and proximal popliteal lesions and demonstrated acceptable stent patency and freedom from CD‐TLR with a low fracture rate. These data suggest that use of a single long stent provides reasonable long‐term outcomes when intervention is required for symptomatic SFA and proximal popliteal arterial disease. © 2015 Wiley Periodicals, Inc.

Atheromatous Occlusive Lesions of the Popliteal Artery Treated with Stent Grafts: Predictive Factors of Midterm Patency

Because of its location, the popliteal artery is exposed to important biomechanical constraints, inducing a specific risk of thrombosis of stents, little studied in the literature. The objective of this monocentric retrospective study was to evaluate the patency of stents implanted in the popliteal artery to treat atheromatous lesions and the risk factors predisposing to thrombosis. Between January 2009 and July 2013, all the patients receiving stents for a residual stenosis or a complication of angioplasty in the popliteal artery or the distal anastomosis of a femoropopliteal bypass were included retrospectively and in an intention to treat. Forty-six patients (17 women), with a 71.5years median age (range, 45-90years), including 17 diabetic patients (37%) and 7 hemodialysis patients (15%), were operated in 51 limbs for claudication (n=25, 49%), critical ischemia (n=18, 35%), or acute ischemia (n=8, 16%). Thirty stenoses >70% (59%) and 21 thromboses (41%) were treated with 56 autoexpandable stents, with an average diameter of 6mm (range, 5-8mm) and an average length of 5cm (range, 4-15cm), including 39 lesions in P1 (above the patella), 8 in P2 (articular), and 4 in P3 (distal popliteal artery). The following factors were analyzed according to univariate and multivariate models: age, gender, Society for Vascular Surgery score, symptomatology, type and location of lesion, number of stents deployed, and dimension of stents. Technical success was of 98% (n=50), including 1 insufficient result of the endovascular treatment. At 30days, one patient treated for critical ischemia died (2%) and one residual popliteal stenosis was treated by bypass (2%). After a 27.6±10.07month follow-up, restenosis (>50%) was detected in 5 cases including 4 asymptomatic and a popliteal thrombosis occurred in 9 cases, including 3 asymptomatic cases. Eight secondary interventions were necessary, including 4 endovascular procedures, 3 bypasses, and only 1 major amputation (thigh). The primary and secondary patencies at 12months and 24months were 80% and 65%, and 90% and 74%, respectively. The multivariate analysis showed that the type of lesion (stenosis versus occlusion; odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2-22.9, P=0.032) and the number of stents implanted (1 vs. 2 stents; OR [95% CI], 12.7 [1.8-88.5]; P=0.011) were independent predictive factors of secondary thrombosis. The endovascular treatment of the atheromatous popliteal lesions appears to be a satisfactory alternative. The implantation of 1 stent in the popliteal artery is recommended in the event of popliteal occlusion, whereas for a stenosis, it must be reserved for patients with residual stenosis or in the event of complications of angioplasty, such as dissection or elastic recoil. Stent must be single, with deployment of a long stent in the event of long lesion.

Treatment of complex atherosclerotic femoropopliteal artery disease with a self-expanding interwoven nitinol stent: midterm results from the Leipzig SUPERA 500 registry

To examine the efficacy and durability of an interwoven self-expanding nitinol stent in the treatment of complex femoropopliteal artery lesions in unselected patients. Five hundred and twenty-seven limbs in 470 patients with femoropopliteal arterial disease were treated with SUPERA stents. Follow-up data were prospectively collected in a single-centre registry and were available for 439 patients (492 limbs). The patients were followed by Doppler ultrasound, stent roentgenograms, estimation of Rutherford-Becker class (RBC) and ankle-brachial index (ABI). Total occlusions were present in 277 limbs (52.6%) and 52.4% had either moderate or severe calcification. The mean lesion length was 126.4 mm. The primary patency (PP) rates were 83.3% after 12 months and 72.8% at two years. The secondary patency rates were 98.1% after 12 months and 92.0% at two years. Patency rates did not differ between superficial femoral artery (SFA) and popliteal lesions. Between baseline and a mean of 21 months of follow-up, mean ABI increased from 0.53 to 0.91, and mean RBC decreased from 3.0 to 1.9 (p<0.001 for both comparisons). Radiographs performed on 229 patients at a mean of 16.6 months confirmed the absence of stent fractures in all patients. Over a two-year surveillance period, the patency rate and fracture resistance of SUPERA stents implanted for complex femoropopliteal artery disease were high.

Smoking Cessation and Clinical Outcomes in Young Patients Undergoing Endovascular Treatment for Critical Limb Ischemia

as initial indication for treatment who received BM stent were less likely to develop critical limb ischemia after stent occlusion (OR, 0.25; P 1⁄4 .016). Conclusions: Compared to BM stent use of CS in the treatment of advanced SFA and popliteal lesions is associated with higher primary patency rates. Patients are more likely to advance from claudication to critical limb ischemia after failure of a covered stent.

Gender Differences in the Long-Term Outcomes of Infrainguinal Arterial Revascularization: Retrospective Multicenter Analysis

as initial indication for treatment who received BM stent were less likely to develop critical limb ischemia after stent occlusion (OR, 0.25; P 1⁄4 .016). Conclusions: Compared to BM stent use of CS in the treatment of advanced SFA and popliteal lesions is associated with higher primary patency rates. Patients are more likely to advance from claudication to critical limb ischemia after failure of a covered stent.

Comparison of Outcomes Between Bare Metal and Covered Nitinol Stents in the Treatment of TASC C and D Superficial Femoral Artery (SFA) and Popliteal Lesions

Comparison of Outcomes Between Bare Metal and Covered Nitinol Stents in the Treatment of TASC C and D Superficial Femoral Artery (SFA) and Popliteal Lesions

Popliteal lesion due to traction during unicompartmental knee revision surgery

Popliteal artery injury is a rare but known complication in knee surgery. Only one article in current literature reports that the risk increases during revision knee surgery. A new case is described in which an injury to the popliteal artery occurred during lateral unicompartmental to total knee arthroplasty revision surgery. This vascular injury occurred 5–10 cm below the tibial resection level in a healthy patient with a history of cruris fracture with plate osteosynthesis and lateral unicompartmental knee arthroplasty. This paper stresses the importance of being aware that trauma and surgery can create fibrosis in which the popliteal artery can get fixated, thus reducing the scope for safe manipulation of the knee during secondary surgery.