Purpose: To detail a percutaneous technique for distal plantar venous arterialization in diabetic, end-stage renal disease (ESRD) patients with no-option critical limb ischemia (CLI).
Technique: After failure of standard intraluminal recanalization attempts, a subintimal approach through the posterior tibial artery (PTA) is begun using a 0.014-inch, 190- or 300-cm-long guidewire supported by a 2-×20-mm, low-profile balloon catheter positioned a short distance behind the narrow "U-shaped" loop in the guidewire. Typically, heavy calcification in the distal tortuous segment of the PTA prevents reentry to the arterial true lumen; however, an entry in the distal lateral or medial plantar vein from a subintimal channel in the plantar artery can be intentionally pursued as a bailout technique, pointing the tip of the guidewire opposite to the arterial wall calcifications. Venous access is confirmed by contrast injection through the balloon catheter. Once the guidewire is advanced in the distal lateral or medial plantar vein and a plantar arteriovenous fistula (AVF) has been created, the AV anastomosis and the occluded PTA segment are dilated with 0.014-inch balloon catheters. The technique has been attempted in 9 consecutive diabetic, ESRD patients (mean age 69 years; 5 men) with no-option CLI; an AVF was created between the PTA and plantar vein in 7 patients. The mean TcPO at 1 month was 30±17 mm Hg (vs 7.3±2.2 at baseline). Six ulcers healed over an average of 21±4 weeks. Three of the 9 patients had below-knee amputations.
Conclusion: Although further investigations are required, distal plantar venous arterialization may represent a promising technique to improve recanalization rates and limb salvage in diabetic ESRD patients with extremely calcified PTA occlusions.
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http://dx.doi.org/10.1177/1526602817750211 | DOI Listing |
JBJS Essent Surg Tech
January 2025
The Ohio State University College of Medicine, Columbus, Ohio.
Background: An all-inside endoscopic flexor hallucis longus (FHL) tendon transfer is indicated for the treatment of chronic, full-thickness Achilles tendon defects. The aim of this procedure is to restore function of the gastrocnemius-soleus complex while avoiding the wound complications associated with open procedures.
Description: This procedure can be performed through 2 endoscopic portals, a posteromedial portal (the working portal) and a posterolateral portal (the visualization portal).
JBJS Essent Surg Tech
November 2024
Department of Orthopaedics Foot and Ankle Surgery, The Ohio State University, Columbus, Ohio.
Sci Rep
October 2024
Department of Respiratory, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, 100091, China.
Background: Recent studies have highlighted that TACE in conjunction with Lenvatinib (TACE-L) offers a promising adjunct therapy for advanced HCC patients, outperforming TACE plus Sorafenib (TACE-S). However, there has been a lack of research comparing these two regimens for intermediate HCC.
Aims: This study aims to address the research gap by evaluating the efficacy of TACE-L versus TACE-S in intermediate HCC patients.
J Vasc Surg Venous Lymphat Disord
January 2025
Research Laboratory of Venous Hemodynamics, Phlebocenter LLC, Kaliningrad, Russia; Clinic of Phlebology "VenoClinica", Yekaterinburg, Russia.
Objective: Ambulatory venous pressure (AVP) is the drop of pressure observed in the superficial veins of the lower leg during movement. This phenomenon has been linked to the function of the calf muscle pump (CMP) and the competence of venous valves. Nevertheless, the concept of the CMP function remains controversial.
View Article and Find Full Text PDFJ Perinat Med
September 2024
Non-Surgical Foot and Ankle Center, Hospital for Special Surgery, New York, USA.
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