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Background: We present a standardized protocol of endovascular revascularization for patients with acute limb ischemia due to popliteal artery aneurysm (PAA) thromboembolic complication, based on the combination of vacuum-assisted thromboaspiration to improve tibiopedal outflow and covered stent graft to exclude the PAA.
Methods: All patients with a diagnosis of PAA complicated by thromboembolic events undergoing total endovascular rescue were prospectively enrolled in a dedicated database from November 2018 to November 2021. To assess vessel patency, the TIPI (Thromboaspiration In Peripheral Ischemia) classification was used. The primary end point was the primary technical success (at least one tibial vessel with a TIPI flow of 2 or 3). The 30-day overall mortality and amputation rates were considered as secondary end points. Patients' overall survival, limb salvage, freedom from reocclusion and reinterventions were reported as secondary late outcomes using Kaplan-Meier method.
Results: Seventeen male patients were enrolled with a mean age of 75.7 ± 9 years. Rutherford grading score was IIa in 52.9% (9/17) and IIb in 47.1% (8/17). PAA mean diameter was 37.4 ± 11.2 mm. All patients had tibial arteries involvement, and in 9 cases (52.9%) there was also the occlusion of the PAA. Mechanical thrombectomy with Indigo/Penumbra thromboaspiration system was used in all patients. PAAs were excluded using one or more VIABAHN covered endografts (range 1-3 pieces). Technical success was achieved in 94.1%. Fasciotomy was performed in 1 case (5.9%). Mortality and amputation rates at 30-day follow-up were respectively 0% and 5.9%. Survival rates at 6, 12, and 24 months were respectively 94.1%, 86.3%, and 67.9%. Secondary patency was achieved in all cases (100%). Freedom from reintervention was 80.4%, 65.8%, and 54.8% at 6-, 12-, and 24-month follow-up. Limb salvage was 88.2% at 6-, 12-, and 24-month follow-up, respectively.
Conclusions: Although preliminary, our experience of total endovascular rescue for complicated PAA with thromboembolic events highlighted promising rates of limb salvage at 30 days after intervention. The total endovascular approach seems able to maximize tibiopedal outflow offering an interesting strategy in limb salvage.
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http://dx.doi.org/10.1016/j.avsg.2022.08.013 | DOI Listing |
J Orthop Trauma
December 2024
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD.
Objectives: To identify clinical, demographic, and patient-reported outcomes (PROs) associated with return to work after lower extremity traumatic injury requiring amputation or limb salvage.
Methods: Design: Cross-sectional study.
Setting: Multi-center across 25 countries.
Front Surg
December 2024
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Background: Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease (PAD). Patients with diabetes mellitus (DM) have a faster progression of PAD and a fourfold increased risk of CLTI compared to patients without DM. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculation, relieve ischemic pain and reduce the number of amputations in patients with PAD.
View Article and Find Full Text PDFKhirurgiia (Mosk)
December 2024
Petrozavodsk State University, Petrozavodsk, Russia.
Objective: To evaluate the mid-term results of endovascular revascularization of the lower extremities through primary retrograde distal approach.
Material And Methods: We prospectively analyzed the mid-term results of 74 endovascular surgeries via primary retrograde distal approach in 69 patients with lower extremity ischemia. Mean age of patients was 68.
Plast Reconstr Surg Glob Open
December 2024
From the Department of Surgery, Associates in Medicine and Surgery, Fort Myers, FL.
Background: Complex and chronic lower extremity defects present a surgical challenge and can progress to eventual amputation if closure is not achieved. In addition to morbidity and mortality, these defects have a significant impact on patient quality of life and represent a substantial cost burden to the healthcare system. Ovine forestomach matrix (OFM) grafts are an advanced tissue scaffold option to supplement the surgical reconstruction ladder and may augment limb preservation in cases of complex lower extremity defects.
View Article and Find Full Text PDFOrthop Surg
December 2024
Department of Orthopedics, The 960th Hospital of the People's Liberation Army, Jinan, China.
Objective: Aseptic loosening (AL) is a common mechanical complication following reconstruction of the distal femoral cemented prosthesis (DFCP), often resulting in severe bone loss, which complicates prosthesis revision. 3D-printed personalized implants represent an emerging solution for the reconstruction of complex bone defects. This study aimed to investigate the early therapeutic effects of using a 3D-printed, customized, uncemented stem prosthesis for revising aseptic AL in DFCP.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!