Outcome and Distal Access Patency in Subintimal Arterial Flossing with Antegrade-Retrograde Intervention for Chronic Total Occlusions in Lower Extremity Critical Limb Ischemia.
Adult
Aged
Aged, 80 and over
Amputation, Surgical
Chronic Disease
Critical Illness
Endovascular Procedures
/ adverse effects
Female
Humans
Ischemia
/ diagnostic imaging
Limb Salvage
Lower Extremity
/ blood supply
Male
Middle Aged
Peripheral Arterial Disease
/ diagnostic imaging
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
Journal
Journal of vascular and interventional radiology : JVIR
ISSN: 1535-7732
Titre abrégé: J Vasc Interv Radiol
Pays: United States
ID NLM: 9203369
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
03
08
2019
revised:
05
12
2019
accepted:
07
12
2019
pubmed:
5
3
2020
medline:
29
9
2020
entrez:
5
3
2020
Statut:
ppublish
Résumé
To report the outcome and distal access patency of the Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique for chronic total occlusion (CTO) in critical limb ischemia (CLI). From January 2009 to June 2015, 220 SAFARI procedures were performed for 200 limbs in 191 patients (108 males [56.5%]; median age, 70 years old; range, 36 to 97 years old) with CLI (9.4% were Fontaine classification 3; and 90.6% were Fontaine classification 4). Distal access was obtained from the distal superficial femoral artery (n = 6), popliteal artery (n = 49), anterior tibial artery (n = 56), dorsalis pedis (n = 51), peroneal artery (n = 12), posterior tibial artery (n = 45), and lateral plantar artery (n = 1). Distal access hemostasis was obtained with internal balloon tamponade in 71.4% (n = 157). Outcome measurements were technical success, freedom from major amputation and complications. Preprocedural angiograms of clinically driven repeat interventions were reviewed in 73 cases for distal access patency. Technical success was achieved in 80.5% (n = 177). Reasons for technical failure include inability to obtain distal access (n = 3), cross the occlusion retrogradely (n = 16), re-enter the true lumen (n = 9), and achieve antegrade blood flow after the procedure (n = 15). Freedom from major amputation for technically successful procedures was 84.7%, 82.9%, and 81.9% at 6, 12, and 24 months, respectively. There were 3 cases of distal access bleeding with 1case that required coil embolization. The distal access remained patent in 80.8% of observable cases with repeated endovascular intervention. Distal retrograde arterial access (SAFARI) technique is safe and effective in the treatment of CTOs in the context of CLI, after failure of antegrade revascularization.
Identifiants
pubmed: 32127314
pii: S1051-0443(19)31033-4
doi: 10.1016/j.jvir.2019.12.006
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
601-606Informations de copyright
Copyright © 2019 SIR. Published by Elsevier Inc. All rights reserved.