The Role of the Endovascular Surgeon for Lower Extremity Ischemia
| Autor: | Natalia Markevich, S. Nahata, Th. Jacob, Richard W. Schutzer, William Yorkovich, Sreedhar Kallakuri, Anil Hingorani, Enrico Ascher, A. Hou |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty Percutaneous medicine.medical_treatment Arterial Occlusive Diseases Balloon Axillary artery Ischemia Angioplasty medicine.artery medicine Humans Minimally Invasive Surgical Procedures Life Tables Vascular Patency Aged Retrospective Studies Gangrene Leg Vascular disease business.industry Stent General Medicine medicine.disease Popliteal artery Surgery Female Radiology business Angioplasty Balloon |
| Zdroj: | Acta Chirurgica Belgica. 104:527-531 |
| ISSN: | 0001-5458 |
| DOI: | 10.1080/00015458.2004.11679609 |
| Popis: | UNLABELLED Since the data investigating endovascular therapy performed by surgeons is scarce, we retrospectively reviewed our experience of endovascular procedures performed by vascular surgeons in the operating room for lower extremity ischemia due to stenotic lesions. METHODS A total of 14,424 procedures were performed by our division between January 1990--October 2003. Of these, 500 involved a balloon angioplasty. These made up 3.5% of the total caseload. The median age of the patients who underwent these 500 balloon angioplasty was 72+/-0.5 years old; 65% were male; 50% had a history of diabetes mellitus, and 6% had ESRD. Indications for the procedures included acute ischemia (47 cases), critical ischemia (rest pain, gangrene, or ischemic ulcers in 254 cases), failing bypass (64 cases), severe claudication (134 cases), and preoperative for a popliteal artery aneurysm repair. RESULTS 244 of the procedures were percutaneous, and the remaining 256 were combined with some type of open procedure. Those performed as an open technique were in combination with a bypass (135 cases) and in combination with a patch angioplasty (31cases). Balloon angioplasties were performed of the aorta (5 cases), iliac arteries (281 cases), the superficial femoral artery (SFA) (101 cases), the popliteal artery (44 cases), the tibial vessels (77 cases), the subclavian/axillary artery (5 cases) and failing grafts (26 cases). Balloon angioplasty was attempted in eight cases and failed due to inability to cross the lesion with a guidewire. Intraoperative complications included 4 dissections, inability to dilate the lesion adequately (2 cases), and rupture of two iliac lesions that underwent open repair (1 case) or repair with a stent graft (1 case). Stents were initially used highly selectively but recently are now being deployed more liberally in the iliac arteries (total 251 cases with stents). CONCLUSIONS Based on these data, we suggest that balloon angioplasty is a useful tool that can be performed by vascular surgeons safely. The advantages to the patients include one combined procedure to treat lower extremity ischemia. |
| Databáze: | OpenAIRE |
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