Hybrid revascularization of chronic limb-threatening ischemia using popliteal below-knee and tibial trifurcation open endarterectomy distally plus inter-woven nitinol stenting proximally
| Autor: | Laura G. Núñez, Luis J. García Domínguez, Irene Ramos Moreno, Manuel Miralles Hernández |
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| Rok vydání: | 2022 |
| Předmět: |
Chronic Limb-Threatening Ischemia
Male medicine.medical_specialty Percutaneous medicine.medical_treatment Ischemia Hemodynamics Endarterectomy Revascularization medicine.artery Alloys medicine Humans Popliteal Artery Treatment Failure Aged 80 and over business.industry Angioplasty Endovascular Procedures Surgical wound General Medicine medicine.disease Popliteal artery Surgery Tibial Arteries Lower Extremity Amputation Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 80:386-391 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2021.10.056 |
| Popis: | Objectives Chronic limb-threatening ischemia (CLTI) is frequently due to multilevel, heavily calcified lesions, and it is often associated with desert foot. Effective revascularization currently presents an additional challenge due to the increasing age, comorbidities, and frailty related to these patients. Pure endovascular treatment often fails to achieve effective and durable revascularization and it is associated with still high amputation rates. We present a novel hybrid approach and discuss its usefulness for limb salvage in complex infrainguinal lesions. Methods Two no-option patients for both anatomical and medical-comorbidity reasons, were treated consecutively for CLTI. Both of them had prior failed percutaneous endovascular treatment, and bypass revascularization had been ruled out. We describe the technical details of an aggressive, but still less invasive hybrid approach, consisting of open distal popliteal artery (PA) and tibial trifurcation endarterectomy plus patch angioplasty, associated with proximal endovascular treatment with inter-woven nitinol stent from the superficial femoral artery (SFA) to the endarterectomized area. Results Technical success and salvage of the affected limb were achieved in both cases, presenting significant postoperative clinical and hemodynamic improvement and allowing early discharge hospital at home. There was no surgical wound infection or other complications. Conclusions This hybrid approach through a single incision is safe and effective in the short term and can be used with excellent results for CLTI in high-risk and /or no-option patients. |
| Databáze: | OpenAIRE |
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