PURPOSE: The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access. MATERIALS AND METHODS: Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 ± 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56 patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted. RESULTS: Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 ± 1.1 vs. 15.7 ± 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively). CONCLUSION: The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.

Gandini, R., Uccioli, L., Spinelli, A., Del Giudice, C., Da Ros, V., Volpi, T., et al. (2013). Alternative techniques for treatment of complex below-the knee arterial occlusions in diabetic patients with critical limb ischemia. CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 36(1), 75-83 [10.1007/s00270-012-0344-x].

Alternative techniques for treatment of complex below-the knee arterial occlusions in diabetic patients with critical limb ischemia.

GANDINI, ROBERTO;UCCIOLI, LUIGI;Da Ros,V;SIMONETTI, GIOVANNI MARIA EGISTO
2013-01-01

Abstract

PURPOSE: The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access. MATERIALS AND METHODS: Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 ± 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56 patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted. RESULTS: Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 ± 1.1 vs. 15.7 ± 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively). CONCLUSION: The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.
2013
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA
Settore MED/13 - ENDOCRINOLOGIA
English
Con Impact Factor ISI
Gandini, R., Uccioli, L., Spinelli, A., Del Giudice, C., Da Ros, V., Volpi, T., et al. (2013). Alternative techniques for treatment of complex below-the knee arterial occlusions in diabetic patients with critical limb ischemia. CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 36(1), 75-83 [10.1007/s00270-012-0344-x].
Gandini, R; Uccioli, L; Spinelli, A; Del Giudice, C; Da Ros, V; Volpi, T; Meloni, M; Simonetti, Gme
Articolo su rivista
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/74349
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