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1. Arterialização venosa superficial com veia safena magna in situ: a experiência de um único centro

Author

Karlene Thayane Barros da Silva, Marcos Antonio Bonacorso Manhanelli Filho, José Francisco Moron Morad, Fábio Linardi, and José Augusto Costa

Subjects
isquemia crítica, preservação do membro, salvamento de membro, arterialização do arco venoso do pé, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Resumo Contexto A arterialização do arco venoso dorsal do pé é uma técnica indicada em casos de isquemia crítica de membros inferiores sem leito distal adequado que possibilite tratamento convencional, como revascularização, angioplastia ou tratamento clínico. Objetivos O propósito do trabalho foi apresentar o resultado da arterialização do arco venoso do pé em 16 pacientes submetidos a essa técnica. Métodos Tratou-se de um estudo analítico descritivo retrospectivo transversal, baseado na revisão de prontuários de 16 pacientes submetidos à arterialização do arco venoso dorsal do pé para salvamento de membro, entre janeiro de 2016 a janeiro de 2021. Resultados Dos 16 pacientes submetidos à arterialização do arco venoso do pé, 25% (4) evoluíram para amputação maior durante a mesma internação, e 6,25% (1) pacientes evoluíram para amputação maior após 6 meses. Os demais pacientes (68,75%, 11) tiveram seus membros preservados, sendo que 10 foram submetidos a amputações menores (pododáctilos e antepé), e 1 paciente não necessitou de procedimento adicional. Conclusões A técnica de arterialização do arco venoso dorsal do pé deve ser considerada em casos selecionados. Trata-se de uma alternativa válida para a preservação do membro na impossibilidade de tratamento convencional.

Published
2024
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2. Clinical impact of the infrapatellar location in symptomatic peripheral arterial disease patients.

Author

Chiabrando, Juan G., Garagoli, Fernando D., Abraham-Foscolo, Maria M., Corna, Giuliana, de-los-Milagros-Fleitas, Maria, Valle-Raleigh, Juan, Medina-de-Chazal, Horacio A., Berrocal, Daniel H., Rabellino, Jose M., and Bluro, Ignacio M.

Subjects
*ARTERIAL diseases, *PERIPHERAL vascular diseases, *ELECTRONIC health records, *UNIVERSITY hospitals, *CARDIOVASCULAR diseases, *REVASCULARIZATION (Surgery), *CONFIDENCE intervals, *REGRESSION analysis
Abstract

Background: Peripheral artery disease (PAD) frequently affects multiple segments of the limbs. Contradictory data have reported worse prognosis in aortoiliac lesions, nevertheless, diabetes and chronic limb ischemia frequently affects the infrapa-tellar territory. Our aim was to assess the impact of infrapatellar disease in cardiovascular outcomes. Methods: We performed a retrospective, observational cohort study at a university hospital in Argentina. Electronic health records were retrospectively reviewed including symptomatic PAD patients requiring revascularization. A multivariable regression model was performed to account for confounders. The primary endpoint was a composite of hospitalizations due to chronic limb threatening ischemia (CLTI) and major amputation events between infrapatellar and suprapatellar patients. Minor amputation events, all-cause death, myocardial infarction (MI), stroke, and major cardiovascular events (MACE) were secondary endpoints. Results: From January 2014 through July 2020, a total of 309 patients were included in the analysis. 151 patients had suprapatellar disease, and 158 had infrapatellar disease. The primary composite endpoint occurred in 35 patients (22.2%) in the infrapatellar patients and 18 patients (11.9%) in the suprapatellar patients (HR = 2.16; 95% confidence interval [CI] = [1.22-3.82]; p = 0.008). Both com-ponents of the primary outcomes occurred more frequently in infrapatellar patients. Minor amputation events were more pre-valent in infrapatellar patients (HR = 5.09; 95% CI = [1.47-17.6]; p = 0.010). Death, MI, stroke, and MACE events were not different among groups (all p > 0.05). Conclusion: Infrapatellar disease was an independent factor for increased hospitalization of CLTI, major and minor amputations events, compared to suprapatellar disease in symptomatic revascularized PAD patients. [ABSTRACT FROM AUTHOR]

Published
2023
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3. COVID-19 diagnosis in a patient with critical limb ischemia: complications and clinical outcomes.

Author

de Athayde Soares, Rafael, Salem Vedovello, Rafael, Guedes de Medeiros, Samanta Christine, Zaffani Nunes, Celso, Sian, Carlos Alberto, and de Melo Jorge, Paulo Daenekas

Subjects
*COVID-19 testing, *POPLITEAL artery, *ENDOVASCULAR surgery, *PEOPLE with diabetes, *ARTIFICIAL respiration, *FOOT ulcers, *DEBRIDEMENT, *DISSECTING aneurysms
Abstract

A 67-year-old male diabetic patient with systemic arterial hypertension was admitted to the emergency department with a necrotic ulcer in the left external malleolus and no palpable popliteal or pedal pulses. Arterial Duplex ultrasound identified femoropopliteal occlusion, with popliteal refilling below the knee and a patent peroneal artery. An endovascular procedure was performed, requiring retrograde access to the popliteal artery to re-establish blood flow and deploy a popliteal stent. Technical success was achieved and the patient underwent debridement of the wound. Two days later, about 48 hours after the operation, the patient began to exhibit respiratory symptoms, with coughing and dyspnea. He immediately underwent a chest CT that identified ground glass opacities, the crazy-paving pattern, and bilateral air bronchogram in the lungs. A reverse transcription - polymerase chain reaction (RT-PCR) test was positive for SARS-Cov-2. The patient was moved to an intensive care unit and put on mechanical ventilation. Both hydroxychloroquine and azithromycin were administered. Despite appropriate treatment, the patient died 4 days after he was diagnosed with COVID-19. [ABSTRACT FROM AUTHOR]

Published
2020
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4. Factors associated with outcome of endovascular treatment of iliac occlusive disease: a single-center experience.

Author

de Athayde Soares, Rafael, Fernando Matielo, Marcelo, Brochado-Neto, FranciscoCardoso, Martins Cury, Marcus Vinícius, Borges Costa, Veridiana, Pereira Sanjuan, Maria Clara, Stchelkunoff Pecego, Christiano, and Sacilotto, Roberto

Subjects
*ENDOVASCULAR surgery, *ILIAC artery diseases, *ANGIOPLASTY, *THERAPEUTICS
Abstract

Background: Endovascular treatment (ET) of iliac occlusive disease (IOD) is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives: To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods: This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA), between January 2009 and January 2015. Patients with critical limb ischemia or incapacitating claudication were included. Results: In total, 48 IA procedures were performed in 46 patients, with an initial technical success rate of 95.83%. Failure occurred in two patients, who were excluded, leaving 44 patients and 46 IA. The primary patency, secondary patency, limb salvage, and survival rates at 1200 days were 88%, 95.3%, 86.3%, and 69.9%, respectively. Univariate and multivariate Cox regression revealed that the primary patency rate was significantly worse in patients with TASC type C/D than in patients with TASC type A/B (p = 0.044). Analysis of factors associated with major amputation using Cox regression showed that the rate of limb loss was greater in patients with TASC type C/D (p = 0.043). Male gender was associated with reduced survival (p = 0.011). Conclusions: TASC type C/D was associated with a higher number of reinterventions and with worse limb loss and primary patency rates. Male gender was associated with a worse survival rate after ET of IOD. [ABSTRACT FROM AUTHOR]

Published
2018
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5. Células-tronco de medula óssea em isquemia crítica de membros Bone marrow stem cells in critical limb ischemia

Author

José Dalmo Araujo, José Dalmo Araujo Filho, Emerson Ciorlin, Milton A. Ruiz, Oswaldo T. Greco, Roberto V. Ardito, and Mario Lago

Subjects
Células-tronco, isquemia crítica, células-tronco adultas, medula óssea, Stem cell, critical ischemia, adult stem cells, bone marrow, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Os autores discutem aspectos clínicos e de tratamento convencional da isquemia critica dos membros inferiores e consideram a possibilidade de tratamento com células- -tronco autógenas de medula óssea para os pacientes que já esgotaram, sem sucesso, todos os meios de tratamento conhecidos. Comentam sobre o histórico, as fontes, as experiências animais e clínicas e, finalmente, apresentam sua experiência inicial com seis pacientes, todos com indicação de amputação maior ou menor. Em apenas um paciente não foi possível evitar a amputação. Além de ótimos resultados, quanto à supressão da dor e cicatrização de lesões isquêmicas, pode-se notar a ausência de quaisquer efeitos colaterais deletérios, sugerindo que a terapia celular é eficiente e segura, demandando, porém, mais pesquisas e estudos randomizados para se tornar uma terapia de uso corrente.The authors discuss clinical aspects and conventional treatment of lower limb critical ischemia and the alternative of therapy with autogenous bone marrow stem cells in patients who have exhausted, without success, all the current means of treatment. They comment on the historical aspects, the sources, animal experiments, clinical research and, finally, their initial experience with six patients, all of whom had previous indication of major or minor amputation. For only one patient amputation could not be avoided. In addition to excellent results in pain relief and healing of ischemic ulcers, no deleterious side effects were noted suggesting that this type of cell therapy is safe and efficient although further research and randomized studies are needed to make this a standard therapy.

Published
2009

6. Arterialização do arco venoso do pé para tratamento da tromboangeíte obliterante Arterialization of the venous arch of the foot for the treatment of thromboangiitis obliterans

Author

Cesar Roberto Busato, Carlos Alberto Lima Utrabo, Ricardo Zanetti Gomes, Joel Kengi Housome, Eliziane Hoeldtke, Cristiano Teixeira Pinto, Rafael Ignácio Brandão, and Cintia Doná Busato

Subjects
Arterialização venosa, isquemia crítica, fístulas arteriovenosas terapêuticas, salvamento de membro, tromboangeíte obliterante, Venous arterialization, critical ischemia, therapeutic arteriovenous fistulas, limb salvage, thromboangiitis obliterans, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Em isquemia crítica sem leito arterial distal, um dos modos de irrigar o membro isquêmico é derivar o fluxo de maneira retrógrada através do sistema venoso. As primeiras tentativas de fístulas arteriovenosas terapêuticas datam do início do século passado. Realizadas na parte proximal dos membros inferiores, não obtiveram resultados favoráveis. A partir da década de 70, com os trabalhos pioneiros de Lengua, as fístulas passaram a ser estendidas até o pé, e os bons resultados apareceram em várias publicações. Os autores relatam a evolução de um caso de tromboangeíte obliterante submetida ao procedimento. Essa é uma cirurgia de indicação precisa, que requer estudo pré-operatório arterial e venoso e observância a detalhes de técnica operatória.In critical ischemia without arterial run-off, it is possible to irrigate the ischemic limb by turning the course of the flow reversely through the venous system. The first experiments with therapeutic arteriovenous fistulas date from the beginning of the last century. They were performed in the proximal area of the lower limbs, but showed unfavorable results. Since the 1970's, with the pioneer studies of Lengua, fistulas started being extended to the foot and several publications have reported good outcomes. The authors report the evolution of a case of thromboangiitis obliterans which was submitted to the procedure. This is an accurate surgical procedure which requires arterial and venous preoperative study and the observance of technical operative details.

Published
2008
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7. A terapia celular no tratamento da isquemia crítica dos membros inferiores Cell therapy for the treatment of critical ischemia of the lower limbs

Author

José Dalmo de Araújo, José Dalmo de Araújo Filho, Emerson Ciorlin, Milton Artur Ruiz, Lílian Piron Ruiz, Oswaldo Tadeu Greco, Mario Roberto Lago, and Roberto Vito Ardito

Subjects
terapia celular, células tronco, isquemia crítica, cell therapy, stem cells, critical limb ischemia, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Os autores fazem um histórico sobre as pesquisas com células-tronco embrionárias e do cordão umbilical, suas respectivas vantagens e desvantagens. Seguem com as discussões sobre células-tronco adultas, sua definição, histórico, fontes e participação nos processos de regeneração tecidual, particularmente no endotélio. Ressaltam a importância de fatores que mobilizam as células-tronco adultas a partir da medula óssea: citocinas, angiopoietinas e outros fatores de crescimento. As células-tronco adultas mobilizam-se sob a forma de células endoteliais progenitoras, que têm origem comum com as células endoteliais a partir dos hemangioblastos. Os fatores de mobilização manifestam-se em condições de hipoxia e fazem com que as células endoteliais progenitoras se localizem nos locais de isquemia para produzir a neovasculogênese, que se faz por três possíveis mecanismos: a angiogênese (formação de novos capilares a partir de brotos de capilares já existentes), a arteriogênese (relacionada à circulação colateral) e a vasculogênese (vasos realmente novos). Fazem, a seguir, uma análise da literatura relativa à experimentação animal e aos estudos clínicos. Concluem ressaltando que as células-tronco adultas, embora tenham um grande potencial de uso, ainda demandam muito estudo e pesquisa para se firmar como método terapêutico.The authors review the history of the researches on embryonic and umbilical cord vein stem cells, their advantages and disadvantages. They proceed with comments on adult stem cells, their concept, history, sources and role on tissue regenerative processes, mainly on the endothelium. They stress the importance of factors that mobilize the adult stem cells from the bone marrow: cytokines, angyopoietine and other growth factors. The adult stem cells are mobilized as endothelial progenitor cells, which have a common origin with the endothelial cells from the hemangioblasts. The mobilizing factors are activated under hypoxia and promote the homing of the endothelial progenitor cells on the ischemic sites in order to generate the neovasculogenesis, which is accomplished through three possible mechanisms: angiogenesis (new capillaries from sprouts of the existing ones), arteriogenesis (related to collateral circulation) and vasculogenesis (actual new vessels). An appraisal of the literature is made with regard to animal and clinical sets Finally, they stress that adult stem cells, although bearing an enormous potential, still demand a considerable amount of work to become a current therapeutic method.

Published
2005
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8. COVID-19 diagnosis in a patient with critical limb ischemia: complications and clinical outcomes

Author

Soares, Rafael de Athayde, Vedovello, Rafael Salem, Medeiros, Samanta Christine Guedes de, Nunes, Celso Zaffani, Sian, Carlos Alberto, and Jorge, Paulo Daenekas de Melo

Subjects
critical limb ischemia, endovascular surgery, isquemia crítica, COVID-19, angioplasty, doença arterial obstrutiva periférica, peripheral occlusive arterial disease, gangrene, tratamento endovascular, angioplastia, gangrena
Abstract

A 67-year-old male diabetic patient with systemic arterial hypertension was admitted to the emergency department with a necrotic ulcer in the left external malleolus and no palpable popliteal or pedal pulses. Arterial Duplex ultrasound identified femoropopliteal occlusion, with popliteal refilling below the knee and a patent peroneal artery. An endovascular procedure was performed, requiring retrograde access to the popliteal artery to re-establish blood flow and deploy a popliteal stent. Technical success was achieved and the patient underwent debridement of the wound. Two days later, about 48 hours after the operation, the patient began to exhibit respiratory symptoms, with coughing and dyspnea. He immediately underwent a chest CT that identified ground glass opacities, the crazy-paving pattern, and bilateral air bronchogram in the lungs. A reverse transcription – polymerase chain reaction (RT-PCR) test was positive for SARS-Cov-2. The patient was moved to an intensive care unit and put on mechanical ventilation. Both hydroxychloroquine and azithromycin were administered. Despite appropriate treatment, the patient died 4 days after he was diagnosed with COVID-19. Resumo Paciente do sexo masculino, 67 anos, diabético, hipertenso, foi admitido no pronto-socorro com histórico de úlcera necrótica no maléolo externo esquerdo, sem pulsos poplíteos e distais palpáveis. A ultrassonografia Doppler arterial identificou oclusão femoropoplítea, com reenchimento da artéria poplítea infragenicular e perviedade da artéria fibular. Foi realizado procedimento endovascular, com necessidade de acesso retrógrado na artéria poplítea para restabelecer o fluxo sanguíneo e realizar implante de stent poplíteo. O sucesso técnico foi alcançado e, em seguida, o paciente foi submetido ao desbridamento da ferida. No segundo dia, cerca de 48 horas de pós-operatório, o paciente apresentou quadro respiratório com tosse e dispneia. Foi submetido a uma tomografia computadorizada do tórax, que identificou opacidades em vidro fosco e broncograma aéreo bilateralmente nos pulmões, com teste de reverse transcription – polymerase chain reaction (RT-PCR) positivo para SARS-Cov-2. O paciente foi transferido para uma unidade de terapia intensiva, necessitando de ventilação mecânica. Recebeu hidroxicloroquina e azitromicina. Apesar do tratamento em suporte intensivo, o paciente morreu 4 dias após o diagnóstico de COVID-19.

Published
2020

9. COVID-19 diagnosis in a patient with critical limb ischemia: complications and clinical outcomes

Author

Celso Zaffani Nunes, Carlos Alberto Sian, Paulo Daenekas de Melo Jorge, Samanta Christine Guedes de Medeiros, Rafael de Athayde Soares, and Rafael Salem Vedovello

Subjects
critical limb ischemia, medicine.medical_specialty, RD1-811, medicine.medical_treatment, Case Report, peripheral occlusive arterial disease, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, medicine.artery, Angioplasty, isquemia crítica, Medicine, Diseases of the circulatory (Cardiovascular) system, 030212 general & internal medicine, gangrene, angioplastia, gangrena, Gangrene, Mechanical ventilation, Peroneal Artery, business.industry, Stent, COVID-19, angioplasty, Critical limb ischemia, medicine.disease, Intensive care unit, Popliteal artery, Surgery, endovascular surgery, RC666-701, doença arterial obstrutiva periférica, medicine.symptom, tratamento endovascular, Cardiology and Cardiovascular Medicine, business
Abstract

A 67-year-old male diabetic patient with systemic arterial hypertension was admitted to the emergency department with a necrotic ulcer in the left external malleolus and no palpable popliteal or pedal pulses. Arterial Duplex ultrasound identified femoropopliteal occlusion, with popliteal refilling below the knee and a patent peroneal artery. An endovascular procedure was performed, requiring retrograde access to the popliteal artery to re-establish blood flow and deploy a popliteal stent. Technical success was achieved and the patient underwent debridement of the wound. Two days later, about 48 hours after the operation, the patient began to exhibit respiratory symptoms, with coughing and dyspnea. He immediately underwent a chest CT that identified ground glass opacities, the crazy-paving pattern, and bilateral air bronchogram in the lungs. A reverse transcription – polymerase chain reaction (RT-PCR) test was positive for SARS-Cov-2. The patient was moved to an intensive care unit and put on mechanical ventilation. Both hydroxychloroquine and azithromycin were administered. Despite appropriate treatment, the patient died 4 days after he was diagnosed with COVID-19.

Published
2020

10. Late presentation of critical upper limb ischemia caused by pseudarthrosis of the clavicle

Author

Miyamotto, Marcio, Sanvido, Lucas Vasconcelos, Brendolan, Luan Facttore, Cezar, Amilton, Neves, Giana Caroline Strack, de Souza, Izara Castro, and Moreira, Ricardo César Rocha

Subjects
Relato De Caso, critical ischemia, thoracic outlet syndrome, cardiovascular system, isquemia crítica, artéria subclávia, Case Report, cardiovascular diseases, subclavian artery, síndrome do desfiladeiro torácico
Abstract

Compression of the subclavian artery in the thoracic outlet is a well-known phenomenon. In rare cases, bone abnormalities, such as pseudarthrosis of the clavicle, can cause arterial compression at this level. Pseudarthrosis may develop as a result of trauma, which is the more common form, or it may be congenital. Here, the authors describe the case of a 44-year-old patient with critical ischemia of the right upper limb. She had a history of untreated right clavicle fracture at 9 months of age which had progressed to pseudarthrosis and extrinsic compression of the subclavian artery causing occlusion. The segment of the clavicle involved was resected and late thromboembolectomy of the subclavian, brachial, distal arteries was performed, with good results.

Published
2018

11. Usefulness of ultrasound-guided tibio-pedal access in patients with critical limb ischemia.

Author

Huici-Sanchez M, Martí-Mestre FJ, Martinez-Rico C, Espinar-Garcia E, Jiménez-Guiu X, Romera-Villegas A, and Vila-Coll R

Subjects
Aged, Chronic Limb-Threatening Ischemia, Female, Humans, Ischemia diagnostic imaging, Ischemia surgery, Male, Treatment Outcome, Ultrasonography, Interventional, Vascular Patency, Peripheral Arterial Disease
Abstract

Introduction: Retrograde access performed guided by fluoroscopy or ultrasound. We aimed to analyze the usefulness of ultrasound in retrograde access in patients with critical limb ischemia., Methods: Observational analytical study. From December 2013 to June 2019. We included all retrograde accesses that were guided by ultrasound. Our register assesses demographic and clinical data, the vessel used as retrograde access, the procedure performed, the amount of contrast agent used and time of fluoroscopy, access failure, and local complications., Results: On 715 procedures performed, was used ultrasound-guided retrograde access in 25 patients (64% men). The mean age was 74.8 years (45-90), with 92% of diabetics and 32% of chronic renal failure. Two patients with Rutherford stage 4 and 23 with stage 5-6. In 24 (96%) patients the ultrasound-guided puncture was successful, while in one (4%) of them, it was not possible to enter the target vessel. After the punch, was achieved the technical success of revascularization in 19 (79.2%) patients, with 5 (20.8%) in whom did not the arterial injury was not overcome. The arteries used as retrograde access were: anterior tibial 11, posterior tibial 10, and peroneal in 4. The mean of contrast used was 63 mL (9-100 mL) with an average time of 43 min (15-76 min). Complications related did not observe in retrograde access., Conclusions: Ultrasound-guided retrograde distal access is an effective method that may use as a bailout method in those endovascular procedures in which it is not possible to cross the lesion anterogradely., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2022
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12. Factors associated with outcome of endovascular treatment of iliac occlusive disease: a single-center experience

Author

Soares, Rafael de Athayde, Matielo, Marcelo Fernando, Brochado-Neto, Francisco Cardoso, Cury, Marcus Vinícius Martins, Costa, Veridiana Borges, Sanjuan, Maria Clara Pereira, Pecego, Christiano Stchelkunoff, and Sacilotto, Roberto

Subjects
endovascular treatment, critical limb ischemia, doença oclusiva líaca, claudicação limitante, incapacitating claudication, iliac occlusive disease, amputação maior, isquemia crítica, tratamento endovascular, major amputation
Abstract

Background Endovascular treatment (ET) of iliac occlusive disease (IOD) is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA), between January 2009 and January 2015. Patients with critical limb ischemia or incapacitating claudication were included. Results In total, 48 IA procedures were performed in 46 patients, with an initial technical success rate of 95.83%. Failure occurred in two patients, who were excluded, leaving 44 patients and 46 IA. The primary patency, secondary patency, limb salvage, and survival rates at 1200 days were 88%, 95.3%, 86.3%, and 69.9%, respectively. Univariate and multivariate Cox regression revealed that the primary patency rate was significantly worse in patients with TASC type C/D than in patients with TASC type A/B (p = 0.044). Analysis of factors associated with major amputation using Cox regression showed that the rate of limb loss was greater in patients with TASC type C/D (p = 0.043). Male gender was associated with reduced survival (p = 0.011). Conclusions TASC type C/D was associated with a higher number of reinterventions and with worse limb loss and primary patency rates. Male gender was associated with a worse survival rate after ET of IOD. Resumo Contexto O tratamento endovascular da doença oclusiva ilíaca (DOI) é bem estabelecido. O uso de stents nas angioplastias ilíacas (AI) alcançou estimativas de salvamento de membro e perviedade similares às de cirurgias abertas, porém com menor morbimortalidade. Objetivos Demonstrar os desfechos clínicos a longo prazo, principalmente as estimativas de salvamento de membro (ESM) e perviedade, do tratamento endovascular da DOI e os fatores associados. Método Estudo de coorte retrospectiva e consecutiva incluindo pacientes com DOI e isquemia crítica ou claudicação limitante submetidos a AI entre janeiro de 2009 a janeiro de 2015. Resultados Foram realizadas 48 AI em 46 pacientes, com uma taxa de sucesso técnico inicial de 95,83%. Ocorreu falha técnica em dois pacientes, os quais foram excluídos da análise, restando 44 pacientes e 46 AI. As estimativas de perviedade primária, perviedade secundária, ESM e sobrevida aos 1.200 dias foram de 88%, 95,3%, 86,3% e 69,9%, respectivamente. A regressão de Cox univariada e multivariada revelou que a perviedade primária foi pior em pacientes com classificação TASC C/D do que em pacientes TASC A/B (p = 0,044). Quando analisamos os fatores associados à amputação maior, verificou-se que lesões TASC tipo C/D (p = 0,043) apresentaram piores resultados. O sexo masculino foi associado com sobrevida reduzida (p = 0,011). Conclusões Classificação TASC tipo C/D foi associada a um maior número de reintervenções, maior perda de membro e piores estimativas de perviedade primária. O sexo masculino foi associado a uma pior sobrevida.

Published
2018

13. Factors associated with outcome of endovascular treatment of iliac occlusive disease: a single-center experience

Author

Roberto Sacilotto, Maria Clara Pereira Sanjuan, Veridiana Borges Costa, Francisco Cardoso Brochado-Neto, Rafael de Athayde Soares, Marcelo Fernando Matielo, Marcus Vinícius Martins Cury, and Christiano Stchelkunoff Pecego

Subjects
endovascular treatment, critical limb ischemia, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_treatment, lcsh:Surgery, 030204 cardiovascular system & hematology, Single Center, 03 medical and health sciences, 0302 clinical medicine, doença oclusiva líaca, claudicação limitante, Angioplasty, iliac occlusive disease, medicine, isquemia crítica, 030212 general & internal medicine, Survival rate, major amputation, business.industry, Proportional hazards model, Mortality rate, amputação maior, Retrospective cohort study, Critical limb ischemia, lcsh:RD1-811, Surgery, lcsh:RC666-701, incapacitating claudication, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Claudication, tratamento endovascular
Abstract

Background Endovascular treatment (ET) of iliac occlusive disease (IOD) is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA), between January 2009 and January 2015. Patients with critical limb ischemia or incapacitating claudication were included. Results In total, 48 IA procedures were performed in 46 patients, with an initial technical success rate of 95.83%. Failure occurred in two patients, who were excluded, leaving 44 patients and 46 IA. The primary patency, secondary patency, limb salvage, and survival rates at 1200 days were 88%, 95.3%, 86.3%, and 69.9%, respectively. Univariate and multivariate Cox regression revealed that the primary patency rate was significantly worse in patients with TASC type C/D than in patients with TASC type A/B (p = 0.044). Analysis of factors associated with major amputation using Cox regression showed that the rate of limb loss was greater in patients with TASC type C/D (p = 0.043). Male gender was associated with reduced survival (p = 0.011). Conclusions TASC type C/D was associated with a higher number of reinterventions and with worse limb loss and primary patency rates. Male gender was associated with a worse survival rate after ET of IOD. Resumo Contexto O tratamento endovascular da doença oclusiva ilíaca (DOI) é bem estabelecido. O uso de stents nas angioplastias ilíacas (AI) alcançou estimativas de salvamento de membro e perviedade similares às de cirurgias abertas, porém com menor morbimortalidade. Objetivos Demonstrar os desfechos clínicos a longo prazo, principalmente as estimativas de salvamento de membro (ESM) e perviedade, do tratamento endovascular da DOI e os fatores associados. Método Estudo de coorte retrospectiva e consecutiva incluindo pacientes com DOI e isquemia crítica ou claudicação limitante submetidos a AI entre janeiro de 2009 a janeiro de 2015. Resultados Foram realizadas 48 AI em 46 pacientes, com uma taxa de sucesso técnico inicial de 95,83%. Ocorreu falha técnica em dois pacientes, os quais foram excluídos da análise, restando 44 pacientes e 46 AI. As estimativas de perviedade primária, perviedade secundária, ESM e sobrevida aos 1.200 dias foram de 88%, 95,3%, 86,3% e 69,9%, respectivamente. A regressão de Cox univariada e multivariada revelou que a perviedade primária foi pior em pacientes com classificação TASC C/D do que em pacientes TASC A/B (p = 0,044). Quando analisamos os fatores associados à amputação maior, verificou-se que lesões TASC tipo C/D (p = 0,043) apresentaram piores resultados. O sexo masculino foi associado com sobrevida reduzida (p = 0,011). Conclusões Classificação TASC tipo C/D foi associada a um maior número de reintervenções, maior perda de membro e piores estimativas de perviedade primária. O sexo masculino foi associado a uma pior sobrevida.

Published
2018

14. Usefulness of ultrasound-guided tibio-pedal access in patients with critical limb ischemia.

Author

Huici-Sanchez M, Martí-Mestre FJ, Martinez-Rico C, Espinar-Garcia E, Jiménez-Guiu X, Romera-Villegas A, and Vila-Coll R

Abstract

Introduction: Retrograde access performed guided by fluoroscopy or ultrasound. We aimed to analyze the usefulness of ultrasound in retrograde access in patients with critical limb ischemia., Methods: Observational analytical study. From December 2013 to June 2019. We included all retrograde accesses that were guided by ultrasound. Our register assesses demographic and clinical data, the vessel used as retrograde access, the procedure performed, the amount of contrast agent used and time of fluoroscopy, access failure, and local complications., Results: On 715 procedures performed, was used ultrasound-guided retrograde access in 25 patients (64% men). The mean age was 74.8 years (45-90), with 92% of diabetics and 32% of chronic renal failure. Two patients with Rutherford stage 4 and 23 with stage 5-6. In 24 (96%) patients the ultrasound-guided puncture was successful, while in one (4%) of them, it was not possible to enter the target vessel. After the punch, was achieved the technical success of revascularization in 19 (79.2%) patients, with 5(20.8%) in whom did not the arterial injury was not overcome. The arteries used as retrograde access were: anterior tibial 11, posterior tibial 10, and peroneal in 4. The mean of contrast used was 63 mL (9-100 ml) with an average time of 43 minutes (15- 76 min). Complications related did not observe in retrograde access., Conclusions: Ultrasound- guided retrograde distal access is an effective method that may use as a bailout method in those endovascular procedures in which it is not possible to cross the lesion anterogradely., (Copyright © 2021 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Published
2021
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15. Tratamento endovascular de doença arterial obstrutiva abaixo do joelho: existem limites para a revascularização? – experiência de 5 anos de um centro

Author

Jacinta Campos, Rita Augusto, Alexandra Canedo, Pedro Sousa, Pedro Brandão, Fernando Marinho, Andreia Coelho, João Vasconcelos, Ricardo Gouveia, Daniel Brandão, and Miguel Lobo

Subjects
03 medical and health sciences, Endovascular techniques, 0302 clinical medicine, General Computer Science, Intervenções abaixo do joelho, 030204 cardiovascular system & hematology, Técnicas endovasculares, Isquemia crítica, Below‐the‐knee interventions, Critical ischemia, 030218 nuclear medicine & medical imaging
Abstract

ResumoIntroduçãoO tratamento endovascular das artérias infrageniculares é descrito como uma forma terapêutica eficaz em doentes com isquemia crítica. Associa‐se a elevadas taxas de limb salvage e baixa morbimortalidade. Com este trabalho propomos rever o nosso sucesso técnico e clínico no tratamento endovascular destas artérias, com ênfase nas lesões complexas, sobretudo quando é incerta a permeabilidade das artérias podais.Material e métodosAvaliamos retrospetivamente a experiência do serviço no tratamento endovascular de lesões infrageniculares, incluindo os doentes submetidos a primeiro procedimento por isquemia crítica de novo, durante o período de janeiro/2010 a agosto/2014 (275 doentes). Foram revistos os processos clínicos e os procedimentos angiográficos. Os principais outcomes avaliados foram: taxa de sucesso técnico, taxa de reintervenção, taxa de limb salvage e tempo de cicatrização lesional. Foi efetuada uma subanálise dos resultados relativos às oclusões longas.ResultadosO sucesso técnico no tratamento de estenoses infrageniculares foi de 98,9%. Identificaram‐se oclusões em 44,9% dos doentes (39,4% com pelo menos um eixo apresentando oclusão longa). A recanalização por via anterógrada foi tentada em todos os doentes e conseguida em 92,8%. Adicionalmente, 5,4% das lesões foram recanalizadas por via retrógrada com acesso distal. Foi efetuada a repermeabilização de oclusões longas em 23,6% dos doentes (27,2% destas não apresentavam outflow podálico antes da recanalização). A taxa de insucesso foi de 3,6. A taxa de reintervenção foi de 26,2%. A taxa de limb salvage a um ano foi de 91,3%. O tempo médio de cicatrização lesional foi de 5,3 meses. Observou‐se uma associação entre o maior número de eixos permeáveis até ao pé no fim do procedimento e o limb salvage (p=0,026), e uma associação inversa com o tempo de cicatrização (p=0,015). Para estes parâmetros foi identificada uma tendência para melhores resultados com a revascularização angiossómica (p=0,090 e 0,097, respetivamente).ConclusõesOs resultados apresentados são favoráveis e estão de acordo com literatura descrita nos centros especializados. O tratamento das lesões arteriais infrageniculares longas, mesmo perante situações em que é questionável inicialmente a permeabilidade das artérias podais, parece constituir uma forma de tratamento viável e com resultados favoráveis a curto/médio prazo.AbstractIntroductionEndovascular surgery is an effective way to treat below the knee disease in critical limb ischemia patients. It has been described to have high limb salvage rates with low associated morbidity and mortality. The purpose of this work is to review our results in below the knee endovascular procedures, focusing on complex below the knee lesions, particularly when it is uncertain if and which below the ankle and foot arteries are patent.Material and methodsWe did a retrospective analysis of our Department's experience in endovascular treatment of below the knee disease, including patients submitted to first procedures for a de novo critical limb ischemia, during the period from January/2010 to August/2014 (275 patients). We reviewed both clinical files and patients angiograms. The primary outcomes were: technical success rate, reintervention rate, limb salvage rate and lesion healing time. We did a subanalysis of the outcomes related to the treatment of long below the knee occlusions.ResultsTechnical success in treating below the knee stenosis was 98.9%. Below the knee occlusions were detected in 54.9% of the patients (39.4% with at least one vessel with a long occlusion). Antegrade recanalization was attempted in all patients and achieved in 92.8%. Distal retrograde recanalization was successful in another 5.4% of the patients. In 23.6% of the patients a long occlusion recanalization was performed (27.6% of these patients had no aparent foot outflow before the recanalization). Failure rate was 3.6%. Reintervention rate was 26.2%. Limb salvage rate was 91.3% (one‐year). The mean time for ulcer healing was 5.3 months. More tibial vessels patent at the end of the procedure was associated with higher limb salvage rate (p=0.026) and faster ulcer healing time (p=0.015). For these parameters the angiossomic revascularization had a tendency to be associated with better results (p=0.090 and 0.097 accordingly).ConclusionHence we present favourable results in the endovascular treatment of below the knee disease, comparable to specialized centres. The treatment of long below the knee occlusions can be achieved, even when there is doubt of below the ankle arteries patency, thus presenting good short and medium term results.

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16. Ainda há lugar para a revascularização ultradistal na era endovascular? A propósito de 2 casos clínicos

Author

Pedro Garrido, Gonçalo Sousa, Marco Pato, José Fernandes e Fernandes, Luís Mendes Pedro, Luís Silvestre, and Ruy Fernandes e Fernandes

Subjects
Ultra‐distal revascularization, Doença tíbio‐peroneal, Tibioperoneal disease, Salvação de membro, General Computer Science, Falência pós‐angioplastia, Limb salvage, Critical limb ischemia, Failed angioplasty, cardiovascular diseases, Isquemia crítica, Revascularização ultradistal
Abstract

ResumoA cirurgia endovascular tem atualmente um papel preponderante no tratamento de doentes com isquemia crítica (IC) por doença do sector tíbio‐peroneal, reduzindo substancialmente o número de procedimentos de revascularização aberta.No entanto, quando não é possível a abordagem endovascular ou na sua falência e existindo um padrão apropriado, podemos considerar a cirurgia de bypass distal ou ultradistal como uma alternativa válida na salvação do membro em doentes selecionados?Apresentam‐se neste artigo os casos de 2 doentes com isquemia crítica em que, pela ineficácia ou falência do tratamento endovascular inicial, foi efetuada uma cirurgia de revascularização ultradistal com salvação do membro.AbstractEndovascular interventions currently play a major role in the treatment of critical limb ischemia due to atherosclerotic disease of the infrapopliteal arteries. They are responsible for reducing the numbers of open surgical revascularization procedures.However, the question remains whether a surgical bypass to the pedal arteries should be considered as a valid option to avoid amputation, when an endovascular option is not feasible or has resulted in failure.We present two cases of critical limb ischemia, in which a first attempt at revascularization by an endovascular procedure was unsuccessful. In both cases ultradistal bypasses to the pedal arteries resulted in limb salvage.

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