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Superficial Femoral Artery
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The superficial artery is the femoral artery (large artery of the thigh) after the profunda femoris artery branch point (to differentiate the femoral artery segments before and after the branch point).
Arterial Kink and Damage in Normal Segments of the Superficial Femoral and Popliteal Arteries Abutting Nitinol Stents ? A Common Cause of Late Occlusion and Restenosis? A Single-Center Experience
Arterial Kink and Damage in Normal Segments of the Superficial Femoral and Popliteal Arteries Abutting Nitinol Stents ? Stenting across this area of bend with relatively stiff nitinol stents (stents that do not compress well longitudinally) can exacerbate the bend in the native artery at the ends of the stent and cause traumatic interaction between the native artery and the stent edge. A suboptimal angioplasty result led us to place a 7 mm x 150 mm Protégé stent in the old 6 mm x 100 mm ...
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Initial Experience in the Treatment of Chronic Superficial Femoral Artery Occlusion with Fiberoptic Guidance Technology
Background: Although procedural success rates for treating chronic occlusions are relatively high, dissections and perforations often require stenting. Methods: A fiberoptic guidance system that visualizes lesion characteristics and incorporates a radiofrequency energy source to aid in crossing total occlusions was used in three men and one woman with superficial femoral artery lesions that were 8?50 cm long and 5?144 months old. Results: Five lesions were attempted and successfully crossed, and there were no observed dissections or perforations. Ankle-brachial indexes returned to normal in two of the four patients. The guidance system was useful in visualizing and treating chronic total femoral occlusions.
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Popliteal Approach for Treatment of Flush Superficial Femoral Artery Occlusions ? A Percutaneous Alternative to Open Repair
A Percutaneous Alternative to Open Repair Feature: Popliteal Approach for Treatment of Flush Superficial Femoral Artery Occlusions ? Nitinol stents in the superficial femoral artery (SFA) have fared better than stainless steel self-expanding stents and balloon-expandable stents. In this case report, recanalization of an SFA chronic total occlusion (CTO) via the popliteal approach with use of a self-expanding nitinol stent graft (Viabahn, WL Gore & Associates, Flagstaff, Arizona) is ...
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Discussion question: Will drug-eluting stens have a major impact in prevention of restenosis after non-coronary interventions? From promise to emerging realities
From promise to emerging realities - VDM editorial board members share their thoughts Drug-eluting stents (DES) have revolutionized the treatment of obstructive coronary disease and expanding their applications to the periphery is inevitable. The in-stent mean percent diameter stenosis was 22.6% in the sirolimus-eluting stent group versus 30.9% in the uncoated stent group at 6-month follow-up (P=0.294). The in-stent mean lumen diameter was significantly larger in the sirolimus-eluting stent...
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Excimer Laser-Assisted Angioplasty in Severe Infrapopliteal Disease and CLI: The CIS "LACI Equivalent" Experience
Background: 12-month major amputation rates in ?true limb salvage? (Rutherford class 5-6 with established tissue loss) are reported as > 90% if nonrevascularable and 25% if revascularable. Twenty-four month mortality rates of > 40-50% are reported post amputation and < 50% will ambulate with a prosthesis. The encouraging Laser Angioplasty for Critical Limb Ischemia (LACI) 6-month limb salvage (LS) rate of 93% prompted adoption of excimer laser assisted angioplasty as one of our primary infrapopliteal treatments for ?TLS.? Methods: Between October 2001 ? October 2003, 62 patients (62 limbs) with Rutherford class 5-6 symptoms presented with severe infrapopliteal disease without single vessel ?straight line flow? to the foot. Seventy infrapopliteal arteries (IA) were treated, including posterior tibial 21/70 (30%), peroneal 16/70 (23%), anterior tibial 8/70 (11%), tibioperoneal trunk 14/70 (20%), and multiple 11/70 (16%). Thirty out of 62 (48%) and 22/62 (35%) required superficial femoral artery (SFA) and popliteal artery (PA) laser assisted angioplasty respectively. Five out of 62 (8%) patients required the ?step-by-step? technique. Results: Procedural success 59/62 (95.2%) with 9/62 (14.5%) requiring a secondary reintervention [bypass 2/62 (3.2%) and repeat laser angioplasty 7/62 (11.2%)] at mean 7 months (range 1-23 months). No periprocedural deaths or major surgical vascular complications. Four out of 62 (6.4%) had minor (< 3cm) hematomas. Six- and 12-month mortality rates were 3/37 (8.1%) and 4/24 (16.6%) respectively. Six- and 12-month LS rates were 34/37 (91.8%) and 20/24 (83.3%) respectively. Arteries stented included SFA 15/23 (65%), PA 4/12 (33%), and IA 7/62 (11.2%). Conclusion: Excimer laser assisted angioplasty is safe and effective in achieving 6- and 12-month LS in patients with severe infrapopliteal disease and advanced limb ischemia, therefore warranting further investigation.
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Endovascular-First Strategy in Patients with Critical Limb Ischemia
Purpose: To assess outcomes of percutaneous infrainguinal endovascular interventions as the initial therapeutic modality in patients with critical limb ischemia (CLI). Materials and Methods: We performed a retrospective review of 33 consecutive interventions in 29 patients over a period of 24 months at a single center. Mean follow-up was 11.4 months. Technical success was defined as the ability to obtain in-line arterial flow into the foot with less than a 20% residual stenosis using percutaneous techniques. Limb salvage was defined as the ability to avoid major level amputation (below or above knee). Follow-up included clinical examination and noninvasive vascular evaluation by color-flow duplex ultrasound. Results: Thirty-three limbs were treated for disabling claudication (n = 2), rest pain (n = 10) or ulceration/gangrene (n = 21). All patients were male. Technical success was achieved in 31 limbs (93.9%). Intra-procedural complications included clinically significant embolization (n = 2, successfully treated by thrombolysis) and acute respiratory failure (n = 1). Post-procedure complications included puncture site pseudoaneurysm necessitating operative repair (n = 1), and acute renal failure (n = 1). Two patients died within 30 days post-procedure of cardiac related events. Of those patients who had a technically successful procedure, 5 underwent a major level amputation during the follow-up period. The limb salvage rate was 83.9%. Conclusions: An ?endovascular-first? strategy can yield good limb salvage rates in patients with advanced lower extremity limb ischemia.
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Description of a New Angiographic Sign: Dynamic Left Subclavian Artery Obstruction
The arterial system is structurally dynamic with forces imparted upon it, causing torsion, kinking, and strain. After endovascular stent placement, these forces may ultimately lead to stent fractures, which have been well documented in the superficial femoral artery. The left subclavian artery has been thought to be relatively immobile in its proximal segment. We demonstrate two cases of dynamic left subclavian artery obstruction due to respiratory variation.
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Is Endovascular Treatment Going to Put Open Surgery Out of Business?
Endovascular surgery, like other forms of minimally invasive surgery, has developed considerably over the last decade, following the trend set by laparoscopic surgery. Level I evidence to support this surge in interventional techniques has been less convincing. This article reviews the development of stenting and endovascular surgery, drawing comparisons between outcomes following open and endovascular procedures.
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Long SFA Occlusion Recanalization Using the Outback Re-Entry Catheter
The patient is a 83-year-old diabetic woman with a non-healing ischemic ulcer of the plantar aspect of her left foot, in spite of aggressive wound care management. Non-invasive vascular tests revealed incompressible ankle vessels and toe pressures less than 25 mm Hg. An angiogram of the left lower extremity showed a long occlusion of the superficial femoral artery, reconstitution of a small but patent popliteal artery, and a single anterior tibial arterial runoff (Figure 1). Attempt at wire traversal of the SFA occlusion was not initially successful, due to subintimal passage of the wire and inability to re-enter the reconstituted true lumen of the popliteal artery.
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Percutaneous revascularization for SFA/popliteal arterial disease: how and when will endovascular techniques and devices become truly competitive with bypass surgery?
VDM editorial board members share their thoughts"> Percutaneous revascularization for SFA/popliteal arterial disease: how and when will endovascular techniques and devices become truly competitive with bypass surgery? Discussion Forum: Percutaneous revascularization for SFA/popliteal arterial disease: how and when will endovascular techniques and devices become truly competitive with bypass surgery? In each subset, endovascular SFA/popliteal therapy (ESPT) has become more truly competitive ...
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