RESUMEN
Non-traumatic or spontaneous dissection of the superficial femoral artery is an extremely rare entity, being more common in the external iliac artery in relation to intensive physical activity, pregnancy, among others. It has a variable clinical presentation. The diagnosis is made through angio-tomography (Angio-CT), angio-resonance (Angio-MR) and/or arteriography, the last one being diagnostic and therapeutic. The case of a 62-year-old female patient with a history of high blood pressure who consulted due to intense pain in the left lower limb is discussed. The diagnosis of dissection was made through arteriography and she underwent endovascular repair, showing favorable results.
RESUMEN
BACKGROUND: In-stent restenosis remains a common and important complication after endovascular treatment of superficial femoral artery peripheral artery disease. It occurs in 14 to 35% of cases in 1 year and there is still no efficient treatment for this condition. Paclitaxel-coated balloons have shown promising results. OBJECTIVE: Investigate the 3 year results of superficial femoral artery in-stent restenosis treated with paclitaxel-coated balloon angioplasty, using the Lutonix™ 035 device. METHODS: We conducted a retrospective observational study with patients with symptomatic (Rutherford 2 to 5) superficial femoral artery in-stent restenosis, that were treated with paclitaxel-coated balloon angioplasty using the Lutonix™ 035 device, in a single center from January 2016 to December 2020. Duplex scan was used to follow the patients. Primary patency was obtained through Kaplan-Meier analysis. Mortality, and amputation rates were also evaluated. RESULTS: 105 patients were included. Two patients had technical failure and required an additional stent, and were thus excluded. 103 patients were analyzed. Primary patency was 91.26, 80.47, and 67.71%, respectively, in the first, second, and third year after the procedure. There were no deaths 30 days after the procedure. There were no major amputations during the 3 year follow-up. CONCLUSION: Paclitaxel-coated balloon angioplasty with the Lutonix™ 035 device was a safe and effective treatment to superficial femoral artery in-stent restenoses. The results were maintained along the 3 year follow-up.
Asunto(s)
Angioplastia de Balón , Reestenosis Coronaria , Enfermedad Arterial Periférica , Humanos , Arteria Femoral/diagnóstico por imagen , Resultado del Tratamiento , Estudios de Seguimiento , Paclitaxel/efectos adversos , Grado de Desobstrucción Vascular , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Constricción Patológica , Materiales Biocompatibles Revestidos , Arteria PoplíteaRESUMEN
OBJECTIVE: The objective of the study was to present patients with peripheral vascular disease (PVD) who underwent hybrid procedures at our institution, the results of these interventions for a 5-year period and determine patency, mortality, failure, and amputation rates compared to the literature. MATERIAL AND METHODS: Observational, single center, retrospective, and cross-sectional study which analyzed data gathered from the vascular quality initiative from patients who had hybrid revascularization procedures from January 2010 to December 2015. RESULTS: 87 patients were identified: 51 (58%) male, 36 (41%) female, 9 (10%) had critical limb ischemia (CLI), and 78 (90%) claudication. We analyzed results of hybrid interventions in their variations. Technical success rate was 100%, patency at 2 years 88.5% (primary 65%, primary-assisted 18.3%, and secondary 4.5%) and 11.49% failure rate (lost patency < 1 year, conversion to open or/and amputation). Predictors of failure were: Female, previous chronic heart failure, longer length of stay, and previously transferred from another hospital. Amputation rate was 12.6% (10.3% major and 2.2% minor amputation), the only significant predictor was age (p = 0.035, odds ratio = 0.89) (0.806-99). CONCLUSIONS: Hybrid procedures are effective to treat patients with either CLI or claudication. Our study had outcomes comparable to the literature, with similar patency, amputation, and complication rates. We conclude it is a safe and effective option for PVD with multi-level disease.
OBJETIVO: Presentar pacientes con EAP que requirieron procedimientos híbridos en nuestra institución, resultados en 1 periodo de 5 años y determinar permeabilidad, mortalidad, falla y rangos de amputación comparado con la literatura. MATERIAL Y MÉTODOS: Estudio observacional un céntrico, retrospectivo y transversal que analizó datos obtenidos del VQI de pacientes post-revascularización híbrida de Enero 2010 a Diciembre 2015. RESULTADOS: Se identificaron 87 pacientes: 51 masculinos (58%) y 34 femeninos (41%). 9 (10%) presentaron isquemia crítica, 78 (90%) claudicación. Se analizaron resultados de dichas intervenciones en sus variaciones, con éxito técnico 100%, permeabilidad a 2 años 88.5% (primaria 65%, primaria asistida 18.3%, secundaria 4.5%) y 11.49% de falla (pérdida de permeabilidad < 1 año, conversión a cirugía abierta y/o amputación). Predictores de falla: femenino, IC, larga EIH, traslado de hospital previo). El rango de amputación fue 12.6% (10.3% mayor, 2-2% amputación menor) y el único predictor significativo fue edad (p = 0.035, OR = 0.89) (0.806-99). CONCLUSIONES: Los procedimientos híbridos son efectivos para tratar pacientes con isquemia crítica o claudicación. Nuestro estudio tuvo resultados similares a la literatura,permeabilidad, riesgo de amputación y complicaciones comparables con lo descrito. Concluimos que es una opción segura y efectiva para tratar pacientes con EAP multinivel.
Asunto(s)
Procedimientos Endovasculares , Enfermedad Arterial Periférica , Femenino , Humanos , Masculino , Amputación Quirúrgica , Estudios Transversales , Claudicación Intermitente/etiología , Claudicación Intermitente/cirugía , Isquemia/cirugía , Recuperación del Miembro , Enfermedad Arterial Periférica/cirugía , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Los aneurismas femorales son raros y más aún en la arteria femoral superficial. Estos representan solo el 3 por ciento de todos los aneurismas periféricos. El objetivo de este trabajo fue presentar el caso de un aneurisma verdadero aislado en arteria femoral superficial asociado a síndrome del dedo azul. Se reporta un paciente masculino de 75 años, fumador, con antecedentes patológicos personales de hipertensión arterial, que llega remitido con urgencia desde su área de salud por presentar cambios de coloración (cianosis), frialdad y dolor en la planta y los dedos del pie derecho (microembolias distales). En la tomografía computarizada contrastada se observó aneurisma aislado en la arteria femoral superficial de 4,5 cm de diámetro transversal. Se decidió operar al paciente y se realizó aneurismectomía con interposición de injerto protésico con politetrafluoroetileno, con una configuración de anastomosis término-terminal. Tuvo una evolución clínica posoperatoria inmediata y tardía satisfactoria. Entre los aneurismas femorales, los que afectan a la arteria femoral superficial están menos descritos y pueden complicarse con trombosis, embolización distal o rotura. Existe un alto consenso para su reparación, al eliminar la fuente embólica, prevenir la trombosis, tratar la rotura, eliminar cualquier efecto de masa y restaurar la perfusión de la extremidad distal. Dado que el síndrome del dedo azul puede ser la primera manifestación de esta enfermedad, su rápido reconocimiento, diagnóstico precoz de la fuente embolígena y tratamiento médico-quirúrgico pueden evitar la amputación mayor o la muerte del paciente(AU)
Femoral aneurysms are rare and even more so in the superficial femoral artery. These account for only 3 percent of all peripheral aneurysms. The objective of this study was to present the case of an true isolated aneurysm in the superficial femoral artery associated with blue finger syndrome. A 75-year-old male patient, smoker, with a personal pathological history of arterial hypertension, is reported to be urgently referred from his health area for presenting changes in coloration (cyanosis), coldness and pain in the sole and toes of the right foot (distal microembolisms). The contrasted computed tomography showed an isolated aneurysm in the superficial femoral artery of 4.5 cm transverse diameter. It was decided to operate on the patient and aneurysmectomy was performed with interposition of prosthetic graft with polytetrafluoroethylene, with a configuration of termino-terminal anastomosis. He had a satisfactory immediate and late postoperative clinical evolution. Among femoral aneurysms, those affecting the superficial femoral artery are less described and can be complicated by thrombosis, distal embolization, or rupture. There is a high consensus for their repair by removing the embolic source, preventing thrombosis, treating rupture, eliminating any mass effects and restoring perfusion of the distal limb. Since blue finger syndrome may be the first manifestation of this pathology, its rapid recognition, early diagnosis of the emboligenic source and medical-surgical treatment can prevent major amputation or death of the patient(AU)
Asunto(s)
Humanos , Masculino , Anciano , Diagnóstico Precoz , Arteria Femoral , Aneurisma , Tomografía Computarizada por Rayos X , HipertensiónRESUMEN
Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.
Pseudoaneurismas micóticos da artéria femoral superficial (AFS) são raros, e geralmente são secundários à colonização de uma placa aterosclerótica durante bacteremia. Relatamos o caso de um paciente masculino diabético de 68 anos que chegou ao Serviço de Emergência com pirexia e massa expansiva dolorosa na coxa esquerda. Apresentava histórico de diarreia e havia sido tratado 16 dias antes para pseudoaneurisma da AFS, que foi excluído com stent coberto e sem antibioticoterapia adjuvante. A angiotomografia computadorizada demonstrou um abscesso ao redor dos vasos femorais e trombose do stent. Sob anestesia geral, realizamos desbridamento extenso, remoção do material endovascular, ligadura de AFS e antibioticoterapia empírica. Culturas de sangue e tecidos foram positivas para Escherichia coli. Na consulta de seguimento aos 3 meses, o paciente negou claudicação. Em pacientes selecionados, pseudoaneurismas micóticos podem ser tratados com ligadura de AFS.
RESUMEN
Abstract Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.
Resumo Pseudoaneurismas micóticos da artéria femoral superficial (AFS) são raros, e geralmente são secundários à colonização de uma placa aterosclerótica durante bacteremia. Relatamos o caso de um paciente masculino diabético de 68 anos que chegou ao Serviço de Emergência com pirexia e massa expansiva dolorosa na coxa esquerda. Apresentava histórico de diarreia e havia sido tratado 16 dias antes para pseudoaneurisma da AFS, que foi excluído com stent coberto e sem antibioticoterapia adjuvante. A angiotomografia computadorizada demonstrou um abscesso ao redor dos vasos femorais e trombose do stent. Sob anestesia geral, realizamos desbridamento extenso, remoção do material endovascular, ligadura de AFS e antibioticoterapia empírica. Culturas de sangue e tecidos foram positivas para Escherichia coli. Na consulta de seguimento aos 3 meses, o paciente negou claudicação. Em pacientes selecionados, pseudoaneurismas micóticos podem ser tratados com ligadura de AFS.
Asunto(s)
Humanos , Masculino , Anciano , Aneurisma Infectado , Aneurisma Falso , Arteria Femoral , Muslo , Stents , Escherichia coli/patogenicidad , Procedimientos Endovasculares , FiebreRESUMEN
Purpose: To report the 12-month results of a multicenter, prospective, randomized controlled trial to determine if the ZILVER PTX paclitaxel-eluting stent was noninferior in terms of safety and efficacy compared with surgical bypass. Materials and Methods: This is a study in symptomatic TransAtlantic Inter-Society Consensus (TASC) C and D femoropopliteal lesions comparing endovascular ZILVER PTX stenting vs surgical bypass surgery using a prosthetic graft (ClinicalTrials.gov identifier NCT01952457). Between October 2013 and July 2017, 220 patients (mean age 68.6±10.5 years; 159 men) were enrolled and randomized to the ZILVER PTX treatment group (113, 51.4%) or the bypass treatment group (107, 48.6%). Most of the lesions were occlusions (208, 94.5%); the mean lesion length was 247.1±69.3 mm. The primary outcome measure was primary patency at 12 months, defined as no evidence of binary restenosis or occlusion within the target lesion or bypass graft based on a duplex-derived peak systolic velocity ratio <2.4 and no clinically-driven target lesion revascularization (TLR) in endovascular cases or reintervention to restore flow in the bypass. Results: The estimated 12-month primary patency rate was 74.5% (95% CI 66.3% to 82.7%) for the ZILVER PTX group vs 72.5% (95% CI 63.7% to 81.3%) for the bypass arm (p=0.998). Freedom from TLR at 12 months was 80.9% (95% CI 73.3% to 88.5%) for the ZILVER PTX group vs 76.2% (95% CI 68.0% to 84.4%) for the bypass group (p=0.471). The 30-day complication rate was significantly lower in the ZILVER PTX group (4.4% vs 11.3%, p=0.004). Also, procedure time and hospital stay were significantly shorter in the ZILVER PTX group (p<0.001 for both). Conclusion: With noninferior patency results, a lower complication rate, and shorter procedures and hospital stays, paclitaxel-eluting stenting might become a recommended treatment for long TASC C and D femoropopliteal lesions.
Asunto(s)
Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Stents Liberadores de Fármacos , Procedimientos Endovasculares/instrumentación , Arteria Femoral/cirugía , Paclitaxel/administración & dosificación , Enfermedad Arterial Periférica/terapia , Arteria Poplítea/cirugía , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular/efectos adversos , Brasil , Fármacos Cardiovasculares/uso terapéutico , Procedimientos Endovasculares/efectos adversos , Europa (Continente) , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Paclitaxel/efectos adversos , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/fisiopatología , Estudios Prospectivos , Diseño de Prótesis , Recurrencia , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
The development of post-catheterization arterial pseudoaneurysms is one of the most common vascular access complications following angiographies and endovascular interventions. Different therapeutic options to treat these lesions have been used. We herein report the case of a 79-year-old woman who was referred to our service for evaluation with a post-catheterization superficial femoral artery pseudoaneurysm measuring 4 cm. Owing to the anatomical location of the arterial pseudoaneurysm and the patient's refusal to undergo open surgery, we treated the lesion using an endovascular approach with a balloon tamponade. The procedure was successful, and the patient recovered well and was discharged from the hospital without complications. At 6-month follow-up she remained symptom-free and without recurrence.
RESUMEN
Isolated true aneurysms of the superficial femoral artery (SFA) are rare, accounting for 0.5% of peripheral aneurysms. The literature up to 2012 contains reports of just 103 patients with isolated SFA aneurysms. The main complications are thrombosis, distal embolization, and rupture, which is the most common of the three. The authors report the case of a 55-year-old male patient admitted to the emergency service with pain and a pulsatile mass in the left thigh, subsequently confirmed as rupture of an SFA aneurysm. The patient underwent open aneurysm repair with ligature and revascularization with a reversed saphenous vein bypass.
RESUMEN
Aneurismas verdadeiros isolados da artéria femoral superficial (AFS) são raros, representando 0,5% dos aneurismas periféricos. Até 2012, existiam relatos na literatura de apenas 103 pacientes com aneurismas verdadeiros isolados da AFS. As principais complicações associadas são: trombose, embolização distal e rotura, sendo a última a mais comum. Os autores relatam o caso de um paciente masculino, de 55 anos, atendido emergencialmente com dor e massa pulsátil em coxa esquerda, condição posteriormente diagnosticada como ruptura de aneurisma da AFS. O paciente foi submetido à correção cirúrgica emergencial com ligadura do aneurisma e revascularização com veia safena magna reversa, com evolução satisfatória
Isolated true aneurysms of the superficial femoral artery (SFA) are rare, accounting for 0.5% of peripheral aneurysms. The literature up to 2012 contains reports of just 103 patients with isolated SFA aneurysms. The main complications are thrombosis, distal embolization, and rupture, which is the most common of the three. The authors report the case of a 55-year-old male patient admitted to the emergency service with pain and a pulsatile mass in the left thigh, subsequently confirmed as rupture of an SFA aneurysm. The patient underwent open aneurysm repair with ligature and revascularization with a reversed saphenous vein bypass
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Arteria Femoral , Aneurisma , Vena Safena , Muslo , Trombosis , Factores Sexuales , Ultrasonografía/métodos , Extremidad Inferior , Procedimientos Endovasculares/métodosRESUMEN
PURPOSE: To describe a novel technique designed to safely and precisely deploy the Supera stent accurately at the ostium of the proximal superficial femoral artery (SFA) without compromising the profunda and common femoral arteries. TECHNIQUE: After antegrade crossing of the chronic total occlusion (CTO) at the SFA ostium and accurate predilation of the entire SFA lesion, a retrograde arterial access is obtained. The Supera stent is navigated in retrograde fashion to position the first crown to be released just at the SFA ostium. Antegrade dilation is performed across the retrograde access site to obtain adequate hemostasis. The technique has been applied successfully in 21 patients (mean age 78.1±8.2 years; 13 men) with critical limb ischemia using retrograde Supera stenting from the proximal anterior tibial artery (n=6), the posterior tibial artery (n=2), retrograde stent puncture in the mid to distal SFA (n=2), the native distal SFA/proximal popliteal segment (n=6), and the distal anterior tibial artery (n=5). No complications were observed. CONCLUSION: Distal retrograde Supera stent passage and reverse deployment allow precise and safe Supera stenting at the SFA ostium.
Asunto(s)
Angioplastia de Balón/instrumentación , Arteria Femoral , Isquemia/terapia , Enfermedad Arterial Periférica/terapia , Stents , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Constricción Patológica , Costa Rica , Enfermedad Crítica , Femenino , Arteria Femoral/diagnóstico por imagen , Humanos , Isquemia/diagnóstico por imagen , Italia , Masculino , Enfermedad Arterial Periférica/diagnóstico por imagen , Diseño de Prótesis , Resultado del Tratamiento , Estados UnidosRESUMEN
Femoral artery aneurysms are rare and generally affect elderly patients. They are often diagnosed in combination with aneurysms in other locations, such as peripheral and aortic aneurysms. This case report describes a young patient whose superficial femoral artery (SFA) had a clinical presentation suggestive of a ruptured aneurysm. The patient underwent standard treatment, with aneurysmectomy and interposition of the ipsilateral saphenous vein. A review of the literature confirms the rarity of this case.
Os aneurismas de artéria femoral são raros e ocorrem geralmente em pacientes idosos. Estão frequentemente associados a outros aneurismas, tanto periféricos como de aorta abdominal. O presente relato refere-se a um jovem portador de aneurisma de artéria femoral superficial (AFS), cuja apresentação clínica foi a ruptura. O paciente foi submetido ao tratamento convencional, com ressecção do aneurisma e interposição de veia safena magna ipsilateral. A revisão da literatura corrobora a raridade do caso.
Asunto(s)
Humanos , Masculino , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Arteria Femoral/patología , Angiografía/métodos , Cannabis/toxicidad , Cocaína/toxicidad , Ecocardiografía Doppler/métodosRESUMEN
Purpose: To evaluate the safety and effectiveness of a new system to facilitate intraluminaladvancement of conventional guidewires through chronic total occlusions (CTO) of thesuperficial femoral artery (SFA) and popliteal artery.Methods: The ENABLER-P Balloon Catheter System uses a unique balloon-anchoringmechanism and an automated balloon inflation device for steady, controlled advancementof a standard non-hydrophilic guidewire. The system was evaluated in 37 patients (22 men;mean age 67 years (range 4187) with femoropopliteal CTOs averaging 86 mm in length(range 10340). The device was used in a variety of occlusions, including heavily calcified,long, and fibrotic lesions. After successful guidewire recanalization facilitated by thesystem, occluded arterial segments were treated conventionally with balloon angioplasty,atherectomy, and stents as appropriate.Results: The primary endpoint of successful crossing was achieved in 86% (32/37) of theoverall study population. The average activation time for successful crossing was5.3 minutes (range 0.422). Of the 32 cases successfully crossed with the ENABLER-PSystem, all but 1 was successfully recanalized. One (3%) device-related complicationoccurred when the wire was advanced into a side branch when treating a 300-mm-longflush ostial SFA occlusion; the resulting perforation was managed with a covered stentwithout further sequelae.Conclusion: This novel system, which provides enhanced force to a standard guidewire tipfor controlled intraluminal advancement, is a promising device for the treatment ofperipheral CTOs.
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Angioplastia Coronaria con Balón , Arteria Femoral , Arteria Poplítea , Enfermedad Arterial PeriféricaRESUMEN
O aneurisma de artéria femoral superficial é um evento raro que costuma manifestar-se em pacientes com idade avançada, frequentemente associado a outros aneurismas, periféricos ou de aorta abdominal. O caso relatado refere-se a um paciente cujo aneurisma de artéria femoral superficial se apresentou roto e associado a um aneurisma de aorta abdominal. Foi submetido à revascularização cirúrgica fêmoro-poplítea mediante prótese de politetrafluoretileno, com sucesso. A revisão da literatura demonstra que embora haja uma tendência à manifestação aguda da doença, principalmente como ruptura, os resultados com o tratamento cirúrgico são excelentes.
Superficial femoral artery aneurysm is rare and usually occurs in elderly patients, often associated with peripheral or abdominal aortic aneurysms. In the reported case, the patient presented with a ruptured superficial femoral artery aneurysm associated with an abdominal aortic aneurysm. A successful femoropopliteal bypass was performed using a polytetrafluorethylene graft. Literature review shows that, despite the tendency for acute onset of the aneurysm, primarily with a rupture, surgical results are excellent.