VASCULAR DISEASE MANAGEMENT
September 2014, Vol. 11, No. 9
Retrograde Pedal Approach for Below-the-Ankle Revascularization in Patients With Critical Limb Ischemia
Luis Mariano Palena, MD; Marco Manzi, MD
From the Interventional Radiology Unit, Foot and Ankle Clinic, Policlinico Abano Terme, Abano Terme Padova, Italy.
Diabetic patients with critical limb ischemia (CLI) usually have significant multilevel arterial disease, very often with compromised outflow in pedal arteries. The combination of severe arterial occlusion with the increased blood flow requirement, necessary to achieve the healing of skin lesions or surgical incisions, makes this population particularly challenging to treat. Additionally, diabetic and CLI patients have a high rate of comorbidities, which increase surgical risks. Recent studies support the role of endovascular therapy in diabetic patients with CLI caused by below-the-knee (BTK) and below-the-ankle (BTA) arterial occlusive disease, as percutaneous angioplasty for BTK and BTA vascular disease has shown to be feasible and safe in this setting, with good results in terms of limb salvage and amputation-free survival rates. Nonetheless, success rate remains suboptimal in a significant percentage of patients, related to a diffuse arterial disease with tibial and pedal arteries involvement. In addition to the traditional approach, pedal-plantar loop technique, transcollateral recanalization, and retrograde percutaneous access have been shown to be beneficial in increasing success rates, achieving a complete and successful revascularization, necessary for limb salvage and ulcer healing, and avoiding amputations. We hereby propose an overview of our experience with the retrograde pedal techniques to improve the success rate in the endovascular treatment of diabetic foot.
Approach to Treatment of Refractory Type II Endoleaks
Parag Patel, MD1; Joseph Zechlinski, MD1; Jeff Elbich, MD2
From 1Medical College of Wisconsin, Milwaukee, and 2Medical College of Virginia, Richmond.
Endovascular repair of abdominal aortic aneurysms (EVAR) has been well established over the past two decades. However, high reintervention rates and delayed aneurysm rupture have been reported in early trials necessitating the need for continued surveillance. Endoleaks are the most common complication following EVAR. Management of these can often be problematic. Technical success is predicated on correct identification of the endoleak type. Type II endoleaks are most commonly seen. Successful treatment of continued aneurysm sac growth related to type II endoleaks can be approached by either transarterial or direct sac injection. However, complete exclusion of the inflow and outflow vessels contributing to backfilling of the aneurysm sac is required for successful long-term outcomes, namely prevention of continued aneurysm sac growth. Techniques to approach such repair of refractory type II endoleaks are discussed.
Popliteal Artery Occlusion After Total Knee Replacement: A Vascular Team Approach for Limb Salvage
Sohail Khan, MD; Hamid Salam, MD; John Kessels, MD
From St. Tammany Parish Hospital, Covington, Louisiana.
Popliteal artery occlusion is a rare complication of total knee arthroplasty with direct injury being the most common cause. We present an interesting case that presented to us 6 weeks after total knee arthroplasty with critical leg ischemia. The possible cause of the arterial occlusion was thought to be the knee implant compressing the popliteal artery. Timely communication between the wound care specialist, endovascular operator, and vascular surgeon led to limb salvage. Appropriate use of skin perfusion pressure as well as pedal access approach will also be discussed.
FDA Approval of Varithena Foam for Varicose Veins: An Interview With Marlin Schul, MD
Interview by Jennifer Ford
* Articles are subject to change at the editor’s discretion.