Article Sidebar
Views PDF: 116
Outcomes of retrograde intervention for chronic lower extremity arterial disease at Hanoi Heart Hospital
Main Article Content
Abstract
Background: Chronic lower extremity arterial disease, mostly caused by atherosclerotic etiology, has been increasing in recent years. Currently, there has been a shift in the treatment of chronic lower extremity arterial disease from open surgical treatment to endovascular intervention, even with complex TASC, C, D lesions.
Objectives: Evaluate the results of retrograde intervention for chronic occlusive lesions of lower limb arteries.
Methods: From April 2021 to August, the cross sectional, descriptive study was carried out on 27 patients with lower limb artery disease, treated by retrograde intervention in Interventional Department, Hanoi Heart hospital. All patients were evaluated characteristics by clinical symptoms, ankle- brachial index and lesion characteristics before and after the intervention, complications, short -term results.
Results: Patients with severe claudication: 70.4%, severe limb ischemia: 29.6%, the average ABI was 0.59. The majority of lesions belong to TASC II C and D (96.3%). Retrograde vascular access was ATA: 33.3%, PTA: 22.2%, popliteal artery: 14.8% , distal SFA: 7.4%, CFA: 22.2%. Vascular access under ultrasound guidance is 92.6%, under DSA: 7.4%. Subinimal guide wire: 74.1%, intraluminal guide wire 25.9%. Technical success was 100%. There were 21 cases (77.8%) with stent placement, 6 cases (22.2%) with balloon dilatation alone. The post-procedure complication was pseudoaneurysm at the puncture site (7.4%). Target lesion revascularization (TLR) rate after 1 month was 100%, after 6 months was 83.3%.
Conclusions: Retrograde intervention to treat chronic occlusive lesions of lower extremity arteries is an effective, safe, and minimally invasive method. The "key" to performing retrograde intervention is distal vascular access.
Article Details
Keywords
peripheral artery disease, lower extremity artery disease, percutaneous transluminal angioplasty, retrograde access, retrograde intervention
References
2. Diehm C, Schuster A, Allenberg JR, Darius H, Haberl R, Lange S, Pittrow D, von Stritzky B, Tepohl G, Trampisch HJ. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross- sectional study. Atherosclerosis. 2004;172:95–105. doi: 10.1016/s0021-9150(03)00204-1
3. Grøndal N, Søgaard R, Lindholt JS. Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial). Br J Surg. 2015;102:902–906. doi: 10.1002/bjs.9825
4. Nguyen Lan Viet, Research on disease patterns of in-patients at the Vietnam Heart Institute during 2003-2007. Journal of Vietnamese Cardiology, 2010. 52: p. 11-17.
5. Banerjee S, Sarode K, Patel A, et al. Comparative assessment of guidewire and microcatheter vs a crossing device-based strategy to traverse infrainguinal peripheral artery chronic total occlusions. J Endovasc Ther. 2015;22(4):525–534.
6. Tepe G, Micari A, Keirse K, et al. Drug-coated balloon treatment for femoropopliteal artery disease: the chronic total occlusion cohort in the IN.PACT global study. JACC Cardiovasc Interv. 2019;12(5):484–493.
7. Vietnam National Heart Association, 2010 Recommendations on cardiovascular and metabolic diseases. Ho Chi Minh City Medical Publishing Company, 2010.
8. Norgren, L., et al., Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg, 2007. 45 Suppl S: p. S5-67.
9. Kudo, T., F.A. Chandra, and S.S. Ahn, The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J Vasc Surg, 2005. 41(3): p. 423-35; discussion 435.
10. Hoang Van, Short-term outcomes of endovascular therapy for chronic lower extremity arterial disease, the Vietnam Journal of Cardiovascular and Thoracic Surgery, Vol. Special, 2021 Dec, p.212 - 219
11. Gerhard-Herman, M.D., et al., 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017. 135(12): p. e686-e725.
12. Lee JH. Retrograde Tibio-Pedal Access Technique. J Cardiovasc Interv. 2023;2:e18. https://doi.org/10.54912/jci.2023.0005
13. Tips and tricks for a correct "endo approach". J Cardiovasc Surg (Torino). 2013 Dec;54(6):685-711. Authors. R Ferraresi 1, L M Palena, G Mauri, M Manzi
14. Ko, Y.G., et al., Improved technical success and midterm patency with subintimal angioplasty compared to intraluminal angioplasty in long femoropopliteal occlusions. J Endovasc Ther, 2007. 14(3): p. 374-81.
15. Ly Duc Ngoc, et al, Intervention results treatment of chronic total occlusion of the femoral artery at cardiovascular center – E hospital, the Vietnam Journal of Cardiovascular and Thoracic Surgery, Vol.40, 2023 Jan, p.37 – 46.
16. Dinh Huynh Linh, P.M.H., Nguyen Ngoc Quang, Nguyen Tuan Hai, Nguyen Anh Quan, Nguyen Thi Mai Huong, Dinh Thi Thu Huong, Short-term outcomes of endovascular therapy for chronic peripheral artery diseases. Journal of Vietnamese Cardiology, 2016. 75+76: p. 123-130.
17. Nguyen Duy Tan, T.Q.T., Outcomes of peripheral vascular interventions in patients with aortoiliac and lower extremity artery disease. vietnam medical journal, 2021. 498(n02 - January- 2021): p. 198-202.
18. Conrad, M.F., et al., Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J Vasc Surg, 2006. 44(4): p. 762-9.