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Complications of femoropopliteal and infrapopliteal arterial bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Frank M. Davis, Peter K. Henke
Selection of the proximal inflow source can include the profunda femoris artery, which may serve as a useful alternative inflow source. The mid-profunda femoris artery or distal profunda femoris artery is typically exposed by a longitudinal incision on the upper thigh, lateral to the sartorius muscle (Figure 27.1). The soft tissue is dissected until the sartorius muscle can be retracted medially. The superficial femoral artery is visualized and retracted medially as well. Dissection is carried out between the adductor magnus and the vastus medialis to expose the profunda femoris artery. Division of the lateral femoral circumflex vein overlying the profunda femoris artery may be necessary to provide adequate exposure. Additionally, the superficial femoral artery may be used as an alternate inflow source, provided it is free of proximal obstructive disease. If a vertical incision has been made in the groin, this can be extended distally. The sartorius muscle is retracted laterally to further expose the superficial femoral artery. The mid-superficial femoral artery and distal superficial femoral artery may be approached via a near vertical incision on the medial thigh near the posterior border of the sartorius muscle.
Single Best Answer Assessment
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
John McCafferty, James M Forsyth
An 80-year-old male patient comes to see you (his community physician) in your rural community practice. The patient is complaining of severe pain in his right foot and toes that is present all the time. He is struggling to sleep at night and is now forced to sleep sitting up in a chair. He has also developed a small ulcer on the great toe. These new symptoms started about 3 weeks ago. He also says that when he walks about 20 m he gets severe calf pain that forces him to stop. He has been getting this calf pain for years but it has been gradually worsening. On examination you can only feel a faint femoral pulse, but nothing distally. Using your wireless ultrasound probe you identify a heavily diseased common femoral artery with significantly reduced colour flow. The patient's superficial femoral artery also appears to have a number of areas of stenotic disease. Which of the following statements is correct?
The infrarenal aorta, aortic bifurcation, and iliac arteries: Advice about balloon angioplasty and stent placement
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
When femoral artery access is not possible on one side or the other and brachial artery access is suboptimal, another approach is retrograde access of the proximal superficial femoral artery. The artery should be relatively disease free. If the artery is 5 mm or larger and the access site is in the proximal few centimeters of the vessel, it can be closed with a closure device. If the superficial femoral artery is smaller or appears diseased, it is usually best to perform open exposure of the artery, undertake the procedure, and then close the artery with sutures.
Diabetic lumbosacral plexopathy: an unpredictable clinical entity
Published in Disability and Rehabilitation, 2023
Muhammad Faraz Jeddi, Roger Zebaze, Isabelle Urbano, Sarah Skinner, Vinamra Jain, Marc Budge
Ms S, a 59-year-old lady with a 10-year history of T2DM was urgently brought to the emergency department of a regional Hospital in Victoria, Australia, after recovering from an episode of cardiac arrest due to a pulseless electrical arrest (PEA). She sustained another episode of PEA whilst in the emergency department. She was intubated, required inotropic and vasopressor support, and transferred immediately to the intensive care unit (ICU). Urgent computed tomography pulmonary angiography (CTPA) revealed saddle pulmonary embolism (PE) at the bifurcation of the main pulmonary arteries and extending into the lobar and segmental vessels with involvement of the right side greater than the left (Figure 1). There was also extensive thrombosis occluding the left leg common and superficial femoral veins and extensive atherosclerosis occluding the length of her left superficial femoral artery. She received urgent thrombolysis with tenecteplase. She remained in ICU for a week after which she had recovered sufficiently to be transferred to the ward for ongoing management and rehabilitation.
Current perspectives on bioresorbable scaffolds in coronary intervention and other fields
Published in Expert Review of Medical Devices, 2021
Xinlei Wu, Sijing Wu, Hideyuki Kawashima, Hironori Hara, Masafumi Ono, Chao Gao, Rutao Wang, Mattia Lunardi, Faisal Sharif, William Wijns, Patrick W. Serruys, Yoshinobu Onuma
Igaki–Tamai BRS (Kyoto Medical Planning Co, Japan) is made of PLLA and it is drug-free. REMEDY stent is the successor of the Igaki–Tamai scaffold for peripheral arteries with a zig-zag helical design. The strut thickness is 0.17 mm. The Igaki–Tamai scaffold received the CE mark for application in peripheral arteries in November 2007. GAIA-DEB study enrolled 20 patients with symptomatic superficial femoral artery disease. The treatment provided angioplasty with a paclitaxel-coated balloon and subsequent implantation of the Igaki–Tamai BRS. At 12 months, 11 out of 19 patients have lost in-stent patency, and 8 patients had TLR [103]. In a prospective, observational study, 99 patients with femoral-popliteal stenosis or occlusion were included. The primary endpoint was the absence of clinically driven TLR at 12 months. TLR rate was 19% at 6 months and rose to 33% at 12 months. Primary patency was 68% at 6 months and 58% at 12 months. Unfortunately, the results were inferior to current metallic stent outcomes [104]. There are two ongoing trials of REMEDY stent. The first trial is the ALSTER study, which is a multi-center, global study enrolling up to 600 patients. The aim is to evaluate the safety and efficacy of the REMEDY stent for the treatment of superficial femoral artery and iliac lesions. The other is a smaller study named SPECTRUM study, where it will enroll 300 patients with peripheral artery disease in Germany and Austria.
Current utilization and future directions of robotic-assisted endovascular surgery
Published in Expert Review of Medical Devices, 2020
Peter Legeza, Gavin W. Britz, Thomas Loh, Alan Lumsden
The RAPID trial [28] evaluated the feasibility and safety of robotic technology using the CorPath 200 system for PVI. This prospective single-arm trial enrolled 20 patients with a total of 29 lesions. Primary endpoints were technical success and safety, secondary endpoints included clinical procedural success, fluoroscopy time, contrast volume, procedure time, and adverse events. The treated lesions (n = 29) distributed between the superficial femoral artery (89.7%) and the popliteal artery (10.3%). In 65.5% of the treated lesions, balloon angioplasty alone was performed, and in 34.5% of the lesions, provisional stenting was required. All stents were placed manually. The investigators reported 100% technical, safety and clinical success, and absence of significant adverse events. The favorable results of this trial led to the FDA clearance of the platform for PVI. Mean fluoroscopy time was 6.8 ± 3.4 min. In comparison, studies describing results of the conventional manual treatment of similar femoropopliteal lesions are reporting fluoroscopy times between 7.4 and 16.4 min [29–31].