Endovaskulárne techniky rekanalizácie femoropliteálnych okluzií

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Subintimal angioplasty for advanced lower extremity ischemia due to TASC II C and D lesions of the superficial femoral artery. Sidhu R et al. Vasc Endovascular Surg. 2010 Nov;44(8):633-7. Epub 2010 Jul 30 OBJECTIVE: Subintimal angioplasty (SA) has evolved into a viable revascularization procedure for complex lower extremity lesions. Although patency rates are lower than those for autogenous bypass, limb salvage rates are comparable. This study reviewed the 8-year experience of SA in a single center. METHODS: Records of patients undergoing SA were reviewed. Clinical presentation and noninvasive exams were used to classify patients. Lesions were categorized by TransAtlantic InterSociety Consensus (TASC) II guidelines. Outcomes included technical success, patency, amputation-free survival, and limb salvage. RESULTS: 120 patients with TASC II C/D lesions underwent SA. Technical success was 91%. Primary patency at 6 and 12 months was 90% and 73%. Secondary patency at 6 and 12 months was 94% and 85%. One-year amputation-free survival was 90%. One-year limb salvage was 98%. CONCLUSIONS: SA for TASC C/D lesions is a safe procedure and may be considered an alternative to bypass, especially in high-risk patients.
Clinical follow-up in endovascular treatment for TASC C-D lesions in femoro-popliteal segment. Rabellino M et al. Catheter Cardiovasc Interv 2009; 5: 701 - 705 Objective: To demonstrate the technical success and clinical follow-up after endovascular treatment of femoropopliteal segment TASC II C and D lesions. Methods: From July 2002 to February 2007, 234 limbs in 190 patients with femoropopliteal segment TASC II C (n = 112) and D (n = 122) lesions were treated. Endovascular treatment consisted of PTA, fibrinolysis and PTA, subintimal recanalization and PTA, and finally stent graft. Patients were clinically evaluated at 30 days, 3, 6 month, and at 1 year in the outpatient setting with clinical examination and ankle-brachial indices (ABI). In the case of stent placement, additional ultrasound evaluation was performed at 12, 24, and 48 month. Results: 49.5% of procedures were performed on patients with lifestyle-limiting claudication (IC) and 50.5% were performed for critical limb ischemia (CLI). Technical success, defined as successful recanalization and treatment of the occluded vessel, was achieved in 97% of cases. Periprocedural mortality was 3.15% and all deaths occurred in the CLI group. A follow-up 13 ± 6 months and was achieved in 76%. During the follow-up, clinical outcome for IC group and clinical CLI group was asymptomatic 72% vs. 29.8%, symptomatic with clinical improvement 22% vs. 33.7%, and major amputation 3% vs. 23.3%. Conclusion: The majority of claudicating patients with femoropopliteal TASC II C and D lesions will benefit from the endovascular treatment. Patient presenting CLI have a worse outcome, nevertheless the endovascular treatment can delay amputation, preserving the native vessel and does not impede surgical bypass if needed. For this reason, we consider that endovascular treatment may be the first choice treatment even in femoropopliteal TASC II C and D lesions. © 2009 Wiley-Liss, Inc.
Page 1 and 2: Rekanalizácia dlhých femoropoplit
Page 3: Techniky • intraluminálna rekana
Page 6 and 7: Výsledky na SÚSCCH a.s. • 05/20
Page 10: Kazuistika II • 58r. muž, DM II
Page 16: Komplikácie • 73r. žena prijat
Page 19 and 20: EBM: SIR vs BG Bypass: zlatý štan
Page 21: EBM: SIR vs BG Subintimal Angioplas
Page 25: Záver • EVL je vo fem-pop rieči

Endovaskulárne techniky rekanalizácie femoropliteálnych okluzií

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