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DOI10.1177/1526602817750211
Endovascular Distal Plantar Vein Arterialization in Dialysis Patients With No-Option Critical Limb Ischemia and Posterior Tibial Artery Occlusion: A Technique for Limb Salvage in a Challenging Patient Subset
Gandini, Roberto1; Merolla, Stefano1; Scaggiante, Jacopo1; Meloni, Marco2; Giurato, Laura2; Uccioli, Luigi2; Konda, Daniel1
通讯作者Merolla, Stefano
来源期刊JOURNAL OF ENDOVASCULAR THERAPY
ISSN1526-6028
EISSN1545-1550
出版年2018
卷号25期号:1页码:127-132
英文摘要

Purpose: To detail a percutaneous technique for distal plantar venous arterialization in diabetic, end-stage renal disease (ESRD) patients with no-option critical limb ischemia (CLI). Technique: After failure of standard intraluminal recanalization attempts, a subintimal approach through the posterior tibial artery (PTA) is begun using a 0.014-inch, 190- or 300-cm-long guidewire supported by a 2-x20-mm, low-profile balloon catheter positioned a short distance behind the narrow "U-shaped" loop in the guidewire. Typically, heavy calcification in the distal tortuous segment of the PTA prevents reentry to the arterial true lumen; however, an entry in the distal lateral or medial plantar vein from a subintimal channel in the plantar artery can be intentionally pursued as a bailout technique, pointing the tip of the guidewire opposite to the arterial wall calcifications. Venous access is confirmed by contrast injection through the balloon catheter. Once the guidewire is advanced in the distal lateral or medial plantar vein and a plantar arteriovenous fistula (AVF) has been created, the AV anastomosis and the occluded PTA segment are dilated with 0.014-inch balloon catheters. The technique has been attempted in 9 consecutive diabetic, ESRD patients (mean age 69 years; 5 men) with no-option CLI; an AVF was created between the PTA and plantar vein in 7 patients. The mean TcPO2 at 1 month was 30 +/- 17 mm Hg (vs 7.3 +/- 2.2 at baseline). Six ulcers healed over an average of 21 +/- 4 weeks. Three of the 9 patients had below-knee amputations. Conclusion: Although further investigations are required, distal plantar venous arterialization may represent a promising technique to improve recanalization rates and limb salvage in diabetic ESRD patients with extremely calcified PTA occlusions.


英文关键词arteriovenous fistula below-the-ankle revascularization critical limb ischemia desert foot ischemic ulcer limb salvage no-option CLI occlusion plantar vein posterior tibial artery subintimal recanalization vein arterialization
类型Article
语种英语
国家Italy
收录类别SCI-E
WOS记录号WOS:000422783900019
WOS关键词VENOUS ARTERIALIZATION ; FOOT ; METAANALYSIS ; ANGIOPLASTY ; OUTCOMES
WOS类目Surgery ; Peripheral Vascular Disease
WOS研究方向Surgery ; Cardiovascular System & Cardiology
资源类型期刊论文
条目标识符http://119.78.100.177/qdio/handle/2XILL650/210831
作者单位1.Univ Tor Vergata, Dept Diagnost & Mol Imaging Intervent Radiol & Ra, Viale Oxford 81, I-00133 Rome, Italy;
2.Univ Tor Vergata, Dept Syst Med, Rome, Italy
推荐引用方式
GB/T 7714
Gandini, Roberto,Merolla, Stefano,Scaggiante, Jacopo,et al. Endovascular Distal Plantar Vein Arterialization in Dialysis Patients With No-Option Critical Limb Ischemia and Posterior Tibial Artery Occlusion: A Technique for Limb Salvage in a Challenging Patient Subset[J],2018,25(1):127-132.
APA Gandini, Roberto.,Merolla, Stefano.,Scaggiante, Jacopo.,Meloni, Marco.,Giurato, Laura.,...&Konda, Daniel.(2018).Endovascular Distal Plantar Vein Arterialization in Dialysis Patients With No-Option Critical Limb Ischemia and Posterior Tibial Artery Occlusion: A Technique for Limb Salvage in a Challenging Patient Subset.JOURNAL OF ENDOVASCULAR THERAPY,25(1),127-132.
MLA Gandini, Roberto,et al."Endovascular Distal Plantar Vein Arterialization in Dialysis Patients With No-Option Critical Limb Ischemia and Posterior Tibial Artery Occlusion: A Technique for Limb Salvage in a Challenging Patient Subset".JOURNAL OF ENDOVASCULAR THERAPY 25.1(2018):127-132.
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