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DOI | 10.1177/1526602817750211 |
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
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ISSN | 1526-6028 |
EISSN | 1545-1550 |
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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