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Intraprocedural Distal Embolization After Femoropopliteal Angioplasty: Is There a Role for Below-the-Knee Stents?

  • Clinical Investigation
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Abstract

Purpose

Intraprocedural distal embolization is an accepted complication of femoropopliteal angioplasty. The purpose of this study is to assess the use of below-the-knee stents in the “bail-out” of conventional methods.

Materials and Methods

We retrospectively reviewed 1485 of femoropopliteal angioplasties that were performed in our centre in a 4-year period and analysed 12 cases (<1%) where distal embolization that required further intervention occurred. In all cases lesions were chronic and 75% suffered from critical limb ischaemia. The target vessel was the SFA in all of the cases with a long (>10 cm) occlusion in 50%. A three-vessel run-off was present in only 25%. Patients that received a stent as a limb salvage attempt were analysed. Outcome measures were technical success, clinical success and procedure-related complications. Multivariate regression analysis of the factors related to stenting was also performed.

Results

In 41% of the cases with distal embolization, recanalization with aspiration, thrombolysis or angioplasty offered a satisfactory result. In 59%, conventional methods were ineffective; a stent was deployed in 85%, whereas in 15% surgical embolectomy was required. Technical and clinical success of the stent cases was 100% without any procedure-related complications. There was significance (p < 0.05) between critical limb ischaemia and stenting; single-vessel run-off has also shown a positive trend (p = 0.88).

Conclusion

Stents appear as a valid salvage option for infragenicular distal embolization when conventional methods fail; the likelihood of having to use a stent is higher for patients with critical limb ischaemia and a single-vessel run-off.

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References

  1. Katsanos K, Tepe G, Tsetis D, Fanelli F. Standards of practice for superficial femoral and popliteal artery angioplasty and stenting. Cardiovasc Intervent Radiol. 2014;37(3):592–603.

    Article  PubMed  Google Scholar 

  2. Karnabatidis D, Katsanos K, Kagadis GC, et al. Distal embolism during percutaneous revascularization of infra-aortic arterial occlusive disease: an underestimated phenomenon. J Endovasc Ther. 2006;13(3):269–80.

    Article  PubMed  Google Scholar 

  3. Axisa B, Fishwick G, Bolia A, Thompson MM, London NJ, Bell PR, Naylor AR. Complications following peripheral angioplasty. Ann R Coll Surg Engl. 2002;84(1):39–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Schrijver AM, De Borst GJ, Van Herwaarden JA, Vonken EJ, Moll FL, Vos JA, De Vries JP. Catheter-directed thrombolysis for acute upper extremity ischaemia. J Cardiovasc Surg. 2015;56(3):433–9.

    CAS  Google Scholar 

  5. Schrijver AM, de Vries JP, van den Heuvel DA, Moll FL. Long-term outcomes of catheter-directed thrombolysis for acute lower extremity occlusions of native arteries and prosthetic bypass grafts. Ann Vasc Surg. 2016;31:134–42.

    Article  PubMed  Google Scholar 

  6. Weitsman T, Meerkin D. Primary percutaneous coronary intervention: devices to prevent no-reflow phenomenon. Interv Cardiol. 2013;5:289–300.

    Article  Google Scholar 

  7. Fojik SP, Kronick LS. Cardiovascular innovations: novel mechanical aspiration system to improve thrombus aspiration speed, force, and control. Cardiovasc Revasc Med. 2013;14:160–3.

    Article  Google Scholar 

  8. Benenati JF, Saxon RR, Schonholz C, et al. Indigo percutaneous mechanical thrombectomy system. Endovasc Today. 2014;13:102–7.

    Google Scholar 

  9. Gandini R, Merolla S, Chegai F, Del Giudice C, Stefanini M, Pampana E. Foot embolisation during limb salvage procedures in critical limb ischaemia patients successfully managed with mechanical thromboaspiration: a technical note. J Endovasc Ther. 2015;22(4):558–63.

    Article  PubMed  Google Scholar 

  10. Lee MS, Singh V, Wilentz JR, Makkar RR. AngioJet thrombectomy. J Invasive Cardiol. 2004;16:587–91.

    PubMed  Google Scholar 

  11. Spiliopoulos S, Theodosiadou V, Katsanos K, et al. Long-term clinical outcomes of infrapopliteal drug-eluting stent placement for critical limb ischaemia in diabetic patients. J Vasc Interv Radiol. 2015;26(10):1423–30.

    Article  PubMed  Google Scholar 

  12. Canaud L, Ozdemir BA, Belli AM, Loftus IM, Thompson MM, Hinchliffe RJ. Infrainguinal angioplasty with drug-eluting stents and balloons. J Vasc Surg. 2014;59(6):1721–36 (Review).

    Article  PubMed  Google Scholar 

  13. Sacks D, McClenny TE, Cardella JF, et al. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:199–202.

    Article  Google Scholar 

  14. Sacks D, Marinelli DL, Martin LG, Spies JB. Society of Interventional Radiology Technology Assessment Committee. Reporting standards for clinical evaluation of new peripheral arterial revascularization devices. J Vasc Interv Radiol. 2003;14:S395–404.

    Article  PubMed  Google Scholar 

  15. Axisa B, Fishwick G, Bolia A, et al. Complications following peripheral angioplasty. Ann R Coll Surg Engl. 2002;84:39–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. McDermott JC, Crummy AB. Complications of angioplasty. Semin Interv Radiol. 1994;11:145–9.

    Article  Google Scholar 

  17. Sturm E, Goldberg D, Goldberg S. Embolic protection devices in saphenous vein graft and native vessel percutaneous intervention: a review. Curr Cardiol Rev. 2012;8(3):192–9 (Review).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Morrissey NJ. When is embolic protection needed in lower extremity interventions and how should it be done. J Cardiovasc Surg. 2012;53:173–5.

    CAS  Google Scholar 

  19. Lam RC, Shah S, Faries PL, et al. Incidence and clinical significance of distal embolization during percutaneous interventions involving the superficial femoral artery. J Vasc Surg. 2007;46:1155–9.

    Article  PubMed  Google Scholar 

  20. Brancaccio G, Lombardi R, Stefanini T, et al. Comparison of embolic load in femoro-popliteal interventions: percutaneous transluminal angioplasty versus stenting. Vasc Endovasc Surg. 2012;46:229–35.

    Article  Google Scholar 

  21. Kastrup A, Gröschel K, Krapf H, et al. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke. 2003;34:813–9.

    Article  PubMed  Google Scholar 

  22. Karnabatidis D, Katsanos K, Kagadis GC, et al. Distal embolism during percutaneous revascularization of infra-aortic arterial occlusive disease: an underestimated phenomenon. J Endovasc Ther. 2006;13(3):269–80.

    Article  PubMed  Google Scholar 

  23. Mix JW, Stevens SL. Commentary. Lam RC, Shah S, Faries PL, McKinsey JF, Kent KC, Morrissey NJ. Incidence and clinical significance of distal embolization during percutaneous interventions involving the superficial femoral artery. J Vasc Surg. 2007;46:1155–1159. Perspect Vasc Surg Endovasc Ther. 2008;20(4):387–8.

  24. Spiliopoulos S, Katsanos K, Fragkos G, Karnabatidis D, Siablis D. Treatment of infrainguinal thromboembolic complications during peripheral endovascular procedures with AngioJet rheolytic thrombectomy, intraoperative thrombolysis, and selective stenting. J Vasc Surg. 2012;56(5):1308–16.

    Article  PubMed  Google Scholar 

  25. Karnabatidis D, Spiliopoulos S, Tsetis D, Siablis D. Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischaemia. Cardiovasc Interv Radiol. 2011;34:1123–36.

    Article  Google Scholar 

  26. Müller-Hülsbeck S, Jahnke T, Liess C, Glass C, et al. In vitro comparison of four cerebral protection filters for preventing human plaque embolization during carotid interventions. J Endovasc Ther. 2002;9:793–802.

    PubMed  Google Scholar 

  27. Sangiorgi G, Colombo A. Embolic protection devices. Heart. 2003;89:990–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Tendera M, Aboyans V, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2851–906.

    Article  PubMed  Google Scholar 

  29. Anderson JL, Halperin JL, Albert N, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:1555–70.

    Article  Google Scholar 

  30. Katsanos K, Spiliopoulos S, Krokidis M, Karnabatidis D, Siablis D. Does below-the-knee placement of drug-eluting stents improve clinical outcomes? J Cardiovasc Surg. 2012;53:195–203.

    CAS  Google Scholar 

  31. Scheinert D, Katsanos K, Zeller T, et al. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. J Am Coll Cardiol. 2012;60:2290–5.

    Article  PubMed  Google Scholar 

  32. Rastan A, Tepe G, Krankenberg H, et al. Sirolimus-eluting stents vs. bare-metal stents for treatment of focal lesions in infrapopliteal arteries: a double-blind, multi-centre, randomized clinical trial. Eur Heart J. 2011;32:2274–81.

    Article  CAS  PubMed  Google Scholar 

  33. Galanakis N, Kontopodis N, Peteinarakis I, Kehagias E, Ioannou CV, Tsetis D. Direct stenting in patients with acute lower limb arterial occlusions: immediate and long-term results. Cardiovasc Intervent Radiol. 2017;40(2):192–201.

    Article  PubMed  Google Scholar 

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Correspondence to Miltiadis Krokidis.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Krokidis, M., Ali, T., Hilliard, N. et al. Intraprocedural Distal Embolization After Femoropopliteal Angioplasty: Is There a Role for Below-the-Knee Stents?. Cardiovasc Intervent Radiol 40, 1155–1163 (2017). https://doi.org/10.1007/s00270-017-1621-5

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  • DOI: https://doi.org/10.1007/s00270-017-1621-5

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