Document Detail

Implications of in situ thrombosis and distal embolization during superficial femoral artery endoluminal intervention.
MedLine Citation:
PMID:  19748214     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endoluminal therapy for superficial femoral artery (SFA) occlusive disease is commonplace, but the incidence and outcomes of in situ thrombosis (IST) and distal embolization (DE) have not been well defined. The aim of this study was to examine the impact of IST and DE on long-term outcomes of SFA interventions. METHODS: A database of patients undergoing endovascular treatment of the SFA was queried. Patients who developed either IST treated by pharmacomechanical lytic therapy or DE were selected and compared to those without either event (control). Kaplan-Meier survival analyses were performed to assess time-dependent outcomes, with 2-year outcomes reported. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. RESULTS: There were 818 limbs that underwent endovascular treatment for symptomatic SFA disease (59% for claudication and 41% rest pain and tissue loss). In the control group, 69% underwent angioplasty, 16% underwent primary stenting, and 15% underwent laser/directional atherectomy. In the IST group, these numbers were 41%, 28%, and 31%, respectively, while in the DE group they were 35%, 32%, and 33%, respectively. Overall the rates were 7.3% with 3.5% suffering IST (all treated with lytic therapy) and 3.8% suffering DE (68% treated percutaneously and the remainder treated by embolectomy). Females were more likely to experience either event. Compared to the control group, only one-third of the patients who suffered DE had primary angioplasty, while the remainder underwent primary stenting or laser/directional atherectomy. There was no difference in primary, assisted primary, or secondary patency rates between the control and DE groups. DE resulted in significantly lower limb salvage (87 + or - 2% vs. 68 + or - 8%, control vs. DE, p<0.05) and freedom from recurrent symptoms (73 + or - 2% vs. 69 + or - 8%, control vs. DE, p<0.05), while IST treated with lytic therapy was associated with lower patency (67 + or - 2% vs. 37 + or - 6% primary, 77 + or - 2% vs. 41 + or - 9% assisted primary, and 79 + or - 2% vs. 44 + or - 9%, secondary, control vs. IST, p<0.01). There was no difference in outcomes based on whether surgical or percutaneous therapy was used to treat DE. While preoperative tibial runoff did not influence limb loss after DE, it was significantly associated with decreased patency after IST. CONCLUSION: DE during SFA interventions is associated with limb loss independently of preoperative runoff and subsequent intervention while the use pharmacomechanical lytic therapy for IST is associated with loss of patency but equivalent limb salvage and freedom from recurrent symptoms.
Mark G Davies; Jean Bismuth; Wael E Saad; Joseph J Naoum; Imran T Mohiuddin; Eric K Peden; Alan B Lumsden
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Publication Detail:
Type:  Journal Article     Date:  2009-09-11
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-04-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  14-22     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, 6550 Fannin, Smith Tower, Suite 1401, Houston, TX 77030, USA.
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MeSH Terms
Aged, 80 and over
Angioplasty / adverse effects*,  instrumentation
Arterial Occlusive Diseases / mortality,  physiopathology,  therapy*
Atherectomy / adverse effects*
Case-Control Studies
Constriction, Pathologic
Databases as Topic
Embolism / etiology*,  mortality,  physiopathology,  therapy
Factor Analysis, Statistical
Femoral Artery* / physiopathology
Kaplan-Meiers Estimate
Limb Salvage
Middle Aged
Proportional Hazards Models
Risk Assessment
Risk Factors
Thrombolytic Therapy / adverse effects
Thrombosis / etiology*,  mortality,  physiopathology,  therapy
Time Factors
Treatment Outcome
Vascular Patency

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