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Objective To evaluate the safety and efficacy of mechanical thrombectomy in treating in-stent restenosis of lower extremity arteriosclerosis obliterans. Methods From May 2015 to Sep 2016, the clinical data of 9 cases of lower extremity arteriosclerosis obliterans who were with in-stent restenosis(3 were stent graft)were retrospectively collected, and of which 7 were males and 2 were females with a mean age of (75.4 ± 6.3)years old. All the cases were treated by mechanical thrombectomy of Rotarex catheter. All the patients were diagnosed via low-extremity artery CTA, and treated by means of the Rotarex catheter, combined with angioplasty and stent if necessary. All patients received antiplatelet therapy. Doppler ultrasonography was taken during the followed-up. Results All the 9 cases were successed in technology, without complications in hospital. All patients received Rotarex mechanical thrombectomy. Six of which used balloon and 1 stent implanted. The ABI increased from 0.29 ± 0.07 to 0.88 ± 0.07 after treatment, the difference was statistically significant(t=28.875,P<0.05). All the patients were followed up for 3—18 (median time, 11.5)months. No death and symptoms recurrence appeared during the follow-up. Conclusions Mechanical thrombectomy using Rotarex catheter is a safe and effective treatment for in-stent restenosis in lower extremity arterial diseases.
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Objective To investigate the safety and clinical value of using ExoSeal vascular closure device (VCD) in interventional management via antegrade femoral access.Methods Clinical and imaging data of 303 patients (316 affected limbs) who were received interventional procedure via antegrade femoral access closure were retrospectively analyzed.ExoSeal VCD (VCD group,n=127) and manual compression (MC group,n =176) were performed to make femoral artery puncture point hemostasis.The time of hemostasis,actual immobilization time,technical success rate and vascular related complications were recorded and compared between the two groups.Results In VCD group and MC group,the time of hemostasis were (3.68 ± 2.40) min and (18.32 ± 4.54) min,the actual immobilization time were (3.45±5.30) h and (10.44±14.68) h,the technical success rates were 98.52％ (133/135) and 93.92％ (170/181),and the complication rates were 2.22％ (3/135) and 8.84％ (16/181),respectively.There were statistically significant differences between two groups (all P＜0.05).In VCD group,there were 2 cases of subcutaneous hematomas,and 1 case of retroperitoneal hematoma.In MC group,there were 15 cases of subcutaneous hematomas and 1 case of acute thrombosis in the puncture side limb.Conclusion Regarding hemostasis of puncture site in interventional management via antegrade femoral access,the use of ExoSeal VCD is safe and effective.
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Objective To explore the security and the short term efficacy of VIABAHN stents in the treatment of branching area lesions in lower extremity arterial diseases. Methods The data of 16 patients (11 male and 5 female, aged 59.0 to 81.0 with median of 71.6) with lower extremity arterial occlusive disease from November 2014 to June 2015 were analyzed retrospectively. All lesions were located around the branching area of the lower extremity artery (3 cases in the internal iliac artery orifice, 6 cases in the deep femoral artery orifice and 7 cases in the vascular net around the knee). The short?term effects on these patients in the follow-up period, such as the success rate of surgical technique, the improvement of symptoms and the incidence of complications were summarized. Results Revascularization was technically successful in all 16 patients, and ischemic symptoms relieved significantly after the operation. The ABI were 0.36±0.12 before and 0.89±0.10 after the operation. The patients were followed up for 3 to 9 months (median 5.5 months). All the patients were achieved limb salvage and no complication occurred. Conclusions VIABAHN stent is safe and effective for the treatment of lower extremity arterial occlusive disease. The branches around the lesion can be covered with VIABAHN stents.
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ObjectiveTo observe the short term efficacy and safety of cryoplasty in treatment of lower extremity arterial occlusive disease. MethodsTwenty five patients (27 limbs) scheduled for lower extremity artery balloon angioplasty were randomized to cryoplasty [ group CRYO, 10 patients with 8 male,age ( 76 ± 8 ) years]or conventional balloon angioplasty [ group COBA, 15 patients with 13 male, age ( 68 ±4) years], In CRYO group, the average lesion length and stenosis were (6.7 ±0.9) cm and, (91±6)％, respectively. The average ankle-brachial index (ABI) was 0. 46 ±0. 07 before treatment. According to Fontaine clinical stages, 7 patients (7/10) in this group were staged Ⅱ and the other 3 (3/10) were staged Ⅲ. According to Trans Atlantic Inter Society Consensus (TASC), 8 patients (8/10) were classified as TASC type A and the other 2 (2/10) were TASC type B. In COBA group, the average lesion length and stenosis were (6. 5 ± 0. 7 ) cm and ( 89 ± 7 ) ％, respectively. The average ABI was 0. 48 ± 0. 08 before treatment.According to Fontaine clinical stages, 13 patients (13/15) were stagedⅡand the other 2(2/15) were staged Ⅲ. And, according to TACS, 13 patients (13/15) were classified as TASC type A and the other 2 (2/15) were TASC type B. The clinical symptoms and signs had no significant difference between the two groups ( P ＞ 0. 05 ).Clinical status was evaluated according to Rutherford classification.The clinical efficacy on the 2nd and 30 th day after the operation was compared using analysis of variance with repeated measurements. ResultsTechnical success was achieved in all patients both in CRYO group (10/10) and in COBA group (15/15). None patient in CRYO group occurred postoperative complication.One patient in COBA group ( 1/15 ) occurred vessel wall dissection. In CRYO group, clinical status were remarkably improved in 8 patients (8/10) and moderately improved in 2 patients (2/10) ; while, in COBA group, they were remarkably improved in 13 patients ( 13/15 ) and moderately improved in 2 patients ( 2/15 ). The average ABI was 0. 84 ± 0. 04 in group CRYO and 0. 84 ± O. 05 in group COBA ( P ＝ 0. 20).The average stenosis was (29 ± 4) ％ in group CRYO and (32 ± 4) ％ in group COBA ( P ＝ 0. 55 ). No significant difference was detected between the two groups.Both the average ABI and stenosis presented statistically significant difference between pre-operation and post-operation in both groups ( P ＜ 0. 01,respectively).Conclusions Cryoplasty is safe for the treatment of lower extremity arterial occlusive disease, which showed a good short-term result in this research.
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The covered stents has been increasingly used in the prevention and treatment of the restenosis of the transjugular intrahepatic portosystemic shunt (TIPS), outcoming with obvious achievement, Viatorr stent-graft has been proved to be more efficient for the improvement of shunt patency. The purpose of the article is to review the formation, the character, the application and efficacy of the covered stents used in TIPS. With the improvement of covered stents, TIPS will regain its lost popularity in the treatment of portal hypertension.