Amro Ahmed, Aqtash Obadah, Elhamdani Adee, El-Hamdani Mehiar
Department of Cardiovascular Services, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
Case Rep Vasc Med. 2018 Dec 25;2018:9543250. doi: 10.1155/2018/9543250. eCollection 2018.
Kissing Balloon Technique using retrograde pedal approach together with anterograde common femoral artery (CFA) approach could be the treatment of choice in patients with diseased infrapopliteal artery bifurcation. We report seven cases where the KBT was utilized for the treatment of diseased infrapopliteal artery bifurcation using retrograde pedal access in conjunction with the conventional common femoral artery (CFA) access.
We reviewed all seven cases that underwent KBT with the combination of pedal and common femoral access in a single-center study from 2014 to 2015 utilizing Rutherford classification severity index; all cases were deemed stage 3 (severe claudication) to stage 6 (severe ischemic ulcers or frank gangrene). With the exception of two cases, contralateral femoral access was obtained, with sheath sizes varying from 4 to 6 French for both CFA and pedal access. Ultrasound was utilized for ipsilateral pedal access in all seven cases.
Arterial revascularization was successfully achieved by the KBT in all patients without any complications. All patients achieved procedural success, which is defined as residual stenosis of less than 30% with no dissection or thrombosis and clinical success that is defined as resolution of symptoms (absence of intermittent claudication and healing of the ulcer) as well as improvement in the arterial brachial index (ABI). During follow-up, out of the seven cases, repeat angiogram was performed for one case, which showed patent arteries with no residual lesions.
In patients with popliteal and tibioperoneal trunk bifurcation lesions, Kissing Balloon Technique using retrograde pedal access in conjunction with the conventional anterograde access appeared to be successful, safe, and effective technique with lower access site complications and shorter procedure time.
采用逆行足背入路联合顺行股总动脉（CFA）入路的亲吻球囊技术可能是腘下动脉分叉病变患者的首选治疗方法。我们报告了7例使用逆行足背入路联合传统股总动脉（CFA）入路的亲吻球囊技术治疗腘下动脉分叉病变的病例。
我们回顾了2014年至2015年在单中心研究中接受亲吻球囊技术联合足背和股总动脉入路的所有7例病例，采用卢瑟福分类严重程度指数；所有病例均被判定为3期（重度间歇性跛行）至6期（严重缺血性溃疡或明显坏疽）。除2例病例外，均获得对侧股动脉入路，CFA和足背入路的鞘管尺寸为4至6法国规格。所有7例病例均使用超声进行同侧足背入路。
所有患者均通过亲吻球囊技术成功实现动脉血运重建，无任何并发症。所有患者均获得手术成功，定义为残余狭窄小于30%，无夹层或血栓形成，临床成功定义为症状缓解（无间歇性跛行且溃疡愈合）以及动脉肱指数（ABI）改善。随访期间，7例病例中有1例进行了重复血管造影，显示动脉通畅，无残余病变。
对于腘动脉和胫腓干分叉病变患者，采用逆行足背入路联合传统顺行入路的亲吻球囊技术似乎是一种成功、安全且有效的技术，具有较低的入路部位并发症和较短的手术时间。
