Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer 52621, Ramat Gan, Affiliated to "Sackler" School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer 52621, Ramat Gan, Affiliated to "Sackler" School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Vasc Interv Radiol. 2019 Apr;30(4):554-559. doi: 10.1016/j.jvir.2018.08.030. Epub 2019 Mar 1.
To evaluate the dorsalis pedis artery (DPA) approach as a single access site for revascularization in patients with critical limb ischemia (CLI) when the femoral approach is hostile or unavailable.
A retrospective review of patients who underwent iliac and femoropopliteal ipsilateral revascularization via a single access site from the DPA between January 2017 and February 2018 was performed. Fifteen limbs in 15 patients (10 men and 5 women; average age 72 y; range, 49-96 y) with CLI and unavailable femoral access were included. Patients were unsuitable candidates for a surgical bypass graft. Treated limbs were classified as Rutherford category 5 and 6 in 12 patients and category 4 in 3 patients. Treated occluded segments involved 2 iliac arteries, 12 femoropopliteal arteries, 1 bypass graft, and 2 posterior tibial arteries. Technical success was defined as recanalization of the occluded artery with residual stenosis < 30% and improvement in ankle-brachial index after 24 hours. Patients were followed for up to 13 months. Endpoints were freedom from reintervention and limb salvage for 1 year.
Technical success was achieved in 14 of 15 patients (93%). Stents were placed in 13 of 15 patients (86%). No complications were encountered immediately after the procedure. Median follow-up was 7.1 months (range, 1.4-13.5 mo). One patient was lost to follow-up. Reintervention was needed in 5 limbs after an average of 4.2 months. Limb salvage rate at 1 year was 83%.
Using the DPA as a single access could be a valuable approach when traditional access sites are unavailable for treating patients with CLI.
当股动脉入路存在敌对或不可用时，评估足底动脉（DPA）入路作为治疗严重肢体缺血（CLI）患者的单一血运重建入路的效果。
回顾性分析了 2017 年 1 月至 2018 年 2 月期间通过 DPA 单一入路进行同侧髂动脉和股腘动脉血运重建的患者。共纳入 15 例患者的 15 条肢体（男 10 例，女 5 例；平均年龄 72 岁；年龄范围 49-96 岁），这些患者存在 CLI 和不可用的股动脉入路。患者不适合进行外科旁路移植。治疗的肢体在 12 例患者中被分为 Rutherford 5 级和 6 级，在 3 例患者中被分为 4 级。治疗的闭塞段包括 2 条髂动脉、12 条股腘动脉、1 条旁路移植血管和 2 条胫后动脉。技术成功定义为闭塞动脉再通，残余狭窄<30%，24 小时后踝肱指数改善。患者随访时间最长达 13 个月。终点是 1 年内免于再次干预和肢体挽救。
15 例患者中有 14 例（93%）达到了技术成功。15 例患者中有 13 例（86%）放置了支架。手术后立即无并发症发生。中位随访时间为 7.1 个月（范围，1.4-13.5 个月）。1 例患者失访。平均 4.2 个月后，5 条肢体需要再次干预。1 年时的肢体挽救率为 83%。
当传统入路无法用于治疗 CLI 患者时，将 DPA 作为单一入路可能是一种有价值的方法。
