Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France.
Angiology Unit, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France.
Cardiovasc Intervent Radiol. 2019 Dec;42(12):1800-1805. doi: 10.1007/s00270-019-02310-w. Epub 2019 Aug 21.
This technical note describes a total percutaneous technique to perform ultrasound and fluoroscopy-assisted femoropopliteal bypass in long superficial femoral artery (SFA) lesions, using standard equipment, through a juxta-anatomical superficial femoral vein (SFV) tunnel.
Three percutaneous accesses were obtained under ultrasound guidance. The first was retrograde, with crossover maneuver, at the contralateral groin. The second was a proximal SFV-to-SFA stump puncture. The third was a distal popliteal artery-to-popliteal vein puncture. Through the described snaring and capture maneuvers, one single 0.018″ guide wire entered the femoral vein through the SFA stump and re-entered the popliteal artery distally. The fistulous tracts were then dilated and covered stents deployed and post-dilated.
Three patients aged 68 ± 3 years and presenting Rutherford 4 chronic limb ischemia were treated with this technique. The mean SFA lesion length was 22.6 ± 3 cm. The mean procedure duration was 88 ± 18 min. No intraoperative complication occurred. The postoperative course was uneventful. In particular, no deep vein thrombosis occurred. Rutherford stage decreased from 4 to 1 in all patients, with a mean follow-up duration of 6.6 ± 2 months.
The main advantage of the technique is avoiding calcification issues by abandoning the trans-arterial recanalization approach for long calcified lesions. The second interest is its feasibility by simple endovascular means without any particular or dedicated device. However, longer follow-up is needed to assess safety and durability.
本技术说明描述了一种通过标准设备，经解剖毗邻的股浅静脉（SFV）隧道，利用超声和透视辅助技术，对长段股浅动脉（SFA）病变行全经皮股腘旁路术的方法。
在超声引导下获得 3 个经皮入路。第一个是逆行的，采用对侧腹股沟的交叉操作。第二个是股浅静脉到股浅动脉残端的近端穿刺。第三个是远端腘动脉到小隐静脉的穿刺。通过所描述的套扎和捕获操作，一根 0.018"导丝穿过股浅动脉残端进入股静脉，并重新进入小隐动脉远端。然后扩张瘘管并放置覆盖支架，再进行后扩张。
3 名 68±3 岁的 Rutherford 4 级慢性肢体缺血患者接受了该技术治疗。股浅动脉病变的平均长度为 22.6±3cm。平均手术时间为 88±18min。术中无并发症发生。术后过程平稳。特别是，无深静脉血栓形成。所有患者的 Rutherford 分期均从 4 级降至 1 级，平均随访时间为 6.6±2 个月。
该技术的主要优势在于通过放弃经动脉再通方法，避免了长段钙化病变的钙化问题。其次，其通过单纯的血管内手段而非任何特殊或专用设备即可实现，具有可行性。然而，还需要更长时间的随访来评估安全性和耐久性。
