Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan.
Catheter Cardiovasc Interv. 2021 Apr 1;97(5):E697-E703. doi: 10.1002/ccd.29471. Epub 2021 Jan 23.
The efficacy and clinical outcomes of a novel technique "HIRANODOME" (Interim hemostatic technique with HIgh pressure for Regional blood flow in the superficial femoral Artery, NOninvasive Distal protection Occlusion MEthod) in preventing distal embolization during endovascular treatment (EVT) of femoropopliteal lesions were evaluated.
Distal embolization of femoropopliteal lesions may worsen limb ischemia or cause limb loss. Conventional filter wires are cumbersome and expensive and may cause vessel injury. HIRANODOME can, therefore, be a feasible and noninvasive alternative.
Between April 2007 and August 2018, 94 consecutive patients who underwent EVT for femoropopliteal lesions along with anticipated distal embolization were identified. About 9 out of these 94 patients were excluded due to filter device use and 8 were excluded due to acute limb ischemia. Consequently, 77 patients using HIRANODOME for distal protection were included. HIRANODOME involved wrapping the Tometakun around the knee to enable external compression of the popliteal artery, thereby blocking the blood flow. The evaluation items were 30-day mortality, 30-day major amputation, prevention from distal embolization, and thrombus capture rate.
The mean age was 74.4 ± 10.3 years, 53.2% were men, 55.8% were diabetic, and 9.1% were on hemodialysis. The mean lesion length was 199.5 ± 94.4 mm; 79.2% were class C/D lesions (TASC II classification). The 30-day mortality and major amputation rates were 1.9 and 1.0%, respectively. The rate of prevention of distal embolization or no-flow/slow-flow phenomenon was 93.4%. Capture of thrombus was observed in 66 lesions (62.3%).
The HIRANODOME technique was effective in preventing distal embolization during EVT of femoropopliteal lesions.
评估新型技术“ HIRANODOME ”（股浅动脉区域血流高压力临时止血技术，无创远端保护闭塞方法）在预防股腘病变血管内治疗（EVT ）过程中远端栓塞的疗效和临床结果。
股腘病变的远端栓塞可能会使肢体缺血恶化或导致肢体丧失。常规的滤网器既繁琐又昂贵，并且可能会造成血管损伤。因此， HIRANODOME 可以作为一种可行的非侵入性替代方法。
在 2007 年 4 月至 2018 年 8 月期间，共确定了 94 例接受股腘病变 EVT 治疗并预期发生远端栓塞的连续患者。其中有 9 例因使用滤网器而被排除，有 8 例因急性肢体缺血而被排除。因此，共纳入了 77 例使用 HIRANODOME 进行远端保护的患者。 HIRANODOME 通过将 Tometakun 包裹在膝盖周围，对腘动脉进行外部压迫，从而阻断血流。评估项目为 30 天死亡率、30 天主要截肢率、预防远端栓塞和血栓捕获率。
患者平均年龄为 74.4 ± 10.3 岁，53.2%为男性，55.8%患有糖尿病，9.1%正在接受血液透析。平均病变长度为 199.5 ± 94.4mm；79.2%为 C/D 类病变（TASC II 分类）。30 天死亡率和主要截肢率分别为 1.9%和 1.0%。预防远端栓塞或无血流/血流缓慢现象的发生率为 93.4%。在 66 个病变部位观察到血栓捕获（62.3%）。
HIRANODOME 技术在预防股腘病变 EVT 过程中的远端栓塞方面是有效的。
