Clinical studySafety and Short-term Outcomes following Controlled Blunt Microdissection Revascularization of Symptomatic Arterial Occlusions of the Pelvis and Lower Extremities
Section snippets
Materials and Methods
Institutional review board approval is not required for retrospective clinical studies at the study center. Informed consent for the procedure was obtained from all study patients. From June 2003 through March 2007, 61 consecutive patients underwent 67 procedures for 86 chronic totally occluded arteries; these patients constitute the study sample. All patients underwent controlled blunt microdissection catheter–assisted percutaneous revascularization of symptomatic arterial chronic total
Results
The study group consisted of 61 patients (46 men, 75%) with a mean age of 72.3 years ± 9.4 who underwent 67 procedures in 86 arterial segments. The cardiovascular risk factors included dyslipidemia in 61 of 61 patients (100%), hypertension in 60 (98%), smoking history in 47 (77%), coronary artery disease in 43 (70%), and diabetes mellitus in 27 (44%). The mean baseline serum creatinine level was 1.34 mg/dL ± 0.69 (118 ± 61 μmol/L; mean estimated GFR, 49.7 mL/min per 1.73 m2 body surface area ±
Discussion
In this single-center study, we present our results for safety, technical, short-term clinical, and hemodynamic success rates of controlled blunt microdissection catheter-assisted (Frontrunner XP) revascularization of symptomatic lower-extremity chronic total occlusions. The technical success rate with use of this catheter was 84%, and technical success was predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months is 92% and is predicted by renal function,
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2021, Journal of Vascular and Interventional RadiologyCitation Excerpt :Additionally, patients with ESRD undergoing chronic hemodialysis have increased rates of ICU admission, with a calculated 15.6 ICU admissions per 100 patients per year compared with 0.58 ICU admissions per 100 patients per year in those without ESRD (5,6). Infection is one of the most common complications in patients with TDCs, with a reported incidence of catheter-related bloodstream infections (CRBSIs) in dialysis patients of 1.1–5.5 episodes per 1000 catheter days (7), and is directly related to patient morbidity, mortality, and healthcare costs (2,8,9). Current guidelines recommend an individualized approach to the management of CRBSI in patients with TDCs, typically consisting of systemic antibiotics and multiple options regarding catheter management (2), including TDC removal with exchange over a guidewire, TDC removal with replacement after a central-venous-catheter-free period, or TDC retention with or without the use of an antibiotic lock.
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P.A.S. is a paid consultant for Cordis. None of the other authors have identified a conflict of interest.