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22/11/2010 · Who's the best surgeon for unblocking your arteries

Which 'plumber' would the experts choose to perform the risky op

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Regarding the rate of primary patency, the results of several studies in the literature considered heterogeneous populations, also differing in the location of the segments treated. Chan et al. reported primary patency rates of the femoropopliteal stent implanted in the segment after six and 12 months of 83.5% and 78.6%, respectively, in 82 limbs treated with Supera® stent (IDEV Technologies Inc., Webster, United States). In the Durability-200 study, Bosiers et al. analyzed 100 patients, 71% of whom were treated for intermittent claudication and 29% treated for critical ischemia, with their injuries classified as TASC C and D, and used the devices in the femoropopliteal segment. These authors obtained a primary patency of 85.4% at 6 months and of 64.8% at 12 months. As for stents implanted in the popliteal segment, Kickuth et al. studied 35 patients with intermittent claudication and critical limb ischemia, in which auto-expandable nitinol stents were implanted in the popliteal artery. In 22 cases, stents were implanted in the distal portion of the popliteal artery, and in the other cases, in the tibiofibular trunk, with a primary patency rate of 82% and a limb salvage rate of 100%. In the present study, most stents were implanted in the middle segment, and in only six cases (42.9%), stents were implanted in the distal segment, crossing the joint line. A primary patency and an assisted primary patency of 85.7% and 92.8% were obtained, respectively, at the six-month follow-up, in a population consisting of patients with critical ischemia of Rutherford classes 5 and 6, and in arteriographic lesions classified as TASC B and C, with a similar rate of limb salvage.

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The choice of the stent depends on the anatomic characteristics of the lesion, such as its location and the extent of calcification, as well as the characteristics of the stent – its diameter, length, profile, flexibility, long-term durability, and resistance to fracture. The limitations to stent implant in the popliteal artery include insufficient radial force to maintain the patency of the vessel, and the possibility of folding and fractures of the device. Stent fracture is associated with high incidence of restenoses and occlusions. Scheinert et al. detected radiographically 64 fractures in 261 stents (24.5%) used in the treatment of femoropopliteal lesions. The primary patency rate obtained in the 12 months’ follow-up was significantly lower in patients with fracture (41.1% vs. 84.3%,


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11/09/2017 · Heart attack is most often caused by narrowing of the arteries by cholesterol plaque and their subsequent rupture
The long-term primary patency rates for percutaneous transluminal angioplasty using first and second generation stents for the treatment of the popliteal artery have been disappointing. However, results with the new nitinol stents seem promising. Our objective was to evaluate short-term clinical outcomes using the superflexible nitinol stent in the treatment of atherosclerotic lesions in popliteal segments.

Treatment for blocked arteries in the legs, or peripheral artery disease, will involve consulting a physician to assess the degree of ..
Patients of both genders, with limiting intermittent claudication, pain at rest in the affected limb or with ipsilateral trophic lesion, and with lesions restricted to the popliteal artery and the presence of at least one leg artery for distal run-off, were treated. Patients with creatinine clearance

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The lesions were classified into TASC B (50%) and C (50%). Regarding their location, 71.4% of cases were in the proximal segment of popliteal artery (P1), and in 28.6% of the cases were in middle or distal segments, in equal proportion (P2 and P3). In eight cases (57.1%), the stents were implanted in previously occluded vessels, with pre-dilation performed in all lesions.

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In the evaluation of the run-off bed, the majority of patients had only one patent artery (78.6%) and the fibular artery was the most frequently observed. A mean of 1.3 ± 0.4 arteries by treated limb was obtained ().

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The demographic characteristics, comorbidities, and indications for treatment are described in . Mean age was 73 ± 11 years, 50% of patients were male, and approximately two-thirds were diabetic. The left leg was the most frequently treated limb (57.1%) and all patients had trophic lesions with tissue loss. Patients with intermittent claudication or pain at rest were not treated.

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It was possible to achieve the target lesion revascularization in all cases with the use of one stent, obtaining technical success in 100%. The average extent of lesion coverage was 177 ± 18mm (120–200mm). Ten stents (71.4%) with a diameter of 6mm and four stents (28.6%) with a diameter of 5mm were used. There were no cases of intraoperative dissection or embolization. The areas of more frequent stent landing were the middle segment of popliteal artery (P2) in eight cases (57.1%) and the distal segment (P3) of the artery, crossing the joint knee, in six cases (42.9%). No implants occurred in the proximal segment (P1). Mean procedure times and of radioscopy were, respectively, 55 ± 43 minutes (range 20–240 min) and 19 ± 14 minutes (range 5–66 min). The mean volume of iodinated contrast used was 88 ± 41mL. In one case, a distal retrograde access by the dorsalis pedis artery was performed, thanks to the impossibility of crossing the target lesion by the anterograde technique. No complications with respect to the puncture site () were observed.