Intraoperative prebypass arteriography for infrageniculate revascularization
Background: Selection of the optimal distal target for infrageniculate arterial revascularization remains difficult in patients with multilevel occlusive disease due to poor visualization of the distal vasculature by preoperative arteriography. Prebypass, intraoperative arteriography (IOA) with dire...
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creator | Huber, Thomas S. Back, Martin R. Flynn, Timothy C. Harward, Timothy R.S. Culp, William C. Carlton, Lori M. Seeger, James M. |
description | Background: Selection of the optimal distal target for infrageniculate arterial revascularization remains difficult in patients with multilevel occlusive disease due to poor visualization of the distal vasculature by preoperative arteriography. Prebypass, intraoperative arteriography (IOA) with direct injection of contrast into the infrageniculate arteries may improve distal arterial visualization and bypass target selection.
Methods: One hundred fourteen extremities in 104 consecutive patients requiring infrageniculate bypass were prospectively studied. All patients underwent preoperative contrast arteriography (CA) of the aortoiliac and lower extremity arteries using iodinated and/or CO
2 contrast and digital subtraction techniques. IOAs were obtained at operation to confirm the adequacy of the distal runoff from the predicted bypass target and to identify potentially superior targets. The preoperative plan formulated from the CA was compared to the actual procedure performed based on the IOA. The CA and IOA were also independently reviewed postoperatively by two blinded vascular surgeons to determine the number of patent vessel segments visualized and the number of segments with |
doi_str_mv | 10.1016/S0002-9610(97)00083-4 |
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Methods: One hundred fourteen extremities in 104 consecutive patients requiring infrageniculate bypass were prospectively studied. All patients underwent preoperative contrast arteriography (CA) of the aortoiliac and lower extremity arteries using iodinated and/or CO
2 contrast and digital subtraction techniques. IOAs were obtained at operation to confirm the adequacy of the distal runoff from the predicted bypass target and to identify potentially superior targets. The preoperative plan formulated from the CA was compared to the actual procedure performed based on the IOA. The CA and IOA were also independently reviewed postoperatively by two blinded vascular surgeons to determine the number of patent vessel segments visualized and the number of segments with <50% stenosis.
Results: Revascularization was done in 105 of 114 extremities (92%), whereas amputation was required as the initial procedure in 9 patients (8%). The IOA altered the operative plan based on the CA in 27 of 144 patients (24%). Changes in the planned bypass procedures included selection of a more distal anastomotic site in 13 of 102 patients (13%), selection of a more proximal anastomotic site in 4 of 102 (4%), selection of a different artery for the distal anastomosis in 3 of 102 (3%), and amputation rather than bypass in 2 of 102 patients (2%) with no suitable distal bypass target on the IOA. The IOA also resulted in bypass rather than planned amputation in 5 of 12 patients (42%) deemed unreconstructable on the preoperative CA. A mean of 13 minutes was required for IOA and an adequate study was obtained on the first attempt in 98 of 144 patients (86%). On postoperative review, more patent vessel segments but fewer segments with <50% stenosis were identified on the IOA compared to the CA.
Conclusions: Prebypass intraoperative arteriography facilitates selection of the optimal distal bypass target during infrageniculate revascularization and can result in initial limb salvage in select patients deemed unreconstructable by preoperative contrast arteriography.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/S0002-9610(97)00083-4</identifier><identifier>PMID: 9293846</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adequacy ; Aged ; Amputation ; Anastomosis ; Angiography ; Angiography, Digital Subtraction - economics ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - economics ; Arterial Occlusive Diseases - surgery ; Arteries ; Arteriography ; Biological and medical sciences ; Blood Vessel Prosthesis - economics ; Carbon dioxide ; Cardiovascular system ; Extremities ; Female ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Monitoring, Intraoperative - economics ; Monitoring, Intraoperative - methods ; Postoperative Period ; Predictive Value of Tests ; Preoperative Care ; Prospective Studies ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Runoff ; Segments ; Stenosis ; Subtraction ; Visualization</subject><ispartof>The American journal of surgery, 1997-08, Vol.174 (2), p.205-209</ispartof><rights>1997</rights><rights>1997 INIST-CNRS</rights><rights>Copyright Elsevier Limited Aug 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-55419ee21b5633e09a1a36d9dc1748adc77f4b5bbbfda0a1b14e7a79001a69a83</citedby><cites>FETCH-LOGICAL-c417t-55419ee21b5633e09a1a36d9dc1748adc77f4b5bbbfda0a1b14e7a79001a69a83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2847450159?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>309,310,314,780,784,789,790,3550,23930,23931,25140,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2834089$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9293846$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huber, Thomas S.</creatorcontrib><creatorcontrib>Back, Martin R.</creatorcontrib><creatorcontrib>Flynn, Timothy C.</creatorcontrib><creatorcontrib>Harward, Timothy R.S.</creatorcontrib><creatorcontrib>Culp, William C.</creatorcontrib><creatorcontrib>Carlton, Lori M.</creatorcontrib><creatorcontrib>Seeger, James M.</creatorcontrib><title>Intraoperative prebypass arteriography for infrageniculate revascularization</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Background: Selection of the optimal distal target for infrageniculate arterial revascularization remains difficult in patients with multilevel occlusive disease due to poor visualization of the distal vasculature by preoperative arteriography. Prebypass, intraoperative arteriography (IOA) with direct injection of contrast into the infrageniculate arteries may improve distal arterial visualization and bypass target selection.
Methods: One hundred fourteen extremities in 104 consecutive patients requiring infrageniculate bypass were prospectively studied. All patients underwent preoperative contrast arteriography (CA) of the aortoiliac and lower extremity arteries using iodinated and/or CO
2 contrast and digital subtraction techniques. IOAs were obtained at operation to confirm the adequacy of the distal runoff from the predicted bypass target and to identify potentially superior targets. The preoperative plan formulated from the CA was compared to the actual procedure performed based on the IOA. The CA and IOA were also independently reviewed postoperatively by two blinded vascular surgeons to determine the number of patent vessel segments visualized and the number of segments with <50% stenosis.
Results: Revascularization was done in 105 of 114 extremities (92%), whereas amputation was required as the initial procedure in 9 patients (8%). The IOA altered the operative plan based on the CA in 27 of 144 patients (24%). Changes in the planned bypass procedures included selection of a more distal anastomotic site in 13 of 102 patients (13%), selection of a more proximal anastomotic site in 4 of 102 (4%), selection of a different artery for the distal anastomosis in 3 of 102 (3%), and amputation rather than bypass in 2 of 102 patients (2%) with no suitable distal bypass target on the IOA. The IOA also resulted in bypass rather than planned amputation in 5 of 12 patients (42%) deemed unreconstructable on the preoperative CA. A mean of 13 minutes was required for IOA and an adequate study was obtained on the first attempt in 98 of 144 patients (86%). On postoperative review, more patent vessel segments but fewer segments with <50% stenosis were identified on the IOA compared to the CA.
Conclusions: Prebypass intraoperative arteriography facilitates selection of the optimal distal bypass target during infrageniculate revascularization and can result in initial limb salvage in select patients deemed unreconstructable by preoperative contrast arteriography.</description><subject>Adequacy</subject><subject>Aged</subject><subject>Amputation</subject><subject>Anastomosis</subject><subject>Angiography</subject><subject>Angiography, Digital Subtraction - economics</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - economics</subject><subject>Arterial Occlusive Diseases - surgery</subject><subject>Arteries</subject><subject>Arteriography</subject><subject>Biological and medical sciences</subject><subject>Blood Vessel Prosthesis - economics</subject><subject>Carbon dioxide</subject><subject>Cardiovascular system</subject><subject>Extremities</subject><subject>Female</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative - economics</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Postoperative Period</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Care</subject><subject>Prospective Studies</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Runoff</subject><subject>Segments</subject><subject>Stenosis</subject><subject>Subtraction</subject><subject>Visualization</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkE1r3DAQhkVpSLdpf0LA0BLag1uNJVvSqZTQj8BCDm3PYiyPUwWv5Ur2wvbXR_vBHnrpSRrmeYeXh7Fr4B-AQ_PxB-e8Kk0D_J1R7_OgRSmfsRVoZUrQWjxnqzPygr1M6TGPAFJcsktTGaFls2Lru3GOGCaKOPstFVOkdjdhSgXGmaIPDxGn37uiD7HwYx_xgUbvlgFnKiJtMe3_0f_N6TC-Yhc9Dolen94r9uvrl5-338v1_be728_r0klQc1nXEgxRBW3dCEHcIKBoOtM5UFJj55TqZVu3bdt3yBFakKRQmdweG4NaXLGb490phj8LpdlufHI0DDhSWJJVplINaJPBN_-Aj2GJY-5mKy2VrDnUe6o-Ui6GlCL1dop-g3Fngdu9a3twbfcirVH24NrKnLs-XV_aDXXn1Elu3r897bMmHLK80fl0xiotJD-U_HTEKCvbeoo2OU-jo85HcrPtgv9PkSfAPpv1</recordid><startdate>19970801</startdate><enddate>19970801</enddate><creator>Huber, Thomas S.</creator><creator>Back, Martin R.</creator><creator>Flynn, Timothy C.</creator><creator>Harward, Timothy R.S.</creator><creator>Culp, William C.</creator><creator>Carlton, Lori M.</creator><creator>Seeger, James M.</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>19970801</creationdate><title>Intraoperative prebypass arteriography for infrageniculate revascularization</title><author>Huber, Thomas S. ; Back, Martin R. ; Flynn, Timothy C. ; Harward, Timothy R.S. ; Culp, William C. ; Carlton, Lori M. ; Seeger, James M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-55419ee21b5633e09a1a36d9dc1748adc77f4b5bbbfda0a1b14e7a79001a69a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adequacy</topic><topic>Aged</topic><topic>Amputation</topic><topic>Anastomosis</topic><topic>Angiography</topic><topic>Angiography, Digital Subtraction - economics</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - economics</topic><topic>Arterial Occlusive Diseases - surgery</topic><topic>Arteries</topic><topic>Arteriography</topic><topic>Biological and medical sciences</topic><topic>Blood Vessel Prosthesis - economics</topic><topic>Carbon dioxide</topic><topic>Cardiovascular system</topic><topic>Extremities</topic><topic>Female</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative - economics</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Postoperative Period</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Care</topic><topic>Prospective Studies</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Runoff</topic><topic>Segments</topic><topic>Stenosis</topic><topic>Subtraction</topic><topic>Visualization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huber, Thomas S.</creatorcontrib><creatorcontrib>Back, Martin R.</creatorcontrib><creatorcontrib>Flynn, Timothy C.</creatorcontrib><creatorcontrib>Harward, Timothy R.S.</creatorcontrib><creatorcontrib>Culp, William C.</creatorcontrib><creatorcontrib>Carlton, Lori M.</creatorcontrib><creatorcontrib>Seeger, James M.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huber, Thomas S.</au><au>Back, Martin R.</au><au>Flynn, Timothy C.</au><au>Harward, Timothy R.S.</au><au>Culp, William C.</au><au>Carlton, Lori M.</au><au>Seeger, James M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative prebypass arteriography for infrageniculate revascularization</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>1997-08-01</date><risdate>1997</risdate><volume>174</volume><issue>2</issue><spage>205</spage><epage>209</epage><pages>205-209</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>Background: Selection of the optimal distal target for infrageniculate arterial revascularization remains difficult in patients with multilevel occlusive disease due to poor visualization of the distal vasculature by preoperative arteriography. Prebypass, intraoperative arteriography (IOA) with direct injection of contrast into the infrageniculate arteries may improve distal arterial visualization and bypass target selection.
Methods: One hundred fourteen extremities in 104 consecutive patients requiring infrageniculate bypass were prospectively studied. All patients underwent preoperative contrast arteriography (CA) of the aortoiliac and lower extremity arteries using iodinated and/or CO
2 contrast and digital subtraction techniques. IOAs were obtained at operation to confirm the adequacy of the distal runoff from the predicted bypass target and to identify potentially superior targets. The preoperative plan formulated from the CA was compared to the actual procedure performed based on the IOA. The CA and IOA were also independently reviewed postoperatively by two blinded vascular surgeons to determine the number of patent vessel segments visualized and the number of segments with <50% stenosis.
Results: Revascularization was done in 105 of 114 extremities (92%), whereas amputation was required as the initial procedure in 9 patients (8%). The IOA altered the operative plan based on the CA in 27 of 144 patients (24%). Changes in the planned bypass procedures included selection of a more distal anastomotic site in 13 of 102 patients (13%), selection of a more proximal anastomotic site in 4 of 102 (4%), selection of a different artery for the distal anastomosis in 3 of 102 (3%), and amputation rather than bypass in 2 of 102 patients (2%) with no suitable distal bypass target on the IOA. The IOA also resulted in bypass rather than planned amputation in 5 of 12 patients (42%) deemed unreconstructable on the preoperative CA. A mean of 13 minutes was required for IOA and an adequate study was obtained on the first attempt in 98 of 144 patients (86%). On postoperative review, more patent vessel segments but fewer segments with <50% stenosis were identified on the IOA compared to the CA.
Conclusions: Prebypass intraoperative arteriography facilitates selection of the optimal distal bypass target during infrageniculate revascularization and can result in initial limb salvage in select patients deemed unreconstructable by preoperative contrast arteriography.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>9293846</pmid><doi>10.1016/S0002-9610(97)00083-4</doi><tpages>5</tpages></addata></record> |
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subjects | Adequacy Aged Amputation Anastomosis Angiography Angiography, Digital Subtraction - economics Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - economics Arterial Occlusive Diseases - surgery Arteries Arteriography Biological and medical sciences Blood Vessel Prosthesis - economics Carbon dioxide Cardiovascular system Extremities Female Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Monitoring, Intraoperative - economics Monitoring, Intraoperative - methods Postoperative Period Predictive Value of Tests Preoperative Care Prospective Studies Radiodiagnosis. Nmr imagery. Nmr spectrometry Runoff Segments Stenosis Subtraction Visualization |
title | Intraoperative prebypass arteriography for infrageniculate revascularization |
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