Distal embolization during percutaneous revascularization of the lower extremity arteries
Anja Boc1,2, Aleš Blinc1,3, Vinko Boc1
1Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
Distal embolization (DE) during endovascular therapy for peripheral artery disease is rare (0.9%). DE occurred more in women and without prior antiplatelet use, but was mostly managed successfully with minimally invasive procedures.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Arterial Disease Management
Background:
- Percutaneous endovascular therapy is a primary treatment for symptomatic peripheral arterial disease.
- Distal embolization (DE) is a potential complication of these procedures.
- Understanding DE incidence and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of distal embolization (DE) during endovascular revascularization for lower limb chronic atherosclerotic lesions.
- To identify risk factors associated with DE.
- To evaluate the management strategies and success rates for DE.
Main Methods:
- Retrospective analysis of 2054 endovascular revascularization interventions.
- Procedures included balloon angioplasty and/or stent implantation, excluding atherectomy.
- Data collected on patient demographics, pre-intervention treatment, lesion location, and DE incidence and management.
Main Results:
- Overall incidence of DE was 0.9%.
- DE was significantly more frequent in females (1.6% vs 0.5%), patients without prior antiplatelet treatment (2.1% vs 0.6%), and femoropopliteal stenting (2.2% vs 0.8%).
- Percutaneous aspiration successfully managed DE in 84% of cases; 16% required surgical thromboembolectomy.
Conclusions:
- The incidence of DE during endovascular treatment of lower limb atherosclerotic lesions without atherectomy is low.
- Female sex, absence of prior antiplatelet therapy, and femoropopliteal stenting are associated with increased DE risk.
- Most DE events can be effectively managed using percutaneous techniques.
Abstract:
Background: Percutaneous endovascular therapy is nowadays the leading treatment option for patients with symptomatic peripheral arterial disease, but it can be complicated with distal embolization (DE). Patients and methods: We retrospectively analyzed 2054 endovascular revascularization interventions performed in patients with disabling claudication or chronic critical limb ischemia in the Catheterisation Laboratory of the Department of Vascular Diseases, University Medical Centre Ljubljana between January 2014 and December 2018. Lesions were treated by balloon angioplasty and/or stent implantation, without atherectomy. Results: The overall incidence of DE was 0.9%. DE was more frequent in females than males (1.6% vs 0.5%, p = 0.011), in the absence of antiplatelet treatment prior to intervention compared to previous antiplatelet treatment (2.1% vs 0.6%, p = 0.005) and in femoropopliteal stenting compared to angioplasty without stenting (2.2% vs 0.8%, p = 0.037). DE was successfully managed with percutaneous aspiration, in combination with angioplasty when necessary, in 84% of cases. In remaining 16% of patients, DE was managed with surgical thromboembolectomy. Conclusions: The incidence of DE during endovascular revascularization of chronic atherosclerotic lesions in lower limb arteries without use of atherectomy was low. DE was more frequent in women, in patients without prior antiplatelet treatment and in femoropopliteal stenting. The majority of DE was successfully managed percutaneously.
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