Incidence and risk factors of vascular complications following endovascular treatment of peripheral arterial disease via
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ORIGINAL ARTICLE
Incidence and risk factors of vascular complications following endovascular treatment of peripheral arterial disease via the popliteal artery Yoko Yanagita • Katsuo Noda
Received: 2 May 2010 / Accepted: 6 March 2011 / Published online: 14 April 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract To evaluate vascular complications associated with endovascular treatment (EVT) of peripheral arterial disease (PAD) through the popliteal artery and to identify the risk factors for these complications. Between November 2005 and January 2009, 63 patients with PAD received EVT via the popliteal artery. Retrograde (n = 58) and antegrade (n = 5) transpopliteal procedures were performed to target 77 lesions, including 12 distal to the trifurcation. Thirty-five punctures were performed under ultrasound guidance and 7 under angiographic guidance; 21 punctures were performed without any guidance. Vascular complications were evaluated by physical examination and duplex ultrasonography. Vascular complications at the popliteal puncture site occurred in 8 patients (12.7%): 6 hematomas and 2 arteriovenous fistulas (AVF). Seven of 24 patients receiving hemodialysis (HD) (29%) had significantly higher complications (P = 0.004) compared with 1 of 39 patients not receiving hemodialysis (non-HD) (2.6%). HD alone was also a significant risk factor for hematoma (P = 0.010). Both AVF occurred in HD patients (P = 0.141), and one occurred despite ultrasound-guided puncture. Ultrasound-guided puncture showed no significant improvement in reducing both complications. The combination of antiplatelet and anticoagulant therapy showed no statistical significance in overall complications. In non-HD patients, the transpopliteal approach in the EVT Y. Yanagita (&) Department of Cardiology, Fukuoka Wajiro Hospital, 2-2-75 Wajirogaoka, Higashi-ku, Fukuoka, Fukuoka 811-0213, Japan e-mail: [email protected] K. Noda Department of Cardiology, Kumamoto Central Hospital, 1-5-1 Tainoshima, Kumamoto, Kumamoto 862-0965, Japan
of PAD seems to be safe. More attention should be paid to HD patients when using the transpopliteal approach due to a higher complication rate. Keywords Transpopliteal approach Vascular complications Peripheral arterial disease
Introduction Complications at the puncture site have been reported to be the most common problem of transluminal angioplasty [1]. Retrograde popliteal artery (PA) catheterization for treating lesions of the superficial femoral artery (SFA) or proximal PA was first described in 1988 by Tonnesen et al. [2]. In 1990, Schroeder [3] first described a case report on catheterlysis and percutaneous transluminal angioplasty below the knee using the antegrade transpopliteal approach in a patient with femoral artery obstruction. The retrograde transpopliteal approach is now considered a useful technique in the endovascular treatment (EVT) of iliofemoral lesions, especially of chronic total occlusion (CTO) in SFA [4]. However, only a few reports using this approach w
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