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At least 55 records · Page 3Linked to original sources
PubMed2001

Common femoral artery ligation and local debridement: a safe treatment for infected femoral artery pseudoaneurysms.

PURPOSE: The management of infected femoral artery pseudoaneurysms (IFAPs) is difficult and controversial. Use of synthetic or autologous conduit during arterial revascularization in these cases is complicated by the presence of sepsis and unavailability of autologous venous conduit. We present the results of common femoral artery (CFA) ligation and local drainage with debridement for the treatment of IFAP. METHODS: A retrospective chart review of six consecutive patients from 1995 to 1999 who presented with IFAP from intravenous drug abuse was performed. Inpatient records, anesthesia records, and outpatient clinic charts were reviewed. All patients were men with right-sided lesions. All six patients abused heroin, and five (83%) abused heroin and cocaine. All six patients had a duplex ultrasound scan, and five (83%) patients had a digital subtraction angiogram to confirm the clinical diagnosis. Proximal vascular control was achieved retroperitoneally through an oblique suprainguinal incision. After vascular isolation and test clamping of the distal external iliac artery (EIA), the pedal pulses were examined with continuous wave Doppler scan. If a Doppler signal was present, this was followed with CFA ligation and local drainage and debridement of the IFAP. RESULTS: Pain at injection site and fever with chills were present in five (83%) and three (50%) patients, respectively. A pulsatile groin mass and thigh or leg edema were present in five (83%) patients. Three patients (50%) had a palpable pedal pulse, and all six had a Doppler signal over a pedal artery at presentation. The mean white cell count was 15.6 thousand per cubic millimeter (range, 9.2-19.3). All patients had a Doppler signal over a pedal artery after distal EIA/CFA test occlusion and ligation. None of the patients required an amputation, and all six patients regained their preoperative ambulatory status. The mean follow-up period was 25 months. Two patients had mild claudication (5-6 blocks) at 18 months and 2 years after surgery. All six patients received drug rehabilitation, but they admitted to drug abuse after surgery and rehabilitation. CONCLUSION: CFA ligation and local debridement are safe treatment modalities for IFAP, if there is an intraoperative Doppler signal over a pedal artery during test occlusion of the distal EIA/CFA. CFA ligation avoids the use and therefore the risk of synthetic conduit infection, because there is a high incidence of postoperative drug injection despite aggressive drug rehabilitation.

Adult↗
PubMed1978

Reconstruction of the deep femoral artery.

Deep femoral artery reconstruction was performed on 54 extremities. Best results were obtained in patients with severe rest pain and minor ischemic ulcerations. Intermittent claudication generally did not improve significantly. The mean operative flow to deep femoral artery was 170 mg/min. and the increase in peripheral pressure 20 mm Hg.

Amputation, Surgical↗
PubMed1980

Upstream stenosis. Its diagnosis by Doppler signals from the femoral artery.

Transcutaneous femoral artery Doppler signals were measured with a 10-MHz pencil probe in 263 lower limbs of 135 patients. The Doppler waveforms were compared with arteriograms in 125 limbs with lower-limb ischemia and in 138 controls in the detection of minor (< 50%) and major (> 50%) iliac-artery stenosis. Doppler maximum velocity-time waveforms were obtained using a maximum frequency follower, and the wave-form shape was analyzed using a Laplace transform (LT) to produce a coefficient, the LT damping. Pulsatility index (PI) was also calculated. In 62 limbs with minor artery disease, mean LT damping was significantly greater than normal (0.5 +/- 0.15 vs 0.33 +/- 0.06; P < .001). In 63 limbs with major iliac stenosis, mean LT damping was higher still (0.78 +/- 0.16; P < .02). The LT damping was not affected by increased distal impedance and there was a good correlation with iliac stenosis in 65 limbs with an occluded superficial femoral artery (r = -0.73). The results with PI were inferior at every grade of severity of iliac disease when assessed by receiver-operator characteristic curves. These results suggest that LT damping is a sensitive method of analyzing femoral Doppler signals in the noninvasive detection of iliac artery stenosis.

Arterial Occlusive Diseases↗
PubMed2005

Arterial reconstruction of infected femoral artery pseudoaneurysms using superficial femoral-popliteal vein.

BACKGROUND: Infected femoral artery pseudoaneurysms (IFAPs) secondary to percutaneous arterial access, injection of illegal substances, and from infected synthetic grafts, appear to be increasing in incidence. Ligation of IFAPs without revascularization offers control of infection but may risk limb ischemia. Revascularization with extraanatomic synthetic grafts may risk reinfection and abrupt thrombosis. Excision of IFAPs with revascularization using superficial femoral popliteal vein (SFPV) provides both control of infection and excellent limb perfusion. STUDY DESIGN: A retrospective review was conducted of patients diagnosed with IFAP who underwent resection and revascularization with SFPV at a single medical center. Outcomes measured included reinfection and amputation rate. These were compared with other series using various methods to treat IFAPs. RESULTS: Eleven patients with IFAP were encountered from 1992 to 2004. Mean age was 64 years (+/-10 SD). Five patients developed IFAP secondary to percutaneous arterial access procedures. Four patients developed infected femoral artery pseudoaneurysms secondary to synthetic graft infection. Two patients developed IFAP secondary to injection of illegal substances in the femoral region. All patients had positive wound cultures initially. Staphylococcus was the most common organism found in wound cultures. All patients underwent resection of IFAP with lower extremity revascularization using SFPV. There was no incidence of limb ischemia and no perioperative deaths in this series. CONCLUSIONS: Excision of IFAP with revascularization can be successfully achieved using SFPV. This method may prove to be superior to other methods with apparent higher patency rates and resistance to reinfection.

Aged↗
PubMed1975

Geometry, blood flow, and reconstruction of the deep femoral artery.

The deep femoral artery is the main source of blood supply to the leg and foot when the superficial femoral artery is occluded. In this situation, the geometry of the trunk of the deep femoral artery represents a stenosis of 50 per cent interposed between the common femoral artery and the collateral circuit of the deep femoral artery. Intimal thickening of only 0.5 and 1.0 mm increases this anatomic stenosis to 64 and 76 per cent, respectively. Beyond the trunk, the cross-sectional area of the deep femoral artery circuit increases at each arterial division. Any reconstruction of the deep femoral artery intended to increase its inflow must extend down to at least its first important bifurcation if it is to overcome this trunk "stenosis". This requirement ex plains the effectiveness of proper reconstruction of the deep femoral artery in avoiding or delaying amputation in patients with ischemic symptoms and occlusion of the superficial femoral artery who are not candidates for femoropopliteal reconstruction. In this group, the absence of plaque on the arteriogram does not contraindicate reconstruction.

Angiography↗
PubMed2004

Successful arterial reconstruction with collateral artery bypass for a femoral artery aneurysm: report of a case.

The outcome of surgery for femoral artery aneurysms is dependent on the preoperative status of the runoff vessels. We report a case of a femoral artery aneurysm complicated by thromboembolic obstruction of the distal superficial femoral and profunda femoris arteries. Fortunately, the collateral arteries were viable runoff vessels for restoring adequate blood flow to the limb.

Aged↗
PubMed2006

Percutaneous ex-vivo femoral arterial bypass: a novel approach for treatment of acute limb ischemia as a complication of femoral arterial catheterization.

This report describes the use of a percutaneous ex-vivo femoral arterial bypass in three patients with acute lower extremity ischemia that occurred as a complication of femoral artery catheterization. Utilizing standard equipment and techniques, a percutaneous ex-vivo femoral artery bypass can restore antegrade flow to the ischemic limb in patients with impaired aorto-iliac inflow circulation, which may arise from iatrogenic dissection or the need for large in-dwelling sheaths required for hemodynamic support. This technique is considered a temporizing measure when conventional therapies are not possible. Contrast angiography is recommended to localize and define the cause of limb ischemia, and to permit safe placement of vascular sheaths in the "donor and recipient" arteries.

Acute Disease↗
PubMed1995

Long-term results with the Palmaz stent in the superficial femoral artery.

PURPOSE: Femoral stenting has demonstrated inconsistent and often disappointing long-term results. To compare out experience, we retrospectively analyzed a series of patients who had Palmaz balloon-expandable stents placed exclusively for superficial femoral artery (SFA) lesions. METHODS: From January 1990 to November 1993, 39 patients were evaluated for claudication (79%) or critical ischemia in 42 limbs. The culprit lesions were confined to the SFA: 24 (57%) occlusions and 18 (43%) stenoses, including 3 restenotic lesions. Stenting was elective in 12 (29%) cases: the 3 restenoses and 9 chronic, calcified occlusions. The remaining stents were applied for postangioplasty residual stenosis or angioscopic findings of thrombogenic luminal irregularities. A total of 55 prostheses were successfully implanted. All patients were maintained on ticlopidine and followed by routine duplex scanning. Follow-up angiography was performed in 28 (72%) patients between 4 and 45 months. RESULTS: In the postprocedural period, two acute thromboses (4.8%) occurred within 48 hours in patients who had long occlusions and poor runoff; no other major complications were encountered, for a clinical success rate of 95%. Follow-up evaluation ranged from 4 months to 4 years with a mean of 25 months. The restenosis rate was 19% (34% in occlusions; 10% in stenotic lesions, p = NS). At 24 months, cumulative primary patency was 77% and secondary patency 89%. CONCLUSIONS: Palmaz stents performed will in the SFA, demonstrating a low acute thrombosis rate and good long-term patency. The incidence of restenosis is likely to be greater in occlusions than in stenoses.

Aged↗
PubMed1993

Selective management of iatrogenic femoral artery injuries.

Increased femoral artery catheterization for therapy and diagnosis has resulted in a concomitant increase in iatrogenic femoral artery injuries. A 33-month experience at two affiliated institutions was reviewed to evaluate the results of a selective approach to management of these complications. During this period, 9576 femoral artery catheterizations were performed. Eighty-nine femoral artery injuries were treated surgically or by ultrasound-guided compression therapy. Cardiac catheterization procedures predominated and 61% of patients were anticoagulated. Thirty-eight cases were treated surgically: 14 pseudoaneurysms, 16 hematomas, 6 arteriovenous fistulas, 2 thromboses. Local anesthesia was used in 28 cases (74%). Arterial repair was required in 34 cases, with control being achieved below the inguinal ligament in 33 cases (97%). Punctures were found in the superficial femoral or profunda femoral rather than the common femoral artery in 17 of 38 cases (44%, P < 0.001 compared with the ultrasound group). There were two deaths (5.3%), six wound infections (16%), and no limb loss. Ultrasound-guided compression was preferentially used for stable or slowly expanding pseudoaneurysms. Cases with large hematomas causing skin ischemia were treated surgically. The pseudoaneurysms ranged from 2 to 7 cm in diameter. This technique was effective in 46 of 51 cases (90%). A single thromboembolic complication was treated by thrombolysis. There were no late recurrences. We conclude that (1) iatrogenic femoral artery injuries are associated with postcatheterization anticoagulation and punctures not located in the common femoral artery; (2) injuries requiring surgery can usually be treated under local anesthesia with infrainguinal arterial control; (3) ultrasound-guided compression is an effective method for treating iatrogenic pseudoaneurysms not associated with large hematomas.

Aneurysm↗
PubMed1996

Responses to mechanical stimuli of isolated basilar and femoral arteries of the Rhesus monkey are different.

The present study aimed to determine regional differences in diameter response to mechanical stimuli such as flow (shear stress) and transmural pressure (myogenic response) of the isolated basilar artery and femoral artery from Rhesus monkeys. Whether or not spontaneous tone developed, a transmural pressure-diameter relation was determined after the equilibration period. Vessels were then constricted with a submaximal dose of prostaglandin-F(2 alpha) (PGF(2 alpha); 1.23-2 mu M) and a flow-diameter relation (0-2,000 mu l/min) and a pressure-diameter (15-125 cm H(2)O) relation were determined. Endothelium function was tested with the calcium ionophore A-23187 (1.0 mu M). The vessels were then maximally dilated (papaverine, 100 mu M) and a passive pressure-diameter relation was determined. The responses of the basilar and the femoral arteries were markedly different. The basilar artery developed spontaneous tone, while the femoral artery did not. The basilar artery showed flow-induced constriction (P = 0.024), while the femoral artery dilated when flow was increased (P = 0.0005). The myogenic index of the two arteries during treatment with PGF(2 alpha) was not different (P = 0.49) and the strength of the myogenic response was such that the diameter of both arteries stayed constant over the pressure range studied. We conclude that the responses to mechanical stimuli of the basilar artery and the femoral artery of the Rhesus monkey are markedly different.

Animals↗
PubMed1980

Effect of removal and substitution of potassium ions on the adrenergic and cholinergic reactivity in canine femoral artery.

Canine femoral arteries responded to acetylcholine with relaxations; these were abolished in potassium free solution, restored by potassium or rubidium but not by cesium or amonium. Potassium and rubidium were equipotent in inducing ouabain-sensitive relaxation, while amonium and cesium were less potent. The results (1) confirm that sodium-potassium exchanges are indirectly involved in cholinergic relaxation of arterial smooth muscle and (2) suggest that membrane hyperpolarisation resulting from increased electrogenic sodium transport does not affect the inhibitory response to the cholinergic transmitter.

Acetylcholine↗
PubMed1992

Femoral artery blood flow monitoring has distinct advantages for examining redistribution of blood flow in fetal acidosis.

Changes of blood flow in umbilical artery, carotid artery and femoral artery were examined during the progression of acidemia in fetal sheep by means of indwelling transit-time ultrasonic blood flow meters. Moreover, catecholamines in fetal blood were measured and its interrelation to the alteration in blood flow was examined. Gradually progressing fetal acidemia was induced by repeated cord compression. Umbilical blood flow showed a initial increase thereafter maintaining a plateau through the experiment, which seemed to be dependent on fetal arterial pressure. Carotid artery flow gradually increased until the arterial pH in fetal blood declined to 7.20 and remained at this level even though the acidemia further progressed. Femoral artery flow markedly decreased around fetal arterial blood pH 7.20 and its change correlated well with the plasma level of catecholamines. This change of femoral artery flow may be evaluated by examination of the flow index as well as flow volume. Redistribution of blood flow in the progression of fetal acidemia may be initiated at around fetal arterial pH 7.20 and can be detected by studying femoral artery flow.

Acidosis↗
PubMed1996

Atherosclerotic femoral artery aneurysms: increase in deep femoral aneurysms?

Based on a clinical suspicion of an increase in the proportion of deep femoral aneurysms, we reviewed the case records of patients who underwent reconstructive procedures for femoral aneurysms to investigate if this could be confirmed and explained by selection of patient or modality of diagnosis. A study was made of 17 atherosclerotic femoral aneurysms operations occurring in 17 patients from 1989 to 1994. Eleven associated aneurysms were found. Eleven patients presented with an expanding swelling, 4 with rupture 3 with thrombosis and 2 were asymptomatic. Fourteen aneurysms involved the common femoral artery and 3 the deep femoral artery. The proportion of deep femoral aneurysm was therefore 3/17 = 18%. Previous series report that aneurysms of the profunda femoris artery occurs in only 1% to 2.6% of all femoral artery aneurysms. No explanation was found for this significant increase (p < 0.05).

Adult↗
PubMed2005

Stent placement for severe stenosis in the deep femoral artery with the occluded superficial femoral and popliteal arteries.

In both superficial and deep femoral artery involvement, where angioplasty of the former is not suitable or feasible, angioplasty of the latter seems to be the method of choice and is a less invasive and efficient treatment particularly for limb threatening ischemia, an appropriate obstruction morphology provided. The authors describe a case of a 73-year-old man, with a rest pain of the foot and intermittent cyanosis of the toe, who underwent stent placement with transluminal angioplasty for severe stenosis in the deep femoral artery with the occluded superficial femoral and popliteal artery. The patient's ankle brachial index was remarkably increased from 0.25 to 0.61, and the preoperative symptoms were improved.

Aged↗