A new technique of anterograde puncture for chronic limb-threatening ischemia with superficial femoral artery flush occlusion: vascular sheath fenestration.

Zhaopeng He, Boyu Wang, Haoyong Meng, Lei Zhang, Qingfu Zhang

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Article in Heart and vessels, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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Zhaopeng He *Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Rd, Shijiazhuang, 050000, Hebei, China.

Boyu Wang *Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Rd, Shijiazhuang, 050000, Hebei, China.

Haoyong MengDepartment of Intervention, The First Hospital of Hebei Medical University, Shijiazhuang, China.

Lei Zhang *Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Rd, Shijiazhuang, 050000, Hebei, China. 57002230@hebmu.edu.cn.

Qingfu Zhang *Department of Burn and Wound Repair Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Rd, Shijiazhuang, 050000, Hebei, China.

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6 · The paper itself

Abstract

We introduce a technique for treating chronic limb-threatening ischemia with superficial femoral artery flush occlusion, facilitating intravascular treatment when conventional anterograde puncture is challenging. This retrospective study reviewed 37 patients who underwent vascular sheath fenestration assisted anterograde puncture to complete endovascular treatment for chronic limb-threatening ischemia from December 2022 to December 2023. All patients had superficial femoral artery flush occlusion, meeting chronic limb-threatening ischemia diagnostic criteria. Evaluations included intraoperative radiation dose, technical success rate, patency rate, limb retention rate, and postoperative complications from surgery to a 12-month follow-up. The mean age of the patients was 70 ± 10 years, with an age range of 46 to 90 years. A significant proportion of the cases presented with severe chronic limb-threatening ischemia, with 78.4% classified as Rutherford ≥ 5, 51.3% as WiFi ≥ 3, and 97.3% as Global Limb Anatomic Staging System III. In all surgical procedures, a plain old balloon angioplasty was utilized for anterograde dilation. Subsequently, based on angiographic findings, treatment involved either drug-coated balloon dilation combined with stent implantation or drug-coated balloon dilation alone. Successful revascularization was achieved in all cases, resulting in marked clinical and hemodynamic improvements, as evidenced by the mean ankle-brachial index increasing from 0.49 preoperatively to 0.86 postoperatively. The 12-month follow-up outcomes were as follows: limb salvage rate of 94.6%, primary patency rate of 83.8%, assisted primary patency rate of 91.9%, and secondary patency rate of 94.6%. The incidence of postoperative complications was 8.1%. The average duration of hospital stay was 8.43 ± 2.72 days. The vascular sheath fenestration assisted anterograde puncture technique demonstrates favorable surgical outcomes and merits consideration as a viable treatment option for chronic limb-threatening ischemia patients with superficial femoral artery occlusion.

Indexed as

Angioplasty, BalloonChronic Limb-Threatening IschemiaEndovascular ProceduresFemoral ArteryIschemiaPeripheral Arterial DiseaseAgedAged, 80 and overChronic DiseaseFemaleFollow-Up StudiesHumansMaleMiddle AgedPuncturesRetrospective StudiesAnterograde punctureChronic limb-threatening ischemiaGlobal Limb Anatomic Staging SystemSuperficial femoral artery flush occlusionVascular sheath fenestrationVascular sheath fenestration assisted anterograde puncture technique for superficial femoral artery flush occlusion

Identifiers

PMID40085217

DOI10.1007/s00380-025-02534-6

PMCPMC12464102

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