title: Investigations of a thermosensitive gel to temporarily occlude crural arteries in femoro-distal bypass surgery.
abstract: OBJECTIVE
  Long occlusions in calcified crural arteries are a major cause of endovascular technical failure in patients with critical limb ischaemia. Therefore, distal bypasses are mainly performed in patients with heavily calcified arteries and with consequently delicate clamping. A new reverse thermosensitive polymer (RTP) is an alternative option to occlude target vessels. The aim of the study is to report our technical experience with RTP and to assess its safety and efficiency to temporarily occlude small calcified arteries during anastomosis time.
  
  
  METHODS
  Between July 2010 and December 2011, we used RTP to occlude crural arteries in 20 consecutive patients with 20 venous distal bypasses. We recorded several operative parameters, such as volume of injected RTP, duration of occlusion and anastomotic time. Quality of occlusion was subjectively evaluated. Routine on-table angiography was performed to search for plug emboli. Primary patency, limb salvage and survival rates were reported at 6 months.
  
  
  RESULTS
  In all patients, crural artery occlusion was achieved with the RTP without the use of an adjunct occlusion device. Mean volume of RTP used was 0.3 ml proximally and 0.25 ml distally. Mean duration of occlusion was 14.4 ± 4.5 min, while completion of the distal anastomosis lasted 13.4 ± 4.3 min. Quality of occlusion was judged as excellent in eight cases and good in 12 cases. Residual plugs were observed in two patients and removed with an embolectomy catheter, before we amended the technique for dissolution of RTP. At 6 months, primary patency rate was 75% but limb salvage rate was 87.5%. The 30-day mortality rate was 10%.
  
  
  CONCLUSIONS
  This study shows that RTP is safe when properly dissolved and effective to occlude small calcified arteries for completion of distal anastomosis.
authors.affiliation: Department of Thoracic and Vascular Surgery, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland. valerie.decrouy-duruz@chuv.ch
authors.forename: V
authors.initials: V
authors.lastname: Decrouy-Duruz
authors.forename: C
authors.initials: C
authors.lastname: Dubuis
authors.forename: S
authors.initials: S
authors.lastname: Déglise
authors.forename: J-M
authors.initials: JM
authors.lastname: Corpataux
authors.forename: F
authors.initials: F
authors.lastname: Saucy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001831:Body Temperature; D003250:Constriction; D017128:Embolectomy; D004617:Embolism / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007269:Injections, Intra-Arterial; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D020442:Poloxamer / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D061205:Vascular Calcification / Q000150:complications* / Q000175:diagnosis; D058017:Vascular Grafting / Q000009:adverse effects / Q000401:mortality; D014654:Vascular Patency
chemical_list: C539704:LeGoo; D020442:Poloxamer