title: Intraprocedural Distal Embolization After Femoropopliteal Angioplasty: Is There a Role for Below-the-Knee Stents?
abstract: OBJECTIVE
  Intraprocedural distal embolization is an accepted complication of femoropopliteal angioplasty. The purpose of this study is to assess the use of below-the-knee stents in the "bail-out" of conventional methods.
  
  
  METHODS
  We retrospectively reviewed 1485 of femoropopliteal angioplasties that were performed in our centre in a 4-year period and analysed 12 cases (<1%) where distal embolization that required further intervention occurred. In all cases lesions were chronic and 75% suffered from critical limb ischaemia. The target vessel was the SFA in all of the cases with a long (>10 cm) occlusion in 50%. A three-vessel run-off was present in only 25%. Patients that received a stent as a limb salvage attempt were analysed. Outcome measures were technical success, clinical success and procedure-related complications. Multivariate regression analysis of the factors related to stenting was also performed.
  
  
  RESULTS
  In 41% of the cases with distal embolization, recanalization with aspiration, thrombolysis or angioplasty offered a satisfactory result. In 59%, conventional methods were ineffective; a stent was deployed in 85%, whereas in 15% surgical embolectomy was required. Technical and clinical success of the stent cases was 100% without any procedure-related complications. There was significance (p < 0.05) between critical limb ischaemia and stenting; single-vessel run-off has also shown a positive trend (p = 0.88).
  
  
  CONCLUSIONS
  Stents appear as a valid salvage option for infragenicular distal embolization when conventional methods fail; the likelihood of having to use a stent is higher for patients with critical limb ischaemia and a single-vessel run-off.
authors.affiliation: Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK. mkrokidis@hotmail.com.
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Krokidis
authors.affiliation: Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Tariq
authors.initials: T
authors.lastname: Ali
authors.affiliation: Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hilliard
authors.affiliation: Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Shaida
authors.affiliation: Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Winterbottom
authors.affiliation: Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Brendan
authors.initials: B
authors.lastname: Koo
authors.affiliation: Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Teik Choon
authors.initials: TC
authors.lastname: See
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D004617:Embolism / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Below-the-knee stents; Complications; Distal embolization; Peripheral vascular interventions