May 2019

Protection from renal injury with popliteal artery micro-puncture and minimized radiographic contrast use with critical SFA lesions, low EGFR, and high creatinine levels

Süha Sadullah Özdilek1, Fatma Ferda Kartufan3, Soner Sanioğlu2, Hakan Öntaş4, Kayıhan Kara5, Halit Yerebakan2

1 Department of Cardiovascular Surgery, Sakarya Research and Training Hospital, Sakarya, 2 Department of Cardiovascular Surgery, Yeditepe Univesity Hospital, Ataşehir, Istanbul, 3 Department of Anesthesia and Intensive Care, Yeditepe Univesity Hospital, Ataşehir, Istanbul, 4 Department of Cardiovascular Surgery, Balıkesir Atatürk City Hospital, Balıkesir, 5 Department of Internal Medicine, Turkish Ministry of Defence, Turkish Naval Forces Command Primary Health Center, Çankaya, Ankara, Turkey

DOI:10.4328/ECAM.10001

Abstract

Aim: In recent years endovascular treatment of symptomatic peripheral arterial disease (PAD) provides many advantages like fast application, fast recovery and low cost in many cases. And it is recommended as a primary revascularization strategy in a wide range of many PAD patients rather than surgical treatment of symptomatic peripheral arterial disease (PAD). However optimal methods of catheter-based treatment for renal insufiency patients remain controversial. Material and Method: In Yeditepe University Faculty of Medicine Hospital between 2017-2018, we performed endovascular treatment with ipsilateral popliteal artery puncture of 18 patients. Pre-op creatinin , EGFR and post-operative creatinin levels and puncture area complications were compared. Results: Primary end-point was technical success with popliteal access without any post-operative complications and low dosage contrast usage. Secondary end-point was 3 months follow-up stenosis degree. No punction area complications were notted. None of patients had any hematoma, ecchymosis or pseudoaneurisyms in puncture area. And after procedure none of patients had to have dialisysis treatment despite high level of kreatinin and low EGFR values. In third month control follow-up patients were asymptomatic and no recurren vascular disease was seen in doppler usg. Discussion: As a conclusion, balloon angioplasty performed with ipsilateral popliteal ar- tery micro-puncture with manually low dosage opaque use, allows the shortest way to access the target lesion and it protects the kidney from opaque toxication with minimizing the amount of opaque usage for superficial femoral artery lesions. Therefore, renal protection was ensured before and after the operation without dialysis in diabetic patients with low EGFR and borderline high creatinine levels in the study group. Furthermore, the incidence of complications is lower with popliteal artery micro-puncture than femoral artery puncture.

Keywords

Renal Insuffiency; Popliteal Artery Micro-Puncture; Endovascular Treatment; Drug Eluting Balloon; Symptomatic Peripheral Artery Disease

Corresponding Author: Halit Yerebakan, Yeditepe University Hospital Cardiovascular Surgery Department, İçerenköy Mah. Hastane Sok. No:4,4/1 Ataşehir, İstanbul, Turkey. GSM: +905332719284 • F.: +90 2164693796 • E-Mail: drhalid@gmail.com • ORCID ID: 0000-0001-9476-3145

How to Cite: Süha Sadullah Özdilek, Fatma Ferda Kartufan, Soner Sanioğlu, Hakan Öntaş, Kayıhan Kara, Halit Yerebakan. Protection from renal injury with popliteal artery micro-puncture and minimized radiographic contrast use with critical SFA lesions, low EGFR, and high creatinine levels. Eu Clin Anal Med 2019;7(2): 18-22.