TY - JOUR
T1 - Spontaneous recanalization of arterial occlusions
T2 - An unusual mechanism for symptomatic improvement
AU - Gargiulo, Nicholas J.
AU - Veith, Frank J.
AU - Lipsitz, Evan C.
AU - Ohki, Takao
AU - Suggs, William D.
AU - Cayne, Neal S.
AU - Dadian, Nishan
AU - Wain, Reese A.
AU - Hobson, Robert W.
AU - Ascher, Enrico
AU - Adelman, Mark
AU - Walsh, Daniel
N1 - Funding Information:
From the Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine. Supported by grants from The James Hilton Manning and Emma Austin Manning Foundation, The Anna S. Brown Trust, The New York Institute for Vascular Studies, and The William J. von Liebig Foundation. Competition of interest: nil. Presented at the Sixteenth Annual Meeting of the Eastern Vascular Society, Boston, Mass, May 2-5, 2002. Reprint requests: Frank J. Veith, MD, Division of Vascular Surgery, Mon-tefiore Medical Center, 111 E 210th St, New York, NY 10467 (e-mail: fjvmd@msn.com). Copyright © 2002 by The Society for Vascular Surgery and The American Association for Vascular Surgery. 0741-5214/2002/$35.00 + 0 24/6/129650 doi:10.1067/mva.2002.129650
PY - 2002/12/1
Y1 - 2002/12/1
N2 - Objective: Patients with infrainguinal occlusive disease may experience spontaneous symptomatic improvement. This is generally thought to be from augmented collateral circulation. This study reports another mechanism. Methods: Over a 20-year period, 4123 paients underwent lower extremity arteriography for limb ischemia. For a variety of reasons, 451 patients had repeat arteriography. Results: Five patients were identified as having conclusive arteriographic evidence of spontaneous recanalization of occluded arterial segments without having undergone any surgical or thrombolytic interventions. Repeat contrast arteriography was performed on these patients for failing grafts (n = 2) or contralateral lower extremity ischemia (n = 3). Three other patients had magnetic resonance arteriographic or duplex arteriographic evidence of spontaneous arterial recanalization. Spontaneous recanalizaton occurred in ileofemoral (n = 2), superficial femoral (n = 2), popliteal (n = 3), and peroneal (n = 1) arterial segments. The average time interval of occlusion to recanalization was 21 weeks (2 weeks to 2 years). Two of the eight patients had failed revascularization procedures before spontaneous recanalization. All eight patients had restoration of pulses distal to the recanalized segments and significant symptomatic improvement as defined with the Society for Vascular Surgery/American Association for Vascular Surgery categories for limb ischemia. Conclusion: Spontaneous recanalization of arterial segments can occur and must be considered when evaluating other proposed treatments of critical limb ischemia, including cilostazol, lytic agents, and angiogenic agents, such as vascular endothelial growth factor. Although its true incidence is unknown, this represents another mechanism for spontaneous symptomatic improvement without treatment in patients with severe limb ischemia.
AB - Objective: Patients with infrainguinal occlusive disease may experience spontaneous symptomatic improvement. This is generally thought to be from augmented collateral circulation. This study reports another mechanism. Methods: Over a 20-year period, 4123 paients underwent lower extremity arteriography for limb ischemia. For a variety of reasons, 451 patients had repeat arteriography. Results: Five patients were identified as having conclusive arteriographic evidence of spontaneous recanalization of occluded arterial segments without having undergone any surgical or thrombolytic interventions. Repeat contrast arteriography was performed on these patients for failing grafts (n = 2) or contralateral lower extremity ischemia (n = 3). Three other patients had magnetic resonance arteriographic or duplex arteriographic evidence of spontaneous arterial recanalization. Spontaneous recanalizaton occurred in ileofemoral (n = 2), superficial femoral (n = 2), popliteal (n = 3), and peroneal (n = 1) arterial segments. The average time interval of occlusion to recanalization was 21 weeks (2 weeks to 2 years). Two of the eight patients had failed revascularization procedures before spontaneous recanalization. All eight patients had restoration of pulses distal to the recanalized segments and significant symptomatic improvement as defined with the Society for Vascular Surgery/American Association for Vascular Surgery categories for limb ischemia. Conclusion: Spontaneous recanalization of arterial segments can occur and must be considered when evaluating other proposed treatments of critical limb ischemia, including cilostazol, lytic agents, and angiogenic agents, such as vascular endothelial growth factor. Although its true incidence is unknown, this represents another mechanism for spontaneous symptomatic improvement without treatment in patients with severe limb ischemia.
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U2 - 10.1067/mva.2002.129650
DO - 10.1067/mva.2002.129650
M3 - Article
C2 - 12469047
AN - SCOPUS:0036997951
SN - 0741-5214
VL - 36
SP - 1161
EP - 1166
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 6
ER -