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Hoyano M, Ozaki K, Nishida K, Sakai R, Kubota N, Takano T, Okubo T, Kimura S, Yanagawa T, Ozawa T, Kashimura T, Minamino T. High-Resolution Angioscopy of Endoluminal Stent Graft at 6 Months After Implantation. Circ J 2019; 83:1970. [PMID: 30842362 DOI: 10.1253/circj.cj-18-1229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Makoto Hoyano
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kota Nishida
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Ryohei Sakai
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Naoki Kubota
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Toshiki Takano
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takeshi Okubo
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Shinpei Kimura
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takao Yanagawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takuya Ozawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takeshi Kashimura
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
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Schneider PA, Laird JR, Tepe G, Brodmann M, Zeller T, Scheinert D, Metzger C, Micari A, Sachar R, Jaff MR, Wang H, Hasenbank MS, Krishnan P. Treatment Effect of Drug-Coated Balloons Is Durable to 3 Years in the Femoropopliteal Arteries: Long-Term Results of the IN.PACT SFA Randomized Trial. Circ Cardiovasc Interv 2019; 11:e005891. [PMID: 29326153 PMCID: PMC5771683 DOI: 10.1161/circinterventions.117.005891] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/29/2017] [Indexed: 01/23/2023]
Abstract
Supplemental Digital Content is available in the text. Background— Randomized controlled trials have reported favorable 1-year outcomes with drug-coated balloons (DCBs) for the treatment of symptomatic peripheral arterial disease when compared with standard percutaneous transluminal angioplasty (PTA). Evidence remains limited on the durability of the treatment effect with DCBs in the longer term. Methods and Results— IN.PACT SFA is a single-blind, randomized trial (Randomized Trial of IN.PACT Admiral Paclitaxel-Coated Percutaneous Transluminal Angioplasty [PTA] Balloon Catheter vs Standard PTA for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery [SFA] and/or Proximal Popliteal Artery [PPA]) that enrolled 331 patients with symptomatic (Rutherford 2–4) femoropopliteal lesions up to 18 cm in length. Patients were randomized 2:1 to receive treatment with DCB or PTA. The 36-month assessments included primary patency, freedom from clinically driven target lesion revascularization, major adverse events, and functional outcomes. At 36 months, primary patency remained significantly higher among patients treated with DCB compared with PTA (69.5% versus 45.1%; log rank P<0.001). The rates of clinically driven target lesion revascularization were 15.2% and 31.1% (P=0.002) for the DCB and PTA groups, respectively. Functional outcomes were similarly improved between treatment groups even though subjects in the DCB group required significantly fewer reinterventions versus those in the PTA group (P<0.001 for target lesion revascularization, P=0.001 for target vessel revascularization). There were no device- or procedure-related deaths as adjudicated by an independent Clinical Events Committee. Conclusions— Three-year results demonstrate a durable and superior treatment effect among patients treated with DCB versus standard PTA, with significantly higher primary patency and lower clinically driven target lesion revascularization, resulting in similar functional improvements with reduced need for repeat interventions. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01175850 for IN.PACT SFA phase I in the European Union and NCT01566461 for IN.PACT SFA phase II in the United States.
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Affiliation(s)
- Peter A Schneider
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.).
| | - John R Laird
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Gunnar Tepe
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Marianne Brodmann
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Thomas Zeller
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Dierk Scheinert
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Christopher Metzger
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Antonio Micari
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Ravish Sachar
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Michael R Jaff
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Hong Wang
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Melissa S Hasenbank
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Prakash Krishnan
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
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Werner M, Gomari-Grisar F, Belalcazar S, Hirschl M, Kalchhauser G, Al-Taiee B, Jäger N, Westhausser C, Tischler M, Tischler R. Prospective Evaluation of the TIGRIS Vascular Stent Within a Modern Treatment Algorithm. J Endovasc Ther 2019; 26:637-642. [PMID: 31303096 DOI: 10.1177/1526602819862778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To prospectively evaluate the safety and efficacy of the TIGRIS Vascular Stent in the superficial femoral artery (SFA) and proximal popliteal artery within a treatment algorithm that reserved stent usage for more challenging patients. Materials and Methods: This prospective, single-center study enrolled 97 patients (mean age 68.7 years; 66 men) who were treated for 100 de novo or nonstented restenotic femoropopliteal lesions (≥70% stenosis) and had recoil or dissection after plain balloon predilation. The average lesion length was 5.6±2.3 cm (maximum 8 cm per protocol). The composite primary efficacy outcome was 12-month primary patency, defined as a peak systolic velocity ratio ≤2.5 at the stented target lesion on duplex ultrasound, and no clinically-driven reintervention within the stented segment. The primary safety outcome was freedom from device- and procedure-related target vessel revascularization, target limb major amputation (above the metatarsals), or death through 30 days. Secondary outcomes included secondary patency, clinically-driven target lesion revascularization (TLR), Rutherford category change relative to baseline, and binary restenosis of the target lesion. Results: All devices were successfully implanted with no device-related complications at the time of implant or within the 30-day postimplant window. The average stented length was 7.0±2.5 cm; no stent elongation was observed during deployment. One patient was lost to follow-up before 12 months and another died of an unrelated cause, leaving 95 patients (98 lesions) available for 12-month follow-up and 77 patients/lesions for the 24-month preliminary analysis. The binary primary and secondary patency rates at 12 months were 92.9% and 100%. The binary freedom from TLR was 94.9%. At 24 months, the Kaplan-Meier estimate of primary patency was 90.0%. Conclusion: This prospective study demonstrated that the TIGRIS Vascular Stent is a safe and effective device in a modern treatment algorithm that reserved bare stent use for postangioplasty dissection or recoil in distal femoropopliteal arteries.
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Affiliation(s)
- Martin Werner
- Department of Angiology, Hanusch Krankenhaus, Vienna, Austria
| | | | | | - Mirko Hirschl
- Department of Angiology, Hanusch Krankenhaus, Vienna, Austria
| | | | - Baker Al-Taiee
- Department of Radiology, Hanusch Krankenhaus, Vienna, Austria
| | - Nadja Jäger
- Department of Radiology, Hanusch Krankenhaus, Vienna, Austria
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Cole JM, Salavitabar A, Armstrong AK, Berman DP. Use of the Gore Viabahn VBX balloon‐expandable endoprosthesis in the congenital heart disease population. Catheter Cardiovasc Interv 2019; 94:416-421. [DOI: 10.1002/ccd.28389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/17/2019] [Accepted: 06/22/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Jason M. Cole
- Pediatric CardiologyNationwide Children's Hospital Columbus Ohio
| | | | | | - Darren P. Berman
- Pediatric CardiologyNationwide Children's Hospital Columbus Ohio
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Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg 2019; 58:S1-S109.e33. [PMID: 31182334 PMCID: PMC8369495 DOI: 10.1016/j.ejvs.2019.05.006] [Citation(s) in RCA: 739] [Impact Index Per Article: 147.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GUIDELINE SUMMARY Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.
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Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA.
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University Hospital of Liège, Wallonia, Belgium
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Niles, IL, USA
| | - Florian Dick
- Department of Vascular Surgery, Kantonsspital St. Gallen, St. Gallen, and University of Berne, Berne, Switzerland
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, The University of Adelaide Medical School, Adelaide, South Australia, Australia
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University Hospitalof Poitiers, Poitiers, France
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Victor Aboyans
- Department of Cardiology, Dupuytren, University Hospital, France
| | - Murat Aksoy
- Department of Vascular Surgery American, Hospital, Turkey
| | | | | | | | - Jill Belch
- Ninewells Hospital University of Dundee, UK
| | - Michel Bergoeing
- Escuela de Medicina Pontificia Universidad, Catolica de Chile, Chile
| | - Martin Bjorck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
| | | | | | - Joseph Dawson
- Royal Adelaide Hospital & University of Adelaide, Australia
| | - Eike S Debus
- University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Germany
| | - Andrew Dueck
- Schulich Heart Centre, Sunnybrook Health, Sciences Centre, University of Toronto, Canada
| | - Susan Duval
- Cardiovascular Division, University of, Minnesota Medical School, USA
| | | | - Roberto Ferraresi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico, Città Studi, Milan, Italy
| | | | - Mauro Gargiulo
- Diagnostica e Sperimentale, University of Bologna, Italy
| | | | | | | | - Wei Guo
- 301 General Hospital of PLA, Beijing, China
| | | | | | - Prasad Jetty
- Division of Vascular and Endovascular Surgery, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | | | | | - Wei Liang
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, China
| | - Robert Lookstein
- Division of Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | | | | | | | | | | | | | - Juan E Paolini
- Sanatorio Dr Julio Mendez, University of Buenos Aires, Argentina
| | - Manesh Patel
- Division of Cardiology, Duke University Health System, USA
| | | | | | | | - Lee Rogers
- Amputation Prevention Centers of America, USA
| | | | - Peter Schneider
- Kaiser Foundation Hospital Honolulu and Hawaii Permanente Medical Group, USA
| | - Spence Taylor
- Greenville Health Center/USC School of Medicine Greenville, USA
| | | | - Martin Veller
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jinsong Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Restenosis Prevention With Drug Eluting or Covered Stents in Femoropopliteal Arterial Occlusive Disease: Evidence From a Comprehensive Network Meta-analysis. Eur J Vasc Endovasc Surg 2019; 58:61-74. [PMID: 31202582 DOI: 10.1016/j.ejvs.2018.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND/OBJECTIVE Endovascular interventions for femoropopliteal (FP) arterial diseases are limited by the development of restenosis. Current drug coated devices are capable of preventing restenosis by releasing antiproliferative agents to the vessel wall. However, default strategies for the treatment of FP diseases remain controversial. The aim of this study was to investigate the efficacy differences between drug eluting stents (DES), covered stents (CS), and other commonly used endovascular treatments in FP lesions, including drug coated balloons (DCBs), bare metal stents (BMS), and percutaneous transluminal angioplasty (PTA). METHODS A comprehensive network meta-analysis was conducted using data from relevant randomised control trials published up to 16 December 2018. Primary patency and target lesion revascularisation (TLR) at 12 months were set as the primary and secondary end points, respectively. RESULTS Twenty-eight eligible trials including 4728 patients were selected. DES was ranked as the most effective treatment in the multidimensional analysis of primary patency; however, there was no significant difference in the efficacy of DES and that of CS, DCB, and BMS. However, in short lesions (<10 cm), DES was significantly more effective than DCB (odds ratio 0.35; 95% confidence interval 0.15-0.83). Primary patency at 12 months was significantly lower with PTA. In terms of preventing TLR, DCB was ranked first, followed by DES, CS, BMS, and PTA. TLR was significantly higher with PTA than with other treatment strategies. CONCLUSION The findings of this network meta-analysis suggest that this is not the appropriate time to identify the best endovascular treatment strategy for the FP segment. DES is effective in maintaining mid-term patency, especially in short lesions, whereas DCB seems more suitable for clinical use.
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Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg 2019; 69:3S-125S.e40. [PMID: 31159978 PMCID: PMC8365864 DOI: 10.1016/j.jvs.2019.02.016] [Citation(s) in RCA: 710] [Impact Index Per Article: 142.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.
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Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif.
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University Hospital of Liège, Wallonia, Belgium
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Niles, Ill
| | - Florian Dick
- Department of Vascular Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, The University of Adelaide Medical School, Adelaide, South Australia
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, Tex
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University Hospitalof Poitiers, Poitiers, France
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minn
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Shimada Y, Armstrong EJ. Primary Stenting: Default Therapy or Landmark Comparator? J Endovasc Ther 2019; 26:168-171. [DOI: 10.1177/1526602819833065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Yoshihisa Shimada
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Ehrin J. Armstrong
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- Division of Cardiology, University of Colorado, Aurora, CO, USA
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Uhl C, Dadras A, Reichmann F, Betz T, Zorger N, Toepel I, Steinbauer M. Long-term results of the heparin-bonded Viabahn stent graft in femoropopliteal TASC C and D lesions with a covered stent length of minimum 25 cm. Vascular 2019; 27:553-559. [DOI: 10.1177/1708538119840863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Heparin-bonded covered stent grafts (Viabahn) are used to treat femoropopliteal long-segment arteriosclerotic lesions. The aim of this study was to evaluate the long-term outcome of Viabahn grafts with a covered stent length of minimum 25 cm. Methods We conducted a retrospective analysis of patients receiving a heparin-bonded stent graft in our clinic who met the length criteria between July 2010 and March 2018. Primary endpoints were patency rates, limb salvage and survival after five years. Secondary endpoint was the 30-day outcome including early complications. Results A total of 62 patients (45 male, median age 70.5 years) were included. The median arteriosclerotic lesion length was 25 cm (22.0–41.3 cm), the minimum covered stent length was 25 cm (25–46 cm). All lesions were TASC C and D lesions. The 30-day mortality was 0%, an early stent graft occlusion occurred in 8.1%. A major amputation was performed in 1.6%. Primary patency, primary assisted patency, secondary patency, limb salvage and survival were 38.5%, 45.7%, 52.4%, 92.8% and 68.9% after five years. Distal stent graft end below the femoral condyles and critical limb ischemia was associated with a significant decreased survival. The diameter of the stent had no influence on the outcome. Conclusion The Viabahn stent graft for long segment arteriosclerotic lesions is a feasible treatment with adequate long-term results.
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Affiliation(s)
- C Uhl
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Regensburg, Germany
| | - A Dadras
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Regensburg, Germany
| | - F Reichmann
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Regensburg, Germany
| | - T Betz
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Regensburg, Germany
| | - N Zorger
- Department of Radiology and Interventional Radiology, Barmherzige Brueder Regensburg, Regensburg, Germany
| | - I Toepel
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Regensburg, Germany
| | - M Steinbauer
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Regensburg, Germany
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60
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Sheeran D, Wilkins LR. Long Chronic Total Occlusions: Revascularization Strategies. Semin Intervent Radiol 2019; 35:469-476. [PMID: 30728663 DOI: 10.1055/s-0038-1676343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The treatment of chronic total occlusions (CTO) in patients with peripheral arterial disease (PAD) is a complex topic with multiple treatment techniques and treatment strategies. The interventionalist treating patients with PAD should have both a defined treatment algorithm and multiple techniques available for crossing these challenging lesions. This article will cover techniques for treating CTOs and provide an overview of current available evidence.
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Affiliation(s)
- Daniel Sheeran
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Luke R Wilkins
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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61
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Outcomes for popliteal artery injury repair after discharge: A large-scale population-based analysis. J Trauma Acute Care Surg 2019; 86:173-180. [DOI: 10.1097/ta.0000000000002118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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62
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Lin TC, Chen PL, Lee CY, Shih CC, Chen IM. Covered stent versus bare-metal stents for chronic total occluded long complicated femoropopliteal lesions: A 2-year single center review. J Chin Med Assoc 2019; 82:44-49. [PMID: 30839403 DOI: 10.1097/jcma.0000000000000005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To compare the efficacy, safety, and results of Viabahn versus bare-metal stents (BMS) in chronic total occluded (CTO) long femoropopliteal lesions. METHODS From April 2009 to August 2014, a total 97 patients (71.2 ± 9.7, 45-90 years old, 70 males) with occluded femo-ropopliteal lesions underwent Viabahn (55 patients) or BMS (42 patients) implantation. The clinical findings, procedural factors, and overall outcomes were collected and analyzed. RESULTS The average lesion length was 22.1 ± 4.8 cm in the Viabahn group and 17.8 ± 3.3 cm in the BMS group. Both groups had a 100% technical success rate. Although there was no difference between the groups in complication, mortality, and major amputation rates, the Viabahn group had a significantly better average post-operative ankle brachial index (ABI) at 1-year and 2-year follow-ups. The Viabahn group also had significantly less in-stent restenosis (ISR) and target lesion revascularization (TLR) compared with the BMS group. Nevertheless, the two groups shared similar 2-year primary patency rates (63.6% vs. 50.0%, p = .178) and 2-year secondary patency rates (85.5% vs. 81.0%, p = .554). CONCLUSION Both Viabahn and BMS were efficient treatments for long femoropopliteal CTO lesions. However, the Viabahn group had significantly improved results compared with the BMS group in TLR and ISR, but the difference was not sufficient enough to result in different primary and secondary patency rates.
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Affiliation(s)
- Ting-Chao Lin
- Division of Cardiovascular Surgery, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Department of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Po-Lin Chen
- Department of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiu-Yang Lee
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institution of Clinical Medicine, School of medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - I-Ming Chen
- Department of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Kansal A, Long CA, Patel MR, Jones WS. Endovascular treatment of femoro-popliteal lesions. Clin Cardiol 2018; 42:175-183. [PMID: 30324655 DOI: 10.1002/clc.23098] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022] Open
Abstract
Peripheral artery disease (PAD) is a major health concern affecting more than 200 million people worldwide and studies have shown PAD to be a strong predictor of mortality, morbidity, and disability. The management of PAD is multi-tiered and advancements in technology have given physicians more options for endovascular revascularization if medical therapy does not result in substantial improvement. Many randomized controlled trials have reported efficacy of various therapies including laser atherectomy, stent technology, and drug-coated balloons over standard percutaneous transluminal angioplasty; however, uncertainty regarding the best standard of care remains unclear because of a lack of head to head comparisons between novel therapies. Furthermore, variability in the reported clinical outcomes exists and makes it difficult to evaluate the superiority of any specific treatment modality, especially for functional capacity and quality of life. Recently established consensus definitions for clinical outcomes coupled with investigators incorporating direct comparisons within clinical trials will be crucial to establish consistent care and meaningful gain in treatment for these patients. This review will highlight the treatment modalities, literature supporting each treatment modality, and insight into why they are being used and why variation exists around the United States.
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Affiliation(s)
- Aman Kansal
- Duke Heart Center, Division of Cardiology, School of Medicine, Duke University, Durham, North Carolina
| | - Chandler A Long
- Division of Vascular Surgery, School of Medicine, Duke University, Durham, North Carolina
| | - Manesh R Patel
- Duke Heart Center, Division of Cardiology, School of Medicine, Duke University, Durham, North Carolina.,Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - W Schuyler Jones
- Duke Heart Center, Division of Cardiology, School of Medicine, Duke University, Durham, North Carolina.,Duke Clinical Research Institute, Duke University, Durham, North Carolina
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Waezi N, Saha S, Bougioukas I, Emmert A, Danner BC, Baraki H, Kutschka I, Zenker D, Stojanovic T, Jebran AF. Viabahn stent graft compared with prosthetic surgical above-knee bypass in treatment of superficial femoral artery disease: Long-term results of a retrospective analysis. Medicine (Baltimore) 2018; 97:e12449. [PMID: 30290602 PMCID: PMC6200476 DOI: 10.1097/md.0000000000012449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prosthetic surgical above-knee bypass (pAKB) is a standard therapy in superficial femoral artery (SFA) occlusive disease in absence of suitable vein. Viabahn graft has been established as a promising alternative. Since limited comparative data are available, we conducted a retrospective study to compare long-term outcomes of these 2 therapies in a real-world setting.Records of 52 patients (60 limbs), who were treated by pAKB (29 limbs) or Viabahn (31 limbs) were reviewed. Patients were followed up by clinical assessment, physical examination, and resting ankle brachial index (ABI) after 3, 6, 12 months and yearly thereafter. Long-term data were available for 97% in the Viabahn and 93% for pAKB after 73 ± 3.7 months (mean ± standard error [SE]).Long-term primary and secondary patencies in Viabahn group were 40% and 70%, respectively, after 63 ± 2.8 months (mean ± SE). Total lesion length was 19 ± 11.06 cm (mean ± SE), graft size was 6 ± 0.72 mm (mean ± SE). Hospital stay was 4.8 ± 0.72 days (mean ± SE). Limb salvage was achieved in 90%. Patients in the pAKB group showed a total lesion length of 24.39 ± 1.97 cm (mean ± SE), graft size was 7 ± 0.99 mm (mean ± SE). Long-term analysis after 83 ± 6.8 months (mean ± SE) revealed a primary patency of 78% with a secondary patency of 94%. Hospital stay was 10.4 ± 1.27 days (mean ± SE). Limb salvage was ensured in 97%. Long-term primary patency was lower for Viabahn (P = .044), secondary patency (P = .245), and leg salvage (P = .389) were not significantly different. However, hospital stay was shorter (P = .0002) for Viabahn.Long-term analysis of Viabahn revealed a significantly lower primary patency, a similar secondary patency, limb salvage, and significantly shorter hospital stay when compared with pAKB. Our data suggest that pAKB is still a valuable option in patients suitable for an open operation. However, Viabahn can be used as a less invasive treatment in high risk patients.
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Affiliation(s)
- Narges Waezi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Shekhar Saha
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Ioannis Bougioukas
- Department of Cardiothoracic Surgery, Voelklingen Heart Centre, Völklingen
| | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Bernhard Christoph Danner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Hassina Baraki
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Ingo Kutschka
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Dieter Zenker
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | | | - Ahmad Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
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Chen PL, Lin TC, Chen IM. Hybrid Viabahn-Assisted Bypass for Long Femoro-Popliteal Occlusive Disease - Midterm Results. Circ J 2018; 82:2160-2164. [PMID: 29848901 DOI: 10.1253/circj.cj-18-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Endovascular therapy has become the first-line treatment for most peripheral artery diseases, but re-entry into the true lumen is not always possible, particularly in some cases of chronic total occlusion (CTO). We previously reported a novel hybrid Viabahn-assisted bypass (VAB) technique to facilitate revascularization of the femoro-popliteal CTO. This study assessed the midterm results of VAB technique.Methods and Results:Between January 2013 and April 2017, 440 patients received femoro-popliteal intervention and 17 of them (mean age, 76.2 years; 11 male patients) were treated using the VAB technique. The technical success was 100%. The mean follow-up period was 27.4±14.4 months (range, 6-50 months). Two patients underwent major amputation at 6 and 11 months postoperatively, but they died of acute myocardial infarction and of sepsis, respectively. Another 3 patients received re-intervention because of edge stenosis of the Viabahn stent graft. Another patient had acute Viabahn thrombosis and was treated using open thrombectomy. The primary and secondary patency rates at 12 months were both 88.2%, and at 24 months they were 69.2% and 84.6%, respectively. CONCLUSIONS The VAB technique could be a safe and feasible alternative treatment for long femoro-popliteal CTO when conventional treatments fail. The technical success is high, and the midterm patency rates are acceptable.
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Affiliation(s)
- Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital.,Department of Medicine, School of Medicine, National Yang-Ming University
| | - Ting-Chao Lin
- Department of Medicine, School of Medicine, National Yang-Ming University.,Heart Center, Cheng-Hsin Rehabilitation Medical Center
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital.,Department of Medicine, School of Medicine, National Yang-Ming University
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Percutaneous transluminal angioplasty/stent treatment of totally occlusive iliofemoral artery with limb ischemia: Experience of surgical team. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:414-421. [PMID: 32082772 DOI: 10.5606/tgkdc.dergisi.2018.15503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/20/2018] [Indexed: 11/21/2022]
Abstract
Background In this study, we present our center's experience on percutaneous transluminal angioplasty/stenting. Methods Between January 2015 and March 2017, a total of 40 patients (34 males, 6 females; mean age 64.5±8.7 years; range, 49 to 85 years) who were treated in our clinic due to totally occluded iliofemoral artery disease were included. There were 45 legs and 51 targeted vessels. Hybrid procedure was performed to those patients with iliofemoral or femoropopliteal bypass grafts. Results A total of 48 target vessels (94.1%) were implanted using 55 stents at the initial attempt. Failed three target vessels (5.9%) were treated by surgical revascularization. There was no procedure-related mortality. Below-knee amputation was performed in one patient after 70 days. Two patients underwent single-finger amputation. Contrast nephropathy occurred in one patient and this patient was treated medically. The mean follow-up was 16.7±5 (range, 8 to 29) months. After follow-up, 41 stents were found to be patent without any intervention, and the primary patency rate was 74.5%. Five stent thrombosis patients (12.5%) were treated at different times. Conclusion Our study results suggest that percutaneous transluminal angioplasty/stent treatment may be advisable in patients with significant comorbidities. The lower rates of complication in the stent series strongly suggest that, in experienced hands, percutaneous transluminal angioplasty/stent can offer lower procedural risks than surgical revascularization. Hybrid procedure is likely to be a reasonable choice for previously intervened comorbid patients for limb salvage.
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Zierler RE, Jordan WD, Lal BK, Mussa F, Leers S, Fulton J, Pevec W, Hill A, Murad MH. The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures. J Vasc Surg 2018; 68:256-284. [PMID: 29937033 DOI: 10.1016/j.jvs.2018.04.018] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022]
Abstract
Although follow-up after open surgical and endovascular procedures is generally regarded as an important part of the care provided by vascular surgeons, there are no detailed or comprehensive guidelines that specify the optimal approaches with regard to testing methods, indications for reintervention, and follow-up intervals. To provide guidance to the vascular surgeon, the Clinical Practice Council of the Society for Vascular Surgery appointed an expert panel and a methodologist to review the current clinical evidence and to develop recommendations for follow-up after vascular surgery procedures. For those procedures for which high-quality evidence was not available, recommendations were based on observational studies, committee consensus, and indirect evidence. Recognizing that there are numerous published reports on the role of duplex ultrasound for surveillance of infrainguinal vein bypass grafts, the Society commissioned a systematic review and meta-analysis on this topic. The panel classified the strength of each recommendation and the corresponding quality of evidence on the basis of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system: recommendations were graded either strong or weak, and the quality of evidence was graded high, moderate, or low. The resulting recommendations represent a wide variety of open surgical and endovascular procedures involving the extracranial carotid artery, thoracic and abdominal aorta, mesenteric and renal arteries, and lower extremity arterial revascularization. The panel also identified many areas in which there was a lack of high-quality evidence to support their recommendations. This suggests that there are opportunities for further clinical research on testing methods, threshold criteria, and the role of surveillance as well as on the modes of failure and indications for reintervention after vascular surgery procedures.
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Affiliation(s)
| | | | - Brajesh K Lal
- Department of Surgery, University of Maryland, Baltimore, Md
| | - Firas Mussa
- Department of Surgery Palmetto Health/University of South Carolina School of Medicine, Columbia, SC
| | - Steven Leers
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Joseph Fulton
- Department of Surgery, Westchester Medical Center, Poughkeepsie, NY
| | - William Pevec
- Division of Vascular Surgery, University of California, Davis, Sacramento, Calif
| | - Andrew Hill
- Division of Vascular & Endovascular Surgery, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minn
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Golla MS, Acharji S, Paul TK, Madapathi P, Garcia LA. Stent graft treatment for infra-inguinal arterial disease for either instent-restenosis and denovo lesions associated with very high rates of failure. Catheter Cardiovasc Interv 2018; 91:1130-1135. [PMID: 29214713 DOI: 10.1002/ccd.27431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 02/26/2017] [Accepted: 10/30/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND FDA approved the Gore Viabahn (WL Gore, Flagstaff, AZ, USA) stent for both femoro-popliteal arterial denovo and instent restenosis (ISRS) lesions. To date there is little data on Viabahn stent graft outcomes in ISRS arterial disease. METHODS Between 2007 and 2014 we identified 734 patients who underwent 1573 endovascular interventions in our institution for infra-inguinal revascularization. Among these, 48 patients had 143 Viabahn stents placed. Of these, 26 patients had 94 stents placed for ISRS and 22 patients had 49 stents placed for denovo lesions. RESULTS The patients in the ISRS group were younger and more likely to have hypertension, hyperlipidemia, coronary artery disease, compared to the patients in the denovo group. Stents were placed principally for femoro-popliteal lesions, with mean length of 21 ± 12.5 cm (19.2 ± 14, ISRS vs. 22.1 ± 11, denovo; P = 0.2). Both groups had low primary patency rates during one year follow up (54% vs. 33%, OR = 2.3 (0.9-2.2). Target lesion revascularization (TLR) (57% vs. 27%, P < 0.0001, OR = 3.7, CI = 1.8-8) and surgical revascularization (21% vs. 4%, OR = 6.3, CI = 1.4-28) occurred more frequently in the ISRS group than in the denovo group. Amputation rate (17% vs. 31%, OR 0.7, CI = 0.2-1), cumulative blockage (defined as ISRS and thrombosis) (62% vs. 47%, P = 0.09, OR = 1.8, CI = 0.9-3.6), and Restenosis (40% vs. 31%, OR 1.5, CI = 0.7-3.2) were not statistically different between the two groups. Mean duration of follow-up was 12.8 ± 13 months. CONCLUSION Stent graft treatment using the Gore Viabahn for denovo and ISRS in femoro-popliteal arterial obstructive disease have high restenosis and failure rates, of both stent patency and limb outcomes, which is consistent with existed literature.
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Affiliation(s)
- Maheswara S Golla
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Subasit Acharji
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Timir K Paul
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Praveena Madapathi
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Lawrence A Garcia
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Feldman DN, Armstrong EJ, Aronow HD, Gigliotti OS, Jaff MR, Klein AJ, Parikh SA, Prasad A, Rosenfield K, Shishehbor MH, Swaminathan RV, White CJ. SCAI consensus guidelines for device selection in femoral-popliteal arterial interventions. Catheter Cardiovasc Interv 2018; 92:124-140. [DOI: 10.1002/ccd.27635] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Herbert D. Aronow
- The Warren Alpert Medical School of Brown University; Providence Rhode Island
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70
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Gatto L, Frati G, Biondi-Zoccai G, Giordano A. Commentary: All That Glitters Is Not Zilver: Promises and Disappointments of Endovascular Devices for Superficial Femoral Artery Disease. J Endovasc Ther 2018; 25:302-305. [PMID: 29673300 DOI: 10.1177/1526602818769390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Laura Gatto
- 1 Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Giacomo Frati
- 2 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,3 Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- 2 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,3 Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
| | - Arturo Giordano
- 4 Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy.,5 Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy
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72
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Lin TC, Huang CY, Chen PL, Lee CY, Shih CC, Chen IM. Edge Stenosis After Covered Stenting for Long Superficial Femoral Artery Occlusive Disease: Risk Factor Analysis and Prevention With Drug-Coated Balloon Angioplasty. J Endovasc Ther 2018; 25:313-319. [DOI: 10.1177/1526602818771345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report a retrospective analysis of risk factors for edge restenosis after Viabahn stent-graft treatment of superficial femoral artery (SFA) occlusive disease and determine any protective effect of drug-coated balloons (DCBs) used at the time of stent-graft implantation. Methods: Between October 2011 and July 2016, 110 patients (mean age 73.3±7.6 years; 78 men) were treated with the Viabahn stent-graft for long SFA occlusions. Thirty-eight (34.5%) patients had DCB reinforcement at the distal edge of the stent-graft. For analysis, the population was divided into groups of no edge stenosis patients (n=88; mean lesion length 22.4±4.2 cm) and edge stenosis patients (n=22; mean lesion length 23.5±5.7 cm). The clinical outcomes, ankle-brachial indices, computed tomography angiography findings, and patency were compared at a minimum of 12 months. Logistic regression analysis was employed to determine risk factors for edge stenosis; the results are presented as the odds ratio (OR) and 95% confidence interval. Results: No differences in clinical or procedural characteristics were identified except the higher incidence of diabetes (p=0.008) and greater need for retrograde access (p=0.033) in the edge stenosis group. DCB reinforcement reduced the incidence of edge stenosis (p=0.021) and target lesion revascularization (TLR; p=0.010) and resulted in a significantly higher 1-year primary patency rate (92.1% vs 76.4%, p=0.042). However, multivariate analysis revealed only poor distal runoff (OR 0.31, 95% CI 0.11 to 0.83, p=0.020) as a predictor of edge stenosis. Conclusion: The risk of edge stenosis after Viabahn implantation was higher in patients with poor distal runoff. DCB reinforcement over the distal edge reduced edge stenosis, decreased 1-year TLR, and improved 1-year primary patency.
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Affiliation(s)
- Ting-Chao Lin
- Division of Cardiovascular Surgery, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yang Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Lin Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Yang Lee
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Ming Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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73
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Dias-Neto M, Matschuck M, Bausback Y, Banning-Eichenseher U, Steiner S, Branzan D, Staab H, Varcoe RL, Scheinert D, Schmidt A. Endovascular Treatment of Severely Calcified Femoropopliteal Lesions Using the “Pave-and-Crack” Technique: Technical Description and 12-Month Results. J Endovasc Ther 2018; 25:334-342. [DOI: 10.1177/1526602818763352] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report midterm results of the “pave-and-crack” technique to facilitate safe and effective scaffolding of heavily calcified femoropopliteal lesions in preparation for delivery of a Supera interwoven stent. Methods: Data were collected retrospectively on 67 consecutive patients (mean age 71±8 years; 54 men) treated with this technique between November 2011 and February 2017 at a single center. A third (22/64, 34%) of the patients had critical limb ischemia (CLI). Most lesions were TASC D (52/67, 78%), and the majority were occlusions (61/66, 92%). The mean lesion length was 26.9±11.2 cm. Nearly two-thirds (40/64, 62%) had grade 4 calcification (Peripheral Arterial Calcium Scoring System). To prepare for Supera stenting, the most heavily calcified segments of the lesion were predilated aggressively to obliterate recoil. A Viabahn stent-graft was then implanted to “pave” the lesion and protect from vessel rupture as aggressive predilation continued until the calcified plaque was “cracked” before lining the entire lesion with a Supera stent. Patency and target lesion revascularization (TLR) rates were estimated using the Kaplan-Meier method. Results: Procedural success was achieved in 100% and technical success (residual stenosis <30%) in 98% (66/67). The mean cumulative stent lengths were 16±9 cm for the Viabahn and 23±12 cm for the Supera. Only 2 complications occurred (distal embolization and access-site pseudoaneurysm). Two CLI patients died within 30 days, and 3 patients (all claudicants) underwent a TLR. Patients were followed for a mean 19±18 months, during which another 2 CLI patients died and 1 patient had a major amputation. One-year primary and secondary patency estimates were 79% and 91%, respectively; freedom from TLR was 85%. Conclusion: Despite severe lesion calcification, patients experienced high technical success and a safe and durable therapy at midterm follow-up with the femoropopliteal “pave-and-crack” technique.
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Affiliation(s)
- Marina Dias-Neto
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal
- Cardiovascular Research Center, Faculty of Medicine, University of Porto, Portugal
| | - Manuela Matschuck
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | - Yvonne Bausback
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | | | - Sabine Steiner
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | | | - Holger Staab
- Vascular Surgery, University Hospital Leipzig, Germany
| | - Ramon L. Varcoe
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Dierk Scheinert
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | - Andrej Schmidt
- Division of Interventional Angiology, University Hospital Leipzig, Germany
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74
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Phillips JA, Falls A, Kolluri R, Whipp A, Collins C, Mohir-Sadaai S, Reid B, Patil N, Alston M, Troyan M, Ansel GM. Full Drug-Eluting Stent Jacket: Two-Year Results of a Single-Center Experience With Zilver PTX Stenting for Long Lesions in the Femoropopliteal Arteries. J Endovasc Ther 2018; 25:295-301. [DOI: 10.1177/1526602818762805] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the 1- and 2-year patency and reintervention rates with the Zilver PTX drug-eluting stent (DES) in long complex femoropopliteal disease. Methods: A retrospective review was conducted of 89 consecutive patients (mean age 68.7±9.8 years; 86 men) with femoropopliteal occlusive disease (Rutherford category 2–6) treated with the Zilver PTX between December 2012 and December 2013. Mean lesion length for the entire cohort was 24.2±11.3 cm (median 24.0, range 4–48). The patient population was dichotomized into a short lesion (≤20 cm) group (n=41; mean lesion length 13.3±5.6 cm) and the full DES jacket (>20 cm) group (n=48; mean lesion length 33.0±6.5 cm). Primary endpoints were duplex-derived restenosis (peak systolic velocity ratio >2.5), clinically driven reintervention, and major amputation. Results: The incidence of restenosis was lower in the short lesion group at 1 year (19% vs 40% for the longer lesions, p=0.050) and 2 years (39% vs 54%, respectively; p=0.331). The short lesion group had significantly lower rates of reintervention at both 1 year (2% vs 21% in long lesions, p=0.009) and 2 years (12% vs 33%, p=0.019). Conclusion: Treatment of femoropopliteal lesions >20 cm with the Zilver PTX appears to be a clinically effective therapy for patients with symptomatic peripheral artery disease. However, there is an increase in restenosis and a need for reintervention that continues to progress up to 2 years.
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Affiliation(s)
| | | | - Raghu Kolluri
- OhioHealth Heart and Vascular Physicians, Columbus, OH, USA
| | | | | | | | | | | | | | | | - Gary M. Ansel
- OhioHealth Heart and Vascular Physicians, Columbus, OH, USA
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75
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Koifman E, Lipinski MJ, Buchanan K, Yu Kang W, Escarcega RO, Waksman R, Bernardo NL. Comparison of treatment strategies for femoro-popliteal disease: A network meta-analysis. Catheter Cardiovasc Interv 2018; 91:1320-1328. [DOI: 10.1002/ccd.27484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/05/2017] [Accepted: 12/17/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Michael J. Lipinski
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Kyle Buchanan
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Won Yu Kang
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ricardo O. Escarcega
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Nelson L. Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
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76
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Kim TH, Chavarria N, Dahal K, Azrin M, Lee J. Jetstream XC Device for Treatment of Long Viabahn Stents Occlusions in the Superficial Femoral Artery: A Report of Two Cases. Ann Vasc Dis 2017. [PMID: 29515712 PMCID: PMC5835424 DOI: 10.3400/avd.cr.17-00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Repeated restenotic events are common in superficial femoral artery and as of late, Viabahn stent grafts have been FDA (U.S. Food & Drug Administration) approved. Viabahn have been particularly attractive given that they provided a physical barrier for the development of neointimal hyperplasia. This particular feature however, also underscores one of the main limitations of the therapy; providing a physical barrier of collateral circulation and predisposing to acute limb ischemia. Viabahn endograft thrombosis is characterized by stent edge stenosis and endograft thrombosis. Here we present 2 cases of Viabahn graft thrombosis successfully treated with the Jetstream atherectomy device, a rotational cutter with aspiration capacity.
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Affiliation(s)
- Tae-Hoon Kim
- UConn Health, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | - Khagendra Dahal
- Division of Cardiovascular Medicine, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Michael Azrin
- UConn Health, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Juyong Lee
- UConn Health, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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77
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Cipollari S, Yokoi H, Ohki T, Kichikawa K, Nakamura M, Komori K, Nanto S, O'Leary EE, Lottes AE, Saunders AT, Dake MD. Long-Term Effectiveness of the Zilver PTX Drug-Eluting Stent for Femoropopliteal Peripheral Artery Disease in Patients with No Patent Tibial Runoff Vessels-Results from the Zilver PTX Japan Post-Market Surveillance Study. J Vasc Interv Radiol 2017; 29:9-17.e1. [PMID: 29122449 DOI: 10.1016/j.jvir.2017.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/15/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate 2-year results of the Zilver PTX (Cook Medical, Bloomington, Indiana) drug-eluting stent (DES) for femoropopliteal peripheral artery disease (PAD) in patients with no continuous patent infrapopliteal runoff arteries compared with patients with ≥ 1 continuous patent runoff vessels. MATERIALS AND METHODS A retrospective analysis of patients with femoropopliteal PAD enrolled in the Zilver PTX Post-Market Surveillance Study in Japan was performed. There were no exclusion criteria. Outcomes, including freedom from target lesion revascularization (TLR), patency, and clinical benefit, for the no-runoff group (n = 54) were compared with the runoff group (n = 846). RESULTS The 2 groups were similar in terms of demographics, lesion characteristics, and comorbidities (P > .05). There was a higher incidence of critical limb ischemia in the no-runoff group compared with the runoff group (44.8% vs 19.7%; P < .01). There were 3 amputations (5.6%) in the no-runoff group versus 7 amputations (0.8%) in the runoff group (P = .02). At 2 years, freedom from TLR rates were 81.3% versus 83.8% (P = .87), patency rates were 68.4% versus 70.7% (P = .95), and clinical benefit rates were 73.7% versus 80.0% (P = .16) in the no-runoff versus runoff group, respectively. CONCLUSIONS Results in patients with no continuous patent tibial runoff were favorable through 2 years and similar to results for patients with ≥ 1 continuous patent runoff vessels, indicating that the Zilver PTX DES may be a valid treatment option for patients with these difficult-to-treat lesions.
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Affiliation(s)
- Stefano Cipollari
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Cardiovascular Research Center, 300 Pasteur Drive, Stanford, CA 94305-5407
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Takao Ohki
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | | | | | | | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Cardiovascular Research Center, 300 Pasteur Drive, Stanford, CA 94305-5407.
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Jaff MR, Nelson T, Ferko N, Martinson M, Anderson LH, Hollmann S. Endovascular Interventions for Femoropopliteal Peripheral Artery Disease: A Network Meta-Analysis of Current Technologies. J Vasc Interv Radiol 2017; 28:1617-1627.e1. [PMID: 29031986 DOI: 10.1016/j.jvir.2017.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To use network meta-analysis (NMA) to determine the optimal endovascular strategy for management of femoropopliteal peripheral artery disease (PAD) given the lack of multiple prospective randomized trials to guide treatment decisions. MATERIALS AND METHODS NMA is a new meta-analytic method that permits comparisons among any 2 therapies by combining results of a collection of clinical trials conducted in the same or similar patient population. NMA was used to analyze data from 15 randomized controlled trials (RCTs) and 10 prospective, multicenter, single-arm trials (combined evidence [CE] NMA) that evaluated target lesion revascularization (TLR) for 5 endovascular strategies: bare metal stent (BMS), polymer-covered metal stent (CMS), drug-eluting stent (DES), drug-coated balloon (DCB) and percutaneous transluminal angioplasty (PTA). RESULTS The RCT and CE NMAs included 2,912 (6,091) patients with 3,151 (6,786) person-years of follow-up. In the CE NMA, DCB provided a statistically significant 68% reduction in TLR compared with PTA and a statistically significant 53% reduction in TLR compared with BMS. BMS, CMS, and DES provided reductions in TLR of 33%, 48%, and 58% compared with PTA, with statistical significance achieved for CMS and DES. The significant reductions in TLR for DCB compared with PTA and BMS were replicated in the RCT NMA. CONCLUSIONS This NMA demonstrated that DCB provided better reduction in TLR rates compared with PTA and BMS.
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Affiliation(s)
- Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462.
| | | | - Nicole Ferko
- Cornerstone Research Group, Burlington, Ontario, Canada
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Sridharan ND, Boitet A, Smith K, Noorbakhsh K, Avgerinos E, Eslami MH, Makaroun M, Chaer R. Cost-effectiveness analysis of drug-coated therapies in the superficial femoral artery. J Vasc Surg 2017; 67:343-352. [PMID: 28958476 DOI: 10.1016/j.jvs.2017.06.112] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/23/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Drug-coated balloons (DCBs) may increase durability of endovascular treatment of superficial femoral artery (SFA) disease while avoiding stent-related risks. The purpose of this study was to use meta-analytic data of DCB studies to compare the cost-effectiveness of potential SFA treatments: DCB, drug-eluting stent (DES), plain old balloon angioplasty (POBA), or bare-metal stent (BMS). METHODS A search for randomized controlled trials comparing DCB with POBA for treatment of SFA disease was performed. Hazard ratios were extracted to account for the time-to-event primary outcome of target lesion revascularization. Odds ratios were calculated for the secondary outcomes of primary patency (PP) and major amputation. Incorporating pooled data from the meta-analysis, cost-effectiveness analysis, assuming a payer perspective, used a decision model to simulate patency at 1 year and 2 years for each index treatment modality: POBA, BMS, DCB, or DES. Costs were based on current Medicare outpatient reimbursement rates. RESULTS Eight studies (1352 patients) met inclusion criteria for meta-analysis. DCB outperformed POBA with respect to target lesion revascularization over time (pooled hazard ratio, 0.41; P < .001). Risk of major amputation at 12 months was not significantly different between groups. There was significantly improved 1-year PP in the DCB group compared with POBA (pooled odds ratio, 3.30; P < .001). In the decision model, the highest PP at 1 year was seen in the DES index therapy strategy (79%), followed by DCB (74%), BMS (71%), and POBA (64%). With a baseline cost of $9259.39 per patent limb at 1 year in the POBA-first group, the incremental cost per patent limb for each other strategy compared with POBA was calculated: $14,136.10/additional patent limb for DCB, $38,549.80/limb for DES, and $59,748,85/limb for BMS. The primary BMS option is dominated by being more expensive and less effective than DCB. Compared directly with DCB, DES costs $87,377.20 per additional patent limb at 1 year. Based on the projected PP at 1 year in the decision model, the number needed to treat for DES compared with DCB is 20. At current reimbursement, the use of more than two DCBs per procedure would no longer be cost-effective compared with DES. At 2 years, DCB emerges as the most cost-effective index strategy with the lowest overall cost and highest patency rates over that time horizon. CONCLUSIONS Current data and reimbursements support the use of DCB as a cost-effective strategy for endovascular intervention in the SFA; any additional effectiveness of DES comes at a high price. Use of more than one DCB per intervention significantly decreases cost-effectiveness.
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Affiliation(s)
- Natalie D Sridharan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Aureline Boitet
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Kenneth Smith
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Kathy Noorbakhsh
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthymios Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel Makaroun
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
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80
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Miller AJ, Takahashi EA, Harmsen WS, Mara KC, Misra S. Treatment of Superficial Femoral Artery Restenosis. J Vasc Interv Radiol 2017; 28:1681-1686. [PMID: 28935472 DOI: 10.1016/j.jvir.2017.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/25/2017] [Accepted: 07/29/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine the predictors of restenosis, major adverse limb events (MALEs), postoperative death (POD), and all-cause mortality after repeat endovascular treatment of superficial femoral artery (SFA) restenosis. MATERIALS AND METHODS This was a retrospective review of 440 patients with 518 SFA lesions who were treated between January 2002 and October 2011. Ninety-six limbs were treated for restenosis with bare metal stents (BMSs) or percutaneous transluminal angioplasty (PTA), of which 28 limbs developed another restenosis requiring a third procedure. The interaction measured in this study was between the second and third intervention. Predictors of SFA patency, MALEs, POD, and all-cause mortality after SFA restenosis treatment were identified. RESULTS Patients who were treated with BMSs (n = 51) had similar rates of restenosis compared with patients who were treated with PTA (n = 45) (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.68-2.90; P = .37). Patients in the BMS group who took statins had a significantly lower risk of restenosis than patients who did not take statins (HR 0.13; 95% CI 0.04-0.41; P < .001). Stage 4-5 chronic kidney disease (CKD) (n = 12) was associated with a significantly higher risk of MALE + POD (HR 6.17; 95% CI 1.45-26.18; P = .014) and all-cause mortality (HR 2.83; 95% CI 1.27-6.33; P = .01). Clopidogrel was protective against all-cause mortality (HR 0.41; 95% CI 0.20-0.80; P = .01). CONCLUSIONS Patients in the BMS group who took statins at the time of intervention had a significantly lower risk of developing restenosis. Stage 4-5 CKD was a risk factor for MALE + POD and all-cause mortality, while clopidogrel decreased all-cause mortality risk.
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Affiliation(s)
- Andrew J Miller
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - William S Harmsen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Clinical Statistics, Mayo Clinic, Rochester, Minnesota
| | - Kristin C Mara
- Department of Clinical Statistics, Mayo Clinic, Rochester, Minnesota
| | - Sanjay Misra
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota.
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81
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Schneider PA. Evolution and current use of technology for superficial femoral and popliteal artery interventions for claudication. J Vasc Surg 2017; 66:916-923. [DOI: 10.1016/j.jvs.2017.05.110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
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82
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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 55:305-368. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 662] [Impact Index Per Article: 94.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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83
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Garcia LA, Rocha-Singh KJ, Krishnan P, Zeller T, Tepe G, Fleming M, Granada JF, Turco MA, Tieché C, Jaff MR. Angiographic classification of patterns of restenosis following femoropopliteal artery intervention: A proposed scoring system. Catheter Cardiovasc Interv 2017; 90:639-646. [PMID: 28795488 DOI: 10.1002/ccd.27198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To propose a classification system for characterizing angiographic femoropopliteal artery restenosis patterns associated with common endovascular modalities. BACKGROUND Peripheral artery disease is a worldwide issue affecting millions of people. Despite a myriad of endovascular technologies available to treat peripheral artery disease of the femoropopliteal arteries, restenosis remains a common failure mode. Characterizing common patterns of restenosis is important to discern the potential impact of baseline patient, lesion, and procedural characteristics, as well as treatment modalities on either the primary success or the failure patterns associated with restenosis. METHODS Studies included in the analysis were from previous core laboratory-adjudicated femoropopliteal artery disease trials and registries reflecting a wide array of treatment modalities. RESULTS From the subjects enrolled and analyzed, there were 403 total angiograms for analysis and adjudication. Target lesion revascularization images of the 32 validation cases were evaluated for index treated length, diameter stenosis, and lesion morphology characteristics. The following lesion types are proposed: Type 1 "Focal" pattern, which may be "Edge Proximal" or "Edge Distal" depending on location; a Type 2 "Multifocal" pattern which may also exhibit edge restenosis, but may also be "Edge Bilateral"; a Type 3 "Moderate" pattern and a Type 4 "Diffuse" pattern; and finally, a Type 5 "Occlusion". CONCLUSIONS A classification system that enables healthcare professionals to anticipate and describe failures following the index procedure, thereby impacting the choice of options for retreatment, may facilitate consistency and standardization within the heterogeneous field of endovascular device treatments for the femoropopliteal artery.
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Affiliation(s)
| | - Krishna J Rocha-Singh
- St. John's Hospital, Prairie Education and Research Cooperative, Springfield, Illinois
| | | | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | | | | | - Juan F Granada
- CRF-Skirball Center for Innovation, Orangeburg, New York
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84
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Outcomes of the Japanese multicenter Viabahn trial of endovascular stent grafting for superficial femoral artery lesions. J Vasc Surg 2017; 66:130-142.e1. [DOI: 10.1016/j.jvs.2017.01.065] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/09/2017] [Indexed: 01/24/2023]
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85
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Design and Comparison of Large Vessel Stents: Balloon Expandable and Self-Expanding Peripheral Arterial Stents. Interv Cardiol Clin 2017; 5:365-380. [PMID: 28582034 DOI: 10.1016/j.iccl.2016.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endovascular stenting has evolved over the last 50 years since its inception into the framework of management of vascular atherosclerotic disease. Stent design has evolved as lesion complexity has increased. Nevertheless, certain first principles regarding stent design have been recapitulated time and again with every iteration of endovascular stents. This article reviews principles of endovascular stent design and compares and contrasts key aspects of balloon expandable and self-expanding stents.
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86
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Klein AJ, Jaff MR, Gray BH, Aronow HD, Bersin RM, Diaz-Sandoval LJ, Dieter RS, Drachman DE, Feldman DN, Gigliotti OS, Gupta K, Parikh SA, Pinto DS, Shishehbor MH, White CJ. SCAI appropriate use criteria for peripheral arterial interventions: An update. Catheter Cardiovasc Interv 2017; 90:E90-E110. [PMID: 28489285 DOI: 10.1002/ccd.27141] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/05/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Herbert D Aronow
- The Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | | | | | | | | | - Kamal Gupta
- University of Kansas Medical Center, Kansas City, KS
| | - Sahil A Parikh
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY
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87
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Creation of an Extraluminal Arterial Bypass Graft Using a Commercially Available Self-Expanding Stent Graft: Feasibility Study in a Porcine Model. Cardiovasc Intervent Radiol 2017; 40:1447-1453. [PMID: 28474113 DOI: 10.1007/s00270-017-1672-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to assess the technical feasibility of ultrasound-guided endovascular creation of a percutaneous extraluminal arterial bypass graft without a surgically created arterial anastomosis. MATERIALS AND METHODS Nine swine were utilized for this IACUC-approved study using a carotid bypass model in swine. Using sonographic guidance, percutaneous access was obtained to the proximal and distal common carotid artery. A self-expanding stent graft was advanced through the proximal carotid access site, tunneled subcutaneously, then advanced through the distal carotid access site, and deployed. The stent grafts were monitored weekly for patency using ultrasound. Angiography was performed at 4 weeks to evaluate for graft patency. Gross pathologic analysis was performed on the explanted stent grafts. RESULTS In eight out of the nine swine (89%), percutaneous extraluminal bypass graft creation was technically successful, with brisk flow through the stent graft to the distal circulation, complete exclusion of the bypassed segment of carotid artery, and no extravasation. The technical failure was due to stent graft maldeployment. Of the six swine evaluated for patency, four grafts were patent at the 4-week end point. Both occluded stent grafts were due to extraluminal extrusion of one end, likely related to neck movement and growth in neck length. CONCLUSION The percutaneous arterial bypass technique had a high technical success rate and a graft patency rate of 67% at 4 weeks, with early occlusions possibly related to limitations of the animal model.
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88
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Mallios A, Blebea J, Buster B, Messiner R, Taubman K, Ma H. Laser Atherectomy for the Treatment of Peripheral Arterial Disease. Ann Vasc Surg 2017; 44:269-276. [PMID: 28479446 DOI: 10.1016/j.avsg.2017.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the study was to investigate the clinical results of laser atherectomy in the treatment of peripheral arterial disease. METHODS Retrospective analysis of consecutive patients underwent laser atherectomy at a single institution during a 7-year period by vascular surgeons and interventional cardiologists in a tertiary university-affiliated hospital. Clinical data were retrieved from patient charts and hospital electronic medical records along with the associated arteriograms. RESULTS A total of 461 lesions in 343 limbs were treated in 300 patients with a mean age of 70 years. The indication was critical limb ischemia (CLI) with rest pain or tissue loss in 227 (66%) of interventions and claudication in 116 (34%). All procedures included an associated balloon angioplasty, while stenting was performed in 33%. Technical success was achieved in 99% with only 2 (<1%) cases with an acute procedure-related complication requiring surgical intervention. At a mean follow-up of 28 months (range, 1-87 months; median 24 months), 156 patients (45%) became asymptomatic or achieved significant clinical improvement (resolution of tissue loss or rest pain), 60 (17%) remained with CLI, 30 (9%) had a major proximal amputation, and 18 (5%) had a minor amputation. Freedom from major amputation was 90% at 5 years by life-table analysis. Univariate statistical analysis demonstrated the risk of a major amputation to be associated with diabetes, hemodialysis, and tissue loss (P < 0.05 to P < 0.005), while multivariate logistic regression analysis indicated diabetes to be overwhelmingly important (RR: 4.84; 95% confidence interval [CI]: 1.1-21.3; P < 0.05). In a similar manner, multivariate analysis indicated dialysis (RR: 2.46; 95% CI: 1.01-5.98; P < 0.05) and CLI (RR: 2.27; 95% CI: 1.42-3.65; P < 0.01) were associated with higher likelihood for lack of clinical improvement. There was no difference in major amputation rates between surgeons and interventional cardiologists (RR: 1.5; 95% CI: 0.7-2.1; P < 0.1) although it was 3 times more likely for the patients treated by surgeons to suffer from CLI (odds ratio: 3.2; 95% CI: 1.9-5.4; P < 0.0001). CONCLUSIONS Laser atherectomy is a safe and useful adjunct in limb salvage. Diabetics have much higher probability of requiring a proximal amputation, while those on dialysis and with CLI are least likely to gain clinical benefit.
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Affiliation(s)
- Alexandros Mallios
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK; Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
| | - John Blebea
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Bryan Buster
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Ryan Messiner
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Kevin Taubman
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Harry Ma
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
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89
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Garcia LA, Rosenfield KR, Metzger CD, Zidar F, Pershad A, Popma JJ, Zaugg M, Jaff MR. SUPERB final 3-year outcomes using interwoven nitinol biomimetic supera stent. Catheter Cardiovasc Interv 2017; 89:1259-1267. [DOI: 10.1002/ccd.27058] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Lawrence A. Garcia
- Division of Cardiology and Vascular Medicine; St. Elizabeth Medical Center, Tufts University School of Medicine; Boston Massachusetts
| | | | | | - Frank Zidar
- Coronary and Vascular Interventions; Austin Heart Hospital; Austin Texas
| | - Ashish Pershad
- Department of Interventional Cardiology; Banner Good Samaritan Medical Center; Phoenix Arizona
| | - Jeffrey J. Popma
- Cardiology, Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Margo Zaugg
- Abbott Vascular, Inc; Santa Clara California
| | - Michael R. Jaff
- Harvard Medical School, Massachusetts General Hospital; Boston Massachusetts
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Abstract
Percutaneous therapies for peripheral artery disease continue to evolve with new techniques and devices. Although guidelines-recommended therapies have impacted cardiovascular morbidity and mortality, endovascular interventions have been shown to reduce limb pain, improve quality of life, and prolong walking distance for those with claudication and to reduce amputation rates among those with critical limb ischemia. Novel devices such as drug-eluting stents and drug-coated balloons have improved patency for moderate-length lesions, whereas others allow treatment of heavily calcified and tortuous segments. New adjunctive devices to cross lesions and reduce or modify associated plaque have also been developed, although level 1 data regarding their efficacy are sparse. There has also been a better mechanistic understanding of lower extremity endovascular treatment using tools such as intravascular ultrasound. This information has highlighted the need for better stent size selection for the femoropopliteal arterial segments and larger balloon diameters for the tibial arteries. Moreover, a wound perfusion approach with direct in-line flow, the so-called angiosome approach, and reconstruction of the pedal loop have been advocated for improved wound healing. Technical advances such as the tibiopedal access and reentry methods have allowed crossing of lesions that were considered no option for the endovascular approach in the past. Collectively, there has been increased awareness, interest, and commitment by various specialty societies and organizations to advance the treatment of peripheral artery disease and critical limb ischemia. This is also evident by the recent coalition of 7 professional societies and organizations that represented >150 000 allied health professionals and millions of patients with peripheral artery disease at the 2015 Centers for Medicaid and Medicare Services Medicare Evidence Development and Coverage Analysis Committee meeting. The percutaneous therapies for peripheral artery disease continue to evolve with longer follow-up with randomized data and larger prospective registries. In the future, it is hopeful that we will treat the lower extremity arteries according to segments, taking into account plaque morphology, luminal versus subintimal crossing, location, and stenotic versus occlusive disease. Until then, we must identify the most cost-effective, efficacious, and safe treatment for each patient. The goal of this article is to aid the practicing vascular specialist consider the optimal choices for the management of patients with vascular disease.
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Affiliation(s)
- Mehdi H Shishehbor
- From Heart and Vascular Institute, Cleveland Clinic, OH (M.H.S.); and the Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.)
| | - Michael R Jaff
- From Heart and Vascular Institute, Cleveland Clinic, OH (M.H.S.); and the Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.).
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91
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Acute infection of Viabahn stent graft in the popliteal artery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 3:69-73. [PMID: 29349381 PMCID: PMC5757776 DOI: 10.1016/j.jvscit.2017.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
Abstract
Peripheral stents are increasingly used for treatment of peripheral arterial disease, yet all implanted devices are potentially at risk for infection. We describe a 51-year-old man who underwent stenting in the femoropopliteal artery and presented 3 days later with leg pain, fever, and evidence of peripheral stigmata of embolization. Blood cultures grew methicillin-resistant Staphylococcus aureus and remained persistently positive despite antibiotic therapy. At surgical exploration, the popliteal artery had essentially been disintegrated by the infection, with only visible stent graft maintaining arterial continuity. Acute stent graft infections are rare and must be managed promptly to reduce morbidity.
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92
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Halpin D, Erben Y, Jayasuriya S, Cua B, Jhamnani S, Mena-Hurtado C. Management of Isolated Atherosclerotic Stenosis of the Common Femoral Artery: A Review of the Literature. Vasc Endovascular Surg 2017; 51:220-227. [PMID: 28376704 DOI: 10.1177/1538574417702773] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Common femoral endarterectomy (CFE) remains the standard of care for treatment of atherosclerotic stenosis of the common femoral artery (CFA). Endovascular interventions have become the first-line therapy for atherosclerotic disease of the aortoiliac and femoropopliteal systems. Recent reports have documented high rates of technical success and low rates of complications with endovascular management of CFA stenosis. This study is a contemporary review of the surgical and endovascular literature on the management CFA stenosis and compares the results of these methods. METHODS A search of OVID Medline identified all published reports of revascularization of isolated atherosclerotic CFA stenosis. For each study selected for review, the number of patients, number of limbs treated, percentage of patients with critical limb ischemia, and mean length of follow-up was recorded. Study end points included survival, primary patency, freedom from target lesion revascularization (TLR), freedom from amputation, and complications. RESULTS The review included 7 CFE studies and 4 endovascular studies. Survival was similar between the groups. Primary patency was consistently higher with CFE compared to endovascular therapy. Freedom from TLR was lower with CFE compared to endovascular therapy. Morbidity and mortality was also higher with CFE compared to endovascular therapy. Freedom from amputation was not consistently reported in the endovascular studies. CONCLUSION There is limited data to support endovascular treatment of isolated CFA atherosclerosis. CFE has durable results, but there is significant morbidity and mortality resulting from this procedure. Endovascular interventions have low rates of complications, high rates of technical success, good short-term patency but increased need for repeat interventions when compared to surgery. Further trial data comparing CFE with endovascular therapy is needed to guide the management of CFA stenosis.
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Affiliation(s)
- David Halpin
- 1 Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Young Erben
- 2 Department of Surgery, Vascular Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Sasanka Jayasuriya
- 1 Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Bennett Cua
- 1 Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Sunny Jhamnani
- 1 Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- 1 Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA
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93
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Babaev A, Hari P, Gokhale R, Zavlunova S. A single-center retrospective analysis of patency rates of intraluminal versus subintimal endovascular revascularization of long femoropopliteal occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:399-404. [PMID: 28347605 DOI: 10.1016/j.carrev.2017.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/11/2017] [Accepted: 03/16/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The evaluation of patency rates of intraluminal versus subintimal endovascular revascularization of long femoropopliteal (FP) lesions. BACKGROUND Chronic total occlusions (CTO) of the FP artery in peripheral interventions are crossed either with a support catheter-guidewire based technique or subintimal dissection and re-entry device assisted approach. Both techniques have a high procedural success rate, but their long term patency is not well studied. There is also lack of comparative data addressing the patency of long non-CTO vs. CTO occlusions. METHODS We performed a single center retrospective analysis, studying the patency rates in 215 patients (254 limbs) with TASC C and D FP lesions treated with stents. There were 3 patient groups: without CTO (non-CTO); CTO crossed using support catheter and guide-wire (CTO-SW) and CTO crossed with a re-entry device (CTO-RE). RESULTS There were 155 limbs in CTO-SW group; 50 in CTO-RE group and 49 in non-CTO. Lesion length (mean±SD) was 251.81±7.48mm in CTO-SW group; 280±13.18mm in CTO-RE group and 248.77±13.31 in non-CTO group (p=non-significant). In-stent restenosis (ISR) at a mean follow-up of 19.26±16.14months did not differ between groups occurring in 23 (47%) limbs in non-CTO; 66 (42%) in CTO-SW; and 24 (48%) in CTO-RE. Smoking and stent fracture were predictors of ISR by multivariate analysis. CONCLUSION In patients with long FP lesions, ISR rates were similar between patients with and without CTO. In the CTO group mid-term vessel patency was not affected by the crossing technique utilized.
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Affiliation(s)
- Anvar Babaev
- New York University Department of Medicine, Division of Cardiology.
| | - Pawan Hari
- New York University Department of Medicine, Division of Cardiology
| | - Rohit Gokhale
- New York University Department of Medicine, Division of Cardiology
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94
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Rocha-Singh KJ, Beckman JA, Ansel G, Lyden SP, Schneider P, Mehta M, Dake M, Mullin CM, Jaff MR. Patient-level meta-analysis of 999 claudicants undergoing primary femoropopliteal nitinol stent implantation. Catheter Cardiovasc Interv 2017; 89:1250-1256. [DOI: 10.1002/ccd.27029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/18/2017] [Indexed: 11/07/2022]
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95
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Tran K, Ullery BW, Kret MR, Lee JT. Real-World Performance of Paclitaxel Drug-Eluting Bare Metal Stenting (Zilver PTX) for the Treatment of Femoropopliteal Occlusive Disease. Ann Vasc Surg 2017; 38:90-98. [DOI: 10.1016/j.avsg.2016.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/23/2016] [Accepted: 08/06/2016] [Indexed: 11/28/2022]
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96
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Palena LM, Diaz-Sandoval LJ, Sultato E, Brigato C, Candeo A, Brocco E, Manzi M. Feasibility and 1-Year outcomes of subintimal revascularization with supera®
stenting of long femoropopliteal occlusions in critical limb ischemia. Catheter Cardiovasc Interv 2016; 89:910-920. [DOI: 10.1002/ccd.26863] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 10/23/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Luis M. Palena
- Interventional Radiology Unit, Foot & Ankle clinic, Policlinico Abano Terme - Abano Terme (PD); Italy
| | - Larry J. Diaz-Sandoval
- Department of Internal Medicine, Division of Cardiovascular Medicine; Metro Health Hospital, Michigan State University; Wyoming Michigan
| | - Enrico Sultato
- Interventional Radiology Unit, Foot & Ankle clinic, Policlinico Abano Terme - Abano Terme (PD); Italy
| | - Cesare Brigato
- Interventional Radiology Unit, Foot & Ankle clinic, Policlinico Abano Terme - Abano Terme (PD); Italy
| | - Alessandro Candeo
- Interventional Radiology Unit, Foot & Ankle clinic, Policlinico Abano Terme - Abano Terme (PD); Italy
| | - Enrico Brocco
- Interventional Radiology Unit, Foot & Ankle clinic, Policlinico Abano Terme - Abano Terme (PD); Italy
| | - Marco Manzi
- Interventional Radiology Unit, Foot & Ankle clinic, Policlinico Abano Terme - Abano Terme (PD); Italy
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97
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Yokoi H, Ohki T, Kichikawa K, Nakamura M, Komori K, Nanto S, O'Leary EE, Lottes AE, Snyder SA, Dake MD. Zilver PTX Post-Market Surveillance Study of Paclitaxel-Eluting Stents for Treating Femoropopliteal Artery Disease in Japan: 12-Month Results. JACC Cardiovasc Interv 2016; 9:271-277. [PMID: 26847118 DOI: 10.1016/j.jcin.2015.09.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/27/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This multicenter, prospective, post-market surveillance study in Japan evaluates the paclitaxel-coated Zilver PTX stent in real-world patients with complex lesions. BACKGROUND The Zilver PTX stent is the first drug-eluting stent (DES) approved for the superficial femoral artery. Previously, results from a large randomized study and a complementary, large single-arm study supported the safety and effectiveness of the DES. METHODS There were no exclusion criteria, and consecutive patients with symptomatic peripheral artery disease (PAD) treated with the DES were enrolled in the study. Clinically driven target lesion revascularization (TLR) was defined as reintervention performed for ≥50% diameter stenosis after recurrent clinical symptoms of PAD. Clinical benefit was defined as freedom from persistent or worsening symptoms of ischemia. Patency was evaluated by duplex ultrasound where physicians considered this standard of care. RESULTS In this study, 907 patients were enrolled at 95 institutions in Japan. There were numerous comorbidities including high incidences of diabetes (58.8%), chronic kidney disease (43.8%), and critical limb ischemia (21.5%). Lesions were also complex, with an average length of 14.7 cm, 41.6% total occlusions, and 18.6% in-stent restenosis. In total, 1,861 DES were placed in 1,075 lesions. Twelve-month follow-up was obtained for >95% of eligible patients. Freedom from TLR was 91.0%, and clinical benefit was 87.7% through 12 months. The 12-month primary patency rate was 86.4%. CONCLUSIONS Despite more challenging lesions, results from the current study are similar to outcomes from the previous Zilver PTX studies, confirming the benefit of the Zilver PTX DES in a real-world patient population. (Zilver PTX Post-Market Study in Japan; NCT02254837).
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Affiliation(s)
- Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan.
| | - Takao Ohki
- Department of Surgery, Jikei University Hospital, Tokyo, Japan
| | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Division of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinsuke Nanto
- Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | | | | | | | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California
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98
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Banerjee S, Sarode K, Mohammad A, Gigliotti O, Baig MS, Tsai S, Shammas NW, Prasad A, Abu-Fadel M, Klein A, Armstrong EJ, Jeon-Slaughter H, Brilakis ES, Bhatt DL. Femoropopliteal Artery Stent Thrombosis: Report From the Excellence in Peripheral Artery Disease Registry. Circ Cardiovasc Interv 2016; 9:e002730. [PMID: 26839391 DOI: 10.1161/circinterventions.115.002730] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are limited data on femoropopliteal artery stent thrombosis (ST), which is a serious adverse outcome of peripheral artery interventions. METHODS AND RESULTS Index procedures resulting in femoropopliteal ST were compared with stent procedures without subsequent ST in the Excellence in Peripheral Artery Disease registry. The study data had a total of 724 cases of stent procedures and 604 unique patients. Femoropopliteal ST occurred in 26 of 604 patients (4.3%) over a median follow-up of 6 months post procedure. ST was more likely to occur in men (96.3% versus 82.2%; P=0.026) and to have an initial intervention for chronic total occlusions (88.5% versus 64.0%; P=0.01). There was no significant difference in ST between drug-coated and bare-metal stents (4.4% versus 3.4%; P=0.55), but the rate of ST was significantly higher with self-expanding covered stent grafts compared with bare-metal stents (10.6% versus 3.4%; P=0.02). ST was significantly associated with an increased risk of 12-month major adverse limb events (hazard ratio, 4.99; 95% confidence interval, 2.31-10.77; P<0.001) compared with no ST. On multivariate analysis, treatment of chronic total occlusion lesions (odds ratio, 3.46; 95% confidence interval, 0.98-12.20; P=0.05) and in-stent restenosis lesions (odds ratio, 5.30; 95% confidence interval, 1.83-15.32; P=0.002) were independently associated with an increased risk of ST. CONCLUSIONS In a multicenter peripheral interventional registry, femoropopliteal ST occurred in 4.3% of patients who underwent stent procedures, and it was associated with treatment of chronic total occlusions and in-stent restenosis lesions, and had higher 12-month major adverse limb events. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01904851.
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Affiliation(s)
- Subhash Banerjee
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
| | - Karan Sarode
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Atif Mohammad
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Osvaldo Gigliotti
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Mirza S Baig
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Shirling Tsai
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Nicolas W Shammas
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Anand Prasad
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Mazen Abu-Fadel
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Andrew Klein
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Ehrin J Armstrong
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Haekyung Jeon-Slaughter
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Emmanouil S Brilakis
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Veteran Affairs North Texas Healthcare System, Dallas (S.B., K.S., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.B., A.M., M.S.B., S.T., H.J.-S., E.S.B.); Seton Medical Center, Austin, TX (O.G.); Midwest Cardiovascular Research Foundation, Davenport, IA (N.W.S.); Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio (A.P.); Department of Internal Medicine, University of Oklahoma Medical Center (M.A.-F.); John Cochran Veteran Affairs Medical Center, St. Louis, MO (A.K.); Eastern Colorado Veteran Affairs Healthcare System, Denver (E.J.A.); and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
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Abstract
Critical limb ischemia (CLI), the most advanced form of peripheral artery disease, is associated with significant morbidity, mortality, and health care resource utilization. It is also associated with physical, as well as psychosocial, consequences such as amputation and depression. Importantly, after a major amputation, patients are at heightened risk of amputation on the contralateral leg. However, despite the technological advances to manage CLI with minimally invasive technologies, this condition often remains untreated, with significant disparities in revascularization and amputation rates according to race, socioeconomic status, and geographic region. Care remains disparate across medical specialties in this rapidly evolving field. Many challenges persist, including appropriate reimbursement for treating complex patients with difficult anatomy. This paper provides a comprehensive summary that includes diagnostic assessment and analysis, endovascular versus open surgical treatment, regenerative and adjunctive therapies, and other important aspects of CLI.
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100
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Olin JW, White CJ, Armstrong EJ, Kadian-Dodov D, Hiatt WR. Peripheral Artery Disease: Evolving Role of Exercise, Medical Therapy, and Endovascular Options. J Am Coll Cardiol 2016; 67:1338-57. [PMID: 26988957 DOI: 10.1016/j.jacc.2015.12.049] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 12/16/2022]
Abstract
The prevalence of peripheral artery disease (PAD) continues to increase worldwide. It is important to identify patients with PAD because of the increased risk of myocardial infarction, stroke, and cardiovascular death and impaired quality of life because of a profound limitation in exercise performance and the potential to develop critical limb ischemia. Despite effective therapies to lower the cardiovascular risk and prevent progression to critical limb ischemia, patients with PAD continue to be under-recognized and undertreated. The management of PAD patients should include an exercise program, guideline-based medical therapy to lower the cardiovascular risk, and, when revascularization is indicated, an "endovascular first" approach. The indications and strategic choices for endovascular revascularization will vary depending on the clinical severity of the PAD and the anatomic distribution of the disease. In this review, we discuss an evidence-based approach to the management of patients with PAD.
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Affiliation(s)
- Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute & Marie-Joseé and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Ehrin J Armstrong
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Denver, Colorado, and Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute & Marie-Joseé and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William R Hiatt
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, Colorado
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