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Lee HY, Park UJ, Kim HT, Roh YN. The Effect of Severe Femoropopliteal Arterial Calcification on the Treatment Outcome of Femoropopliteal Intervention in Patients with Ischemic Tissue Loss. Vasc Specialist Int 2020; 36:96-104. [PMID: 32611842 PMCID: PMC7333084 DOI: 10.5758/vsi.200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose We investigated the effect of severe calcification of the femoropopliteal artery on intervention outcomes in patients with ischemic tissue loss. Materials and Methods A retrospective review of the first endovascular treatment of the femoropopliteal artery for ischemic tissue loss between May 2010 and February 2018 was performed. The calcification of femoropopliteal lesions was estimated by the Compliance 360° score, and lesions with a score of 4 were defined as severe calcification lesions. Results Overall, 135 first femoropopliteal endovascular procedures on 135 limbs from 112 patients were included in this study. Among the 135 limbs that received treatement of the femoropopliteal arteries, 74 limbs had Trans-Atlantic Inter Society Consensus (TASC) A or B lesions and 61 limbs had TASC C or D lesions. Among 61 cases of TASC C or D lesions, 21 limbs (34.4%) had severe calcification; there was no statistically significant difference in limb salvage (P=0.75), and amputation-free survival (P=0.11) based on the degree of calcification. However, the survival rate in TASC C or D lesions was significantly different between the two groups (non-severe calcification group vs severe calcification group at 1-year, 2-years, and 3-years: 88.6%, 79.7%, and 61.0% vs 70.0%, 56.0%, and 28.0%, respectively, P=0.01). In multivariate analysis of influencing factors for poor survival in TASC C or D using the Cox proportional hazards model, severe calcification (hazard ratio, 2.362; 95% confidence interval, 1.035-5.391; P=0.041) was a statistically significant risk factor. Conclusion Severe femoropopliteal artery calcification was associated with poor survival, especially in TASC C or D lesions.
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Affiliation(s)
- Hyun Yong Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ui Jun Park
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyoung Tae Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Young-Nam Roh
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
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Kum S, Ipema J, Chun-yin DH, Lim DM, Tan YK, Varcoe RL, Hazenberg CEVB, Ünlü Ç. Early and Midterm Experience With the Absorb Everolimus-Eluting Bioresorbable Vascular Scaffold in Asian Patients With Chronic Limb-Threatening Ischemia: One-Year Clinical and Imaging Outcomes From the DISAPEAR Registry. J Endovasc Ther 2020; 27:616-622. [DOI: 10.1177/1526602820922524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report an experience with the Absorb bioresorbable vascular scaffold (BVS) in an Asian cohort with chronic limb-threatening ischemia (CLTI) from the DISAPEAR ( Drug Impregnated Bioresorbable Stent in Asian Population Extremity Arterial Revascularization) registry. Materials and Methods: A retrospective analysis was conducted of 41 patients (median age 64 years; 23 men) with CLTI owing to >50% de novo infrapopliteal lesions (n=53) treated with the Absorb BVS between August 2012 and June 2017. The majority of patients (37, 90%) had diabetes, 24 (59%) had ischemic heart disease, and 39 (95%) had Rutherford category 5/6 ischemia with tissue loss. The mean lesion length was 22.7±17.2 mm; 10 (24%) lesions were severely calcified. Assessments included technical success, primary patency, freedom from clinically-driven target lesion revascularization (CD-TLR), amputation-free survival, limb salvage, complete wound healing, resolution of rest pain, and resolution of CLTI without TLR at 6 and 12 months after the index intervention. Results: Overall, 69 scaffolds were implanted in the 53 lesions, with 100% technical success. There were no deaths within 30 days of the index procedure. The primary patency rates at 6 and 12 months were 95% and 86%, respectively. The corresponding rates of freedom from CD-TLR were 98% and 93%, respectively. Freedom from major amputation was 98% at both time points, and amputation-free survival was 93% and 85% at 6 and 12 months after the index procedure. Wound healing occurred in 31 patients (79%) with Rutherford category 5/6 ischemia by the end of 12 months. Conclusion: The Absorb BVS demonstrated good 1-year patency and clinical outcomes in CLTI patients with complex infrapopliteal disease.
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Affiliation(s)
- Steven Kum
- Vascular Service, Department of Surgery, Changi General Hospital, Singapore
| | - Jetty Ipema
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Derek Ho Chun-yin
- Vascular Service, Department of Surgery, Changi General Hospital, Singapore
| | - Darryl M. Lim
- Vascular Service, Department of Surgery, Changi General Hospital, Singapore
| | - Yih Kai Tan
- Vascular Service, Department of Surgery, Changi General Hospital, Singapore
| | - Ramon L. Varcoe
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | - Çağdaş Ünlü
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, the Netherlands
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Zheng H, Li L, Xu C, Liu H, Wang S, Tang X, Zhang Z, Weng W, Ku Y, Wang G, Ding H, Chen Z. A Quantitative Method for Prediction of True Lumen Recanalization in Chronic Total Occlusion of the Superficial Femoral Artery. Ann Vasc Surg 2020; 77:101-108. [PMID: 32339694 DOI: 10.1016/j.avsg.2020.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to examine a quantitative method for evaluating calcification in failure in recanalization (FR) in endovascular treatment of superficial femoral artery (SFA) chronic total occlusion, and to investigate the possibility of using a formula to predict the incidence of true lumen recanalization (TR) in such cases. METHODS Patients who met the inclusion criteria were retrospectively analyzed in our center from January 2012 to September 2017. A Calcification Lesion Analyzing and Scoring System (CLASS) was established to quantify the characteristics of calcification in SFA computed tomography slices, which were ranked as grade 1-4 and class A-E. Corresponding scores were obtained, and the Cumulative Calcification Score (CCSO) of occlusive SFA was calculated on the basis of CLASS. The factors correlating to FR and the formula for predicting TR were evaluated. RESULTS A total of 215 patients were included in this study. There were 150 cases of TR and 65 cases of subintimal recanalization; 12 (5.6%) cases had FR. The maximum CLASS of occlusion was correlated with FR. Not only the formula including Trans-Atlantic Inter-Society Consensus II grade and CCSO but also the formula including occlusion length and CCSO predicted the incidence of TR well. CONCLUSIONS The degree of the most severe calcification in occlusive lesions clearly affects success in recanalization. Two quantitative formulas that combine occlusion length or Trans-Atlantic Inter-Society Consensus II grade with CCSO can predict TR in endovascular treatment of SFA lesions with chronic total occlusion.
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Affiliation(s)
- Huanqin Zheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Li
- The First Hospital of Tsinghua University, Beijing, China
| | - Chuang Xu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Sheng Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaobin Tang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zheng Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenhai Weng
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yijie Ku
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Guangzhi Wang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hui Ding
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Zhong Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Lai Z, Zhang X, Shao J, Li K, Fang L, Xu L, Yu X, Wang J, Liu X, Lei J, Liu B. One-year results of drug-coated balloons for long and occlusive Femoropopliteal artery disease: a single-arm trial. BMC Cardiovasc Disord 2020; 20:65. [PMID: 32028896 PMCID: PMC7006174 DOI: 10.1186/s12872-020-01356-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The performance of drug-coated balloons (DCBs) in femoropopliteal interventions has been proven through randomized trials in short lesions and lesions with relatively low proportion of occlusions. There is limited evidence of DCBs in long or occlusive lesions. This study is to investigate the efficacy of the paclitaxel-coated balloon for treatment of long and occlusive femoropopliteal arterial lesions. Methods A single-arm trial including 44 femoropopliteal lesions (chronic total occlusion (CTO) plus > 10 cm) treated with DCBs was performed to collect data of average 1-year follow-up. Endpoints contain primary patency, target lesion revascularization (TLR), amelioration of the Rutherford classification, change of ankle brachial index (ABI) and major adverse events. Results Technical success is 97.7% while device success is 100%. Mean lesion length was 186 ± 86.3 cm. Stent implantation was performed in 13.6%. Cumulative probability of primary patency was 78.8% ± 6.8% at 1 year while that of freedom from TLR was 91.4% ± 4.9%. Rutherford classification improved from average 3.3 ± 1.0 to 2.1 ± 1.4 (p < 0.001) at follow-up with a 72.7% amelioration rate. Ankle-branchial index changed from 0.33 ± 0.40 to 0.67 ± 0.37 (p = 0.002). No major adverse event was observed. Conclusion These results suggest that it is safe and effective to treat long and totally occlusive femoropopliteal artery disease with DCBs. Further studies are demanded to confirm these results.
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Affiliation(s)
- Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Zhang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lijing Fang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Leyin Xu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxi Yu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jingjing Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiu Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinsong Lei
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Haine A, Schmid MJ, Schindewolf M, Lenz A, Bernhard SM, Drexel H, Baumgartner I, Dopheide JF. Comparison Between Interwoven Nitinol and Drug Eluting Stents for Endovascular Treatment of Femoropopliteal Artery Disease. Eur J Vasc Endovasc Surg 2019; 58:865-873. [DOI: 10.1016/j.ejvs.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022]
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Touma J, Senemaud J, Jaziri A, Cochennec F, Desgranges P. Percutaneous Trans-venous Femoropopliteal Bypass in Long Occlusions of the Superficial Femoral Artery. Cardiovasc Intervent Radiol 2019; 42:1800-1805. [PMID: 31435757 DOI: 10.1007/s00270-019-02310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/05/2019] [Accepted: 08/10/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This technical note describes a total percutaneous technique to perform ultrasound and fluoroscopy-assisted femoropopliteal bypass in long superficial femoral artery (SFA) lesions, using standard equipment, through a juxta-anatomical superficial femoral vein (SFV) tunnel. MATERIALS AND METHODS Three percutaneous accesses were obtained under ultrasound guidance. The first was retrograde, with crossover maneuver, at the contralateral groin. The second was a proximal SFV-to-SFA stump puncture. The third was a distal popliteal artery-to-popliteal vein puncture. Through the described snaring and capture maneuvers, one single 0.018″ guide wire entered the femoral vein through the SFA stump and re-entered the popliteal artery distally. The fistulous tracts were then dilated and covered stents deployed and post-dilated. RESULTS Three patients aged 68 ± 3 years and presenting Rutherford 4 chronic limb ischemia were treated with this technique. The mean SFA lesion length was 22.6 ± 3 cm. The mean procedure duration was 88 ± 18 min. No intraoperative complication occurred. The postoperative course was uneventful. In particular, no deep vein thrombosis occurred. Rutherford stage decreased from 4 to 1 in all patients, with a mean follow-up duration of 6.6 ± 2 months. CONCLUSION The main advantage of the technique is avoiding calcification issues by abandoning the trans-arterial recanalization approach for long calcified lesions. The second interest is its feasibility by simple endovascular means without any particular or dedicated device. However, longer follow-up is needed to assess safety and durability.
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Affiliation(s)
- Joseph Touma
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France.
| | - Jean Senemaud
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Asma Jaziri
- Angiology Unit, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Frédéric Cochennec
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Pascal Desgranges
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
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Stavroulakis K, Argyriou A, Watts M, Varghese JJ, Estes BA, Torsello G, Bisdas T, Huasen B. How to deal with calcium in the superficial femoral artery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:572-581. [PMID: 31241269 DOI: 10.23736/s0021-9509.19.11038-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite the continuous evolution of endovascular therapy, severe calcification remains a major issue for the minimally invasive treatment of superficial femoral artery (SFA) disease. The presence of calcium might negatively affect both the crossing of peripheral lesions and outcomes of all available treatment modalities and is therefore associated with unfavorable acute and long-term results. This manuscript summarizes the challenges raised from severe calcified atherosclerotic lesions and presents the outcomes of the various endovascular modalities in the treatment of calcified SFA disease.
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Affiliation(s)
| | - Angeliki Argyriou
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany
| | - Mike Watts
- Vascular Institute of Atlantic Medical Imaging, Brick, Galloway, and Cape May Court House, NJ, USA
| | - Joji J Varghese
- Department of Interventional Cardiology, Hendrick Medical Center, Abilene, TX, USA
| | - Bailey A Estes
- Department of Interventional Cardiology, Hendrick Medical Center, Abilene, TX, USA
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, Athens Medical Center, Athens, Greece
| | - Bella Huasen
- Department of Interventional Radiology, Royal Preston LTHTR, Manchester, UK
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Zeller T, Lopez L, Pigott JP. Acute Outcomes With a Novel Plaque Modification System in Real-World Femoropopliteal Lesions. J Endovasc Ther 2019; 26:333-341. [DOI: 10.1177/1526602819849955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose: To report outcomes of a multicenter feasibility study using the FLEX Vessel Prep (VP) System, a novel technology that facilitates plaque incision and lumen gain in stenosed or occluded femoropopliteal arteries prior to balloon angioplasty. Materials and Methods: Two hundred fifty-five patients (mean age 71.8±9.1 years) were treated with the FLEX VP System at 38 centers between December 2015 and November 2017. Average lesion length was 133±88 mm. Average baseline stenosis was 92%±11%; 112 (44.3%) of 253 patients presented with a chronic total occlusion. Conventional or drug-coated balloon (DCB) angioplasty was performed in all patients after vessel preparation. Vessel measurements were derived from angiograms acquired at baseline, after FLEX passage, and after subsequent ancillary procedures. Logistic regression analyses were performed to identify baseline or procedure variables that predicted the need for provisional stenting. Results: Average percent reduction in vessel stenosis following treatment with the FLEX VP System was 27%±17%. No flow-limiting dissection, vessel perforation, or embolization was observed; 15 (5.9%) patients had minor (type A or B) dissections. Provisional stenting was performed in 49 (19.2%) patients. Average stenosis following angioplasty ± stenting was 9.1%±7.4%; 9 (3.6%) patients had significant residual stenosis ≥30%. Logistic regression analyses found that patients with dissections, longer lesions, and those receiving conventional balloon dilation alone were most likely to undergo stenting. Conclusion: In a real-world patient population with long, complex femoropopliteal lesions, use of the FLEX VP System as vessel preparation for angioplasty improved acute outcomes compared to historical controls. The rate of provisional stenting was low, and no serious vessel complications were observed.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | - Louis Lopez
- Allen County Cardiology, Saint Joseph Hospital, Fort Wayne, IN, USA
| | - John P. Pigott
- Jobst Vascular Institute, Promedica Healthcare Systems, Toledo, OH, USA
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Iida O, Mano T. Role of IVUS in the Endovascular Treatment of Calcified Femoropopliteal Lesions. J Endovasc Ther 2019; 26:331-332. [PMID: 30935281 DOI: 10.1177/1526602819838991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Osamu Iida
- 1 Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Toshiaki Mano
- 1 Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Hyogo, Japan
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Fujihara M, Kozuki A, Tsubakimoto Y, Takahara M, Shintani Y, Fukunaga M, Iwasaki Y, Nakama T, Yokoi Y. Lumen Gain After Endovascular Therapy in Calcified Superficial Femoral Artery Occlusive Disease Assessed by Intravascular Ultrasound (CODE Study). J Endovasc Ther 2019; 26:322-330. [DOI: 10.1177/1526602819836095] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To assess calcium patterns in superficial femoral artery (SFA) disease before and after balloon angioplasty ± stent implantation using fluoroscopy, angiography, and intravascular ultrasound (IVUS) imaging and then correlate calcification severity and midterm clinical outcomes. Materials and Methods: A multicenter investigation was carried out to retrospectively review 130 symptomatic patients (mean age 73.2±8.4 years; 86 men) with de novo SFA lesions who had successfully undergone endovascular therapy (EVT) at 7 centers between January and October 2015. The primary outcome was lumen gain measured as minimum lumen area (MLA) in post-EVT IVUS images according to calcification severity. The secondary outcomes included rates of stent malapposition, restenosis, and clinically-driven target lesion revascularization (TLR). Results: A total of 102 (78.5%) cases had calcification in the lesions over a mean length of 64.3±72.8 mm. Of these, 70 cases were classified as having bilateral calcification according to fluoroscopy and angiography; 50 (49%) lesions had ≥180° calcification according to IVUS. The lumen gain in calcified lesions was significantly smaller than in the 28 noncalcified lesions (14.1±4.4 vs 17.8±5.2 mm2, p<0.001). IVUS-evaluated circumferential distribution of calcium (<180° or ≥180°) was independently associated with lumen gain after EVT (p<0.001). Among the calcification characteristics, a calcification angle ≥180° showed the strongest correlation to postprocedure MLA. Moreover, the restenosis rate was significantly higher in the severe (≥180°) calcification group (p<0.018). The severity of calcification was also associated with the risk of stent malapposition (p=0.022 for trend) but not TLR (p=0.57). Conclusion: IVUS evaluation of calcification in SFA lesions predicted lumen gain after EVT. Severe calcification in a ≥180° arc prevented successful dilation of the lesion with either plain balloon angioplasty or a nitinol stent. Accurate assessment of calcification patterns by IVUS is useful in maximizing the efficacy of endovascular therapy.
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Affiliation(s)
- Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Amane Kozuki
- Department of Cardiology, Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Yusuke Iwasaki
- Department of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
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Tsujimura T, Takahara M, Iida O, Hiramori S, Hayakawa N, Karashima E, Miura T, Teramura M, Ichihashi K, Kojima T, Aihara H, Yamaoka T, Fujihara M, Tosaka A, Doijiri T, Mano T, Soga Y. One-Year Clinical Outcomes following Implantation of Innova TM Self-Expanding Nitinol Stents in Patients with Peripheral Artery Diseases Presenting Femoropopliteal Artery Lesions. J Atheroscler Thromb 2019; 26:847-855. [PMID: 30842350 PMCID: PMC6800395 DOI: 10.5551/jat.47399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Although the Innova™ self-expanding nitinol stent (Boston Scientific, Marlborough, MA) exhibits acceptable performance in long-term safety and efficacy when used for the treatment of femoropopliteal (FP) lesions, clinical outcomes following its implantation have not been systematically studied in real-world settings. We investigated the one-year clinical outcomes after implantation of Innova™ self-expanding nitinol stents for the treatment of FP lesions in real-world settings. Methods: In this multicenter study, 481 lesions in 453 consecutive patients with peripheral artery disease (PAD) (74 ± 9 years; male, 70%; diabetes mellitus, 61%; dialysis, 27%; critical limb ischemia, 37%) who underwent endovascular therapy with the implantation of Innova™ self-expanding nitinol stents for FP lesions were analyzed from February 2016 to April 2017. The primary endpoint was one-year restenosis, whereas the secondary endpoints included one-year major adverse limb events and predictors for one-year restenosis. Results: The mean lesion length was 18 ± 10 cm. One-year restenosis and major adverse limb event rates were 36% and 18%, respectively. Multivariate analysis revealed that the presence of diabetes mellitus (odds ratio [OR]: 1.83; 95% confidence interval [CI]: 1.07–3.13), distal reference vessel diameter (OR: 1.86; 95% CI: 1.09–3.16), spot stenting (OR: 2.27; 95% CI: 1.27–4.06), and lack of one-year cilostazol treatment (OR: 0.58; 95% CI: 0.33–1.00) were independent risk factors for one-year restenosis. Conclusion: The current study demonstrated one-year clinical outcomes after Innova™ self-expanding nitinol stent placement for the treatment of FP lesions, including challenging cases in real-world settings.
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Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | | | | | - Takashi Miura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Kei Ichihashi
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital
| | - Tai Kojima
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Hideaki Aihara
- Department of Cardiology, Tsukuba Medical Center Hospital
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de Athayde Soares R, Matielo MF, Brochado Neto FC, Pires APM, de Almeida RD, de Jesus Martins M, Sacilotto R. Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease. JRSM Cardiovasc Dis 2019; 8:2048004019828941. [PMID: 30792856 PMCID: PMC6376522 DOI: 10.1177/2048004019828941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives In this paper, we report the long-term outcomes of the endovascular treatment of femoropopliteal occlusive disease, focusing on the importance of calcification and runoff outflow on limb salvage and patency, and the factors associated with these outcomes at a single center. Methods This retrospective cohort study included consecutive patients with femoropopliteal occlusive who underwent femoropopliteal angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between January 2015 and July 2017. Results In total, 86 femoropopliteal occlusive angioplasties were performed in 86 patients, with an initial technical success rate of 95.34%. The mean ± standard deviation follow-up time was 880 ± 68.84 days. The analysis was performed at 720 days. Technical failure occurred in four patients, who were excluded from the analysis, leaving 82 patients and 82 femoropopliteal occlusive angioplasties. The estimated primary patency, secondary patency, limb salvage, and overall survival rates at 720 days were 60%, 96%, 90%, and 82.5%, respectively. In univariate and multivariate analyses, Cox regression showed worse primary patency rates in patients with one tibial vessel or isolated popliteal artery runoff (p = 0.005), calcification grade 4 (p = 0.019), calcification grade > 2 (p = 0.017), small vessel diameter < 4 mm (p = 0.03) or primary angioplasty without stenting (p = 0.021). A univariate analysis showed worse limb salvage in patients with one tibial vessel or isolated popliteal artery runoff (p = 0.039). Conclusions In this study, the main factors associated with worse outcomes in the endovascular treatment of femoropopliteal occlusive in terms of loss of primary patency were one tibial vessel or isolated popliteal artery runoff, calcification grade 4, or calcification grade > 2, small vessel diameter < 4 mm, and no stents use. One tibial vessel or isolated popliteal artery runoff was also associated with limb loss in a univariate Cox regression analysis.
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Affiliation(s)
- Rafael de Athayde Soares
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Marcelo Fernando Matielo
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | - Ana Paula Maia Pires
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Rogério Duque de Almeida
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Murilo de Jesus Martins
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Roberto Sacilotto
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
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Kobayashi N, Hirano K, Yamawaki M, Araki M, Sakai T, Obokata M, Sakamoto Y, Mori S, Tsutsumi M, Nauchi M, Honda Y, Makino K, Shirai S, Sugizaki Y, Fukagawa T, Kishida T, Ito Y. Comparison of Balloon Angioplasty and Stent Implantation for Femoropopliteal Disease According to Patient and Lesion Subgroup. Circ Rep 2019; 1:94-101. [PMID: 33693119 PMCID: PMC7890277 DOI: 10.1253/circrep.cr-18-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background:
Little is known about the superiority of balloon angioplasty vs. stent implantation for femoropopliteal (FP) lesions according to subgroup. Methods and Results:
This study involved 1,018 de novo (balloon angioplasty, n=462; stent implantation, n=556) and 114 in-stent restenosis (ISR) FP lesions (balloon angioplasty, n=69; stent implantation, n=45) treated with endovascular therapy. For de novo FP lesions, the 3-year primary patency rate was significantly better with stent implantation than with balloon angioplasty (61% vs. 69%, log-rank P=0.001), but it was similar for ISR FP lesions (40% vs. 43%, log-rank P=0.83). For de novo FP lesions, stent implantation was favorable in all subgroups except for female sex (hazard ratio [HR], 0.92; 95% CI: 0.65–1.31, P=0.66), critical limb ischemia (CLI; HR, 0.70; 95% CI: 0.46–1.06, P=0.10), calcified lesion (HR, 0.81; 95% CI: 0.46–1.39, P=0.44), and poor tibial run-off (HR, 0.86; 95% CI: 0.59–1.25, P=0.42) subgroups. No difference was found between the 2 treatment strategies for ISR FP lesions in the majority of subgroups. Stent implantation, however, was favorable in totally occluded ISR FP lesions (HR, 0.45; 95% CI: 0.21–1.01, P=0.05). Conclusions:
The primary patency rate in de novo FP lesions for the 2 treatment strategies was similar in the female, calcified lesion, CLI, and poor tibial run-off subgroups. Stent implantation was superior to balloon angioplasty for totally occluded ISR FP lesions.
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Affiliation(s)
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | - Tsuyoshi Sakai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | | | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Masahiro Nauchi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | - Kenji Makino
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Yuta Sugizaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | - Tomoya Fukagawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
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Soga Y, Nakamura M, Hirose K, Ito N, Tomoi Y, Hiramori S, Ando K. Primary Use of the TruePath Crossing Device for Infrainguinal Chronic Total Occlusions With Intravascular Ultrasound Evaluation. J Endovasc Ther 2018; 25:592-598. [PMID: 30117364 DOI: 10.1177/1526602818793901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the use of the TruePath crossing device as the primary recanalization tool for infrainguinal chronic total occlusions (CTO). METHODS A retrospective analysis was conducted of 50 patients (mean age 75 years; 26 men) with 55 infrainguinal CTOs treated with the TruePath between March 2017 and September 2017 at a single center. The mean occlusion length was 138±55 mm, and femoropopliteal lesions accounted for 65% of the 55 lesions. The primary outcome measure was CTO crossing using the TruePath alone; secondary outcomes were assisted success (>50% lumen gain using the TruePath), device-related complications, and intraluminal crossing evaluated by intravascular ultrasound (IVUS). RESULTS Complete success was achieved in 33 (60%) of 55 lesions having a mean occlusion length of 145±72 mm. Among these, the true lumen crossing rate was 97% according to IVUS evaluation. Assisted success was achieved in 15 (68%) of the 22 failures. Complete/assisted success, in which the TruePath was thought to have contributed to CTO crossing, was attained in 48 (87%) of the 55 lesions. Three (5.5%) complications were observed: a perforation, an access-site hematoma, and acute occlusion; only the perforation was device related (1.8%). Multivariate analysis showed PACCS grade 4 (odds ratio 4.5, 95% confidence interval 1.33 to 15.5, p=0.02) was an independent predictor of TruePath failure. CONCLUSION Primary use of the TruePath crossing device for infrainguinal CTOs demonstrated a satisfactory complete success rate and a high rate of IVUS-documented intraluminal crossing with few device-related complications. Severe calcification is an independent predictor of TruePath failure.
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Affiliation(s)
- Yoshimitsu Soga
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Miho Nakamura
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kaoru Hirose
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhiro Ito
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yusuke Tomoi
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Seiichi Hiramori
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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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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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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67
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Powell RJ, Jaff MR, Schroë H, Benko A, Diaz-Cartelle J, Müller-Hülsbeck S. Stent placement in the superficial femoral and proximal popliteal arteries with the innova self-expanding bare metal stent system. Catheter Cardiovasc Interv 2017; 89:1069-1077. [PMID: 28296239 DOI: 10.1002/ccd.26976] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/16/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The SuperNOVA trial was designed to evaluate performance of the Innova Vascular Self-Expanding Stent System (Boston Scientific, Marlborough, MA) for treating lesions in the femoropopliteal arteries. METHODS Patients with chronic lower limb peripheral artery disease (Rutherford category 2, 3, or 4) and atherosclerotic lesions in the native superficial femoral and/or proximal popliteal artery (lengths 30-190 mm) were enrolled in this single-arm, multinational study. Major adverse events (MAEs) were defined as all-cause death through 1 month, target limb major amputation, and target lesion revascularization (TLR). Vessel primary patency was defined as core laboratory-adjudicated duplex ultrasonography-derived peak systolic velocity ratio ≤2.4 in the absence of TLR, surgical bypass of the target lesion, or major amputation of the target limb. Primary safety and efficacy endpoints were evaluated at 12 months, with follow-up through 24 months also reported. RESULTS SuperNOVA patients (N = 299; mean age 67.4 ± 9.7 years, 74% men, 41% with diabetes) had a mean lesion length of 93.2 mm. The MAE-free rate was 99.7% at 30 days, 85.8% at 12 months, and 77% at 24 months. Kaplan-Meier estimates of primary patency and TLR-free rates were 68.7% and 78.0%, respectively, at 24 months. Clinical improvements were sustained through 2 years, with 80% of patients displaying no or minimal symptoms (Rutherford category 0-1) at 24 months. CONCLUSIONS In the SuperNOVA study, the Innova Stent System demonstrated an excellent safety profile and acceptable clinical outcomes despite the challenging anatomical characteristics of the lesions. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Michael R Jaff
- VasCore, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | - Andrew Benko
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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