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Schneider PA. The conundrum of below the knee (BTK) drug delivery. Vasc Med 2023; 28:581-582. [PMID: 37844136 DOI: 10.1177/1358863x231204626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA, USA
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Li M, Tu H, Yan Y, Guo Z, Zhu H, Niu J, Yin M. Meta-analysis of outcomes from drug-eluting stent implantation in femoropopliteal arteries. PLoS One 2023; 18:e0291466. [PMID: 37733656 PMCID: PMC10513203 DOI: 10.1371/journal.pone.0291466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE In recent years, studies of drug-eluting stent (DES) for femoropopliteal artery diseases (FPADs) have been gradually published. To explore whether this type of stent is superior to the traditional bare metal stent (BMS), we performed this study. METHODS A systematic search for randomized controlled trials (RCTs) in Excerpta Medica Database (Embase), PubMed, Web of Science (WOS), and Cochrane Library was performed on November 29, 2022. We innovatively adopted the hazard ratio (HR), the most appropriate indicator, as a measure of the outcomes that fall under the category of time-to-event data. The HRs was extracted directly or indirectly. Then, the meta-analyses using random effects model were performed. The bias risks of included papers were assessed by the Cochrane Risk of Bias 2.0 tool. This study was registered on the PROSPER platform (CRD42023391944) and not funded. RESULTS Seven RCTs involving 1,889 participants were found. After pooled analyses, we obtained results without propensity on each of the following 3 outcomes of interest: in-stent restenosis (ISR) -free survival, primary patency (PP) survival, and target lesion revascularization (TLR) -free survival (P >0.05, respectively). Because the results of pooled analyses of the other two outcomes of interest (all-cause death free survival and clinical benefit survival) had high heterogeneity both, they were not accepted by us. CONCLUSION For FPADs, the DES has not yet demonstrated superiority or inferiority to BMS, in the ability to maintain PP, avoid ISR and TLR.
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Affiliation(s)
- Mingxuan Li
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Haixia Tu
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Yu Yan
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Zhen Guo
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Haitao Zhu
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | | | - Mengchen Yin
- Beijing Fengtai You’anmen Hospital, Beijing, China
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Keiser C, Maleckis K, Struczewska P, Jadidi M, MacTaggart J, Kamenskiy A. A method of assessing peripheral stent abrasiveness under cyclic deformations experienced during limb movement. Acta Biomater 2022; 153:331-341. [PMID: 36162765 PMCID: PMC9810438 DOI: 10.1016/j.actbio.2022.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 01/07/2023]
Abstract
Poor outcomes of peripheral arterial disease stenting are often attributed to the inability of stents to accommodate the complex biomechanics of the flexed lower limb. Abrasion damage caused by rubbing of the stent against the artery wall during limb movement plays a significant role in reconstruction failure but has not been characterized. Our goals were to develop a method of assessing the abrasiveness of peripheral nitinol stents and apply it to several commercial devices. Misago, AbsolutePro, Innova, Zilver, SmartControl, SmartFlex, and Supera stents were deployed inside electrospun nanofibrillar tubes with femoropopliteal artery-mimicking mechanical properties and subjected to cyclic axial compression (25%), bending (90°), and torsion (26°/cm) equivalent to five life-years of severe limb flexions. Abrasion was assessed using an abrasion damage score (ADS, range 1-7) for each deformation mode. Misago produced the least abrasion and no stent fractures (ADS 3). Innova caused small abrasion under compression and torsion but large damage under bending (ADS 7). Supera performed well under bending and compression but caused damage under torsion (ADS 8). AbsolutePro produced significant abrasion under bending and compression but less damage under torsion (ADS 12). Zilver fractured under all three deformations and severely abraded the tube under bending and compression (ADS 15). SmartControl and SmartFlex fractured under all three deformations and produced significant abrasion due to strut penetration (ADS 20 and 21). ADS strongly correlated with clinical 12-month primary patency and target lesion revascularization rates, and the described method of assessing peripheral stent abrasiveness can guide device selection and development. STATEMENT OF SIGNIFICANCE: Poor outcomes of peripheral arterial disease stenting are related to the inability of stents to accommodate the complex biomechanics of the flexed lower limb. Abrasion damage caused by rubbing of the stent against the artery wall during limb movement plays a significant role in reconstruction failure but has not been characterized. Our study presents the first attempt at assessing peripheral stent abrasiveness, and the proposed method is applied to compare the abrasion damage caused by Misago, AbsolutePro, Innova, Zilver, SmartControl, SmartFlex, and Supera peripheral stents using artery-mimicking synthetic tubes and cyclic deformations equivalent to five life-years of severe limb flexions. The abrasion damage caused by stents strongly correlates with their clinical 12-month primary patency and target lesion revascularization rates, and the described methodology can be used as a cost-effective and controlled way of assessing stent performance, which can guide device selection and development.
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Affiliation(s)
- Courtney Keiser
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Kaspars Maleckis
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States
| | - Pauline Struczewska
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States
| | - Majid Jadidi
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States,Corresponding author. (A. Kamenskiy)
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Ravikumar N, Sreejith G, Law SHC, Anand P, Varghese N, Kagdi S, Kang N, Nashnoush M, Salam S, Ongidi I. Comparative Analysis of Endovascular Intervention and Endarterectomy in Patients with Femoral Artery Disease: A Systematic Review and Meta-Analysis. Hematol Rep 2022; 14:179-202. [PMID: 35735737 PMCID: PMC9222618 DOI: 10.3390/hematolrep14020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/25/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Abstract
Peripheral artery disease is a prevalent illness affecting more than 200 million people worldwide. A commonly used technique to manage the condition has been open endarterectomy. However, in recent times, a shift towards minimally invasive techniques has resulted in endovascular intervention as a popular alternative. This review aims to assess the safety and efficacy of endovascular intervention when compared with endarterectomy. A systematic review of the articles published in PubMed, Ovid, Embase, and Scopus within the last 10 years was conducted. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa and NICE quality assessment scales were used. A meta-analysis of proportions was performed using the RStudio software (RStudio Team (2021). RStudio: Integrated Development Environment for R, PBC, Boston, MA, USA). Twenty-six studies were included, with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). Technical success was greater for endarterectomy than endovascular intervention with an odds ratio of 0.38; 95% CI [0.27–0.54]. In terms of safety as well endovascular intervention was better than endarterectomy with an odds ratio of 0.22; 95% CI [0.15 to 0.31] for wound infection. Endovascular intervention is a safe and effective procedure; however, it cannot be considered superior to endarterectomy.
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Affiliation(s)
- Nidhruv Ravikumar
- Department of Medicine, School of Medicine, Queen’s University Belfast, Belfast BT7 1NN, UK;
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Correspondence: ; Tel.: +44-75135-44949
| | - Gopika Sreejith
- Department of Medicine, School of Medicine, Queen’s University Belfast, Belfast BT7 1NN, UK;
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
| | - Sharon Hiu Ching Law
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Prakhar Anand
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Medicine, National University of Ireland, Galway, H91 TK33 Galway, Ireland
| | - Noah Varghese
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Biochemistry, Western University, London, ON N6A 3K7, Canada
| | - Samrin Kagdi
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Biological Sciences and Health and Society, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Navneet Kang
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Mohamed Nashnoush
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- School of Health Sciences, Dalhousie University, Halifax, NS B3H 4R2, Canada
- IWK Health Center, Halifax, NS B3K 6R8, Canada
| | - Sihat Salam
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Biomedical science, York University, Toronto, ON M3J 1P3, Canada
| | - Ibsen Ongidi
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Human anatomy, School of Medicine, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya
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Gupta R, Malgor RD, Siada S, Lai S, Al-Musawi M, Malgor EA, Jacobs DL. Critical Appraisal of the Contemporary Use of Atherectomy to Treat Femoral-Popliteal Atherosclerotic Disease. J Vasc Surg 2021; 75:697-708.e9. [PMID: 34303802 DOI: 10.1016/j.jvs.2021.07.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 07/06/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Atherectomy has become increasingly used as an endovascular treatment of lower extremity atherosclerotic disease in the United States. Concerns and controversies about its indication and outcomes exist. The goal of this systematic review and meta-analysis was to investigate the outcomes and complications related to atherectomy to treat femoropopliteal atherosclerotic disease. METHODS A systematic review following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed. Four major scientific repositories, MEDLINE, EMBASE, The Cochrane Library, and Thompson Web of Sciences were queried from their inception to April 5, 2020. Data was reviewed and entered in a dedicated dataset by the investigators. Outcomes included patency rates, clinical and hemodynamic improvement, and morbidity and mortality associated with atherectomy interventions. RESULTS Twenty-four studies encompassing 1900 patients met inclusion criteria for this study. 74.3% of patients presented with Rutherford class (RC) 1-3 and 25.7% presented with RC class 4-6. 1445 patients underwent atherectomy, and 455 patients were treated without atherectomy. Atherectomy patients underwent directional atherectomy (DA, n = 851), rotational atherectomy (RA, n = 851), laser atherectomy (LA, n = 201), and orbital atherectomy (OA, n = 78). The majority of patients additionally received adjunct treatments which were variable across studies and included a combination of stenting, balloon angioplasty (BA), or drug coated balloon (DCB) angioplasty. Technical success was achieved in 92.3% of cases. Distal embolization, vessel perforation, and dissection occurred in 3.4%, 1.9%, and 4% of cases respectively. Initial patency was 95.4% and at 12-month median follow up primary patency was 72.6%. ABI improved from pre-operative mean of 0.6 to post-operative mean of 0.84. Incidence of major amputation and mortality over the follow up period was 2.2% and 3.4% respectively. CONCLUSIONS This review of the published data suggests that femoropopliteal atherectomy can be completed safely while modestly improving ABIs and maintaining one-year patency in nearly three out of four patients; however, this is based on heterogeneous studies that skew generalizable conclusions about atherectomy's efficacy. Atherectomy places a high cost burden on the healthcare system and is utilized in the United States at a higher rate than in other countries. Our review of the literature does not demonstrate clear atherectomy superiority to alternatives that would warrant pervasive and increasing use of this costly technology. Future work should focus on developing high quality randomized controlled trials to determine specific patient and lesion characteristics in which atherectomy can add value.
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Affiliation(s)
- Ryan Gupta
- General Surgery resident, Department of Surgery, University of Colorado, Anschutz medical center, Aurora, CO
| | - Rafael D Malgor
- Associate Professor, Division of Vascular and Endovascular Surgery, University of Colorado, Anschutz medical center, Aurora, CO.
| | - Sammy Siada
- Vascular Surgery Fellow, Division of Vascular and Endovascular Surgery, University of Colorado, Anschutz medical center, Aurora, CO
| | - Samuel Lai
- General Surgery resident, Department of Surgery, University of Colorado, Anschutz medical center, Aurora, CO
| | - Mohammed Al-Musawi
- Research Associate, Division of Vascular and Endovascular Surgery, University of Colorado, Anschutz medical center, Aurora, CO
| | - Emily A Malgor
- Assistant Professor, Division of Vascular and Endovascular Surgery, University of Colorado, Anschutz medical center, Aurora, CO
| | - Donald L Jacobs
- Chief, Division of Vascular and Endovascular Surgery, University of Colorado, Anschutz medical center, Aurora, CO
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Engin AY, Saydam O. Rotational atherectomy with adjunctive balloon angioplasty in calcified chronic total occlusions of superficial femoral artery. Vascular 2020; 29:682-692. [DOI: 10.1177/1708538120970817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The aim was to report the mid-term outcomes of Jetstream™ rotational atherectomy device in complex femoropopliteal lesions. Methods Between November 2016 and April 2018, 55 patients who were treated with rotational atherectomy and adjunctive balloon angioplasty due to complex femoropopliteal lesions were retrospectively scanned. Results Fifty-five patients who underwent endovascular treatment with rotational atherectomy for chronic total occlusive femoropopliteal lesions were included in the study. Technical success rate was 100%. The mean age was 63 (±10.5) years. The cohort included 25 (45.4%) diabetics and 45 (81.8%) current smokers. The mean length of the lesions was 20.8 ± 11.2 cm. Chronic total occlusive lesions were detected in 35 (63.6%) patients, and mixed-type steno-occlusive lesions were detected in 20 patients (36.4%). Thirty-three (60%) lesions were moderate or severely calcified. Adjunctive balloon angioplasty was performed with plain old balloon angioplasty (POBA) on 31 (56.4%) patients and with drug-coated balloon angioplasty on 24 (43.6%) patients. After adjunctive balloon angioplasty, flow limiting dissection was observed in 20 (36.3%) patients, and 17 (30.9%) patients needed stent implantation. The Kaplan–Meier analysis method estimated that the overall primary patency rates at 12 and 24 months were 81.8% and 70.9%, respectively. Overall, secondary patency rates at 12 and 24 months were 94.5% and 80%. No statistically significant differences of 24-month primary patency and secondary patency rates were found between patients treated with drug-coated balloon angioplasty and POBA as an adjunctive therapy, even though primary patency (83.3% vs. 61.3%, p = .06) and secondary patency (91.7% vs. 71%, p = .56) rates of drug-coated balloon angioplasty were slightly higher than POBA. Patients with claudication had better primary patency (90.5% vs. 58.8%, p = .001) and secondary patency (100% vs. 67.6%, p = .004) rates than patients with critical limb ischemia at 24 months. Significant differences between patients who did and did not stop smoking were found in 24-month primary patency (57% vs. 88%, p = .007) and secondary patency (67% vs. 96%, p = .007). Six patients underwent unplanned amputation. There were eight (14.5%) mortalities during follow-up. Conclusions Rotational atherectomy with adjunctive balloon angioplasty has satisfactory technical success rates and mid-term outcomes. As an adjunctive method, there was no difference between drug-coated balloon angioplasty s and POBAs. Smoking cessation is always the first-step treatment to improve mid-term patency results. Patients with critical limb ischemia have worse patency results compared to the patients with claudication.
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Affiliation(s)
- Aysen Y Engin
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Onur Saydam
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
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7
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Zamani N, Sharath SE, Browder RC, Barshes NR, Braun JD, Mills JL, Kougias P, Younes HK. Outcomes after Endovascular Stent Placement for Long-Segment Superficial Femoral Artery Lesions. Ann Vasc Surg 2020; 71:298-307. [PMID: 32891746 DOI: 10.1016/j.avsg.2020.08.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endovascular intervention is commonly pursued as first-line management of symptomatic, long-segment superficial femoral artery (SFA) disease. The relative effectiveness and comparative long-term outcomes among bare metal stents (BMS), covered stents (CS), and drug-eluting stents (DES) for long-segment SFA lesions remain uncertain. METHODS A retrospective cohort study identified patients with symptomatic SFA lesions measuring at least 15 cm in length who successfully received an endovascular stent (BMS, CS, or DES). The outcomes were patency, patient presentation upon stent occlusion, amputation-free survival (AFS), and all-cause mortality. Proportional hazards regressions and a multinomial logistic regression model were used to control for significant confounders. RESULTS A total of 226 procedures were analyzed (BMS: 95 [42%]; CS: 74 [33%]; DES: 57 [25%]). There were no significant differences among the 3 stent types with respect to age, prevalence of either diabetes or end-stage renal disease, or smoking history. The median length of the SFA lesion varied across the cohorts (BMS: 28 cm [interquartile range, IQR 20-30]; CS: 26 cm [IQR 20-30]; DES: 20 cm [IQR 16-25]; P = 0.002). The unadjusted primary patency of BMS at 12, 24, and 48 month following index stent placement was 57%, 47%, and 44%, respectively. This is compared to 62%, 49%, and 42% for CS, and 81%, 66%, and 53% for DES, respectively (log-rank P = 0.044). In adjusted models, however, there were no significant differences in primary patency among the stent types. Compared to CS however, DES was associated with improved primary-assisted patency (hazard ratio [HR] for patency loss: 0.35, P = 0.008) and secondary patency (HR: 0.32, P = 0.011). Across the entire follow-up period, stent occlusions occurred in 38 (40%) BMS cases, 42 (57%) CS, and 11 (19%) DES (P < 0.001). Of these, acute limb ischemia (ALI) occurred in 2 (5%) BMS cases, 14 (33%) CS, and 1 (9%) DES (P = 0.010). After adjustment, the relative risk of presenting with ALI as opposed to claudication was 27 times greater among patients re-presenting with occluded CS compared to BMS (P = 0.020). There were no significant differences in AFS or all-cause mortality across the 3 cohorts. CONCLUSIONS For long-segment SFA lesions, DES is associated with improved primary-assisted and secondary patency over long-term follow-up. In the event of stent occlusion, CS is associated with an increased risk of ALI.
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Affiliation(s)
- Nader Zamani
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Sherene E Sharath
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Rocky C Browder
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Neal R Barshes
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Jonathan D Braun
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Panos Kougias
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Houssam K Younes
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.
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Draxler MS, Al-Adas Z, Abbas D, Kavousi Y, Kabbani LS, Lin JC, Weaver MR, Shepard AD, Nypaver TJ. Outcome benefit of arterial duplex stent imaging after superficial femoral artery stent implantation. J Vasc Surg 2020; 73:179-188. [PMID: 32437951 DOI: 10.1016/j.jvs.2020.02.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/16/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE In-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion or symptom recurrence. Arterial duplex stent imaging (ADSI) can be used in the surveillance for recurrent stenosis; however, its uniform application is controversial. In this study, we aimed to determine, in patients undergoing SFA stent implantation, whether surveillance with ADSI yielded a better outcome than in those with only ankle-brachial index (ABI) follow-up. METHODS We performed a retrospective analysis of all patients undergoing SFA stent implantation for occlusive disease at a tertiary care referral center between 2009 and 2016. The patients were divided into those with ADSI and those with ABI follow-up only. Life-table analysis comparing stent patency, major adverse limb events (MALEs), limb salvage, and mortality between groups was performed. RESULTS There were 248 patients with SFA stent implantation included, 160 in the ADSI group and 88 in the ABI group. Groups were homogeneous in clinical indications of claudication and critical limb-threatening ischemia (for ADSI, 39% and 61%; for ABI, 38% and 62%; P = .982) and TransAtlantic Inter-Society Consensus class A, B, C, and D lesions (for ADSI, 17%, 45%, 16%, and 22%; for ABI, 21%, 43%, 16%, and 20%; P = .874). Primary patency was similar between groups at 12, 36, and 56 months (ADSI, 65%, 43%, and 32%; ABI, 69%, 34%, and 34%; P = .770), whereas ADSI patients showed an improved assisted primary patency (84%, 68%, and 54%) vs ABI patients (76%, 38%, and 38%; P = .008) and secondary patency. There was greater freedom from MALEs in the ADSI group (91%, 76%, and 64%) vs the ABI group (79%, 46%, and 46%; P < .001) at 12, 36, and 56 months of follow-up. ADSI patients were more likely to undergo an endovascular procedure as their initial post-SFA stent implantation intervention (P = .001), whereas ABI patients were more likely to undergo an amputation (P < .001). CONCLUSIONS In SFA stent implantation, patients with ADSI follow-up demonstrate an advantage in assisted primary patency and secondary patency and are more likely to undergo an endovascular reintervention. These factors are likely to have effected a decrease in MALEs, indicating the benefit of a more universal adoption of post-SFA stent implantation follow-up ADSI.
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Affiliation(s)
| | - Ziad Al-Adas
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Daniyal Abbas
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Yasaman Kavousi
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Loay S Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Judith C Lin
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
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Drug-Eluting Balloon Versus Drug-Eluting Stent for Complex Femoropopliteal Arterial Lesions. J Am Coll Cardiol 2019; 74:205-215. [DOI: 10.1016/j.jacc.2019.04.057] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/24/2022]
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10
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Hawkins BM, Varghese B. Simple Treatment for Complex Femoropopliteal Disease?: Midterm Drug-Coated Balloon Results From the AcoArt I Trial. JACC Cardiovasc Interv 2018; 11:2354-2356. [PMID: 30448171 DOI: 10.1016/j.jcin.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Beau M Hawkins
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Benoy Varghese
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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11
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Strobel HA, Qendro EI, Alsberg E, Rolle MW. Targeted Delivery of Bioactive Molecules for Vascular Intervention and Tissue Engineering. Front Pharmacol 2018; 9:1329. [PMID: 30519186 PMCID: PMC6259603 DOI: 10.3389/fphar.2018.01329] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/29/2018] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases are the leading cause of death in the United States. Treatment often requires surgical interventions to re-open occluded vessels, bypass severe occlusions, or stabilize aneurysms. Despite the short-term success of such interventions, many ultimately fail due to thrombosis or restenosis (following stent placement), or incomplete healing (such as after aneurysm coil placement). Bioactive molecules capable of modulating host tissue responses and preventing these complications have been identified, but systemic delivery is often harmful or ineffective. This review discusses the use of localized bioactive molecule delivery methods to enhance the long-term success of vascular interventions, such as drug-eluting stents and aneurysm coils, as well as nanoparticles for targeted molecule delivery. Vascular grafts in particular have poor patency in small diameter, high flow applications, such as coronary artery bypass grafting (CABG). Grafts fabricated from a variety of approaches may benefit from bioactive molecule incorporation to improve patency. Tissue engineering is an especially promising approach for vascular graft fabrication that may be conducive to incorporation of drugs or growth factors. Overall, localized and targeted delivery of bioactive molecules has shown promise for improving the outcomes of vascular interventions, with technologies such as drug-eluting stents showing excellent clinical success. However, many targeted vascular drug delivery systems have yet to reach the clinic. There is still a need to better optimize bioactive molecule release kinetics and identify synergistic biomolecule combinations before the clinical impact of these technologies can be realized.
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Affiliation(s)
- Hannah A. Strobel
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Elisabet I. Qendro
- Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Eben Alsberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Marsha W. Rolle
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
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12
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Pourafkari L, Choi C, Garajehdaghi R, Tajlil A, Dosluoglu HH, Nader ND. Neutrophil-lymphocyte ratio is a marker of survival and cardiac complications rather than patency following revascularization of lower extremities. Vasc Med 2018; 23:437-444. [PMID: 29848209 DOI: 10.1177/1358863x18774623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The neutrophil-lymphocyte ratio (NLR), as a marker of inflammation, is associated with the severity of peripheral artery disease (PAD). The role of the NLR on predicting future complications after elective revascularization for patients with PAD remains unknown. We aimed to examine the role of the NLR in the development of major adverse limb events (MALE) and the long-term mortality of these patients. We evaluated 1708 revascularization procedures from May 2001 to December 2015 at the Veterans Affairs Western New York Healthcare System from a prospectively maintained vascular database that included demographics, comorbidities and pre-procedural medications. Peri-procedural laboratory findings including complete blood cell count and metabolic panel were further retrieved from the electronic health record. The NLR was calculated, and the patients were categorized into tertiles according to NLR cut-off points. Multivariate Cox regression analysis was performed to determine MALE and 10-year mortality. The primary endpoint of the study was MALE, and the secondary endpoint included 10-year mortality. A total of 1228 patients were included for final analyses. Patients in the third NLR tertile were more likely to experience MALE during the follow-up period ( p<0.001). In addition, fewer patients in tertile 3 survived over the follow-up period compared to tertiles 1 and 2 ( p<0.0001). Patients in tertile 3 tended to be older with a higher frequency of hypertension, diabetes, chronic kidney disease, coronary artery disease and congestive heart failure. Our multivariate analysis demonstrated that the NLR was independently associated with higher rates of MALE in the affected vessels following revascularization procedures. Similarly, the NLR was revealed to be an independent predictor of higher long-term mortality in these patients.
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Affiliation(s)
- Leili Pourafkari
- 1 Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,2 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Catherine Choi
- 1 Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Reza Garajehdaghi
- 1 Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Arezou Tajlil
- 2 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hasan H Dosluoglu
- 1 Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,3 Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA
| | - Nader D Nader
- 1 Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,3 Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA
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13
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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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14
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Lucatelli P, Cini M, Tommasino G, Benvenuti A, Guaccio G, Bascetta S, Neri E, Ricci C. Use of the Gore Tigris Vascular Stent in Advanced Femoropopliteal Peripheral Arterial Disease. J Vasc Interv Radiol 2018; 29:614-622. [PMID: 29452721 DOI: 10.1016/j.jvir.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To prospectively evaluate the safety and efficacy of using the Tigris vascular stent (Gore, Flagstaff, Arizona) alone or in combination with the Viabahn stent (Gore) for revascularizing femoropopliteal Trans-Atlantic Intersociety Consensus (TASC) type B-D lesions with varying degrees of calcification. MATERIALS AND METHODS Patients with Rutherford stage ≥ 3 and TASC type ≥ B were included in the study. From January 2015 to April 2017, 31 segments in 31 patients (21 men, ovarall mean age 73.3 ± 9.2 years) were treated. The breakdown by TASC type and Rutherford stage were TASC B (n = 12), C (n = 6), and D (n = 13), and Rutherford 3 (n = 28) and 4 (n = 3). The lesions were located in the common femoral artery (n = 1), superficial femoral artery (SFA; n = 20), distal SFA to P1 (n = 3), popliteal P1 (n = 1), popliteal P1-3 (n = 3), popliteal P2-3 (n = 2), and 1 femoropopliteal bypass. There were 18 occlusions (58.1%) and 13 stenoses (41.9%). The mean diseased segment length was 15.5 ± 9.9 cm with 80.6% of moderate/severe calcification. The follow-up consisted of color Doppler ultrasound and clinical assessment at 1, 3, 6, 9, 12, and 15 months. RESULTS Technical success was 100%. There were no periprocedural or postprocedural complications. The mean stented lesion length was 17.2 ± 10.5 cm with a mean follow-up of 13.1 ± 6.9 months. Primary patency rates at 6, 9, 12, and 15 months were, respectively, 100% (24/31 patients), 90.5% (21/31 patients), 88.9% (20/31 patients), and 80% (15/31 patients). The median postprocedural Rutherford stage was 1. Three occlusions occurred at 7, 9, and 14 months, leading to a target lesion revascularization of 9.7% and a secondary patency of 100% at 15 months. Logistic analysis results demonstrated that lesion length (P = .003) was associated with reocclusion. Amputation-free survival at 15 months was 100%. Intrastent restenosis was observed in four cases (12.9%) but none were associated with worsening of symptoms. No stent fractures were observed. CONCLUSIONS The Tigris stent used alone or in combination with a Viabahn stent for femoropopliteal TASC B-D lesions demonstrated acceptable 12-month primary patency with a low reintervention rate.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy.
| | - Marco Cini
- Vascular and Interventional Radiology Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Giulio Tommasino
- Cardiac and Great Vessels Surgery Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Antonio Benvenuti
- Cardiac and Great Vessels Surgery Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Giulia Guaccio
- Cardiac and Great Vessels Surgery Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Stefano Bascetta
- Vascular and Interventional Radiology Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Eugenio Neri
- Cardiac and Great Vessels Surgery Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Carmelo Ricci
- Vascular and Interventional Radiology Unit, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
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15
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Morphological characteristics of chronic total occlusion: predictors of different strategies for long-segment femoral arterial occlusions. Eur Radiol 2017; 28:897-909. [DOI: 10.1007/s00330-017-5003-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
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16
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Nordanstig J, Pettersson M, Morgan M, Falkenberg M, Kumlien C. Assessment of Minimum Important Difference and Substantial Clinical Benefit with the Vascular Quality of Life Questionnaire-6 when Evaluating Revascularisation Procedures in Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2017; 54:340-347. [PMID: 28754429 DOI: 10.1016/j.ejvs.2017.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient reported outcomes are increasingly used to assess outcomes after peripheral arterial disease (PAD) interventions. VascuQoL-6 (VQ-6) is a PAD specific health-related quality of life (HRQoL) instrument for routine clinical practice and clinical research. This study assessed the minimum important difference for the VQ-6 and determined thresholds for the minimum important difference and substantial clinical benefit following PAD revascularisation. MATERIALS AND METHODS This was a population-based observational cohort study. VQ-6 data from the Swedvasc Registry (January 2014 to September 2016) was analysed for revascularised PAD patients. The minimum important difference was determined using a combination of a distribution based and an anchor-based method, while receiver operating characteristic curve analysis (ROC) was used to determine optimal thresholds for a substantial clinical benefit following revascularisation. RESULTS A total of 3194 revascularised PAD patients with complete VQ-6 baseline recordings (intermittent claudication (IC) n = 1622 and critical limb ischaemia (CLI) n = 1572) were studied, of which 2996 had complete VQ-6 recordings 30 days and 1092 a year after the vascular intervention. The minimum important difference 1 year after revascularisation for IC patients ranged from 1.7 to 2.2 scale steps, depending on the method of analysis. Among CLI patients, the minimum important difference after 1 year was 1.9 scale steps. ROC analyses demonstrated that the VQ-6 discriminative properties for a substantial clinical benefit was excellent for IC patients (area under curve (AUC) 0.87, sensitivity 0.81, specificity 0.76) and acceptable in CLI (AUC 0.736, sensitivity 0.63, specificity 0.72). An optimal VQ-6 threshold for a substantial clinical benefit was determined at 3.5 scale steps among IC patients and 4.5 in CLI patients. CONCLUSIONS The suggested thresholds for minimum important difference and substantial clinical benefit could be used when evaluating VQ-6 outcomes following different interventions in PAD and in the design of clinical trials.
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Affiliation(s)
- J Nordanstig
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Gothenburg, Sweden.
| | - M Pettersson
- Health and Care Sciences, Gothenburg University, Gothenburg, Sweden
| | - M Morgan
- Bay of Plenty Clinical School, Tauranga Hospital, Tauranga, New Zealand
| | - M Falkenberg
- Department of Radiology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - C Kumlien
- Department of Cardio-Thoracic and Vascular Surgery and Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
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17
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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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18
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Steinvil A, Bernardo N, Rogers T, Koifman E, Buchanan K, Alraies MC, Shults C, Torguson R, Okubagzi PG, Pichard AD, Satler LF, Ben-Dor I, Waksman R. Use of an ePTFE-covered nitinol self-expanding stent graft for the treatment off pre-closure device failure during transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:128-132. [DOI: 10.1016/j.carrev.2016.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 12/17/2022]
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19
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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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20
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van de Weijer MAJ, Kruse RR, Schamp K, Zeebregts CJ, Reijnen MMPJ. Morbidity of femoropopliteal bypass surgery. Semin Vasc Surg 2016; 28:112-21. [PMID: 26655055 DOI: 10.1053/j.semvascsurg.2015.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A systemic review of published reports on the incidence of early (<30 days) adverse events occurring after above- or below-knee femoropopliteal bypass surgery was conducted to provide contemporary outcomes data for comparative reporting. A total of 38 articles were included describing 6,374 femoropopliteal bypasses in 6,007 patients. Fifty-two percent were male and the mean age was 64.6 years (range, 40 to 93 years). The various studied types of complications were reported in 10 to 34 of 38 articles and definitions were often missing. The overall 30-day morbidity rate was 36.8%. The wound infection rate was 7.8% (range, 0.0 to 17.4%) accompanied with dermal necrosis in 0.4%. Graft infection was described in 2.4% (range, 0.0 to 5.3%) of cases. Postoperative bleeding was seen in 7.4% (range, 0.0 to 26%), of which 2.5% required return to surgery. Occlusions were reported in 12.0% (range, 0.0 to 59%). Lymphedema occurred in 2.9% (range, 0.0 to 9.6%) of cases and surgical site seroma formation occurred in 2.0% (range, 1.0% to 3.0%). Overall 30-day mortality rate was 2.3% (range 0.0 to 4.3%). Pooled data comparing vein grafts and prosthetic grafts revealed no significant difference (P = .10; risk ratio = 0.82; 95% confidence interval, 0.66-1.03; I(2) = 0%) in the incidence of complications. This review confirmed the morbidity of femoropopliteal bypass surgery is inconsistently reported and definitions are lacking. Because one-third of patients can be expected to experience an adverse event after femoropopliteal bypass grafting, standards on defining and reporting complications are necessary if comparative outcome standards are developed.
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Affiliation(s)
| | - Rombout R Kruse
- Department of Surgery, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Katja Schamp
- Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6816 AD, Arnhem, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG, Groningen, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6816 AD, Arnhem, The Netherlands.
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21
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Affiliation(s)
- Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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22
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Cawich I, Paixao ARM, Marmagkiolis K, Lendel V, Rodriguez-Araujo G, Rollefson WA, Mego DM, Cilingiroglu M. Immediate and intermediate-term results of optical coherence tomography guided atherectomy in the treatment of peripheral arterial disease: Initial results from the VISION trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:463-467. [PMID: 27477305 DOI: 10.1016/j.carrev.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/26/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term patency rates for percutaneous peripheral arterial interventions are suboptimal. Optical coherence tomography (OCT) guided atherectomy may yield superior patency by optimizing plaque removal while preserving the tunica media and adventitia. METHODS The VISION study is a multicenter prospective study of patients with peripheral arterial disease undergoing OCT guided atherectomy with the Pantheris™ device. In 11 patients enrolled in a single center, we report procedural and clinical outcomes, at 30days and 6months. RESULTS The mean age was 63±11years and 73% (n=8) were men. The target lesion was in the superficial femoral artery in 82% (n=9) of the patients. Mean stenosis severity was 87%±10% and mean lesion length was 39±31mm. Procedural success was observed in all patients with no device related complications. Mean post-atherectomy stenosis was 18%±15%. Almost all excised tissue consisted of intimal plaque (94%). At 30days, significant improvements in Rutherford class, VascuQoL scores and ABI were observed, 0.9±0.8 vs. 3.1±0.7 (p=0.01), 4.9±1.9 vs. 3.6±1.5 (p=0.03) and 1.04±0.19 vs. 0.80±0.19 (p<0.01) respectively. At 6months, there were significant improvements in Rutherford class (1.0±1.0 vs. 3.1±0.7, p=0.01) and ABI (0.93±0.19 versus 0.80±0.19, p=0.02) but not in VascuQoL scores (3.7±1.4 versus 3.6±1.5, p=0.48). Target lesion revascularization occurred in 18% (n=2) of the patients. CONCLUSION OCT guided atherectomy resulted in high procedural success, no device related complications and encouraging results up to 6months. Histological analysis suggested little injury to the media and adventitia. Larger studies are needed to confirm the efficacy of this approach.
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Affiliation(s)
- Ian Cawich
- Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA
| | - Andre R M Paixao
- Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA
| | | | - Vasili Lendel
- Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA
| | | | - William A Rollefson
- Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA
| | - David M Mego
- Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA
| | - Mehmet Cilingiroglu
- Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA; Koc University, School of Medicine, Istanbul, Turkey.
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Sampathkumar S, Schieber AT, Toris CB. A Schlemm’s canal scaffold for the treatment of elevated IOP. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1210006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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24
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Krishnan P, Tarricone A, Ali Z, Purushothaman KR, Overbey J, Vasquez M, Wiley J, Kapur V, Gujja K, Atallah RT, Nasiadko K, Kini A, Sharma S. Intravascular Ultrasound Is an Effective Tool for Predicting Histopathology-Confirmed Evidence of Adventitial Injury Following Directional Atherectomy for the Treatment of Peripheral Artery Disease. J Endovasc Ther 2016; 23:672-3. [PMID: 27413065 DOI: 10.1177/1526602816647364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Prakash Krishnan
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Arthur Tarricone
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Ziad Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | | | - Jessica Overbey
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Miguel Vasquez
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Jose Wiley
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Vishal Kapur
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Karthik Gujja
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | | | | | - Annapoorna Kini
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Samin Sharma
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
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Padgett ME, McCord TJ, McClung JM, Kontos CD. Methods for Acute and Subacute Murine Hindlimb Ischemia. J Vis Exp 2016. [PMID: 27403963 DOI: 10.3791/54166] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity and mortality in developed countries, and animal models that reliably reproduce the human disease are necessary to develop new therapies for this disease. The mouse hindlimb ischemia model has been widely used for this purpose, but the standard practice of inducing acute limb ischemia by ligation of the femoral artery can result in substantial tissue necrosis, compromising investigators' ability to study the vascular and skeletal muscle tissue responses to ischemia. An alternative approach to femoral artery ligation is the induction of gradual femoral artery occlusion through the use of ameroid constrictors. When placed around the femoral artery in the same or different locations as the sites of femoral artery ligation, these devices occlude the artery over 1 - 3 days, resulting in more gradual, subacute ischemia. This results in less substantial skeletal muscle tissue necrosis, which may more closely mimic the responses seen in human PAD. Because genetic background influences outcomes in both the acute and subacute ischemia models, consideration of the mouse strain being studied is important in choosing the best model. This paper describes the proper procedure and anatomical placement of ligatures or ameroid constrictors on the mouse femoral artery to induce subacute or acute hindlimb ischemia in the mouse.
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Affiliation(s)
- Michael E Padgett
- Division of Cardiology, Department of Medicine, Duke University Medical Center
| | - Timothy J McCord
- Division of Cardiology, Department of Medicine, Duke University Medical Center
| | - Joseph M McClung
- Division of Cardiology, Department of Medicine, Duke University Medical Center
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Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Machan LS, Snyder SA, O'Leary EE, Ragheb AO, Zeller T. Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial. Circulation 2016; 133:1472-83; discussion 1483. [PMID: 26969758 PMCID: PMC4823823 DOI: 10.1161/circulationaha.115.016900] [Citation(s) in RCA: 380] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Abstract
Background— This randomized controlled trial evaluated clinical durability of Zilver PTX, a paclitaxel-coated drug-eluting stent (DES), for femoropopliteal artery lesions. Outcomes compare primary DES versus percutaneous transluminal angioplasty (PTA), overall DES (primary and provisional) versus standard care (PTA and provisional Zilver bare metal stent [BMS]), and provisional DES versus provisional BMS. Methods and Results— Patients with symptomatic femoropopliteal artery disease were randomly assigned to DES (n=236) or PTA (n=238). Approximately 91% had claudication; 9% had critical limb ischemia. Patients experiencing acute PTA failure underwent secondary randomization to provisional BMS (n=59) or DES (n=61). The 1-year primary end points of event-free survival and patency showed superiority of primary DES in comparison with PTA; these results were sustained through 5 years. Clinical benefit (freedom from persistent or worsening symptoms of ischemia; 79.8% versus 59.3%, P<0.01), patency (66.4% versus 43.4%, P<0.01), and freedom from reintervention (target lesion revascularization, 83.1% versus 67.6%, P<0.01) for the overall DES group were superior to standard care in nonrandomized comparisons. Similarly, clinical benefit (81.8% versus 63.8%, P=0.02), patency (72.4% versus 53.0%, P=0.03), and freedom from target lesion revascularization (84.9% versus 71.6%, P=0.06) with provisional DES were improved over provisional BMS. These results represent >40% relative risk reduction for restenosis and target lesion revascularization through 5 years for the overall DES in comparison with standard care and for provisional DES in comparison with provisional BMS. Conclusions— The 5-year results from this large study provide long-term information previously unavailable regarding endovascular treatment of femoropopliteal artery disease. The Zilver PTX DES provided sustained safety and clinical durability in comparison with standard endovascular treatments. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00120406.
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Affiliation(s)
- Michael D Dake
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.).
| | - Gary M Ansel
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Michael R Jaff
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Takao Ohki
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Richard R Saxon
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - H Bob Smouse
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Lindsay S Machan
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Scott A Snyder
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Erin E O'Leary
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Anthony O Ragheb
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
| | - Thomas Zeller
- From Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA (M.D.D.); Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus (G.M.A.); The Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); Department of Surgery, Jikei University Hospital, Tokyo, Japan (T.O.); Department of Diagnostic Imaging and Interventional Radiology, Tri-City Medical Center, Oceanside, CA (R.R.S.); Department of Radiology, OSF St. Francis Medical Center, Peoria, IL (H.B.S.); Department of Radiology, The University of British Columbia, Vancouver, Canada (L.S.M.); Cook Research Incorporated, West Lafayette, IN (S.A.S., E.E.O'L., A.O.R.); and Department of Angiology, Herz Zentrum, Bad Krozingen, Germany (T.Z.)
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Burket MW. Drug-Eluting Stents Are the Default Strategy for Superficial Femoral Artery Intervention NowResponse to Burket. Circulation 2016; 133:320-9; discussion 329. [DOI: 10.1161/circulationaha.115.018034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Intermittent Claudication due to Peripheral Artery Disease: Best Modern Medical and Endovascular Therapeutic Approaches. Curr Cardiol Rep 2015; 17:86. [DOI: 10.1007/s11886-015-0643-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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29
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Rundback JH, Herman K“C, Patel A. Superficial Femoral Artery Intervention: Creating an Algorithmic Approach for the Use of Old and Novel (Endovascular) Technologies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:400. [DOI: 10.1007/s11936-015-0400-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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AGARWAL SHIVKUMAR, NADKARNI GIRISHN, YACOUB RABI, PATEL ACHINTA, JENKINS JAMESS, COLLINS TYRONEJ, ANNAPUREDDY NARENDER, KUMBALA DAMODAR, BODANA SHIRISHA, BENJO ALEXANDREM. Comparison of Cutting Balloon Angioplasty and Percutaneous Balloon Angioplasty of Arteriovenous Fistula Stenosis: A Meta-Analysis and Systematic Review of Randomized Clinical Trials. J Interv Cardiol 2015; 28:288-95. [DOI: 10.1111/joic.12202] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- SHIV KUMAR AGARWAL
- Department of Internal Medicine; Division of Cardiology; University of Arkansas Medical Sciences; Little Rock Arkansas
| | - GIRISH N. NADKARNI
- Department of Medicine; Division of Nephrology; Icahn School of Medicine at Mount Sinai; New York New York
| | - RABI YACOUB
- Department of Medicine; Division of Nephrology; Icahn School of Medicine at Mount Sinai; New York New York
| | - ACHINT A. PATEL
- Department of Public Health; Icahn School of Medicine at Mount Sinai; New York New York
| | - JAMES S. JENKINS
- Department of Internal Medicine; Division of Cardiology; Ochsner Clinic Foundation; New Orleans Louisiana
| | - TYRONE J. COLLINS
- Department of Internal Medicine; Division of Cardiology; Ochsner Clinic Foundation; New Orleans Louisiana
| | - NARENDER ANNAPUREDDY
- Department of Medicine; Division of Rheumatology; Vanderbilt University Medical Center; Nashville Tennessee
| | - DAMODAR KUMBALA
- Department of Internal Medicine; Division of Nephrology; Ochsner Clinic Foundation; New Orleans Louisiana
| | - SHIRISHA BODANA
- Department of Internal Medicine; Division of Nephrology; Ochsner Clinic Foundation; New Orleans Louisiana
| | - ALEXANDRE M. BENJO
- Department of Internal Medicine; Division of Cardiology; Ochsner Clinic Foundation; New Orleans Louisiana
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OCT evaluation of directional atherectomy compared to balloon angioplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:373-5. [PMID: 25753654 DOI: 10.1016/j.carrev.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/13/2015] [Accepted: 02/20/2015] [Indexed: 11/20/2022]
Abstract
Directional atherectomy (DA) is one of the most commonly used modalities for the treatment of obstructive femoropopliteal peripheral arterial disease (PAD), especially in patients with large and calcified atherosclerotic plaques. The effect of directional atherectomy to the vascular wall compared to balloon angioplasty by optical coherence tomography (OCT) has not been previously described. We present the first case of OCT after directional atherectomy with SilverHawk followed by angiosculpt balloon angioplasty.
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32
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Klein AJP. The DEFINITIVE LE: atherectomy's ability to leave no trace or need for more DEFINITIVE data? JACC Cardiovasc Interv 2014; 7:934-6. [PMID: 25147040 DOI: 10.1016/j.jcin.2014.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 05/16/2014] [Accepted: 05/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew J P Klein
- St. Louis VA Healthcare System, Department of Medicine, Division of Cardiology, St. Louis, Missouri; Department of Medicine, Division of Cardiology, Saint Louis University School of Medicine, St. Louis, Missouri.
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