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Schmehl J, Tepe G. Current status of bare and drug-eluting stents in infrainguinal peripheral vascular disease. Expert Rev Cardiovasc Ther 2014; 6:531-8. [DOI: 10.1586/14779072.6.4.531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bifurcated coronary stents for infrapopliteal angioplasty in critical limb ischemia. J Vasc Surg 2013; 57:1006-13. [DOI: 10.1016/j.jvs.2012.09.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/25/2012] [Accepted: 09/30/2012] [Indexed: 11/21/2022]
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Setacci C, de Donato G, Teraa M, Moll F, Ricco JB, Becker F, Robert-Ebadi H, Cao P, Eckstein H, De Rango P, Diehm N, Schmidli J, Dick F, Davies A, Lepäntalo M, Apelqvist J. Chapter IV: Treatment of Critical Limb Ischaemia. Eur J Vasc Endovasc Surg 2011; 42 Suppl 2:S43-59. [DOI: 10.1016/s1078-5884(11)60014-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rand T, Lammer J, Rabbia C, Maynar M, Zander T, Jahnke T, Müller-Hülsbeck S, Scheinert D, Manninen HI. Percutaneous Transluminal Angioplasty versus Turbostatic Carbon–coated Stents in Infrapopliteal Arteries: InPeria II Trial. Radiology 2011; 261:634-42. [DOI: 10.1148/radiol.11101357] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yoo YS, Park HS, Lee T, Kang SK. Drug-eluting Stent Implantation for a Below-the-knee Chronic Total Occlusion Lesion: A Case Report. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Young Sun Yoo
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Kwon Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Balzer JO, Khan V, Thalhammer A, Vogl TJ, Lehnert T. Below the knee PTA in critical limb ischemia results after 12 months: Single center experience. Eur J Radiol 2010; 75:37-42. [DOI: 10.1016/j.ejrad.2010.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/31/2010] [Indexed: 11/25/2022]
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Abstract
Infrainguinal peripheral occlusive disease is increasingly being treated by endovascular techniques. Bare metal stainless steel, self-expanding nitinol stents, drug-eluting and covered stents (stent grafts) are becoming increasingly more important adjuncts to percutaneous translumninal angioplasty in the treatment of peripheral artery disease. In this article the available evidence supporting the use of stents in the femoropopliteal and tibial arteries will be described as well as their limitations. Future stent developments will also be discussed.
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Conrad MF, Kang J, Cambria RP, Brewster DC, Watkins MT, Kwolek CJ, LaMuraglia GM. Infrapopliteal balloon angioplasty for the treatment of chronic occlusive disease. J Vasc Surg 2009; 50:799-805.e4. [DOI: 10.1016/j.jvs.2009.05.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 05/13/2009] [Accepted: 05/14/2009] [Indexed: 11/25/2022]
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Shammas NW. Restenosis after lower extremity interventions: current status and future directions. J Endovasc Ther 2009; 16 Suppl 1:I170-82. [PMID: 19317571 DOI: 10.1583/08-2564.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The incidence of restenosis after percutaneous peripheral interventions (PPI) varies considerably depending upon the vascular bed but appears to be highest in the femoropopliteal and tibioperoneal arteries. The restenosis process in the periphery does not appear to stop at the 6-month mark, as seen with bare metal stents in the coronary arteries, but continues for a longer time, possibly years, after the intervention. This review evaluates the incidence of restenosis following lower extremity arterial interventions and potential drugs or devices that could alter this process, including nonpharmacological (stents, cryoplasty, Cutting Balloon angioplasty, atherectomy, brachytherapy, and photodynamic therapy) and pharmacological (systemic and direct drug delivery) approaches. A global strategy to achieve optimal outcome with PPI is offered: (1) obtain excellent acute angiographic results with less dissection and recoil, (2) protect the distal tibial vascular bed, and (3) reduce smooth muscle cell proliferation with pharmacological intervention.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, Cardiovascular Medicine, Davenport, Iowa 52803, USA.
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Biondi-Zoccai GGL, Sangiorgi G, Lotrionte M, Feiring A, Commeau P, Fusaro M, Agostoni P, Bosiers M, Peregrin J, Rosales O, Cotroneo AR, Rand T, Sheiban I. Infragenicular Stent Implantation for Below-the-Knee Atherosclerotic Disease: Clinical Evidence From an International Collaborative Meta-Analysis on 640 Patients. J Endovasc Ther 2009; 16:251-60. [PMID: 19642789 DOI: 10.1583/09-2691.1] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Bosiers M, Lioupis C, Deloose K, Verbist J, Peeters P. Two-Year Outcome after Xpert Stent Implantation for Treating Below the Knee Lesions in Critical Limb Ischemia. Vascular 2009; 17:1-8. [DOI: 10.2310/6670.2009.00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the efficacy of Xpert (Abbott Vascular, Abbott Park, IL) nitinol stents for the treatment of infrapopliteal lesions in patients with Critical Limb Ischemia (CLI). Between May 2005 and November 2007, 94 CLI patients (70 male, mean age 73.5 years) received 134 Xpert stents in 102 limbs. Seventy-nine patients (71.2%) were scored as Rutherford Category 4, 31 patients (27.9%) as Category 5 and 1 patient (0.9%) as Category 6. Primary endpoint of this study was defined as 2-year duplex derived primary patency. Secondary endpoints were 2-year limb salvage rate and the absence of reintervention after the index procedure. Kaplan Meier analysis reported 2-year primary patency and limb salvage rates of 54.4% and 90.8%, respectively. Stratification by lesion location did not reveal any significant differences in 2-year primary patency rates in proximal and distal below the knee lesions. Our results suggest that treatment with nitinol Xpert stents can be considered effective for treating CLI patients, with satisfying patency outcome.
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Affiliation(s)
- Marc Bosiers
- *Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium; †Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Christos Lioupis
- *Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium; †Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Koen Deloose
- *Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium; †Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Jürgen Verbist
- *Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium; †Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Patrick Peeters
- *Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium; †Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
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Karnabatidis D, Katsanos K, Spiliopoulos S, Diamantopoulos A, Kagadis GC, Siablis D. Incidence, anatomical location, and clinical significance of compressions and fractures in infrapopliteal balloon-expandable metal stents. J Endovasc Ther 2009; 16:15-22. [PMID: 19281287 DOI: 10.1583/08-2530.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the incidence, anatomical location, and clinical impact of fractures and/or compression of infrapopliteal balloon-expandable metal stents implanted for critical limb ischemia (CLI) treatment. METHODS This prospective study included 63 CLI patients (45 men; mean age 71.3+/-9.5 years) who had been treated with infrapopliteal angioplasty and stent placement for 191 lesions in 84 limbs. In all, 369 stents (296 stainless steel and 73 cobalt-chromium alloy) were implanted; 239 were placed overlapping in tandem lesions. Mean length of the overall stented segment was 4.4+/-6.3 cm (range 1.6-14.0). Stents were located in the tibioperoneal (n = 34), anterior tibial (n = 195), posterior tibial (n = 63), and peroneal (n = 77) arteries. Follow-up consisted of digital subtraction angiography and infrapopliteal radiography imaging at 2 different angles. Evaluation of stents for the presence of fracture and/or compression was done after digital processing at the highest possible magnification. Stent fractures were defined according to published standards, whereas compression was classified as severe shape alteration and/or collapse of the stent mesh. Angiographic restenosis was based on a 50% threshold. RESULTS Mean follow-up was 15+/-11 months (range 6-60). Image analysis detected 1 (0.3%) severe stent fracture (complete separation and misalignment of stent struts) and 11 (3.0%) stent compressions. Infrapopliteal stent fracture and compressions were associated with increased artery restenosis [100% (12/12) versus 47.3% (169/357), p<0.001] and an increased rate of clinical deterioration and clinically-driven reinterventions [41.7% (5/12 limbs) versus 19.4% (14/72 limbs), p = 0.04]. The single fracture and most of the compressions were located in the distal third of the anterior tibial artery. CONCLUSION Stent fractures and compressions of infrapopliteal balloon-expandable metal stents are infrequent. However, they may be related to increased restenosis.
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Karnabatidis D, Katsanos K, Siablis D. Infrapopliteal Stents:Overview and Unresolved Issues. J Endovasc Ther 2009; 16 Suppl 1:I153-62. [DOI: 10.1583/08-2593.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bosiers M, Peeters P, D'Archambeau O, Hendriks J, Pilger E, Düber C, Zeller T, Gussmann A, Lohle PNM, Minar E, Scheinert D, Hausegger K, Schulte KL, Verbist J, Deloose K, Lammer J. AMS INSIGHT--absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis. Cardiovasc Intervent Radiol 2008; 32:424-35. [PMID: 19093148 PMCID: PMC2700251 DOI: 10.1007/s00270-008-9472-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 10/31/2008] [Accepted: 11/05/2008] [Indexed: 11/25/2022]
Abstract
Endoluminal treatment of infrapopliteal artery lesions is a matter of controversy. Bioabsorbable stents are discussed as a means to combine mechanical prevention of vessel recoil with the advantages of long-term perspectives. The possibility of not having a permanent metallic implant could permit the occurrence of positive remodeling with lumen enlargement to compensate for the development of new lesions. The present study was designed to investigate the safety of absorbable metal stents (AMSs) in the infrapopliteal arteries based on 1- and 6-month clinical follow-up and efficacy based on 6-month angiographic patency. One hundred seventeen patients with 149 lesions with chronic limb ischemia (CLI) were randomized to implantation of an AMS (60 patients, 74 lesions) or stand-alone percutaneous transluminal angioplasty (PTA; 57 patients, 75 lesions). Seven PTA-group patients “crossed over” to AMS stenting. The study population consisted of patients with symptomatic CLI (Rutherford categories 4 and 5) and de novo stenotic (>50%) or occlusive atherosclerotic disease of the infrapopliteal arteries who presented with a reference diameter of between 3.0 and 3.5 mm and a lesion length of <15 mm. The primary safety endpoint was defined as absence of major amputation and/or death within 30 days after index intervention and the primary efficacy endpoint was the 6-month angiographic patency rate as confirmed by core-lab quantitative vessel analysis. The 30-day complication rate was 5.3% (3/57) and 5.0% (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively. On an intention-to-treat basis, the 6-month angiographic patency rate for lesions treated with AMS (31.8%) was significantly lower (p = 0.013) than the rate for those treated with PTA (58.0%). Although the present study indicates that the AMS technology can be safely applied, it did not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels.
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Affiliation(s)
- Marc Bosiers
- Department of Vascular Surgery, AZ St-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium.
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