1
|
Noory E, Böhme T, Staus PI, Eltity-Uhl D, Horakh A, Bollenbacher R, Westermann D, Zeller T. Evaluation of acute and midterm outcomes after complex combined antegrade/retrograde recanalization for occlusions of the femoropopliteal and infrapopliteal arteries. J Vasc Surg 2024:S0741-5214(24)01669-0. [PMID: 39111587 DOI: 10.1016/j.jvs.2024.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND When antegrade recanalization of femoropopliteal and/or infrapopliteal occlusions fails, retrograde access has become an established option. To evaluate the results of combined antegrade and retrograde recanalization of femoropopliteal and infrapopliteal occlusions, patients undergoing secondary retrograde recanalization attempts were analyzed retrospectively. METHODS The primary end point was the success of the procedure (successful occlusion crossing using the antegrade/retrograde technique). Secondary end points include complication rate, primary patency and target lesion revascularization (TLR) rate, amputation rate, changes in ankle-brachial index, and Rutherford-Becker class. Predictors for procedure failure and TLR were analyzed. RESULTS We included 888 patients: 362 with femoropopliteal (group 1), 353 with infrapopliteal (group 2), and 173 with multilevel (group 3) recanalization. Critical limb-threatening ischemia was present in group 1, 2, and 3 in 36%, 62%, and 76% of patients, respectively. The intervention was successful in 92.5%, 93.8%, and 90.8% of the respective cases (P = .455). The overall peri-interventional complication rate was 7.2%. At 6, 12, and 24 months, primary patency was highest in group 1 (63.9%, 45.8%, and 33.3%), followed by group 3 (59.8%, 46.1%, and 33.3%), and group 2 (58.5%, 43.1%, and 30.4%; P = .537). The risk of undergoing repeated TLR within 24 months was 31.4% for group 1, 39.1% for group 2, and 45.7% for group 3. At 24 months, the survival rates in groups 1, 2, and 3 were 93.8%, 79.4%, and 87.5%, respectively. Over 24 months, 75 patients (8.4%) had to undergo amputation. Significant improvements in both ankle-brachial index and Rutherford-Becker class were present at discharge as well as at 6, 12, and 24 months (P < .001). Dialysis dependency was a predictor of unsuccessful antegrade/retrograde recanalization (P = .048). Lesion length (P = .0043), dialysis (P = .033), and recanalization level (P = .013) increase the risk of TLR. CONCLUSIONS Using a combined antegrade/retrograde access, recanalization of occluded femoropopliteal and/or infrapopliteal arteries can be achieved in a large number of cases. Owing to the high rate of repeated TLR across all lesion localizations, the indication for antegrade and retrograde recanalization may be limited to patients with critical limb-threatening ischemia.
Collapse
Affiliation(s)
- Elias Noory
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Tanja Böhme
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Paulina Ines Staus
- Institute for Medical Biometry and Statistics (IMBI), University of Freiburg, Freiburg, Germany
| | - Dinah Eltity-Uhl
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Andrea Horakh
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Roaa Bollenbacher
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Zeller
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| |
Collapse
|
2
|
Jiang C, Zhao Y, Zhang WW, Chen Z, Zeng Q, Li F. Recanalization of superficial femoral artery chronic total occlusion through retrograde popliteal approach recanalization of superficial femoral artery chronic total occlusion. Heliyon 2024; 10:e30872. [PMID: 38828305 PMCID: PMC11140595 DOI: 10.1016/j.heliyon.2024.e30872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose This retrospective study aims to evaluate the safety, practicality, and efficacy of the independent retrograde popliteal approach for recanalization superficial femoral artery (SFA) occlusions when the bilateral common femoral artery approach is unavailable, such as after endovascular aneurysm repair or common iliac artery stenting. Methods This treatment was considered for patients with contralateral iliac artery occlusion, severe iliac tortuosity, or those who had previously undergone endovascular aneurysm repair or common iliac stenting. Patients with SFA lesions extending into the P1-P2 segment of the popliteal artery or with calcification in the P3 segment were excluded. Angioplasty and stenting were conducted via the popliteal artery approach, with hemostasis at the puncture site achieved using an EXOSEAL vascular closure device. Patients were routinely followed up at 3, 6, and 12 months, and annually thereafter. Results Forty-eight consecutive patients with SFA occlusion who underwent endovascular treatment via the retrograde popliteal artery approach were included in this study. Retrograde puncture of the popliteal artery was successful in all cases. Six-French sheaths were utilized in all procedures. The EXOSEAL vascular closure device was successfully applied in all 48 cases. No instances of pseudoaneurysms, arteriovenous fistulas, major bleeding, or embolic complications were observed. The technical success rate for SFA recanalization was 100 %. All patients experienced clinical improvement. The ankle-brachial index significantly increased from an initial 0.33 ± 0.11 at admission to 0.81 ± 0.19 at discharge (P < 0.001). The mean follow-up period was 25.1 ± 11.7 months. Kaplan-Meier analysis revealed primary patency rates of 82.5 % at 12 months and 71.8 % at 24 months. No patients required major amputation during the follow-up period. Conclusion The endovascular treatment of SFA occlusions via the independent retrograde popliteal approach is a viable alternative, demonstrating a low incidence of puncture-related complications and a high success rate of recanalization.
Collapse
Affiliation(s)
- Chuli Jiang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, China
| | - Wayne W. Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington, and Puget Sound VA Health Care System, USA
| | - Zheng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, China
| | - Qiu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, China
| |
Collapse
|
3
|
Meng LW, Xie XL, Zhou XH, Liu SQ, Hou ZG. Design, Optimization, and Modeling of a Hydraulic Soft Robot for Chronic Total Occlusions. Biomimetics (Basel) 2024; 9:163. [PMID: 38534848 DOI: 10.3390/biomimetics9030163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Chronic total occlusion (CTO) is one of the most severe and sophisticated vascular stenosis because of complete blockage, greater operation difficulty, and lower procedural success rate. This study proposes a hydraulic-driven soft robot imitating the earthworm's locomotion to assist doctors or operators in actively opening thrombi in coronary or peripheral artery vessels. Firstly, a three-actuator bionic soft robot is developed based on earthworms' physiological structure. The soft robot's locomotion gait inspired by the earthworm's mechanism is designed. Secondly, the influence of structure parameters on actuator deformation, stress, and strain is explored, which can help us determine the soft actuators' optimal structure parameters. Thirdly, the relationship between hydraulic pressure and actuator deformation is investigated by performing finite element analysis using the bidirectional fluid-structure interaction (FSI) method. The kinematic models of the soft actuators are established to provide a valuable reference for the soft actuators' motion control.
Collapse
Affiliation(s)
- Ling-Wu Meng
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiao-Liang Xie
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiao-Hu Zhou
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Shi-Qi Liu
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Zeng-Guang Hou
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| |
Collapse
|
4
|
Kokkinidis DG, Schizas D, Pargaonkar S, Karamanis D, Mylonas KS, Hasemaki N, Palaiodimos L, Varrias D, Tzavellas G, Siasos G, Klonaris C, Kharawala A, Chlorogiannis DD, Georgopoulos S, Bakoyiannis C. Differences between Lower Extremity Arterial Occlusion vs. Stenosis and Predictors of Successful Endovascular Interventions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2029. [PMID: 38004078 PMCID: PMC10673017 DOI: 10.3390/medicina59112029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: In patients with peripheral artery disease, there is insufficient understanding of characteristics that predict successful revascularization of the lower extremity (LE) chronic total occlusions (CTOs) and baseline differences in demographic, clinical, and angiographic characteristics in patients with LE CTO vs. non-CTO. We aim to explore these differences and predictors of successful revascularization among CTO patients. Materials and Methods: Two vascular centers enrolled LE-CTO patients who underwent endovascular revascularization. Data on demographics, clinical, angiographic, and interventional characteristics were collected. LE non-CTO arterial stenosis patients were compared. A total of 256 patients with LE revascularization procedures were studied; among them, 120 had CTOs and 136 had LE stenosis but no CTOs. Results: Aspirin use (Odds ratio, OR: 3.43; CI 1.32-8.88; p = 0.011) was a positive predictor whereas a history of malignancy (OR: 0.27; CI 0.09-0.80; p = 0.018) was a negative predictor of successful crossing in the CTO group. The CTO group had a higher history of myocardial infarction (29.2 vs. 18.3%, p = 0.05), end-stage renal disease (19.2 vs. 9.6%, p = 0.03), and chronic limb-threatening ischemia as the reason for revascularization (64.2 vs. 22.8%, p < 0.001). They were more likely to have advanced TransAtlantic Inter-Society Consensus (TASC) stages, multi-vessel revascularization procedures, longer lesions, and urgent treatment. Conclusions: The use of aspirin is a positive predictor whereas a history of malignancy is a negative predictor for successful crossing in CTO lesions. Additionally, LE-CTO patients have a higher incidence of comorbidities, which is expected given their higher disease burden. Successful endovascular re-vascularization can be associated with baseline clinical variables.
Collapse
Affiliation(s)
- Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sumant Pargaonkar
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Dimitrios Karamanis
- Department of Economics, University of Piraeus, 18534 Piraeus, Greece
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA
| | - Konstantinos S Mylonas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Natasha Hasemaki
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Georgios Tzavellas
- Department of Vascular Surgery, Ball Memorial Hospital, Muncie, IN 47303, USA
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Klonaris
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Amrin Kharawala
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | | | - Sotirios Georgopoulos
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | |
Collapse
|
5
|
Ritter JC, Vo UG, Moss JL. Feasibility of the Complete Endovascular Reconstruction of the Trifurcation (CERT) Technique for Revascularisation in Chronic Limb Threatening Ischemia. Vasc Endovascular Surg 2022; 56:15385744221106275. [PMID: 35655119 DOI: 10.1177/15385744221106275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BackgroundRevascularisation of patients with chronic limb threatening ischaemia due to arterial lesions in the below the knee segment can be challenging. This study describes a novel technique that allows a complete endovascular reconstruction of the trifurcation (CERT) utilising stents in the below the knee segment when conventional techniques are exhausted, or have failed to deliver an acceptable result, leading to remaining outflow compromise. Methods: Eight patients with Rutherford 5 chronic limb threatening ischaemia underwent CERT between January 1st, 2018 and January 1st, 2020. All patients underwent ultrasound at 6 weeks post operatively and then at variable intervals until the completion of the follow up period in March 2020. Results: Technical success of the CERT technique was achieved in all patients. Six patients had anterior tibial artery/Tibioperoneal trunk reconstructions, whilst 2 patients were stented directly into posterior tibial and peroneal artery. Five patients (63%) achieved wound healing. All-cause mortality was 25% (2 patients) with 1 patient achieving wound healing prior to death. Two stents were occluded during the follow up period. The first was asymptomatic and had achieved wound healing. The second was symptomatic with stent occlusion and a delayed presentation with Rutherford 3 acute limb ischaemia. Conclusions: Complete endovascular reconstruction of the trifurcation is a feasible option to achieve revascularisation in patients with tissue loss and below the knee arterial lesions allowing a continuous reconstruction of the trifurcation segment keeping the anatomical configuration intact. Clinical outcomes appear acceptable however larger series are needed.
Collapse
Affiliation(s)
- Jens Carsten Ritter
- Department of Vascular and Endovascular Surgery, 418838Fiona Stanley Hospital, Perth, WA, Australia
- Faculty of Medicine, 1649Curtin University, Perth, WA, Australia
| | - Uyen Giao Vo
- Department of Vascular and Endovascular Surgery, 418838Fiona Stanley Hospital, Perth, WA, Australia
| | - Jana-Lee Moss
- Department of Vascular and Endovascular Surgery, 418838Fiona Stanley Hospital, Perth, WA, Australia
| |
Collapse
|
6
|
Mazzaccaro D, Giannetta M, Righini P, Modafferi A, Malacrida G, Nano G. Endovascular Materials and Their Behavior in Peripheral Vascular Surgery. Front Surg 2022; 9:900364. [PMID: 35599784 PMCID: PMC9115547 DOI: 10.3389/fsurg.2022.900364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Endovascular techniques have progressively become the first option for the treatment of stenosis and occlusions of both aorto-iliac and femoro-popliteal district. The development of new technologies and new materials has broadened the applicability of the endovascular techniques, allowing the treatment of each lesion with the most suitable material. A knowledge of the behavior of endovascular materials when treating peripheral arterial disease (PAD) is, therefore, crucial for optimization of the results. Here, we aim to review the most important technical features of the actually available endovascular materials for treating PAD.
Collapse
Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
7
|
Fanelli F. Treating Peripheral Chronic Total Occlusions: Putting a New Device in Perspective. J Vasc Interv Radiol 2022; 33:60-61. [PMID: 34980452 DOI: 10.1016/j.jvir.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Fabrizio Fanelli
- Vascular and Interventional Radiology Unit, Careggi University Hospital, Florence, Italy.
| |
Collapse
|
8
|
Therasse E, Benko A, Brodmann M, Hadziomerovic A. A Multinational, Single-Arm Pivotal Study Assessing the Performance of the SoundBite Crossing System for Peripheral Chronic Total Occlusions (The PROSPECTOR Study). J Vasc Interv Radiol 2021; 33:50-59. [PMID: 34628039 DOI: 10.1016/j.jvir.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/08/2021] [Accepted: 07/10/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This study aimed to demonstrate the efficacy and safety of the SoundBite Crossing System‒Peripheral (SCS-P) to facilitate crossing chronic total occlusions (CTOs) of infrainguinal arteries. MATERIALS AND METHODS This clinical trial was approved by the Ethics Committees of all 4 participating centers and enrolled 52 patients with symptomatic de novo infrainguinal CTOs. Technical device success, the primary efficacy endpoint, was defined as the ability to facilitate the treatment of the target lesion by crossing a portion or the whole length of the CTO. Freedom from SCS-P-related major adverse events (MAEs) at 30 days after the procedure was the primary safety endpoint. RESULTS The SCS-P met the primary efficacy and safety endpoints in 92.3% (48/52) and 100% (52/52) of subjects, respectively. Technical device success with postprocedural patency and freedom from SCS-P-related MAEs was achieved in 88.5% (46/52) of subjects. The mean CTO crossing time was 20.0 minutes ± 30.8, and the SCS-P was able to traverse the whole CTO and enter the distal true lumen without the need of any other device in 59.6% (31/52) of subjects. The mean Rutherford category and ankle-brachial index improvement at the 30-day follow-up was 2.4 ± 1.17 and 0.23 ± 0.22, respectively. CONCLUSIONS The SCS-P demonstrated a satisfactory safety and performance profile to cross peripheral CTOs and enter the distal true lumen of infrainguinal CTOs.
Collapse
Affiliation(s)
- Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Andrew Benko
- Department of Radiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Adnan Hadziomerovic
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
9
|
Weissler EH, Gutierrez JA, Patel MR, Swaminathan RV. Successful Peripheral Vascular Intervention in Patients with High-risk Comorbidities or Lesion Characteristics. Curr Cardiol Rep 2021; 23:32. [PMID: 33666765 DOI: 10.1007/s11886-021-01465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Certain comorbidities and lesion characteristics are associated with increased risk for procedural complications, limb events, and cardiovascular events following peripheral vascular intervention (PVI) in patients with peripheral arterial disease (PAD). The purpose of this review is to provide an overview of high-risk modifiable and unmodifiable patient characteristics and its relative impact on clinical outcomes such as amputation risk and mortality. Furthermore, general approaches to potentially mitigating these risks through pre-intervention planning and use of modern devices and techniques are discussed. RECENT FINDINGS Diabetes, tobacco use, and older age remain strong risk factors for the development of peripheral arterial disease. Recent data highlight the significant risk of polyvascular disease on major limb and cardiac events in advanced PAD, and ongoing studies are assessing this risk specifically after PVI. Challenging lesion characteristics such as calcified disease and chronic total occlusions can be successfully treated with PVI by utilizing novel devices (e.g., intravascular lithotripsy, re-entry devices) and techniques (e.g., subintimal arterial "flossing" with antegrade-retrograde intervention). Understanding high-risk patient comorbidities and lesion characteristics will improve our ability to counsel and manage patients with advanced PAD. Continued device innovation and novel techniques will aid in procedural planning for successful interventions to improve clinical outcomes.
Collapse
Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | - J Antonio Gutierrez
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA.
| |
Collapse
|
10
|
Sheikh AB, Llanos-Chea F, Jelani QUA, Anantha-Narayanan M, Attaran R, Schneider M, Ionescu C, Regan C, Nagpal S, Smolderen KG, Mena-Hurtado C. Safety and efficacy outcomes of the Pioneer Plus catheter in endovascular revascularization of lower extremity chronic total occlusions. J Vasc Surg 2021; 74:746-755. [PMID: 33592298 DOI: 10.1016/j.jvs.2021.01.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our aim was to evaluate the efficacy and safety outcomes of the Pioneer Plus catheter (Philips, San Diego, Calif) and report the in-hospital and 30-day outcomes of lower extremity chronic total occlusion (CTO) interventions assisted by the Pioneer Plus catheter. In addition, we explored the factors associated with procedural success. METHODS We conducted a retrospective review of 135 consecutive procedures in 116 patients from July 2011 to September 2018 performed by eight operators with various levels of experience at a high-volume center where the Pioneer Plus catheter was used for lower extremity CTO. The patient demographics, preprocedural symptoms, preprocedural testing results, procedural setting, and angiography findings were abstracted. The outcomes were divided into device-related and procedure-related outcomes. Device-related efficacy outcome included procedural success. Device-related safety outcomes included device-related complications. Procedure-related outcomes included procedure-related complications, 30-day major adverse cardiovascular events, and 30-day major adverse limb events. We conducted univariate comparisons of the provider, patient, and procedural characteristics stratified by procedural success. RESULTS Procedural success was observed in 118 procedures overall (87.4%), and success rates ≤95.8% were observed for operators with an experience level of >25 devices deployed. No device-related complications, such as pseudoaneurysm formation, vessel perforation, or arteriovenous fistula formation, were observed. The Pioneer Plus catheter was mostly often used for CTO in the superficial femoral and popliteal arteries. Overall, the procedure-related complications included access site hematoma (5.2%), major bleeding (0.7%), pseudoaneurysm formation (0.7%), distal embolization (1.5%), and acute arterial thrombosis (1.5%). The 30-day major adverse limb events included index limb unplanned amputation (0.7%), index limb reintervention (4.4%), and index limb acute limb ischemia (0.7%) and occurred in 5.9% of the procedures. The only factor associated with procedural success was operator experience (P < .0001). CONCLUSIONS The results from the present study have shown that Pioneer Plus catheter use is safe and effective when used to cross lower extremity CTO. However, further investigation is needed to identify patient- and provider-level factors to optimize patient outcomes.
Collapse
Affiliation(s)
- Azfar Bilal Sheikh
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn.
| | - Fiorella Llanos-Chea
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Qurat-Ul-Ain Jelani
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Mahesh Anantha-Narayanan
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Robert Attaran
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Marabel Schneider
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Costin Ionescu
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Christopher Regan
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Sameer Nagpal
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Kim G Smolderen
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Carlos Mena-Hurtado
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| |
Collapse
|
11
|
Hartwig JW, Braet DJ, Smith JB, Bath J, Vogel TR. Optical coherence tomography and plaque morphology for revascularization of the superficial femoral artery. Quant Imaging Med Surg 2021; 11:290-299. [PMID: 33392029 DOI: 10.21037/qims-20-707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The optical coherence tomography (OCT) catheter, Ocelot (Avinger Inc., Redwood City, CA), has been utilized to cross Trans-Atlantic Inter-Society Consensus Document (TASC) D lesions. Studies have assessed the characteristics of high-risk plaques in the carotid artery, but few, if any data exist evaluating OCT and plaque morphology in the superficial femoral artery (SFA). This study assessed SFA plaque morphology using OCT and lesion crossing success in chronic total occlusions (CTOs). Methods We reviewed patients who underwent attempted infrainguinal revascularization with TASC D CTOs using the Ocelot catheter between June 2014 and June 2018, and recorded demographic information, smoking status, and medical comorbidities. A matched cohort of 44 successfully crossed lesions was compared to 44 that failed; images insufficient for analysis were excluded. The morphology of the plaque was studied using OCT at the proximal cap, midpoint of the lesion, and the distal cap. Morphologic data studied included the intima-media thickness ratio, cross-sectional area of the plaque, and gray-scale median of the plaque. Results A total of 140 patients who underwent lower extremity procedures for TASC D lesions of the SFA with OCT imaging were reviewed with a crossing rate of 69.0%. No significant differences were found between crossed and uncrossed lesions for intima-media thickness or cross-sectional area at the proximal cap, the midpoint, or the distal cap. A lower gray-scale median at the proximal cap was associated with the ability to cross the chronic SFA occlusion (P=0.05). Subgroup analysis stratified by smoking and calcium content also demonstrated that a lower gray-scale median at the proximal cap was associated with the ability to cross the chronic SFA occlusion (P=0.01 and P=0.04, respectively). Conclusions Lower gray-scale median at the proximal cap of a chronic SFA occlusion calculated using OCT images was associated with the ability to successfully cross the lesion. Higher plaque gray-scale median is correlated with increased calcium, greater fibrous tissue, and signal-rich plaques. Gray-scale median in the proximal cap is useful marker to determine plaque composition and subsequent technical success for crossing chronic SFA occlusions. Further studies are needed to fully determine the utility of OCT images to predict successful endovascular revascularization of chronic SFA occlusions.
Collapse
Affiliation(s)
- Jacob W Hartwig
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Drew J Braet
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Jamie B Smith
- Department of Family and Community Medicine, University of Missouri, School of Medicine Columbia, Columbia, MO, USA
| | - Jonathan Bath
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Todd R Vogel
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| |
Collapse
|
12
|
El Khoury R, Cataneo JL, Paredes JA, Schwartz AM, Jacobs CE, White JV, Schwartz LB. "Failure-to-Cross" in Patients Undergoing Percutaneous Peripheral Intervention: The Nonreimbursed Procedure. Ann Vasc Surg 2020; 70:349-354. [PMID: 32603846 DOI: 10.1016/j.avsg.2020.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Percutaneous peripheral intervention (PPI) is often the first mode of therapy for patients with symptomatic arterial occlusive disease. Technical success generally remains high although "failure-to-cross" still complicates 5-20% of cases. Extended efforts to cross long, occlusive lesions can utilize significant hospital and practitioner resources. The hospital is typically reimbursed for this effort as facility fees are charged by the hour and materials are charged per use. However, given the lack of a CPT® code for "failure-to-cross," practitioners are rarely appropriately compensated. The purpose of this study is to analyze the predictors, technical details, outcomes, and costs of "failure-to-cross" during PPI. METHODS All PPI procedures over a 2-year period at a single institution were retrospectively reviewed. Clinical characteristics, results, costs, and reimbursements obtained from hospital cost accounting were compared among successful therapeutic interventions, crossing failures, and diagnostic angiograms without attempted intervention. RESULTS A total of 146 consecutive PPIs were identified; the rate of "failure-to-cross" was 11.6% (17 patients). The majority of patients with "failure-to-cross" were male (82%) with single-vessel runoff (53%). Compared to successful interventions, the incidences of chronic limb-threatening ischemia (82% vs. 70%, P = 0.34) and infrapopliteal occlusive disease were similar (47% vs. 31%, P = 0.20). "Failure-to-cross" procedures were just as long as successful procedures; there were no significant differences in fluoroscopy time (27 ± 10 vs. 24 ± 14 min, P = 0.52), in-room time (106 ± 98 vs. 103 ± 44 min, P = 0.84), or contrast dye volume utilization (73 ± 37 vs. 96 ± 54 mL, P = 0.12). As expected, "failure-to-cross" procedures incurred far higher hospital charges and costs compared to noninterventional diagnostic angiograms (charges $13,311 ± 6,067 vs. $7,690 ± 1,942, P < 0.01; costs $5,289 ± 2,099 vs. $2,826 ± 1,198, P < 0.01). Despite the additional time and effort spent attempting to cross difficult lesions, the operators were reimbursed at the same low rate as a purely diagnostic procedure (average fee charge $7,360; average reimbursement $992). After 1 year, the 17 patients in whom lesions could not be crossed were treated with advanced interventional procedures with success (n = 2), surgical bypass grafting (n = 5), extremity amputation (n = 4), or no additional intervention in their salvaged limb (n = 6). CONCLUSIONS Patients whose lesions cannot be crossed during PPI fare worse than patients undergoing successful interventions. Hospital costs and charges appropriately reflect the high technical difficulty and resource utilization of extended attempts at endovascular therapy. For practitioners, crossing lesions during PPI is truly a "pay-for-performance" procedure in that only successful procedures are reasonably reimbursed.
Collapse
Affiliation(s)
- Rym El Khoury
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - Jose L Cataneo
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - Juan A Paredes
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | | | - Chad E Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - Lewis B Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL.
| |
Collapse
|
13
|
Qanadli SD. Research in Vascular Medicine: Where We Are and Where We Are Going. Front Cardiovasc Med 2020; 7:45. [PMID: 32266295 PMCID: PMC7105770 DOI: 10.3389/fcvm.2020.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Salah D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
14
|
Kokkinidis DG, Katsaros I, Jonnalagadda AK, Avner SJ, Chaitidis N, Bakoyiannis C, Kakkar A, Secemsky EA, Giri JS, Armstrong EJ. Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Femoropopliteal Chronic Total Occlusions: A Systematic Review of 87 Studies and 4,665 Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:34-45. [DOI: 10.1016/j.carrev.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
|
15
|
Five-year outcomes after revascularization of superficial femoral artery occlusion using Ocelot catheter. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:472-476. [PMID: 31933664 PMCID: PMC6956451 DOI: 10.5114/aic.2019.90222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/14/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The population of patients with lower limb atherosclerosis includes a considerable proportion of individuals with long superficial femoral artery (SFA) lesions. Chronic total occlusions (CTOs) represent the "last frontier" of percutaneous interventions. While open strategies are considered earlier as standard management for these lesions, the results of a number of trials indicate that endovascular management might become an effective alternative to surgery. Material and methods This paper presents 5-year outcomes of a first-in-man (FIM) study (before CE mark) and the registry of OCT Guided Ocelot Catheter (Avinger) for chronic total occlusions of the superficial femoral artery. The study group comprised 10 patients with Rutherford 3 lower limb ischemia including nine men and one woman. Results The efficacy of the primary intervention was 90%. Angiography performed at 6 months of the procedure, according to the study protocol, revealed 3 and 1 cases of restenosis and reocclusion, respectively, repaired using PTA and open common and deep femoral artery patch plasty. Doppler ultrasound performed at 1, 2 and 5 years after the primary intervention did not reveal significant target vessel restenosis. The primary and primary-assisted patency was 89%. During a 5-year follow-up, four peripheral percutaneous interventions and one femoropopliteal bypass surgery were performed in non-target limbs. There were no cardiovascular deaths, myocardial infarction or stroke and no amputation was required. Conclusions This is a first-in-man study reporting long-term follow-up after SFA CTO revascularization using the Ocelot catheter. The catheter proved to have a satisfactory safety profile and a high proportion of CTO crossings. A 5-year follow-up revealed high primary and primary-assisted patency rates.
Collapse
|
16
|
Kuserli Y, Kavala AA. Retrograde Popliteal Access and Balloon Dilatation of Chronic Total Occlusion of Superficial Femoral Arteries. Ann Vasc Surg 2019; 64:253-262. [PMID: 31634601 DOI: 10.1016/j.avsg.2019.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the effectiveness of retrograde popliteal access in subjects with chronic total occlusion of the superficial femoral artery. METHODS A retrospective review of subjects who underwent balloon dilatation via retrograde popliteal access (RPA) is included. Age, gender, tobacco use, comorbid diseases, body mass index, ejection fraction, claudication distance (0 to 50 meters, 50 to 100 meters and 100 to 150 meters), preoperative Rutherford scale, and Ankle-brachial index (ABI) are noted for each subject. A duplex ultrasound (DUS) was performed preoperatively. The localization side of the lesion (right-left), the length of the atherosclerotic segment, and the localization of the diseased segment (proximal superficial femoral artery [SFA], mid-SFA, distal SFA, popliteal-above the knee) were noted. Subjects were followed for at least one year after the procedure. Subjects were reevaluated in the first, 6th, and 12th months after the procedure. In control subjects, Rutherford class and ABI were noted. A DUS was performed to detect restenosis. The subjects' preoperative Rutherford class and ABI and restenosis degree were compared with their postoperative values. RESULTS A total of 93 subjects (75.3% male, 24.7% female; mean age 68.57 ± 8.70 years old) were evaluated. In all 93 (100%) subjects, successful RPA was achieved. Overall, balloon dilatation via RPA was successful in 86 (92.47%) of the 93 subjects. The procedural success rate was 92.47%. The occluded segment was on the right side in 49.5% of the subjects (n = 46) and on the left side in 50.5% (n = 47) of the subjects. The mean length of the lesion was 10.77 ± 2.21 cm, and the average stenosis degree was 95.9 ± 5.05%. The localization of the occluded segment was in the proximal SFA, mid SFA, distal SFA and popliteal above the knee in 45.2%, 50.5%, 25.8% and 10.8% of the patients, respectively.When comparing the successful and unsuccessful groups, target lesion length (10.48 ± 2.01 vs. 14.43 ± 0.79, P < 0.001), mid-SFA localization (n = 40 vs. n = 7, P = 0,012) and claudication distance in the first 50 meters (P = 0,003) were significantly higher in subjects with failed balloon dilatation via RPA. When the Rutherford scale was examined, the mild, moderate, and severe claudication ratios were 23.7%, 29%, and 47.3%, respectively. After the procedure, 61.3% of the cases were asymptomatic, and 38.7% had mild claudication. The change in the Rutherford scale was statistically significant (P < 0,001). When the ABI measurements were examined before procedure, it increased from 0.63 ± 0.08 before to 0.90 ± 0.06 after the procedure, indicating a statistically significant difference (P < 0,001). When Doppler findings were examined, in the successful RPA group, the no-stenosis percentages were 82.6%, 72.1%, and 65.1 at the first, 6th, and 12th month follow-up, respectively. The mean disease-free survival time was 9.80 ± 0.39 months. In the first year, subjects were divided according to stenosis degree. Subjects with less than 50% stenosis were compared with subjects with more than 50% stenosis to detect the preprocedural characteristics that affect the restenosis degree. Tobacco use, chronic obstructive pulmonary disease, hyperlipidemia, chronical renal insufficiency, and popliteal above the knee localization were significantly higher in subjects who had more than 50% stenosis 1 year after the procedure (P = 0.009, P = 0.015, P = 0.044, P = 0.001, and P = 0.017, respectively). CONCLUSIONS RPA under DUS guidance is an effective method. RPA has high procedural success rate with low morbidity. Longer target lesion length, mid-SFA localization, and claudication distance in first 50 meters found to be related factors with RPA balloon dilatation failure. Restenosis rates after 12 months of follow-up is low and comparable with literature.
Collapse
Affiliation(s)
- Yusuf Kuserli
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Aycan Kavala
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| |
Collapse
|
17
|
Teraa M, de Vries M. Substent Anchor Technique for Recanalisation of a Full Metal Jacket Femoropopliteal Occlusion: An Unconventional Road to Rome. EJVES Short Rep 2018; 41:24. [PMID: 30582022 PMCID: PMC6300431 DOI: 10.1016/j.ejvssr.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mattijs de Vries
- Department of Vascular Surgery, Diakonessenhuis, Utrecht, the Netherlands
| |
Collapse
|