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Palena LM, Isernia G, Parlani G, Veroux P, Ficarelli I, Frascheri A, Pischedda A, Patrone L, Dionisi CP, Cianni R, Airoldi F, Landino P, Kleiban A, Filauri P, Passalacqua G, Antignani PL, De Rose E, Valls A, Biondi-Zoccai G, Manzi M. A multicenter prospective observational study appraising the effectiveness of the Supera stent after subintimal recanalization of femoro-popliteal artery occlusion: The SUPERSUB II study. Catheter Cardiovasc Interv 2024; 103:963-971. [PMID: 38566517 DOI: 10.1002/ccd.31028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/04/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Complex femoropopliteal artery disease represents a challenge. The Supera stent holds the promise of improving the results of endovascular therapy for complex femoropopliteal disease. AIMS We aimed at appraising the early and long-term effectiveness of the Supera stent after successful subintimal angioplasty (SuperSUB strategy) for complex femoropopliteal lesions. METHODS We conducted a multicenter, prospective, single-arm observational study including consecutive patients at participating centers in whom Supera was implanted after successful subintimal angioplasty for complex femoropopliteal lesions. RESULTS A total of 92 patients were included Femoropopliteal arteries were the most common target, and lesion length was 261 ± 102 mm. Most procedures were technically demanding, with antegrade femoral access in 35 (38%) and retrograde distal access in 55 (60%). Supera stent length was 281 ± 111 mm, with 4, 5, and 6 mm devices being most commonly used: 32 (35%), 35 (38%), and 23 (25%), respectively. Technical success was achieved in 100% of subjects, as was clinical success (per subject), whereas procedural success (per subject) was obtained in 98%. At 24 months, freedom from clinically driven target lesion revascularization was 93%, whereas primary patency was 87%. When compared with a similar historical cohort, Supera stent use appeared to be associated with a reduction in resources. CONCLUSION Use of Supera stent after successful subintimal recanalization of complex lower limb arterial lesions yields favorable procedural results, which are maintained over follow-up, and are associated also with a favorable resource use profile.
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Affiliation(s)
- Luis Mariano Palena
- Interventional Radiology Unit, Endovascular Interventions & Research, Foot & Ankle Clinic, Policlinico, Abano Terme, Italy
- Endovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giacomo Isernia
- Vascular Surgery Unit, A.O. Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Gianbattista Parlani
- Vascular Surgery Unit, A.O. Hospital Santa Maria della Misericordia, Perugia, Italy
| | | | | | - Arian Frascheri
- Hemodynamics O.U., Hospital Sant'Antonio Abate, Erice, Italy
| | - Aldo Pischedda
- Interventional Radiology Unit, A.O.U. Sassari, Sassari, Italy
| | - Lorenzo Patrone
- Vascular and Interventional Radiology Unit, London North-West University NHS Trust-London, London, UK
| | | | - Roberto Cianni
- Interventional Radiology Unit, A.O. San Camillo Forlanini, Rome, Italy
| | - Flavio Airoldi
- Interventional Cadiovascolar Unit, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| | - Pietro Landino
- Interventional Cardiology Unit, Casa di Cura Maddaloni, Maddaloni, Italy
| | - Andrès Kleiban
- Endovascular Areas, Instituto Medico Ceniclar, Rosario, Argentina
| | - Pietro Filauri
- Interventional Radiology Unit, Avezzano Hospital, Avezzano, Italy
| | | | | | | | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Marco Manzi
- Interventional Radiology Unit, Endovascular Interventions & Research, Foot & Ankle Clinic, Policlinico, Abano Terme, Italy
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Fresilli M, Oddi FM, Morosetti D, Di Girolamo A, Micali R, Ippoliti A, Gandini R. Recanalization of Chronic Femoropopliteal Total Occlusions after Failed Anterograde Attempt: Use of an Intravascular Ultrasound-Guided Re-entry Catheter versus the Bidirectional Approach. J Vasc Interv Radiol 2024; 35:377-383. [PMID: 38008377 DOI: 10.1016/j.jvir.2023.11.011] [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: 03/23/2023] [Revised: 10/21/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023] Open
Abstract
PURPOSE To analyze the feasibility and effectiveness of the use of an intravascular ultrasound (IVUS)-guided re-entry catheter (IGRC) for femoropopliteal chronic total occlusions (FP-CTOs) after a failed anterograde approach compared with the bidirectional approach without the IGRC. MATERIALS AND METHODS Between June 2019 and December 2022, an IGRC (Pioneer Plus; Philips Volcano, San Diego, California) was used in 52 patients after failure of conventional recanalization techniques (Group A). In the same period, 48 patients who were also eligible for IGRC use were treated without IGRC using the bidirectional approach (Group B). In Groups A and B, 12 (23.1%) and 3 (6.2%) patients experienced claudication, and 40 (76.9%) and 45 (93.7%) patients experienced critical limb-threatening ischemia, respectively. Clinical and procedural records, angiographic imaging findings, and follow-up data were collected, analyzed, and reviewed. RESULTS Technical success was achieved in 49 (94.2%) patients in Group A and 44 (91.7%) patients in Group B (P = .616). Use of the IGRC was associated with a reduction of procedural time (120 vs 133 minutes; P < .001), radiation exposure (47 vs 59 Gy cm2; P < .001), iodinated contrast medium use (98 vs 138 mL; P = .028), and intraprocedural discomfort (numerical rating scale score, 4 vs 6; P < .001). CONCLUSIONS Use of the IGRC was equivalently successful for FP-CTO recanalization compared with the use of the bidirectional approach, but it reduced radiation exposure, iodinated contrast medium used, patient discomfort, and procedural time. These advantages suggest that IGRC could be favored as the next-choice option for FP-CTOs after failure of anterograde recanalization.
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Affiliation(s)
- Mauro Fresilli
- Vascular Surgery Unit, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
| | - Fabio Massimo Oddi
- Vascular Surgery Unit, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Daniele Morosetti
- Diagnostic Neuroradiology Unit, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Alessia Di Girolamo
- Vascular Surgery Unit, Cardio-Toraco-Vascular Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy
| | - Rosario Micali
- Vascular Surgery Unit, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Arnaldo Ippoliti
- Vascular Surgery Unit, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Roberto Gandini
- Diagnostic Neuroradiology Unit, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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Cohen I, Raskin D, Barash Y, Silverberg D, Halak M, Khaitovich B. Performance of BeBack Crossing Catheter in Chronic Total Occlusion in Patients With Chronic Limb-Threatening Ischemia: A Single-Center Experience. J Endovasc Ther 2023:15266028231204264. [PMID: 37849280 DOI: 10.1177/15266028231204264] [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: 10/19/2023]
Abstract
PURPOSE To describe a single-center experience in the treatment of chronic limb-threatening ischemia (CLTI) with the application of BeBack catheter (Bentley InnoMed, Germany) in patients with arterial chronic total occlusion (CTO). MATERIALS AND METHODS A retrospective review of patients who underwent limb revascularizations using the BeBack catheter between 2015 and 2022. All patients had an initial failed attempt using a traditional guidewire and catheter technique. Technical success was considered whenever a successful re-entry or lesion crossing using the study device was achieved. Procedural success was defined as recanalization of the occluded artery with residual stenosis of less than 30%, and improvement in ankle-brachial index (ABI) after 24 hours. A Rutherford score was assigned to each limb and affected anatomical segments and lesion length were documented. Procedural access sites and complications were noted. RESULTS The study included 72 patients who underwent 78 procedures using the BeBack crossing catheter. Procedural success was achieved in 91% of cases, with a technical success rate of 92.3%. The most frequently involved occluded segments were the femoral and popliteal arteries. The average ABI improved from 0.59 to 0.95 after the procedure. The most used access site was the contralateral femoral, and the BeBack catheter was employed on 85 occasions. Only 1 patient suffered a severe immediate adverse effect, and during the 30-day follow-up period, 2 patients needed reintervention. Unfortunately, 3 patients died during the follow-up period. CONCLUSION The BeBack catheter offers a viable option for the treatment of patients with chronic total occlusion, with high procedural success and a low complication rate. CLINICAL IMPACT The BeBack catheter presents a notable advancement for clinicians managing chronic limb-threatening ischemia (CLTI) and arterial chronic total occlusion (CTO), showcasing over 90% procedural and technical success rates in this study. Its adept ability to navigate and recanalize occluded segments provides a robust alternative, especially when traditional techniques falter. This innovation may chane clinical strategies in vascular interventions, offering an efficient and reliable option, thereby potentially enhancing patient outcomes in limb revascularizations.
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Affiliation(s)
- Israel Cohen
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Raskin
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Silverberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Vascular Surgery, Sheba Medical Center, Tel HaShomer, Israel
| | - Moshe Halak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Vascular Surgery, Sheba Medical Center, Tel HaShomer, Israel
| | - Boris Khaitovich
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rippel K, Ruhnke H, Jehs B, Kroencke T, Scheurig-Muenkler C. Technical success and associated economic implications of conventional re-entry devices in subintimal recanalization of femoro-popliteal chronic total occlusions. Diagn Interv Radiol 2023; 29:492-499. [PMID: 36993776 PMCID: PMC10679609 DOI: 10.4274/dir.2022.221107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Re-entry devices contribute to the high success rate of subintimal recanalization of chronic total occlusions (CTO). However, to date, there are no studies comparing the available conventional re-entry devices concerning the impact of their technical success on economic aspects, as these devices differ greatly in their acquisition costs. This prospective observational study intends to contribute to this question. METHODS Prior to the start of the prospective study, all previous applications of the Outback® in femoro-popliteal CTO since its introduction to our hospital were analyzed retrospectively (n = 31). From June 2018 until January 2020, all patients with femoro-popliteal CTO treated with clear subintimal recanalization were included (n = 109). In the case of failed spontaneous re-entry, either the OffRoad® (study arm I, n = 20) or the Enteer® catheter (study arm II, n = 20) was used. If assisted re-entry failed, the Outback® device was used as a bailout. Baseline demographic and clinical data, morphologic characteristics, and technical success were documented. Additional per-patient costs due to the use of re-entry devices were analyzed. RESULTS A retrospective evaluation of all Outback® applications revealed a technical success rate of 97% (30/31). In the prospective study, 63% (68/109) were successfully treated without using re-entry devices. The overall procedural success was 95% (103/109). In study arm I, the OffRoad® achieved a success rate of 45% (9/20), with a subsequent successful application of the Outback® in 80% (8/10) of the failed cases. In study arm II, the Enteer® was successfully employed in 60% (12/20) of cases, and the Outback® was then used successfully in a further 62% (5/8) of cases. Too large a distance between the device and the target lumen was a knockout criterion for all tested devices, leading to a subgroup analysis with the exclusion of three cases, resulting in a success rate of 47% for the OffRoad® and 67% for the Enteer® device. Furthermore, in severe calcification, only the Outback® reliably enabled revascularization. Significant savings of almost €600 were only achieved in study arm II according to German prices. CONCLUSION With proper patient selection, a gradual approach with the Enteer® as the primarily used device, with the Outback® used additionally in case of failure, leads to significant savings and can be recommended. In severe calcification, the Outback® should be used as the primary device.
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Affiliation(s)
- Katharina Rippel
- Clinic of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Hannes Ruhnke
- Clinic of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Bertram Jehs
- Clinic of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas Kroencke
- Clinic of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Technical Success of the GoBack™ Crossing Catheter in Chronic Total Occlusion in Patients with Chronic Limb Threatening Ischemia. Cardiovasc Intervent Radiol 2022; 45:641-645. [PMID: 35318526 DOI: 10.1007/s00270-021-03033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/25/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To assess the technical success of GoBack™ crossing catheter in chronic total occlusion. MATERIALS AND METHODS A retrospective review of chronic limb threatening ischemia (CLTI) patients treated for chronic total occlusions (CTO) with the application of the GoBack™ crossing catheter (Upstream Peripheral Technologies, Haifa, Israel) between May 2020 and January 2021 was performed. Sixteen GoBack catheters were applied in twelve limbs in 12 patients (ten men, average age 75.7 years). Treated limbs were classified as Rutherford Category 5 and 6 in ten patients and four in two patients. Average occlusion length was 287 mm (62-466). All occluded arteries were heavily calcified. Technical success was defined as successful application of the GoBack catheter for lesion crossing or luminal reentry. RESULTS Successful application of the four French catheter was achieved in 11 of the 12 cases (92%) for reentry in external iliac (1), superficial femoral (2), popliteal (2) and posterior tibial (1) arteries in six out of six cases (100%) and lesion crossing in popliteal (4), peroneal (1) and posterior tibial arteries in five out of six cases (83%). The 2.9 Fr catheter was successfully applied once out of four (25%) in lesion crossing in the posterior tibial artery. CONCLUSION The GoBack™ 4 Fr crossing catheter in revascularization of CLI patients with CTO could be valuable when manual crossing or reentry is unsuccessful and is applicable from any access site.
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O'Reilly M, Beatty R, McBride S, Brennan B, Dockery P, Duffy GP. A method of characterising the complex anatomy of vascular occlusions and 3D printing biomimetic analogues. J Anat 2022; 242:64-75. [PMID: 35255526 PMCID: PMC9773163 DOI: 10.1111/joa.13648] [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: 11/04/2021] [Revised: 01/12/2022] [Accepted: 02/17/2022] [Indexed: 12/25/2022] Open
Abstract
Chronic total occlusions (CTOs) occur in approximately 40% of individuals with symptomatic peripheral arterial disease and are indicative of critical limb ischaemia. Currently, few medical devices can effectively treat CTOs long-term, with amputation often required. This is due to a lack of knowledge of CTO anatomy, making device design and testing difficult. This study is a proof-of-concept study, which aimed to develop a workflow for further characterising the complex multi-material anatomy of CTOs and creating 3D models of CTO components, which may be useful in producing a vascular CTO biomimetic for device testing. Here, we establish such a workflow using samples of atheromatous plaques. We focus on a high-resolution, non-destructive microcomputed tomography (μCT) technique which enables visualisation of occlusion anatomy at a greater resolution than computed tomography angiography (CTA), which is the typical modality used for CTO clinical visualisation. Four arteries (n = 2 superficial femoral; n = 2 popliteal) with evidence of atheromatous plaques were cut into 8 cm segments, which were then stained with iodine and scanned at low resolution, with calcified regions rescanned at high resolution. Resulting files were manually segmented to generate 3D models, which were then 3D printed in resin using a stereolithography printer to produce parts suitable for creating a biomimetic. In total, μCT files from three arterial segments (n = 2 high resolution, n = 1 low resolution) were deemed suitably calcified for segmentation, and thus were segmented to produce 3D models. 3D models of the arterial wall, intima and atheromatous calcium deposits from a high-resolution popliteal artery scan were successfully 3D printed at several scales. While this research is at an early stage, it holds great promise. The workflow for segmentation and 3D printing various components of an atheromatous plaque established here is replicable and uses software and equipment which are accessible to research laboratories in both academia and industry. The ability to print detailed models on a desktop 3D printer is unprecedented and can be improved further, which is promising for future development of biomimetics with multi-material detail of both soft tissue and calcified components of a vascular occlusion. Indeed, this workflow provides a solid foundation for future studies of CTO anatomy and the creation of true, multi-material CTO biomimetics. Such biomimetics may enable the development of improved interventional devices, as they would mimic the general in vivo CTO environment. As this method cannot be applied in vivo, we cannot yet produce patient-specific biomimetics, however, these analogues would still be important in device development, which would improve patient outcomes in critical limb ischaemia.
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Affiliation(s)
- Muireann O'Reilly
- Discipline of Anatomy and Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland,CÚRAM, SFI Research Centre for Medical DevicesNational University of Ireland GalwayGalwayIreland
| | - Rachel Beatty
- Discipline of Anatomy and Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland,SFI Research Centre for Advanced Materials and Bioengineering Research (AMBER)Trinity College Dublin & National University of Ireland GalwayGalwayIreland
| | - Shauna McBride
- Discipline of Anatomy and Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland
| | - Benjamin Brennan
- Discipline of Anatomy and Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland,CÚRAM, SFI Research Centre for Medical DevicesNational University of Ireland GalwayGalwayIreland
| | - Peter Dockery
- Discipline of Anatomy and Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland
| | - Garry P. Duffy
- Discipline of Anatomy and Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland,CÚRAM, SFI Research Centre for Medical DevicesNational University of Ireland GalwayGalwayIreland,SFI Research Centre for Advanced Materials and Bioengineering Research (AMBER)Trinity College Dublin & National University of Ireland GalwayGalwayIreland
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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.
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Tsitsiou Y, Ekpe J, Harris L, Kashef E, Hamady M. Use and effectiveness of Pioneer re-entry device for subintimal true lumen re-entry: single-centre data and a review of the literature. CVIR Endovasc 2021; 4:81. [PMID: 34854997 PMCID: PMC8637523 DOI: 10.1186/s42155-021-00268-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION During subintimal angioplasty (SIA), it is not always possible to re-enter the vessel lumen due to a variety of factors. Recanalization using hydrophilic wires and catheters alone, apart from its potential technical failure, is also limited by minimal control over the re-entry point. This is frequently well beyond the point of occlusion, thus often compromising important collaterals. In order to bypass the obstruction and attain controlled re-entry into the lumen of the diseased vessel, a re-entry device (RED) may be required. This paper assesses our centre's experience with the safety and efficacy of the Pioneer re-entry system and systematically reviews the pertinent literature. METHOD A single centre retrospective study of subintimal angioplasty involving the use of the Pioneer Plus intravascular guided reentry catheter was performed. Patient demographics including age, gender, risk factors, comorbidities clinical indication and complications were recorded. Lesion characteristics, including location and severity of calcification were also assessed. A systematic literature review of all reported studies where the Pioneer RED was used for iliac and lower limb revascularization was conducted by 2 of the authors using the PubMed (MEDLINE) and EMBASE databases. RESULTS The study comprised 30 cases. Technical success was 97%. A small, quickly resolved extravasation was the only device related complication. These results are in line with the systematic review which identified 16 studies using the Pioneer RED, reporting a technical success rate of 87.4-100% (median = 100%) and complication rate of 0-25.8% (median = 0%). However, due to heterogeneity in definitions of technical success, data was not pooled.
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Affiliation(s)
- Yvonne Tsitsiou
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jadesola Ekpe
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Laura Harris
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elika Kashef
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mohamad Hamady
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
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Fusion imaging guidance for endovascular recanalization of peripheral occlusive disease. J Vasc Surg 2021; 75:610-617. [PMID: 34492289 DOI: 10.1016/j.jvs.2021.07.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/29/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Endovascular procedures are now the first line option for treatment of lower extremity arterial disease. Fusion imaging guidance has been reported to reduce radiation exposure and reintervention rates during fenestrated and branched endovascular repairs, but limited literature exists on its benefits during lower extremity arterial disease endovascular procedures, and more specifically peripheral occlusive disease (POD). This study aims to evaluate the radiation exposure and technical success benefits of fusion imaging guidance in a large cohort of patients treated endovascularly for complex POD. METHODS From January 2017 to September 2019, in a single center, all consecutive patients presenting symptomatic occlusions (Rutherford Baker categories 3 to 6) in the setting of POD and treated endovascularly were retrospectively assessed for inclusion. All procedures were performed under augmented fluoroscopy guidance (Vessel ASSIST, GE Healthcare), overlaying on live imaging the 3D path for transluminal recanalization based on the preoperative computed tomography angiography. Technical success, dose area product (DAP), total cumulated air kerma (CAK), and fluoroscopy time were collected. DAP results were compared with the literature. RESULTS During the study period, 179 patients were treated for iliac (n = 56) or femoropopliteal (n = 123) symptomatic arterial occlusions. Technical success was reported in 171 of 179 procedures (95.5%). The use of a re-entry catheter was required to achieve technical success in 11 patients (6.1%). Mean DAP and CAK were 15.44 Gy·cm2 and 135 mGy, respectively, with a mean fluoroscopy time of 15.04 minutes. DAP and CAK were significantly higher in the iliac group when compared with the femoropopliteal group, although fluoroscopy time was not significantly different. DAP was lower than levels reported in the literature. CONCLUSIONS Routine use of fusion imaging guidance during POD endovascular treatment is associated with low radiation exposure, high technical success, and reduced need for re-entry systems.
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Kim M, Cho SB. [Interventional Treatments for Femoropopliteal Arterial Disease and Recent Updates]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:527-540. [PMID: 36238772 PMCID: PMC9432457 DOI: 10.3348/jksr.2021.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Peripheral arterial occlusive disease (PAOD) of the femoropopliteal artery is commonly caused by atherosclerosis. It can present with varying clinical symptoms depending on the degree of disease, ranging from intermittent claudication to critical limb ischemia and tissue loss. Therefore, appropriate and timely treatment is required to improve symptoms and salvage the affected limbs. Interventional approaches for femoropopliteal arterial disease commonly include percutaneous transluminal angioplasty, atherectomy, and stent placement. Over the years, endovascular recanalization has been widely performed for treating PAOD due to continuous developments in its techniques and availability of dedicated devices with the inherent advantage of being minimal invasive. In this review, we introduce various types of endovascular treatment methods, discuss the results of clinical research from existing literature, and illustrate the treatment procedures using representative images.
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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.
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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.
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Kokkinidis DG, Armstrong EJ. Current developments in endovascular therapy of peripheral vascular disease. J Thorac Dis 2020; 12:1681-1694. [PMID: 32395311 PMCID: PMC7212127 DOI: 10.21037/jtd.2019.12.130] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
More than 200 million people worldwide have peripheral artery disease (PAD) or its most severe manifestation, critical limb ischemia (CLI). While endovascular treatment has become first line therapy in most cases, a number of challenges remain for optimal treatment of femoropopliteal (FP) or infrapopliteal (IP) disease, especially when these lesions are severely calcified, chronic total occlusions (CTOs) or in-stent restenosis (ISR). Continued evolution of technologies has significantly improved the outcomes for endovascular treatment. A number of new devices are in the pipeline right now, including new paclitaxel eluting stents and balloons, intravascular lithotripsy to treat severely calcified lesions, adventitial delivery of anti-restenotic agents to limit restenosis rates, and percutaneous femoro-popliteal bypass.
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Affiliation(s)
- Damianos G Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Aurora, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Aurora, CO, USA
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Tamburrini L, Weisser G, Espinola-Klein C. Reentry devices for chronic arterial occlusions. VASA 2019; 48:451-452. [DOI: 10.1024/0301-1526/a000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Luca Tamburrini
- Center of Cardiology – Cardiology I, Section of Angiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Gerhard Weisser
- Center of Cardiology – Cardiology I, Section of Angiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Christine Espinola-Klein
- Center of Cardiology – Cardiology I, Section of Angiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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