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Brodmann M, Wissgott C, Brechtel K, Lichtenberg M, Blessing E, Tarra T, Zeller T. Optimized drug-coated balloon angioplasty of the superficial femoral and proximal popliteal arteries using the Tack Endovascular System: Tack Optimized Balloon Angioplasty (TOBA) III 24-month results in standard and long lesions. Catheter Cardiovasc Interv 2023; 102:701-712. [PMID: 37560824 DOI: 10.1002/ccd.30800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/07/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The Tack Endovascular System is a minimal-metal dissection repair device that is purpose-built to treat post-percutaneous angioplasty (PTA) arterial dissections in patients with peripheral arterial disease (PAD). The Tack Optimized Balloon Angioplasty (TOBA) III trial evaluated the safety and effectiveness of the Tack Endovascular System in patients with superficial femoral artery (SFA) and/or proximal popliteal artery (PPA) dissection after PTA with a drug-coated balloon (DCB). The objective of this study is to report the results in the standard- (SL) and long-lesion (LL) cohorts through 24 months. DESIGN The TOBA III study was a prospective, multicenter, single-arm study including patients suffering from Rutherford category 2-4 PAD. Outcomes were assessed according to pre-specified lesion length in SL ( ≥ 20 mm and ≤150 mm) and LL ( > 150 mm and ≤250 mm) cohorts. Follow-up was through 24 months. RESULTS TOBA III enrolled 201 patients, 169 patients in the SL cohort and 32 in the LL cohort. At 24 months, the Kaplan-Meier estimates of freedom from major adverse events were 91.7% and 82.6% for the SL cohort and LL cohort, respectively. Kaplan-Meier estimates of freedom from clinically driven-target lesion revascularization (CD-TLR) were 92.3% in the SL cohort and 82.6% in the LL cohort. At 24 months, 78.8% of SL patients and 69.2% of LL patients experienced an improvement of >2 Rutherford categories (both cohorts p < 0.001). The baseline ankle-brachial index improved from 0.68 ± 0.18 to 0.93 ± 0.16 in the SL (p < 0.001) and from 0.62 ± 0.23 to 0.87 ± 0.15 in the LL cohort (p < 0.001) at 24 months. CONCLUSION The 24-month results of the TOBA III trial support the safety and effectiveness of the Tack Endovascular System in patients who required post-PTA dissection repair in the SFA and PPA following DCB angioplasty for claudication and rest pain. In both the SL and LL cohorts, Tack placement was associated with sustained freedom from CD-TLR through 24 months as well as sustained improvements in Rutherford categories, ankle-brachial index, and quality of life.
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Affiliation(s)
| | | | - Klaus Brechtel
- Interventional Radiology, Franziskus-Hospital Berlin, Berlin, Germany
| | | | - Erwin Blessing
- SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Trisha Tarra
- Philips North America, LLC, Cambridge, Massachusetts, USA
| | - Thomas Zeller
- Universitaets-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
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Kaki A, Alraies MC, Kajy M, Blank N, Glazier JJ, Mohamad T, Elder M, Schreiber T. Large bore occlusive sheath management. Catheter Cardiovasc Interv 2019; 93:678-684. [DOI: 10.1002/ccd.28101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/03/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Amir Kaki
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
| | - M. Chadi Alraies
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
| | - Marvin Kajy
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
| | - Nimrod Blank
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
| | - James J. Glazier
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
| | - Tamam Mohamad
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
| | - Mahir Elder
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
| | - Theodore Schreiber
- Wayne State University School of MedicineDetroit Medical Center Detroit Michigan
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Nishibe T, Yamamoto K, Seike Y, Ogino H, Nishibe M, Koizumi J, Dardik A. Endovascular Therapy for Femoropopliteal Artery Disease and Association of Risk Factors With Primary Patency. Vasc Endovascular Surg 2015; 49:236-41. [DOI: 10.1177/1538574415614406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The treatment of femoropopliteal artery disease remains controversial, without clear guidelines specifying the indications for endovascular therapy (EVT). Accordingly, we retrospectively examined our experience of using EVT to treat femoropopliteal artery disease. A total of 91 limbs in 82 patients underwent EVT for the treatment of femoropopliteal artery disease. Percutaneous transluminal angioplasty alone was performed in 20 limbs, and additional stenting was performed in 71 limbs. The 1-year primary patency, primary-assisted patency, limb salvage, and survival rates were 76%, 88%, 96%, and 92%, respectively. Multivariate Cox analysis of primary patency showed that critical limb ischemia (CLI; hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.08-5.33; P < .01) and TASC II C/D disease (HR, 2.70; 95% CI, 1.14-6.39; P < .05) were independent predictors of decreased primary patency. In conclusion, patients with CLI or extensive lesions have reduced patency after EVT for femoropopliteal artery disease.
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Affiliation(s)
- Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyohito Yamamoto
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Jun Koizumi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Alan Dardik
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, CT, USA
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Nishibe T, Maruno K, Iwahori A, Fujiyoshi T, Suzuki S, Takahashi S, Ogino H, Nishibe M. The Role of Common Femoral Artery Endarterectomy in the Endovascular Era. Ann Vasc Surg 2015; 29:1501-7. [DOI: 10.1016/j.avsg.2015.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 11/28/2022]
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Smolock CJ, El-Sayed HF, Davies MG. Outcomes of Femoropopliteal Interventions for Critical Ischemia in the Hemodialysis-Dependent Patient. Ann Vasc Surg 2015; 29:237-43. [DOI: 10.1016/j.avsg.2014.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/20/2014] [Accepted: 07/26/2014] [Indexed: 11/28/2022]
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Erwin PA, Shishehbor MH. Contemporary Management of Femoral Popliteal Revascularization. Interv Cardiol Clin 2014; 3:517-530. [PMID: 28582077 DOI: 10.1016/j.iccl.2014.06.004] [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: 06/07/2023]
Abstract
Symptomatic peripheral artery disease of the femoral popliteal segment can be treated by surgical and endovascular revascularization, but controversy exists about the best approach. Conventional approaches to revascularization have focused on lesion anatomy to decide on bypass versus endovascular treatment, but advances in endovascular therapy make an endovascular-first approach increasingly feasible-either as a single approach or as an adjunct to short-segment bypass (ie, hybrid procedure). In this review, we discuss the medical, endovascular, and surgical treatment of femoral popliteal revascularization with a special emphasis on advances in percutaneous therapy.
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Affiliation(s)
- Phillip A Erwin
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Smolock CJ, Anaya-Ayala JE, Kaufman Y, Bavare CS, Patel MS, El-Sayed HF, Lumsden AB, Davies MG. Current efficacy of open and endovascular interventions for advanced superficial femoral artery occlusive disease. J Vasc Surg 2013; 58:1267-75.e1-2. [DOI: 10.1016/j.jvs.2013.02.252] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/17/2022]
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Smolock CJ, Anaya-Ayala JE, El-Sayed HF, Naoum JJ, Lumsden AB, Davies MG. Clinical efficacy of concomitant tibial interventions associated with superficial femoral artery interventions in critical limb ischemia. J Vasc Surg 2013; 57:19-27. [DOI: 10.1016/j.jvs.2012.06.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/14/2012] [Accepted: 06/16/2012] [Indexed: 01/01/2023]
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Impact of metabolic syndrome on the outcomes of superficial femoral artery interventions. J Vasc Surg 2012; 55:985-993.e1; discussion 993. [DOI: 10.1016/j.jvs.2011.10.109] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 10/21/2011] [Accepted: 10/22/2011] [Indexed: 01/08/2023]
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Morris-Stiff G, Moawad M, Appleton N, Davies G, Hicks E, Davies C, Lewis MH. Long-term clinical outcome following lower limb arterial angioplasty. Ann R Coll Surg Engl 2011; 93:250-4. [PMID: 21477442 DOI: 10.1308/147870811x566394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the clinical outcome of lower limb arterial angioplasty in a busy district general hospital practice. PATIENTS AND METHODS All angioplasties performed from January 1999 to December 2004 were identified and data collected included cardiovascular risk factors, indications for and complications of angioplasty, limb salvage and patient survival rates, and clinically significant re-stenoses. RESULTS 471 interventions were performed in 385 patients (231 men, 154 women). The median age was 67.9 years (range: 39-93 years). Indications for angioplasty were critical ischaemia (n=247, 52%) and lifestyle-limiting intermittent claudication (n=224, 48%). Stenotic lesions accounted for 378 (80%) cases and occlusion for 93 (20%). Radiological success was obtained in 417 (88.5%), improving to 93.6% if only those in whom access was achieved were included. Post-angioplasty complications were observed in 42/471 (9.1%) of interventions. The actual patient survival at 1, 2, and 3 years was 87.4%, 85.1% and 83.2% respectively. Indication for angioplasty and the number of lesions present were identified as risk factors for outcome on multivariate analysis. The cumulative post-angioplasty patency rates at 1, 2 and 3 years were 86.0%, 83.1% and 81.6% respectively. The only factor associated with patency was the mode of presentation. CONCLUSIONS Angioplasty for lower limb peripheral vascular disease can be performed safely and efficaciously with a high technical success rate and a low complication rate. The patient survival and post-angioplasty patency data reflect the progressive and multi-site nature of the underlying disease process.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK
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Hu H, Zhang H, He Y, Jin W, Tian L, Chen X, Li M. Endovascular nitinol stenting for long occlusive disease of the superficial femoral artery in critical limb ischemia: a single-center, mid-term result. Ann Vasc Surg 2011; 25:210-6. [PMID: 21315233 DOI: 10.1016/j.avsg.2010.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 08/04/2010] [Accepted: 09/26/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of the present study was to assess the mid-term patency rate of nitinol stent implantation in patients with long superficial femoral artery (SFA) stenosis or occlusion. This is a retrospective, single-center study. METHODS The data of 138 patients were retrospectively assessed in our center to determine the patency rate after nitinol stenting of the SFA. MATERIALS Data for 165 limbs from 138 patients were collected. Each limb showed a long lesion with a total occlusion of >10 cm and mean lesion length of 20.35 ± 9.46 cm (range, 10-32 cm). Nitinol self-expanding stent implantations were performed in each limb. A total of 258 stents were implanted into 165 limbs (average, 1.56 stents/limb). Each patient received clinical and ultrasound/computerized tomographic angiography/magnetic resonance angiography evaluations before the procedure and underwent clinical status evaluation and an ankle-brachial index test at discharge and at 12, 24, and 36 months thereafter. RESULTS The initial technical success rate of revascularization was 91.51% (151/163). During follow-up, nine patients died because of myocardial infarction, cerebral infarction, and pneumonia, and 14 patients were lost to follow-up. The mean follow-up period for 150 limbs from 124 patients was 25.46 months (range, 6-51). During follow-up, 19 in-stent restenoses and 15 occlusions were diagnosed. In all, 30 re-interventions were performed, including six balloon angioplasties, three secondary cutting balloon angioplasties, 10 restenting procedures, four bypass surgeries, two bone marrow stem cell transplantations, and five limb amputations. Analysis showed the primary patency rates at 12, 24, and 36 months were 92.4%, 78.3%, and 62.1%, respectively, and the overall assisted-primary patency rates were 94.4%, 84.6%, and 75.8%, respectively. CONCLUSIONS Nitinol self-expanding stent implantation seems to be a good choice for older patients with long SFA occlusions. Although the short- and mid-term patency results were good, more observations are needed to assess its long-term efficiency.
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Affiliation(s)
- Hang Hu
- Department of Vascular Surgery, Zhejiang University, Hangzhou, People's Republic of China
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Davies MG, Bismuth J, Saad WE, Naoum JJ, Peden EK, Lumsden AB. Outcomes of interventions for recurrent disease after endoluminal intervention for superficial femoral artery disease. J Vasc Surg 2010; 52:331-9.e1-2. [DOI: 10.1016/j.jvs.2010.02.278] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 02/24/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
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Davies MG, Bismuth J, Saad WE, Naoum JJ, Mohiuddin IT, Peden EK, Lumsden AB. Implications of In Situ Thrombosis and Distal Embolization during Superficial Femoral Artery Endoluminal Intervention. Ann Vasc Surg 2010; 24:14-22. [DOI: 10.1016/j.avsg.2009.06.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 05/26/2009] [Accepted: 06/23/2009] [Indexed: 12/01/2022]
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Lumsden AB, Davies MG, Peden EK. Medical and endovascular management of critical limb ischemia. J Endovasc Ther 2009; 16:II31-62. [PMID: 19624074 DOI: 10.1583/08-2657.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Critical limb ischemia (CLI) is the term used to designate the condition in which peripheral artery disease has resulted in resting leg or foot pain or in a breakdown of the skin of the leg or foot, causing ulcers or tissue loss. If not revascularized, CLI patients are at risk for limb loss and for potentially fatal complications from the progression of gangrene and the development of sepsis. The management of CLI requires a multidisciplinary team of experts in different areas of vascular disease, from atherosclerotic risk factor management to imaging, from intervention to wound care and physical therapy. In the past decade, the most significant change in the treatment of CLI has been the increasing tendency to shift from bypass surgery to less invasive endovascular procedures as first-choice revascularization techniques, with bypass surgery then reserved as backup if appropriate. The goals of intervention for CLI include the restoration of pulsatile, inline flow to the foot to assist wound healing, the relief of rest pain, the avoidance of major amputation, preservation of mobility, and improvement of patient function and quality of life. The evaluating physician should be fully aware of all revascularization options in order to select the most appropriate intervention or combination of interventions, while taking into consideration the goals of therapy, risk-benefit ratios, patient comorbidities, and life expectancy. We discuss the incidence, risk factors, and prognosis of CLI and the clinical presentation, diagnosis, available imaging modalities, and medical management (including pain and ulcer care, pharmaceutical options, and molecular therapies targeting angiogenesis). The endovascular approaches that we review include percutaneous transluminal angioplasty (with or without adjunctive stenting); subintimal angioplasty; primary femoropopliteal and infrapopliteal deployment of bare nitinol, covered, drug-eluting, or bioabsorbable stents; cryoplasty; excimer laser-assisted angioplasty; excisional atherectomy; and cutting balloon angioplasty.
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Affiliation(s)
- Alan B Lumsden
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, 6550 Fannin Street, Suite 1401, Houston, TX 77030, USA.
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Davies MG, Saad WE, Peden EK, Mohiuddin IT, Naoum JJ, Lumsden AB. Percutaneous Superficial Femoral Artery Interventions for Claudication—Does Runoff Matter? Ann Vasc Surg 2008; 22:790-8. [DOI: 10.1016/j.avsg.2008.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 04/02/2008] [Accepted: 04/08/2008] [Indexed: 10/21/2022]
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Davies MG, Saad WE, Peden EK, Mohiuddin IT, Naoum JJ, Lumsden AB. Impact of runoff on superficial femoral artery endoluminal interventions for rest pain and tissue loss. J Vasc Surg 2008; 48:619-25; discussion 625-6. [DOI: 10.1016/j.jvs.2008.04.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 03/25/2008] [Accepted: 04/08/2008] [Indexed: 11/17/2022]
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Chung SW, Sharafuddin MJ, Chigurupati R, Hoballah JJ. Midterm Patency following Atherectomy for Infrainguinal Occlusive Disease: A Word of Caution. Ann Vasc Surg 2008; 22:358-65. [PMID: 18411033 DOI: 10.1016/j.avsg.2007.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 11/28/2007] [Accepted: 12/04/2007] [Indexed: 10/21/2022]
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Cryoballoon Angioplasty Broadens the Role of Primary Angioplasty and Reduces Adjuvant Stenting in Complex Superficial Femoral Artery Lesions. J Am Coll Surg 2008; 206:524-32. [DOI: 10.1016/j.jamcollsurg.2007.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 08/21/2007] [Accepted: 09/10/2007] [Indexed: 11/18/2022]
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Ferreira M, Lanziotti L, Monteiro M, Abuhadba G, Capotorto L, Nolte L, Fearnot N. Superficial Femoral Artery Recanalization with Self-expanding Nitinol Stents: Long-term Follow-up Results. Eur J Vasc Endovasc Surg 2007; 34:702-8. [DOI: 10.1016/j.ejvs.2007.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
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Bakken AM, Palchik E, Hart JP, Rhodes JM, Saad WE, Davies MG. Impact of diabetes mellitus on outcomes of superficial femoral artery endoluminal interventions. J Vasc Surg 2007; 46:946-958; discussion 958. [DOI: 10.1016/j.jvs.2007.06.047] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 06/25/2007] [Indexed: 11/26/2022]
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Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg 2007; 45:776-83. [PMID: 17398386 DOI: 10.1016/j.jvs.2006.12.046] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 12/12/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Central (superior vena cava, brachiocephalic, or subclavian) venous stenoses are a major impediment to long-term arteriovenous access in the upper extremities. The optimal management of these stenoses is still undecided. The purpose of this study was to determine the outcomes of primary angioplasty (PTA) vs primary stenting (PTS) in a dialysis access population at a tertiary referral academic medical center. METHODS A database of consecutive hemodialysis patients undergoing endovascular treatment for central venous stenosis was developed for the period 1995 through 2003. This database was retrospectively reviewed. Vessels exposed to either primary high-pressure balloon angioplasty or primary stenting were examined. Vessels undergoing stenting after failed or suboptimal angioplasty were defined as failures at the time of stenting despite the potential continued patency upon completion of stenting. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Cox proportional hazards analysis was performed for time-dependent variables. Data are presented as mean +/- standard deviation where appropriate. RESULTS PTS was used to treat 26 patients (35% male; average age, 57 +/- 15 years) with 26 central venous stenoses, and 47 patients (45% male; average age, 57 +/- 18 years) with 49 central venous stenoses were treated with PTA. The PTS group underwent 71 percutaneous interventions per stenosis (average, 2.7 +/- 2.4 interventions), and the PTA group underwent 98 interventions per stenosis (average, 2.0 +/- 1.6 interventions). The PTS group hemodialysis access site was an average of 1.0 +/- 1.3 years old at the time of the initial intervention, and the hemodialysis access in the PTA group was an average of 1.1 +/- 1.2 years old. Primary patency was equivalent between groups by Kaplan-Meier analysis, with 30-day rates of 76% for both groups and 12-month rates of 29% for PTA and 21% for PTS (P = .48). Assisted primary patency was also equivalent (P = .08), with a 30-day patency rate of 81% and 12-month rate of 73% for the PTA group, vs PTS assisted patency rates of 84% at 30 days, and 46% at 12 months. Ipsilateral hemodialysis access survival was equivalent between groups. CONCLUSIONS Endovascular therapy with PTA or PTS for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule with both treatments. Although neither offers truly durable outcomes, PTS does not improve on the patency rates more than PTA and does not add to the longevity of ipsilateral hemodialysis access sites.
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Affiliation(s)
- Andrew M Bakken
- Center for Vascular Disease, Department of Surgery, University of Rochester, Rochester, NY 14642, USA
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Mannava K, Money SR. Current management of peripheral arterial occlusive disease: a review of pharmacologic agents and other interventions. Am J Cardiovasc Drugs 2007; 7:59-66. [PMID: 17355166 DOI: 10.2165/00129784-200707010-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Peripheral arterial occlusive disease (PAOD) of the lower extremities is becoming more prevalent worldwide. Nonsurgical treatment options provide the foundation for management. Lifestyle and risk factor modification should be emphasized in this patient population because of the associated adverse cardiovascular events. This includes implementation of a regular walking and smoking-cessation programs, aggressive control of hyperlipidemia, hypertension and diabetes mellitus, and treatment of hyperhomocysteinemia. Antiplatelet agents such as aspirin (acetylsalicylic acid) or clopidogrel are not specifically indicated for claudication but these drugs should be used in all patients with PAOD to prevent secondary ischemic events. Currently, cilostazol is the only US FDA approved agent that appears effective for the treatment of claudication symptoms. Several agents have been used with success outside of the US and others are still undergoing testing. Definitive recommendations cannot be made on the use of these drugs until further evaluation is completed. Ongoing research with new strategies for angiogenesis and the use of progenitor cells has yielded encouraging results, particularly for patients with critical limb ischemia and limited options. Advances in endovascular technology over the last several years have greatly enhanced the ability to diagnose and treat specific anatomic lesions that previously would have required open surgical correction. The use of percutaneous transluminal angioplasty and stents in the lower extremities has had considerable success when following specific guidelines such as those set forth by the TransAtlantic Inter-Society Consensus Working Group.
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Affiliation(s)
- Krishna Mannava
- Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
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Ferreira M, Capotorto LF, Abuhadba G, Monteiro M, Lanziotti L. Recanalização da artéria femoral superficial com stents Zilver: técnica padronizada e análise retrospectiva de 3 anos. J Vasc Bras 2006. [DOI: 10.1590/s1677-54492006000400005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: Descrever a técnica de recanalização endovascular da artéria femoral superficial e fazer uma análise retrospectiva dos 3 primeiros anos da técnica. MÉTODOS: Análise retrospectiva dos pacientes tratados entre 2001 e 2004, visando obter as taxas de perviedade das recanalizações. A amostra considerada neste estudo consta de 79 artérias femorais superficiais recanalizadas em 61 pacientes, nos quais foram utilizados exclusivamente a técnica descrita e o mesmo modelo de stent de nitinol auto-expansível (Zilver, COOK). RESULTADOS: Dos 61 pacientes, 8% possuíam isquemia crítica de membro inferior e 92% apresentavam claudicação incapacitante refratária ao tratamento clínico. A melhora clínica foi observada e referida pelos pacientes numa relação direta à perviedade das recanalizações. A análise estatística demonstrou taxas acumuladas de perviedade primária assistida de 98, 91 e 84% em 12, 24 e 37 meses, respectivamente. As taxas de perviedade, entendida como fluxo continuado nas recanalizações, foram de 96, 93 e 93% em 12, 24 e 37 meses, respectivamente. CONCLUSÕES: Consideramos a técnica da recanalização da artéria femoral superficial um método ao mesmo tempo pouco invasivo, com reduzidas complicações e de consideráveis taxas de sucesso anatômico e perviedade, que, em conjunto, são capazes de proporcionar satisfação e qualidade de vida aos pacientes portadores de doença arterial obstrutiva periférica.
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