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Korosoglou G, Feld J, Langhoff R, Lichtenberg M, Stausberg J, Hoffmann U, Rammos C, Malyar N. Safety and Effectiveness of Debulking for the Treatment of Infrainguinal Peripheral Artery Disease. Data From the Recording Courses of vascular Diseases Registry in 2910 Patients. Angiology 2024:33197241263381. [PMID: 38904281 DOI: 10.1177/00033197241263381] [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: 06/22/2024]
Abstract
We investigated the safety and efficacy of debulking infrainguinal lesions in patients with peripheral artery disease (PAD) undergoing endovascular revascularization (EVR) as part of the RECording Courses of vascular Diseases (RECCORD) registry. Patient and lesion specific characteristics, including the lesion complexity score (LCS) were analyzed. The primary endpoint encompassed: (i) clinical improvement in Rutherford categories, (ii) index limb re-interventions, and (iii) major amputations during follow-up. The secondary endpoint included the need for bail-out stenting. Overall, 2910 patients were analyzed; 2552 without and 358 with debulking-assisted EVR. Patients were 72 (interquartile range (IQR) = 15) years old and 1027 (35.3%) had diabetes. Overall complication rates were similarly low in the debulking vs the non-debulking group (4.7 vs 3.2%, P = .18). However, peripheral embolizations rates were low but more frequent with debulking vs. non-debulking procedures (3.9 vs 1.1%, P < .001). After adjustment for clinical and lesion-specific parameters, including LCS, no differences were noted for the primary endpoint (odds ration (OR) = 0.99, 95%CI = 0.69-1.41, P = .94). Bail-out stenting was less frequently performed in patients with debulking-assisted EVR (OR = 0.5, 95%CI = 0.38-0.65, P < .0001). Debulking-assisted EVR is currently used in ∼12% of EVR with infrainguinal lesions and is associated with lower bail-out stent rates but higher peripheral embolization rates; no differences were found regarding index limb re-intervention and amputation rates.
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Affiliation(s)
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Ralf Langhoff
- Department of Angiology, Sankt-Gertrauden-Krankenhaus, Berlin, Germany
| | | | | | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital Munich, Munich, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Duisburg, Germany
| | - Nasser Malyar
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiology, Münster, Germany
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Patrone L, Falcone G, Coscas R, Lichaa H, Antaredja M, Fanelli F, Blessing E. Retrograde Peroneal Artery Approach to Treat Infra-Inguinal Arterial Chronic Total Occlusions: A Multicentre Experience and Technical Considerations. J Clin Med 2024; 13:2770. [PMID: 38792312 PMCID: PMC11121828 DOI: 10.3390/jcm13102770] [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: 03/25/2024] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Retrograde access of the peroneal artery (PA) is considered technically challenging and at risk of bleeding. The aim of this multicentre retrospective study was to assess the safety, feasibility, and technical success of this access route for infrainguinal endovascular recanalizations. Methods: We retrospectively analyzed 186 consecutive patients treated over a 7-year period (May 2014-August 2021) who underwent endovascular recanalization of infra-inguinal lesions using a PA access route. In all cases, retrograde PA access was obtained following a failed attempt to cross the occlusion via the antegrade route. Results: Among the 186 patients, 120 were males (60.5%) and the mean age was 76.8 ± 10.7 years old (44-94 years). One hundred and thirteen patients (60.7%) suffered from chronic limb threatening ischemia (CLTI). All patients presented with chronic total occlusions (CTO) and a failed conventional antegrade recanalization attempt. Retrograde access was performed under angiographic guidance in 185 cases (99.5%). It was successfully established in 171 cases (91.9%). The total rate of retrograde puncture-related complications was 2.1% (two puncture site bleedings of which one necessitated fasciotomy and two cases of arteriovenous fistulas managed conservatively). The Major Adverse Event (MAE) rate at 30 days was 1.6% (3/186). Conclusions: Retrograde recanalization of challenging infra-inguinal lesions via PA is safe and effective in experienced hands.
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Affiliation(s)
- Lorenzo Patrone
- West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow HA1 3UJ, UK;
| | - Gianmarco Falcone
- Interventional Radiology Department, Ospedale Careggi, 50134 Firenze, Italy; (G.F.); (F.F.)
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France;
| | - Hady Lichaa
- Tennessee Health Science Center, Ascension Saint Thomas Heart, Nashville, TN 37203, USA;
| | - Muliadi Antaredja
- Department of Angiology, Clinic for Vascular Medicine, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Fabrizio Fanelli
- Interventional Radiology Department, Ospedale Careggi, 50134 Firenze, Italy; (G.F.); (F.F.)
| | - Erwin Blessing
- Department of Angiology, Clinic for Vascular Medicine, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
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Trenkler C, Blessing E, Jehn A, Karcher J, Schoefthaler C, Schmidt A, Korosoglou G. Retrospective Case Control Matched Comparison of the Antegrade Versus Retrograde Strategy After Antegrade Recanalisation Failure in Complex de novo Femoropopliteal Occlusive Lesions. Eur J Vasc Endovasc Surg 2024; 67:799-808. [PMID: 38182107 DOI: 10.1016/j.ejvs.2023.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/04/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To investigate dissection severity, need for bailout stenting and limb outcomes in patients undergoing antegrade vs. retrograde revascularisation. METHODS Consecutive patients who underwent either antegrade or retrograde revascularisation after failed antegrade recanalisation of long femoropopliteal chronic total occlusion (CTO) due to symptomatic peripheral artery disease between January 2017 and June 2022 were studied. Retrospective case control matching was used to adjust for lesion length and calcification using the peripheral artery calcification scoring system (PACSS). Procedural outcomes included severity of dissection (Type A to F dissections, numerically graded on a scale from 0 - 6 with increasing severity) after angioplasty and number and location of stents needed to be implanted during the index procedure. Additionally, clinically driven target lesion revascularisation (CD-TLR) and major (above ankle) amputation rates were assessed during follow up. RESULTS A total of 180 patients were analysed who underwent antegrade (n = 90) or retrograde after failed antegrade (n = 90) recanalisation. The median patient age was 76.0 (interquartile range [IQR] 67.0, 82.0) years and 76 (42.2%) were female. Moreover, 78 patients (43.3%) had intermittent claudication, whereas 102 (56.7%) had chronic limb threatening ischaemia (CLTI). The mean lesion length was 30.0 (IQR 24.0, 36.0) cm with moderate to severe (3.0 [IQR 2.0, 4.0]) lesion calcification. Dissection severity after angioplasty was higher in the antegrade than retrograde after failed antegrade recanalisation group (4.0 [IQR 3.0, 4.0] vs. 3.0 [IQR 2.0, 4.0]; p < .001). Additionally, the number of stents in all segments and the rate of bailout stenting in popliteal segments was significantly higher with the antegrade strategy (2.0 [IQR 1.0, 3.0] vs. 1.0 [IQR 0, 2.0], p < .010; and 37% vs. 14%, p < .001). During a median follow up of 1.48 (IQR 0.63, 3.09) years, CD-TLR rates (p = .90) and amputation rates in patients with CLTI (p = .15) were not statistically significant. CONCLUSION In complex femoropopliteal CTOs, retrograde after failed antegrade recanalisation, is safe for endovascular revascularisation, which in experienced hands may result in less severe dissections and lower rates of stent placement. However, considering the relatively short follow up, CD-TLR and amputation rates were not statistically different between the two approaches. [German Clinical Trials Register: DRKS00015277.].
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Affiliation(s)
- Christian Trenkler
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Erwin Blessing
- Department of Angiology, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Amila Jehn
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Jan Karcher
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Christoph Schoefthaler
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Andrej Schmidt
- Department of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany.
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Siu HK, Schultz E, LeBrun S, Liou M, Kwan TW. Safety of Retrograde Tibial-Pedal Access and Intervention in Patients with Single Remaining Non-Occluded Infra-Popliteal Runoff Artery. J Cardiovasc Dev Dis 2023; 10:463. [PMID: 37998521 PMCID: PMC10672062 DOI: 10.3390/jcdd10110463] [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: 09/28/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The adaptation of retrograde tibial-pedal access for peripheral angiogram and intervention is limited by the lack of operator experience and concern for small distal vessel injury. This study evaluates the safety of the retrograde tibial-pedal access for peripheral angiogram and intervention in patients with two vessel infra-popliteal artery chronic total occlusions, where the access point is the sole remaining non-occluded infra-popliteal artery. METHODS A retrospective analysis of 5687 consecutive patients who underwent peripheral angiograms by retrograde tibial-pedal access via the single remaining non-occluded infra-popliteal artery was performed. Patients who had retrograde tibial-pedal access at the sole remaining infra-popliteal artery confirmed by angiography were included. Clinical and ultrasound data of the accessed infra-popliteal vessel up to 6 months were collected. RESULTS The cohort consisted of 314 patients (152 males; mean age 77.9 years). At 6 months, access vessel complications occurred in 15 patients (4.8%). Access vessel occlusion occurred in 9 out of 314 patients (2.9%), arteriovenous fistula in 4 (1.3%), with spontaneous resolution in 2, pseudoaneurysm requiring thrombin injection in 2 (0.6%) and non-cardiovascular death in 1 (0.3%). No uncontrolled bleeding, procedure-related hospitalizations or limb amputations occurred. CONCLUSIONS Routine primary retrograde tibial-pedal access for lower extremity peripheral artery diagnostic angiography and intervention in patients with single infra-popliteal artery runoff can be safety performed in an outpatient setting with infrequent and manageable complications.
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Affiliation(s)
- Henry K. Siu
- Chinatown Cardiology, P.C., New York, NY 10013, USA (T.W.K.)
- Department of Medicine, Division of Cardiology, Lenox Hill Hospital, New York, NY 10075, USA
| | - Emily Schultz
- Department of Medicine, Division of Cardiology, Lenox Hill Hospital, New York, NY 10075, USA
| | - Sandrine LeBrun
- Department of Medicine, Division of Cardiology, Lenox Hill Hospital, New York, NY 10075, USA
| | - Michael Liou
- Chinatown Cardiology, P.C., New York, NY 10013, USA (T.W.K.)
| | - Tak W. Kwan
- Chinatown Cardiology, P.C., New York, NY 10013, USA (T.W.K.)
- Department of Medicine, Division of Cardiology, Lenox Hill Hospital, New York, NY 10075, USA
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5
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N’Dandu Z, Khaled K, Agbodji RA, Papapostolou G, Schmidt A, Korosoglou G. Endovascular Treatment of Complicated Popliteal Aneurysms Using the Novel "Trap and Fix" Technique. JACC Case Rep 2023; 24:102029. [PMID: 37869223 PMCID: PMC10589440 DOI: 10.1016/j.jaccas.2023.102029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 10/24/2023]
Abstract
Herein, we present 2 patients with lower limb ischemia caused by complicated popliteal aneurysms with thrombosis and distal embolization, compromising blood flow to the foot. In both cases, covered stents were first implanted guided by intravascular ultrasound and computed tomography angiography, respectively. After "trapping" the thrombi, mechanical thrombectomy or further stent implantations were performed, "fixing" the remaining lesions and preventing embolization. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Zola N’Dandu
- Department of Cardiology, Ochsner Health System, Ochsner Medical Center-Kenner, Kenner, Louisiana, USA
| | - Khaldia Khaled
- Department of Cardiology, Ochsner Health System, Ochsner Medical Center-Kenner, Kenner, Louisiana, USA
| | - Richard Ayetevi Agbodji
- Clinical Research Coordinator, Tulane Center of Clinical Research, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Georgios Papapostolou
- Department of Vascular Surgery, St Josef Hospital Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Andrej Schmidt
- Department of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, Gesundheitszentrum Rhein Neckar Hospital Weinheim, Weinheim, Germany
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Donas KP, Psyllas A, Pitoulias AG, Kazemtash M, Dahi F, Abu Bakr N, Korosoglou G. Periprocedural Outcomes of Rotational Atherectomy-Assisted Balloon Angioplasty in Isolated Atherosclerotic Popliteal Artery Lesions: The ISO-POP Trial. J Clin Med 2023; 12:jcm12082797. [PMID: 37109133 PMCID: PMC10144177 DOI: 10.3390/jcm12082797] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Treatment of calcified popliteal artery lesions represents an ongoing challenge for vascular specialists. Biomechanical forces of external compression, torsion and elongation that occur with locomotion in the popliteal segment can lead to stent fractures and occlusions. The aim of our study was to assess the procedural success rate of atherectomy in combination with balloon angioplasty for isolated calcified popliteal artery lesions. METHODS Between January 2020 and December 2022, 62 patients with isolated atherosclerotic lesions of the popliteal artery underwent endovascular treatment by use of rotational atherectomy (Phoenix, Philips USA, (subgroup A) or Jetstream, Boston USA, (subgroup B), atherectomy systems) and additional balloon angioplasty in two vascular centers. The primary outcome measures were: 1. periprocedural clinical and technical success (<30% residual stenosis and no need for bailout stenting due to flow-limiting dissection) and 2. postprocedural increase in the ankle brachial index of more than 0.1. RESULTS The overall rate of bailout stenting was 4.8%, whereas the procedural success rate was 98.4%. The rate of procedural complications included 3.7% and 5.7% peripheral embolizations in the subgroups A and B, respectively, and no vessel perforations were noted. All embolizations were successfully treated by catheter aspiration or capture in the pre-treatment placed filter system. In addition, 1 (3.7%) pseudoaneurysm in the groin was reported in subgroup A and treated by surgical means. Median ABI of the affected limbs improved from 0.55 (0.2) to 0.70 (0.2) in subgroup A and from 0.50 (0.2) to 0.95 (0.1) in subgroup B (DABI of 0.15 versus 0.45, p < 0.001). CONCLUSIONS The combination of rotational atherectomy and balloon angioplasty in the popliteal artery showed reproducible outcomes in 2 centers, with low incidence of complications and low rates of bail-out stenting. These findings may contribute to more liberal use of such devices especially in segments with high risk for stent factures and occlusions.
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Affiliation(s)
- Konstantinos P Donas
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Anastasios Psyllas
- Department of Vascular and Endovascular Surgery, Marienhospital Wesel, 46483 Wesel, Germany
| | - Apostolos G Pitoulias
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Majid Kazemtash
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Firouza Dahi
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Nizar Abu Bakr
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Grigorios Korosoglou
- Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, 69469 Weinheim, Germany
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7
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Roberts JD. Surgery or Endovascular Therapy for Chronic Limb Ischemia. N Engl J Med 2023; 388:e37. [PMID: 36920767 DOI: 10.1056/nejmc2300713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Korosoglou G, Schmidt A, Lichtenberg M, Torsello G, Grözinger G, Mustapha J, Varcoe RL, Wulf I, Heilmeier B, Müller OJ, Zeller T, Blessing E, Langhoff R. Best crossing of peripheral chronic total occlusions. VASA 2023; 52:147-159. [PMID: 36924047 DOI: 10.1024/0301-1526/a001066] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Together with colleagues from different disciplines, including cardiologists, interventional radiologists and vascular surgeons, committee members of the of the German Society of Angiology (Deutsche Gesellschaft für Angiologie [DGA]), developed a novel algorithm for the endovascular treatment of peripheral chronic total occlusive lesions (CTOs). Our aim is to improve patient and limb related outcomes, by increasing the success rate of endovascular procedures. This can be achieved by adherence to the proposed crossing algorithm, aiding the standardization of endovascular procedures. The following steps are proposed: (i) APPLY Duplex sonography and if required 3D techniques such as computed tomography or magnetic resonance angiography. This will help you to select the optimal access site. (ii) EVALUATE the CTO cap morphology and distal vessel refilling sites during diagnostic angiography, which are potential targets for a retrograde access. (iii) START with antegrade wiring strategies including guidewire (GW) and support catheter technology. Use GW escalation strategies to penetrate the proximal cap of the CTO, which may usually be fibrotic and calcified. (iv) STOP the antegrade attempt depending on patient specific parameters and the presence of retrograde options, as evaluated by pre-procedural imaging and during angiography. (v) In case of FAILURE, consider advanced bidirectional techniques and reentry devices. (vi) In case of SUCCESS, externalize the GW and treat the CTO. Manage the retrograde access at the end of the endovascular procedure. (vii) STOP the procedure if no progress can be obtained within 3 hours, in case of specific complications or when reaching maximum contrast administration based on individual patient's renal function. Consider radiation exposure both for patients and operators. In this manuscript we systematically follow and explain each of the steps (i)-(vi) based on practical examples from our daily routine. We strongly believe that the integration of this algorithm in the daily practice of endovascular specialists, can improve vessel and patient specific outcomes.
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Affiliation(s)
| | - Andrej Schmidt
- Department of Interventional Angiology, University Hospital Leipzig, Germany
| | | | - Giovanni Torsello
- Institute for Vascular Research, Franziskus Hospital, University Hospital Münster, Germany
| | - Gerd Grözinger
- Department of Radiology, University of Tübingen, Germany
| | - Jihad Mustapha
- Advanced Cardiac & Vascular Centers, Grand Rapids, Michigan, USA
| | - Ramon L Varcoe
- Department of Vascular Surgery, University of New South Wales, Sydney, Australia
| | - Ito Wulf
- Cardiovascular Center Oberallgaeu-Kempten, Allgaeu Hospital Group, Immenstadt, Germany
| | | | - Oliver J Müller
- Department of Internal Medicine III, German Centre for Cardiovascular Research, University Hospital Kiel, Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Thomas Zeller
- Department of Interventional Angiology, University Hospital Freiburg/Bad Krozingen, Germany
| | - Erwin Blessing
- Department of Angiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Langhoff
- Brandenburg Medical School Theodor Fontane, Campus, Clinic Brandenburg, Berlin, Germany
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Korosoglou G, Schmidt A, Lichtenberg M, Torsello G, Grözinger G, Mustapha J, Varcoe RL, Zeller T, Blessing E, Langhoff R. Crossing Algorithm for Infrainguinal Chronic Total Occlusions: An Interdisciplinary Expert Opinion Statement. JACC Cardiovasc Interv 2023; 16:317-331. [PMID: 36792256 DOI: 10.1016/j.jcin.2022.11.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 02/16/2023]
Abstract
A crossing algorithm was developed for the endovascular treatment of peripheral chronic total occlusive lesions (CTOs) to educate, guide, and appropriately influence clinical practice aiming at harmonization and standardization of endovascular procedures. The following steps are proposed: One, duplex sonography and if required computed tomography or magnetic resonance angiography for the selection of the optimal access site. Two, angiographic evaluation of the proximal/distal cap morphology, presence of collaterals at the origin of the proximal cap and at the distal vessel refilling site. In addition, evaluation of distal vessels, including their diameters and quality, and the presence of calcification or stents within the occlusion zone. Three, antegrade wiring strategies, guidewire (GW) and support catheter technology, as well as GW escalation strategies. Stop the antegrade attempt depending on clinical indication for peripheral artery disease treatment and the presence of retrograde options. Four, retrograde access site, support catheter, or sheath insertion and wiring technology from distally. Five, considering strategy change when progress cannot by achieved, using advanced bidirectional techniques and re-entry devices. Six, in case of successful GW passage from retrograde, GW externalization and treatment from antegrade. Management of the retrograde access by internal or external hemostasis at the end of the procedure. Alternatively, stop the procedure if no progress can be obtained within 3 hours or in case of specific complications. By establishing the algorithm in the daily routine of endovascular specialists, improvements in vessel- and patient-specific outcomes are anticipated. In addition, future research, and continuous collaboration between experts is warranted.
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Affiliation(s)
| | - Andrej Schmidt
- Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany
| | | | - Giovanni Torsello
- University Hospital Münster, Institute for Vascular Research, Franziskus Hospital, Münster, Germany
| | - Gerd Grözinger
- University of Tübingen, Department of Radiology, Tübingen, Germany
| | - Jihad Mustapha
- Advanced Cardiac & Vascular Centers, Grand Rapids, Michigan, USA
| | - Ramon L Varcoe
- University of New South Wales, Department of Vascular Surgery, Sydney, New South Wales, Australia
| | - Thomas Zeller
- University Hospital Freiburg/Bad Krozingen, Department of Interventional Angiology, Bad Krozingen, Germany
| | - Erwin Blessing
- University Heart and Vascular Center, Department of Angiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Langhoff
- Brandenburg Medical School Theodor Fontane, Campus, Clinic Brandenburg, Brandenburg an der Havel, Berlin, Germany
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10
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Korosoglou G, Giusca S, Langhoff R, Lichtenberg M, Lawall H, Schellong S, Stausberg J, Hoffmann U, Enders D, Malyar N. Safety and Effectiveness of Endovascular Therapy for the Treatment of Peripheral Artery Disease in Patients with and without Diabetes Mellitus. Angiology 2022; 73:956-966. [PMID: 35324343 DOI: 10.1177/00033197221075857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study investigated the distribution of risk factors, lesion characteristics and endovascular revascularization (EVR) strategies in patients with peripheral arterial disease (PAD) with vs without diabetes mellitus (DM). Data were collected within the RECcording COurses of vasculaR Diseases (RECCORD) registry. Demographic data, lesion localization (iliac vs femoropopliteal vs below-the-knee (BTK)) and lesion complexity score (LCS) based on number of affected segments, and lesion length (< 10 vs 10-20 vs > 20 cm), EVR strategies and peri-procedural complications were analysed in 786 patients with and 1337 without diabetes mellitus. Patients with diabetes mellitus were older (71.6 ± 9.6 vs 69.4 ± 10.5 years, P < .001) and had higher LCS and more often BTK lesions (P < .05 for all). Lesions were treated less frequently with stents (48.7 vs 59.6%, P < .001) in patients with diabetes mellitus, whereas a non-significant trend was noticed for higher DCB treatment rates (48.3 vs 44.4%, P = .07). Post-interventional ankle-brachial index (ABI) increase was similar (from .77 ± .28 to .92 ± .25 with diabetes mellitus and from .74 ± .21 to .90 ± .20 without diabetes mellitus, P < .001 for both). Peri-/post-procedural complications were low in both groups (4.6%). Patients with diabetes mellitus, who undergo endovascular revascularization are older, have more comorbidities and higher target lesion complexity. However, treatment success rates are similar and complication rates are low.
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Affiliation(s)
| | - Sorin Giusca
- GRN Hospital Weinheim, Cardiology and Vascular Medicine, Weinheim, Germany
| | - Ralf Langhoff
- Department of Angiology, Sankt-Gertrauden-Krankenhaus, Berlin, Germany
| | | | | | | | | | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital Munich, Munich, Germany
| | - Dominic Enders
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Nasser Malyar
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, 39069University Hospital Muenster, Muenster, Germany
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