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Loureiro L, Pinelo A, Veterano C, Rocha H, Castro J, Machado R. Navigating complexity: The Supera's triumph in femoropopliteal lesions. Vascular 2024:17085381241246321. [PMID: 38588331 DOI: 10.1177/17085381241246321] [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: 04/10/2024]
Abstract
INTRODUCTION The femoropopliteal sector endovascular treatment is particularly challenging due to its high tortuosity and torsional forces. Better results are still needed to ensure the long-term patency of stenting in this area. The Supera stent appears to change this paradigm. METHODS This single-center retrospective cohort study aims to evaluate the efficacy and safety of femoropopliteal stenting with Supera in a real-world population. Seventy-nine patients were treated between January 2015 and December 2020, and the results are reported with a median follow-up of 28 months. RESULTS Indications for revascularization were chronic limb-threatening ischemia with tissue loss (73.6%) or ischemic rest pain (17.7%) and claudication (7.6%). Thirty-six patients (45.6%) were classified as GLASS stage III according to the Global Limb Anatomic Staging System, with 65.8% and 30.4% in grades 3 and 4 of femoropopliteal and infrapopliteal sectors, respectively. The 36-month primary, primary-assisted, and secondary patency rates were 68.6%, 72.0%, and 79.0%, respectively, with an amputation-free survival rate of 86.6%. There was no significant difference between primary patency rates in GLASS stages I-II compared with GLASS stage III (36-month primary patency rates of 72% vs 63% respectively, p = 0.342) nor in amputation-free survival (88% vs 84%, p = 0.877). After adjusting for potential confounders, only the stent conformation significantly affected the primary patency rates, with a higher hazard of reintervention for the elongated (HR = 3.179; p = 0.36; CI 1.081-9.347) and the compressed (HR = 3.014; p = 0.42; CI 1.039-8.746) forms. CONCLUSIONS The 36-month patency of the Supera stents in our real-world cohort was similar to other reported series. The GLASS stage did not interfere with the stent patency, proving it is a good choice even in the most adverse anatomy patients. Only the non-nominal stent conformation affected the primary patency rates in our patients.
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Affiliation(s)
- Luis Loureiro
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Andreia Pinelo
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Carlos Veterano
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Henrique Rocha
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João Castro
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rui Machado
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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Messeder SJ, López-Peña G, Pepper C, Saratzis A. Biomimetic Stents for Infrainguinal Peripheral Arterial Disease: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2024; 67:468-479. [PMID: 37931680 DOI: 10.1016/j.ejvs.2023.11.007] [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: 06/02/2023] [Revised: 09/30/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Biomimetic stents are peripheral infrainguinal self expanding stents that mimic the anatomy of the vasculature and artery movement. They are indicated for use in infrainguinal arteries. This research aimed to synthesise all current evidence on the use of biomimetic stents as adjuncts for endovascular treatment of infrainguinal peripheral arterial disease (PAD), helping to guide clinical decision making. DATA SOURCES MEDLINE, Embase, CINAHL and Cochrane databases. REVIEW METHODS Random effects meta-analysis following PRISMA guidelines (PROSPERO registration CRD42022385256). Study quality was assessed using the Joanna Briggs Institute critical appraisal tools checklist, and certainty assessment through the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Endpoints included primary patency, target lesion revascularisation, stent fracture, secondary patency, and Death at one year. RESULTS In total, 37 studies were included in the meta-analysis (33 cohort studies, two case series, and two randomised controlled trials [RCTs]), representing 4 480 participants. Of these, 34 studies included data on the Supera (81.5% of participants) and three studies reported data on the BioMimics 3D (18.5% of participants) stents. The pooled primary patency rate of 33 studies at one year follow up was 81.4% (95% confidence interval [CI] 78.7 - 83.9%), and the pooled target lesion revascularisation rate of 18 studies at one year was 12.2% (95% CI 9.6 - 15.0%). The certainty of evidence outcome rating as qualified by GRADE was very low for both. Only one study reported a positive stent fracture rate at one year follow up of 0.4% with a certainty of evidence outcome of low. CONCLUSION Using biomimetic stents for infrainguinal PAD may be associated with acceptable one year primary patency and target lesion revascularisation rates, with a near negligible one year stent fracture rate. Their use should be considered in those presenting with infrainguinal PAD undergoing endovascular revascularisation. A RCT is necessary to determine their clinical and cost effectiveness.
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Affiliation(s)
- Sarah Jane Messeder
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK; British Heart Foundation, Clinical Research Training Fellow, Leicester, UK.
| | - Gabriel López-Peña
- Leicester Vascular Institute, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK
| | - Coral Pepper
- Library and Information Services, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK
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Nasr B, Gouailler F, Marret O, Guillou M, Chaillou P, Guyomarc'h B, Maurel B, Gouëffic Y. Treatment of Long Femoropopliteal Lesions With Self-Expanding Interwoven Nitinol Stent: 24 Month Outcomes of the STELLA-SUPERA Trial. J Endovasc Ther 2023; 30:98-105. [PMID: 35114841 DOI: 10.1177/15266028221075227] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The performance of self-expanding interwoven nitinol stent (Supera) in femoropopliteal interventions has been proven through trials with short lesions and with relatively low proportion of occlusions. There is limited evidence of Supera stent in long lesions. The aim of this study was to assess the clinical safety and efficiency of the Supera stent in the treatment of long femoropopliteal lesions (Trans-Atlantic Inter-Society Consensus [TASC] C/D) in patients with symptomatic peripheral arterial disease (PAD). METHODS The STELLA SUPERA (STEnting Long de L'Artère fémorale superficielle par le stent métallique Supera) is a prospective, 2-center, single-arm study. Patients with symptomatic (Rutherford stages 2-6) de novo and TASC C/D lesions of the femoropopliteal segment were treated with Supera stent. The primary endpoint was the primary sustained clinical improvement at 12 months. Follow-up included clinical examination, duplex scan, and biplane X-ray up to 24 months. RESULTS Between December 2016 and October 2018, 48 symptomatic patients with 49 femoropopliteal lesions (TASC D = 32, 65%) were treated. The mean lesion length was 234 ± 123 mm, and 78% were total occlusion. The mean stented lesion length was 273 ± 127 mm. At 12 and 24 months, the primary sustained clinical improvement rate was 87.2% and 79.7%, respectively. The Rutherford category assessment was significantly improved at 24 months compared with baseline (p=0.02). At 24 months, the primary patency and freedom from target lesion revascularization (TLR) rates were 77.9% and 86.9%, respectively. The ankle-brachial pressure index increased from 0.62 ± 0.15 at baseline to 0.93 ± 0.15 at 24 months (p<0.0001). There were no stent fractures at 24 months. CONCLUSION The use of Supera stent in long lesions (TASC C/D) is a safe and effective endovascular alternative. These results reinforce the need for randomized clinical trials to assess the value of interwoven stents for long femoropopliteal lesions.
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Affiliation(s)
- Bahaa Nasr
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Flora Gouailler
- Service de Chirurgie Vasculaire, Clinique Océane, Vannes, France
| | - Olivier Marret
- Service de Chirurgie Vasculaire, CH de la Roche sur Yon, La Roche-sur-Yon, France
| | - Marie Guillou
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Philippe Chaillou
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Béatrice Guyomarc'h
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Blandine Maurel
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France.,Laboratoire de Physiopathologie de la Résorption Osseuse, Inserm-UN UMR-957, Nantes, France
| | - Yann Gouëffic
- Laboratoire de Physiopathologie de la Résorption Osseuse, Inserm-UN UMR-957, Nantes, France.,Service de Chirurgie Vasculaire et Endovasculaire, Groupe Hospitalier Paris St Joseph, Paris, France
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Mosarla RC, Armstrong E, Bitton-Faiwiszewski Y, Schneider PA, Secemsky EA. State-of-the-Art Endovascular Therapies for the Femoropopliteal Segment: Are We There Yet? JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1. [PMID: 36268042 PMCID: PMC9581461 DOI: 10.1016/j.jscai.2022.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Peripheral arterial disease is an increasingly prevalent condition with significant associated morbidity, mortality, and health care expenditure. Endovascular interventions are appropriate for most patients with either ongoing symptoms of intermittent claudication despite lifestyle and medical optimization or chronic limb-threatening ischemia. The femoropopliteal segment is the most common arterial culprit responsible for claudication and the most commonly revascularized segment. Endovascular approaches to revascularization of the femoropopliteal segment are advancing with an evolving landscape of techniques for arterial access, device-based therapies, vessel preparation, and intraprocedural imaging. These advances have been marked by debate and controversy, notably related to the safety of paclitaxel-based devices and necessity of atherectomy. In this review, we provide a critical overview of the current evidence, practice patterns, emerging evidence, and technological advances for endovascular intervention of the femoropopliteal arterial segment.
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Affiliation(s)
| | - Ehrin Armstrong
- Adventist Heart and Vascular Institute, St Helena, California
| | | | | | - Eric A. Secemsky
- Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Corresponding author: (E.A. Secemsky)
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Low J, Shih T, Lu E, Derubertis BG, Baril DT. Midterm Results of the Supera Stent for the Treatment of Femoropopliteal Occlusive Disease. Ann Vasc Surg 2022; 86:177-183. [PMID: 35779806 DOI: 10.1016/j.avsg.2022.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Supera (Abbott Vascular, Santa Clara, CA) stent is an interwoven nitinol, shape-memory stent with high strength and flexibility characteristics which are purported to increase resistance to kinking and compression. The purpose of this study was to review single-center outcomes of the use of this stent in the femoropopliteal segment. METHODS We performed a single-center, retrospective analysis of patients who underwent Supera stent placement for femoropopliteal occlusive disease from 2016-2019. Data was collected on patient demographics and procedural details. Follow-up imaging data, including duplex imaging and ankle-brachial indices, and clinical data were abstracted from encounter notes. RESULTS Sixty-two patients with 72 unique Supera stent placements were identified. Mean age was 76 and 69% were male. 56% of patients had severe calcification and 11% had moderate calcification. 48% of lesions were Trans-Atlantic Inter-Society Consensus Document C or D lesions. Primary patency rates at 12, 24, and 36 months were 85%, 82%, and 75%, respectively. Primary patency was not affected significantly by lesion length, degree of calcification, number of outflow vessels, concomitant interventions, or stent size. CONCLUSIONS These results demonstrate sustained primary patency with the Supera stent over a 3-year interval in treatment of patients with femoropopliteal occlusive disease, including in the setting of severely calcified vessels.
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Affiliation(s)
- Josiah Low
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Terri Shih
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Eileen Lu
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brian G Derubertis
- Division of Vascular Surgery, Weill Cornell Medical College, New York, NY
| | - Donald T Baril
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
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Yang M, Shi B, Lubo MA, Yu C, Zhang X, Li T, Zhang X, Wang Y, Zhuang B. Treatment of atherosclerotic femoropopliteal artery disease with Supera interwoven nitinol stent: a real-world study in China. Ann Vasc Surg 2022; 85:183-189. [PMID: 35271965 DOI: 10.1016/j.avsg.2022.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/06/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the outcomes of Supera stent deployment in Chinese patients with atherosclerotic femoropopliteal artery (FPA) disease in a real-world setting. METHODS This retrospective cohort study collected and analyzed the medical records of 246 consecutive patients who received Supera stents for FPA disease at the China Academy of Chinese Medical Sciences Xiyuan Hospital between February 2017 and December 2019. All study patients underwent balloon angioplasty and were treated with Supera stents (Abbott Vascular, Santa Clara, CA, USA). The primary outcome was the rate of primary patency 12 months after discharge. RESULTS The analyses included 246 consecutive patients and 260 lesions. The mean ± SD age was 73.2±9.9 years and most patients (60.2%) were male. Of the 260 treated lesions, Supera stents were deployed in eight (3.1%) cases after previous stent fracture. Critical limb ischemia was diagnosed in 87.3% of the limbs, and 84 (32.3%) and 83 (31.5%) cases were classified as TransAtlantic Inter-Society Consensus (TASC) C and D, respectively. The majority of the lesions was in situ (80.8%) and located in the superficial femoral artery (45.0%) or the femoropopliteal artery (45.8%). The mean lesion length was 147.7 mm. Nominal deployment (-10% to 10% compression) was the most common deployment scenario (84.1%). The 1-year primary patency rate was 80.6%. Lesions that occurred as restenosis (OR = 3.34, 95% CI: 1.03-10.85, P = 0.045) or in-stent restenosis (OR = 2.88, 95% CI: 1.03-8.07, P = 0.045) were independently associated with occlusion or stenosis after stent deployment. No stent fracture was observed in the study. CONCLUSIONS Our study indicates that the use of Supera stents is feasible for treatment of Chinese patients with FPA disease. The long-term results reveal high primary patency.
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Affiliation(s)
- Miao Yang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bo Shi
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - M A Lubo
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunli Yu
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xueyuan Zhang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tiantian Li
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuan Zhang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yujie Wang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baixi Zhuang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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STAHLBERG E, PLANERT M, ANTON S, SIEREN M, WIEDNER M, BARKHAUSEN J, GOLTZ JP. Functional angiograms after stent implantation into the femoropopliteal artery. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Li H, Rha SW, Choi BG, Choi SY, Moon SK, Jang WY, Kim W, Ahn JH, Park SH, Choi WG, Yang RF, Bai WW, Choi CU, Ryu YG, Baek MJ, Oh DJ. Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent. BMC Cardiovasc Disord 2021; 21:323. [PMID: 34193057 PMCID: PMC8246708 DOI: 10.1186/s12872-021-02141-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. METHODS In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. RESULTS We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). CONCLUSIONS COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.
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Affiliation(s)
- Hu Li
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.,Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sang Ki Moon
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Ji Hun Ahn
- Department of Cardiology, Soon Chun Hyang University Gumi Hospital, Gumi-si, Republic of Korea
| | - Sang-Ho Park
- Department of Cardiology, Soonchunhyang University Cheonan Hospital Korea, Cheonan-Ii, Republic of Korea
| | - Woong Gil Choi
- Department of Internal Medicine, School of Medicine, Konkuk University, Chungju, Republic of Korea
| | - Rui Feng Yang
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wen Wei Bai
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Yang Gi Ryu
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Man Jong Baek
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
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Stahlberg E, Allmendinger AC, Anton S, Planert M, Jacob F, Barkhausen J, Goltz JP. Post-dilatation of an interwoven nitinol stent using a paclitaxel-coated balloon for revascularization of complex femoro-popliteal lesions. Cardiovasc Interv Ther 2020; 36:338-346. [PMID: 32803671 DOI: 10.1007/s12928-020-00697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
To evaluate technical success, safety and efficacy of post-dilatation of an interwoven nitinol stent using a paclitaxel-coated balloon (PCB) for revascularization of complex femoro-popliteal lesions. Thirty patients (26 male, mean age 70 ± 7 years) suffering from peripheral artery disease (PAD) (Rutherford category II-III) underwent revascularization of chronic total occlusions (n = 22, 73%) or severe stenosis (n = 8, 27%) of the femoro-popliteal segment. Mean lesion length was 251 ± 85 mm. Lesions were treated by pre-dilatation (POBA), implantation of a helical interwoven stent and post-dilatation with a PCB. Technical success was defined as residual stenosis < 30%. Follow-up included clinical visits, duplex ultrasound and ABI at 6 and 12 months. Endpoints were patency (re-stenosis < 50%), complications, improvement of Rutherford category and ABI. Regarding patency two sub-groups were compared: long-("LL"; < 25 cm, n = 12, mean 175 ± 38 mm) and ultra-long lesions ("ULL"; ≥ 25 cm, n = 13, mean 322 ± 43 mm). Technical success was 100%. In 1/30 patients (3.3%), a minor complication occurred (embolism). The overall primary and secondary patency rates at 12 months were 80.0% (95% CI 72.5-96.9%) and 92.0% (95% CI 84.7-100%). In the LL-sub-group, primary patency was 100%, and in the ULL-sub-group, primary patency was 61.5% (95% CI 51.8-92.3%) (p = 0.056), and secondary patency 84.6% (95% CI 71.3-100%), respectively. Rutherford category increased by at least one category in 92% of patients, ABI increased from 0.52 ± 0.13 (baseline) to 0.9 ± 0.14 (12 months) (p = 0.001). Five patients underwent target lesion revascularization during follow-up (bypass: n = 1, endovascular: n = 4). No death was observed during follow-up. Post-dilatation of an interwoven nitinol stent using a paclitaxel-coated-balloon proved to be safe and effective with promising outcomes in long- and ultra-long lesions up to 12 months of follow-up.
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Affiliation(s)
- Erik Stahlberg
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Ann Christin Allmendinger
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Susanne Anton
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Mathis Planert
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Fabian Jacob
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jan Peter Goltz
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, SANA Hospital, Lübeck, Germany
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10
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Armstrong EJ, Jeon-Slaughter H, Kahlon RS, Niazi KA, Shammas NW, Banerjee S. Comparative Outcomes of Supera Interwoven Nitinol vs Bare Nitinol Stents for the Treatment of Femoropopliteal Disease: Insights From the XLPAD Registry. J Endovasc Ther 2019; 27:60-65. [PMID: 31686573 DOI: 10.1177/1526602819885652] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a propensity score analysis comparing outcomes of the Supera interwoven nitinol stent to bare nitinol stents (BNS) in the femoropopliteal segment. Materials and Methods: A retrospective study was conducted utilizing data extracted from the Excellence in Peripheral Artery Disease (XLPAD) registry (ClinicalTrials.gov identifier NCT01904851) on 871 patients (mean age 65.1 years; 713 men) who underwent femoropopliteal balloon angioplasty with either Supera stent implantation in 118 limbs or other contemporary BNS in 753 limbs between January 2006 and December 2016. All patients in both groups were matched for baseline demographic and clinical characteristics in a 1:1 propensity score matching using the nearest neighbor method to create the 118-patient matched BNS cohort. One-year outcomes included all-cause mortality, target vessel revascularization (TVR), and target limb revascularization (TLR). An additional core laboratory analysis was conducted to measure the deployed length of Supera stents. Results: In unmatched data, the Supera stent group had a numerically lower rate of TVR (7.6% vs 13.4%, p=0.08) and a significantly lower 1-year TLR rate (7.6% vs 16.2%, p=0.02) compared to the BNS group. Both groups had similar 1-year mortality (2.5% vs 2.7%, p=0.9). Kaplan-Meier analysis demonstrated that the Supera group had a significantly lower risk of TVR (p=0.02) and TLR (p=0.002) than the BNS group. After propensity matching, the 1-year TVR estimate was lower for Supera stents (7.6% vs 12.7%, p=0.08) and significantly lower for TLR (7.6% vs 13.6%, p=0.04) than the BNS group. There was no statistically significant association between Supera stent elongation (>10% of the labeled stent length) and 1-year risk of TLR (p=0.6). Conclusion: Supera stent usage in femoropopliteal intervention was associated with reduced risk of 1-year repeat target limb revascularization compared with BNS treatment in both unmatched and matched cohorts.
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Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, University of Colorado, Denver, CO, USA.,Rocky Mountain Regional VA Medical Center, Denver, CO, USA
| | - Haekyung Jeon-Slaughter
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Healthcare System, Dallas, TX, USA
| | - Ravi S Kahlon
- Division of Cardiology, University of Colorado, Denver, CO, USA.,Rocky Mountain Regional VA Medical Center, Denver, CO, USA
| | | | | | - Subhash Banerjee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Healthcare System, Dallas, TX, USA
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Giannopoulos S, Armstrong EJ. Newly approved devices for endovascular treatment of femoropopliteal disease: a review of clinical evidence. Expert Rev Cardiovasc Ther 2019; 17:729-740. [PMID: 31575289 DOI: 10.1080/14779072.2019.1675512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Femoropopliteal lesions account for a significant proportion of endovascular interventions for peripheral artery disease. In this manuscript, we review the literature on the application of newly approved devices in the treatment of atherosclerotic lesions at this segment.Areas covered: New drug-coating technologies provide sustained drug-eluting over time and better scaffolds are more resistant to the increased biomechanical stress at the femoropopliteal segment. Thus, the newer drug-eluting stents (i.e. Eluvia®), nitinol interwoven stents (i.e. Supera®), and drug-coated balloons (i.e. Stellarex®) are associated with improved pharmacokinetic profiles and promising primary patency rates. A major predictor of technical failure and restenosis is the calcification of the target vessel. Recently, intravascular lithotripsy of calcified lesions at the femoropopliteal segment with the Shockwave® balloon was introduced as a feasible treatment option for these complex lesions. Finally, we also describe the Tack Endovascular System®, the first-of-its-type, for the repair of post-angioplasty dissections.Expert opinion: The use of innovative stent designs and novel drug-coating, the application of adjunctive intravascular lithotripsy, and the combined use of new devices treating complications might improve the overall outcomes of angioplasty, thereby promising favorable outcomes even for more complex lesions.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome. Ann Vasc Surg 2019; 62:397-405. [PMID: 31449958 DOI: 10.1016/j.avsg.2019.06.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Reports our experience for the first 50 cases of use of Supera stent for popliteal atherosclerotic lesions treatment. METHODS This prospective single-arm trial enrolled the first 50 limbs (46 patients) treated in our center with a Supera stent for symptomatic atherosclerotic disease of the popliteal artery. Also, a follow-up of 36 months is reported. RESULTS The mean preoperative ankle-brachial index increased from 0.38 ± 0.37 before intervention to 0.63 ± 0.46 postoperatively at 12 months (P = 0.014), 0.66 ± 0.39 at 24 months (P = 0.023), and 0.74 ± 0.46 at 36 months (P = 0.029). Primary patency at 12, 24, and 36 months were 89.6%, 72.3%, and 70.2%, and primary assisted patency was 93.8%, 87.2%, and 85.1%, respectively, by Kaplan-Meier estimates. After 3 years of follow-up, age <75 years (P = 0.034) and Trans-Atlantic Inter-Society Consensus (TASC)-II D lesions (P = 0.041) constituted risk factors for stent occlusion. During the follow-up of the patients, none of them developed stent fracture as evidenced on plain radiographs during follow-up. Implantation defects did not constitute a risk factor for stent restenosis. CONCLUSIONS Based on the results of this study, Supera stent has shown an excellent 3-year patency in this difficult-to-treat anatomic segment. In our experience, younger patients and complex lesions (TASC-II type D) were positive significant predictors for restenosis. In our cohort, post deployment stent conformation did not influence patency. Nevertheless, further investigations, including randomized studies comparing the Supera stent with other stent platforms, drug eluting angioplasty, or atherectomy devices, are mandatory.
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13
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San Norberto EM, Fidalgo- Domingos LA, García-Saiz I, Taylor J, Vaquero C. Endovascular Treatment of Popliteal Artery Occlusion Caused by a Ruptured Supera Interwoven Nitinol Stent. Ann Vasc Surg 2019; 59:308.e9-308.e13. [DOI: 10.1016/j.avsg.2019.02.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 10/26/2022]
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Peker A, Balendran B, Paraskevopoulos I, Krokidis M. Demystifying the Use of Self-Expandable Interwoven Nitinol Stents in Femoropopliteal Peripheral Arterial Disease. Ann Vasc Surg 2019; 59:285-292. [PMID: 31009734 DOI: 10.1016/j.avsg.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
Femoropopliteal atherosclerosis affects a significant percentage of the world population, leading to intermittent claudication and critical limb ischemia. The femoropopliteal segment has a unique set of biomechanical challenges that must be considered and overcome for treatment. The use of stents is a reality and a necessity in peripheral interventions. The success of first-generation femoropopliteal stents was limited by their rigidity and deformability. The standard nitinol stents overcame certain biomechanical challenges because of their superelasticity and thermal shape memory, although stent fracture is still an issue. Therefore, interwoven nitinol stents with helical structure have been developed, borrowing the concept from biliary stents, aiming to provide good flexibility while still maintaining a uniform cell size and significant radial strength. This unique interwoven structure gains it advantage in the femoropopliteal region. The purpose of this review article is to investigate the current published evidence of the use of self-expandable interwoven nitinol stents in femoropopliteal arterial disease and compare them with other endovascular treatment options.
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Affiliation(s)
- Ahmet Peker
- The Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Miltiadis Krokidis
- The Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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15
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Deloose K, Martins I, Neves C, Callaert J. Endovascular treatment for the common femoral artery: is there a challenger to open surgery? THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:8-13. [PMID: 30428661 DOI: 10.23736/s0021-9509.18.10787-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Common femoral artery (CFA) atherosclerotic lesions currently remain one of the last limitations for adoption of endovascular repair as the first-line treatment. The bulky, eccentric, heavily calcified character of the CFA plaques, frequent involvement of the femoral bifurcation, easy surgical accessibility and last but not least, favorable long-term outcomes still make CFA disease treatment part of the surgical domain. In the last 5 years, improvement of the endovascular equipment and technical skills of the operators have led to an increase in percutaneous CFA procedures. Especially the vascular mimetic implant Supera Peripheral Stent system (Abbott Vascular), with its extreme crush resistance (if correctly implanted), seems to be an ideal tool to deal with eccentric calcified plaques, crush risk and maintaining access possibilities. The multicentric, prospective, single arm VMI-CFA Trial evaluates the outcome of treatment of symptomatic (Rutherford 2-4) CFA stenotic or occlusive lesions with the Supera Peripheral Stent System. A 6-month cumulative primary patency rate of 100% is noticed, up to 210 days. The cumulative freedom from TLR rate is 100%. Four patients died, not procedure or device related. From a clinical point of view, a tremendous switch from Rutherford 2-4 towards Rutherford 0-1 happened. No procedure nor device related adverse events are noticed. These short-term data confirm the safety and feasibility of an endovascular approach with the Supera stent to the "no-stent zone" CFA. Of course 12- and 24-month data are essential to bring more clarification in this interesting field.
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Affiliation(s)
- Koen Deloose
- Department of Vascular Surgery, A.Z. Sint Blasius Hospital, Dendermonde, Belgium -
| | - Igor Martins
- Department of Vascular Surgery, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
| | - Caio Neves
- Department of Vascular Surgery, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
| | - Joren Callaert
- Department of Vascular Surgery, A.Z. Sint Blasius Hospital, Dendermonde, Belgium
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Utilization of Vasculoprotective Therapy for Peripheral Artery Disease: A Systematic Review and Meta-analysis. Am J Med 2018; 131:1332-1339.e3. [PMID: 30056102 DOI: 10.1016/j.amjmed.2018.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Practice guidelines recommend that patients with peripheral artery disease receive antiplatelets, statins, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). We sought to quantify the rates of prescribing these therapies in patients with peripheral artery disease in the literature. METHODS We performed a systematic review and meta-analysis of treatment prescribing rates in observational studies containing peripheral artery disease patients published on or after the year 2000. We also assessed whether prescribing rates are increasing over time. RESULTS A total of 86 studies were available for analysis. The aggregate sample size across all studies was 332,555. The pooled estimates for utilization of antiplatelets, statins, and ACE inhibitors or ARBs were 75% (95% confidence interval [CI], 71%-79%), 56% (95% CI, 52%-60%), and 53% (95% CI, 49%-58%), respectively. Statin use was directly related to publication year (+2.0% per year, P < .001), but this was not the case for antiplatelets (P = .68) or ACE inhibitors or ARBs (P = .066). CONCLUSIONS Although some improvement in statin prescribing has occurred in recent years, major practice gaps exist in the treatment of peripheral artery disease. Effective measures to close these gaps should be implemented.
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Bhatt H, Kovach R, Janzer S, George JC. S UPERA stent outcomes in A bove-The- K nee Interv E ntions: Effects of COMP ression and EL ongation ( SAKE - COMPEL ) Sub-study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:512-515. [DOI: 10.1016/j.carrev.2017.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/12/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
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Lugenbiel I, Grebner M, Zhou Q, Strothmeyer A, Vogel B, Cebola R, Müller O, Brado B, Mittnacht M, Kohler B, Katus H, Blessing E. Treatment of femoropopliteal lesions with the AngioSculpt scoring balloon – results from the Heidelberg PANTHER registry. VASA 2018; 47:49-55. [DOI: 10.1024/0301-1526/a000671] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Treatment of calcified femoropopliteal lesions remains challenging, even in the era of drug-eluting balloon angioplasty. Lesion recoil and dissections after standard balloon angioplasty in calcific lesions often require subsequent stent implantation. Additionally, poor patency rates in calcified lesions despite the use of drug-eluting balloons may be due to the limited penetration depth of the antiproliferative drug in the presence of vascular calcium deposits. Therefore, preparation of calcified lesions with the AngioSculpt™ scoring balloon might be a valuable option either as a stand-alone treatment, followed by drug-eluting balloon angioplasty or prior to subsequent stent deployment. Patients and methods: In this retrospective, single centre registry, 124 calcified femoropopliteal lesions were treated in 101 subsequent patients. All patients were treated with scoring balloon angioplasty, either alone, in combination with drug-eluting balloons, or prior to stent deployment. The primary outcome was safety and technical success during the index procedure as well as patency at six and 12 months, as evaluated by duplex sonography. Results: Successful scoring was safely performed in all 124 lesions with the AngioSculpt™ balloon. Overall primary patency after 12 months was 81.2 %. Patency rates did not differ significantly between the three treatment strategies. Degree of calcification did not predict patency. Improved clinical outcomes (Rutherford-Becker class and ankle-brachial index) were also observed in the study cohort. Conclusions: Preparation with the AngioSculpt™ scoring balloon offers a safe and valuable treatment option for calcified femoropopliteal lesions.
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Affiliation(s)
- Ira Lugenbiel
- Augenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michaela Grebner
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Qianxing Zhou
- Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, Guangdong, China
| | | | - Britta Vogel
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Rita Cebola
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Oliver Müller
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | | | - Hugo Katus
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Cho SB, Choi HC, Bae E, Park TJ, Baek HJ, Park SE, Ryu KH, Moon JI, Choi BH, Bae K, Jeon KN. Angioplasty and stenting for the proximal anastomotic stenosis of a brachio-axillary bypass graft using a helical interwoven nitinol stent: A case report. Medicine (Baltimore) 2017; 96:e9073. [PMID: 29390303 PMCID: PMC5815715 DOI: 10.1097/md.0000000000009073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Thrombosis due to anastomotic site stenosis is the most common complication in patients with brachio-axillary arteriovenous graft (AVG). Intravascular stent placement may play a special role in the salvage of dialysis grafts that have been previously performed percutaneous angioplasty or surgical procedure on the graft. Herein, we applied a novel stent named Supera which has a high degree of flexibility and resistance to external compression for treating a patient with recurrent venous anastomotic stenosis of brachio-axillary AVG. PATIENTS CONCERNS AND DIAGNOSES We report a case of the patient with end-stage renal disease who presented with brachio-axillary AVG malfunction. INTERVENTIONS The patient underwent repeated percutaneous angioplasty with thrombectomy for total graft occlusion, and we placed the Supera stent to salvage the graft. OUTCOMES Postprocedural Doppler ultrasonography did not show any restenosis on the 1- and 3-month follow-up periods, and average flow volume in the stent was >1000 mL/min. And he has been on dialysis for 6 months without any problems after stent placement. LESSONS The Supera stent is a useful treatment option of interventional procedure for recurrent venous anastomotic stenosis of brachio-axillary AVG in the clinical practice.
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Affiliation(s)
- Soo Buem Cho
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju
| | - EunJin Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital
| | - Tae Jin Park
- Department of Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
| | - Kyungsoo Bae
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon
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Kronlage M, Wassmann M, Vogel B, Müller OJ, Blessing E, Katus H, Erbel C. Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2937-2945. [PMID: 29062225 PMCID: PMC5638576 DOI: 10.2147/dddt.s143226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a highly prevalent disorder with a substantial economical burden. Dual antiplatelet treatment (DAPT) upon endovascular stenting to prevent acute thrombotic reocclusions is an universally accepted practice for postinterventional management of PAD patients. However, the optimal period of time for DAPT upon endovascular stenting is not known. METHODS In the current nonrandomized, retrospective monocentric study, we evaluated the duration of DAPT upon endovascular stenting. A total of 261 endovascular SFA and iliac stenting procedures were performed on 214 patients and these patients were subdivided into a short (4-6 weeks) or a prolonged (8-12 weeks) DAPT regime group. More than 65% of the patients included were male, approximately 35% were diabetic, and 61% had a history of smoking. Of all the patients, 90% exhibited a Rutherford stage 2-3, and approximately half of the patients had a moderate-to-severe calcified target lesion with a length of >13 cm. Major safety end points were defined as any bleeding, compartment syndrome, and ischemic events. In addition to this, patency, all-cause mortality, as well as amputation were followed up over a period of 12 months upon intervention. RESULTS Twelve months after endovascular stenting, primary patency in our cohort was comparable between the groups (83.94% short vs 79.8% long DAPT, P>0.05). Major bleeding occurred in 18 cases without any difference between the groups (P>0.05). In addition, during the 12-month follow-up, 6 (3.4%) patients in the short and 3 (3.5%) in the prolonged DAPT regime suffered a stroke/transient ischemic attack (P>0.05). In addition, there was no difference regarding mortality and amputation rate comparing short vs prolonged DAPT regime in a 12-month follow-up. CONCLUSION In the current cohort, prolonged DAPT after endovascular stenting had no beneficial effect on the outcome in a 12-month follow-up.
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Affiliation(s)
- Mariya Kronlage
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Maximilian Wassmann
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Britta Vogel
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Oliver J Müller
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | | | - Hugo Katus
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg.,DZHK German Center for Cardiovascular Research, Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christian Erbel
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
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de Boer SW, van den Heuvel DAF, de Vries-Werson DAB, Vos JA, Fioole B, Vroegindeweij D, Elgersma OE, Tutein Nolthenius RP, Heyligers JMM, Bosma GPT, de Leeuw B, Bouwman LH, Böckler D, Dovzhanskiy DI, Vos FWF, Vink TWF, Hooijboer PGA, Hissink RJ, de Vries JPPM. Short-term Results of the RAPID Randomized Trial of the Legflow Paclitaxel-Eluting Balloon With Supera Stenting vs Supera Stenting Alone for the Treatment of Intermediate and Long Superficial Femoral Artery Lesions. J Endovasc Ther 2017; 24:783-792. [DOI: 10.1177/1526602817725062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanne W. de Boer
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Jan Albert Vos
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Damnis Vroegindeweij
- Department of Interventional Radiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Otto E. Elgersma
- Department of Interventional Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Jan M. M. Heyligers
- Department of Vascular Surgery, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Gerlof P. T. Bosma
- Department of Interventional Radiology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Bernart de Leeuw
- Department of Interventional Radiology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Lee H. Bouwman
- Department of Vascular Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Dittmar Böckler
- Clinic for Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | | | - Floris W. F. Vos
- Department of Vascular Surgery, Medical Centre Leeuwarden, the Netherlands
| | - Ted W. F. Vink
- Department of Interventional Radiology, Medical Centre Leeuwarden, the Netherlands
| | | | - Rutger J. Hissink
- Department of Vascular Surgery, Scheper Hospital, Emmen, the Netherlands
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Impact of Implantation Defects on Intermediate Outcome of Supera Stent for Popliteal Artery Stenosis. Ann Vasc Surg 2017; 41:186-195. [DOI: 10.1016/j.avsg.2016.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/05/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022]
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Abstract
Critical limb ischemia (CLI) is a clinical syndrome of ischemic pain at rest or tissue loss, such as nonhealing ulcers or gangrene, related to peripheral artery disease. CLI has a high short-term risk of limb loss and cardiovascular events. Noninvasive or invasive angiography help determine the feasibility and approach to arterial revascularization. An endovascular-first approach is often advocated based on a lower procedural risk; however, specific patterns of disease may be best treated by open surgical revascularization. Balloon angioplasty and stenting form the backbone of endovascular techniques, with drug-eluting stents and drug-coated balloons offering low rates of repeat revascularization. Combined antegrade and retrograde approaches can increase success in long total occlusions. Below the knee, angiosome-directed angioplasty may lead to greater wound healing, but failing this, any straight-line flow into the foot is pursued. Hybrid surgical techniques such as iliac stenting and common femoral endarterectomy are commonly used to reduce operative risk. Lower extremity bypass grafting is most successful with a good quality, long, single-segment autogenous vein of at least 3.5-mm diameter. Minor amputations are often required for tissue loss as a part of the treatment strategy. Major amputations (at or above the ankle) limit functional independence, and their prevention is a key goal of CLI therapy. Medical therapy after revascularization targets risk factors for atherosclerosis and assesses wound healing and new or recurrent flow-limiting disease. The ongoing National Institutes of Health-sponsored Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia (BEST-CLI) study is a randomized trial of the contemporary endovascular versus open surgical techniques in patients with CLI.
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Affiliation(s)
- Scott Kinlay
- From the Cardiovascular Division, Department of Medicine, VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Myint M, Schouten O, Bourke V, Thomas SD, Lennox AF, Varcoe RL. A Real-World Experience With the Supera Interwoven Nitinol Stent in Femoropopliteal Arteries. J Endovasc Ther 2016; 23:433-41. [DOI: 10.1177/1526602816639543] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the safety and midterm patency of the Supera interwoven nitinol stent in a real-world population and determine deployment and patient-related factors that may predispose to loss of patency. Methods: A retrospective analysis was conducted of 111 consecutive limbs from 97 patients (mean age 75.3 years; 68 men) with severe atherosclerotic disease of the superficial femoral and popliteal arteries that were treated with Supera stents between June 2012 and October 2014. Half the patients had claudication (56%); the remainder had rest pain (19%) and tissue loss (26%). Forty-eight (43%) lesions were chronic total occlusions, and more than half were classified as TransAtlantic Inter-Society Consensus C (22%) or D (30%). Results: All 146 Supera stents (1.32 stents per limb) were deployed successfully, extending over a mean length of 175.5±130.5 mm to treat lesions averaging 151.5±127.1 mm long. At 30 days, Kaplan-Meier estimated freedom from death, target lesion revascularization, and amputation was 97.3%. Primary patency and freedom from clinically driven target lesion revascularization rates were 87.1% and 95.0% at 6 months, respectively, and 78.9% and 87.6% at 12 months, respectively. Four distinct mechanisms for failure were identified in the 13 limbs in which patency was lost; stent intussusception (n=4), compromised inflow or outflow (n=2), gross oversizing (n=1), and neoplastic thrombophilia (n=1); the cause of 5 occlusions could not be identified. Conclusion: In this heterogeneous group that included long and complex atheromatous femoropopliteal lesions, the Supera stent achieved excellent clinical and patency results at 1 year. Further improvement may be achieved through careful patient selection and the avoidance of deployment pitfalls.
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Affiliation(s)
- Michael Myint
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Olaf Schouten
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Victor Bourke
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
| | - Shannon D. Thomas
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrew F. Lennox
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
| | - Ramon L. Varcoe
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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25
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Treitl M, Reiser MF, Treitl KM. [Stent-assisted recanalization of femoropopliteal arterial occlusive disease. Influence of stent design on patency rates]. Radiologe 2016; 56:233-9. [PMID: 26842999 DOI: 10.1007/s00117-016-0077-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite enormous technical progress the results of endovascular treatment of the femoropopliteal vasculature are unsatisfactory and its role is still controversially discussed. In the past decade numerous new stent designs have come onto the market but it is unclear whether they have benefits with respect to patency rates. OBJECTIVES Comparison of published data on patency rates and target lesion revascularization rates after use of different stent designs in the femoropopliteal vasculature. MATERIAL AND METHODS Analysis of 25 published studies and registries from 2006 to 2015 for classical open-cell stents, interwoven stents and partially or fully covered stents. RESULTS AND CONCLUSION The published data are heterogeneous and comparative studies for different stent designs are completely missing. Over the past decade the patency rates after femoropopliteal stenting could be improved. According to available data stenting of short lesions < 5 cm does not show any benefit compared to isolated balloon angioplasty. Primary stenting is now recommended for intermediate and longer lesions > 6.4 cm. Due to the heterogeneity of published data a clear benefit for a specific stent design is not obvious; however, data for interwoven stents are promising and show a tendency towards improved patency, at least for certain lesions. Randomized controlled comparative trials are needed to confirm this result.
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Affiliation(s)
- M Treitl
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland.
| | - M F Reiser
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - K M Treitl
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland
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26
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Chan YC, Cheng SW, Cheung GC. Predictors of restenosis in the use of helical interwoven nitinol stents to treat femoropopliteal occlusive disease. J Vasc Surg 2015; 62:1201-9. [DOI: 10.1016/j.jvs.2015.05.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022]
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27
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Abstract
Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.
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Affiliation(s)
- Arun K Thukkani
- From BJCMG Cardiology, Missouri Baptist Hospital, Saint Louis (A.K.T.); and Cardiovascular Divisions, VA Boston Healthcare System and Brigham and Women's Hospital, MA
| | - Scott Kinlay
- From BJCMG Cardiology, Missouri Baptist Hospital, Saint Louis (A.K.T.); and Cardiovascular Divisions, VA Boston Healthcare System and Brigham and Women's Hospital, MA.
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28
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Bishu K, Armstrong EJ. Supera self-expanding stents for endovascular treatment of femoropopliteal disease: a review of the clinical evidence. Vasc Health Risk Manag 2015. [PMID: 26203255 PMCID: PMC4508067 DOI: 10.2147/vhrm.s70229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Femoropopliteal lesions account for a significant proportion of endovascular interventions for peripheral artery disease in patients with disabling claudication or chronic limb ischemia. The femoropopliteal artery crosses two joint structures (hip and knee joints) and courses through the muscular adductor canal in the thigh, which places the artery at increased biomechanical stress. There is a critical need for stent platforms with a reduced risk of stent fracture while maintaining patency during long-term follow-up. The Supera peripheral stent system has a braided nickel–titanium alloy stent designed to withstand the unique stressors along the course of the femoropopliteal artery. This design may be associated with improved patency in association with reduced stent fracture rates on short- and medium-term follow-up. Further studies, including randomized controlled studies, comparing the Supera interwoven nickel–titanium alloy stent system with other stent platforms and angioplasty alone are needed.
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Affiliation(s)
- Kalkidan Bishu
- Division of Cardiology, University of Colorado, Aurora, USA ; Denver VA Medical Center, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, University of Colorado, Aurora, USA ; Denver VA Medical Center, Denver, CO, USA
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29
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Panico A, Jafferani A, Shah F, Dieter RS. Advances in Peripheral Arterial Disease Endovascular Revascularization. Cardiol Clin 2015; 33:89-98. [DOI: 10.1016/j.ccl.2014.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Yiu WK, Conte MS. Primary Stenting in Femoropopliteal Occlusive Disease – What Is the Appropriate Role? –. Circ J 2015; 79:704-11. [DOI: 10.1253/circj.cj-15-0199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wai-ki Yiu
- Division of Vascular and Endovascular Surgery, University of California
| | - Michael S. Conte
- Division of Vascular and Endovascular Surgery, University of California
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