1
|
Abstract
Background: Disabling peripheral arterial disease (PAD) of femoropopliteal segment is usually treated with percutaneous balloon dilatation, and when this is not successful, stent is placed. Long-term patency of stent is often compromised due to in-stent restenosis (ISR). We aimed to identify factors associated with bailout stenting, and to recognise risk factors for ISR in procedures without paclitaxel application. Patients and methods: We analysed 592 consecutive successful femoropopliteal interventions performed in patients with either disabling intermittent claudication or chronic critical limb ischemia (CLI). In patients with stent implantation, clinical and ultrasound (US) examination were performed one year after the intervention to establish the presence of ISR, defined as >50% stenosis on US imaging. Results: Bailout stenting was required in 133 (22.5%) procedures. Patients with stent placement were younger (70±10 vs 72±11 years, p=0.007) and less often presented with CLI (29.3% vs 40.5%, p=0.019). They more often reported smoking (63.2% vs 49.2%, p=0.005), less often had diabetes mellitus (35.3% vs 47.5%, p=0.013) and arterial hypertension (82.0% vs 90.8%; p=0.004). Stenting was also dependent on lesion complexity (TASC II C>B>A; p<0.001). Subgroup analysis of 110 procedures with bare metal stent (BMS) placement performed in 107 patients revealed ISR in 46.4% of stents, in half of cases it was symptomatic. Neither clinical nor lesion characteristics proved to differ between the group of procedures with ISR and group of procedures without ISR. Conclusions: Factors associated with bailout stenting were age, diabetes mellitus, arterial hypertension, smoking, clinical picture of PAD and complexity of treated lesions. We did not find any risk factors influencing development of ISR in BMS.
Collapse
Affiliation(s)
- Anja Boc
- Faculty of Medicine, Institute of Anatomy, University of Ljubljana, Ljubljana, Slovenia.,Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Barbara Eržen
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rok Luciano Perme
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
2
|
Mohamedali A, Kiwan G, Kim T, Zhang Y, Zhuo H, Tonnessen B, Dardik A, Chaar CIO. Reinterventions in Patients with Claudication and Chronic Limb Threatening Ischemia. Ann Vasc Surg 2021; 79:56-64. [PMID: 34656724 DOI: 10.1016/j.avsg.2021.07.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/27/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) present with claudication or chronic limb threatening ischemia (CLTI). CLTI patients have a more advanced stage of atherosclerosis and increased comorbidities compared to claudicants, and are at an elevated risk of major amputation and mortality after lower extremity revascularization (LER). However, the frequency of reinterventions for claudication and CLTI have not been compared. Our hypothesis is that patients with CLTI undergo more frequent reinterventions to prevent major amputation. METHODS A single-center retrospective chart review of consecutive patients undergoing lower extremity revascularization (LER) for PAD in 2013-2015 was performed. Patients were stratified based on indication for revascularization into claudication or CLTI. Patient characteristics, outcomes, and reinterventions were compared between the 2 groups. RESULTS There were 826 patients undergoing LER and 44% (N = 361) had CLTI. Patients treated for CLTI were more likely to be smokers (P < 0.001), to have diabetes (P< 0.001), chronic renal insufficiency (P< 0.001), end stage renal disease (P< 0.001), and cardiac disease (P< 0.001). CLTI patients were less likely to be on optimal medical management as reflected by decreased rate of aspirin (P< 0.001), ADP receptor/P2Y12 inhibitors (P< 0.001), and statins (P< 0.001) compared to patients with claudication. Patients with CLTI had significantly higher major amputation (3.7% vs. 0.2%, P< 0.001) and mortality (1.4% vs. 0.2%, P = 0.092) at 30 days. At long-term follow up, patients with CLTI had higher rates of major amputation (15.5% vs. 1.3%, P < 0.001) and mortality (37.1% vs. 18.1%, P < 0.001) compared to patients with claudication. There was a significant difference in mean follow-up time between the 2 cohorts (claudication: 3.7 ± 1.5 years versus CLTI: 2.6 ± 1.8 years, P < 0.001). There was no significant difference in the ipsilateral reintervention rate between the 2 groups (claudication: 39.6% vs. CLTI: 42.7%, P = 0.37) or the mean number of ipsilateral reinterventions (claudication: 2.0 ± 1.6 vs. CLTI: 2.0 ± 1.7). However, after adjusting for follow-up time, the mean number of reinterventions per year was significantly higher for CLTI patients compared to patients with claudication (1.4 ± 2.2 vs. .6 ± 0.7 intervention per year, P < 0.001). CONCLUSIONS Patients undergoing LER for CLTI undergo more frequent reinterventions over time compared to patients treated for claudication. Research on reinterventions after LER should include reporting of the frequency of reintervention adjusted for the follow up period in addition to the reintervention rate defined as the percentage of patients undergoing reintervention.
Collapse
Affiliation(s)
- Alaa Mohamedali
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT.
| | - Gathe Kiwan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Tanner Kim
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Yawei Zhang
- Division of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Haoran Zhuo
- Division of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Britt Tonnessen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| |
Collapse
|
3
|
ACCROCCA F, SIANI A, GABRIELLI R, DE VIVO G, SMEDILE G, RIZZO AR, CASTRUCCI T, BARTOLI S. The insidious femoropopliteal tract. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.23736/s1824-4777.21.01493-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
4
|
Chae IH, Yoon CH, Ko YG, Min PK, Lee JH, Yu CW, Lee SW, Lee SR, Choi SH, Koh YS, Choi D. Differential efficacy between stenting and plain balloon angioplasty for femoropopliteal disease with or without total occlusion. Korean J Intern Med 2020; 35:1114-1124. [PMID: 32088945 PMCID: PMC7487302 DOI: 10.3904/kjim.2019.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/02/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIMS Whether the presence of chronic total occlusion (CTO) affects patency after stenting in femoropopliteal lesions is unknown. We determined the effects of plain balloon angioplasty (POBA) in comparison with those of stenting on patency for femoropopliteal CTO and stenosis (non-CTO). METHODS We analyzed data from the Korean Vascular Intervention Society Endovascular Therapy in Lower-Limb Artery Diseases Registry, a multicenter cohort of patients with lower extremity peripheral arterial disease. Data from 1,329 patients and 1558 limbs treated with endovascular intervention for at least one femoropopliteal lesion were evaluated. RESULTS Among the 1,558 limbs, 345, 432, 275, and 506 were in the non-CTO-POBA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. During follow-up, loss of clinical primary patency, a composite of freedom from restenosis or clinically driven target lesion revascularization, occurred in 65 (18.8%), 68 (15.7%), 62 (22.5%), and 113 limbs (22.3%) in the non-CTO-POBA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. The patients in the non-CTO-stent group showed a significantly better clinical primary patency than those in the no-CTO-POBA group, whereas those in the CTO-stent and CTO-POBA groups showed no significant differences. After inverse probability of treatment weighting to balance the differences among covariates between the non-CTO-stent and non-CTO-POBA groups, the non-CTO-stent group still showed superior clinical primary patency as compared with the non-CTO-POBA group. CONCLUSION In the patients with femoropopliteal stenosis without CTO, stenting resulted in better clinical outcomes than balloon angioplasty. The presence of CTO in the femoropopliteal lesion should be considered when selecting a suitable device for performing endovascular procedures.
Collapse
Affiliation(s)
- In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea
- Correspondence to Chang-Hwan Yoon, M.D. Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7052 Fax: +82-31-787-4052 E-mail:
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Ki Min
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Seok Koh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Ng JJ, Choong AMTL. Letter by Ng and Choong Regarding Article, "Absence of Long-Term Benefit of Revascularization in Patients With Intermittent Claudication: Five-Year Results From the IRONIC Randomized Controlled Trial". Circ Cardiovasc Interv 2020; 13:e009322. [PMID: 32519891 DOI: 10.1161/circinterventions.120.009322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jun Jie Ng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore. Division of Vascular and Endovascular Surgery, National University Heart Centre Singapore. Singapore Vascular Surgical Collaborative
| | - Andrew M T L Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore. Division of Vascular and Endovascular Surgery, National University Heart Centre Singapore. Singapore Vascular Surgical Collaborative
| |
Collapse
|
6
|
Device Selection in Femoral-Popliteal Arterial Interventions. Interv Cardiol Clin 2020; 9:197-206. [PMID: 32147120 DOI: 10.1016/j.iccl.2019.12.001] [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: 12/24/2022]
Abstract
Endovascular intervention devices for femoral-popliteal arterial disease have evolved in the last decade to more effectively treat patients with symptoms of claudication, improve tissue healing, and prevent amputation in patients with critical limb ischemia. Drug-eluting stents and drug-coated balloon therapies have demonstrated significant improvements in short- and mid-term patency and decreases in future target vessel interventions over uncoated balloon angioplasty. Adjunctive lesion preparation options including atherectomy devices are available to treat more complex and calcified lesions, but comparative data are still required.
Collapse
|
7
|
Geiger MA, Guillaumon AT. Primary stenting for femoropopliteal peripheral arterial disease: analysis up to 24 months. J Vasc Bras 2019; 18:e20160104. [PMID: 31191625 PMCID: PMC6542323 DOI: 10.1590/1677-5449.010416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022] Open
Abstract
Background Primary stenting is a well-established treatment option for femoropopliteal arterial obstructive disease. There is a shortage of Brazilian studies of the subject. Objectives To evaluate short and mid-term clinical and radiological outcomes in patients classified as Rutherford 3-6 and treated with stenting of femoropopliteal lesions. Methods Analysis based on a prospectively populated database of patients treated from July 2012 to July 2015. The primary endpoint was primary patency. Secondary endpoints were clinical and ankle/brachial index changes. Target Vessel Revascularization, limb salvage rate and death, within a 24-month follow-up period. Results 64 patients were enrolled, including 61 TASC II A / B lesions (95%). The primary patency rates at 6, 12, and 24 months were 95.2%, 79.1% and 57.9%, respectively. Cox regression analysis revealed lower patency rates in patients with occlusive disease (hazard ratio [HR], 6.64; 95% confidence interval [CI], 1.52-28,99, p = 0.02), as well as patency loss about 6 times higher in TASC B than in TASC A patients ([HR], 5.95, 95% CI, 1.67-21.3, p = 0.0061). At 12 months, 90.38% of the patients remained asymptomatic. The limb salvage rate at 24 months was 94.3% (95% CI, 87.9-100%). Freedom from TVR at 24 months was 90.5% (95% CI 82.8-98.9%). Conclusions Results of primary patency were compatible with international studies, despite the more advanced stage of the vascular disease observed in our group. Occlusive disease and complex lesions were both associated with worse outcomes.
Collapse
Affiliation(s)
- Martin Andreas Geiger
- Universidade Estadual de Campinas - UNICAMP, Hospital de Clínicas, Disciplina de Moléstias Vasculares, Campinas, SP, Brasil
| | - Ana Terezinha Guillaumon
- Universidade Estadual de Campinas - UNICAMP, Hospital de Clínicas, Disciplina de Moléstias Vasculares, Campinas, SP, Brasil
| |
Collapse
|
8
|
Yalcin M, Tiryakioglu O. Early and mid-term results of surgical and endovascular intervention in total occlusion of superficial femoral artery: Which one is better? INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_37_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Vossen RJ, Vahl AC, Leijdekkers VJ, Montauban van Swijndregt AD, Balm R. Long-Term Clinical Outcomes of Percutaneous Transluminal Angioplasty with Optional Stenting in Patients with Superficial Femoral Artery Disease: A Retrospective, Observational Analysis. Eur J Vasc Endovasc Surg 2018; 56:690-698. [PMID: 30108029 DOI: 10.1016/j.ejvs.2018.06.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The recent ESC guideline advises primary stent placement in superficial femoral arterial disease (SFAD). The aim of this study was to compare clinical outcomes of SFAD patients selected for stent placement with plain percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS A single centre retrospective, observational analysis was performed of all consecutive patients undergoing endovascular treatment for SFAD from 2004 to 2015. Primary endpoints were primary and secondary clinical patency rates in patients with or without stent placement. Secondary endpoints were recurrence rates and number of amputations. Kaplan-Meier curves were used to compare patency rates. Multivariable Cox regression analysis was performed to adjust for confounding variables and to identify variables associated with loss of patency. RESULTS A total of 389 patients were analysed with a median follow up of 42 months. Two hundred and fifty one patients (64.5%) were stented. Primary clinical patency rates at 1, 3, and 5 years were 82.8%, 71.0%, and 65.6% after PTA and 76.3%, 65.7%, and 58.1% after stent placement (PTA-S), respectively (p = .30). Secondary patency rates were also comparable for the PTA and PTA-S group resulting in 1, 3 and 5 year clinical secondary patency of 89.1%, 81.0%, and 76.3% in the PTA group versus 87.8%, 78.5%, and 71.9% in the PTA-S group (p = .58). Multivariable analysis revealed equal primary and secondary clinical patency between the treatment groups. The absolute re-intervention rate was 29.3%. The number of re-interventions and amputation rate did not significantly differ between the two groups (p = .41 and p = .75). CONCLUSIONS Selective stenting in patients with SFAD shows comparable results in long-term clinical outcomes in patients who were treated with plain PTA as well as patients who are selected for stent placement. An approach of selective stenting is justified.
Collapse
Affiliation(s)
- Rianne J Vossen
- Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands.
| | - Anco C Vahl
- Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands
| | | | | | - Ron Balm
- Department of Vascular Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
10
|
Feldman DN, Armstrong EJ, Aronow HD, Gigliotti OS, Jaff MR, Klein AJ, Parikh SA, Prasad A, Rosenfield K, Shishehbor MH, Swaminathan RV, White CJ. SCAI consensus guidelines for device selection in femoral-popliteal arterial interventions. Catheter Cardiovasc Interv 2018; 92:124-140. [DOI: 10.1002/ccd.27635] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Herbert D. Aronow
- The Warren Alpert Medical School of Brown University; Providence Rhode Island
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Ben Hammamia M, Ben Mrad M, Derbel B, Miri R, Ziadi J, Ghedira F, Denguir R, Kalfat T. [Femoropopliteal angioplasty: Short- and mid-term results]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:204-212. [PMID: 28705338 DOI: 10.1016/j.jdmv.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Percutaneous endovascular therapy is becoming a primary option for managing femoropopliteal occlusive disease. The purpose of this study was to evaluate the mid-term results of endovascular treatment of femoropopliteal arterial disease. METHODS Femoropopliteal percutaneous transluminal angioplasty was performed on 162 consecutive limbs (160 patients) from January 2006 to January 2016. RESULTS In our study, 87.6% of patients had critical limb ischemia. Lesions were classified as Trans-Atlantic Inter-Society Consensus (TASC) A (43%), B (43%), C (7%), and D (7%). Femoropopliteal interventions included angioplasty only in 70 cases (43.2%), and the remaining 92 (56.8%) received at least one stent. Technical success was achieved in 98.7% of patients, with three deaths and a major morbidity rate of 15%. The actuarial primary patency at 12 and 36 month was 65.4% and 40.2%, respectively, 33 peripheral reinterventions were performed after femoropopliteal axis occlusion, resulting in an actuarial primary limb preservation rate of 94.4 at 12 months. Comparison between angioplasty only and the use of stent show no difference in primary patency (P=0.832) and limb salvage (P=0.67). Negative predictors of primary patency determined by univariate analysis included popliteal location (P<0.001) and TASC D (P<0.001). However, diabetes mellitus (P=0.001) and poor run off (P<0.001) were the principal predictive factors of limb loss. CONCLUSION Femoropopliteal angioplasty can be performed with a low morbidity and mortality. Intermediate primary patency is directly related to TASC classification and popliteal localization.
Collapse
Affiliation(s)
- M Ben Hammamia
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie.
| | - M Ben Mrad
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - B Derbel
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - R Miri
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - J Ziadi
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - F Ghedira
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - R Denguir
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - T Kalfat
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| |
Collapse
|
12
|
Goldsweig AM, Aronow HD. Novel Strategies to Reduce Femoropopliteal Restenosis: Low-Dose Paclitaxel-Coated Balloons and Paclitaxel-Coated Balloons Plus Stenting. Circulation 2017; 135:2237-2240. [PMID: 28424224 DOI: 10.1161/circulationaha.117.028308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew M Goldsweig
- From Lifespan Cardiovascular Institute and Warren Alpert Medical School of Brown University, Providence, RI
| | - Herbert D Aronow
- From Lifespan Cardiovascular Institute and Warren Alpert Medical School of Brown University, Providence, RI.
| |
Collapse
|
13
|
Results of primary stent therapy for femoropopliteal peripheral arterial disease at 7 years. J Vasc Surg 2016; 64:1696-1702. [DOI: 10.1016/j.jvs.2016.05.073] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
|
14
|
Islam J, Robbs JV. Comparison between superficial femoral artery stenting and bypass surgery in severe lower-limb ischaemia: a retrospective study. Cardiovasc J Afr 2015; 26:34-7. [PMID: 25784315 PMCID: PMC4814758 DOI: 10.5830/cvja-2014-074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/27/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Symptomatic femoro-popliteal disease is treated by bypass surgery or angioplasty with or without stenting. The aim of this study was to compare the results of stenting and bypass surgery with regard to limb salvage in patients with severe leg ischaemia. METHODS A total of 213 patients with femoro-popliteal disease presenting with severe claudication or critical limb ischaemia between January 2009 and December 2013 were evaluated; 118 patients (139 limbs) had stents placed and 95 patients (104 limbs) had bypass surgery. Most (60%) presented with critical limb ischaemia (rest pain 40%, tissue necrosis 20%), and the remainder with severe claudication. The treatment groups had matching risk factors. RESULTS The average age was 66 years and 73% were male. Tissue necrosis was found in 26% of the stent group and 12% of the bypass group (p = 0.009). In the stent group 26% had adjunctive procedures, compared to 16% in the bypass group (p = 0.138). During the one-year follow up, there were 30 stent occlusions (22%) and 18 graft occlusions (17%) (p = 0.42). There were 14 major amputations (10%) in the stent group, and 13 (13%) in the bypass group (p = 0.68). Limb salvage rate was 90% in the stent group, and 88% in the bypass group (p = 0.68). There were no peri-operative deaths in the stent group, but one in the bypass group (1%). One-year mortality rate was equal (8%) in both groups (p = 1.00). CONCLUSION One-year outcome was comparable in both groups with regard to mortality, stent or graft patency and limb salvage rates.
Collapse
Affiliation(s)
- J Islam
- Department of Vascular Surgery, Grey's Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | - J V Robbs
- University of KwaZulu-Natal, and Entabeni Hospital, Durban, South Africa
| |
Collapse
|
15
|
Shammas NW. Commentary: The Adluminal Origin of Restenosis in Peripheral Artery Interventions and Its Implications for the Development of Future Treatment Strategies. J Endovasc Ther 2015; 22:716-8. [DOI: 10.1177/1526602815600712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
16
|
Rigatelli G, Palena M, Cardaioli P, dell'Avvocata F, Giordan M, Vassilev D, Manzi M. Prolonged high-pressure balloon angioplasty of femoropopliteal lesions: Impact on stent implantation rate and mid-term outcome. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:126-30. [PMID: 25009562 PMCID: PMC4076452 DOI: 10.3969/j.issn.1671-5411.2014.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 05/22/2014] [Accepted: 05/25/2014] [Indexed: 11/24/2022]
Abstract
Objectives To assess the impact on stent implantation rate and mid-term outcomes of prolonged high pressure angioplasty of femoropopliteal lesions. Methods We retrospectively enrolled 620 consecutive patients from January 2011 to December 2011 (75.6 ± 12.3 years, 355 males, 76.5% in Rutherford class 5–6), referred for critical limb ischemia and submitted to prolonged high-pressure angioplasty of femoropopliteal lesions. The definition of prolonged high-pressure angioplasty includes dilation to at least 18 atm for at least 120 s. Procedural data, and clinical and instrumental follow-up were analyzed to assess stent implantation rate and mid-term outcomes. Results The preferred approach was ipsilateral femoral antegrade in 433/620 patients (69.7%) and contralateral cross-over in 164/620 (26.4%) and popliteal retrograde + femoral antegrade in 23/620 (3.7%). Techniques included subintimal angioplasty in 427/620 patients (68.8%) and endoluminal angioplasty in 193/620 patients (31.2%). The prolonged high pressure balloon angioplasty procedure was successful in 86.2% (minor intra-procedural complications rate 15.7 %), stent implantation was performed in 74 patients (11.9%), with a significant improvement of ankle-brachial index (0.29 ± 0.6 vs. 0.88 ± 0.3, P < 00.1) and Rutherford class (5.3 ± 0.8 vs. 0.7 ± 1.9, P < 0.01), a primary patency rate of 86.7%, restenosis of 18.6 % on Doppler ultrasound and a target lesion revascularization of 14.8% at a mean follow-up of 18.1 ± 6.4 months (range 1–24 months). Secondary patency rate was 87.7%. Conclusions Prolonged high pressure angioplasty of femoropopliteal lesions appears to be safe and effective allowing for an acceptable patency and restenosis rates on mid-term.
Collapse
Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Mariano Palena
- Interventional Radiology Unit, Abano Terme General Hospital, Padova, Italy
| | - Paolo Cardaioli
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Fabio dell'Avvocata
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Massimo Giordan
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Dobrin Vassilev
- Interventional Cardiology Department, National Heart Institute, Sofia, Bulgaria
| | - Marco Manzi
- Interventional Radiology Unit, Abano Terme General Hospital, Padova, Italy
| |
Collapse
|
17
|
Borghese O, Sapienza P, Venturini L, Bononi M, di Marzo L. Considerations. Vasc Endovascular Surg 2014; 48:365-6. [DOI: 10.1177/1538574414540343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ottavia Borghese
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Luigi Venturini
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Marco Bononi
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Luca di Marzo
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| |
Collapse
|
18
|
Friedell ML, Stark KR, Kujath SW, Carter RR. Current status of lower-extremity revascularization. Curr Probl Surg 2014; 51:254-90. [DOI: 10.1067/j.cpsurg.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/25/2014] [Indexed: 11/22/2022]
|
19
|
Grenville JL, Tan KT, Moshonov H, Rajan DK. Endovascular first strategy for de novo TransAtlantic Inter-Society Consensus C and D femoro-popliteal disease: mid-term outcomes from a single tertiary referral center. Vascular 2014; 23:31-40. [PMID: 24695358 DOI: 10.1177/1708538114529564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Describe outcomes after endovascular intervention of TransAtlantic Inter-Society Consensus C and D femoro-popliteal disease. MATERIALS AND METHODS Retrospective cohort study. Patient demographics, ankle-brachial indices, and lesion details were analyzed from a prospectively maintained database. In all, 980 limbs treated with percutaneous transluminal angioplasty±stenting of the femoro-popliteal segment between 2005 and 2012 were reviewed. Seventy-six patients representing 83 limbs with de novo TransAtlantic Inter-Society Consensus C and D lesions measuring ≥15 cm continuously were identified (mean age 71.3±12.1 years, 62% male). RESULTS Twenty-five (30.1%) limbs were treated for severe claudication and 58 (69.9%) for critical limb ischemia. The mean pre-procedural ankle-brachial index was 0.47±0.19. The mean lesion length was 22.9±4.82 cm. Seventy patients representing 77 limbs were available for a mean follow-up length of 19.5 months (range 0-79). The mean post-procedural ankle-brachial index was 0.71±0.28. Primary, assisted-primary, and secondary patency rates were 68.1%, 72.7%, and 83.3% at 6 months, 55.3%, 63.6%, and 58.3% at 12 months, and 38.2%, unavailable, and 10.4% at 24 months, respectively. CONCLUSIONS Angioplasty-first strategy for TransAtlantic Inter-Society Consensus C and D lesions of the femoro-popliteal artery can be safely performed. However, patency drastically decreases after 12 months suggesting further improvements are required to achieve longer-term clinical benefit.
Collapse
Affiliation(s)
- Jeffrey Lorne Grenville
- Diagnostic Radiology Program, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Kong Teng Tan
- Department of Medical Imaging, The University Health Network, Toronto, Ontario, Canada
| | - Hadas Moshonov
- Department of Medical Imaging, The University Health Network, Toronto, Ontario, Canada
| | - Dheeraj Kumar Rajan
- Department of Medical Imaging, The University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Liistro F, Angioli P, Porto I, Ricci L, Ducci K, Grotti S, Falsini G, Ventoruzzo G, Turini F, Bellandi G, Bolognese L. Paclitaxel-Eluting Balloon vs. Standard Angioplasty to Reduce Recurrent Restenosis in Diabetic Patients With In-Stent Restenosis of the Superficial Femoral and Proximal Popliteal Arteries: The DEBATE-ISR Study. J Endovasc Ther 2014; 21:1-8. [DOI: 10.1583/13-4420r.1] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
21
|
Gasper WJ, Jimenez CA, Walker J, Conte MS, Seward K, Owens CD. Adventitial nab-rapamycin injection reduces porcine femoral artery luminal stenosis induced by balloon angioplasty via inhibition of medial proliferation and adventitial inflammation. Circ Cardiovasc Interv 2013; 6:701-9. [PMID: 24221390 DOI: 10.1161/circinterventions.113.000195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endovascular interventions on peripheral arteries are limited by high rates of restenosis. Our hypothesis was that adventitial injection of rapamycin nanoparticles would be safe and reduce luminal stenosis in a porcine femoral artery balloon angioplasty model. METHODS AND RESULTS Eighteen juvenile male crossbred swine were included. Single-injury (40%-60% femoral artery balloon overstretch injury; n=2) and double-injury models (endothelial denudation injury 2 weeks before a 20%-30% overstretch injury; n=2) were compared. The double-injury model produced significantly more luminal stenosis at 28 days, P=0.002, and no difference in medial fibrosis or inflammation. Four pigs were randomized to the double-injury model and adventitial injection of saline (n=2) or 500 μg of nanoparticle albumin-bound rapamycin (nab-rapamycin; n=2) with an endovascular microinfusion catheter. There was 100% procedural success and no difference in endothelial regeneration. At 28 days, nab-rapamycin led to significant reductions in luminal stenosis, 17% (interquartile range, 12%-35%) versus 10% (interquartile range, 8.3%-14%), P=0.001, medial cell proliferation, P<0.001, and fibrosis, P<0.001. There were significantly fewer adventitial leukocytes at 3 days, P<0.001, but no difference at 28 days. Pharmacokinetic analysis (single-injury model) found rapamycin concentrations 1500× higher in perivascular tissues than in blood at 1 hour. Perivascular rapamycin persisted ≥8 days and was not detectable at 28 days. CONCLUSIONS Adventitial nab-rapamycin injection was safe and significantly reduced luminal stenosis in a porcine femoral artery balloon angioplasty model. Observed reductions in early adventitial leukocyte infiltration and late medial cell proliferation and fibrosis suggest an immunosuppressive and antiproliferative mechanism. An intraluminal microinfusion catheter for adventitial injection represents an alternative to stent- or balloon-based local drug delivery.
Collapse
Affiliation(s)
- Warren J Gasper
- From the Departments of Vascular Surgery (W.J.G., J.W., M.S.C., C.D.O.) and Pathology (C.A.J.), University of California, San Francisco; and Mercator MedSystems, Inc, San Leandro, California (K.S.)
| | | | | | | | | | | |
Collapse
|
22
|
Saxon RR, Chervu A, Jones PA, Bajwa TK, Gable DR, Soukas PA, Begg RJ, Adams JG, Ansel GM, Schneider DB, Eichler CM, Rush MJ. Heparin-bonded, expanded polytetrafluoroethylene-lined stent graft in the treatment of femoropopliteal artery disease: 1-year results of the VIPER (Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease) trial. J Vasc Interv Radiol 2013; 24:165-73; quiz 174. [PMID: 23369553 DOI: 10.1016/j.jvir.2012.10.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 10/02/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the performance of a heparin-bonded, expanded polytetrafluoroethylene (ePTFE)-lined nitinol endoprosthesis in the treatment of long-segment occlusive disease of the femoropopliteal artery (FPA) and to identify factors associated with loss of patency. MATERIALS AND METHODS In a single-arm, prospective, 11-center study (VIPER [Gore Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease] trial), 119 limbs (113 patients; 69 men; mean age, 67 y), including 88 with Rutherford category 3-5 disease and 72 with Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) C or D lesions of the FPA, underwent stent graft implantation. The mean lesion length was 19 cm; 56% of lesions were occlusions. Follow-up evaluations included color duplex ultrasonography in all patients, with patency defined as a peak systolic velocity ratio< 2.5. RESULTS At 12 months, Rutherford category and ankle-brachial index (ABI) were significantly improved (mean category improvement, 2.4; ABI increased from 0.6±0.2 to 0.9±0.19; P<.0001). Primary and secondary patency rates were 73% and 92%. The primary patency for devices oversized<20% at the proximal landing zone was 88%, whereas the primary patency for devices oversized by>20% was 70% (P = .047). Primary patency was not significantly affected by device diameter (5 vs 6 vs 7 mm) or lesion length (≤20 cm vs>20 cm). The 30-day major adverse event rate was 0.8%. CONCLUSIONS The heparin-bonded, ePTFE/nitinol stent graft provided clinical improvement and a primary patency rate of 73% at 1 year in the treatment of long-segment FPA disease. Careful sizing of the device relative to vessel landing zones is essential for achieving optimal outcomes.
Collapse
Affiliation(s)
- Richard R Saxon
- North County Radiology Medical Group, 3156 Vista Way, Suite 100, Oceanside, CA 92056, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kiguchi MM, Marone LK, Chaer RA, Winger DG, Shi ZY, Celis RI, Makaroun MS, Rhee RY. Patterns of femoropopliteal recurrence after routine and selective stenting endoluminal therapy. J Vasc Surg 2012; 57:37-43. [PMID: 22975333 DOI: 10.1016/j.jvs.2012.06.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/08/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study determined the incidence and characteristics of recurrent disease after femoropopliteal angioplasty, following either selective or routine stenting of diseased site(s). METHODS Retrospective analysis of a prospectively maintained database for femoropopliteal interventions from June 2003 to July 2010 was performed. Interventions during this period were from a single institution, followed up at 1, 3, and 6 months after initial intervention and on a semiannual basis thereafter with clinical examinations and duplex ultrasound imaging. Two groups were identified: those with routine stenting (RS; routine stenting for all diseased areas) and those with selective stenting (SS; selective stenting for only segments which exhibited compromised flow from residual stenosis or significant dissection). Patients who developed recurrent symptoms (claudication, rest pain), a decrease in ankle-brachial index (ABI) (>0.2), or duplex documentation of a significant (>80%) recurrent stenosis underwent reintervention. Patient demographics, comorbidities, Trans-Atlantic Inter-Society Consensus (TASC) II classification, runoff, and degree of calcification (none, mild, moderate, severe) at initial intervention were recorded. The time to reintervention and recurrence pattern were recorded for both groups. RESULTS During the study period, 746 endovascular interventions in 477 patients were performed. Total reintervention rate, including bypass, amputation, and asymptomatic occlusion after initial intervention, was 36.48% (group SS, 42.9%; group RS, 33.1%; P=.04). Of all initial interventions, 182 endovascular reinterventions in 165 patients for recurrent femoropopliteal disease were identified (group SS, 70; group RS, 95). No differences were noted among the groups in gender, comorbidities, initial TASC II classification, run off, calcification scores, or statin or clopidogrel use, or both. Time to recurrence was similar in the RS and SS groups. TASC II classification, runoff score, and degree of calcification were similar between the two groups. Although not statistically significant, analysis of recurrence pattern demonstrated de novo stenosis was more common in the SS group (50.0% vs 34.7%; P=.06). CONCLUSIONS This single-center retrospective study found a significant difference in the incidence of recurrence requiring reintervention between patients treated with selective and routine stenting for femoropopliteal disease. Analysis of endovascular reinterventions, however, reveals no significant difference in recurrence time or recurrence pattern between the two groups. No significant differences were identified in time to recurrence, TASC II classification, runoff, and calcification of endovascular reinterventions between the two groups' end points. Additional prospective studies to evaluate the roles of routine and selective stenting in symptomatic femoropopliteal peripheral arterial disease and to investigate recurrence lesion characteristics and the patency of multiple endovascular interventions between these two groups are needed.
Collapse
Affiliation(s)
- Misaki M Kiguchi
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | | | | | | |
Collapse
|