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Zhou JJ, Alawneh Y, Sewani A, Keshavarz M, Tahmasebi M, Roy T, Kayssi A, Dueck A, Wright GA, Tavallaei MA. The CathPilot: Performance Validation and Preclinical Safety and Feasibility Assessment. IEEE Trans Biomed Eng 2023; 70:3116-3125. [PMID: 37195835 DOI: 10.1109/tbme.2023.3276199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Peripheral endovascular revascularization procedures often fail due to technical limitations of guidewire support, steering, and visualization. The novel CathPilot catheter aims to address these challenges. This study assesses the safety and feasibility of the CathPilot and compares its performance to conventional catheters for peripheral vascular interventions. METHODS The study compared the CathPilot to non-steerable and steerable catheters. The success rates and access times for a relevant target inside a tortuous vessel phantom model were assessed. The reachable workspace within the vessel and the guidewire's force delivery capabilities were also evaluated. To validate the technology, chronic total occlusion tissue samples were used ex vivo to compare crossing success rates with conventional catheters. Finally, in vivo experiments in a porcine aorta were conducted to evaluate safety and feasibility. RESULTS The success rates for reaching the set targets were 31%, 69%, and 100% with the non-steerable catheter, the steerable catheter, and the CathPilot, respectively. CathPilot had a significantly larger reachable workspace, and allowed for up to four times higher force delivery and pushability. In crossing of chronic total occlusion samples, the CathPilot achieved a success rate of 83% and 100%, for fresh and fixed lesions respectively, which was also significantly higher than conventional catheters. The device was fully functional in the in vivo study, and there were no signs of coagulation or damage to the vessel wall. CONCLUSION This study shows the safety and feasibility of the CathPilot system and its potential to reduce failure and complication rates in peripheral vascular interventions. The novel catheter outperformed conventional catheters in all defined metrics. This technology can potentially improve the success rate and outcome of peripheral endovascular revascularization procedures.
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Alawneh Y, Zhou JJ, Sewani A, Tahmasebi M, Roy TL, Kayssi A, Dueck AD, Wright GA, Tavallaei MA. Experimental Protocol and Phantom Design and Development for Performance Characterization of Conventional Devices for Peripheral Vascular Interventions. Ann Biomed Eng 2023:10.1007/s10439-023-03160-x. [PMID: 36808383 DOI: 10.1007/s10439-023-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
Conventional catheter-based interventions for treating peripheral artery disease suffer high failure and complication rates. The mechanical interactions with the anatomy constrain catheter controllability, while their length and flexibility limit their pushability. Also, the 2D X-ray fluoroscopy guiding these procedures fails to provide sufficient feedback about the device location relative to the anatomy. Our study aims to quantify the performance of conventional non-steerable (NS) and steerable (S) catheters in phantom and ex vivo experiments. In a 10 mm diameter, 30 cm long artery phantom model, with four operators, we evaluated the success rate and crossing time in accessing 1.25 mm target channels, the accessible workspace, and the force delivered through each catheter. For clinical relevance, we evaluated the success rate and crossing time in crossing ex vivo chronic total occlusions. For the S and NS catheters, respectively, users successfully accessed 69 and 31% of the targets, 68 and 45% of the cross-sectional area, and could deliver 14.2 and 10.2 g of mean force. Using a NS catheter, users crossed 0.0 and 9.5% of the fixed and fresh lesions, respectively. Overall, we quantified the limitations of conventional catheters (navigation, reachable workspace, and pushability) for peripheral interventions; this can serve as a basis for comparison with other devices.
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Affiliation(s)
- Yara Alawneh
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - James J Zhou
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Alykhan Sewani
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Mohammadmahdi Tahmasebi
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Trisha L Roy
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Ahmed Kayssi
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Andrew D Dueck
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - M Ali Tavallaei
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada.
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of ECBE, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
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Farhan S, Enzmann FK, Bjorkman P, Kamran H, Zhang Z, Sartori S, Vogel B, Tarricone A, Linni K, Venermo M, van der Veen D, Moussalli H, Mehran R, Reijnen MMPJ, Bosiers M, Krishnan P. Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease. J Am Coll Cardiol 2023; 81:358-370. [PMID: 36697136 DOI: 10.1016/j.jacc.2022.10.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND No adequately powered studies exist to compare major clinical outcomes after endovascular therapy (EVT) with stent implantation vs bypass surgery (BSx) for symptomatic femoropopliteal peripheral artery disease. OBJECTIVES This study sought to perform a pooled analysis of individual patient data from all randomized controlled trials comparing EVT vs BSx. METHODS Principal investigators of 5 of 6 available randomized controlled trials agreed to pool individual patient data. The primary endpoint was major adverse limb events, a composite of all-cause death, major amputation, or target limb reintervention. Secondary endpoints included amputation-free survival, individual major adverse limb event components, and primary patency. Early complications were bleeding, infection, or all-cause death within 30 days. RESULTS A total of 639 patients were analyzed with a mean age of 68.1 ± 9.1 years and 29.0% women. Baseline characteristics were comparable between groups. At 2 years, there were no significant differences between patients who received EVT and those who received BSx regarding major adverse limb events (40.1% vs 36.4%; log-rank P = 0.447; adjusted HR [aHR]: 1.04; 95% CI: 0.80-1.36), amputation-free survival (88.1% vs 90.0%; log-rank P = 0.455; aHR for death or amputation: 1.04; 95% CI: 0.63-1.71) and the other secondary endpoints except for primary patency, which was lower in patients who received EVT vs those who received BSx (51.2% vs 61.3%; log-rank P = 0.024; aHR for loss of primary patency: 1.31; 95% CI: 1.02-1.69). EVT was associated with significantly lower rates of early complications (6.8% vs 22.6%; P < 0.001) and shorter hospital stay (3.1 ± 4.2 days vs 7.4 ± 4.9 days; P < 0.001). CONCLUSIONS These findings further support the efficacy and safety of EVT as an alternative to BSx in patients with symptomatic femoropopliteal peripheral artery disease.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Florian K Enzmann
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrick Bjorkman
- Department of Cardiac, Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Haroon Kamran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arthur Tarricone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Klaus Linni
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Maarit Venermo
- Department of Cardiac, Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Herve Moussalli
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Marc Bosiers
- A.Z. Sint-Blasius Hospital, Dendermonde, Belgium
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Nierlich P, Hoelzenbein T, Enzmann F. Is open surgery still the first line of treatment for long femoropopliteal lesions? THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:575-580. [PMID: 35687065 DOI: 10.23736/s0021-9509.22.12347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Treatment of long femoropopliteal lesions remains a challenge for vascular physicians as patients often present with multilevel complex pathologies and consequently face a high amputation risk and associated mortality. This review aimed to assess the current state of optimal revascularizations for the treatment of long femoropopliteal lesions. EVIDENCE ACQUISITION An online literature research of medical databases for original articles and review articles on open and endovascular revascularization of femoropopliteal lesions was conducted using mesh terms. EVIDENCE SYNTHESIS There has been an accumulation of evidence over the last years that endovascular treatment is a feasible and enduring alternative to open surgery for treatment of long femoropopliteal lesions if the lesions are restricted to the superficial femoral artery. But when disease extends to the infragenual level venous bypass remains superior with regards to long-term patency, clinical improvement and limb-salvage. CONCLUSIONS While the role of venous bypass as a first-line treatment might be declining, especially in frail patients or claudicants, the superior clinical improvement and amputation-free survival highlighted in several trials, demonstrate the relevance of bypass surgery. More randomized clinical trials are needed to verify the non-inferiority of endovascular treatment options to open surgery, especially when arterial disease extends below the knee.
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Affiliation(s)
| | | | - Florian Enzmann
- Department of Vascular Surgery, University Innsbruck, Innsbruck, Austria
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Gujja K, Purushottam B, Kapur V, Cox‐Alomar PR, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Outcomes of Endovascular-first Vs Bypass-first Approach For Patients With Chronic Limb-Threatening Ischemia Using A Medicare-Linked Database. Ann Vasc Surg 2022; 85:119-124. [DOI: 10.1016/j.avsg.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022]
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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]
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Potter HA, Alfson DB, Rowe VL, Wadé NB, Weaver FA, Inaba K, O'Banion LA, Siracuse JJ, Magee GA. Endovascular versus open repair of isolated superficial femoral and popliteal artery injuries. J Vasc Surg 2021; 74:814-822.e1. [PMID: 33684481 DOI: 10.1016/j.jvs.2021.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite the increasing use of endovascular therapy for traumatic arterial injuries, little is known about the outcomes of endovascular repair of superficial femoral artery (SFA) and popliteal artery (PA) injuries. In the present study, we compared the characteristics and outcomes of endovascular vs open repair of traumatic SFA and PA injuries. METHODS We performed a retrospective National Trauma Data Bank analysis of trauma patients with a blunt or penetrating injury of the SFA and/or PA who had undergone endovascular or open repair from 2007 to 2014. Multivariate logistic regression was used to compare the outcomes, with propensity score matching used for sensitivity analysis. RESULTS The incidence of SFA and PA injuries was 0.2%, with an overall increase in the annual use of endovascular stent repair from 3.2% in 2007 to 7.6% in 2014 (P = .002). A total of 2,873 patients with an isolated SFA and/or PA injury were included in the present study, of whom 163 (5.7%) had undergone endovascular repair. SFA injuries were more frequently treated with endovascular repair (70% vs 27%) and PA injuries were more often associated with open repair (41.1% vs 54.7%). Open repair was more frequently associated with a concomitant femur fracture or knee dislocation (30.7% vs 38.8%; P = .039). Endovascular repair was not associated with worse in-hospital amputation-free survival (AFS) compared with open repair on univariate analysis (91.1% vs 89.7%; P = .573) or multivariate logistic regression (odds ratio [OR], 1.053; 95% confidence interval [CI], 0.551-2.012; P = .876). Propensity score matching revealed that in-hospital mortality was higher (OR, 3.69; 95% CI, 1.37-9.82; P = .01) and fasciotomy was lower (OR, 0.23; 95% CI, 0.14-0.37; P < .001) in the endovascular repair group, with no significant differences in AFS (OR, 0.86; 95% CI, 0.48-1.67; P = .65). CONCLUSIONS Endovascular repair of SFA and PA injuries has in-hospital AFS comparable to that for open repair, supporting the increasing use of endovascular repair for traumatic SFA and PA injuries in appropriately selected cases. Given the unexpected finding of increased in-hospital mortality after endovascular repair, further studies are necessary to determine the appropriate patient selection and the durability of endovascular repair.
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Affiliation(s)
- Helen A Potter
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Daniel B Alfson
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Vincent L Rowe
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Niquelle B Wadé
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Kenji Inaba
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Los Angeles County+USC Medical Center, University of Southern California, Los Angeles, Calif
| | - Leigh Ann O'Banion
- Vascular Division, Department of Surgery, University of California, San Francisco at Fresno, Fresno, Calif
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
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Daher MDEA, Lopez GE, Duarte PV. Stents in the femoropopliteal territory: prevalence of fractures and their consequences. Rev Col Bras Cir 2020; 47:e20202481. [PMID: 32965301 DOI: 10.1590/0100-6991e-20202481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. To evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. METHOD between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. RESULTS we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). CONCLUSION stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.
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Affiliation(s)
- Marcelo DE Azevedo Daher
- - Hospital Universitário Clementino Fraga Filho - UFRJ, Departamento de Cirurgia Vascular Periférica - Rio de Janeiro - RJ - Brasil
| | - Gaudencio Espinosa Lopez
- - Hospital Universitário Clementino Fraga Filho - UFRJ, Departamento de Cirurgia Vascular Periférica - Rio de Janeiro - RJ - Brasil
| | - Pedro Vaz Duarte
- - Hospital Universitário Clementino Fraga Filho - UFRJ, Departamento de Cirurgia Vascular Periférica - Rio de Janeiro - RJ - Brasil
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Perlander A, Jivegård L, Nordanstig J, Svensson M, Österberg K. Amputation-free survival, limb symptom alleviation, and reintervention rates after open and endovascular revascularization of femoropopliteal lesions in patients with chronic limb-threatening ischemia. J Vasc Surg 2020; 72:1987-1995. [PMID: 32276010 DOI: 10.1016/j.jvs.2020.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The optimal strategy for revascularization in chronic limb-threatening ischemia (CLTI) is not yet completely known and is still under debate. Endovascular treatment methods predominate despite limited evidence for their advantage. In this concurrent, prospective observational cohort study, we investigated outcomes after open and endovascular revascularization in the femoropopliteal segment for CLTI. METHODS Between March 2011 and January 2015, there were 190 patients presenting with CLTI with the principal target lesion in the superficial femoral or popliteal segment who underwent endovascular intervention (n = 117) or bypass surgery (n = 73) and were observed prospectively. The choice of revascularization technique was based on international and local guidelines. All patients were observed for 2 years. The primary end point was amputation-free survival (AFS) assessed with Kaplan-Meier estimates; secondary end points included CLTI symptom alleviation rates and reintervention rates. A Cox proportional hazards regression model was used to investigate risk factors for amputation and death. RESULTS AFS at 2 years was 59% in the endovascular group and 76% in the bypass group (P = .020). Kaplan-Meier survival analysis confirmed a significant difference in AFS, with mortality rate as the main driver for the observed intergroup AFS difference. In sequential multivariable regression analysis, the observed difference in AFS between the groups favored bypass surgery and remained significant after controlling for covariates of known prognostic importance (hazard ratio, 2.38; 95% confidence interval, 1.14-4.96). At 2 years, a higher proportion of patients subjected to bypass surgery remained free from ischemic rest pain, wounds, and gangrene (65% vs 45%; P = .009). The proportions of patients who underwent reintervention within 2 years were similar in the two groups (38% vs 39%; P = .90), but repeated reinterventions were more frequent in the bypass group. CONCLUSIONS At 2 years, bypass surgery was associated with higher AFS than endovascular intervention, a finding that could not be explained only by differences in case mix. More patients who had bypass surgery were free from CLTI symptoms at both 1 year and 2 years after revascularization. Reinterventions to maintain patency were equally common after bypass and endovascular intervention.
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Affiliation(s)
- Angelica Perlander
- Department of Vascular Surgery, Sahlgrenska University Hospital, and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lennart Jivegård
- Health Technology Assessment Centre (HTA-centrum) Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joakim Nordanstig
- Department of Vascular Surgery, Sahlgrenska University Hospital, and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Klas Österberg
- Department of Vascular Surgery, Sahlgrenska University Hospital, and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lawaetz M, Fisker L, Lönn L, Sillesen H, Eiberg J. In Situ Vein Bypass Is Superior to Endovascular Treatment of Femoropopliteal Lesions in Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2020; 67:437-447. [PMID: 32234573 DOI: 10.1016/j.avsg.2020.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The objective of the study was to compare bypass surgery and endovascular revascularization of the femoropopliteal segment in patients with peripheral arterial disease and critical limb-threatening ischemia (CLTI). METHODS This is a single-center study including patients undergoing first-time lower extremity intervention with peripheral bypass surgery or percutaneous transluminal angioplasty with or without stenting (PTA/S) of the femoropopliteal segment because of CLTI from 2011 to 2015. Based on prospective entered data from the Danish Vascular Registry, the primary end points were amputation-free survival, overall mortality, and reinterventions. RESULTS A total of 679 patients with CLTI were included of which 35% (n = 239) were treated with PTA/S, 54% (n = 363) with vein bypass, and 11% (n = 77) with synthetic bypass. After 3 years, amputation-free survival was significantly better with a vein bypass (41.8% [95% CI: 35-48.4]) than both PTA/S (29.7% (95% CI: 22.7-37)) and synthetic bypass (31.7% [95% CI: 19-45.1]). Overall, the endovascular-treated patients faced more than 50% increased risk of major amputation or death than that of a vein bypass, after adjusting for comorbidity and Trans-Atlantic Inter-Society Consensus (TASC) classification (HR: 1.56 [95% CI: 1.21-2.05]). As expected, postoperative complications, length of hospital stay, and reinterventions were more frequent in the bypass groups. CONCLUSIONS In this nonrandomized study, autologous vein bypass was superior to both PTA/S and synthetic bypass in regard to amputation-free survival and overall mortality. Despite the increased frequency of surgical complications, a vein bypass appears justified in both shorter (TASC B-C) and longer (TASC D) femoropopliteal lesions.
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Affiliation(s)
- Martin Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Denmark.
| | - Lasse Fisker
- Department of Vascular Surgery, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Lönn
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Rigshospitalet, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
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Corti A, Chiastra C, Colombo M, Garbey M, Migliavacca F, Casarin S. A fully coupled computational fluid dynamics – agent-based model of atherosclerotic plaque development: Multiscale modeling framework and parameter sensitivity analysis. Comput Biol Med 2020; 118:103623. [DOI: 10.1016/j.compbiomed.2020.103623] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
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Biagioni RB, Nasser F, Matielo MF, Burihan MC, Brochado Neto FC, Ingrund JC, Sacilotto R. Comparison of Bypass and Endovascular Intervention for Popliteal Occlusion with the Involvement of Trifurcation for Critical Limb Ischemia. Ann Vasc Surg 2019; 63:218-226. [PMID: 31536796 DOI: 10.1016/j.avsg.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study is to analyze the technical aspects and outcomes of the treatment of occlusion of the popliteal artery with the involvement of the trifurcation treated with a bypass (open) and endovascular (endo) approach. METHODS Overall, 108 consecutive procedures were enrolled retrospectively. Patients were evaluated in 2 groups: the endo group (65 patients) and the open group (43 patients). Primary outcome were MALE (major adverse limb events), amputation-free survival, and early mortality (until 30 days). Secondary outcome was overall survival in 3 years. Inclusion criteria were Rutherford 4 and 5 and occlusion of the popliteal artery with the involvement of trifurcation and, at least, 1 infrapopliteal artery of runoff. RESULTS Technical success was achieved in 100% of patients in the open and 96.9% of patients in the endo group. Freedom from MALE was 73.5% and 68.5% for 1 and 3 years respectively for the endo group, and 84.3% and 77.2% respectively for the open group (P = 0.413). Considering the total number of major reinterventions executed until 3 years, the reinterventions was statistically more performed in the endo compared to the open group (P = 0.0459). Amputation-free survival for the endo group in 30 days, 1 year, and 3 years was 93.7%, 79.3%, and 66.0%, respectively, and the amputation-free survival for the open group was 88.4%, 77.4%, and 64.3% (P = 0.726). Early mortality was 9.3% for the open group and 1.5% for the endo group (P = 0.060). In 3 years, the overall survival was 75.1% in the open group and 84.3% in the endo group. CONCLUSIONS In 3 years, follow-up endovascular treatment of occlusion of the popliteal artery with the involvement of the trifurcation has similar time freedom from MALE compared to open approach. Overall and amputation-free survival was not different between the groups besides more reinterventions in patients who underwent endovascular approach.
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Affiliation(s)
- Rodrigo Bruno Biagioni
- Santa Marcelina Hospital, São Paulo, Brazil; Hospital do Servidor Público Estadual, São Paulo, Brazil.
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Sato K, Emura S, Tomiyoshi H, Morita S. Morphologic Changes of the Femoropopliteal Arterial Segment with Knee Flexion after Endovascular Therapy. Ann Vasc Dis 2019; 12:210-215. [PMID: 31275476 PMCID: PMC6600111 DOI: 10.3400/avd.oa.18-00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The purpose of this study is to investigate morphologic changes of the femoropopliteal arterial segment (FPAS) with knee flexion after endovascular therapy (EVT). Methods: From July 2012 to January 2015, EVT was performed on 12 limbs in 12 consecutive patients who had obliterative lesions in the FPAS. After the implantation of nitinol stents, angiography was performed with the knee in both extension and flexion to investigate morphologic changes of the FPAS. Results: On angiography, the distal end of the implanted stent was placed at various distances (5–10 cm in two cases, 10–15 cm in nine cases, and 15–20 cm in one case) above the knee joint line with the knee in extension. In all cases, although the popliteal artery was highly bent with the knee in flexion, the FPAS morphology was highly variable. However, the most proximal bending point of the FPAS was about 10 cm above the knee joint line. In one case, the artery was occluded at the distal part of the stent 16 months later, probably due to EVT. Conclusion: In EVT of the FPAS, it is important to consider the characteristics and position of the stent to prevent complications.
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Affiliation(s)
- Katsutoshi Sato
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Shogo Emura
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Hideki Tomiyoshi
- Department of Radiology, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Satoru Morita
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
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Biagioni RB, Brandão GD, Biagioni LC, Nasser F, Burihan MC, Ingrund JC. Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia. J Vasc Surg 2019; 69:1510-1518. [DOI: 10.1016/j.jvs.2018.08.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/13/2018] [Indexed: 10/27/2022]
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Comparison of Clinical Outcomes between Endovascular Therapy with Self-Expandable Nitinol Stent and Femoral–Popliteal Bypass for Trans-Atlantic Inter-Society Consensus II C and D Femoropopliteal Lesions. Ann Vasc Surg 2019; 57:137-143. [DOI: 10.1016/j.avsg.2018.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
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17
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Vossen RJ, Philipszoon PC, Vahl AC, Montauban van Swijndregt AD, Leijdekkers VJ, Balm R. A Comparative Cost-Effectiveness Analysis of Percutaneous Transluminal Angioplasty With Optional Stenting and Femoropopliteal Bypass Surgery for Medium-Length TASC II B and C Femoropopliteal Lesions. J Endovasc Ther 2019; 26:172-180. [DOI: 10.1177/1526602819833646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose: To evaluate the total midterm costs and cost-effectiveness of percutaneous transluminal angioplasty with optional stenting (PTA/S) as initial treatment compared with femoropopliteal bypass (FPB) surgery in patients with medium-length TransAtlantic Inter-Society Consensus II (TASC) B and C femoropopliteal lesions. Materials and Methods: Over a period of 3 years, all hospital health care costs for 226 consecutive patients were calculated: 170 patients with a TASC B lesion and 56 patients with a TASC C lesion. In the 135-patient PTA/S group (mean age 69.9±10.9 years; 83 men), 108 (63.5%) patients had TASC B lesions and 27 (48.2%) patients had TASC C lesions. Ninety-one patients (mean age 68.4±10.9 years; 60 men) were treated with FPB for 62 TASC B and 29 TASC C femoropopliteal lesions. The main outcome measure was the primary patency rate at 3-year follow-up. Multiple imputation and bootstrapping techniques were used to analyze the data. The adjusted incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in total costs by the difference in 3-year primary patency rate. Costs were expressed in euros (€), and cost differences are presented with the 95% confidence interval (CI). Results: Mean total costs per patient were €29,058 in the PTA/S treatment group vs €42,437 in the FPB group (mean adjusted difference –€14,820, 95% CI –€29,044 to −€5976). Differences in 3-year primary patency between PTA/S and FPB were small and nonsignificant (68.9% and 70.3%, respectively). An ICER of 563,716 was found, indicating that FPB costs €563,716 more per one extra patient reaching 3-year primary patency in comparison with PTA/S treatment. Conclusion: FPB in medium-length femoropopliteal lesions involved higher total costs when evaluated over a 3-year follow-up period. An endovascular-first approach is recommended, as this will result in cost minimization for patients with medium-length femoropopliteal disease.
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Affiliation(s)
- Rianne J. Vossen
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, the Netherlands
| | - Pilar C. Philipszoon
- Department of Health Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anco C. Vahl
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, the Netherlands
- Clinical Epidemiology, OLVG Amsterdam, the Netherlands
| | | | - Vanessa J. Leijdekkers
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, the Netherlands
| | - Ron Balm
- Amsterdam Cardiovascular Sciences, Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
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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
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19
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Dilaver N, Twine CP, Bosanquet DC. Editor's Choice – Direct vs. Indirect Angiosomal Revascularisation of Infrapopliteal Arteries, an Updated Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2018; 56:834-848. [DOI: 10.1016/j.ejvs.2018.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022]
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20
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Locham SS, Paracha N, Dakour-Aridi H, Nejim B, Rizwan M, Malas MB. Comparison of the Cost of Drug-Eluting Stents versus Bare Metal Stents in the Treatment of Critical Limb Ischemia in the United States. Ann Vasc Surg 2018; 55:55-62.e2. [PMID: 30092444 DOI: 10.1016/j.avsg.2018.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite significant technical advancement in the last decade, the durability of endovascular management of critical limb ischemia (CLI) remains highly debatable. Drug-eluting stents (DESs) are being popularized for the management of CLI after its precedent success in coronary intervention. Initial reports on the durability of DES are promising. However, little is known on the additional cost of this relatively newer technology. The aim of this study is to compare the cost of the traditional bare metal stents (BMSs) to the newly introduced DES in a large cohort of CLI patients. METHODS Using the Premier database (2009-2015), we identified all patients with CLI undergoing DES and BMS. A multivariable generalized linear model was implemented to examine in-hospital cost adjusting for patients' characteristics, comorbidities, and regional characteristics. RESULTS A total of 20,702 patients with CLI underwent peripheral artery revascularization using BMS (18,924 [91.41%]) or DES (1,778 [8.6%]). Majority of patients were males (53%) and whites (71%). Patients undergoing BMS were slightly younger (median age [interquartile range]: 70 [62-79] versus 71 [63-80]) and were more likely to be smokers (46% vs. 39%) and have a history of cerebrovascular disease (10% vs. 8%) and chronic pulmonary disease (24.5% vs. 20.9%) as compared with those undergoing DES (all P < 0.05). On the other hand, DES patients had a high prevalence of diabetes (4% vs. 3%) and renal disease (25% vs. 22%) (both P < 0.05). There was also a significant increase in the proportion of patients undergoing DES and a corresponding decrease in BMS (P < 0.001) over the study period. Median total in-hospitalization cost (BMS: $13,342 [8,574 to 21,166], DES: $13,243 [8,560-20,232], P = 0.76) was similar for both approaches. After adjusting for potential confounders, DES was associated with $407 higher cost than BMS (adjusted mean difference [95% confidence interval]: 407 [17 to 798], P = 0.04). In addition, the cost was $672 higher in teaching hospitals, $1,153 higher in Rural areas, and increased in all regions compared with the Midwest (adjusted mean difference [95% confidence interval]-South: $293 [31 to 555], Northeast: $2,006 [1,517 to 2,495], West: $3,312 [2,930 to 3,695], all P < 0.05). CONCLUSIONS In this large cohort of CLI patients, after controlling for potential confounders, we demonstrated that the cost of endovascular revascularization is significantly higher in patients undergoing DES than those undergoing BMS. Regional disparities in cost were also observed. Further studies looking at the long-term durability and costs of DES versus BMS are needed.
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Affiliation(s)
- Satinderjit S Locham
- Johns Hopkins Bayview Vascular and Endovascular Clinical Research Center, Baltimore, MD
| | - Nawar Paracha
- Johns Hopkins Bayview Vascular and Endovascular Clinical Research Center, Baltimore, MD
| | - Hanaa Dakour-Aridi
- Johns Hopkins Bayview Vascular and Endovascular Clinical Research Center, Baltimore, MD
| | - Besma Nejim
- Johns Hopkins Bayview Vascular and Endovascular Clinical Research Center, Baltimore, MD
| | - Muhammad Rizwan
- Johns Hopkins Bayview Vascular and Endovascular Clinical Research Center, Baltimore, MD
| | - Mahmoud B Malas
- Johns Hopkins Bayview Vascular and Endovascular Clinical Research Center, Baltimore, MD.
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Percutaneous transluminal angioplasty/stent treatment of totally occlusive iliofemoral artery with limb ischemia: Experience of surgical team. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:414-421. [PMID: 32082772 DOI: 10.5606/tgkdc.dergisi.2018.15503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/20/2018] [Indexed: 11/21/2022]
Abstract
Background In this study, we present our center's experience on percutaneous transluminal angioplasty/stenting. Methods Between January 2015 and March 2017, a total of 40 patients (34 males, 6 females; mean age 64.5±8.7 years; range, 49 to 85 years) who were treated in our clinic due to totally occluded iliofemoral artery disease were included. There were 45 legs and 51 targeted vessels. Hybrid procedure was performed to those patients with iliofemoral or femoropopliteal bypass grafts. Results A total of 48 target vessels (94.1%) were implanted using 55 stents at the initial attempt. Failed three target vessels (5.9%) were treated by surgical revascularization. There was no procedure-related mortality. Below-knee amputation was performed in one patient after 70 days. Two patients underwent single-finger amputation. Contrast nephropathy occurred in one patient and this patient was treated medically. The mean follow-up was 16.7±5 (range, 8 to 29) months. After follow-up, 41 stents were found to be patent without any intervention, and the primary patency rate was 74.5%. Five stent thrombosis patients (12.5%) were treated at different times. Conclusion Our study results suggest that percutaneous transluminal angioplasty/stent treatment may be advisable in patients with significant comorbidities. The lower rates of complication in the stent series strongly suggest that, in experienced hands, percutaneous transluminal angioplasty/stent can offer lower procedural risks than surgical revascularization. Hybrid procedure is likely to be a reasonable choice for previously intervened comorbid patients for limb salvage.
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Nejim BJ, Wang S, Arhuidese I, Obeid T, Alshaikh HN, Dakour Aridi H, Locham S, Malas MB. Regional variation in the cost of infrainguinal lower extremity bypass surgery in the United States. J Vasc Surg 2017; 67:1170-1180.e4. [PMID: 29074114 DOI: 10.1016/j.jvs.2017.08.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lower extremity bypass (LEB) remains the gold standard revascularization procedure in patients with peripheral arterial disease. The cost of LEB substantially varies based on patient's characteristics and comorbidities. The aim of this study was to assess regional variation in infrainguinal LEB cost and to identify the specific health care expenditures per service that are associated with the highest cost in each region. METHODS We identified adult patients who underwent infrainguinal LEB in the Premier database between June 2009 and March 2015. Generalized linear regression models were used to report differences between regions in total in-hospital cost and service-specific cost adjusting for patient's demographics, clinical characteristics, and hospital factors. RESULTS A total of 50,131 patients were identified. The median in-hospital cost was $13,259 (interquartile range, $9308-$19,590). The cost of LEB was significantly higher in West and Northeast regions with a median cost of nearly $16,000. The high cost in the Northeast region was driven by the fixed (indirect) cost, whereas the driver of the high cost in the West region was the variable (direct) cost. The adjusted total in-hospital cost was significantly higher in all regions compared with the South (mean difference, West, $3752 [95% confidence interval (CI), 3477-4027]; Northeast, $2959 [95% CI, 2703-3216]; Midwest, 1586 [95% CI, 1364-1808]). CONCLUSIONS In this study, we show the marked regional variability in LEB costs. This disparity was independent from patient clinical condition and hospital factors. Cost inequality across the US represents a financial burden on both the patient and the health system.
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Affiliation(s)
- Besma J Nejim
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Sophie Wang
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Isibor Arhuidese
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md; Division of Vascular Surgery, University of South Florida, Tampa, Fla
| | - Tammam Obeid
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md; Division of Vascular Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Husain Nader Alshaikh
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Hanaa Dakour Aridi
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Satinderjit Locham
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
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Saraidaridis JT, Ergul EA, Clouse WD, Patel VI, Cambria RP, Conrad MF. The Natural History and Outcomes of Endovascular Therapy for Claudication. Ann Vasc Surg 2017; 44:34-40. [DOI: 10.1016/j.avsg.2017.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 03/08/2017] [Accepted: 04/21/2017] [Indexed: 02/06/2023]
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Smoking Habits of Patients Undergoing Treatment for Intermittent Claudication in the Vascular Quality Initiative. Ann Vasc Surg 2017; 44:261-268. [DOI: 10.1016/j.avsg.2017.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 12/29/2022]
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25
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Gujja K, Punukollu G, Kapur V, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Karthik Gujja
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | | | - Vishal Kapur
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
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Cooper R. Managing chronic oedema in a patient with arterial disease and leg ulceration. Br J Community Nurs 2016; Suppl:S16-22. [PMID: 27046424 DOI: 10.12968/bjcn.2016.21.sup4.s16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treating lymphoedema in patients with critical arterial disease can be contraindicated. This case study describes current methods of managing lymphoedema in a patient with arterial disease and leg ulcers. The patient, a 65-year-old male, had paraplegia and lower-limb lymphoedema with leg ulceration for 18 years, as well as arterial disease. The patient was referred to the lymphoedema/vascular service in 2013. Duplex ultrasound indicated superficial femoral occlusion. The arterial disease was treated with an angiogram and angioplasty, and when the blood supply was improved, the lymphoedema was treated. Emphasis was placed on self-care and reducing the need for community nurse involvement. Selfcare included compression bandaging, use of FarrowWrap, low-level light therapy, and ulcer dressings. Outcomes were measured using a telemedicine software programme. The patient's lymphoedema was reduced, leg ulcers healed, and quality of life transformed.
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Affiliation(s)
- Robin Cooper
- Leg Ulcer and Lymphoedema Specialist, Salisbury District Hospital, Salisbury, England
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Matsumi J, Tobita K, Shishido K, Mizuno S, Yamanaka F, Murakami M, Tanaka Y, Takahashi S, Akasaka T, Saito S. Long-term outcomes of SMART stent implantation in patients with femoro-popliteal disease. Catheter Cardiovasc Interv 2016; 88:832-841. [DOI: 10.1002/ccd.26718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 06/01/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Junya Matsumi
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Shingo Mizuno
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Masato Murakami
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Saeko Takahashi
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Takeshi Akasaka
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
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Akamatsu D, Goto H, Kamei T, Miyagi S, Tsuchida K, Kawamura K, Tajima Y, Umetsu M, Watanabe T, Ohuchi N. Efficacy of iliac inflow repair in patients with concomitant iliac and superficial femoral artery occlusive disease. Asian J Surg 2016; 40:475-480. [PMID: 27451009 DOI: 10.1016/j.asjsur.2016.07.004] [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] [Received: 01/04/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In multilevel arterial disease, whether complete revascularization or staged runoff repair should be performed remains controversial. The aim of this study was to evaluate the efficacy of iliac inflow repair and to identify clinical conditions that are associated with the need for runoff repair in concomitant iliac and superficial femoral artery (SFA) occlusive disease. METHODS Patients undergoing inflow repair for complicated flow-limiting iliac lesions with diffuse SFA disease between 2007 and 2013 were retrospectively reviewed. Patients with poor response to inflow repair underwent infrainguinal revascularization (IIR). RESULTS The 29 ischemic limbs examined in this study represent 26 different patients (22 males; mean age, 77 ± 8 years). Indications for inflow repair were Rutherford Classifications III (31%), IV (31%), V (31%), and VI (7%). Severity of the complicated SFA disease was either TASC (TransAtlantic Inter-Society Consensus) type C (14%) or type D (86%). Overall, freedom from IIR was 90% after 30 days and 83% after 1 year. Patients having claudication, rest pain, and shallow ischemic ulcers experienced the relief of symptoms, whereas patients with deep gangrene that needed minor amputation required IIR more frequently (p < 0.01). Anatomical risk factors for poor response to inflow repair were poor quality of the deep femoral artery (p < 0.01) and the flow-limiting popliteal artery (p = 0.02), and poor below-knee runoff (≤ 1 vessel, p < 0.01). CONCLUSION Iliac inflow repair can reverse the symptoms in patients with multilevel arterial occlusive disease that are not associated with gangrenous toes.
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Affiliation(s)
- Daijirou Akamatsu
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
| | - Hitoshi Goto
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
| | - Takashi Kamei
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
| | - Shigehito Miyagi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
| | - Ken Tsuchida
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
| | - Keiichiro Kawamura
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
| | - Yuta Tajima
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
| | - Michihisa Umetsu
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
| | - Tetsuo Watanabe
- Sendai City Hospital, Cardiovascular Surgery, 1-1 Nagamachi, Taihaku-ku Sendai, 982-8502, Japan
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan
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Roy T, Dueck AD, Wright GA. Peripheral Endovascular Interventions in the Era of Precision Medicine: Tying Wire, Drug, and Device Selection to Plaque Morphology. J Endovasc Ther 2016; 23:751-61. [PMID: 27328912 DOI: 10.1177/1526602816653221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Trisha Roy
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Division of Vascular Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Andrew D Dueck
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Division of Vascular Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Graham A Wright
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Department of Medical Biophysics, University of Toronto, ON, Canada
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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.
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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
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