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Yoshioka N, Morita Y, Shimada T, Kobayashi H, Tanikawa Y, Minamiya A, Yamada T, Morishima I. Predicting residual pressure gradients after balloon angioplasty in patients with femoropopliteal artery lesions. Heart Vessels 2024; 39:589-596. [PMID: 38345632 DOI: 10.1007/s00380-024-02372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/24/2024] [Indexed: 06/21/2024]
Abstract
In endovascular therapy (EVT) for femoropopliteal artery (FPA) lesions, studies examining the relationship between lesion morphology and hemodynamic status are limited. The purpose of this study was to investigate FPA lesion characteristics, including imaging findings and their cutoff values that can predict hemodynamic significance after balloon angioplasty. This single-center retrospective study enrolled 50 de novo FPA lesions from 43 patients treated under intravascular ultrasound (IVUS) usage between June 2022 and March 2023. As a physiological parameter, the pressure gradient was measured, and the cutoff value of the residual pressure gradient (RPG) was defined as a systolic pressure > 10 mmHg through the lesions after balloon angioplasty. The pressure gradients were measured using a 0.014-inch wire-guided, rapid exchange-type microcatheter, Navvus II (Acist, Eden Prairie, Minnesota, USA). Predictive risk factors for RPG were analyzed using the random forest (RF) method. The relationship between the variables, RPG, and the cutoff points of each predictor was assessed using the partial dependence plot (PDP) method. RPG was observed in 20% of the lesions after balloon angioplasty. The RF model revealed that the percent diameter stenosis (%DS) and minimum lumen area (MLA) on IVUS assessment were strong predictive factors for RPG after balloon angioplasty. The PDP model revealed that a higher %DS (cutoff 30%) and smaller MLA (cutoff 10 mm2) could predict RPG after balloon angioplasty. Conventional lesion parameters such as %DS and MLA can predict hemodynamic significance during EVT for FPA lesions.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho Ogaki, Gifu, Japan.
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho Ogaki, Gifu, Japan
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroto Kobayashi
- Department of Clinical Engineering, Ogaki Municipal Hospital, Gifu, Japan
| | - Yuya Tanikawa
- Department of Clinical Engineering, Ogaki Municipal Hospital, Gifu, Japan
| | - Akihiro Minamiya
- Department of Clinical Engineering, Ogaki Municipal Hospital, Gifu, Japan
| | - Tetsuya Yamada
- Department of Clinical Engineering, Ogaki Municipal Hospital, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho Ogaki, Gifu, Japan
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Parwani D, Ahmed MA, Mahawar A, Gorantla VR. Peripheral Arterial Disease: A Narrative Review. Cureus 2023; 15:e40267. [PMID: 37448414 PMCID: PMC10336185 DOI: 10.7759/cureus.40267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral arterial disease (PAD) describes the partial or complete occlusion of blood flow in the distal arteries of the body. A decreased arterial patency may occur due to a reduction in the elasticity or diameter of the vessel. The goal of interventions is to decrease incidence and reduce complications by identifying and minimizing the primary causes. This paper discusses PAD affecting the aortoiliac, common femoral, and femoropopliteal arteries. In a significant portion of the population, PAD may lack usual symptoms such as limb pain, claudication, and diminished pulses. Imaging techniques become crucial to ensuring timely diagnosis, monitoring treatment effectiveness, and preventing recurrence. Duplex ultrasound (DUS) is a cheap and non-invasive preliminary technique to detect atherosclerotic plaques and grade arterial stenosis. Magnetic resonance angiography (MRA) provides the added advantage of minimizing artifacts. Digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis but is only employed second-line to DUS or MRA due to the high dose of nephrotoxic contrast. Computed tomography angiography (CTA) is able to overcome the anatomical limitations of DUS and MRA and proves to be a suitable alternative to DSA in patients with renal disease. Preventative measures involve monitoring blood pressure, cholesterol levels, and tobacco usage. First-line treatment options include endovascular procedures as well as surgical interventions in cases of significant arterial involvement. Endovascular treatments involve the use of balloon angioplasty, drug-coated balloons, and drug-coated stents, to name a few, that serve as minimally invasive techniques to manage PAD. Surgical procedures, although more complex, are considered gold-standard treatment options for long and intricate lesions. Endovascular methods are generally preferred over surgical options as the complication risk is severely reduced and the rates of reintervention are comparable to surgical options.
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Affiliation(s)
- Divya Parwani
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
| | - Mohamed A Ahmed
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Anmol Mahawar
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
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Yoshioka N, Tokuda T, Koyama A, Yamada T, Shimamura K, Nishikawa R, Morita Y, Morishima I. Two-year clinical outcomes and predictors of restenosis following the use of polymer-coated paclitaxel-eluting stents or drug-coated balloons in patients with femoropopliteal artery disease. Heart Vessels 2023; 38:429-437. [PMID: 36169709 DOI: 10.1007/s00380-022-02182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/22/2022] [Indexed: 02/07/2023]
Abstract
We aimed to assess the clinical performance and risk factors for patency loss within 2 years following the use of polymer-coated paclitaxel-eluting stents (PC-PESs) and drug-coated balloons (DCBs) in patients with lower extremity artery disease. Multi-center registry data from 151 patients (65 and 86 treated with PC-PES and DCB, respectively) were retrospectively investigated. Two-year primary patency (PP) and clinically driven target lesion revascularization (CD-TLR) were evaluated using Kaplan-Meier analysis. Predictors of restenosis within 2 years of the procedures were analyzed using the random survival forest method. The consistent predictors of restenosis within 1 and 2 years were assessed and validated using Kaplan-Meier analysis. Two-year PP was 77.2 and 57.2% (log rank p = 0.047) and freedom from CD-TLR was 84.4 and 84.8% in the PC-PES and DCB groups, respectively (log rank p = 0.89). In the DCB group, most of the patients (n = 77, 89.5%) were treated with high-dose DCB. Consistent predictors of restenosis were lower vessel diameter and severity of Clinical Frailty Scale in the PC-PES group, and severity of peripheral artery calcification scoring system grade, severity of post dissection pattern, and smaller vessel diameter in the DCB group. The validation analysis revealed that patients with consistent predictors had significantly worse PP values than that of those without in the PC-PES (87.9% vs. 55.3%, log rank p = 0.003) and DCB groups (75.9% vs. 35.2%, log rank p = 0.001). The 2-year PP of DCBs was lower than that of PC-PESs. A smaller vessel diameter could predict restenosis in both devices. Vessel calcification and dissection should be considered when using DCB to ensure longer term patency.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Minokamo, Japan
| | | | - Ryusuke Nishikawa
- Department of Cardiovascular of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
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Dong Q, Tian J, Zheng W, Fan Q, Wu X, Tang Y, Liu T, Yin H. Interleukin-33 protects mice against hindlimb ischemic injury by enhancing endothelial angiogenesis. Int Immunopharmacol 2022; 109:108850. [DOI: 10.1016/j.intimp.2022.108850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022]
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Implementation of Transitional Care Planning is Associated with Reduced Readmission Rates in Patients Undergoing Lower Extremity Bypass Surgery for Peripheral Arterial Disease. Ann Vasc Surg 2022; 84:28-39. [PMID: 35271961 DOI: 10.1016/j.avsg.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Patients undergoing lower extremity bypasses (LEB) are at high risk of developing post-discharge complications requiring readmission. Health systems have developed several strategies to mitigate this risk. One such measure is developing comprehensive Transition Care Planning (TCP), which includes phone calls to patients after being discharged from the hospital. Our study aimed to assess short-term readmission, mortality, and amputation rates of patients who participated in TCP by completing at least one post-discharge follow-up phone call after undergoing LEB for revascularization for peripheral artery disease (PAD). METHODS A retrospective review was completed for patients who underwent LEB surgery between January 2010 and January 2020 to treat PAD at Penn State Hershey Medical Center. Immediate discharge follow-up was done via telephone calls using a standardized script. Patients were then divided into two groups, those who did not have a successful follow-up call (Group I) and those who had at least one successful follow-up call within seven days after discharge (Group II). Univariate analysis was used to compare preoperative demographics, intraoperative variables, and postoperative outcomes. The probability of Readmission and risk factors contributing to it were computed using multiple stepwise forward regression analyses. Epidemiological analysis was done to evaluate the risk of readmission in the group receiving post-discharge follow-up calls. RESULTS A total of 457 patients underwent LEB from 2010 to 2020 and qualified for inclusion in the study. Among these patients, 126 (27.6%) did not have a successful post-discharge follow-up call (Group I), whereas 331 (72.4%) patients did complete a successful call (Group II). The mean age of patients was 66.7 years. There were no significant differences in preoperative baseline patient characteristics or intraoperative factors. Patients who completed a successful call had lower readmission rates within thirty days of the operation (8.8% vs. 17.5%, p=0.008), and this was sustained in multivariate analysis (AOR: 0.18, [CI: 0.05-0.66], p=0.009). However, no differences were observed for thirty-day mortality (Group-I: 3.2% vs. Group-II: 1.2%, p=0.152) or amputation (Group-I: 9.6% vs. Group II 5.9%, p=0.162). Among those who had a successful call, patients with a history of smoking (AOR: 4.05 [CI: 1.21, 17.12] p=0.025], diabetes mellitus (AOR: 3.42 [CI:1.35,8.7] p=0.01) and myocardial infarction (AOR: 7.15 [CI:1.76, 20.1] p=0.006) had much higher chances of readmission. Risk analysis using epidemiological methods showed that by receiving a call, the risk of readmission could be dropped to half (RR: 0.50 [CI: 0.30, 0.84]), with an attributable risk reduction of -8.7% (CI:-15.9%,-1.4%). CONCLUSIONS This single-institution retrospective study demonstrates the importance of immediate discharge follow-up phone calls in patients who undergo open lower extremity revascularization to reduce thirty-day readmissions. Our analysis showed patients who received immediate follow-up phone calls were less likely to be readmitted to the hospital. The development of reliable and efficient systems to enhance immediate discharge follow-up in vascular surgery patients is pivotal to improving quality of care, preventing readmissions, and reducing healthcare costs.
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Clinical Impact of Preoperative Anemia in Patients Undergoing Peripheral Vascular Interventions: A Systematic Review. SURGERIES 2021. [DOI: 10.3390/surgeries2030027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: This systematic review aims to summarize the existing evidence relating to preoperative anemia and clinical outcomes in peripheral vascular surgery patients. Methods: The following databases were searched—PubMed, COCHRANE, LILACS, and Science Research—from 1 January 2010 up to 8 May 2020, with the last search performed on 1 January 2021. An additional manual search for potential primary studies was conducted on major journals (e.g., Anesthesiology, the British Journal of Anesthesia and the European Journal of Anaesthesiology) and reference lists of included studies. Google Scholar was also checked for additional eligible studies. Reviewers independently screened potentially eligible articles and extracted data from included studies on populations, interventions, comparisons, and outcomes. This review was registered at PROSPERO as CRD 180954. Results: In total, 6 observational studies with a combined total of 87,327 participants were analyzed. Data collected in this review suggest that preoperative anemia, especially when hemoglobin is <10 g/dL, is associated with an increased risk of red blood cell transfusions (OR: 7.5; 95% CI 6.3–8.9, p < 0.0001), limb amputation (OR: 5.2; 95% CI 3.1–8.6, p < 0.0001), and death (p < 0.0031). Conclusions: These data suggest an association between preoperative anemia, blood transfusion requirements, and other adverse clinical outcomes among patients subjected to peripheral vascular interventions. However, further investigations, particularly randomized controlled trials, are warranted to better understand the association between preoperative anemia and patients’ prognosis.
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Feng Z, Yang S, Sang H, Xue G, Ni Q, Zhang L, Zhang W, Fang X, Ye M. One-Year Clinical Outcome and Risk Factor Analysis of Directional Atherectomy Followed With Drug-Coated Balloon for Femoropopliteal Artery Disease. J Endovasc Ther 2021; 28:927-937. [PMID: 34251279 DOI: 10.1177/15266028211030527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study investigated the 1-year clinical outcomes of directional atherectomy combined with drug-coated balloon (DA + DCB) in femoropopliteal artery disease (FPAD) from real-world experience. MATERIALS AND METHODS A retrospective study was conducted of patients treated between July 2016 and June 2019 using DA + DCB for FPAD. Patients' demographics, comorbidities, clinical characteristics and outcomes, and angiography and duplex ultrasound findings were analyzed. The 6-month and 1-year primary patency, primary assisted patency, secondary patency, and freedom from clinically-driven target lesion revascularization (CD-TLR) were evaluated. Univariate and multivariate analyses were performed to identify risk factors of primary patency loss or CD-TLR. RESULTS Seventy-nine consecutive patients (83 lesions, mean age 70.9 years, 52 men) were included. Twenty-seven limbs had lifestyle-limiting claudication and 56 limbs had critical limb ischemia. There were 73 and 10 limbs with de novo lesion and in-stent restenosis, respectively. The mean lesion length of all the patients was 22.1 cm. The mean length of chronic total occlusions (CTOs) was 8.3 cm. Severe calcification was found in 32.5% cases. The 1-year primary patency rate was 80.8% and freedom from CD-TLR was 92.2%. The bailout stenting rate was 2.4%. Patients with CTO >10 cm had significantly lower 1-year primary patency rate and freedom from CD-TLR than did patients with CTO ≤10 cm. Total length of CTO (stratified as ≤5 cm, 5-10 cm, >10 cm) was identified as an independent risk factor of 1-year primary patency loss and CD-TLR. CONCLUSION DA + DCB appears to be a safe and effective endovascular therapy to treat FPAD in real-world clinical practice, with a promising 1-year patency rate with a low rate of bailout stenting.
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Affiliation(s)
- Zibo Feng
- Department of Vascular Surgery, Liyuan Hospitial affiliated Tongji Medical Collage of Huazhong University of Science & Technology, Wuhan, China
| | - Shuofei Yang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hongfei Sang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guanhua Xue
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qihong Ni
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lan Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhang
- Biomedical Informatics & Statistics Center, School of Public Health, Fudan University, Shanghai, China
| | - Xin Fang
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Meng Ye
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Polonsky TS, McDermott MM. Lower Extremity Peripheral Artery Disease Without Chronic Limb-Threatening Ischemia: A Review. JAMA 2021; 325:2188-2198. [PMID: 34061140 DOI: 10.1001/jama.2021.2126] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Lower extremity peripheral artery disease (PAD) affects approximately 8.5 million people in the US and approximately 230 million worldwide. OBSERVATIONS Peripheral artery disease is uncommon before aged 50 years but affects up to 20% of people aged 80 years and older. It can be noninvasively diagnosed with the ankle-brachial index (ABI), a ratio of Doppler-recorded pressures in the dorsalis pedis and/or posterior tibial artery in each leg to brachial artery pressures. An ABI value less than 0.90 is 57% to 79% sensitive and 83% to 99% specific for arterial stenosis of at least 50%. Intermittent claudication, consisting of exertional calf pain that does not begin at rest and that resolves within 10 minutes of rest, is considered the classic symptom of PAD. However, 70% to 90% of people with an ABI value less than 0.90 either report no exertional leg symptoms (ie, asymptomatic) or report leg symptoms with walking that are not consistent with classic claudication. Over time, people with PAD restrict walking activity or slow walking speed to avoid leg symptoms. Thus, although approximately 75% of people with PAD report no change in leg symptoms over time, those with PAD have significantly greater annual declines in 6-minute walk performance compared with those without it. Approximately 11% of people with PAD develop chronic limb-threatening ischemia, the most severe form of PAD. Compared with people without PAD, those with the disease have approximately twice the rate of all-cause mortality, cardiovascular mortality, and major coronary events at 10-year follow-up. High-dose statins and antiplatelet therapy with or without antithrombotic therapy reduced rates of coronary events and stroke in people with PAD. Supervised treadmill exercise improved 6-minute walk distance by 30 to 35 m, consistent with a clinically meaningful change, whereas effective home-based walking exercise interventions improved 6-minute walk by 42 to 53 m. Effective home-based exercise programs require behavioral methods, including monitoring by a coach. CONCLUSIONS AND RELEVANCE Peripheral artery disease affects approximately 230 million people worldwide and is associated with increased rates of cardiovascular events, lower extremity events, and functional decline compared with that of people without PAD. People with PAD should be treated with the highest dose of statin tolerated, antithrombotic and/or antiplatelet therapy, and exercise.
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Affiliation(s)
- Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA
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Rathakrishnan B, Secemsky EA. Turning the tide: Evolution of below-the-knee endovascular intervention. Vasc Med 2021; 26:26-27. [PMID: 33314979 DOI: 10.1177/1358863x20978281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bharath Rathakrishnan
- Department of Medicine, Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Department of Medicine, Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Chen F, Liu J, Zhang X, Zhang D, Liao H. Improved 3D Catheter Shape Estimation Using Ultrasound Imaging for Endovascular Navigation: A Further Study. IEEE J Biomed Health Inform 2020; 24:3616-3629. [PMID: 32966224 DOI: 10.1109/jbhi.2020.3026105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Two-dimensional fluoroscopy is the standard guidance imaging method for closed endovascular intervention. However, two-dimensional fluoroscopy lacks depth perception for the intervention catheter and causes radiation exposure for both surgeons and patients. In this paper, we extend our previous study and develop the improved three-dimensional (3D) catheter shape estimation using ultrasound imaging. In addition, we perform further quantitative evaluations of endovascular navigation. METHOD First, the catheter tracking accuracy in ultrasound images is improved by adjusting the state vector and adding direction information. Then, the 3D catheter points from the catheter tracking are further optimized based on the 3D catheter shape optimization with a high-quality sample set. Finally, the estimated 3D catheter shapes from ultrasound images are overlaid with preoperative 3D tissue structures for the intuitive endovascular navigation. RESULTS the tracking accuracy of the catheter increased by 24.39%, and the accuracy of the catheter shape optimization step also increased by approximately 17.34% compared with our previous study. Furthermore, the overall error of catheter shape estimation was further validated in the catheter intervention experiment of in vitro cardiovascular tissue and in a vivo swine, and the errors were 2.13 mm and 3.37 mm, respectively. CONCLUSION Experimental results demonstrate that the improved catheter shape estimation using ultrasound imaging is accurate and appropriate for endovascular navigation. SIGNIFICANCE Improved navigation reduces the radiation risk because it decreases use of X-ray imaging. In addition, this navigation method can also provide accurate 3D catheter shape information for endovascular surgery.
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Ueda E, Toya Y, Wakui H, Kawai Y, Azushima K, Fujita T, Saigusa Y, Yamanaka T, Yabuki Y, Mikami T, Goda M, Sugano T, Tamura K. Low-density-lipoprotein apheresis-mediated endothelial activation therapy to severe-peripheral artery disease study: Rationale and study design. Ther Apher Dial 2020; 24:524-529. [PMID: 32524727 DOI: 10.1111/1744-9987.13546] [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: 12/30/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
A novel approach is required for standard therapy-resistant peripheral arterial disease (PAD). This is a single-center, single-arm, interventional study (LDL Apheresis-Mediated Endothelial Activation Therapy to Severe-Peripheral Artery Disease study), which aims to evaluate the efficacy and safety of lipoprotein apheresis (LA) with a dextran sulfate cellulose column in PAD with controlled serum cholesterol levels. The study participants have standard therapy-resistant PAD with controlled serum cholesterol levels. A total of 35 patients undergo 10 sessions of LA therapy. The ankle-brachial index and vascular quality of life questionnaire are assessed before and after the treatment period as primary outcomes. Registration of patients began in November 2015 and is planned to be concluded in October 2020.
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Affiliation(s)
- Eiko Ueda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuki Kawai
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takayuki Fujita
- Graduate School of Medicine, Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yuichiro Yabuki
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Taro Mikami
- Department of Plastic Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Motohiko Goda
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Teruyasu Sugano
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Li C, You H, Zhang H, Liu Y, Li W, Wang X, Zhang Y. Application of relay puncture technique in treating patients with complicated lower extremity arterial diseases. PeerJ 2019; 7:e6345. [PMID: 30783567 PMCID: PMC6377597 DOI: 10.7717/peerj.6345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/24/2018] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to introduce and evaluate the safety and efficacy of the relay puncture technique in patients with complicated lower extremity arterial diseases. Methods A total of 21 patients (16 male and five female patients; median age: 68.5 years old), who had suffered from lower extremity arterial diseases between December 2014 and July 2017, were retrospectively collected. For all patients, the contralateral femoral artery was not available for puncture access, and the length of the devices was too short for the brachial artery approach. Therefore, the relay puncture technique, in which the first puncture was performed on the brachial artery, followed by an antegrade puncture on the femoral artery, was used to accomplish the endovascular therapy. Percutaneous transluminal angioplasty and/or percutaneous transluminal stenting were/was used to assess the efficacy of the relay puncture technique. The ankle–brachial index (ABI) and Rutherford clinical classification were used to evaluate the improvement of symptoms after treatment. Patients were followed up for 1, 3, 6, and 12 months, and annually (mean: 16.6 months) after discharge. Results The relay puncture treatment had a 100% technical success rate, and immediately decreased the ischemic symptoms of patients after the procedure. The ABI significantly increased from 0.33 ± 0.18 to 0.75 ± 0.21 at the 1-year follow-up time point (P < 0.05). No serious complications occurred during the follow-up period. The 1-year primary patency rate was 71.43%. Conclusion The relay puncture technique is a feasible technique in the hands of experienced and skilled equipment operators for the treatment of lower extremity arterial diseases, when the contralateral femoral artery is not available for puncture, and the length of the device is too short to treat the distal lesion of the femoral artery and popliteal artery through the brachial artery approach.
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Affiliation(s)
- Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Huimin You
- Department of Endocrinology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hong Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yulong Liu
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wanghai Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaobai Wang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yan Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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Ling K, Xu A, Chen Y, Chen X, Li Y, Wang W. Protective effect of a hydrogen sulfide donor on balloon injury-induced restenosis via the Nrf2/HIF-1α signaling pathway. Int J Mol Med 2019; 43:1299-1310. [PMID: 30747216 PMCID: PMC6365080 DOI: 10.3892/ijmm.2019.4076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
Restenosis is liable to occur following treatment with endovascular interventional therapy. Increasing evidence indicates that hydrogen sulfide (H2S) exhibits numerous physiological properties, including antioxidative and cardioprotective disease properties. Thus, the present study aimed to investigate the anti-restenosis effects of H2S and its protective mechanisms. A balloon dilatation restenosis model was used, in which model Sprague-Dawley rats were treated with sodium hydrosulfide (NaHS: A donor of H2S, 30 µmol/kg) by intraperitoneal injection for 4 weeks. Histological observations of the carotid artery were performed, and H2S production and the expression of Nuclear factor-E2-related factor 2 (Nrf2)/hypoxia-inducible factor (HIF)-1α signaling pathway proteins were measured. In addition, human umbilical vein endothelial cells (HUVECs) were treated with NaHS following the inhibition of Nrf2 or HIF-1α expression. The expression of Nrf2/HIF-1α signaling pathway proteins, tube formation and cell migration were evaluated thereafter. The results demonstrated that NaHS treatment significantly increased H2S production in rats with restenosis, and that neointimal thickness decreased significantly in arteries with restenosis. Furthermore, an increase in H2S production enhanced the nuclear accumulation of Nrf2 and expression of its downstream targets, heme oxygenase-1 and superoxide dismutase, as well as HIF-1α. Similar effects of NaHS on the expression of these proteins were observed in HUVECs. Additionally, these findings indicated that NaHS-induced HIF-1α expression was dependent on Nrf2 expression. NaHS treatment also markedly increased tube formation by upregulating vascular endothelial growth factor expression and cell migration, both of which were mediated by the Nrf2/HIF-1α signaling pathway, and suppressed the migration and proliferation of human vascular smooth muscle cells. Thus, NaHS-mediated H2S production was observed to prevent neointimal hyperplasia, promote activation of the Nrf2/HIF-1α signal pathway, and enhance HUVEC tube formation and migration, thereby exerting protective effects on balloon injury-induced restenosis.
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Affiliation(s)
- Ken Ling
- Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Ancong Xu
- The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325200, P.R. China
| | - Yunfei Chen
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Xueyin Chen
- Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Weici Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Chang JW, Heo W, Choi MSS, Lee JH. The appropriate management algorithm for diabetic foot: A single-center retrospective study over 12 years. Medicine (Baltimore) 2018; 97:e11454. [PMID: 29979449 PMCID: PMC6076129 DOI: 10.1097/md.0000000000011454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/18/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetic foot management is a challenge for reconstructive surgeons because it combines dramatically decreased circulation and chronic infection. The goal of managing this condition is to maximize viable tissue; however, unsatisfactory results, such as extremity amputation, are unavoidable in some cases. For appropriate management, thorough understanding of diabetic foot and the phased approach to its management is needed. The purpose of this study is to introduce an optimal algorithm for diabetic foot management by analyzing cases >12 years. METHODS A total of 274 patients with diabetic foot at Hanyang University Guri Hospital from 2005 to 2017 were reviewed. The management process was divided into 5 steps: patient evaluation, wound preparation, improving vascularity, surgery and dressing, and rehabilitation. Patient evaluation included a microbial culture, evaluation of vascularity, and an osteomyelitis assessment. During wound preparation, debridement and negative-pressure wound therapy were performed. Vascularity was improved by radiological intervention or surgical method. Surgery and dressing were performed depending on the indications. Rehabilitation was started after complete wound healing. RESULTS An infection was confirmed in 213 of 263 patients (81.0%). Of 74 cases in which a vascular study was performed, 83.8% showed arterial occlusion. When surgery was performed with complete eradication of the infection in 155 patients, the rate of revision surgery was 20.6%. The revision rate after surgery with a remnant infection of 66 patients was 40.9% (P = .0003). When surgery was performed after successful revascularization for improving blood flow of 47 patients, the rate of revision surgery was 21.3%. In contrast, the revision rate after surgery with unsuccessful or no revascularization of 174 patients was 28.2% (P = .359). CONCLUSION Diabetic foot is a debilitating disease arising from multifactorial process. As its management is complex, a comprehensive but accessible treatment algorithm is needed for successful results. For this reason, the appropriate algorithm for diabetic foot management introduced in this study is significant.
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Yu W, Wang B, Zhan B, Li Q, Li Y, Zhu Z, Yan Z. Statin therapy improved long-term prognosis in patients with major non-cardiac vascular surgeries: a systematic review and meta-analysis. Vascul Pharmacol 2018; 109:1-16. [PMID: 29953967 DOI: 10.1016/j.vph.2018.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/08/2018] [Accepted: 06/21/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate whether statin intervention will improve the long-term prognosis of patients undergoing major non-cardiac vascular surgeries. METHODS Major database searches for clinical trials enrolling patients undergoing major non-cardiac vascular surgeries, including lower limb revascularization, carotid artery surgeries, arteriovenous fistula, and aortic surgeries, were performed. Subgroup analyses, stratified by surgical types or study types, were employed to obtain statistical results regarding survival, patency rates, amputation, and cardiovascular and stroke events. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated by Review Manager 5.3. Sensitivity analysis, publication bias and meta-regression were conducted by Stata 14.0. RESULTS In total, 34 observational studies, 8 prospective cohort studies and 4 randomized controlled clinical trials (RCTs) were enrolled in the present analysis. It was demonstrated that statin usage improved all-cause mortality in lower limb, carotid, aortic and mixed types of vascular surgery subgroups compared with those in which statins were not used. Additionally, the employment of statins efficiently enhanced the primary and secondary patency rates and significantly decreased the amputation rates in the lower limb revascularization subgroup. Furthermore, for other complications, statin intervention decreased cardiovascular events in mixed types of vascular surgeries and stroke incidence in the carotid surgery subgroup. No significant publication bias was observed. The meta-regression results showed that the morbidity of cardiovascular disease or the use of aspirin might affect the overall estimates in several subgroups. CONCLUSIONS This meta-analysis demonstrated that statin therapy was associated with improved survival rates and patency rates and with reduced cardiovascular or stroke morbidities in patients who underwent non-cardiac vascular surgeries.
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Affiliation(s)
- Wenpei Yu
- The Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China; The Thirteenth People's Hospital of Chongqing, The Chongqing Geriatric Hospital, Chongqing 400053, China
| | - Bin Wang
- The Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China; Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, Beijing Key Laboratory of Kidney Disease, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing 100853, China
| | - Bin Zhan
- The Thirteenth People's Hospital of Chongqing, The Chongqing Geriatric Hospital, Chongqing 400053, China
| | - Qiang Li
- The Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Yingsha Li
- The Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Zhiming Zhu
- The Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Zhencheng Yan
- The Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China.
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Takayama T, Matsumura JS. Complete Lower Extremity Revascularization via a Hybrid Procedure for Patients with Critical Limb Ischemia. Vasc Endovascular Surg 2018; 52:255-261. [DOI: 10.1177/1538574418761723] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Complete revascularization, achieving inline flow to the foot through at least 1 patent tibioperoneal artery, is considered to be desirable for treating critical limb ischemia (CLI). Hybrid procedure, combined femoral endarterectomy and endovascular treatment, is commonly performed on patients with CLI because they often present with complicated lower extremity lesions involving the common femoral artery. This study aimed to investigate the efficacy of complete revascularization (CR) achieved by hybrid procedure on limb salvage in patients with CLI. Methods: Between February 2010 and January 2016, 95 limbs (82 patients) were treated by lower extremity hybrid procedure; of these 95 procedures, 61 were for patients with CLI. We defined CR as achieving inline flow to the foot through at least 1 patent tibioperoneal artery. Complete revascularization was performed on 37 limbs, and incomplete revascularization (IR) was performed on 24 limbs. Specific variables, including patient age, male–female ratio, Rutherford classification, preoperative and postoperative ankle–brachial pressure indices (ABIs), follow-up duration (months), primary patency rate, assisted primary patency rate, secondary patency rate, and major amputation rate, were analyzed. Results: The mean age was similar between the groups 67.2 years in the CR group and 70.7 years in the IR group ( P = .11). Limb ischemia severity was significantly higher in the CR group: 63% of the patients scored Rutherford 5 in the CR group, compared to 30% in the IR group ( P = .027). Mean postoperative ABI was significantly higher in the CR group (CR: 0.87, IR: 0.53; P = .0001). Major amputation rate was higher in the IR group (CR: 2.7%, IR: 13%; P = .29), and major amputation-free survival rate at 3 years after the index procedure was higher in the CR group (CR: 97%, IR: 81%; P = .054). Conclusion: Complete lower extremity revascularization was beneficial for patients with CLI, avoiding major amputation.
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Affiliation(s)
- Toshio Takayama
- Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jon S. Matsumura
- Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Chen X, Li J, Zheng C, He Y, Jia J, Wang X, Li D, Shang T, Li M. Drug-delivering endovascular treatment versus angioplasty in artery occlusion diseases: a systematic review and meta-analysis. Curr Med Res Opin 2018; 34:95-105. [PMID: 28837370 DOI: 10.1080/03007995.2017.1372114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The best management of patients with femoropopliteal and infrapopliteal artery occlusion disease is not clear. This study aimed to compare the efficacy of drug-coated balloons (DCBs) and drug-eluting stents (DESs) with percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal or infrapopliteal arterial occlusive disease. METHODS Medline, Cochrane, Embase, and Google Scholar databases were searched for randomized controlled trials from 1 January 2000 until 30 June 2016. RESULTS Compared with PTA, significant benefits in favor of DCB and DES were found for target lesion revascularization (TLR) (OR = 0.38, 95% CI = 0.22 to 0.66, p = .001 for DCB; OR = 0.51, 95% CI = 0.32 to 0.81, p < .001 for DES). Primary patency rate was greater with DCB (p = .001) and DES (p < .001) than PTA. Compared with PTA, a significant reduction in mortality was observed in the DCB group (p = .039) but not in the DES group. Subgroup analysis found a lower rate of TLR and a higher rate of primary patency in the active group (DCB and DES) compared with the control group (PTA) in patients with femoropopliteal arterial occlusion (p ≤ .016) but not in patients with infrapopliteal arterial occlusion (p ≥ .063). Mortality was similar between active replacement and control groups both in the femoropopliteal arterial occlusion and the infrapopliteal arterial occlusion subgroups (all p > .05). CONCLUSIONS Significantly better TLR and primary patency rate were found in the drug-delivering endovascular treatments compared with the PTA group for patients with femoropopliteal arterial occlusion but not for patients with infrapopliteal arterial occlusion.
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Affiliation(s)
- Xudong Chen
- a Department of Vascular Surgery , Zhejiang Provincial People's Hospital, Hangzhou, 310004 , China
| | - Jianhui Li
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Chengfei Zheng
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Yunjun He
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Junjun Jia
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Xiaohui Wang
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Donglin Li
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Tao Shang
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Ming Li
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
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Miller AJ, Takahashi EA, Harmsen WS, Mara KC, Misra S. Treatment of Superficial Femoral Artery Restenosis. J Vasc Interv Radiol 2017; 28:1681-1686. [PMID: 28935472 DOI: 10.1016/j.jvir.2017.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/25/2017] [Accepted: 07/29/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine the predictors of restenosis, major adverse limb events (MALEs), postoperative death (POD), and all-cause mortality after repeat endovascular treatment of superficial femoral artery (SFA) restenosis. MATERIALS AND METHODS This was a retrospective review of 440 patients with 518 SFA lesions who were treated between January 2002 and October 2011. Ninety-six limbs were treated for restenosis with bare metal stents (BMSs) or percutaneous transluminal angioplasty (PTA), of which 28 limbs developed another restenosis requiring a third procedure. The interaction measured in this study was between the second and third intervention. Predictors of SFA patency, MALEs, POD, and all-cause mortality after SFA restenosis treatment were identified. RESULTS Patients who were treated with BMSs (n = 51) had similar rates of restenosis compared with patients who were treated with PTA (n = 45) (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.68-2.90; P = .37). Patients in the BMS group who took statins had a significantly lower risk of restenosis than patients who did not take statins (HR 0.13; 95% CI 0.04-0.41; P < .001). Stage 4-5 chronic kidney disease (CKD) (n = 12) was associated with a significantly higher risk of MALE + POD (HR 6.17; 95% CI 1.45-26.18; P = .014) and all-cause mortality (HR 2.83; 95% CI 1.27-6.33; P = .01). Clopidogrel was protective against all-cause mortality (HR 0.41; 95% CI 0.20-0.80; P = .01). CONCLUSIONS Patients in the BMS group who took statins at the time of intervention had a significantly lower risk of developing restenosis. Stage 4-5 CKD was a risk factor for MALE + POD and all-cause mortality, while clopidogrel decreased all-cause mortality risk.
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Affiliation(s)
- Andrew J Miller
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - William S Harmsen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Clinical Statistics, Mayo Clinic, Rochester, Minnesota
| | - Kristin C Mara
- Department of Clinical Statistics, Mayo Clinic, Rochester, Minnesota
| | - Sanjay Misra
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota.
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Amrock SM, Abraham CZ, Jung E, Morris PB, Shapiro MD. Risk Factors for Mortality Among Individuals With Peripheral Arterial Disease. Am J Cardiol 2017; 120:862-867. [PMID: 28734461 DOI: 10.1016/j.amjcard.2017.05.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Morbidity and mortality from peripheral arterial disease (PAD) continues to increase. Traditional cardiovascular risk factors are implicated in the development of PAD, yet the extent to which those risk factors correlate with mortality in such patients remains insufficiently assessed. Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, Cox proportional hazards models were used to examine the association of cardiovascular risk factors and all-cause and cardiovascular mortality. A total of 647 individuals ≥40 years old with PAD (i.e., ankle-brachial index [ABI] ≤ 0.9) were followed for a median of 7.8 years. There were 336 deaths, of which 98 were attributable to cardiovascular disease. Compared with never smokers, current (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.62 to 3.71) and former (HR 1.62, 95% CI 1.14 to 2.29) smokers with PAD had higher rates of death. Moderate or vigorous physical activity of ≥10 minutes monthly was associated with lower death rates (HR 0.63, 95% CI 0.44 to 0.91). Also associated with increased rates of cardiovascular death were an ABI of <0.5 (HR 2.56, 95% CI 1.28 to 5.15, compared with those with an ABI of 0.7 to 0.9) and diabetes mellitus (HR 2.50, 95% CI 1.33 to 4.73). Neither C-reactive protein nor body mass index was associated with mortality. In conclusion, tobacco use increased the risk of all-cause and cardiovascular death, whereas physical activity was associated with a decreased mortality risk. A low ABI and diabetes were also predictive of cardiovascular death.
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Kearney K, Hira RS, Riley RF, Kalyanasundaram A, Lombardi WL. Update on the Management of Chronic Total Occlusions in Coronary Artery Disease. Curr Atheroscler Rep 2017; 19:19. [DOI: 10.1007/s11883-017-0655-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Mohd Atan BA, Ismail AE, Taib I, Lazim Z. A review on fracture prevention of stent in femoropopliteal artery. IOP CONFERENCE SERIES: MATERIALS SCIENCE AND ENGINEERING 2017; 165:012006. [DOI: 10.1088/1757-899x/165/1/012006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Giri J, Arany Z. Editorial Commentary: Guidance through the "Toolshed" for endovascular revascularization of the lower extremity. Trends Cardiovasc Med 2016; 26:513-4. [PMID: 27113478 DOI: 10.1016/j.tcm.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jay Giri
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zoltan Arany
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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