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Zhou Y, Wang T, He H, Li Q, Wan Z, Lu P, Shu C. Comparative effectiveness of endovascular treatment modalities for de novo femoropopliteal lesions at long-term follow-up: A network meta-analysis of randomized controlled trials. Int J Cardiol 2024; 404:131977. [PMID: 38508322 DOI: 10.1016/j.ijcard.2024.131977] [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: 10/06/2023] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate the best endovascular treatment for de novo femoropopliteal lesions at long-term follow-up through network meta-analysis of randomized controlled trials. METHODS Medical databases were searched on September 17, 2023. 17 trials and 7 treatments were selected. Outcomes were primary patency, target lesion revascularization (TLR), major amputation and all-cause mortality at 3 and/or 5 years. RESULTS Regarding 3-year primary patency, drug-eluting stents (DES) was the best and better than balloon angioplasty (BA; odds ratio [OR], 4.96; 95% confidence interval [CI], 2.68-9.18), bare metal stents (BMS; OR, 2.81; 95% CI, 1.45-5.46), cryoplasty (OR, 6.75; 95% CI, 2.76-16.50), covered stents (CS; OR, 3.25; 95% CI, 1.19-8.87) and drug-coated balloons (DCB; OR, 2.04; 95% CI, 1.14-3.63). Regarding 5-year primary patency, DES was the best and better than BMS (OR, 2.34; 95% CI, 1.10-4.99). Regarding 3-year TLR, DES was the best and better than BA (OR, 0.24; 95% CI, 0.13-0.44). Regarding 5-year TLR, DES was the best and better than BA (OR, 0.20; 95% CI, 0.09-0.42) and balloon angioplasty with brachytherapy (OR, 0.21; 95% CI, 0.06-0.74). Regarding 3- and 5-year major amputation, DCB was the best. Regarding 3-year mortality, DES was the best and better than CS (OR, 0.09; 95% CI, 0.01-0.67). CONCLUSIONS DES was the best treatment regarding 3-year primary patency, TLR and mortality, and DCB was the best regarding major amputation. DES was the best treatment regarding 5-year TLR, and DCB was the best regarding primary patency and major amputation. DES and DCB should be given priority in treating femoropopliteal lesions.
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Affiliation(s)
- Yang Zhou
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Zicheng Wan
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Peng Lu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China; Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Koeckerling D, Raguindin PF, Kastrati L, Bernhard S, Barker J, Quiroga Centeno AC, Raeisi-Dehkordi H, Khatami F, Niehot C, Lejay A, Szeberin Z, Behrendt CA, Nordanstig J, Muka T, Baumgartner I. Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis. Eur Heart J 2023; 44:935-950. [PMID: 36721954 PMCID: PMC10011342 DOI: 10.1093/eurheartj/ehac722] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 02/02/2023] Open
Abstract
AIMS Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy. METHODS AND RESULTS Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints. CONCLUSION Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
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Affiliation(s)
- David Koeckerling
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland.,Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse, 36002 Lucerne, Switzerland
| | - Lum Kastrati
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Joseph Barker
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicestershire LE1 7RH, UK
| | | | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Community Medicine Department, Tehran University of Medical Sciences, PourSina St., Tehran 1417613151, Iran
| | - Christa Niehot
- Literature Searches Support, 3314SC Dordrecht, the Netherlands
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, XII. Városmajor u. 68., 1122 Budapest, Hungary
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Alphonsstraße 14, 22043 Hamburg, Germany
| | - Joakim Nordanstig
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Epistudia, 3011 Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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Nasr B, Dubosq M, Gouëffic Y. Bare metal stent in the area of drug eluting devices for long femoropopliteal lesions. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:581-586. [PMID: 35687067 DOI: 10.23736/s0021-9509.22.12374-8] [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
The advancement in the endovascular treatment and the introduction of novel techniques allowed treatment of more complex and longer femoropopliteal lesions. However, the optimal treatment modality is still a source of controversy. The use of bare metal stents (BMS) showed good results for long femoropopliteal lesions. In this review, we summarized all available data on the different treatment strategies of long femoro-popliteal lesions using BMS. Nevertheless, RCTs with head-to-head comparison between BMS strategies are still needed to have more clarification on the best strategy for the endovascular treatment of long femoropopliteal occlusive lesions.
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Affiliation(s)
- Bahaa Nasr
- Department of Vascular and Endovascular Surgery, Brest University Hospital, Brest, France -
- INSERM UMR 1101, LaTIM, Brest, France -
| | - Maxime Dubosq
- Aortic Center, Institut Cœur-Poumon, CHU Lille, Lille, France
| | - Yann Gouëffic
- Department of Vascular and Endovascular Surgery, Paris St. Joseph Hospital, Paris, France
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Algorithm of Femoropopliteal Endovascular Treatment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091293. [PMID: 36143968 PMCID: PMC9501396 DOI: 10.3390/medicina58091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devices are now available for physicians. However, in order to obtain a high success rate, it is necessary to respect an algorithm whose choice of device is only one step in the treatment. Materials and Methods: The first step is, therefore, to define the approach according to the lesion to be treated. Anterograde approaches (femoral, radial, or humeral) are distinguished from retrograde approaches depending on the patient’s anatomy and surgical history. Secondarily, the lesion will be crossed intraluminally or subintimally using a catheter or an angioplasty balloon. The third step corresponds to the preparation of the artery, which is essential before the implantation of the device. It has a crucial role in reducing the rate of restenosis. Several tools are available and are chosen according to the lesion requiring treatment (stenosis, occlusion). Among them, we find the angioplasty balloon, the atherectomy probes, or intravascular lithotripsy. Finally, the last step corresponds to the choice of the device to be implanted. This is also based on the nature of the lesion, which is considered short, up to 15 cm and complex beyond that. The choice of device will be between bare stents, covered stents, drug-coated balloons, and drug-eluting stents. Currently, drug-eluting stents appear to be the treatment of choice for short lesions, and active devices seem to be the preferred treatment for more complex lesions, although there is a lack of data. Results: In case of failure to cross the lesion, the retrograde approach is a safe and effective alternative. Balloon angioplasty currently remains the reference method for the preparation of the artery, the aim of which is to ensure the intraoperative technical success of the treatment (residual stenosis < 30%), to limit the risk of dissection and, finally, to limit the occurrence of restenosis. Concerning the treatment, the drug-eluting devices seem to present the best results, whether for simple or complex lesions. Conclusions: Endovascular treatment for femoropopliteal lesions needs to be considered upstream of the intervention in order to anticipate the treatment and the choice of devices for each stage.
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Endovascular Treatment and Outcomes for Femoropopliteal In-Stent Restenosis: Insights from the XLPAD Registry. J Interv Cardiol 2022; 2022:5935039. [PMID: 35911663 PMCID: PMC9307356 DOI: 10.1155/2022/5935039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is limited “real-world” evidence examining treatment modalities and outcomes in patients with symptomatic peripheral arterial disease undergoing endovascular treatment of femoropopliteal (FP) in-stent restenosis (ISR). Materials and Methods We compared outcomes in 2,895 patients from the XLPAD registry (NCT01904851) between 2006 and 2019 treated for FP ISR (n = 347) and non-ISR (n = 2,548) lesions. Primary endpoint included major adverse limb events (MALE) at 1 year, a composite of all-cause death, target limb repeat revascularization, or major amputation. Results ISR patients were more frequently on antiplatelet (94.5% vs 89.4%, p=0.007) and statin (68.9% vs 60.3%, p=0.003) therapies. Lesion length was similar (ISR: 145 ± 99 mm vs. non-ISR: 142 ± 99 mm, p=0.55). Fewer treated ISR lesions were chronic total occlusions (47.3% vs. 53.7%, p=0.02) and severely calcified (22.4% vs. 44.7%, p < 0.001). Atherectomy (63.5% vs. 45.0%, p < 0.001) and drug-coated balloons (DCB; 4.7% vs. 1.7%, p < 0.001) were more frequently used in ISR lesions. The distal embolization rate was higher in ISR lesions (2.4% vs. 0.9%, p=0.02). Repeat revascularization (21.5% vs. 16.7%, p=0.04; Figure) was higher and freedom from MALE at 1 year was significantly lower (87% vs. 92.5%, p < 0.001) in the ISR group. Conclusion Atherectomy and DCB are more frequently used to treat FP ISR lesions. Patients with FP ISR have more intraprocedural distal embolization, higher repeat revascularization procedures, and lower freedom from MALE at 1 year.
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Zhao S, Li L, Cui K. Network Analysis of Endovascular Treatment Strategies for Femoropopliteal Arterial Occlusive Disease. J Endovasc Ther 2022:15266028221090434. [PMID: 35392691 DOI: 10.1177/15266028221090434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Endovascular treatment of femoropopliteal arterial diseases remains controversial. We conducted a Bayesian network meta-analysis of randomized controlled trials aiming to investigate the efficacy differences between paclitaxel- or sirolimus-eluting stents, covered stents, drug-coated balloons, bare metal stents, and percutaneous transluminal angioplasty. METHOD MEDLINE, Embase, Ovid, and other relevant online material were searched up to October 21, 2020. Primary endpoints were primary patency and target lesion revascularization at 6, 12, and more than 24 months. RESULTS Thirty-eight eligible trials included 6026 patients. In terms of primary patency, drug eluting stents were ranked as the most effective treatment based on the surface under the cumulative ranking curve values at 6 (80.6), 12 (78.4), and more than 24 months (96.5) of follow-ups. In terms of target lesion revascularization, drug eluting stents were ranked as the most effective treatment based on the surface under the cumulative ranking curve values at 6 (90.3), 12 (71.3), and more than 24 months (82.1) of follow-ups. Covered stents and bare metal stents had higher ranks in target lesion revascularization than those in primary patency. Sirolimus stents had a higher rank than paclitaxel stents. CONCLUSION Drug eluting stents showed encouraging results in primary patency rates and freedom from target lesion revascularization at all phases of follow-up for femoropopliteal arterial diseases. Sirolimus stents appear to be more effective in femoropopliteal segment than paclitaxel stent.
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Affiliation(s)
- Shenyu Zhao
- Department of Cardiovascular Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Lingzhi Li
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiovascular Medicine, West China Hospital of Sichuan University, Chengdu, China
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Bontinis A, Bontinis V, Koutsoumpelis A, Giannopoulos A, Ktenidis K. A systematic review aggregated data and individual participant data meta-analysis of spot stenting in the treatment of lower extremity peripheral arterial disease. Ann Vasc Surg 2022; 85:424-432. [DOI: 10.1016/j.avsg.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
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Influence of Lamina Vastoadductoria Dissection on the Outcomes of Femoral Artery Extensive Lesion Stenting: A Pilot Randomised Investigation. J Biomech 2022; 136:111053. [DOI: 10.1016/j.jbiomech.2022.111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/20/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
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Helou B, Bel-Brunon A, Dupont C, Ye W, Silvestro C, Rochette M, Lucas A, Kaladji A, Haigron P. Influence of balloon design, plaque material composition, and balloon sizing on acute post angioplasty outcomes: An implicit finite element analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3499. [PMID: 33998779 DOI: 10.1002/cnm.3499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
In this work we propose a generic modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment, and evaluating the influence of balloon design, plaque composition, and balloon sizing on acute post-procedural outcomes right after PTA, without stent implantation. Clinically-used PTA balloons were classified into two categories according to their compliance characteristics, and were modeled correspondingly. Self-defined elastoplastic constitutive laws were implemented within the plaque and artery models, after calibration based on experimental and clinical data. Finite element method (FEM) implicit solver was used to simulate balloon inflation and deflation. Besides balloon profile at max inflation, results are mainly assessed in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) obtained immediately after PTA. No variations in ERR nor LGR values were detected when the balloon design changed, despite the differences observed in their profile at max inflation. Moreover, LGR and ERR inversely varied with the augmentation of calcification level within the plaque (-11% vs. +4% respectively, from fully lipidic to fully calcified plaque). Furthermore, results showed a direct correlation between balloon sizing and LGR and ERR, with noticeably higher rates of change for LGR (+18% and +2% for LGR and ERR respectively for a calcified plaque and a balloon pressure increasing from 10 to 14 atm). However a larger LGR comes with a higher risk of arterial rupture. This proposed methodology opens the way for evaluation of angioplasty balloon selections towards clinical procedure optimization.
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Affiliation(s)
- Bernard Helou
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Aline Bel-Brunon
- Univ Lyon, INSA-Lyon, CNRS UMR5259, LaMCoS, Villeurbanne, France
| | - Claire Dupont
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | | | - Claudio Silvestro
- Medtronic, Aortic Peripheral & Venous (APV) Group, Santa Rosa, California, USA
| | | | - Antoine Lucas
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Adrien Kaladji
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Pascal Haigron
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
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Kawamori H, Konishi A, Shinke T, Akahori H, Ishihara M, Tsujita H, Otake H, Toba T, Nakano S, Tanimura K, Tsukiyama Y, Nanba I, Kakei Y, Yasuda T, Omori T, Kubo T, Kozuki A, Shite J, Hirata KI. Efficacy of optical frequency domain imaging in detecting peripheral artery disease: the result of a multi-center, open-label, single-arm study. Heart Vessels 2021; 36:818-826. [PMID: 33481085 DOI: 10.1007/s00380-020-01758-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 12/31/2022]
Abstract
Optical frequency domain imaging (OFDI) is a high-resolution intracoronary imaging modality with fast automated longitudinal pullback. We aimed to evaluate the ability of performing OFDI from the superficial femoral artery (SFA) to the below-knee (BK) artery. This clinical trial was a multi-center, single-arm, open-label study. The primary endpoint was to obtain a clear image of the intra-vascular lumen from the SFA to the BK artery, specifically > 270° visualization of the blood vessel lumen with > 16/21 cross sections. The proportion of the clear image (≥ 85%) was regarded as confirmatory of the ability of OFDI to visualize the vessel lumen. Overall, 20 patients were enrolled. The proportion of the primary endpoint was 90% (18/20), and the pre-specified criterion was successfully attained. The proportion of the clear image assessed by the operator was 100% (20/20), and an additional statistical analysis for the proportion of the visualization, > 270°, of the blood vessel lumen revealed a significantly higher cut-off value than that for the pre-specified criterion, 85% (p = 0.0315). There were three adverse events not related to OFDI. OFDI achieved acceptable visualization of the vessel lumen without any adverse event related to it. After regulatory approval based on the present study, OFDI will be available as a new option of endovascular imaging for peripheral artery diseases in daily practiceTrial registration: This study was registered in the Japanese Registry of Clinical Trials (jRCT 2052190025, https://jrct.niph.go.jp/latest-detail/jRCT2052190025 ).
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Affiliation(s)
- Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Akihide Konishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan. .,Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.,Division of Cardiovascular Medicine, School of Medicine, Showa University, Shinagawa, Japan
| | - Hirokuni Akahori
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroaki Tsujita
- Division of Cardiovascular Medicine, School of Medicine, Showa University, Shinagawa, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shinsuke Nakano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kosuke Tanimura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Isao Nanba
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yasumasa Kakei
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takahiro Yasuda
- Advanced Medical-Engineering Development Center, Kobe University, Kobe, Japan
| | - Takashi Omori
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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Augustin AM, Thein I, Rickert N, Klink T, Bley TA, Kickuth R. Evaluation of superficial femoral artery-lesions after percutaneous transluminal angioplasty: color-coded summation images vs. monochromatic digital subtraction angiography. BMC Med Imaging 2020; 20:67. [PMID: 32552680 PMCID: PMC7302343 DOI: 10.1186/s12880-020-00468-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous transluminal angioplasty (PTA) is increasingly requested in the therapy of peripheral arterial occlusive disease. The evaluation of the technical result after balloon angioplasty with regard to bailout stenting is highly dependent on the operators´ subjective assessment and mainly based on the monochromatic digital subtraction angiography (DSA) images. The aim of this study was to compare color-coded single image as a novel diagnostic tool with monochromatic DSA for the analysis of flow limitation and need for stent implantation after PTA of superficial femoral artery (SFA) stenoses. Methods During a period of 18 months, 213 SFA lesions were treated by PTA with a standard balloon in 170 patients, resulting in a total of 193 endovascular procedures. The median age of the patients was 77 years (range, 35–96 years). Median length of the treated lesions was 10.5 cm (range, 1.0–50 cm). Three interventional radiologists retrospectively evaluated the results of balloon angioplasty with monochromatic as well as post-processed color-coded DSA images for flow limitations to decide if subsequent stent implantation was necessary. Consensus reading of two experienced interventional radiologists 2 months after the initial review served as reference standard to perform a receiver operating characteristics (ROC) analysis. Results ROC analysis for readers A, B and C showed area under the curve (AUC) values of 0.797, 0.865 and 0.804 for color-coded DSA and AUC values of 0.792, 0.843 and 0.872 for monochromatic DSA: a significant advantage of color-coded over conventional monochromatic DSA was not found for readers A and B (p > 0.05). Results of reader C were significantly better in the assessment of monochromatic images (p = 0.023). Diagnostic confidence using color-coded images was slightly higher than in monochromatic images (κ = 0.486 vs. κ = 0.459). Conclusions In this study, color coded DSA did not reveal to be superior to conventional monochromatic DSA when evaluating results of PTA and when deciding whether stent implantation is necessary or not. This technology, however, requires further experiences with special regard to homogeneously trained radiologists and to the time requirement.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
| | - Irina Thein
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Nicole Rickert
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Klink
- Department of Diagnostic and Interventional Radiology, Hospital Bayreuth GmbH, Bayreuth, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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12
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Kawamori H, Konishi A, Otake H, Toba T, Nakano S, Tanimura K, Tsukiyama Y, Namba I, Omori T, Shinke T, Hirata K. Efficacy of optical frequency-domain imaging in detecting peripheral artery disease: a single-center open-label, single-arm study protocol. Cardiovasc Interv Ther 2020; 35:385-391. [DOI: 10.1007/s12928-019-00636-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
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13
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Gad MM, Karrthik AK, Mahmoud AA, Mahmoud AN. Is There a Safety Concern for Drug-Coated Balloons in Peripheral Arterial Disease? Curr Cardiol Rep 2019; 21:126. [PMID: 31494770 DOI: 10.1007/s11886-019-1211-z] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Drug-coated balloons (DEB) and drug-eluting stents (DES) emerged as a tool to aid in lowering the rates of neointimal hyperplasia and target lesion restenosis following endovascular peripheral arterial disease (PAD) interventions. RECENT FINDINGS Although the initial trials comparing these devices with non-drug balloons and stents showed favorable results, more recent data raised concerns regarding the mid to long-term safety of these devices. In this review, we will discuss the evolution of endovascular therapy for PAD, with highlights regarding the recent debates on the long-term safety of the drug-coated devices for treatment of PAD.
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Affiliation(s)
- Mohamed M Gad
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
- School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antonette K Karrthik
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Ahmad A Mahmoud
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Ahmed N Mahmoud
- Division of Cardiology, University of Washington, Seattle, WA, USA.
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14
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Ichihashi S, Shibata T, Fujimura N, Nagatomi S, Yamamoto H, Kyuragi R, Adachi A, Iwakoshi S, Bolstad F, Saeki K, Obayashi K, Kichikawa K. Vessel Calcification as a Risk Factor for In-Stent Restenosis in Complex Femoropopliteal Lesions After Zilver PTX Paclitaxel-Coated Stent Placement. J Endovasc Ther 2019; 26:613-620. [DOI: 10.1177/1526602819860124] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: To evaluate the effect of vessel calcification on in-stent restenosis (ISR) after drug-coated stent (DCS) placement in the femoropopliteal segment. Materials and Methods: A retrospective multicenter study was undertaken involving 220 consecutive symptomatic patients (mean age 73.1±8.3 years; 175 men) with femoropopliteal lesions in 230 limbs treated with the Zilver PTX DCS and having duplex surveillance after the endovascular procedures. Mean lesion length was 16.4±9.8 cm (range 2–40); there were 104 (45.2%) total occlusions and 68 (29.6%) in-stent restenoses (ISR). Twenty (8.7%) vessels had no runoff. The majority of lesions (148, 64.3%) were calcified according to the peripheral arterial calcium scoring system (PACSS). Primary patency was evaluated by duplex. Lesions were classified as either PACSS 0–2 (none or unilateral wall calcification) or PACSS 3 and 4 (bilateral wall calcification). Multivariate analysis was performed to identify variables associated with ISR; the results are given as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 1-, 2-, and 5-year primary patency and freedom from clinically-driven target lesion revascularization estimates were 75.9%, 63.6%, and 45.0%, and 84.7%, 73.7%, and 54.2%, respectively. Major amputations were performed on 4 limbs during follow-up. In multivariate analysis, vessel calcification (adjusted HR 1.718, 95% CI 1.035 to 2.851, p=0.036) was significantly correlated with the occurrence of ISR, along with lesion length (adjusted HR 1.041, 95% CI 1.013 to 1.070, p=0.003), and cilostazol administration (adjusted HR 0.476, 95% CI 0.259 to 0.876, p=0.017). Conclusion: This study suggested that bilateral vessel wall calcification was an independent risk factor for ISR in complex femoropopliteal lesions after Zilver PTX DCS placement, along with lesion length; cilostazol administration had a protective effect.
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Affiliation(s)
- Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Satoru Nagatomi
- Department of Radiology, Nara Medical University, Kashihara, Japan
- Department of Radiology, Sumitomo Hospital, Osaka, Japan
| | | | - Ryoichi Kyuragi
- Division of Vascular Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Akira Adachi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | | | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Kashihara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University, Kashihara, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University, Kashihara, Japan
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15
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Megaly M, Abraham B, Saad M, Mekaiel A, Soukas P, Banerjee S, Shishehbor MH. Outcomes with cilostazol after endovascular therapy of peripheral artery disease. Vasc Med 2019; 24:313-323. [PMID: 31023156 DOI: 10.1177/1358863x19838327] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The role of cilostazol after endovascular therapy (EVT) of peripheral artery disease (PAD) remains unclear. We conducted a meta-analysis for all studies reporting the outcomes of cilostazol after EVT of PAD from January 2000 through November 2018 with the outcomes of interest including primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation. We included eight studies (three randomized controlled trials (RCTs) and five observational studies) with a total of 3846 patients (4713 lesions). During a mean follow-up duration of 12.5 ± 5 months, the use of cilostazol was associated with higher primary patency (OR 2.28, 95% CI (1.77, 2.94), p < 0.001, I2 = 24%), lower risk of TLR (OR 0.37, 95% CI (0.26, 0.52), p < 0.001, I2 = 0%), and lower risk of major amputation (OR 0.15, 95% CI (0.04, 0.62), p = 0.008, I2 = 0%). The use of cilostazol in RCTs was associated with significantly higher odds of primary patency compared with observational studies (OR 3.37 vs 2.28, p-interaction = 0.03). After further subgroup analysis, cilostazol remained associated with higher primary patency regardless of the use of anticoagulants (warfarin) (p-interaction = 0.49). We conclude that the use of cilostazol after EVT of femoropopliteal and iliac lesions is associated with improved primary patency and lower risk of major amputation and TLR. The favorable impact of cilostazol is independent of the use of warfarin. PROSPERO identifier: CRD42018092715.
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Affiliation(s)
- Michael Megaly
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.,2 Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Bishoy Abraham
- 3 Department of Medicine, Ascension St John Hospital, Detroit, MI, USA
| | - Marwan Saad
- 4 Department of Cardiovascular Medicine, Department of Medicine, University of Arkansas, Little Rock, AR, USA.,5 Department of Cardiovascular Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Andrew Mekaiel
- 6 Department of Medicine, Jamaica Hospital Medical Center, Queens, NY, USA
| | - Peter Soukas
- 7 Division of Cardiovascular Medicine, Department of Medicine, Warren Alpert Medical School at Brown University, RI, USA
| | - Subhash Banerjee
- 8 Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mehdi H Shishehbor
- 9 Harrington Heart and Vascular Institute, Case Western Reserve University (CWRU) School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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16
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Vossen RJ, Vahl AC, Leijdekkers VJ, Montauban van Swijndregt AD, Balm R. Long-Term Clinical Outcomes of Percutaneous Transluminal Angioplasty with Optional Stenting in Patients with Superficial Femoral Artery Disease: A Retrospective, Observational Analysis. Eur J Vasc Endovasc Surg 2018; 56:690-698. [PMID: 30108029 DOI: 10.1016/j.ejvs.2018.06.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The recent ESC guideline advises primary stent placement in superficial femoral arterial disease (SFAD). The aim of this study was to compare clinical outcomes of SFAD patients selected for stent placement with plain percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS A single centre retrospective, observational analysis was performed of all consecutive patients undergoing endovascular treatment for SFAD from 2004 to 2015. Primary endpoints were primary and secondary clinical patency rates in patients with or without stent placement. Secondary endpoints were recurrence rates and number of amputations. Kaplan-Meier curves were used to compare patency rates. Multivariable Cox regression analysis was performed to adjust for confounding variables and to identify variables associated with loss of patency. RESULTS A total of 389 patients were analysed with a median follow up of 42 months. Two hundred and fifty one patients (64.5%) were stented. Primary clinical patency rates at 1, 3, and 5 years were 82.8%, 71.0%, and 65.6% after PTA and 76.3%, 65.7%, and 58.1% after stent placement (PTA-S), respectively (p = .30). Secondary patency rates were also comparable for the PTA and PTA-S group resulting in 1, 3 and 5 year clinical secondary patency of 89.1%, 81.0%, and 76.3% in the PTA group versus 87.8%, 78.5%, and 71.9% in the PTA-S group (p = .58). Multivariable analysis revealed equal primary and secondary clinical patency between the treatment groups. The absolute re-intervention rate was 29.3%. The number of re-interventions and amputation rate did not significantly differ between the two groups (p = .41 and p = .75). CONCLUSIONS Selective stenting in patients with SFAD shows comparable results in long-term clinical outcomes in patients who were treated with plain PTA as well as patients who are selected for stent placement. An approach of selective stenting is justified.
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Affiliation(s)
- Rianne J Vossen
- Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands.
| | - Anco C Vahl
- Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands
| | | | | | - Ron Balm
- Department of Vascular Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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17
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Koifman E, Lipinski MJ, Buchanan K, Yu Kang W, Escarcega RO, Waksman R, Bernardo NL. Comparison of treatment strategies for femoro-popliteal disease: A network meta-analysis. Catheter Cardiovasc Interv 2018; 91:1320-1328. [DOI: 10.1002/ccd.27484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/05/2017] [Accepted: 12/17/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Michael J. Lipinski
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Kyle Buchanan
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Won Yu Kang
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ricardo O. Escarcega
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Nelson L. Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
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18
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Schneider PA. Evolution and current use of technology for superficial femoral and popliteal artery interventions for claudication. J Vasc Surg 2017; 66:916-923. [DOI: 10.1016/j.jvs.2017.05.110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
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19
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Sangiorgi G, Martelli E, De Luca F, Biondi-Zoccai G. Commentary: IVUS-Guided Recanalization of Peripheral CTOs: No More Eyes Wide Shut for Physicians? J Endovasc Ther 2017; 24:727-730. [PMID: 28830276 DOI: 10.1177/1526602817727280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Sangiorgi
- 1 Department of Cardiology, Cardiac Catheterization Laboratory, University of Rome Tor Vergata, Rome, Italy
| | - Eugenio Martelli
- 2 Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Sassari, Italy
| | - Fabio De Luca
- 3 Department of Cardiothoracic Surgery, Istituto Clinico Gavazzeni Humanitas, Bergamo, Italy
| | - Giuseppe Biondi-Zoccai
- 4 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,5 Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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20
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Elmahdy MF, Buonamici P, Trapani M, Valenti R, Migliorini A, Parodi G, Antoniucci D. Long-Term Primary Patency Rate After Nitinol Self-Expandable Stents Implantation in Long, Totally Occluded Femoropopliteal (TASC II C & D) Lesions. Heart Lung Circ 2017; 26:604-611. [DOI: 10.1016/j.hlc.2016.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 06/21/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
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21
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Kawasaki D, Fukunaga M, Nakata T, Kato M, Ohkubo N. Comparison of the OUTBACK ® Elite Reentry Catheter and the Bi-directional Approach after Failed Antegrade Approach for Femoro-popliteal Occlusive Disease. J Atheroscler Thromb 2017; 24:1242-1248. [PMID: 28515407 PMCID: PMC5742369 DOI: 10.5551/jat.40048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: A successful antegrade wire crossing for femoro-popliteal chronic total occlusion (FP-CTO) is still a technical challenge. We attempted to demonstrate the safety and feasibility of the OUTBACK® Elite reentry catheter and the bi-directional approach for failed FP-CTO cases with the antegrade approach. Methods: Endovascular therapy for FP-CTO was performed in 219 lesions from May 2013 to December 2016 at Morinomiya Hospital. We retrospectively analyzed the data of 43 consecutive lesions which underwent endovascular therapy using the bi-directional approach with distal access and the mono-directional approach with the OUTBACK® Elite reentry catheter for FP-CTO lesions. The antegrade success using a combination of traditional and Intravascular Ultrasound (IVUS) -guided techniques was achieved in 170 lesions out of a total of 219 lesions. From May 2013 to June 2016 (phase 1), the bi-directional approach with distal access was applied to 22 lesions after failed antegrade approaches. From July 2016 to December 2016 (phase 2), the mono-directional approach with the OUTBACK® Elite reentry catheter was applied to 21 lesions. Results: Clinical and lesion characteristics in phase 1 were not significantly different from those in phase 2. The overall initial technical success rate was 100% in both phases. The total wire number and amount of contrast media were significantly less, and the total procedure time and the total fluoroscopic time were significantly shorter in phase 2 than in phase 1 (p < 0.01). Conclusions: Endovascular therapy for FP-CTO using the OUTBACK® Elite reentry catheter is feasible and safe after a failed antegrade approach.
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Affiliation(s)
- Daizo Kawasaki
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Masashi Fukunaga
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Tsuyoshi Nakata
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
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22
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Ott I, Cassese S, Groha P, Steppich B, Hadamitzky M, Ibrahim T, Kufner S, Dewitz K, Hiendlmayer R, Laugwitz KL, Schunkert H, Kastrati A, Fusaro M. Randomized Comparison of Paclitaxel-Eluting Balloon and Stenting Versus Plain Balloon Plus Stenting Versus Directional Atherectomy for Femoral Artery Disease (ISAR-STATH). Circulation 2017; 135:2218-2226. [PMID: 28424222 DOI: 10.1161/circulationaha.116.025329] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 03/17/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Atherosclerosis in the superficial femoral artery is common in patients suffering from peripheral artery disease. Paclitaxel-eluting balloon (PEB) angioplasty, stenting, and directional atherectomy (DA) have provided new options for the treatment of superficial femoral artery disease; however, the comparative efficacy of these interventional strategies remains uncertain. METHODS One hundred and fifty-five patients with symptomatic peripheral artery disease due to de novo superficial femoral artery stenotic or occlusive lesions were randomized to treatment with plain balloon angioplasty (BA) followed by PEB angioplasty and stenting (n=48), BA and stenting (n=52), or DA with distal protection and bailout stenting (n=55). The primary end point of the study was percentage diameter stenosis after 6 months measured by angiography. Other end points included target lesion revascularization, thrombosis, ipsilateral amputation, binary restenosis, and all-cause mortality at 6 and 24 months. RESULTS Baseline and lesion characteristics were comparable in all groups with a mean lesion length of 65.9±46.8 mm and 56% total occlusions. At 6 months angiography, the percent diameter stenosis was significantly lower in patients treated by PEB angioplasty and stenting (34±31%) as compared with BA angioplasty and stenting (56±29%, P=0.009) or DA (55±29%, P=0.007). Similarly, binary restenosis was significantly lower after treatment with PEB and stenting as compared with BA and stenting or DA. Clinical follow-up at 24 months revealed a lower risk for target lesion revascularization after PEB angioplasty and stenting as compared with BA and stenting or DA. We found no difference in terms of target lesion thrombosis and mortality among groups, and no patient underwent amputation. CONCLUSIONS Treatment of de novo superficial femoral artery lesions with PEB angioplasty and stenting is superior to BA angioplasty and stenting or DA in terms of angiographic diameter stenosis at 6 months and target lesion revascularization at 24 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00986752.
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Affiliation(s)
- Ilka Ott
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.).
| | - Salvatore Cassese
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Philipp Groha
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Birgit Steppich
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Martin Hadamitzky
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Tareq Ibrahim
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Sebastian Kufner
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Karl Dewitz
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Regina Hiendlmayer
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Karl-Ludwig Laugwitz
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Heribert Schunkert
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Adnan Kastrati
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Massimiliano Fusaro
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
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Kaladji A, Giovannetti M, Pascot R, Clochard E, Daoudal A, Lucas A, Cardon A. Preoperative CT-scan-based sizing and in-stent restenosis in peripheral endovascular revascularizations. Vascular 2017; 25:504-513. [PMID: 28330432 DOI: 10.1177/1708538117700764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives This study evaluates the effect of stent sizing with CT-scan on the incidence of restenosis in peripheral arterial disease. Methods This retrospective study included 59 patients with 66 arterial lesions who underwent a endovascular procedure for peripheral arterial disease between April 2013 and October 2013. All patients had de novo iliac or femoral lesions, were candidates for an endovascular procedure alone and underwent CTA preoperatively. The stent actually implanted, whose dimensions were chosen on the basis of the operator's experience on an intraoperative 2D angiography, was compared to the "ideal" stent chosen retrospectively on the basis of precise lesion sizing by the preoperative CTA. Planning was considered "discordant" if there was a difference in length of more than 20 mm and/or a difference in diameter of more than 1 mm between the ideal stent and the actual stent. Results For iliac lesions, discordance essentially concerned stent diameter (36.1%), whereas stent length was the main reason for discordance for femoral lesions (36.7%). The median length of follow-up was 18 months (range 6-24). For iliac lesions, freedom from restenosis at 24 months was higher for patients with concordant planning (90% vs. 62.5%, p = 0.045). Most restenoses occurred in the external iliac artery, where there was a tendency towards oversizing of the implanted stent. For femoral lesions, the restenosis-free rate at 24 months was higher for patients with concordant planning (77.8% vs. 50%, p = 0.057). A multivariate analysis was conducted on the prediction of restenosis. Among factors, only discordant planning was found to be a significant predictor of restenosis with an odds ratio of 0.115 (95% confidence interval, 0.02-0.674; p = 0.016). Conclusion The absence of sizing for peripheral lesions engenders a tendency to choose the wrong stent, in particular in terms of diameter in iliac arteries and length in femoral arteries.
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Affiliation(s)
- Adrien Kaladji
- 1 CHU Rennes, Centre of Cardiothoracic and Vascular Surgery, Rennes, France.,2 INSERM, Rennes, France.,3 University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
| | | | - Remy Pascot
- 1 CHU Rennes, Centre of Cardiothoracic and Vascular Surgery, Rennes, France
| | - Elodie Clochard
- 1 CHU Rennes, Centre of Cardiothoracic and Vascular Surgery, Rennes, France
| | - Anne Daoudal
- 1 CHU Rennes, Centre of Cardiothoracic and Vascular Surgery, Rennes, France
| | - Antoine Lucas
- 1 CHU Rennes, Centre of Cardiothoracic and Vascular Surgery, Rennes, France.,2 INSERM, Rennes, France.,3 University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
| | - Alain Cardon
- 1 CHU Rennes, Centre of Cardiothoracic and Vascular Surgery, Rennes, France
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Abstract
The superficial femoral artery is a complex artery subject to a unique set of biomechanical loading conditions in its course through the leg. Plain balloon angioplasty and balloon-expandable stents had unacceptably high rates of restenosis, necessitating target vessel revascularization. Nitinol alloy is well suited to provide the strength and flexibility needed of stents to withstand the external forces posed by the environment of the superficial femoral artery. Advances in stent technology with the addition of a slow-releasing antiproliferative agent and changes in scaffold design have shown promise in reducing the rates of stent fracture and in-stent restenosis.
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Affiliation(s)
- Ashwin Nathan
- Cardiovascular Medicine Division, Perelman Center, Hospital of the University of Pennsylvania, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Penn Cardiovascular Quality, Outcomes, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Taisei Kobayashi
- Cardiovascular Medicine Division, Perelman Center, Hospital of the University of Pennsylvania, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Penn Cardiovascular Quality, Outcomes, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jay Giri
- Cardiovascular Medicine Division, Perelman Center, Hospital of the University of Pennsylvania, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Penn Cardiovascular Quality, Outcomes, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA, USA.
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A network meta-analysis of randomized controlled trials comparing treatment modalities for de novo superficial femoral artery occlusive lesions. J Vasc Surg 2016; 65:234-245.e11. [PMID: 27865639 DOI: 10.1016/j.jvs.2016.08.095] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/05/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Treatment of superficial femoral artery (SFA) lesions remains challenging. We conducted a network meta-analysis of randomized controlled trials aiming to explore the efficacy of treatment modalities for SFA "de novo" lesions. METHODS Eleven treatments for SFA occlusive disease were recognized. We used primary patency and binary restenosis at 12-month follow-up as proxies of efficacy for the treatment of SFA lesions. RESULTS A total of 33 studies (66 study arms; 4659 patients) were deemed eligible. In terms of primary patency, odds ratios (ORs) with 95% confidence intervals (CIs) were statistically significantly higher in drug-eluting stent (DES; OR, 10.05; 95% CI, 3.22-31.39), femoropopliteal bypass surgery (BPS; OR, 7.15; 95% CI, 2.27-22.51), covered stent (CS; OR, 3.56; 95% CI, 1.33-9.53), and nitinol stent (NS; OR, 2.83; 95% CI, 1.42-5.51) compared with balloon angioplasty (BA). The rank order from higher to lower primary patency in the multidimensional scaling was DES, BPS, NS, CS, drug-coated balloon, percutaneous transluminal angioplasty with brachytherapy, stainless steel stent, cryoplasty (CR), and BA. Combination therapy of NS with CR and drug-coated balloon were the two most effective treatments, followed by NS, CS, percutaneous transluminal angioplasty with brachytherapy, cutting balloon, stainless steel stent, BA, and CR in terms of multidimensional scaling values for binary restenosis. CONCLUSIONS DES has shown encouraging results in terms of primary patency for SFA lesions, whereas BPS still maintains its role as a principal intervention. On the contrary, BA and CR appear to be less effective treatment options.
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Kay M, Rogoveanu R, Hodson J, Tallowin S, Hopkins J, Duddy M, Vohra R. Factors Affecting the Results of Superficial Femoral Artery Stenting. Vasc Endovascular Surg 2015; 49:228-35. [PMID: 26584581 DOI: 10.1177/1538574415614405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to assess the durability of superficial femoral artery (SFA) stents and factors that affect stent patency. METHODS A retrospective assessment of 214 SFA stent procedures between 2003 and 2012 was conducted from a prospectively compiled database. Patency rates and patient outcomes were compiled from case notes and computerized records. Stent patency was confirmed by either duplex scan or clinical examination (palpable distal pulse). Survival and patency were compared across a range of factors using Kaplan-Meier plots and log-rank tests. Factors found to be significant were further assessed by Cox regression models. RESULTS Data were analyzed for 214 limbs in 205 patients. Inclusion criteria included those patients who received an SFA stent for treatment of claudication or critical limb ischemia (CLI) with follow-up data. This gave a study group of 151 limbs divided into 76 claudicant and 75 patients with CLI (male-female ratio = 103:48, mean age 71 years, standard deviation 11.7). Seventy-one percent of procedures were elective and 29% were emergency procedures; 53% of procedures were carried out on a day case basis. Median follow-up was 11 months (range 1 day-89 months). Patency was significantly worse for patients with CLI (P = .009), with a 1- and 3-year patency of 63% and 34% compared to 79% and 60% in patients with claudication. Significant factors associated with patency included oral therapy controlled diabetes (P = .003), lesions located in either the mid-SFA (P = .029) or the mid-popliteal (P = .013), and periprocedural complications (P = .005). There was no significant difference in patency rates between insulin-dependent and nondiabetic patients (hazard ratio: 1.0, 95% confidence interval: 0.4-5.6, P = .983). The overall amputation rate for the total study group was 5%. Patients with 1- and 3-year survival were 98% and 96% in the claudication group and 74% and 51%, respectively, in the CLI group. CONCLUSION SFA stents have superior outcomes in claudicants. Patency is related to severity of disease, diabetes, and location of disease.
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Affiliation(s)
- Mark Kay
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Radu Rogoveanu
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - James Hodson
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Simon Tallowin
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Jonathan Hopkins
- Department of Interventional Radiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Martin Duddy
- Department of Interventional Radiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Rajiv Vohra
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
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DONG RUIQI, JIANG WENTAO, ZHANG MING, LEUNG AARON, WONG MS. REVIEW: HEMODYNAMIC STUDIES FOR LOWER LIMB AMPUTATION AND REHABILITATION. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415300057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
No matter what the reason and level of amputation are, amputees will face many complex postoperative problems and potential complications. From the perioperative stage to lengthy rehabilitation process, patients need comprehensive and cautious therapies to help them rebuild their physical and mental health. Although there is some scattered information, the achievements of hemodynamic study for lower limb amputation and rehabilitation have not been systematically classified and summarized. The purpose of this review is to introduce and discuss the hemodynamic issues in preoperative diagnosis, surgical techniques and postoperative problems in the past two decades. Whether from clinical or biomechanical perspective, the investigations of the former two stages have been relatively mature and gained some clear outcomes, even if some conclusions are conflicting and controversial. While in terms of the postoperative problems, such as the common pressure ulcers, DTI and muscle atrophy, there is a lack of vascular or blood flow state studies specifically for lower residual limb. Therefore, the future research focus of hemodynamics for lower limb amputation should probably be the detailed investigations on the relationships between various blood flow parameters and certain common complications. Although hemodynamic research has made some achievements at this stage, it is believed that more advanced and reliable techniques are pending for further explorations and developments.
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Affiliation(s)
- RUIQI DONG
- Laboratory of Biomechanical Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - WENTAO JIANG
- Laboratory of Biomechanical Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - MING ZHANG
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, P. R. China
| | - AARON LEUNG
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, P. R. China
| | - M. S. WONG
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, P. R. China
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Abstract
Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.
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Affiliation(s)
- Arun K Thukkani
- From BJCMG Cardiology, Missouri Baptist Hospital, Saint Louis (A.K.T.); and Cardiovascular Divisions, VA Boston Healthcare System and Brigham and Women's Hospital, MA
| | - Scott Kinlay
- From BJCMG Cardiology, Missouri Baptist Hospital, Saint Louis (A.K.T.); and Cardiovascular Divisions, VA Boston Healthcare System and Brigham and Women's Hospital, MA.
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29
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Management of a severe soft-tissue infection after varicose vein surgery despite peripheral arterial occlusive disease. PHLEBOLOGIE 2015. [DOI: 10.12687/phleb2268-4-2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryWe describe a 65-year-old male with severe soft tissue infection of both lower legs. He had infected ulcer after stripping of small saphenous vein in tumescent anaesthesia and excision of side branches, and was referred from a foreign clinic. Intraarterial angiography of the pelvic and legs vessels showed severe stenosis in the left deep femoral artery and a tandem stenosis of superficial artery. A hybrid procedure with intraoperative percutaneus angioplasty combined with femoral xenogenic patch as well as local wound treatment with negative pressure wound therapy and subsequent mesh graft transplantation were carried out. We observed complete healing of ulcers within four weeks.
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Banerjee S, Sarode K, Patel A, Mohammad A, Parikh R, Armstrong EJ, Tsai S, Shammas NW, Brilakis ES. Comparative Assessment of Guidewire and Microcatheter vs a Crossing Device-Based Strategy to Traverse Infrainguinal Peripheral Artery Chronic Total Occlusions. J Endovasc Ther 2015; 22:525-34. [PMID: 25985785 DOI: 10.1177/1526602815587707] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare success rates of a guidewire and microcatheter strategy vs the use of specialized crossing devices to traverse infrainguinal peripheral artery chronic total occlusions (CTOs). METHODS For this analysis, data on 438 consecutive infrainguinal CTO interventions in 438 patients (mean age 63.2 years; 402 men) performed between August 2006 and May 2014 were extracted from the multicenter Excellence in Peripheral Artery Disease (XLPAD) database (ClinicalTrials.gov; identifier NCT01904851). Primary technical success constituted placement of a guidewire in the true lumen, past the distal CTO cap, with the initial crossing strategy. RESULTS A wire-catheter strategy was used in 295 (67.4%) and a specialized CTO crossing device in 143 (32.6%) patients (p<0.001). Primary crossing technical success was higher with CTO devices (72.1% vs 51.9%, p<0.001). The primary wire-catheter arm used significantly more secondary CTO devices (28.1% vs 17.5%) and/or provisional re-entry devices (26.7% vs 4.9%) compared with the primary CTO device arm (both p<0.001). Secondary crossing technical success (defined as crossing with an alternate strategy: 67.5% vs 71.4%, p=1.000), provisional crossing technical success (defined as use of a re-entry device: 84.2% vs 87.5%, p=0.768), and procedure success (93.6% vs 90.9%, p=0.332) were similar between the wire-catheter and CTO device strategies, respectively. No differences were observed in periprocedural complications or 30-day adverse events; however, at 12 months, there was a significantly higher surgical revascularization rate in the primary wire-catheter arm (8.8% vs 2.8%, p=0.025). CONCLUSION Infrainguinal peripheral artery CTO crossing is frequently attempted with a wire-catheter technique; however, an initial CTO crossing device approach is associated with higher primary technical success. Overall procedure success is similar with both strategies.
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Affiliation(s)
- Subhash Banerjee
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karan Sarode
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA
| | | | - Atif Mohammad
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ehrin J Armstrong
- VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO, USA
| | - Shirling Tsai
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Emmanouil S Brilakis
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
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Dominguez A, Bahadorani J, Reeves R, Mahmud E, Patel M. Endovascular therapy for critical limb ischemia. Expert Rev Cardiovasc Ther 2015; 13:429-44. [DOI: 10.1586/14779072.2015.1019472] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ng VG, Mena C, Pietras C, Lansky AJ. Local delivery of paclitaxel in the treatment of peripheral arterial disease. Eur J Clin Invest 2015; 45:333-45. [PMID: 25615282 DOI: 10.1111/eci.12407] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite advancements from balloon angioplasty to drug-eluting stents, primary patency rates after endovascular revascularization of peripheral artery disease have remained inferior compared to surgery. Endovascular revascularization has been limited by restenosis and mechanical stent failure. Thus, there is increased research into other nonstent-based local drug delivery modalities, which can provide an active drug to inhibit restenosis focally and avoid the risk of systemic adverse effects. METHODS This review will summarize the unique properties of paclitaxel and studies on paclitaxel local delivery for the treatment of peripheral artery disease. A MEDLINE search for relevant peer-reviewed scientific literature published in English was conducted. Search terms included but were not limited to paclitaxel pharmacodynamics, paclitaxel local drug delivery, and drug eluting balloons, with a focus on the use of paclitaxel in the context of coronary and peripheral vascular disease. RESULTS The primary search produced 182 results of which 51 papers were relevant. Of the 51 relevant papers, 27 were original research papers and 24 were either review papers, commentary or opinion papers. CONCLUSIONS Paclitaxel has several chemical properties, which make it ideal for local drug delivery including its hydrophobicity, ability to concentrate into the arterial intima layer and prolonged effect on cells even after brief exposure periods. Local delivery of paclitaxel via injection catheters, balloon catheters and coated balloons has shown encouraging results in terms of efficacy and safety in small-scale animal and clinical studies. Additional preclinical and clinical studies are needed to determine the long-term efficacy and safety of these treatments in humans.
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Affiliation(s)
- Vivian G Ng
- Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, CT, USA
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Erwin PA, Shishehbor MH. Contemporary Management of Femoral Popliteal Revascularization. Interv Cardiol Clin 2014; 3:517-530. [PMID: 28582077 DOI: 10.1016/j.iccl.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Symptomatic peripheral artery disease of the femoral popliteal segment can be treated by surgical and endovascular revascularization, but controversy exists about the best approach. Conventional approaches to revascularization have focused on lesion anatomy to decide on bypass versus endovascular treatment, but advances in endovascular therapy make an endovascular-first approach increasingly feasible-either as a single approach or as an adjunct to short-segment bypass (ie, hybrid procedure). In this review, we discuss the medical, endovascular, and surgical treatment of femoral popliteal revascularization with a special emphasis on advances in percutaneous therapy.
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Affiliation(s)
- Phillip A Erwin
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Park SH, Rha SW, Choi CU, Kim EJ, Oh DJ, Cho YH, Choi WG, Lee SJ, Kim YH, Choi SH, Kim WH, Kim KC, Cho JH, Kim JH, Kim SM, Bae JH, Bong JM, Kang WY, Baek JY, Seo JB, Chung WY, Park MW, Her SH, Suh J, Kim MW, Kim YJ, Choi HJ, Soh JW. Efficacy of two different self-expanding nitinol stents for atherosclerotic femoropopliteal arterial disease (SENS-FP trial): study protocol for a randomized controlled trial. Trials 2014; 15:355. [PMID: 25208688 PMCID: PMC4171579 DOI: 10.1186/1745-6215-15-355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/20/2014] [Indexed: 12/31/2022] Open
Abstract
Background There have been few randomized control trials comparing the incidence of stent fracture and primary patency among different self-expanding nitinol stents to date. The SMART™ CONTROL stent (Cordis Corp, Miami Lakes, Florida, United States) has a peak-to-valley bridge and inline interconnection, whereas the COMPLETE™-SE stent (Medtronic Vascular, Santa Rosa, California, United States) crowns have been configured to minimize crown-to-crown interaction, increasing the stent's flexibility without compromising radial strength. Further, the 2011 ESC (European society of cardiology) guidelines recommend that dual antiplatelet therapy with aspirin and a thienopyridine such as clopidogrel should be administered for at least one month after infrainguinal bare metal stent implantation. Cilostazol has been reported to reduce intimal hyperplasia and subsequent repeat revascularization. To date, there has been no randomized study comparing the safety and efficacy of two different antiplatelet regimens, clopidogrel and cilostazol, following successful femoropopliteal stenting. Methods/Design The primary purpose of our study is to examine the incidence of stent fracture and primary patency between two different major representative self-expanding nitinol stents (SMART™ CONTROL versus COMPLETE™-SE) in stenotic or occlusive femoropopliteal arterial lesion. The secondary purpose is to examine whether there is any difference in efficacy and safety between aspirin plus clopidogrel versus aspirin plus cilostazol for one month following stent implantation in femoropopliteal lesions. This is a prospective, randomized, multicenter trial to assess the efficacy of the COMPLETE™-SE versus SMART™ CONTROL stent for provisional stenting after balloon angioplasty in femoropopliteal arterial lesions. The study design is a 2x2 randomization design and a total of 346 patients will be enrolled. The primary endpoint of this study is the rate of binary restenosis in the treated segment at 12 months after intervention as determined by catheter angiography or duplex ultrasound. Discussion This trial will provide powerful insight into whether the design of the COMPLETE™-SE stent is more fracture-resistant or effective in preventing restenosis compared with the SMART™ CONTROL stent. Also, it will determine the efficacy and safety of aspirin plus clopidogrel versus aspirin plus cilostazol in patients undergoing stent implantation in femoropopliteal lesions. Trial registration Registered on 2 April 2012 with the National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT01570803).
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Affiliation(s)
| | - Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Republic of Korea.
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Atomic layer deposition enhanced grafting of phosphorylcholine on stainless steel for intravascular stents. Colloids Surf B Biointerfaces 2014; 121:238-47. [DOI: 10.1016/j.colsurfb.2014.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 06/05/2014] [Accepted: 06/09/2014] [Indexed: 01/06/2023]
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Abstract
Improvements in the design of endovascular devices and technical skills of interventionalists have opened new possibilities for patients with a wide range of peripheral vascular diseases. In lower extremity peripheral artery disease, percutaneous treatments have become the predominant revascularization strategy for simple and complex lesions. Newer generations of stents and drug-coated balloons have demonstrated strong potential in the treatment of femoropopliteal and infrainguinal diseases. One of the most dramatic advances in the recent past has been endovascular repair of thoracic and abdominal aortic aneurysms, which has become the preferred approach in lieu of open surgical repair. Contemporary trials have established the safety and effectiveness of carotid stenting in selected patients with severe stenosis. Endovascular treatments for venous occlusive disease have long been underutilized, but their effectiveness is being increasingly recognized. This review covers new endovascular procedures performed by interventional cardiologists for peripheral vascular diseases.
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Chowdhury MM, McLain AD, Twine CP. Angioplasty versus bare metal stenting for superficial femoral artery lesions. Cochrane Database Syst Rev 2014; 2014:CD006767. [PMID: 24959692 PMCID: PMC6544814 DOI: 10.1002/14651858.cd006767.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower limb peripheral arterial disease (PAD) is a common, important manifestation of systemic atherosclerosis. Stenoses or occlusions in the superficial femoral artery may result in intermittent claudication or even critical ischaemia, which may be treated by balloon angioplasty with or without stenting. This is the first update of a review published in 2009. OBJECTIVES The primary aim was to determine the effect of percutaneous transluminal angioplasty (PTA) compared with PTA with bare metal stenting for superficial femoral artery (SFA) stenoses on vessel patency in people with symptomatic (Rutherford categories1 to 6; Fontaine stages II to IV) lower limb peripheral vascular disease.In addition, we assessed the efficacy of PTA and stenting in improving quality of life, ankle brachial index and treadmill walking distance. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 6). SELECTION CRITERIA Randomised trials of angioplasty alone versus angioplasty with bare metal stenting for the treatment of superficial femoral artery stenoses. DATA COLLECTION AND ANALYSIS Two review authors (MC, CT) independently selected suitable trials, assessed trial quality and extracted data. Furthermore, these two review authors performed assessments of methodological quality and wrote the final manuscript. The third review author (ADM) cross-checked all stages of the review process. MAIN RESULTS We include three new studies in this update, making a total of 11 included trials with 1387 participants. The average age was 69 years and all trials included men and women. Participants were followed for up to two years. There was an improvement in primary duplex patency at six and 12 months in participants treated with PTA plus stent over lesions treated with PTA alone (six months: odds ratio (OR) 2.90, 95% confidence interval (CI) 1.17 to 7.18, P = 0.02, six studies, 578 participants; 12 months: OR 1.78, 95% CI 1.02 to 3.10, P = 0.04, nine studies, 858 participants). This was lost by 24 months (P = 0.06). There was a significant angiographic patency benefit at six months (OR 2.49, 95% CI 1.49 to 4.17, P = 0.0005, four studies, 329 participants) which was lost by 12 months (OR 1.30, 95% CI 0.84 to 2.00, P = 0.24, five studies, 384 participants). Ankle brachial index (ABI) and treadmill walking distance showed no improvement at 12 months (P = 0.49 and P = 0.57 respectively) between participants treated with PTA alone or PTA with stent insertion. Three trials (660 participants) reported quality of life, which showed no significant difference between participants treated with PTA alone or PTA with stent insertion at any time interval. Antiplatelet therapy protocols and inclusion criteria regarding affected arteries between trials showed marked heterogeneity. AUTHORS' CONCLUSIONS Although there was a short-term gain in primary patency there was no sustained benefit from primary stenting of lesions of the superficial femoral artery in addition to angioplasty. Future trials should focus on quality of life for claudication and limb salvage for critical ischaemia.
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Affiliation(s)
- Mohammed M Chowdhury
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation TrustCambridge Vascular UnitHills RoadCambridgeUKCB20QQ
| | - Alexander D McLain
- Royal Gwent HospitalSouth East Wales Regional Vascular NetworkCardiff RoadNewportUKNP20 2UB
| | - Christopher P Twine
- Royal Gwent HospitalSouth East Wales Regional Vascular NetworkCardiff RoadNewportUKNP20 2UB
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Litsky J, Chanda A, Stilp E, Lansky A, Mena C. Critical evaluation of stents in the peripheral arterial disease of the superficial femoral artery - focus on the paclitaxel eluting stent. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:149-56. [PMID: 24920940 PMCID: PMC4045256 DOI: 10.2147/mder.s45472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The endovascular management of obstructive disease of the superficial femoral artery (SFA) is challenging due to unique anatomical and biomechanical forces. Obstructive lesions of the SFA make up the largest proportion of lesions leading to symptomatic peripheral arterial disease. Accordingly, endovascular treatment of SFA disease is becoming increasingly common and, in many cases, is the preferred initial therapy. The use of self-expanding nitinol stents have proven superior to percutaneous transluminal balloon angioplasty in the treatment of intermediate length SFA stenosis. However, achieving durable results, as well as attaining adequate therapy for long occlusions typically seen in clinical practice, remains problematic. Newer technologies, such as paclitaxel eluting stents, seem promising in improving outcomes.
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Affiliation(s)
- Jason Litsky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Arijit Chanda
- Section of Cardiology, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, CT, USA
| | - Erik Stilp
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Carlos Mena
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Randomized Trials for Endovascular Treatment of Infrainguinal Arterial Disease: Systematic Review and Meta-analysis (Part 1: Above the Knee). Eur J Vasc Endovasc Surg 2014; 47:524-35. [DOI: 10.1016/j.ejvs.2014.02.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/12/2014] [Indexed: 11/23/2022]
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Keefer A, Davies MG, Illig KA. Can endovascular therapy of infrainguinal disease for claudication be justified? Expert Rev Cardiovasc Ther 2014; 2:229-37. [PMID: 15151471 DOI: 10.1586/14779072.2.2.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditionally, patients with exercise-induced lower extremity ischemia (claudicants) have been treated conservatively. It is important to remember that this is not because the pain of claudication is less important than pain due to other problems, but because the only 'cure', operative bypass, has been judged too invasive by both patient and physician. Recent data suggest that endovascular treatment of atherosclerotic disease below the inguinal ligament yields good short-term results, with low periprocedural morbidity and does not compromise future surgical alternatives in the long-term. If this approach is to be used as nonoperative treatment for the pain of claudication, however, the authors suggest that long-term success may be less important than the absolute minimization of short-term and periprocedural risk. The authors believe that given the results of modern endovascular therapy it is increasingly less acceptable to tell claudicants to live with their pain if conservative therapy fails. The option of endovascular treatment for infrainguinal atherosclerotic disease should be discussed with every patient whose claudication is significant, and considered as a treatment option in place of continued pain. This approach should be judged against conservative therapy for claudication, not against surgical bypass for limb threat.
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Affiliation(s)
- Adam Keefer
- Division of Vascular Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 652, Rochester, NY 14642, USA
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Simpson EL, Michaels JA, Thomas SM, Cantrell AJ. Systematic review and meta-analysis of additional technologies to enhance angioplasty for infrainguinal peripheral arterial occlusive disease. Br J Surg 2013; 100:1128-37. [DOI: 10.1002/bjs.9196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2013] [Indexed: 11/07/2022]
Abstract
Abstract
Background
There are several additional techniques designed to enhance conventional percutaneous transluminal balloon angioplasty (PTA). This systematic review assessed current evidence on the clinical effectiveness of additional techniques for infrainguinal peripheral arterial occlusive disease (PAD).
Methods
Relevant electronic databases, including MEDLINE, were searched in May 2011. The population comprised participants with symptomatic PAD undergoing endovascular treatment for disease distal to the inguinal ligament. Interventions were additional techniques compared with conventional PTA. Main outcome measures were restenosis and need for reintervention. Randomized clinical trials (RCTs) of clinical effectiveness were assessed for quality and data were extracted. Where appropriate, meta-analysis was undertaken to produce risk ratios (RRs).
Results
Forty RCTs were selected. Meta-analysis showed a significant benefit in reducing restenosis rates at 6 months for self-expanding stents (RR 0·49) and drug-coated balloons (RR 0·40), and at 12 months for endovascular brachytherapy (RR 0·63). There was also evidence that use of a stent-graft significantly reduced restenosis compared with PTA, as did drug-eluting stents compared with bare-metal stents. Meta-analysis showed that use of drug-coated balloons was associated with significantly lower reintervention rates than PTA alone at 6 months (RR 0·24) and 24 months (RR 0·27) of follow-up. There was also evidence of significantly lower reintervention rates for self-expanding stents at 6 months. Other techniques did not show significant treatment effects for restenosis or reintervention.
Conclusion
The conclusions of this review should be tempered by small sample sizes, lack of clinical outcome measures and differing outcome definitions, making direct comparison across trials difficult. However, self-expanding stents, drug-eluting stents and drug-coated balloons appeared to be the most promising technologies worthy of future study.
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Affiliation(s)
- E L Simpson
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - J A Michaels
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - S M Thomas
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - A J Cantrell
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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The United States StuDy for EvalUating EndovasculaR TreAtments of Lesions in the Superficial Femoral Artery and Proximal Popliteal By usIng the Protégé EverfLex NitInol STent SYstem II (DURABILITY II). J Vasc Surg 2013; 58:73-83.e1. [DOI: 10.1016/j.jvs.2012.12.066] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 12/12/2012] [Accepted: 12/20/2012] [Indexed: 11/22/2022]
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Kiguchi MM, Marone LK, Chaer RA, Winger DG, Shi ZY, Celis RI, Makaroun MS, Rhee RY. Patterns of femoropopliteal recurrence after routine and selective stenting endoluminal therapy. J Vasc Surg 2012; 57:37-43. [PMID: 22975333 DOI: 10.1016/j.jvs.2012.06.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/08/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study determined the incidence and characteristics of recurrent disease after femoropopliteal angioplasty, following either selective or routine stenting of diseased site(s). METHODS Retrospective analysis of a prospectively maintained database for femoropopliteal interventions from June 2003 to July 2010 was performed. Interventions during this period were from a single institution, followed up at 1, 3, and 6 months after initial intervention and on a semiannual basis thereafter with clinical examinations and duplex ultrasound imaging. Two groups were identified: those with routine stenting (RS; routine stenting for all diseased areas) and those with selective stenting (SS; selective stenting for only segments which exhibited compromised flow from residual stenosis or significant dissection). Patients who developed recurrent symptoms (claudication, rest pain), a decrease in ankle-brachial index (ABI) (>0.2), or duplex documentation of a significant (>80%) recurrent stenosis underwent reintervention. Patient demographics, comorbidities, Trans-Atlantic Inter-Society Consensus (TASC) II classification, runoff, and degree of calcification (none, mild, moderate, severe) at initial intervention were recorded. The time to reintervention and recurrence pattern were recorded for both groups. RESULTS During the study period, 746 endovascular interventions in 477 patients were performed. Total reintervention rate, including bypass, amputation, and asymptomatic occlusion after initial intervention, was 36.48% (group SS, 42.9%; group RS, 33.1%; P=.04). Of all initial interventions, 182 endovascular reinterventions in 165 patients for recurrent femoropopliteal disease were identified (group SS, 70; group RS, 95). No differences were noted among the groups in gender, comorbidities, initial TASC II classification, run off, calcification scores, or statin or clopidogrel use, or both. Time to recurrence was similar in the RS and SS groups. TASC II classification, runoff score, and degree of calcification were similar between the two groups. Although not statistically significant, analysis of recurrence pattern demonstrated de novo stenosis was more common in the SS group (50.0% vs 34.7%; P=.06). CONCLUSIONS This single-center retrospective study found a significant difference in the incidence of recurrence requiring reintervention between patients treated with selective and routine stenting for femoropopliteal disease. Analysis of endovascular reinterventions, however, reveals no significant difference in recurrence time or recurrence pattern between the two groups. No significant differences were identified in time to recurrence, TASC II classification, runoff, and calcification of endovascular reinterventions between the two groups' end points. Additional prospective studies to evaluate the roles of routine and selective stenting in symptomatic femoropopliteal peripheral arterial disease and to investigate recurrence lesion characteristics and the patency of multiple endovascular interventions between these two groups are needed.
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Affiliation(s)
- Misaki M Kiguchi
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Weinandy S, Rongen L, Schreiber F, Cornelissen C, Flanagan TC, Mahnken A, Gries T, Schmitz-Rode T, Jockenhoevel S. The BioStent: novel concept for a viable stent structure. Tissue Eng Part A 2012; 18:1818-26. [PMID: 22519682 DOI: 10.1089/ten.tea.2011.0648] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Percutaneous stenting of occluded peripheral vessels is a well-established technique in clinical practice. Unfortunately, the patency rates of small-caliber vessels after stenting remain unsatisfactory. The aim of the BioStent concept is to overcome in-stent restenosis by excluding the diseased vessel segment entirely from the blood stream, in addition to providing an intact endothelial cell layer. DESIGN The concept combines the principles of vascular tissue engineering with a self-expanding stent: casting of the stent within a cellularized fibrin gel structure, followed by bioreactor conditioning, allows complete integration of the stent within engineered tissue. MATERIALS AND METHODS Small-caliber BioStents (Ø=6 mm; n=4) were produced by casting a nitinol stent within a thin fibrin/vascular smooth muscle cell (vSMC) mixture, followed by luminal endothelial cell seeding, and conditioning of the BioStent within a bioreactor system. The potential remodeling of the fibrin component into tissue was analyzed using routine histological methods. Scanning electron microscopy was used to assess the luminal endothelial cell coverage following the conditioning phase and crimping of the stent. RESULTS The BioStent was shown to be noncytotoxic, with no significant effect on cell proliferation. Gross and microscopic analysis revealed complete integration of the nitinol component within a viable tissue structure. Hematoxylin and eosin staining revealed a homogenous distribution of vSMCs throughout the thickness of the BioStent, while a smooth, confluent luminal endothelial cell lining was evident and not significantly affected by the crimping/release process. CONCLUSIONS The BioStent concept is a platform technology offering a novel opportunity to generate a viable, self-expanding stent structure with a functional endothelial cell lining. This platform technology can be transferred to different applications depending on the luminal cell lining required.
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Affiliation(s)
- Stefan Weinandy
- Department of Tissue Engineering & Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Hirsch AT, Allison MA, Gomes AS, Corriere MA, Duval S, Ershow AG, Hiatt WR, Karas RH, Lovell MB, McDermott MM, Mendes DM, Nussmeier NA, Treat-Jacobson D. A Call to Action: Women and Peripheral Artery Disease. Circulation 2012; 125:1449-72. [DOI: 10.1161/cir.0b013e31824c39ba] [Citation(s) in RCA: 232] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Xiao L, Huang DS, Tong JJ, Shen J. Efficacy of endoluminal interventional therapy in diabetic peripheral arterial occlusive disease: a retrospective trial. Cardiovasc Diabetol 2012; 11:17. [PMID: 22373102 PMCID: PMC3305574 DOI: 10.1186/1475-2840-11-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this study was to assess the efficacy of interventional therapy for peripheral arterial occlusive disease and the difference between diabetic patients and non-diabetic patients. Methods 139 consecutive patients between September 2006 and September 2010 who underwent percutaneous lower extremity revascularization for arterial lesions were divided into diabetes group (n = 62) and non-diabetes group (n = 77). Before intervention, rest ankle brachial indexes and three dimensional computed tomography angiography from abdominal aorta to tiptoe were performed. The interventional treatments included angioplasty with or without stenting. The clinical outcomes included rest ankle-brachial indexes, primary patency rates, secondary patency rates and limb-salvage rates for 6-month, 12-month, 24-month and 36-month after treatment. The primary and secondary patency rates of all interventions and the limb-salvage rates of the patients are illustrated by Kaplan-Meier curves and compared by log-rank analysis. Results The interventional operation success rates were 98.4% (61/62) in diabetes group and 100% (77/77) in non-diabetes group. The re-interventional operation success rates were 85.7% (18/21) in diabetes group and 76.9% (20/26) in non-diabetes group. The mean value of ankle brachial indexes was significantly increased after intervention (0.397 ± 0.125 versus 0.779 ± 0.137, t = -25.780, P < 0.001) in diabetes group and (0.406 ± 0.101 versus 0.786 ± 0.121, t = -37.221, P < 0.001) in non-diabetes group. Perioperative 30-day mortality was 0%. Major complications included groin hematoma in 7.2%, and pseudoaneurysm formation 2.2%. In diabetes group, 6, 12, 24, and 36-month primary patency rates were 88.7% ± 4.0%, 62.3% ± 6.6%, 55.3% ± 7.0%, and 46.5% ± 7.5%; secondary patency rates were 93.5% ± 3.1%, 82.3% ± 5.1%, 70.8% ± 6.5%, and 65.7% ± 7%; limb-salvage rates were 95.2% ± 2.7%, 87.7% ± 4.4%, 85.5% ± 4.8%, and 81.9% ± 5.8%. In non-diabetes group, 6, 12, 24, and 36-month primary patency rates were 90.9% ± 3.3%, 71.8% ± 5.4%, 71.8% ± 5.4%, and 60.9% ± 6.2%; secondary patency rates were 96.1% ± 2.2%, 91.6% ± 3.3%, 82.7% ± 4.8%, and 71.8% ± 6.2%; limb-salvage rates were 97.4% ± 1.8%, 94.4% ± 2.7%, 90.6% ± 3.7%, and 83.1% ± 5.4%. The differences between two groups were not significant (P > 0.05). Conclusion With a low risk of morbidity and mortality, the percutaneous revascularization accepted by patients does not affect ultimate necessary surgical revascularization and consequently should be considered as the preferred therapy for chronic lower extremity ischemia. The efficacy and prognosis of interventional therapy in diabetic patients is similar that in non-diabetic patients.
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Affiliation(s)
- Liang Xiao
- Department of Radiology, the First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Zeller T, Roubin GS, Burket MW, Khatib Y, Snyder SA, Ragheb AO, White JK, Machan LS. Paclitaxel-Eluting Stents Show Superiority to Balloon Angioplasty and Bare Metal Stents in Femoropopliteal Disease. Circ Cardiovasc Interv 2011; 4:495-504. [DOI: 10.1161/circinterventions.111.962324] [Citation(s) in RCA: 462] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael D. Dake
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Gary M. Ansel
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Michael R. Jaff
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Takao Ohki
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Richard R. Saxon
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - H. Bob Smouse
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Thomas Zeller
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Gary S. Roubin
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Mark W. Burket
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Yazan Khatib
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Scott A. Snyder
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Anthony O. Ragheb
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - J. King White
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
| | - Lindsay S. Machan
- From Stanford University Medical Center, Stanford, CA (M.D.D.); MidWest Cardiology Research Foundation, Columbus, OH (G.M.A.); VasCore, Massachusetts General Hospital, Boston, MA (M.R.J.); Jikei University Hospital, Tokyo, Japan (T.O.); Tri-City Medical Center, Oceanside, CA (R.R.S.); OSF St Francis Medical Center, Peoria, IL (H.B.S.); University of British Columbia, Vancouver, Canada (L.S.M.); Herz Zentrum, Bad Krozingen, Germany (T.Z.); Lenox Hill Hospital, New York, NY (G.S.R.); University of
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48
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Kasapis C, Gurm HS. Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review. Curr Cardiol Rev 2011; 5:296-311. [PMID: 21037847 PMCID: PMC2842962 DOI: 10.2174/157340309789317823] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 02/01/2009] [Accepted: 02/01/2009] [Indexed: 02/08/2023] Open
Abstract
Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease.
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Affiliation(s)
- Christos Kasapis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
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Ikushima I, Yonenaga K, Iwakiri H, Nagoshi H, Kumagai H, Yamashita Y. A better effect of cilostazol for reducing in-stent restenosis after femoropopliteal artery stent placement in comparison with ticlopidine. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2011; 4:83-9. [PMID: 22915934 PMCID: PMC3417878 DOI: 10.2147/mder.s21629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to assess the preventive effect of cilostazol on in-stent restenosis in patients after superficial femoral artery (SFA) stent placement. Materials and methods Of 28 patients with peripheral arterial disease, who had successfully undergone stent implantation, 15 received cilostazol and 13 received ticlopidine. Primary patency rates were retrospectively analyzed by means of Kaplan–Meier survival curves, with differences between the two medication groups compared by log-rank test. A multivariate Cox proportional hazards model was applied to assess the effect of cilostazol versus ticlopidine on primary patency. Results The cilostazol group had significantly better primary patency rates than the ticlopidine group. Cumulative primary patency rates at 12 and 24 months after stent placement were, respectively, 100% and 75% in the cilostazol group versus 39% and 30% in the ticlopidine group (P = 0.0073, log-rank test). In a multivariate Cox proportional hazards model with adjustment for potentially confounding factors, including history of diabetes, cumulative stent length, and poor runoff, patients receiving cilostazol had significantly reduced risk of restenosis (hazard ratio 5.4; P = 0.042). Conclusion This retrospective study showed that cilostazol significantly reduces in-stent stenosis after SFA stent placement compared with ticlopidine.
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Affiliation(s)
- Ichiro Ikushima
- Department of Radiology, Miyakonojo Medical Association Hospital, Miyakonojo, Japan
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50
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Langenberger H, Schillinger M, Plank C, Sabeti S, Dick P, Cejna M, Lammer J, Minar E, Loewe C. Agreement of duplex ultrasonography vs. computed tomography angiography for evaluation of native and in-stent SFA re-stenosis--findings from a randomized controlled trial. Eur J Radiol 2011; 81:2265-9. [PMID: 21703792 DOI: 10.1016/j.ejrad.2011.05.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Multidetector CT angiography (CTA) is a non-invasive imaging technique for evaluation of peripheral vascular disease. CTA might be particularly useful for assessment of intermediate- and long-term morphological outcome after endovascular treatment. Validation of CTA vs. the current imaging standard, colour Doppler ultrasonography (CDUS), for quantification of native and in-stent re-stenosis in the superficial femoral artery (SFA) is required. METHODS Seventy randomized patients who underwent stent implantation (n=47) or balloon angioplasty (n=23) underwent 6-month follow-up with CDUS and CTA. CTA was compared with CDUS in both sub-groups of patients in terms of binary re-stenosis (>50% lumen narrowing) and re-occlusion. Agreement between CTA and CDUS was assessed using Kappa (κ) statistics with 95% confidence intervals, and correlation coefficients. RESULTS Binary re-stenosis was detected in 16/70 (22.9%) patients by CTA and 17/70 (24.3%) patients by CDUS (κ=0.88, 95% CI: 0.80-0.96). Re-stenosis rates after balloon angioplasty were 39.1% (9/23) on CTA and CDUS (κ=0.82, 95% CI: 0.66-0.98), and after stent implantation 14.9% (7/47) on CTA and 17.0% (8/47) on CDUS (κ=0.92, 95% CI: 0.84-1.00). Re-occlusions were detected in 3/70 (4.3%) patients by both CTA and CDUS (κ=0.65; 95% CI 0.54-0.76). Significant correlations (r=0.85, p<0.001) were noted between degree of re-stenosis on CTA and peak velocity ratio on CDUS. The correlation coefficient was higher in patients after balloon angioplasty (r=0.94, p<0.001) than in patients after stent implantation (r=0.71, p<0.001). CONCLUSION CTA and CDUS show excellent agreement for evaluation of native and in-stent re-stenosis after endovascular treatment of SFA obstructions. CTA is an appropriate non-invasive imaging modality for follow-up after endovascular therapy.
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Affiliation(s)
- Herbert Langenberger
- Department of Cardiovascular and Interventional Radiology, Medical University, Vienna, Austria.
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