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Zhao G, Liu Q, Tian Y, Liu J, Cheng J, Ni Z. Evaluation of mechanical properties of poly(
L
‐lactic acid) braided stents with axial stiffeners. J Appl Polym Sci 2022. [DOI: 10.1002/app.52242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gutian Zhao
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Qingwei Liu
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Yuan Tian
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Jinbo Liu
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Jie Cheng
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Zhonghua Ni
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
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Chia D, May KK, Zaw MH, Hartman M, Robless PA, Ho P. Do thrombotic events during endovascular interventions lead to poorer outcomes in patients with severe limb ischemia? Vascular 2014; 23:245-52. [PMID: 25139593 DOI: 10.1177/1708538114546367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Intra-procedural acute thrombosis (IPAT) is a complication of endovascular procedures. We aim to identify risk factors for IPAT and compare the outcomes of patients with or without IPAT. METHODS Paired T test and χ (2) test were used to identify risk factors and short-term outcomes. Kaplan-Meier survival analysis was used for mid-term outcomes. RESULTS A total of 228 procedures were performed with 21 IPAT events (9.21%). The odds ratio of Indian patients developing IPAT was 2.8x (95% CI 1.1-7.6). Patients with in-stent occlusion or prior IPAT were 5.6x (95% CI 1.3-24.2) and 5.6x (95% CI 1.3-24.4) more likely to develop an IPAT event. Patients without IPAT had significantly more improvement in mean runoff score (-1.15 ± 1.31, p < 0.01). The odds of patients with IPAT requiring subsequent endovascular intervention and arterial bypass surgery were 4.2x (95% CI 1.6-10.7) and 7.1x (95% CI 1.9-27.0). There was no significant Kaplan-Meier estimated overall survival or amputation-free survival difference between patients with or without IPAT event. CONCLUSION Indian ethnicity, in-stent occlusion and previous IPAT were associated with higher risk of IPAT. Even after successful endovascular salvage, patients with IPATs were more likely to require secondary revascularization procedure. Patients with IPATs had no decrease in overall survival or amputation-free survival.
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Affiliation(s)
| | - Kyin Kyin May
- Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore
| | - Min Htet Zaw
- Department of Surgery, National University of Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, National University of Singapore, Singapore
| | - Peter A Robless
- Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore
| | - Pei Ho
- Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore
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3
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Pietzsch JB, Geisler BP, Garner AM, Zeller T, Jaff MR. Economic analysis of endovascular interventions for femoropopliteal arterial disease: A systematic review and budget impact model for the United States and Germany. Catheter Cardiovasc Interv 2014; 84:546-54. [DOI: 10.1002/ccd.25536] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/12/2014] [Accepted: 04/28/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Thomas Zeller
- Universitäts-Herzzentrums Freiburg • Bad Krozingen; Bad Krozingen Germany
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Iared W, Mourão JE, Puchnick A, Soma F, Shigueoka DC. Angioplasty versus stenting for subclavian artery stenosis. Cochrane Database Syst Rev 2014; 2014:CD008461. [PMID: 24833157 PMCID: PMC7173691 DOI: 10.1002/14651858.cd008461.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is insufficient evidence to guide stent usage following angioplasty in subclavian artery stenosis. This is an update of a review first published in 2011. OBJECTIVES The aim of this review was to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2014) and CENTRAL (2014, Issue 1). There was no restriction on language. SELECTION CRITERIA Randomised controlled trials of endovascular treatment of subclavian artery lesions comparing angioplasty alone and stent implantation. DATA COLLECTION AND ANALYSIS Two authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, the third author was asked to assess the study for inclusion. MAIN RESULTS To date we have not identified any completed or ongoing randomised controlled trials comparing percutaneous transluminal angioplasty and stenting for subclavian artery stenosis. AUTHORS' CONCLUSIONS There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.
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Affiliation(s)
- Wagner Iared
- Universidade Federal de São Paulo, Brazilian Cochrane CentreDepartment of Internal MedicineSão PauloSão PauloBrazil
| | - José Eduardo Mourão
- Universidade Federal de São PauloDepartment of Diagnostic ImagingSão PauloBrazil
| | - Andrea Puchnick
- Universidade Federal de São PauloDepartment of Diagnostic ImagingSão PauloBrazil
| | - Fernando Soma
- Universidade Federal de São PauloDepartment of Diagnostic ImagingSão PauloBrazil
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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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Abstract
BACKGROUND There is insufficient evidence to guide stent usage following angioplasty in subclavian artery stenosis. OBJECTIVES The aim of this review was to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery. SEARCH STRATEGY The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched August 2011) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3). In addition, the authors searched the MEDLINE, EMBASE and LILACS databases, and handsearched relevant journals. Informal enquiries were made with the major stent device manufacturers to obtain information on unpublished data and any ongoing trials. There was no restriction on language. SELECTION CRITERIA Randomized controlled trials of endovascular treatment of subclavian artery lesions comparing angioplasty alone and stent implantation. DATA COLLECTION AND ANALYSIS Two authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, the third author was asked to assess the study for inclusion. MAIN RESULTS To date we have not identified any completed or ongoing randomized controlled trials comparing percutaneous transluminal angioplasty and stenting for subclavian artery stenosis. AUTHORS' CONCLUSIONS There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.
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Affiliation(s)
- Emil Burihan
- Department of Surgery, Federal University of São Paulo, Rua Botucatu, 640, São Paulo, SP, Brazil
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Morris-Stiff G, Ogunbiyi S, Winter RK, Brown R, Lewis MH. Aortic replacement in aorto-occlusive disease: an observational study. BMC Surg 2008; 8:19. [PMID: 18976456 PMCID: PMC2588438 DOI: 10.1186/1471-2482-8-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 10/31/2008] [Indexed: 11/29/2022] Open
Abstract
Background For many patients with aorto-occlusive disease, where stent deployment is not possible, surgery remains the only treatment option available. The aim of this study was to assess the results of aortic reconstruction surgery performed in patients with critical ischaemia. Methods All patients with critical ischaemia undergoing surgery during 1991–2004 were identified from a prospectively maintained database. Mortality data was verified against death certificate data. Demographic and clinical data were obtained from the clinical notes and the radiology database. Disease was classified as: type I – limited to aorta and common iliac arteries; type II – external iliac disease and type III combined aortic, iliac and infra-inguinal disease. Results 86 patients underwent aortic replacement surgery all of whom had critical ischaemia consisting of: type I (n = 16); type II (n = 37) and type III (n = 33). The 30-day mortality rate was 10.4%, the one-year patient survival was 80%, and the 1-year graft survival was 80%. At 2 years the actual patient survival was 73% and no additional graft losses were identified. All patients surviving 30 days reported excellent symptomatic relief. Early, complications occurred in 6 (7%) patients: thrombosis within diseased superficial femoral arteries (n = 4); haemorrhage and subsequent death (n = 2). Ten (14%) late complications (> 12 months) occurred in the 69 surviving patients and included: anastomotic stenosis (n = 3); graft thrombosis (n = 4), graft infection (n = 3). Four patients developed claudication as a result of more distal disease in the presence of a patent graft, and 1 patient who continued smoking required an amputation for progressive distal disease. Conclusion Aortic reconstruction for patients with extensive aorto-occlussive disease provides long-standing symptomatic relief for the majority of patients. After the first year, there is continued patient attrition due to co-existent cardiovascular disease but no further graft losses.
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Affiliation(s)
- Gareth Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, UK.
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Segev A, Nili N, Qiang B, Charron T, Butany J, Strauss BH. Human-grade purified collagenase for the treatment of experimental arterial chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2006; 6:65-9. [PMID: 16263361 DOI: 10.1016/j.carrev.2005.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 05/26/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic total occlusions (CTO) remain a major limitation of percutaneous interventions. Procedural failure is usually due to the inability to cross the lesion with a guide wire. We have previously shown that local administration of a laboratory-grade collagenase followed by a 72-h waiting period may facilitate guide-wire crossing. The aim of the present study was to evaluate the efficacy and toxicity of a human-grade purified collagenase, suitable for clinical use, in facilitating guide-wire crossing in a rabbit model of femoral artery CTO. METHODS AND RESULTS A chronic total arterial occlusion was constructed in femoral arteries of New Zealand white rabbits. The local administration of purified collagenase solution (150 microg) via an over-the-wire balloon system was performed in 10 CTO. Guide-wire crossing was attempted after 24 h and was successful in all cases. Different doses (50-500 microg) were administered to an additional 17 rabbits to assess collagenase effects. Local subcutaneous bruising was observed at higher doses. Histological evaluation showed no damage to the arterial wall structure. Arterial extracts from collagenase-treated arteries showed increased MMP-2 and MMP-9 activities and higher levels of local MMP-1 and degraded collagen. CONCLUSIONS Local administration of a human-grade purified collagenase degrades collagen in CTO and is highly effective for the facilitation of guide-wire crossing in CTO.
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Affiliation(s)
- Amit Segev
- Roy and Ann Foss Cardiovascular Research Program, Terrence-Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Vogel AM, Paltiel HJ, Kozakewich HPW, Burrows PE, Mulliken JB, Fishman SJ. Iliac artery stenosis in a child with cutis marmorata telangiectatica congenita. J Pediatr Surg 2005; 40:e9-12. [PMID: 16034745 DOI: 10.1016/j.jpedsurg.2005.03.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital disorder. We describe an 8-year-old boy with CMTC who presented with symptomatic claudication and diminished distal pulses. Imaging showed severe stenosis of the right common iliac artery, and the child underwent uncomplicated ilio-iliac bypass using prosthetic graft. This is the first report of a patient with CMTC and major vessel stenosis, successfully treated with a prosthetic graft bypass.
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Affiliation(s)
- Adam M Vogel
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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Kanani RS, Garasic JM. Lower extremity arterial occlusive disease: Role of percutaneous revascularization. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2005; 7:99-107. [PMID: 15935118 DOI: 10.1007/s11936-005-0011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Percutaneous endovascular interventions for peripheral arterial disease are indicated in carefully selected patients with favorable anatomy and associated clinical symptoms. Although endovascular therapy appears to be hemodynamically equivalent to other modalities in isolated iliac disease, this does not appear to be the case for infrainguinal disease, particularly when the disease is diffuse and extensive. Such disease in these beds can often be treated surgically, although there is an increasing role for percutaneous therapies, particularly in patients at higher surgical risk. Catheter-based therapy should be considered an integral part of comprehensive medical therapy in patients with lower extremity peripheral arterial disease. Embarking on an endovascular approach to therapy should involve a frank physician-patient discussion of the risks, benefits, and durability of the proposed procedure tailored to anatomic locale and patient-specific factors.
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Affiliation(s)
- Ronak S Kanani
- Peripheral Vascular Intervention, Division of Cardiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB 800, Boston, MA 02114, USA.
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Serianni RP, Shields CH, Szpisjak DS, Mongan PD. Intraoperative management: peripheral vascular surgery. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2004; 22:307-18, vii. [PMID: 15182871 DOI: 10.1016/s0889-8537(03)00106-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Lower extremity atherosclerotic disease affects nearly 10 million people in the United States. Recent advances in diagnostic imaging and interventional techniques help many patients avoid more invasive surgical procedures. Those reaching the operating room, however,represent a distilled subset of patients who are prone to significant comorbidities. We outline current treatment strategies and discuss anesthetic concerns and techniques for these complex patients.
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Affiliation(s)
- Richard P Serianni
- Department of Anesthesiology, National Naval Medical Center, Bethesda, 8901 Jones Bridge Road, Bethesda, MD 20814, USA.
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Martín-Álvarez A, González-Fueyo M, Malo E, Barbas-Galindo M, Ortega-Martín J, Fernández-Morán C, Vaquero-Morillo F. Angioplastia transluminal percutánea del sector femoropoplíteo distal en la isquemia crítica. ANGIOLOGIA 2004. [DOI: 10.1016/s0003-3170(04)74843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chrysant GS, Goldstein JA, Casserly IP, Rogers JH, Kurz HI, Thorstad WL, Singh J, Lasala JM. Endovascular brachytherapy for treatment of bilateral renal artery in-stent restenosis. Catheter Cardiovasc Interv 2003; 59:251-4. [PMID: 12772252 DOI: 10.1002/ccd.10528] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Percutaneous transluminal angioplasty of renal artery stenosis is an attractive alternative to surgical therapy. However, even with endovascular stenting, the overall rate of restenosis is 21%. While brachytherapy for coronary in-stent restenosis has proven efficacy, its use for renal artery in-stent restenosis has not been formally evaluated. We report a case of bilateral in-stent renal artery restenosis treated with endovascular brachytherapy.
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Affiliation(s)
- George S Chrysant
- Division of Cardiovascular Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Mossop P, Cincotta M, Whitbourn R. First case reports of controlled blunt microdissection for percutaneous transluminal angioplasty of chronic total occlusions in peripheral arteries. Catheter Cardiovasc Interv 2003; 59:255-8. [PMID: 12772253 DOI: 10.1002/ccd.10529] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous transluminal angioplasty (PTA) can fail to revascularize peripheral arteries when a chronic total occlusion (CTO) cannot be crossed by guidewires. This article describes application of a new controlled blunt microdissection (CMD) catheter designed to cross CTOs. Two men presenting with severe claudication had iliac CTOs that resisted crossing with guidewires. Using standard techniques, the CMD catheter was advanced to the CTO. Following attempts to cross the CTO with guidewires, the jaw of the CMD distal assembly was actuated, advancing through the CTO as plaque was blunt-dissected. After angioplasty and stenting, restored distal flow was restored. Ischemic symptoms had not recurred at 1- and 28-month follow-up. The concept of blunt intraluminal microdissection has been applied to convert failing to successful PTA of peripheral arteries. CTOs that had resisted guidewire crossing were successfully crossed using the CMD catheter, allowing treatment by angioplasty and stenting.
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Affiliation(s)
- Peter Mossop
- Department of Medical Imaging and Cardiovascular Research Centre, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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