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Messeder SJ, López-Peña G, Pepper C, Saratzis A. Biomimetic Stents for Infrainguinal Peripheral Arterial Disease: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2024; 67:468-479. [PMID: 37931680 DOI: 10.1016/j.ejvs.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/30/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Biomimetic stents are peripheral infrainguinal self expanding stents that mimic the anatomy of the vasculature and artery movement. They are indicated for use in infrainguinal arteries. This research aimed to synthesise all current evidence on the use of biomimetic stents as adjuncts for endovascular treatment of infrainguinal peripheral arterial disease (PAD), helping to guide clinical decision making. DATA SOURCES MEDLINE, Embase, CINAHL and Cochrane databases. REVIEW METHODS Random effects meta-analysis following PRISMA guidelines (PROSPERO registration CRD42022385256). Study quality was assessed using the Joanna Briggs Institute critical appraisal tools checklist, and certainty assessment through the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Endpoints included primary patency, target lesion revascularisation, stent fracture, secondary patency, and Death at one year. RESULTS In total, 37 studies were included in the meta-analysis (33 cohort studies, two case series, and two randomised controlled trials [RCTs]), representing 4 480 participants. Of these, 34 studies included data on the Supera (81.5% of participants) and three studies reported data on the BioMimics 3D (18.5% of participants) stents. The pooled primary patency rate of 33 studies at one year follow up was 81.4% (95% confidence interval [CI] 78.7 - 83.9%), and the pooled target lesion revascularisation rate of 18 studies at one year was 12.2% (95% CI 9.6 - 15.0%). The certainty of evidence outcome rating as qualified by GRADE was very low for both. Only one study reported a positive stent fracture rate at one year follow up of 0.4% with a certainty of evidence outcome of low. CONCLUSION Using biomimetic stents for infrainguinal PAD may be associated with acceptable one year primary patency and target lesion revascularisation rates, with a near negligible one year stent fracture rate. Their use should be considered in those presenting with infrainguinal PAD undergoing endovascular revascularisation. A RCT is necessary to determine their clinical and cost effectiveness.
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Affiliation(s)
- Sarah Jane Messeder
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK; British Heart Foundation, Clinical Research Training Fellow, Leicester, UK.
| | - Gabriel López-Peña
- Leicester Vascular Institute, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK
| | - Coral Pepper
- Library and Information Services, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK
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Gumus F, Arslanturk O. Usage of rotational atherectomy and drug-coated balloon angioplasty for isolated popliteal artery lesions: two-year results of a retrospective study. Acta Chir Belg 2024:1-7. [PMID: 38294176 DOI: 10.1080/00015458.2024.2313266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/28/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES In this study, perioperative properties and early and mid-term clinical outcomes of endovascular revascularization with a combined usage of rotational atherectomy (RA) and drug-coated balloon angioplasty (DCB) angioplasty for isolated popliteal artery lesion were reported. METHODS A total of 28 patients with isolated popliteal artery stenosis who underwent combined RA and DCB angioplasty between December 2018 and September 2022 were analyzed retrospectively. Temren atherectomy system (Invamed, Ankara, Turkey) and Extender paclitaxel-coated drug-coated balloon catheter (Invamed, Ankara, Turkey) were used in all cases. The main outcome was primary patency; secondary outcomes were technical success, freedom from amputation, and mortality. RESULTS The mean age of patients was 64.2 ± 9.1 years and the majority of the patients were male (n = 20; 71.4%). Types of the lesions were total occlusion in 24 limbs and critical stenosis in 4 limbs. The mean total occlusion length was 65.2 ± 14.2 mm. Flow-limiting dissection was seen in lesions of 2 patients (7.1%) and treated with prolonged balloon dilatation without bail-out stenting requirement. Technical success defined as an adequate vascular lumen (less than 30% stenosis) was achieved in 26 (92.8%) with a mean follow-up of 17.2 ± 8.2 months. The mean primary patency rates at 12 months and 24 months were 92.3% ± 3.2 and 81.2% ± 3.2, respectively. Complications included 1 distal embolization following RA, 2 flow-limiting dissections, and 3 puncture site hematomas. CONCLUSIONS Endovascular procedures using combined RA and DCB angioplasty seem to be effective alternative treatment modalities for the treatment of popliteal artery lesions with high rates of primary patency and freedom from TLR.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Memorial Hospital, Ankara, Turkey
| | - Oguz Arslanturk
- Department of Cardiovascular Surgery, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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Mosarla RC, Armstrong E, Bitton-Faiwiszewski Y, Schneider PA, Secemsky EA. State-of-the-Art Endovascular Therapies for the Femoropopliteal Segment: Are We There Yet? JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1. [PMID: 36268042 PMCID: PMC9581461 DOI: 10.1016/j.jscai.2022.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Peripheral arterial disease is an increasingly prevalent condition with significant associated morbidity, mortality, and health care expenditure. Endovascular interventions are appropriate for most patients with either ongoing symptoms of intermittent claudication despite lifestyle and medical optimization or chronic limb-threatening ischemia. The femoropopliteal segment is the most common arterial culprit responsible for claudication and the most commonly revascularized segment. Endovascular approaches to revascularization of the femoropopliteal segment are advancing with an evolving landscape of techniques for arterial access, device-based therapies, vessel preparation, and intraprocedural imaging. These advances have been marked by debate and controversy, notably related to the safety of paclitaxel-based devices and necessity of atherectomy. In this review, we provide a critical overview of the current evidence, practice patterns, emerging evidence, and technological advances for endovascular intervention of the femoropopliteal arterial segment.
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Affiliation(s)
| | - Ehrin Armstrong
- Adventist Heart and Vascular Institute, St Helena, California
| | | | | | - Eric A. Secemsky
- Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Corresponding author: (E.A. Secemsky)
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Kim M, Cho SB. [Interventional Treatments for Femoropopliteal Arterial Disease and Recent Updates]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:527-540. [PMID: 36238772 PMCID: PMC9432457 DOI: 10.3348/jksr.2021.0057] [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: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Peripheral arterial occlusive disease (PAOD) of the femoropopliteal artery is commonly caused by atherosclerosis. It can present with varying clinical symptoms depending on the degree of disease, ranging from intermittent claudication to critical limb ischemia and tissue loss. Therefore, appropriate and timely treatment is required to improve symptoms and salvage the affected limbs. Interventional approaches for femoropopliteal arterial disease commonly include percutaneous transluminal angioplasty, atherectomy, and stent placement. Over the years, endovascular recanalization has been widely performed for treating PAOD due to continuous developments in its techniques and availability of dedicated devices with the inherent advantage of being minimal invasive. In this review, we introduce various types of endovascular treatment methods, discuss the results of clinical research from existing literature, and illustrate the treatment procedures using representative images.
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Kum S, Ipema J, Huizing E, Tan YK, Lim D, Lok IY, Hazenberg CE, Ünlü Ç. Outcomes of the paclitaxel-eluting Eluvia stent for long femoropopliteal lesions in Asian patients with predominantly chronic limb-threatening ischemia. Vasc Med 2021; 26:267-272. [PMID: 33733963 DOI: 10.1177/1358863x20987894] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The fluoropolymer-coated, paclitaxel-eluting Eluvia stent has shown promising results for the endovascular treatment of femoropopliteal artery lesions in patients with claudication. The aim of the current study was to evaluate efficacy and safety outcomes of the Eluvia stent for the treatment of long femoropopliteal lesions in Asian patients. This is a single-center, retrospective study. The primary endpoint was primary patency at 1 year. Secondary outcomes were 30-days complication rate, technical success, 1-year freedom from clinically driven target lesion revascularization (CD-TLR), limb salvage, survival, amputation-free survival (AFS), wound healing, and clinical improvement. A total of 64 patients with 67 femoropopliteal lesions were included; 78% suffered from diabetes and 84% had chronic limb-threatening ischemia (CLTI). Of those with ischemic wounds, 79% did not have run-off to the foot. Mean lesion length was 193 ± 128 mm and 52% were severely calcified. Primary patency at 1 year was 84% in the overall cohort and 91% in patients with complete lesion coverage with the Eluvia stent. Technical success was achieved in 100% of the cases and 30-day complications occurred in six patients. Twelve-month freedom from CD-TLR, limb salvage, survival, and AFS were 92%, 93%, 85%, and 80%, respectively. In 80% of patients, complete wound healing was experienced and 84% had clinical improvement after 1 year. The Eluvia stent showed promising 12-month patency and clinical results for femoropopliteal treatment in this CLTI-dominant patient population with severely calcified, long lesions. Patient numbers were, however, small; larger trials are required to validate these findings. Aneurysmal change seen in some cases also needs further investigation.
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Affiliation(s)
- Steven Kum
- Department of Surgery, Changi General Hospital, Singapore
| | - Jetty Ipema
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Eline Huizing
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Yih K Tan
- Department of Surgery, Changi General Hospital, Singapore
| | - Darryl Lim
- Department of Surgery, Changi General Hospital, Singapore
| | - Ian Yh Lok
- University of New South Wales, Sydney, NSW, Australia
| | - Constantijn Evb Hazenberg
- Department of Surgery, Division of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, The Netherlands
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Rümenapf G, Morbach S, Rother U, Uhl C, Görtz H, Böckler D, Behrendt CA, Hochlenert D, Engels G, Hohneck A, Sigl M. [Diabetic foot syndrome-Part 2 : Revascularization, treatment alternatives, care structures, recurrency prophylaxis]. Chirurg 2021; 92:173-186. [PMID: 33237367 PMCID: PMC7875854 DOI: 10.1007/s00104-020-01313-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Diabetic foot syndrome (DFS) is the most frequent reason for major amputations in Germany. The majority of foot lesions are triggered by repetitive pressure in diabetic polyneuropathy. Peripheral arterial occlusive disease (PAOD) impairs wound healing and is the main risk factor for amputations. The treatment of wounds and infections as well as timely revascularization are decisive. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusion processes. Both procedures are complementary. Bypass surgery is of great importance for neuroischemic DFS. Multidisciplinary centers that provide revascularization in DFS can achieve an improvement of arterial blood flow in 90% of the cases and reduce the amputation rate by up to 80%. Due to the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of exceptional importance (podological and orthopedic technical care, foot surgery).
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Affiliation(s)
- G Rümenapf
- Oberrheinisches Gefäßzentrum Speyer, Diakonissen-Stiftungs-Krankenhaus Speyer, Paul-Egell-Straße 33, 67346, Speyer, Deutschland.
| | - S Morbach
- Abteilung Diabetologie und Angiologie, Fachbereich , Innere Medizin, Marienkrankenhaus gGmbH Soest, Soest, Deutschland
| | - U Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Görtz
- Klinik für Gefäßchirurgie, Bonifatius Hospital Lingen, Lingen, Deutschland
| | - D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C A Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - D Hochlenert
- Centrum für Diabetologie, Endoskopie und Wundheilung Köln, Köln, Deutschland
| | - G Engels
- Chirurgische Praxis am Bayenthalgürtel, Köln, Deutschland
| | - A Hohneck
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
| | - M Sigl
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
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Krishnappa S, Rachaiah JM, Mariappa HM, Doddamadaiah C, Nanjappa MC. Endovascular Interventions to Superficial Femoral Artery Occlusion: Different Approaches, Technique, and Follow-up. Heart Views 2020; 21:65-74. [PMID: 33014298 PMCID: PMC7507906 DOI: 10.4103/heartviews.heartviews_34_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/19/2019] [Indexed: 12/24/2022] Open
Abstract
Background Superficial femoral artery lesion is one of the main causes for intermittent claudication or critical limb ischemia. Percutaneous transluminal angioplasty is one of the approved therapies for this medical entity. Anatomical factors should be considered in choosing the right approach and puncture.The purpose of this study is to discuss the anatomical, radiological, and technical factors which determine the preference of various approaches and to determine its safety, efficacy, and mid-term clinical and radiological outcome. Methods Retrospectively, data were collected from patients who underwent angioplasty to superficial femoral arteries for total occlusion from January 2015 and June 2018 in our center, we performed angioplasty to 59 occluded superficial femoral artery patients at our center. The ipsilateral femoral artery, ipsilateral popliteal artery, contralateral femoral artery, or upper limb approaches were used depending on the various anatomical factors determined by radiological imaging before the procedure. Results Acute success rate was 91.52%. There were no significant periprocedural complications. At the latest clinical follow-up of mean 25.8 months (10-51), a restenosis rate of 16.67% in infrainguinal arteries and 5.88% in suprainguinal arteries were noted. Conclusions Percutaneous transluminal angioplasty of superficial femoral artery is a proven, viable, safer, and effective option, with good mid-term clinical results and patency rates. Different approaches to be chosen depends on the anatomical and technical factors to get the best possible outcome.
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Affiliation(s)
- Santhosh Krishnappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | - Harsha Mullusoge Mariappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | - Chaitra Doddamadaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
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Yang YB, Shen J, Wang SH, Song JB, Ge F, Xie JP, Qu JS, Mao XZ, Kuang ZC, Shang N, Wang X, Wu YJ, Yang F, Yuan Y, Wang H, Sun J, Fang J, Xiao L. A risk predictor of restenosis after superficial femoral artery stent implantation: relevance of mean platelet volume. BMC Cardiovasc Disord 2020; 20:361. [PMID: 32770951 PMCID: PMC7414580 DOI: 10.1186/s12872-020-01633-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background To investigate the relationship between an increase in the pre- and post-operative mean platelet volume (MPV) and superficial femoral artery in-stent restenosis (ISR) rate. Methods and results We recruited patients that underwent superficial femoral artery stenting for lower extremity arteriosclerosis obliterans at our hospital from March 2015 to March 2018. All patients gave venous blood three days before and following implantation. Doppler ultrasound, computed tomography angiography or digital subtraction angiography were used for regular follow-up examination. Logistic regression was used to identify predictors of ISR after superficial femoral artery stenting. We enrolled 173 patients, of which 34 (19.6%) were determined as having ISR for a mean of 8.9 ± 2.7 months (3–12 months). Neutrophil count, neutrophil ratio, lymphocyte ratio and platelet count pre-implantation, and platelet count and MPV after stent implantation, and the pre- and post-operative mean platelet volume difference (MPVD) and mean platelet volume difference ratio (MPVDR) were all statistically different when comparing the ISR and non-restenosis groups (p < 0.05). A positive correlation was found for post-operative MPV and presence of ISR (r = 0.58; P < 0.001). A MPVD not less than 1.5 fL was associated with an odds ratio of 9.17 (95% CI [3.76 to 22.35]; P < 0.001) for presence of ISR. A MPVDR of not less than 17.9% was associated with an odds ratio of 7.68 (95% CI [3.19 to 18.49]; P < 0.001) for occurrence of ISR. Conclusions An increase in pre- and post-operative MPV was correlated with the occurrence of superficial femoral artery ISR.
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Affiliation(s)
- Yao Bo Yang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Jing Shen
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China.,Shanxi provincial people's Hospital, Taiyuan, Shanxi, China
| | | | - Jian Bo Song
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Fangfang Ge
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jia Pei Xie
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Jiang Shuai Qu
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Xin Zu Mao
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Zhao Cheng Kuang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Nan Shang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Xiang Wang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Ye Jun Wu
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Fan Yang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Yue Yuan
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Hongxin Wang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Jun Sun
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Jicheng Fang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China
| | - Liang Xiao
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Huanggu District, Shenyang, 110000, Liaoning, China.
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Giannopoulos S, Lyden SP, Bisdas T, Micari A, Parikh SA, Jaff MR, Schneider PA, Armstrong EJ. Endovascular Intervention for the Treatment of Trans-Atlantic Inter-Society Consensus (TASC) D Femoropopliteal Lesions: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:52-65. [PMID: 32563709 DOI: 10.1016/j.carrev.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Advancements in the endovascular treatment of femoropopliteal atherosclerotic lesions have led to treatment of more complex lesions, particularly long lesions. The aim of this study was to determine the meta-analytic primary patency and need for re-intervention among patients treated for very long lesions (>200 mm) at the femoropopliteal segment and to identify potential risk factors for loss of patency. METHODS This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted, and the I-square was used to assess heterogeneity. RESULTS Fifty-one studies comprised of 3029 patients were included. The mean lesion length was 269 mm. The primary patency rate at 30 days, 6 m, 1-, 2- and 5-years of follow-up was 98%, 76%, 62%, 55%, and 39% respectively. The incidence of TLR was 16% at one year and 32% at two years. The secondary patency rate at 1, 2, 3 and 5 years was 85%, 71%, 64%, and 64% respectively. Heparin bonded ePTFE covered stents (69%) and paclitaxel eluting stents (73%) demonstrated higher 1-year primary patency rates than self-expanding nitinol stents (55%) or uncoated percutaneous transluminal angioplasty (PTA) with provisional stenting (54%). Lesions treated with a heparin bonded ePTFE covered stent had statistically significant higher odds of remaining patent at 1-year of follow-up (OR: 2.74; 95%CI: 1.63-4.61; p < 0.001) than lesions treated with BMS or PTA. Patients with long femoropopliteal lesions causing critical limb ischemia (CLI) developed restenosis or occlusion more often than patients treated for claudication (HR: 1.63; 95%CI: 1.06-2.49; p = 0.026) during an average follow-up of 26 months. CONCLUSION Primary stenting of femoropopliteal TASC D lesions using drug eluting stents or covered stents results in sustained patency over time. PTA or uncoated nitinol stents demonstrated lower patency rates. However, additional comparative studies are needed to determine the efficacy of newer technologies for the treatment of complex femoropopliteal lesions and provide evidence for the most optimal treatment approach.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic and Foundation, Cleveland, OH, USA
| | | | - Antonio Micari
- Division of Cardiology, Huamitas Gavazzeni, Bergamo, Italy
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy, NY Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
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Giannopoulos S, Jeon-Slaughter H, Kahlon RS, Tejani I, Baskar A, Banerjee S, Armstrong EJ. Comparative 12-Month Outcomes of Drug-Coated Balloon Versus Non-Drug-Coated Balloon Revascularization Strategy in Chronic Limb-Threatening Ischemia: Results From the XLPAD Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1276-1284. [PMID: 32249170 DOI: 10.1016/j.carrev.2020.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Endovascular therapy is often the preferred first treatment option for chronic limb threatening ischemia (CLTI) patients. Drug coated balloons (DCB) reduce restenosis rates compared to percutaneous transluminal angioplasty (PTA), however DCB use has not been studied systematically in patients with CLTI. Thus, the optimal treatment option for these complex lesions remains controversial. METHODS We report on 327 patients with CLTI treated either with DCB (n = 105) or non-DCB (n = 222) for femoropopliteal disease. Data were retrieved from the Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851). Two DCB types were used at the discretion of the operator: Lutonix® (BARD Peripheral Vascular, Inc., Tempe, AZ, USA) and IN.PACT AdmiralTM (Medtronic, Santa Rosa, CA, USA). Odds ratios and the respective 95% confidence interval were synthesized to examine the association between the two groups in terms of all-cause mortality, target limb repeat endovascular or surgical revascularization, target vessel revascularization (TVR), major and minor amputation at 12 months of follow up. RESULTS The mean lesion length was 150.0 mm (SD:123.2) and 151.2 mm (SD:108.3) for the DCB and non-DCB group respectively. No difference between the two groups was detected in terms of all-cause mortality (2.86%vs2.7%,p = .94), target limb repeat endovascular or surgical revascularization (16.19%vs12.61%,p = .25), TVR (16.19%vs.11.71%,p = .26) or minor amputation (15.24%vs10.81%,p = .25) at 12 months of follow up. Although a higher incidence of 12 months major amputation was observed in the DCB group (11%vs.4%,p = .01), after adjusting for several risk factors the odds of major amputation were not statistically different between the DCB and non-DCB groups (OR:1.54;95%CI:0.53-4.51;p = .43). CONCLUSIONS Both DCB and non-DCB strategies are effective modalities for revascularization of patients with CLTI. No differences were identified between the DCB and non-DCB group in terms of late outcomes during 12 months of follow up.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, University of Colorado, Rocky Mountain Regional VA Medical Center, CO, USA
| | - Haekyung Jeon-Slaughter
- Department of Internal Medicine, University of Texas Southwestern Medical Center, VA North Texas Healthcare System, Dallas, TX, USA
| | - Ravi S Kahlon
- Division of Cardiology, University of Colorado, Rocky Mountain Regional VA Medical Center, CO, USA
| | - Ishita Tejani
- Department of Internal Medicine, University of Texas Southwestern Medical Center, VA North Texas Healthcare System, Dallas, TX, USA
| | - Amutha Baskar
- Department of Internal Medicine, University of Texas Southwestern Medical Center, VA North Texas Healthcare System, Dallas, TX, USA
| | - Subhash Banerjee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, VA North Texas Healthcare System, Dallas, TX, USA
| | - Ehrin J Armstrong
- Division of Cardiology, University of Colorado, Rocky Mountain Regional VA Medical Center, CO, USA.
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Schahab N, Kavsur R, Mahn T, Schaefer C, Kania A, Fimmers R, Nickenig G, Zimmer S. Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI). PLoS One 2020; 15:e0230535. [PMID: 32191751 PMCID: PMC7082010 DOI: 10.1371/journal.pone.0230535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Major vascular complications (VCs) of ilio–femoral arterial access after percutaneous coronary interventions are infrequent, but are associated with increased mortality and morbidity. Routine endovascular repair of VCs is becoming the treatment of choice, especially for patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation. Here, we review the different types of vascular access site complications associated with percutaneous coronary interventions (PCIs) and assess the safety and efficacy of endovascular treatment. Methods Data were retrospectively analysed from patients who experienced VCs after transfemoral PCIs, from December 2014 to May 2018. During this period, out of 2833 patients who underwent femoral coronary interventions, 53 (1.9%) experienced major VCs. Results In total, 40/53 (75.5%) cases with major VCs led to unplanned endovascular repair and 13/53 (24.5%) cases required surgical repair. VCs included 17 (32.1%) retroperitoneal bleeding events (BARC-2, 3a,b), 20 (37.7%) intimal dissections, and 16 (30.2%) femoral pseudoaneurysms. Overall, 32 (60.4%) patients received a covered stent, two (3.8%) received a nitinol stent, five (9.4%) patients with dissections were treated with prolonged balloon angioplasty alone, and one patient with femoral pseudoaneurysm underwent thrombin injection with simultaneous balloon occlusion. The mean hospital stay for patients after endovascular treatment was 11.06 ± 5.2 days, while for patients after surgical repair it was 17 ± 8.2 days. Endovascularly treated patients were transfused with red blood cells (13/40 32.5% vs. 2/13 15.4%) significantly more often than patients treated surgically, although surgically treated patients received more red blood cell concentrates per unit than endovascularly treated patients (1 ± 0.47 vs. 2 ± 0.93). During the one-year follow-up, no intermittent claudication was reported, and no patient required secondary endovascular or surgical repair. Conclusions For patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation, endovascular management of VCs following PCIs seems to be a feasible and safe treatment option, and represents an alternative to surgical repair in life-threatening situations. Endovascular treatment was associated with significantly fewer red blood cell concentrates per patient and fewer days in hospital than surgical treatment.
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Affiliation(s)
- Nadjib Schahab
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Refik Kavsur
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Thorsten Mahn
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Alexander Kania
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
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12
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Onishi H, Naganuma T, Hozawa K, Sato T, Ishiguro H, Tahara S, Kurita N, Nakamura S, Nakamura S. Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease. Vasc Endovascular Surg 2019; 53:284-291. [PMID: 30696371 DOI: 10.1177/1538574418824444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. MATERIAL AND METHODS We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. RESULTS There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). CONCLUSION Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.
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Affiliation(s)
- Hirokazu Onishi
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Koji Hozawa
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Tomohiko Sato
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Satoko Tahara
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kurita
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Sunao Nakamura
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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Deloose K, Martins I, Neves C, Callaert J. Endovascular treatment for the common femoral artery: is there a challenger to open surgery? THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:8-13. [PMID: 30428661 DOI: 10.23736/s0021-9509.18.10787-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Common femoral artery (CFA) atherosclerotic lesions currently remain one of the last limitations for adoption of endovascular repair as the first-line treatment. The bulky, eccentric, heavily calcified character of the CFA plaques, frequent involvement of the femoral bifurcation, easy surgical accessibility and last but not least, favorable long-term outcomes still make CFA disease treatment part of the surgical domain. In the last 5 years, improvement of the endovascular equipment and technical skills of the operators have led to an increase in percutaneous CFA procedures. Especially the vascular mimetic implant Supera Peripheral Stent system (Abbott Vascular), with its extreme crush resistance (if correctly implanted), seems to be an ideal tool to deal with eccentric calcified plaques, crush risk and maintaining access possibilities. The multicentric, prospective, single arm VMI-CFA Trial evaluates the outcome of treatment of symptomatic (Rutherford 2-4) CFA stenotic or occlusive lesions with the Supera Peripheral Stent System. A 6-month cumulative primary patency rate of 100% is noticed, up to 210 days. The cumulative freedom from TLR rate is 100%. Four patients died, not procedure or device related. From a clinical point of view, a tremendous switch from Rutherford 2-4 towards Rutherford 0-1 happened. No procedure nor device related adverse events are noticed. These short-term data confirm the safety and feasibility of an endovascular approach with the Supera stent to the "no-stent zone" CFA. Of course 12- and 24-month data are essential to bring more clarification in this interesting field.
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Affiliation(s)
- Koen Deloose
- Department of Vascular Surgery, A.Z. Sint Blasius Hospital, Dendermonde, Belgium -
| | - Igor Martins
- Department of Vascular Surgery, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
| | - Caio Neves
- Department of Vascular Surgery, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
| | - Joren Callaert
- Department of Vascular Surgery, A.Z. Sint Blasius Hospital, Dendermonde, Belgium
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14
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Affiliation(s)
- Jonathan R Thompson
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Cardiovascular Center-5463, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5867, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Cardiovascular Center-5463, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5867, USA.
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15
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Krishnan P, Tarricone A, K-Raman P, Majeed F, Kapur V, Gujja K, Wiley J, Vasquez M, Lascano RA, Quiles KG, Distin T, Fontenelle R, Atallah-Lajam F, Kini A, Sharma S. Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis. Ther Adv Cardiovasc Dis 2018; 12:17-22. [PMID: 29265002 DOI: 10.1177/1753944717745509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to compare 1-year outcomes for patients with femoropopliteal in-stent restenosis using directional atherectomy guided by intravascular ultrasound (IVUS) versus directional atherectomy guided by angiography. METHODS AND RESULTS This was a retrospective analysis for patients with femoropopliteal in-stent restenosis treated with IVUS-guided directional atherectomy versus directional atherectomy guided by angiography from a single center between March 2012 and February 2016. Clinically driven target lesion revascularization was the primary endpoint and was evaluated through medical chart review as well as phone call follow up. CONCLUSIONS Directional atherectomy guided by IVUS reduces clinically driven target lesion revascularization for patients with femoropopliteal in-stent restenosis.
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Affiliation(s)
- Prakash Krishnan
- Mount Sinai Medical Center, 1 Gustave l Levy Place, Box 1080, New York, 10026, NY, USA
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16
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Lindgren HIV, Qvarfordt P, Bergman S, Gottsäter A. Primary Stenting of the Superficial Femoral Artery in Patients with Intermittent Claudication Has Durable Effects on Health-Related Quality of Life at 24 Months: Results of a Randomized Controlled Trial. Cardiovasc Intervent Radiol 2018; 41:872-881. [PMID: 29520431 PMCID: PMC5937864 DOI: 10.1007/s00270-018-1925-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/28/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intermittent claudication (IC) is commonly caused by lesions in the superficial femoral artery (SFA), yet invasive treatment is still controversial and longer term patient-reported outcomes are lacking. This prospective randomized trial assessed the 24-month impact of primary stenting with nitinol self-expanding stents compared to best medical treatment (BMT) alone in patients with stable IC due to SFA disease on health-related quality of life (HRQoL). METHODS One hundred patients with stable IC due to SFA disease treated with BMT were randomized to either stent (n = 48) or control (n = 52) group. HRQoL assessed by Short Form 36 Health Survey (SF-36) and EuroQoL 5-dimensions (EQ5D) 24 months after treatment were primary outcome measures. Walking Impairment Questionnaire, ankle-brachial index (ABI), and walking distance were secondary outcomes. RESULTS Significantly better SF-36 Physical Component Summary (P = 0.024) and physical domain scores such as Physical Function (P = 0.012), Bodily Pain (P = 0.002), General Health (P = 0.037), and EQ5D (P = 0.010) were reported in intergroup comparison between the stent and the control group. Both ABI (from 0.58 ± 0.11 to 0.85 ± 0.18; P < 0.001 in the stent group and from 0.63 ± 0.17 to 0.69 ± 0.18; P = 0.036 in the control group) and walking distance (from 170 ± 90 m to 616 ± 375 m; P < 0.001 in the stent group and from 209 ± 111 m to 331 ± 304 m; P = 0.006 in the control group) improved significantly in intragroup comparisons. CONCLUSIONS In patients with IC caused by lesions in the SFA, primary stenting compared to BMT alone was associated with significant improvements in HRQoL, ABI, and walking distance durable up to 24 months of follow-up. Clinical Trial Registration http://www.clinicaltrials.gov . Unique Identifier: NCT01230229.
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Affiliation(s)
- Hans I V Lindgren
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
- Department of Interventional Radiology and Surgery, Helsingborg Hospital, 251 87, Helsingborg, Sweden.
| | - Peter Qvarfordt
- Department of Interventional Radiology and Surgery, Helsingborg Hospital, 251 87, Helsingborg, Sweden
| | - Stefan Bergman
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Vascular Centre, Skåne University Hospital, 205 02, Malmö, Sweden
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17
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Laird JR, Zeller T, Loewe C, Chamberlin J, Begg R, Schneider PA, Nanjundappa A, Bunch F, Schultz S, Harlin S, Lansky A, Jaff MR. Novel Nitinol Stent for Lesions up to 24 cm in the Superficial Femoral and Proximal Popliteal Arteries: 24-Month Results From the TIGRIS Randomized Trial. J Endovasc Ther 2017; 25:68-78. [PMID: 29285955 DOI: 10.1177/1526602817749242] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of the TIGRIS stent for lesions up to 24 cm in the superficial femoral and proximal popliteal arteries (SFA/PPA). METHODS This prospective, multicenter, randomized study enrolled 274 subjects at 36 sites in the United States and Europe. Subjects were randomly assigned in a 3:1 ratio to treatment with the TIGRIS stent (n=197; mean age 66.7±9.28 years; 141 men) or LifeStent (n=70; mean age 67.9±8.87 years; 49 men). The primary safety endpoint was 30-day freedom from major adverse events (MAE). The primary efficacy endpoint was primary patency at 12 months. Secondary endpoints included target lesion revascularization (TLR) and stent fracture. Clinical success and quality of life were also assessed. RESULTS Mean lesion length (107.6 vs 117.9 mm, p=0.29), procedure success (99.5% vs 97.1%, p=0.17), and freedom from MAE (99.5% vs 100%, p>0.99) were similar for the TIGRIS and control groups, respectively. Likewise, there was no difference in primary patency at 12 months (60.6% vs 63.2%, p=0.73) or 24 months (56.3% vs 50.2%, p=0.60) or in TLR at the same time points (76.6% vs 80.6%, p=0.49; 70.5% vs 67.2%, p=0.85). There were no differences in the changes in Rutherford category or the ankle/brachial index through 24 months. The rate of stent fracture was lower for TIGRIS compared with LifeStent (0% vs 32.7%, p<0.001). CONCLUSION The TIGRIS stent and LifeStent were similarly effective for the treatment of lesions in the SFA and PPA. The high flexibility and zero fracture rate associated with the TIGRIS stent make this device favorable for use in high-flexion arteries.
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Affiliation(s)
| | | | | | | | - Richard Begg
- 5 Heritage Valley Health System, Beaver, PA, USA
| | | | | | | | - Scott Schultz
- 9 Minneapolis Radiology and Vascular Research Foundation, Plymouth, MN, USA
| | - Stuart Harlin
- 10 Coastal Vascular and Interventional, Pensacola, FL, USA
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Hooker JB, Hawkins BM. Critical limb ischemia update and the evolving role of drug-elution technologies. Expert Rev Cardiovasc Ther 2017; 15:891-896. [PMID: 29157024 DOI: 10.1080/14779072.2017.1408409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Critical limb ischemia (CLI) is a prevalent condition associated with cardiovascular mortality and limb loss. Areas covered: This review discusses the epidemiology of CLI, revascularization options, and drug-elution therapies. Expert commentary: Drug-eluting stents (DES) and drug-coated balloons (DCB) improve patency rates in the femoropopliteal segment, and are generally used as first-line therapies. For below-knee disease, angioplasty is the default strategy unless lesions are focal whereby DES can be used to reduce restenosis risk.
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Affiliation(s)
- Jared B Hooker
- a Cardiovascular Diseases Section, Department of Internal Medicine , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Beau M Hawkins
- a Cardiovascular Diseases Section, Department of Internal Medicine , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
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19
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Ben Hammamia M, Ben Mrad M, Derbel B, Miri R, Ziadi J, Ghedira F, Denguir R, Kalfat T. [Femoropopliteal angioplasty: Short- and mid-term results]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:204-212. [PMID: 28705338 DOI: 10.1016/j.jdmv.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Percutaneous endovascular therapy is becoming a primary option for managing femoropopliteal occlusive disease. The purpose of this study was to evaluate the mid-term results of endovascular treatment of femoropopliteal arterial disease. METHODS Femoropopliteal percutaneous transluminal angioplasty was performed on 162 consecutive limbs (160 patients) from January 2006 to January 2016. RESULTS In our study, 87.6% of patients had critical limb ischemia. Lesions were classified as Trans-Atlantic Inter-Society Consensus (TASC) A (43%), B (43%), C (7%), and D (7%). Femoropopliteal interventions included angioplasty only in 70 cases (43.2%), and the remaining 92 (56.8%) received at least one stent. Technical success was achieved in 98.7% of patients, with three deaths and a major morbidity rate of 15%. The actuarial primary patency at 12 and 36 month was 65.4% and 40.2%, respectively, 33 peripheral reinterventions were performed after femoropopliteal axis occlusion, resulting in an actuarial primary limb preservation rate of 94.4 at 12 months. Comparison between angioplasty only and the use of stent show no difference in primary patency (P=0.832) and limb salvage (P=0.67). Negative predictors of primary patency determined by univariate analysis included popliteal location (P<0.001) and TASC D (P<0.001). However, diabetes mellitus (P=0.001) and poor run off (P<0.001) were the principal predictive factors of limb loss. CONCLUSION Femoropopliteal angioplasty can be performed with a low morbidity and mortality. Intermediate primary patency is directly related to TASC classification and popliteal localization.
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Affiliation(s)
- M Ben Hammamia
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie.
| | - M Ben Mrad
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - B Derbel
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - R Miri
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - J Ziadi
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - F Ghedira
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - R Denguir
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - T Kalfat
- Service de chirurgie cardiovasculaire, hôpital La Rabta, faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
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Lindgren H, Qvarfordt P, Åkesson M, Bergman S, Gottsäter A, Jansson I, Litterfeldt E, Lindgren H, Qvarfordt P, Fransson T, Öjersjö A, Hilbertson A, Röjlar T, Åkesson M, Gottsäter A, Gruber G, Hörer T, Larzon T, Jonasson T, Strandberg C, Andersson P, Bergman S, Lundell L, Svensson A, Warvsten M. Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, ABI and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial. Eur J Vasc Endovasc Surg 2017; 53:686-694. [DOI: 10.1016/j.ejvs.2017.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
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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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Rothfuss MA, Unadkat JV, Gimbel ML, Mickle MH, Sejdić E. Totally Implantable Wireless Ultrasonic Doppler Blood Flowmeters: Toward Accurate Miniaturized Chronic Monitors. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:561-578. [PMID: 28038789 DOI: 10.1016/j.ultrasmedbio.2016.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/27/2016] [Accepted: 11/12/2016] [Indexed: 06/06/2023]
Abstract
Totally implantable wireless ultrasonic blood flowmeters provide direct-access chronic vessel monitoring in hard-to-reach places without using wired bedside monitors or imaging equipment. Although wireless implantable Doppler devices are accurate for most applications, device size and implant lifetime remain vastly underdeveloped. We review past and current approaches to miniaturization and implant lifetime extension for wireless implantable Doppler devices and propose approaches to reduce device size and maximize implant lifetime for the next generation of devices. Additionally, we review current and past approaches to accurate blood flow measurements. This review points toward relying on increased levels of monolithic customization and integration to reduce size. Meanwhile, recommendations to maximize implant lifetime should include alternative sources of power, such as transcutaneous wireless power, that stand to extend lifetime indefinitely. Coupling together the results will pave the way for ultra-miniaturized totally implantable wireless blood flow monitors for truly chronic implantation.
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Affiliation(s)
- Michael A Rothfuss
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jignesh V Unadkat
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael L Gimbel
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marlin H Mickle
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Tran K, Ullery BW, Kret MR, Lee JT. Real-World Performance of Paclitaxel Drug-Eluting Bare Metal Stenting (Zilver PTX) for the Treatment of Femoropopliteal Occlusive Disease. Ann Vasc Surg 2017; 38:90-98. [DOI: 10.1016/j.avsg.2016.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/23/2016] [Accepted: 08/06/2016] [Indexed: 11/28/2022]
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Katzen BT. Advances in Vascular Brachytherapy over the Last 10 Years: Focus on Femoropopliteal Applications. J Endovasc Ther 2016; 11 Suppl 2:II19-20. [PMID: 15760259 DOI: 10.1177/15266028040110s619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Restenosis and the need for repeated interventions after percutaneous transluminal angioplasty (PTA) remain major drawbacks limiting a widespread application of this minimally invasive technique in the femoropopliteal segment. During the last decade, vascular brachytherapy (BT) emerged as a promising, novel technology with the potential to reduce the rates of restenosis. Meanwhile, several randomized controlled trials have suggested beneficial short and midterm effects of BT in the femoropopliteal arteries. However, despite substantial advances, many questions remain regarding the utility of vascular BT and its dissemination as a practical tool to prevent restenosis. The risk of complications, such as late stent thrombosis, edge effect, catch-up late restenosis, and potential aneurysm formation, as well as the logistical issues associated with the use of this technology in the catheterization laboratory, are delaying the acceptance of BT for routine use. This article reviews the developments of BT for restenosis prevention during the past decade, focusing on implications for peripheral endovascular treatment.
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Sanina C, Cox-Alomar PR, Krishnan P, Wiley JM. Superficial Femoral Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Jose M. Wiley
- Albert Einstein College of Medicine; Montefiore Einstein Center for Heart & Vascular Care; Bronx NY USA
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Samson RH, Showalter DP, Lepore MR, Ames S. CryoPlasty Therapy of the Superficial Femoral and Popliteal Arteries: A Single Center Experience. Vasc Endovascular Surg 2016; 40:446-50. [PMID: 17202090 DOI: 10.1177/1538574406290048] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Long-term patency remains a significant hurdle in the minimally invasive treatment of arteriosclerosis in the superficial femoral and popliteal arteries. New technologies designed to address the sources of restenosis have recently been introduced. CryoPlasty therapy (Boston Scientific, Natick, Mass) is a new approach designed to significantly reduce injury, elastic recoil, stent implantation, neointimal hyperplasia, and constrictive remodeling. The technique combines the dilatation forces of percutaneous transluminal angioplasty with cold thermal energy applied to the plaque and vessel wall. The cumulative effect of limiting the sources of restenosis with CryoPlasty therapy was shown to demonstrate longer term patency in a prospective, multicenter, Investigational Device Exemption study of the PolarCath Peripheral Dilatation System. The CryoPlasty therapy experience of 1 center is reported, in which 47 lesions in 32 consecutive patients (34 procedures, 33 limbs) were treated. The technical success rate was 96%. There were no type 3 flow-limiting dissections, and only 4 (8.5%) lesions were stented. There were no unanticipated adverse events, specifically no thrombus, acute occlusions, distal embolizations, aneurysms, or groin complications. With an average follow-up of 12 months, only 5 lesions have recurred, 4 requiring re-intervention. The 12-month freedom from restenosis for lesions and limbs treated was 82.2% and 84.4%, respectively. These results are similar to the findings of the Investigational Device Exemption study and are encouraging. CryoPlasty therapy appears to be a viable endovascular therapeutic option to achieve longer term patency without compromising options for future interventions. The lack of early occlusions may be due to a low rate of spiral dissection that may be a particular benefit of this form of angioplasty.
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Affiliation(s)
- Russell H Samson
- Sarasota Memorial Hospital, Sarasota, Florida, Sarasota, FL 34232, USA.
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Laird JR, Biamino G, McNamara T, Scheinert D, Zetterlund P, Moen E, Joye JD. Cryoplasty for the Treatment of Femoropopliteal Arterial Disease: Extended Follow-up Results. J Endovasc Ther 2016; 13 Suppl 2:II52-9. [PMID: 16511955 DOI: 10.1177/15266028060130s209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report the findings from a multicenter study of patients treated with cryoplasty who were then followed for an average of >2 years post-treatment. Methods: Extended clinical follow-up was obtained for 70 patients (45 men; mean age 70.5±8.8 years) who originally received cryoplasty therapy to treat symptoms of intermittent claudication as part of a multicenter investigational device exemption (IDE) study. For all subjects, cryoplasty was used to treat stenoses or occlusions ≤10 cm in the femoropopliteal arteries. The original IDE study protocol enrolled 102 patients with a primary endpoint of target lesion patency at 9 months post-treatment. This collection of additional longer term follow-up data was initiated 2.5 years after the onset of study enrollment. Results: Extended clinical follow-up ranged from 11 to 41 months (mean 31). The clinical patency rate (freedom from target lesion revascularization) calculated by the Kaplan-Meier method was 83.2% after the original follow-up period of 300 days. After >3 years (1253 days), the clinical patency rate was well maintained at 75.0%. Conclusions: Long-term data indicate that cryoplasty is a durable therapy, with relatively low long-term restenosis rates compared to other endovascular treatment approaches.
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Affiliation(s)
- John R Laird
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
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Lyden SP, Shimshak TM. Contemporary Endovascular Treatment for Disease of the Superficial Femoral and Popliteal Arteries: An Integrated Device-Based Strategy. J Endovasc Ther 2016; 13 Suppl 2:II41-51. [PMID: 16472010 DOI: 10.1177/15266028060130s208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endovascular therapy for disease of the superficial femoral artery (SFA) and the popliteal artery remains controversial. Percutaneous treatment of this arterial segment presents a particular technical challenge, as the extent of disease varies from short, focal, and stenotic to long, diffuse, and occluded lesions. Over the last 2 decades, multiple therapies have been evaluated, including simple balloon angioplasty, directional atherectomy, stenting (both balloon-expandable and self-expanding), and more recently, intra-arterial radiation, laser, and cryotherapy. Regardless of which modality is used, however, endovascular therapy as a revascularization strategy has the potential to improve symptoms and quality of life and, in selected patients, to avoid limb amputation. While percutaneous endovascular treatment has been historically associated with high procedural success and favorable short and intermediate-term patency rates, long-term clinical results have proven disappointing. Conventional balloon angioplasty is limited by elastic recoil, dissection, and restenosis. Balloon-expandable stents (particularly in the distal SFA) are associated with late stent deformation and mechanical compression, with resultant late clinical failure. Newer self-expanding stents have shown improved initial results but have been limited by late mechanical fatigue and associated restenosis. With the development of several newer endovascular techniques in recent years, the possibilities for treating this condition have increased dramatically. Currently, no long-term comparative data exist regarding the role of these alternative technologies. This article summarizes and compares important data about new endovascular options for intervention therapy in SFA and popliteal disease. In addition, based on this analysis, we propose a contemporary treatment strategy, integrating older and newer technologies into a real-world algorithm.
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Affiliation(s)
- Sean P Lyden
- Cleveland Clinic College of Medicine at Case Western Reserve University, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Gao M, Zhao X, Tao Y, Wang L, Xia M, Tong Z, Hou C, Hua Y. Incidence and Predictors of In-stent Re-Stenosis in the Superficial Femoral Artery: Evaluation of Long-Term Outcomes by Color Duplex Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:717-726. [PMID: 26678156 DOI: 10.1016/j.ultrasmedbio.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 10/24/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to investigate the incidence and predictors of in-stent re-stenosis (ISR) for nitinol stents in the superficial femoral artery (SFA) by color duplex ultrasound (CDU). In total, 235 patients undergoing SFA stenting were included in the present study. The cumulative ISR rates at 3, 6, 12, 24 and 36 mo post-procedure were 5.4%, 24.0%, 49.0%, 61.5% and 71.5%, respectively. The markedly low peak systolic velocity of the popliteal artery (PSV2) post-operation was inversely correlated with the ISR. The threshold for ≥50% re-stenosis was PSV2 ≤ 63 cm/s with 86.6% sensitivity and 90.5% specificity. With regard to re-occlusion, the PSV2 was ≤40 cm/s with 98.1% sensitivity and 93.4% specificity. Cox regression analysis indicated that the cumulative stent length, diabetes, and pre-stent stenosis level were independent risk factors of ISR. In conclusion, the ISR incidence after SFA stenting is relatively high and CDU follow-up is a feasible method for evaluating ISR.
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Affiliation(s)
- Mingjie Gao
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinyu Zhao
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunlu Tao
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lili Wang
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mingyu Xia
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhu Tong
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chengbei Hou
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Vogl TJ, Bodelle B. Vascular Interventional Therapy. Diagn Interv Radiol 2016. [DOI: 10.1007/978-3-662-44037-7_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clinical outcomes of endovascular treatment of TASC-II C and D femoropopliteal lesions with the Viabahn endoprosthesis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:465-8. [DOI: 10.1016/j.carrev.2015.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/22/2015] [Accepted: 09/01/2015] [Indexed: 11/19/2022]
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Comparing Supervised Exercise Therapy to Invasive Measures in the Management of Symptomatic Peripheral Arterial Disease. Surg Res Pract 2015; 2015:960402. [PMID: 26601122 PMCID: PMC4639651 DOI: 10.1155/2015/960402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/05/2015] [Accepted: 10/11/2015] [Indexed: 11/17/2022] Open
Abstract
Peripheral arterial disease (PAD) is associated with considerable morbidity and mortality. Consensus rightly demands the incorporation of supervised exercise training (SET) into PAD treatment protocols. However, the exact role of SET particularly its relationship with intervention requires further clarification. While supervised exercise is undoubtedly an excellent tool in the conservative management of mild PAD its use in more advanced disease as an adjunct to open or endovascular intervention is not clearly defined. Indeed its use in isolation in this cohort is incompletely reported. The aim of this review is to clarify the exact role of SET in the management of symptomatic PAD and in particular to assess its role in comparison with or as an adjunct to invasive intervention. A systematic literature search revealed a total 11 randomised studies inclusive of 969 patients. All studies compared SET and intervention with monotherapy. Study results suggest that exercise is a complication-free treatment. Furthermore, it appears to offer significant improvements in patients walk distances with a combination of both SET and intervention offering a superior walking outcome to monotherapy in those requiring invasive measures.
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Abu Dabrh AM, Steffen MW, Asi N, Undavalli C, Wang Z, Elamin MB, Conte MS, Murad MH. Bypass surgery versus endovascular interventions in severe or critical limb ischemia. J Vasc Surg 2015; 63:244-53.e11. [PMID: 26372187 DOI: 10.1016/j.jvs.2015.07.068] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 07/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Critical limb ischemia is associated with a significant morbidity and mortality. We systematically reviewed the evidence to compare bypass surgery with endovascular revascularization in patients with critical limb ischemia. METHODS We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus through October 2014 for comparative studies (randomized and nonrandomized). Predefined outcomes of interest were mortality, major amputation, patency, and wound healing. We pooled odds ratios (ORs) of the outcomes of interest using the random-effects model. RESULTS Nine studies that enrolled 3071 subjects were included. There was no significant difference in mortality (OR, 0.72; 95% confidence interval [CI], 0.44-1.16) or amputation (OR, 1.2; 95% CI, 0.87-1.65). Bypass surgery was associated with higher primary patency (OR, 2.50; 95% CI, 1.25-4.99) and assisted primary patency (OR, 3.39; 95% CI, 1.53-7.51). The quality of evidence was low for mortality and amputation outcomes and moderate for patency outcomes. CONCLUSIONS Low quality of evidence due to imprecision and heterogeneity suggests that bypass surgery and endovascular approaches may have similar effect on mortality and major amputations. However, better primary and primary assisted patency can be expected with surgery.
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Affiliation(s)
- Abd Moain Abu Dabrh
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn; Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Mark W Steffen
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn
| | - Noor Asi
- Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Chaitanya Undavalli
- Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Zhen Wang
- Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Mohamed B Elamin
- Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, San Francisco, Calif
| | - Mohammad Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn; Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn.
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Torres-Blanco Á, Edo-Fleta G, Gómez-Palonés F, Molina-Nácher V, Ortiz-Monzón E. Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia. Cardiovasc Intervent Radiol 2015. [DOI: 10.1007/s00270-015-1175-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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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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Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg 2015; 61:2S-41S. [PMID: 25638515 DOI: 10.1016/j.jvs.2014.12.009] [Citation(s) in RCA: 512] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral arterial disease (PAD) continues to grow in global prevalence and consumes an increasing amount of resources in the United States health care system. Overall rates of intervention for PAD have been rising steadily in recent years. Changing demographics, evolution of technologies, and an expanding database of outcomes studies are primary forces influencing clinical decision making in PAD. The management of PAD is multidisciplinary, involving primary care physicians and vascular specialists with varying expertise in diagnostic and treatment modalities. PAD represents a broad spectrum of disease from asymptomatic through severe limb ischemia. The Society for Vascular Surgery Lower Extremity Practice Guidelines committee reviewed the evidence supporting clinical care in the treatment of asymptomatic PAD and intermittent claudication (IC). The committee made specific practice recommendations using the GRADE (Grades of Recommendation Assessment, Development and Evaluation) system. There are limited Level I data available for many of the critical questions in the field, demonstrating the urgent need for comparative effectiveness research in PAD. Emphasis is placed on risk factor modification, medical therapies, and broader use of exercise programs to improve cardiovascular health and functional performance. Screening for PAD appears of unproven benefit at present. Revascularization for IC is an appropriate therapy for selected patients with disabling symptoms, after a careful risk-benefit analysis. Treatment should be individualized based on comorbid conditions, degree of functional impairment, and anatomic factors. Invasive treatments for IC should provide predictable functional improvements with reasonable durability. A minimum threshold of a >50% likelihood of sustained efficacy for at least 2 years is suggested as a benchmark. Anatomic patency (freedom from restenosis) is considered a prerequisite for sustained efficacy of revascularization in IC. Endovascular approaches are favored for most candidates with aortoiliac disease and for selected patients with femoropopliteal disease in whom anatomic durability is expected to meet this minimum threshold. Conversely, caution is warranted in the use of interventions for IC in anatomic settings where durability is limited (extensive calcification, small-caliber arteries, diffuse infrainguinal disease, poor runoff). Surgical bypass may be a preferred strategy in good-risk patients with these disease patterns or in those with prior endovascular failures. Common femoral artery disease should be treated surgically, and saphenous vein is the preferred conduit for infrainguinal bypass grafting. Patients who undergo invasive treatments for IC should be monitored regularly in a surveillance program to record subjective improvements, assess risk factors, optimize compliance with cardioprotective medications, and monitor hemodynamic and patency status.
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Diamantopoulos A, Katsanos K. Treating femoropopliteal disease: established and emerging technologies. Semin Intervent Radiol 2014; 31:345-52. [PMID: 25435660 DOI: 10.1055/s-0034-1393971] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The femoropopliteal artery is the most common site of disease in patients with peripheral arterial disease and presents some of the greatest challenges for interventional radiology. Many patients can be managed with medical treatment combined with supervised exercise alone. However, a significant proportion, especially those suffering from severe intermittent claudication or critical limb ischemia, will require some form of endovascular or surgical revascularization procedure. During the past few years an endovascular-first approach has gained support from all vascular specialties. Today, even complex lesions can be treated successfully with an endovascular approach. Unfortunately, the unique bio-mechanical properties of this vascular segment have limited long-term patency rates and clinical value of the endovascular options. In this review, the authors discuss the methods and techniques for treatment of femoropopliteal lesions and review the current evidence for commercially available devices on patency outcomes following successful recanalization.
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Affiliation(s)
- Athanasios Diamantopoulos
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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S.M.A.R.T. self-expanding nitinol stent for the treatment of atherosclerotic lesions in the superficial femoral artery (STROLL): 1-year outcomes. J Vasc Interv Radiol 2014; 26:21-8. [PMID: 25454735 DOI: 10.1016/j.jvir.2014.09.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/27/2014] [Accepted: 09/28/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess safety and efficacy of the S.M.A.R.T. Vascular Stent System (Cordis Corp, Fremont, California) in obstructive superficial femoral artery (SFA) disease. MATERIALS AND METHODS The single-arm, multicenter STROLL study (S.M.A.R.T. Nitinol Self-Expanding Stent in the Treatment of Obstructive Superficial Femoral Artery Disease) included 250 patients (250 lesions in SFA or proximal popliteal artery). The efficacy endpoint was primary patency defined by freedom from binary restenosis (peak systolic velocity ratio > 2.5) as derived by duplex ultrasound plus clinically driven target lesion revascularization (TLR) at 12 months. RESULTS Mean age of patients was 67.7 years ± 10.3; 47.2% of patients had diabetes; distribution of Rutherford/Becker classes 2, 3, and 4 was 45.8%, 51.4%, and 2.8%. Mean lesion length and reference vessel diameter were 77.3 mm ± 35.3 and 4.9 mm ± 0.7, respectively (23.6% cases with total occlusions). The 30-day freedom from major adverse events (death, index limb amputation, clinically driven TLR) was 100%. The 1-year primary patency was 81.7% by Kaplan-Meier estimate. The presence of diabetes or total occlusion had no effect on primary patency. Ankle-brachial index was 0.4-0.8 in 84.6% of patients at baseline and improved to > 0.8 in 81.0% of patients at 12 months. The proportion of patients in Rutherford/Becker class 3-4 was reduced from 54.2% at baseline to 8.0% at 12 months. Four patients (2.0%) experienced single-stent strut fracture (type I) at 1 year, without associated loss of stent patency. CONCLUSIONS The S.M.A.R.T. Vascular Stent System proved to be safe and effective for endovascular treatment of obstructive SFA and proximal popliteal artery disease, based on 1-year vessel patency and associated hemodynamic and clinical improvements.
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40
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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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41
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Rajebi MR, Peña C. Critical limb ischemia and the diseased popliteal artery. Tech Vasc Interv Radiol 2014; 17:170-6. [PMID: 25241317 DOI: 10.1053/j.tvir.2014.08.005] [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: 11/11/2022]
Abstract
The unique anatomical location and particular biomechanical factors affecting the popliteal artery provide a challenge to determine the proper endovascular, surgical, or combined intervention for patients with critical limb ischemia who often require prompt management in the presence of severe lifestyle-limiting symptoms or of the risk of limb loss or both. Herein, we provide an overview and practical guide for endovascular management of popliteal artery disease in the setting of critical limb ischemia.
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Klein AJ, Pinto DS, Gray BH, Jaff MR, White CJ, Drachman DE. SCAI expert consensus statement for femoral-popliteal arterial intervention appropriate use. Catheter Cardiovasc Interv 2014; 84:529-38. [PMID: 24753020 DOI: 10.1002/ccd.25504] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/06/2014] [Indexed: 11/07/2022]
Abstract
Successful endovascular intervention for femoral-popliteal (FP) arterial disease provides relief of claudication and offers limb-salvage in cases of critical limb ischemia. Technologies and operator technique have evolved to the point where we may now provide effective endovascular therapy for a spectrum of lesions, patients, and clinical scenarios. Endovascular treatment of this segment offers a significant alternative to surgical revascularization, and may confer improved safety for a wide range of patients, not solely those deemed high surgical risk. Although endovascular therapy of the FP segment has historically been hampered by high rates of restenosis, emerging technologies including drug-eluting stents, drug-coated balloons, and perhaps bio-absorbable stent platforms, provide future hope for more durable patency in complex disease. By combining lessons learned from clinical trials, international trends in clinical practice, and insights regarding emerging technologies, we may appropriately tailor our application of endovascular therapy to provide optimal care to our patients. This document was developed to guide physicians in the clinical decision-making related to the contemporary application of endovascular intervention among patients with FP arterial disease.
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Affiliation(s)
- Andrew J Klein
- John Cochran VA Medical Center, St. Louis VA Healthcare System and St. Louis School of Medicine, St. Louis, Missouri
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Katsanos K, Tepe G, Tsetis D, Fanelli F. Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting. Cardiovasc Intervent Radiol 2014; 37:592-603. [DOI: 10.1007/s00270-014-0876-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/04/2013] [Indexed: 11/30/2022]
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Transpopliteal Stenting of Femoral Occlusions in Patients With Critical Limb Ischemia Using a 4-French System. Cardiovasc Intervent Radiol 2014; 37:908-13. [DOI: 10.1007/s00270-014-0891-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 02/23/2014] [Indexed: 10/25/2022]
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Pastromas G, Katsanos K, Krokidis M, Karnabatidis D, Spiliopoulos S. Emerging stent and balloon technologies in the femoropopliteal arteries. ScientificWorldJournal 2014; 2014:695402. [PMID: 24672355 PMCID: PMC3932206 DOI: 10.1155/2014/695402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/31/2013] [Indexed: 02/05/2023] Open
Abstract
Endovascular procedures for the management of the superficial femoral (SFA) and popliteal artery disease are increasingly common. Over the past decade, several stent technologies have been established which may offer new options for improved clinical outcomes. This paper reviews the current evidence for SFA and popliteal artery angioplasty and stenting, with a focus on randomized trials and registries of nitinol self-expanding stents, drug-eluting stents, dug-coated balloons, and covered stent-grafts. We also highlight the limitations of the currently available data and the future routes in peripheral arterial disease (PAD) stent and balloon technology.
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Affiliation(s)
- Georgios Pastromas
- Department of Interventional Radiology, Patras University Hospital, 26504 Patras, Greece
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London SE1 7EH, UK
- Department of Imaging Sciences Biomedical Engineering, School of Medicine, King's College, London WC2R 2LS, UK
| | - Miltiadis Krokidis
- Department of Radiology, Addenbrooke's Hospital, NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Dimitrios Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, 26504 Patras, Greece
| | - Stavros Spiliopoulos
- Department of Interventional Radiology, Patras University Hospital, 26504 Patras, Greece
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Cutting-Balloon Angioplasty Versus Balloon Angioplasty as Treatment for Short Atherosclerotic Lesions in the Superficial Femoral Artery: Randomized Controlled Trial. Cardiovasc Intervent Radiol 2013; 36:1500-1507. [DOI: 10.1007/s00270-013-0603-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/07/2013] [Indexed: 11/25/2022]
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Acin F, de Haro J, Bleda S, Varela C, Esparza L. Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther 2012; 19:585-95. [PMID: 23046322 DOI: 10.1583/jevt-12-3898r.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the efficacy and safety of balloon angioplasty (BA) with optional stenting vs. routine stenting with current open cell nitinol stents for femoropopliteal occlusive disease by analyzing the overall results from all available randomized controlled trials. METHODS A bibliographic search of electronic medical databases (MEDLINE, Embase, ISI Web of Knowledge, and the Cochrane Central Register of Controlled Trials) was conducted to identify relevant articles from 1960 to July 2011. Of the 701 published articles retrieved, 17 clinical trials randomized patients with symptomatic femoropopliteal occlusive disease to either primary BA or primary stenting. Of these, 4 RCTs involved the use of currently employed high flexibility nitinol stents. Thirteen other trials that employed obsolete, steel, or coated stents were excluded. The technical success rate, the target lesion revascularization (TLR) rate, and the binary restenosis rate at 12 months were primary efficacy endpoints; mortality was the primary safety endpoint. The results are reported as the odds ratio (OR) with 2-tailed 95% confidence intervals (95% CI). RESULTS The study population was made up of 627 patients (416 men; mean age 67±10 years) and 665 lesions (361 assigned to the primary stenting and 304 to BA). The mean length of the treated lesion was similar in both groups (74.6±45.7 mm in the stenting group vs. 66.7±41.3 mm in the BA group). Technical success was significantly higher in the stenting group compared to BA (95.8% vs. 64.2%; OR 0.31, 95% CI 0.09 to 0.92, p<0.001). Follow-up ranged from 12 to 24 months. Based on 3 studies, the TLR at 12 months favored the stent group (OR 2.47, 95% CI 0.72 to 8.49, p=0.065), but the difference did not reach statistical significance. However, the 12-month binary restenosis rate was significantly lower in the primary stenting group (OR 3.02, 95% CI 1.3 to 6.71, p<0.001). With respect to the safety endpoint, mortality was similar in both groups (OR 0.83, 95% CI 0.39 to 1.77, p<0.001). CONCLUSION This meta-analysis supports the use of the primary stenting, mainly for long lesions, as a first-line endovascular treatment for symptomatic disease in the femoropopliteal segment, contrary to indications for use in current clinical guidelines.
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Affiliation(s)
- Francisco Acin
- Angiology and Vascular Surgery Department, Hospital Universitario Getafe, Madrid, Spain
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Abstract
Critical limb ischemia represents the most severe form of peripheral arterial disease and carries with it severe morbidity and mortality risks. Because of comorbidity risks, early diagnosis and aggressive medical management make up an important part of the treatment paradigm for these individuals. However, in addition to managing these comorbid conditions, the physician caring for these individuals must be able to provide revascularization options that will improve arterial flow to the threatened extremity and assure healing of complicated wounds. Both open surgical and endovascular therapies have proven beneficial in restoring flow to severely ischemic limbs in these patients. Additionally, combinations of the above therapeutic methods have offered more available options for these patients. This article reviews care of patients with critical limb ischemia with critical assessment of options for medical and revascularization options.
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Affiliation(s)
- Dan Clair
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine,Cleveland, OH 44195, USA.
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Kruger D. Neo-intimal hyperplasia, diabetes and endovascular injury. Cardiovasc J Afr 2012; 23:507-11. [PMID: 22618688 PMCID: PMC3721904 DOI: 10.5830/cvja-2012-019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 03/05/2012] [Indexed: 12/27/2022] Open
Abstract
Diabetes is a significant major risk factor for peripheral arterial disease (PAD) and critical limb ischaemia (CLI), the latter which is also the most common cause of amputation in these patients. Revascularisation of the lower extremities of such patients is imperative for limb salvage and has become First-line therapy. However, the incidence of restenosis following endovascular stenting is very high and is largely due to neo-intimal hyperplasia (NIH), the regulation of which is for the greater part not understood. This article therefore reviews our understanding on the regulation of NIH following stent-induced vascular injury, and highlights the importance of future studies to investigate whether the profile of vascular progenitor cell differentiation, neo-intimal growth factors and lumen diameters predict the severity of post-stent NIH in the peripheral arteries. Results from future studies will (1) better our understanding of the regulation of NIH in general, (2) determine whether combinations of any of the vascular factors discussed are predictive of the extent of NIH postoperatively, and (3) potentially facilitate future therapeutic targets and/or change preventive strategies.
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Affiliation(s)
- Deirdre Kruger
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Fossaceca R, Guzzardi G, Di Terlizzi M, Divenuto I, Malatesta E, Cerini P, Cusaro C, Carriero A. Comparison of cryoplasty and conventional angioplasty for treating stenotic-occlusive lesions of the femoropopliteal arteries in diabetic patients: immediate, mid-term and long-term results. Radiol Med 2012; 117:1176-89. [DOI: 10.1007/s11547-012-0793-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 05/25/2011] [Indexed: 11/25/2022]
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