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Kriens M, Jayet J, Gallien Y, Mercier L, Javerliat I, Coggia M, Coscas R. Influence of Perioperative Factors on Patency After Endovascular and Hybrid Treatments of TASC II D Aortoiliac Occlusive Lesions. Ann Vasc Surg 2024; 99:252-261. [PMID: 37802145 DOI: 10.1016/j.avsg.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Treatment of Trans-Atlantic Inter-Society Consensus (TASC) II D aortoiliac occlusive disease (AIOD D) remains a controversial topic. Although current recommendations support conventional surgical treatment, several recent studies have reported promising results with endovascular and hybrid strategies. The purpose of this work was to describe the outcomes of endovascular and hybrid management of AIOD D and to investigate the influence of perioperative factors on patency. METHODS This was a retrospective single-center study covering the period from 2016 to 2021. The primary end point was primary patency at 12 months. Secondary endpoints included technical success rate, 30-day mortality, early major complication rate, primary assisted and secondary patency at 12 months, and primary patency at 24 months. After descriptive statistical analysis, a survival analysis was conducted using the Kaplan-Meier method. Eighteen perioperative factors potentially associated with primary patency were studied by univariate and multivariate analysis adjusted by a Cox regression model. RESULTS In all, 82 patients (112 limbs) had undergone an attempt at endovascular (n = 55, 67%) or hybrid (n = 27, 33%) treatment for AIOD D over the study period. The technical success rate was 99%. The 30-day mortality rate was 3%. The early major complication rate was 11%. The primary patency rates at 12 and 24 months were 87.9% [80.3; 96.3] and 77% [66.3; 89.3], respectively. The primary assisted and secondary patency rates at 12 months were 92.6% [86.3; 99.2] and 96% [91.4; 100]. Among the perioperative factors studied, the heavily calcified nature of the target lesions was the only variable significantly associated with primary patency loss in the multivariate analysis (P = 0.021). CONCLUSION Although the results of endovascular and hybrid treatment of AOID D are acceptable, future studies should focus on improving patency rates in heavily calcified lesions. Specific tools of endovascular preparation (intravascular lithotripsy, atherectomy) may represent interesting ways of research.
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Affiliation(s)
- Myriam Kriens
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Yves Gallien
- Department of Biostatistics Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Mercier
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
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Freyermuth M, Roisin S, Saidak Z, Matray L, Sevestre MA, Reix T, Soudet S. Contemporary Minimally Invasive Surgery for TASC-D Aorto-Iliac Lesions: Analysis of Outcomes and Risk Factors for Primary and Secondary Patency. Ann Vasc Surg 2023; 97:367-374. [PMID: 37236531 DOI: 10.1016/j.avsg.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND For complex extensive TASC-II D lesions, the standard of care remains conventional surgery. Nevertheless, guidelines tend to broaden endovascular surgery indications in expert centers for patients at high surgical risk with TASC-II D lesions. Due to the increasing use of endovascular surgery in this setting, we planned to evaluate the patency rate of this approach. METHODS We conducted a retrospective study in a tertiary center. All patients treated for symptomatic peripheral arterial disease (PAD) with classified D lesions according to the TASC-II classification and requiring management of the aortoiliac bifurcation were retrospectively included between January 1, 2007 and December 31, 2017. The type of surgical approach was classified as a pure percutaneous approach or hybrid surgery. The main objective was to describe long-term patency results. The secondary objectives were to identify risk factors for loss of patency and long-term complications. The primary outcomes were primary patency, primary-assisted patency, and secondary patency at 5 years of follow-up. RESULTS One hundred and thirty-six patients were included. For the overall population, the primary, primary-assisted, and secondary patency proportions at 5 years were 71.6% (95% confidence interval (CI) 63.2-81%), 82.1% (95% CI 74.9-89.3%), 96.3% (95% CI 92-100%), respectively. For primary patency, there was a significant difference in favor of the covered stent group at 36 months (P < 0.01) and 60 months (P = 0.037). In a multivariate model, only CS and age were associated with a better primary patency (hazard ratio (HR) 0.36, CI 95% [0.15-0.83], P = 0.0193 and an HR 0.07, 95% CI [0.05-0.09], P = 0.005, respectively). The overall rate of perioperative complications was 11%. CONCLUSIONS We report that endovascular and hybrid surgery are safe and effective in the management of TASC-D complex aortoiliac lesions in mid to long-term follow-up. Short-term and long-term complications were all considered as minor.
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Affiliation(s)
| | | | - Zuzana Saidak
- EA Chimere, 7516, Université Picardie Jules Vernes, Amiens, France; Laboratoire de Biochimie, Centre de Biologie Humaine, Amiens, France
| | - Lauranne Matray
- Department of Vascular Surgery, New Clinic of the Union, Boulevard Ratalens, Saint Jean, France
| | - Marie Antoinette Sevestre
- EA Chimere, 7516, Université Picardie Jules Vernes, Amiens, France; Department of Vascular Medicine, Amiens, France
| | | | - Simon Soudet
- EA Chimere, 7516, Université Picardie Jules Vernes, Amiens, France; Department of Vascular Medicine, Amiens, France.
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Roh JW, Shin S, Ko YG, Son NH, Ahn CM, Min PK, Lee JH, Yoon CH, Yu CW, Lee SW, Lee SR, Choi SH, Chae IH, Choi D. Long-Term Clinical Outcomes of Iliac Artery Endovascular Therapy in the Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) Registry. Korean Circ J 2022; 52:529-540. [PMID: 35491481 PMCID: PMC9257150 DOI: 10.4070/kcj.2021.0390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022] Open
Abstract
Iliac artery endovascular therapy achieved excellent technical success and a favorable 5-year target lesion revascularization (TLR)-free survival rate, and Trans-Atlantic Inter-Society Consensus (TASC) D showed a favorable but lower 5-year TLR-free survival compared with other TASC groups. Background and Objectives Limited data are available regarding long-term clinical outcomes of iliac artery endovascular therapy (EVT) in real-world practice. This study investigated long-term outcomes according to Trans-Atlantic Inter-Society Consensus (TASC) classifications. Methods We analyzed data from 1,705 limbs of 1,364 patients from the retrospective cohort of the multicenter Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease registry. The primary endpoint was target lesion revascularization (TLR)-free survival. Results TASC A, B, C, and D lesions were present in 19.4%, 26.2%, 28.7%, and 25.7% of the treated limbs, respectively. The technical success rate was 96.2% and did not differ between TASC lesion types. Complications occurred in 6.8% of cases and more occurred in TASC D (11.8%). Iliac artery EVT showed a 5-year TLR-free survival of 89.2%. The TASC D group had the lowest TLR-free rate of 79.3%. TASC D (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.12–2.73; p=0.014), plain old balloon angioplasty (HR, 4.25; 95% CI, 2.03–8.88; p<0.001), current smoker (HR, 1.89; 95% CI, 1.26–2.83; p=0.002), previous bypass surgery (HR, 3.04; 95% CI, 1.28–7.19; p=0.011), combined femoropopliteal treatment (HR, 4.89; 95% CI, 3.19–7.50; p<0.001), combined below the knee treatment (HR, 2.20; 95% CI, 1.25–3.89; p=0.007), and complications (HR, 1.86; 95% CI, 1.07–3.24; p=0.028) were predictors for TLR. Conclusions Iliac artery EVT achieved excellent technical success and 5-year TLR-free survival. TASC D showed a favorable but lower 5-year TLR-free survival rate and higher complication rate compared with other TASC groups. Trial Registration ClinicalTrials.gov Identifier: NCT02748226
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Affiliation(s)
- Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Sanghoon Shin
- Department of Cardiology, Ewha Womans University Medical Center, Ewha Womans University, Seoul, Korea
| | - Young-Guk Ko
- Department of Cardiology and Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nak-Hoon Son
- Division of Biostatistics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Chul-Min Ahn
- Department of Cardiology and Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Ki Min
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Seoul National University Bundang Hospital, Seoungnam, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Seung Whan Lee
- Division of Cardiology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital, Seoungnam, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
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Saadeddin ZM, Borrebach JD, Hodges JC, Avgerinos ED, Singh M, Siracuse JJ, Makaroun M, Eslami MH. Novel bypass risk predictive tool is superior to the 5-Factor Modified Frailty Index in predicting postoperative outcomes. J Vasc Surg 2021; 72:1427-1435.e1. [PMID: 32972588 DOI: 10.1016/j.jvs.2019.11.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/20/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to develop risk predictive models of 30-day mortality, morbidity, and major adverse limb events (MALE) after bypass surgery for aortoiliac occlusive disease (AIOD) and to compare their performances with a 5-Factor Frailty Index. METHODS The American College of Surgeons National Surgical Quality Improvement Program 2012-2017 Procedure Targeted Aortoiliac (Open) Participant Use Data Files were queried to identify all patients who had elective bypass for AIOD: femorofemoral bypass, aortofemoral bypass, and axillofemoral bypass (AXB). Outcomes assessed included mortality, major morbidity, and MALE within 30 days postoperatively. Major morbidity was defined as pneumonia, unplanned intubation, ventilator support for >48 hours, progressive or acute renal failure, cerebrovascular accident, cardiac arrest, or myocardial infarction. Demographics, comorbidities, procedure type, and laboratory values were considered for inclusion in the risk predictive models. Logistic regression models for mortality, major morbidity and MALE were developed. The discriminative ability of these models (C-indices) were compared with that of the 5-Factor Modified Frailty Index (mFI-5): a general frailty tool determined from diabetes, functional status, history of chronic obstructive pulmonary disease, history of congestive heart failure, and hypertension. Calculators were derived using the most significant variables for each of the three risk predictive models. RESULTS A total of 2612 cases (mean age 65.0, 60% male) were identified, of which 1149 (44.0%) were femorofemoral bypass, 1138 (43.6%) were aortofemoral bypass, and 325 (12.4%) were axillofemoral bypass. Overall, the rates of mortality, major morbidity, and MALE were 2.0%, 8.5%, and 4.9%, respectively. Twenty preoperative risk factors were considered for incorporation in the risk tools. Apart from procedure type, age was the most statistically significant predictor of both mortality and morbidity. Preoperative anemia and critical limb ischemia were the most significant predictors of MALE. All three constructed models demonstrated significantly better discriminative ability (P < .001) on the outcomes of interest as compared with the mFI-5. CONCLUSIONS Our models outperformed the mFI-5 in predicting 30-day mortality, major morbidity, and adverse limb events in patients with AIOD undergoing elective bypass surgery. Calculators were created using the most statistically significant variables to help calculate individual patient's postoperative risks and allow for better informed consent and risk-adjusted comparison of provider outcomes.
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Affiliation(s)
- Zein M Saadeddin
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | | | - Jacob C Hodges
- The Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael Singh
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass
| | - Michel Makaroun
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Mohammad H Eslami
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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5
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Javed IN, Hawkins BM. Aorto-iliac peripheral artery disease. Prog Cardiovasc Dis 2021; 65:9-14. [PMID: 33631164 DOI: 10.1016/j.pcad.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
Aorto-iliac disease is a common manifestation of atherosclerosis. Individuals with this condition are at heightened cardiovascular risk, and may have limb symptoms ranging from claudication to limb-threatening ischemia. A regimen of medical therapy, risk factor modification, and exercise is first line therapy. Revascularization is reserved for individuals with lifestyle-limiting claudication despite conservative therapy and in those with chronic limb-threatening ischemia. Multiple endovascular therapies are now available that enable even the most complex aorto-iliac lesions to be approached and treated with safe and durable results.
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Affiliation(s)
- Isma N Javed
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Beau M Hawkins
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America.
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Çakmak EÖ, Bayam E, Yilmaz F, Kahyaoğlu M, Çelik M, Öcal L, Çakir Ç, Karagöz A, Izgi IA. Midterm Outcomes on Primary Endovascular Treatment of 395 Aortoiliac Occlusive Disease Patients: A Single-Center Experience. Angiology 2021; 72:640-650. [PMID: 33541091 DOI: 10.1177/0003319721991378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the results of endovascular treatment of Trans-Atlantic Inter-Society Consensus II (TASC) A&B, TASC C, and TASC D aortoiliac lesions in a single vascular center. In this retrospective, observational cohort study, we analyzed 395 patients (mean age 61.2 ± 9.0; 359 men) between January 2015 and December 2017. Technical success was achieved in 96.5%; in-hospital mortality was 1.2% (n = 5). Median follow-up was 36 months (range 24-49 months). After 1 and 5 years, the primary patency rates were 99% and 85% for TASC A&B, 90%, and 78% for TASC C, and 90% and 74% for TASC D. Secondary patency rates were 99% and 90% for TASC A&B, 98% and 65% for TASC C, and 97% and 65% for TASC D. Previous peripheral revascularization (hazard ratio: 1.76, 95% CI: 1.01-3.08, P = .04) was associated with decreased primary patency along with lower age, TASC C, and TASC D class. This analysis reported the acceptable effectiveness and safety of stenting for all types of aortoiliac occlusive disease in a modern setting, with few complications and excellent long-term primary and secondary patency rates.
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Affiliation(s)
- Ender Özgün Çakmak
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yilmaz
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Kahyaoğlu
- Department of Cardiology, Gaziantep Abdülkadir Yüksel State Hospital, Gaziantep, Turkey
| | - Mehmet Çelik
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Çayan Çakir
- Department of Cardiology, 215299Van Research and Training Hospital, Van, Turkey
| | - Ali Karagöz
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Akin Izgi
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
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7
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Garg P, Kumar M, Choudhury A, Gupta A, Agarwal Y. Endovascular management and outcomes of aortoiliac occlusive disease. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Della Schiava N, Naudin I, Bordet M, Arsicot M, Tresson P, Giai J, Charles J, Robinson P, Lermusiaux P, Millon A. Analysis of Preoperative CT Scan Can Help Predict Technical Failure of Endovascular Treatment of TASC C-D Aortoiliac Chronic Total Occlusions. Ann Vasc Surg 2020; 72:276-283. [PMID: 32890648 DOI: 10.1016/j.avsg.2020.08.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS To evaluate if features of occlusion analyzable on preoperative computed tomography scan could predict risks of technical failure or iliac rupture of endovascular treatment of TransAtlantic InterSociety Consensus C-D aortoiliac chronic total occlusion. METHODS AND RESULTS All patients treated by endovascular techniques for a TransAtlantic InterSociety Consensus C-D aortoiliac chronic total occlusion between 2009 and 2016 were included (107 patients, 148 iliac arteries). We evaluated the location of the occlusion and the importance of the arterial calcifications. For this factor, patients were divided into 3 groups: the Black occlusion group with mild or no calcifications, the white occlusion group with moderate no protrusive calcifications, and the white protrusive occlusion group with heavy endoluminal calcifications. Technical failure occurred in 11 iliac arteries and peroperative iliac rupture in 6. The location in the external iliac artery is the most significate risk factor of technical failure in univariate (OR = 9.93; P = 0.0012) and multivariate analysis (OR = 15.26; P = 0.0006). The presence of heavy endoluminal calcifications is a further significate risk factor (OR = 13.88; P = 0.0365). Rupture rate was comparable between the 3 groups. CONCLUSIONS Preoperative computed tomography scan can predict risk of technical failure but not of iliac rupture.
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Affiliation(s)
- Nellie Della Schiava
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France.
| | - Iris Naudin
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Marine Bordet
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Matthieu Arsicot
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France
| | - Philippe Tresson
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France
| | - Joris Giai
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
| | - Jérémy Charles
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Philip Robinson
- Clinical Research and Innovation Department, Hospices Civils de Lyon, Lyon, France
| | - Patrick Lermusiaux
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Antoine Millon
- Vascular and Endovascular Surgery Department, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
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9
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Süleymanoğlu M, Burak C, Gümüşdağ A, Yesin M, Rencüzoğulları İ, Karabağ Y, Çağdaş M, Çap M. Assessment of the relation between C-reactive protein to albumin ratio and the severity and complexity of peripheral arterial disease. Vascular 2020; 28:731-738. [DOI: 10.1177/1708538120925952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Peripheral arterial disease is associated with increased cardiovascular mortality and morbidity. C-reactive protein and albumin are biomarkers of inflammation and malnutrition that play key roles in the pathophysiological pathways involved in the progression of atherosclerosis and peripheral arterial disease. In this study, we aimed to assess the relationship between C-reactive protein to albumin ratio and the suprapopliteal peripheral arterial disease severity and complexity as assessed by TransAtlantic Inter-Society Consensus-II (TASC-II) classification. Method Our study enrolled 224 consecutive patients referred for peripheral angiography with the clinical features of possible peripheral arterial disease at a tertiary care center between January 2016 and September 2019. Level of disease and lesion characteristics were defined with reference to angiographic findings according to the TASC-II classification. Results C-reactive protein/albumin ratio levels were significantly higher in TASC-II class C and D than in TASC-II class B patients with a median level of 1.8 to 2.1 vs 1.4, respectively ( p = 0.018). In multivariate regression analysis, C-reactive protein to albumin ratio remained an independent predictor of severe peripheral arterial disease. The predictive performance of C-reactive protein to albumin ratio, C-reactive protein, and albumin were compared by Receiver Operating Characteristic curve analysis. C-reactive protein to albumin ratio surpassed C-reactive protein and albumin in predicting peripheral arterial disease severity and complexity. A level of C-reactive protein to albumin ratio > 0.14 predicted a higher grade of suprapopliteal TASC-II class with sensitivity and specificity of 68.2% and 56.0%, respectively. Conclusion C-reactive protein to albumin ratio was strongly associated with peripheral arterial disease severity and complexity, as assessed by TASC-II classification. Also, C-reactive protein to albumin ratio was found to be a more accurate marker than C-reactive protein and albumin alone in predicting more severe and complex lesions in patients with peripheral arterial disease.
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Affiliation(s)
| | - Cengiz Burak
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Ayça Gümüşdağ
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Mahmut Yesin
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | | | - Yavuz Karabağ
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Metin Çağdaş
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Murat Çap
- Department of Cardiology, M.D. University of Health Sciences, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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10
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Klein AJ, Nasir A. Iliac Artery Intervention. Interv Cardiol Clin 2020; 9:187-196. [PMID: 32147119 DOI: 10.1016/j.iccl.2019.12.009] [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: 10/24/2022]
Abstract
Endovascular revascularization for aortoiliac occlusive disease (AIOD) is now considered first-line therapy for patients with claudication and critical limb ischemia and in asymptomatic patients in whom large-bore access is required (eg, mechanical circulatory support or transcatheter aortic valve replacement). The authors review the data supporting endovascular therapy for AIOD, indications and contraindications for AIOD revascularization, as well as the procedural techniques required to safely perform endovascular therapy in this vascular bed. They review prevention and management of the major complications that can occur during these procedures. Finally, they discuss postprocedural management to maintain patency and optimize patient outcomes.
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Affiliation(s)
- Andrew J Klein
- Piedmont Heart Interventional Cardiology, 95 Collier Road, Suite 2065, Atlanta, GA 30309, USA.
| | - Ammar Nasir
- John Cochran VA Medical Center, Section 2B Cardiology, 915 N. Grand Boulevard, St Louis, MO 63106, USA
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11
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Endovascular treatment of different types of iliac occlusions-Results from an observational study. PLoS One 2019; 14:e0222893. [PMID: 31577801 PMCID: PMC6774573 DOI: 10.1371/journal.pone.0222893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/08/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The aim of this study was to evaluate the results of endovascular therapy on the treatment of different types of iliac occlusions. Materials and methods A bi-center prospective, non-randomized study was conducted on 100 patients (mean age 59.14 ± 8.53; 64 men) who underwent endovascular treatment of iliac occlusive disease between January 2013 and November 2017. We evaluated baseline data, procedure, and follow-up results for the entire group, and according to Trans-Atlantic Inter-Society Consensus (TASC II) classification. The majority of patients (60%) were treated for severe claudication; 56 (56%) patients had TASC B occlusions, 28 patients TASC C, and 16 patients TASC D. Results The mean length of the occluded segments was 61.41 ± 35.15 mm. Procedural complications developed in 6 patients (6%). Mean ankle-brachial pressure index increased from 0.40 ± 0.12 preoperatively to 0.82 ± 0.16 postoperatively. The mean follow-up was 33.18 ± 15.03 months. After 1 and 5 years, the primary patency rates were 98% and 75.1%, and the secondary patency rate was 97% respectively. Regarding occlusion complexity there were no statistical significant differences in primary patency rates (TASC B vs. C vs. D: p = 0.19). There were no statistically significant differences in primary patency rates between patients in different clinical stages, as well as between the type of stents, and location of the occlusion. Conclusion In our study, endovascular treatment for iliac artery occlusions proved to be a safe and efficient approach with excellent primary and secondary patency rates regardless of the complexity of occlusions defined by TASC II classification. This study is aligned with the notion that in well selected patients, endovascular therapy can be the treatment of choice even in complex iliac lesions if performed by experienced endovascular interventionists in high volume centers.
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Kim W, Choi J. Stent Graft Implantation and Superselective Embolization with Liquid Embolic Agent, Onyx for Iatrogenic Common Iliac Artery Pseudoaneurysm and Persistant Endoleak. Vasc Specialist Int 2019; 35:101-104. [PMID: 31297360 PMCID: PMC6609022 DOI: 10.5758/vsi.2019.35.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 11/20/2022] Open
Abstract
A 68-year-old male patient with a history of femoro-femoral bypass following unsuccessful intervention for chronic total iliac occlusion was found to have a saccular pseudoaneurysm of the right common iliac artery (CIA) due to interventional device-related injuries associated with the past endovascular intervention. An iatrogenic pseudoaneurysm in the CIA is generally asymptomatic, but it has a high risk of rupture, regardless of its size or symptoms. Endovascular therapy may be the best treatment option; however, ineffective sealing with a stent graft may lead to a type I endoleak. Under such conditions, use of the liquid embolic agent, Onyx, as a bailout solution for the type 1 endoleak is promising.
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Affiliation(s)
- Wonho Kim
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
| | - Jinho Choi
- Division of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Tokuda T, Hirano K, Soga Y, Iida O, Kawasaki D, Yamauchi Y, Suzuki K, Kamoi D, Tazaki J. Comparison of 3‐year clinical outcomes after endovascular therapy for aortoiliac artery occlusive disease between patients with and without hemodialysis: Subanalysis of the REAL‐AI registry. Catheter Cardiovasc Interv 2018; 92:1345-1351. [DOI: 10.1002/ccd.27865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/25/2018] [Accepted: 08/10/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Takahiro Tokuda
- Department of Cardiovascular MedicineSaiseikai Yokohama City Eastern Hospital Yokohama Kanagawa Japan
| | - Keisuke Hirano
- Department of Cardiovascular MedicineSaiseikai Yokohama City Eastern Hospital Yokohama Kanagawa Japan
| | - Yoshimitsu Soga
- Department of CardiologyKokura Memorial Hospital Kitakyushu Japan
| | - Osamu Iida
- Cardiovascular CenterKansai Rosai Hospital Nishinomiya Hyogo Japan
| | - Daizo Kawasaki
- Cardiovascular Division, Department of Internal MedicineMorinomiya Hospital Osaka Japan
| | - Yasutaka Yamauchi
- Department of Cardiology, Cardiovascular CenterKikuna Memorial Hospital Yokohama Kanagawa Japan
| | - Kenji Suzuki
- Department of CardiologySaiseikai Central Hospital Tokyo Japan
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Müller AM, Langwieser N, Bradaric C, Haller B, Fusaro M, Ott I, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Endovascular Treatment for Steno-Occlusive Iliac Artery Disease: Safety and Long-Term Outcome. Angiology 2017; 69:308-315. [DOI: 10.1177/0003319717720052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We evaluated safety and long-term outcome of endovascular therapy for steno-occlusive iliac artery disease. All endovascular procedures of iliac artery lesions performed at our institution between 2001 and 2014 (n = 676) were retrospectively analyzed. The overall technical success rate was 99% and yielded 100% for stenoses (n = 596) and 95% for chronic total occlusions (n = 80). Lesion complexity defined by the Trans-Atlantic Inter-Society Consensus (TASC) II classification had no impact on success rates (TASC A + B vs C + D; 99.5% vs 98.6%, P = .359). During a median follow-up of 11 months, the overall rate of restenosis was 9.4%. After 1 and 3 years, the primary patency rates were 94% and 86% and the secondary patency rate was 100%, respectively. The TASC II classification had no impact on long-term patency rates (TASC A + B vs C + D; 86% vs 81%). In a multivariable analysis, stent diameter remained the only significant predictor for restenosis (hazard ratio: 0.58; 95% confidence interval: 0.41%-0.81%; P = .002). In this single-center retrospective study, endovascular therapy for steno-occlusive iliac artery disease was associated with high technical and clinical success rates as well as an excellent long-term patency rate irrespective of lesion complexity.
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Affiliation(s)
- Arne M. Müller
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Nicolas Langwieser
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Nicolas von Beckerath
- Allgemeines Krankenhaus Viersen, Abteilung Kardiologie und Angiologie, Viersen, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
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Klein AJ, Jaff MR, Gray BH, Aronow HD, Bersin RM, Diaz-Sandoval LJ, Dieter RS, Drachman DE, Feldman DN, Gigliotti OS, Gupta K, Parikh SA, Pinto DS, Shishehbor MH, White CJ. SCAI appropriate use criteria for peripheral arterial interventions: An update. Catheter Cardiovasc Interv 2017; 90:E90-E110. [PMID: 28489285 DOI: 10.1002/ccd.27141] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/05/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Herbert D Aronow
- The Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | | | | | | | | | - Kamal Gupta
- University of Kansas Medical Center, Kansas City, KS
| | - Sahil A Parikh
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY
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Abstract
Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to significant limitations in patient quality of life. All patients with aortoiliac occlusive disease should be managed with approved medical therapies in addition to a supervised exercise program. Persistence of significant symptoms despite noninvasive therapy should prompt further management with endovascular revascularization. Although patients with the most complex cases of AIOD anatomy may ultimately require surgery, advances in endovascular techniques have made it possible to treat most of these patients with AIOD using an endovascular-first approach.
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Affiliation(s)
- Vladimir Lakhter
- Division of Cardiology, Department of Internal Medicine, Section of Interventional Cardiology, Lewis Katz School of Medicine, Temple University, 3401 North Broad Street, C945, Philadelphia, PA 19140, USA
| | - Vikas Aggarwal
- Division of Cardiology, Department of Internal Medicine, Section of Interventional Cardiology, Lewis Katz School of Medicine, Temple University, 3401 North Broad Street, C945, Philadelphia, PA 19140, USA.
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