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Korosoglou G, Feld J, Langhoff R, Lichtenberg M, Stausberg J, Hoffmann U, Rammos C, Malyar N. Safety and Effectiveness of Debulking for the Treatment of Infrainguinal Peripheral Artery Disease. Data From the Recording Courses of vascular Diseases Registry in 2910 Patients. Angiology 2024:33197241263381. [PMID: 38904281 DOI: 10.1177/00033197241263381] [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: 06/22/2024]
Abstract
We investigated the safety and efficacy of debulking infrainguinal lesions in patients with peripheral artery disease (PAD) undergoing endovascular revascularization (EVR) as part of the RECording Courses of vascular Diseases (RECCORD) registry. Patient and lesion specific characteristics, including the lesion complexity score (LCS) were analyzed. The primary endpoint encompassed: (i) clinical improvement in Rutherford categories, (ii) index limb re-interventions, and (iii) major amputations during follow-up. The secondary endpoint included the need for bail-out stenting. Overall, 2910 patients were analyzed; 2552 without and 358 with debulking-assisted EVR. Patients were 72 (interquartile range (IQR) = 15) years old and 1027 (35.3%) had diabetes. Overall complication rates were similarly low in the debulking vs the non-debulking group (4.7 vs 3.2%, P = .18). However, peripheral embolizations rates were low but more frequent with debulking vs. non-debulking procedures (3.9 vs 1.1%, P < .001). After adjustment for clinical and lesion-specific parameters, including LCS, no differences were noted for the primary endpoint (odds ration (OR) = 0.99, 95%CI = 0.69-1.41, P = .94). Bail-out stenting was less frequently performed in patients with debulking-assisted EVR (OR = 0.5, 95%CI = 0.38-0.65, P < .0001). Debulking-assisted EVR is currently used in ∼12% of EVR with infrainguinal lesions and is associated with lower bail-out stent rates but higher peripheral embolization rates; no differences were found regarding index limb re-intervention and amputation rates.
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Affiliation(s)
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Ralf Langhoff
- Department of Angiology, Sankt-Gertrauden-Krankenhaus, Berlin, Germany
| | | | | | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital Munich, Munich, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Duisburg, Germany
| | - Nasser Malyar
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiology, Münster, Germany
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Tang M, Zeng F, Chang X, He M, Fang Q, Xue L, Luo X, Yin S. Feasibility study of Syngo iFlow in predicting hemodynamic improvement post-endovascular procedure in peripheral artery disease. BMC Cardiovasc Disord 2024; 24:99. [PMID: 38341562 PMCID: PMC10858483 DOI: 10.1186/s12872-024-03762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE This study endeavors to examine the feasibility of predicting the clinical outcomes of patients suffering from peripheral artery disease (PAD) who undergo endovascular intervention, by employing the Syngo iFlow technology. METHODS Retrospectively enrolling 76 patients from December 2021 to May 2023, yielding a total of 77 affected limbs, this study employs clinical outcomes (improvement or otherwise) as the gold standard. Two physicians conducted visual assessments on both DSA and iFlow images to gauge patient improvement and assessed inter-observer consistency for each image modality. The Time to Peak (TTP) of regions of interest (ROI) at the femoral head, knee joint, and ankle joint was measured. Differences in pre- and post-procedure TTP were juxtaposed, and statistically significant parameter cutoff values were identified via ROC analysis. Employing these cutoffs for TTP classification, multivariate logistic regression and the C-statistic were utilized to assess the predictive value of distinct parameters for clinical success. RESULTS Endovascular procedure exhibited technical and clinical success rates of 82.58 and 75.32%, respectively. Diagnostic performance of iFlow image visual assessment surpassed that of DSA images. Inter-observer agreement for iFlow and DSA image evaluations was equivalent (κ = 0.48 vs 0.50). Post-classification using cutoff values, multivariate logistic regression demonstrated the statistical significance of ankle joint TTP in post-procedure iFlow images of the endovascular procedure for clinical success evaluation (OR 7.21; 95% CI 1.68, 35.21; P = 0.010), with a C-statistic of 0.612. CONCLUSION Syngo iFlow color-encoded imagery holds practical value in assessing the technical success of post-endovascular procedures, offering comprehensive lower limb arterial perfusion visualization. Its quantifiable parameters exhibit promising potential for prognosticating clinical success.
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Affiliation(s)
- Ming Tang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China
- The Fifth Clinical College of Medicine, Anhui Medical University, 1166 Wangjiang West Road, Shushan District, Hefei City, 230011, Anhui Province, China
| | - Fanyi Zeng
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China
| | - Xindong Chang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China
| | - Mingfei He
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China
| | - Qingqing Fang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China
| | - Lele Xue
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China
| | - Xinyi Luo
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China
| | - Shiwu Yin
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, 574 Changjiang East Road, Yaohai District, Hefei City, 230011, Anhui Province, China.
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Betge S, Engelbertz C, Espinola-Klein C, Ito W, Heiss C, Heilmeier B, Langhoff R, Malyar NM. Analysis of endovascular therapy for peripheral arterial disease in all German hospitals. VASA 2023; 52:366-378. [PMID: 37799062 DOI: 10.1024/0301-1526/a001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background: The quality of vascular care has significantly improved in part by the expansion of endovascular techniques for the treatment of symptomatic peripheral artery disease (PAD) in recent years. In Germany these are primarily provided by the three disciplines of vascular surgery, angiology, and interventional radiology (IR). However, the relative contribute of angiologists to the total number of cases performed is unknown. Patients and methods: In the present study, we analysed the respective contribution of vascular surgery, angiology, and IR to the delivery of endovascular revascularisations in symptomatic PAD in Germany based on the legally mandatory quality reports representative for the reporting year 2018. Results: Vascular surgery is the most common speciality reporting procedures in German hospitals (n=579; 25.1%), followed by IR (n=264; 11.5%), angiology (n=189; 8.2%) and cardiology (n=17; 0.7%). The combination of vascular surgery and IR was reported in 202 (8.8%), vascular surgery and angiology in 167 (7.2%) and angiology and IR in 65 (2.8%) hospitals, and 63 (2.7%) hospitals reported the combination of all three disciplines. Not every department performed catheter interventions. The analysis of procedures per centre revealed that angiology centres provided the highest numbers for both basic procedures and more complex techniques such as atherectomy, rotational thrombectomy, lithoplasty, selective thrombolysis or the use of re-entry devices. In total, angiology centres provided 24.4% of the total procedures or 23.9% of the so-called basic procedures as a surrogate for patient numbers. Conclusions: While each of the disciplines contribute significantly to the endovascular procedures, angiology centres perform more procedures per centre and more complex procedures than the other disciplines highlighting the important quantitative and qualitative contribution of angiology specialists to the care of vascular patients. The inpatient catheter interventional care of patients with PAD is still too rarely carried out in a multi-disciplinary manner in Germany.
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Affiliation(s)
- Stefan Betge
- Department of Internal Medicine and Angiology, HELIOS-Hospital Salzgitter, Germany
| | | | | | - Wulf Ito
- Heart and Vascular Center, Allgäu Hospital gGmbH, Immenstadt, Germany
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Vascular Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | | | - Ralf Langhoff
- Department of Angiology, St. Gertrauden Hospital, Berlin, Germany
| | - Nasser M Malyar
- Department of Cardiology I, University Hospital Münster, Germany
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Paraskevas KI, Veith FJ. Expansion of Bypass as a Revascularization Option for Patients With Chronic Limb-Threatening Ischemia. Angiology 2023; 74:809-811. [PMID: 36880697 DOI: 10.1177/00033197231162707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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Alnima T, Meijer RI, Spronk HMH, Warlé M, Cate HT. Diabetes- versus smoking-related thrombo-inflammation in peripheral artery disease. Cardiovasc Diabetol 2023; 22:257. [PMID: 37735399 PMCID: PMC10514957 DOI: 10.1186/s12933-023-01990-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
Peripheral artery disease (PAD) is a major health problem with increased cardiovascular mortality, morbidity and disabling critical limb threatening ischemia (CLTI) and amputation. Diabetes mellitus (DM) and cigarette smoke are the main risk factors for the development of PAD. Although diabetes related PAD shows an accelerated course with worse outcome regarding complications, mortality and amputations compared with non-diabetic patients, current medical treatment does not make this distinction and includes standard antiplatelet and lipid lowering drugs for all patients with PAD. In this review we discuss the pathophysiologic mechanisms of PAD, with focus on differences in thrombo-inflammatory processes between diabetes-related and smoking-related PAD, and hypothesize on possible mechanisms for the progressive course of PAD in DM. Furthermore, we comment on current medical treatment and speculate on alternative medical drug options for patients with PAD and DM.
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Affiliation(s)
- T Alnima
- Department of Internal Medicine, Section of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Internal Medicine, Section of Diabetology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - R I Meijer
- Department of Internal Medicine, Section of Diabetology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H M H Spronk
- Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M Warlé
- Department of Vascular Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Ten Cate
- Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
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