1
|
Campbell DB, Sobol CG, Sarac TP, Stacy MR, Atway S, Go MR. The natural history of chronic limb-threatening ischemia after technical failure of endovascular intervention. J Vasc Surg 2023; 78:737-744. [PMID: 37141950 PMCID: PMC10524400 DOI: 10.1016/j.jvs.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES The treatment for chronic limb-threatening ischemia (CLTI) has changed dramatically in the last few decades with a shift toward an endovascular-first approach and aggressive revascularization to achieve limb salvage. As the size of the CLTI population and intervention rates increase, patients will continue to experience technical failure (TF). Here, we describe the natural history of patients after TF of endovascular intervention for CLTI. METHODS We conducted a retrospective cohort study of patients with CLTI who attempted endovascular intervention or bypass at our multidisciplinary limb salvage center from 2013 to 2019. Patient characteristics were collected according to the Society for Vascular Surgery's reporting standards. Primary outcomes included survival, limb salvage, wound healing, and revascularization patency. Product-limit Kaplan-Meier estimated survival functions for these outcomes, and between-group comparisons were made using Mantel-Cox log-rank nonparametric tests. RESULTS We identified 242 limbs from 220 unique patients who underwent primary bypass (n = 30) or attempted endovascular intervention (n = 212) at our limb salvage center. Endovascular intervention was a TF in 31 (14.6%) limbs. After TF, 13 limbs underwent secondary bypass and 18 limbs were managed medically. Patients who experienced TF tended to be older (P < .001), male (P = .003), current tobacco users (P = .014), have longer lesions (P = .001), and have chronic total occlusions of target arteries (P < .001) as compared with those who experienced technical success. Furthermore, the TF group had worse limb salvage (P = .047) and slower wound healing (P = .028), but their survival was not different. Survival, limb salvage, and wound healing were not different in patients who received secondary bypass or medical management after TF. The secondary bypass group was older (P = .012) and had a lower prevalence of tibial disease (P = .049) than the primary bypass group and trended toward decreased survival, limb salvage, and wound healing (P = .059, P = .083, and P = .051, respectively). CONCLUSIONS Increased age, male sex, current tobacco use, longer arterial lesions, and occluded target arteries are associated with TF of endovascular intervention. Limb salvage and wound healing are relatively poor after TF of endovascular intervention, but survival appears comparable with patients who experience technical success. Secondary bypass may not always rescue patients after TF, though our sample size limits statistical power. Interestingly, patients who received a secondary bypass after TF trended toward decreased survival, limb salvage, and wound healing compared with primary bypass.
Collapse
Affiliation(s)
- Drayson B Campbell
- The Ohio State of Medicine, Columbus, OH; Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Carly G Sobol
- The Ohio State of Medicine, Columbus, OH; Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Timur P Sarac
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mitchel R Stacy
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH
| | - Said Atway
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH
| | - Michael R Go
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
2
|
Bai H, Fereydooni A, Zhuo H, Zhang Y, Tonnessen BH, Guzman RJ, Ochoa Chaar CI. Comparison of Atherectomy to Balloon Angioplasty and Stenting for Isolated Femoropopliteal Revascularization. Ann Vasc Surg 2020; 69:261-273. [DOI: 10.1016/j.avsg.2020.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/19/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
|
3
|
Gupta A, Lee MS, Gupta K, Kumar V, Reddy S. A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention. Cardiol Ther 2019; 8:193-209. [PMID: 31630320 PMCID: PMC6828854 DOI: 10.1007/s40119-019-00153-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
Endovascular intervention is often used to treat critical limb ischemia (CLI). Post-intervention treatment with antiplatelet and/or anticoagulant therapy has reduced morbidity and mortality due to cardiovascular complications. The purpose of this review is to shed light on the various pharmacologic treatment protocols for treating CLI following endovascular procedures. We reviewed the literature comparing outcomes after antithrombotic treatment for patients with CLI. We characterized antithrombotic therapies into three categories: (1) mono-antiplatelet therapy (MAPT) vs. dual antiplatelet therapy (DAPT), (2) MAPT vs. antiplatelet (AP) + anticoagulant (AC) therapy, and (3) AC vs. AP + AC therapy. Relevant results and statistics were extracted to determine differences in the rates of the following outcomes: (1) re-stenosis, (2) occlusion, (3) target limb revascularization (TLR), (4) major amputation, (5) major adverse cardiac events, (6) all-cause death, and (7) bleeding. Studies suggest that DAPT reduces post-surgical restenosis, TLR, and amputation for diabetic patients, without increasing major bleeding incidences, compared to MAPT. Also, AP + AC therapy provides overall superior efficacy, with no difference in bleeding incidences, compared to antiplatelet alone. Additionally, the effects were significant for restenosis, limb salvage, survival rates, and cumulative rate of above ankle amputation or death. These results suggest that treatment with DAPT and AP + AC might provide better outcomes than MAPT following the endovascular intervention for CLI, and that the ideal treatment may be related to the condition of the individual patient. However, the studies were few and heterogenous with small patient populations. Therefore, further large controlled studies are warranted to confirm these outcomes.
Collapse
Affiliation(s)
- Amol Gupta
- Heart, Vascular & Leg Center, Bakersfield, CA, USA.
| | - Michael S Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Kush Gupta
- Kasturba Medical College, Mangalore, India
| | - Vinod Kumar
- Heart, Vascular & Leg Center, Bakersfield, CA, USA
| | - Sarath Reddy
- Division of Cardiology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| |
Collapse
|
4
|
Atherectomy-assisted versus percutaneous angioplasty interventions for treatment of symptomatic infra-inguinal peripheral arterial disease. ACTA ACUST UNITED AC 2019; 4:e231-e242. [PMID: 31824991 PMCID: PMC6900743 DOI: 10.5114/amsad.2019.89900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/06/2019] [Indexed: 11/21/2022]
Abstract
Introduction The role of atherectomy (ATHERO) for the treatment of symptomatic infra-inguinal arterial lesions remains controversial. We evaluated the effectiveness and safety of atherectomy-assisted endovascular interventions in comparison with percutaneous angioplasty (PTA). Material and methods A systematic search utilizing MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials was conducted for studies comparing ATHERO with PTA from February 1995 to May 2018. Only studies comparing ATHERO to PTA for symptomatic infra-inguinal disease were included. Random-effects meta-analysis was used to pool the data and endpoints across studies. Study endpoints included vessel dissection, distal embolization, residual stenosis (> 30%), vessel patency at 6 months, target lesion revascularization (TLR) at 12 months and major amputation rates at 1, 6, and 12 months. Results A total of 2923 patients were included from 8 studies. PTA was associated with higher vessel dissection (OR = 4.00, 95% CI: 1.15–13.86) and lower 12-month major amputation rates (OR = 0.73, 95% CI: 0.59–0.90). There was no significant difference between ATHERO and PTA groups in terms of distal embolization (OR = 0.45, 95% CI: 0.04–4.63), residual stenosis (OR = 1.28, 95% CI: 0.58–2.80), vessel patency at 6 months (OR = 1.27, 95% CI: 0.50–3.22), TLR at 12 months (OR = 1.07, 95% CI: 0.46–2.51), or limb amputation at 1 month (OR = 0.69, 95% CI: 0.44–1.07) or 6 months (OR = 1.54, 95% CI: 0.38–6.15). Conclusions In patients undergoing infra-inguinal endovascular interventions, PTA was associated with higher peri-procedural vessel dissection and lower 12-month major amputation rates. Both modalities were associated with similar distal embolization, residual stenosis, and 6-month vessel patency and amputation rates.
Collapse
|
5
|
Abdullah O, Omran J, Enezate T, Mahmud E, Shammas N, Mustapha J, Saab F, Abu-fadel M, Ghadban R, Alpert M, Al-Dadah A. Percutaneous angioplasty versus atherectomy for treatment of symptomatic infra-popliteal arterial disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:423-428. [DOI: 10.1016/j.carrev.2017.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022]
|
6
|
Giaquinta A, Vincenzo A, De Marco E, Veroux M, Veroux P. Everolimus-Eluting Stent for Patients With Critical Limb Ischemia and Infrapopliteal Arterial Occlusive Disease. Vasc Endovascular Surg 2017; 51:60-66. [DOI: 10.1177/1538574416689429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Critical limb ischemia (CLI), despite revascularization, may result in minor or major amputations with devastating psychological effects and a negative impact on patient survival. Randomized clinical trials demonstrated that drug-eluting stents improve 1-year primary patency and decrease target lesion revascularization, compared to standard angioplasty and bare-metal stents, in patients with short occlusive below-the-knee lesions. Objectives: This prospective clinical study was designed to evaluate if one straight-line flow revascularization to the foot, using Xience-Prime Everolimus-Eluting Stent (EES), is an effective treatment of patients in Rutherford-Becker category 4 to 5 with distal popliteal and proximal tibial arteries long occlusive lesions up to 10 cm. Methods: All patients with angiographic documented segment P3 of popliteal artery and proximal tibial arteries stenosis >70%, and lesion length between 20 mm and 100 mm, meeting the inclusion criteria, were included in the Etna Registry. The end points assessed were 1- and 3-year primary patency, major amputation-free survival, target lesion revascularization, and wound healing rates. Results: Between June 2011 and April 2014, 122 patients were included in the study, with mean lesion length of 52.7 mm (range: 20-100 mm). The 1- and 3-year primary patency rates were 88.9% and 80.1%, respectively. The survival, major amputation-free survival, and target lesion revascularization rates were 88.1%, 93%, and 91.5% at 1-year and 70.4%, 89.3%, and 85.1% at 3-year follow-up, respectively. Primary patency influenced major amputation rate, which was 60% in patients with no target artery patency versus 5.4% in patients with patency ( P = .022). At 1-year follow-up, 78 (88.6%) of 88 patients improved 1 or more of their Rutherford-Becker category, and 48 (80%) of 69 patients had wound healing. Conclusions: The results of our study suggest that a conservative approach, with EES, seems feasible in selected patients with CLI and infrapopliteal artery occlusive disease.
Collapse
Affiliation(s)
- Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Ardita Vincenzo
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Ester De Marco
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| |
Collapse
|
7
|
Zhang H, Wang X, Zhang C, Zhu F, Yu Z, Peng X. Pleiotropic effects of survivin in vascular endothelial cells. Microvasc Res 2016; 108:10-6. [DOI: 10.1016/j.mvr.2016.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
|
8
|
Suttmeyer B, Teichgräber U, Rathke H, Albrecht L, Güttler F, Schnackenburg B, Hamm B, de Bucourt M. Initial experience with imaging of the lower extremity arteries in an open 1.0 Tesla MRI system using the triggered angiography non-contrast-enhanced sequence (TRANCE) compared to digital subtraction angiography (DSA). ACTA ACUST UNITED AC 2016; 61:383-92. [DOI: 10.1515/bmt-2014-0181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 11/09/2015] [Indexed: 11/15/2022]
Abstract
Abstract
Purpose:
The aim of this study was to evaluate the feasibility and validity of arterial lower limb imaging with triggered angiography non-contrast enhanced (TRANCE) in an open MRI at 1.0 Tesla (T) compared to digital subtraction angiography (DSA).
Material and methods:
ECG-gated, non-contrast-enhanced magnetic resonance angiography (MRA) was performed in a 1.0-T high-field open magnetic resonance imaging (MRI) system which generates a vertical magnetic field. Three acquisition levels were defined (abdominal and pelvic level, arterial segments above the knee and segments below the knee) and a total of 1782 vessel diameter measurements were taken on a total of 11 patients with suspected peripheral arterial occlusive disease (PAOD) (8 men, 3 women; average age 66 years). In each patient, 162 vessel segments (81 each with TRANCE and DSA) were defined and measured. Pearson correlation coefficients were calculated.
Results:
At the abdominal/pelvic level, all mean values measured with DSA exceeded the mean values obtained with TRANCE. Above the knee, mean vessel diameters were measured smaller in DSA in six, equal in three, and larger in two vessel segments. Below the knee, all measured averages, except for the tibiofibular tract (TFT) measurements, were larger in TRANCE. In total, two small (≤0.3), two moderate (>0.3), 11 good (>0.5), 10 high (>0.7) and 13 very high (>0.8) correlations were obtained.
Conclusions:
Non-contrast-enhanced imaging of the lower limb arteries using a TRANCE-sequence in a 1.0 T open MRI system is feasible with the protocol presented; however, TRANCE tends to underestimate larger vessels and overestimate smaller vessels compared to DSA.
Collapse
|
9
|
Khanolkar UB, Ephrem B. Endovascular reconstruction of popliteal and infrapopliteal arteries for limb salvage and wound healing in patients with critical limb ischemia - A retrospective analysis. Indian Heart J 2016; 68:77-82. [PMID: 26896272 PMCID: PMC4759484 DOI: 10.1016/j.ihj.2015.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/11/2015] [Accepted: 07/14/2015] [Indexed: 11/28/2022] Open
Abstract
Background Advancement in endovascular techniques has led to rapid growth in endovascular revascularization, and it has emerged as a treatment for critical limb ischemia (CLI). Clinical effectiveness of revascularization has been frequently judged by vessel patency and limb salvage, but there is paucity of reports on outcomes of the wound. We present a retrospective analysis of immediate angiographic and 3-month clinical outcome of patients who underwent endovascular reconstruction of popliteal and infrapopliteal arteries for CLI. Methods All patients who underwent endovascular reconstruction of popliteal and/or infrapopliteal arteries for CLI and >70% stenosis on digital subtraction angiography between March 2010 and November 2014 and had a clinical follow-up of at least 3 months were selected for analysis. Results 34 patients underwent endovascular reconstruction. 9 patients (26%) underwent only POBA and remaining 25 (74%) underwent additional stenting. 13 patients (38%) had multiple segmental revascularization. 24 patients (71%) had successful vessel recanalization. Linear flow to foot in at least one artery could be achieved in 20 patients (59%) post revascularization. Successful wound healing occurred in 11 (35%) patients with an additional 7 (21%) patients showing clinical improvement in their wounds. Limb salvage was achieved in 33 patients (97%) at 3-month follow-up. Conclusion Endovascular revascularization of popliteal and infrapopliteal arteries is a feasible, safe, and effective procedure for the treatment of CLI. Normal inflow and outflow with at least one of the three infrapopliteal vessels being patent is essential for adequate healing of chronic ulcers and prevention of major amputation.
Collapse
Affiliation(s)
- Uday B Khanolkar
- Director, Cardiovascular Science, Apollo Victor Hospital, Goa 403601, India.
| | - Biju Ephrem
- Consultant Cardiologist, Apollo Victor Hospital, Goa 403601, India
| |
Collapse
|
10
|
Higashimori A, Iida O, Yamauchi Y, Kawasaki D, Nakamura M, Soga Y, Zen K, Yokoi Y. Outcomes of One straight-line flow with and without pedal arch in patients with critical limb ischemia. Catheter Cardiovasc Interv 2015; 87:129-33. [PMID: 26489531 DOI: 10.1002/ccd.26164] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 07/27/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to compare the outcomes of revascularization strategies for patients with critical limb ischemia (CLI) whereby single vessel run off to the foot was established with or without flow into a patent pedal arch. METHODS We retrospectively analyzed data from 312 consecutive patients with CLI who underwent endovascular therapy (EVT) between December 2009 and February 2011. Below-the-knee angiography identified one vessel run off in 137 patients (44%), and we aimed to compare the outcomes between those patients where revascularization resulted in one-straight-line flow into a patent pedal arch (76 limbs, Group A) versus those who attained one straight-line flow to the distal end of a tibial vessel without flow into a patent pedal arch (61 limbs, Group B). The study endpoints were amputation free survival rate, limb salvage rate and wound healing rate at 12 months after EVT. RESULTS Amputation free survival rate differed significantly between groups (88.2% in group A vs. 65.6% in group B, P = 0.01). Limb salvage rate also differed between groups (98.4% vs.89.3%, P = 0.03). Wound healing rate showed a trend towards difference between the two groups (89.4% vs. 80.6% P = 0.11). CONCLUSIONS Among patients with CLI where only one vessel runoff can be established to the foot, direct flow into a patent pedal arch is essential to improve their clinical outcomes. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | | | - Daizo Kawasaki
- Cardiovascular Center, Morinomiya Hospital, Osaka, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
| | | |
Collapse
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
Tsuchiya T, Iida O, Shiraki T, Soga Y, Hirano K, Suzuki K, Yamaoka T, Miyashita Y, Kitayama M, Kajinami K. Clinical characteristics of patients with Rutherford category IV, compared with V and VI. SAGE Open Med 2015; 3:2050312115597087. [PMID: 26770796 PMCID: PMC4679321 DOI: 10.1177/2050312115597087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/27/2015] [Indexed: 12/20/2022] Open
Abstract
Objective: Patients categorized Rutherford category IV might have different characteristics compared with Rutherford category V and VI. Our study aims were to estimate the clinical differences between Rutherford category IV and Rutherford category V and VI, for those underwent endovascular therapy for isolated infrapopliteal disease, and also to find risk factors for endovascular therapy in Rutherford category IV. Methods: Based on the Japanese multi-center registry data, 1091 patients with 1332 limbs (Rutherford category IV: 226 patients with 315 limbs, Rutherford category V and VI: 865 patients with 1017 limbs) were analyzed retrospectively. Results: Patients’ backgrounds and lesions’ characteristics had significant differences. Both freedom rate from major adverse limb event with perioperative death and amputation-free survival rate at 1 year were better in Rutherford category IV than Rutherford category V and VI (93.6% vs 78.3%, 87.7% vs 66.7%) and those maintained to 3 years (p < 0.0001). Significant predictors for major adverse limb event/perioperative death were small body mass index (<18.5 kg/m3) and initial endovascular therapy success, and those for amputation-free survival were small body mass index (<18.5 kg/m3), non-ambulatory status, high systematic inflammatory reaction (C-reactive protein > 3.0 mg/dL), chronic obstructive pulmonary disease, and coronary artery disease in Rutherford category IV. Conclusion: From the present results, Rutherford category IV should be recognized to have quite different backgrounds and better outcome from Rutherford category V and VI.
Collapse
Affiliation(s)
- Taketsugu Tsuchiya
- Division of Trans-catheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tatsuya Shiraki
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Keisuke Hirano
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Kenji Suzuki
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - Michihiko Kitayama
- Division of Trans-catheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku, Japan
| | - Koji Kajinami
- Division of Cardiology, Kanazawa Medical University Hospital, Kahoku, Japan
| |
Collapse
|
13
|
Suttmeyer B, Teichgräber U, Thomas A, Rathke H, Albrecht L, Jonczyk M, Verba M, Güttler F, Schnackenburg B, Hamm B, de Bucourt M. Non-invasive ECG-triggered 2D TOF MR angiography of the pelvic and leg arteries in an open 1.0-tesla high-field MRI system in comparison to conventional DSA. ACTA ACUST UNITED AC 2015; 59:29-37. [PMID: 24334421 DOI: 10.1515/bmt-2013-0113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/20/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A non-contrast-enhanced 2D time-of-flight magnetic resonance angiography (TOF-MRA) protocol was compared with the gold standard of planar digital subtraction angiography (DSA) by calculating correlations of vessel diameters. METHODS A total of 1134 vascular diameters in 81 corresponding sites were prospectively measured by TOF-MRA and DSA in seven patients (four women, three men; mean age, 68 years). For a total of 162 vascular segments per patient, 81 Spearman's ρ correlation coefficients were calculated, consolidated to 41 due to consideration of symmetry (right/left), and assessed by correlation quality. RESULTS In the 41 consolidated segments, correlations were good, very good, and excellent in 25 segments (n=10>0.5, n=4>0.7, and n=11>0.8), moderate to poor in seven segments (n=4>0.3 and 0<n=3≤0.3), without in two, inverse in three, and nonmeasurable in four segments. Correlations were best for the main arteries above the knee, and these arteries were most consistently visualized. CONCLUSION The TOF-MRA protocol presented here can be performed in an open 1.0-T MRI system in 60-90 min. Visualization is degraded when the target artery leaves the plane orthogonal to the imaging plane (1) or signal yield is poor due to small caliber (2).
Collapse
|
14
|
Abstract
Critical limb ischemia (CLI) is a severe form of peripheral artery disease associated with high morbidity and mortality. The primary therapeutic goals in treating CLI are to reduce the risk of adverse cardiovascular events, relieve ischemic pain, heal ulcers, prevent major amputation, and improve quality of life (QoL) and survival. These goals may be achieved by medical therapy, endovascular intervention, open surgery, or amputation and require a multidisciplinary approach including pain management, wound care, risk factors reduction, and treatment of comorbidities. No-option patients are potential candidates for the novel angiogenic therapies. The application of genetic, molecular, and cellular-based modalities, the so-called therapeutic angiogenesis, in the treatment of arterial obstructive diseases has not shown consistent efficacy. This article summarizes the current status related to the management of patients with CLI and discusses the current findings of the emerging modalities for therapeutic angiogenesis.
Collapse
Affiliation(s)
- Geoffrey O. Ouma
- Department of Medicine, Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Emile R. Mohler
- Department of Medicine, Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Moshe Y. Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| |
Collapse
|
15
|
Todd KE, Ahanchi SS, Maurer CA, Kim JH, Chipman CR, Panneton JM. Atherectomy offers no benefits over balloon angioplasty in tibial interventions for critical limb ischemia. J Vasc Surg 2013; 58:941-8. [PMID: 23755978 DOI: 10.1016/j.jvs.2013.04.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/07/2013] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endovascular adjuncts, like atherectomy, were developed to improve outcomes of endovascular arterial interventions. The true impact of atherectomy on endovascular outcomes remains to be determined, and little data exist on the influence of atherectomy on tibial interventions. Our study compares early and late outcomes of tibial intervention with angioplasty vs atherectomy-assisted interventions. METHODS We completed a retrospective review of all tibial interventions between 2008 and 2010. Outcomes were analyzed using single and multivariate analysis, Cox regression, and Kaplan-Meier curves. Primary outcomes were primary, primary assisted, and secondary patency rates, as well as limb salvage and survival rates. RESULTS Over a 2-year period, 480 tibial interventions were completed for 421 patients. Eighty-seven percent (n = 418) of interventions were performed for critical limb ischemia (CLI) and 13% (n = 62) for claudication. The CLI cohort of 418 interventions was analyzed. These patients had a mean age of 71 years with a mean follow-up time of 16 ± 15 months (range, 0-59 months). Of the 418 interventions, 339 underwent percutaneous transluminal angioplasty (PTA): 333 PTA alone, six PTA + stent. The remaining 79 interventions received atherectomy: 33 laser, 13 directional, and 33 orbital either alone or in conjunction with PTA (11 atherectomy only, 68 atherectomy + PTA). The groups did not differ significantly in terms of demographics, risk factors, or technical success. The atherectomy group had more TASC B lesions (54% vs 38%; P = .013), while the PTA-alone group had more TASC D lesions (25% vs 13%; P = .004). TASC A and C lesions did not differ significantly between the groups. No significant differences existed with respect to the early (30-day) outcomes of loss of patency (11% vs 13%; P = .699), complications (8% vs 13%; P = .292), or major amputation (17% vs 13%; P = .344) in the PTA-alone group vs the atherectomy-assisted group. Kaplan-Meier analysis revealed no difference for all primary outcomes of PTA alone vs the atherectomy-assisted group at 12 and 36 months: primary patency (69%, 55% vs 61%, 46%; P = .158), primary assisted patency (83%, 71% vs 85%, 67%; P = .801), secondary patency (94%, 89% vs 95%, 89%; P = .892), limb salvage (79%, 70% vs 81%, 77%; P = .485), or survival (77%, 56% vs 80%, 50%; P = .944). CONCLUSIONS The adjunctive use of atherectomy offered no improvement in primary outcomes over PTA alone in either early or late outcomes in CLI patients who underwent endovascular tibial interventions. Considering the additional cost and increased procedural time, these findings put into question the routine use of adjunctive atherectomy.
Collapse
Affiliation(s)
- Kevin E Todd
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va
| | | | | | | | | | | |
Collapse
|
16
|
Iida O, Nakamura M, Yamauchi Y, Kawasaki D, Yokoi Y, Yokoi H, Soga Y, Zen K, Hirano K, Suematsu N, Inoue N, Suzuki K, Shintani Y, Miyashita Y, Urasawa K, Kitano I, Yamaoka T, Murakami T, Uesugi M, Tsuchiya T, Shinke T, Oba Y, Ohura N, Hamasaki T, Nanto S. Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia. Circ Cardiovasc Interv 2013; 6:68-76. [DOI: 10.1161/circinterventions.112.975318] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Recent technical advances have made endovascular treatment (EVT) an alternative first-line treatment for critical limb ischemia.
Methods and Results—
A prospective multicenter study was conducted to evaluate the clinical outcomes of 314 Japanese critical limb ischemia patients (mean age, 73±10 years) with infrainguinal arterial lesions who underwent EVT. Patients were enrolled from December 2009 to July 2011 and were followed-up for 12 months. The primary end point was amputation-free survival (AFS) at 12 months. Secondary end points were anatomic, clinical, and hemodynamic measures, including 12-month freedom from major adverse limb events. The 12-month AFS rate was 74%, with body mass index <18.5 (hazard ratio [HR], 2.22;
P
=0.008), heart failure (HR, 1.73;
P
=0.04), and wound infection (HR, 1.89;
P
=0.03) associated with a poor prognosis for AFS. The 12-month major adverse limb event-free rate was 88%, with hemodialysis (HR, 1.98;
P
=0.005), heart failure (HR, 1.69;
P
=0.02), and Rutherford classification 6 (HR, 2.25;
P
=0.002) associated with a poor prognosis for major adverse limb events. The median time for wound healing was 97 days, with body mass index <18.5 (HR, 0.54;
P
=0.03) and wound infection (HR, 0.60;
P
=0.04) being significant risk factors for unhealed wounds after EVT. At 12 months, 34% had undergone reintervention (bypass surgery, 2.6%; repeat EVT, 31.7%), and 73% were major adverse event–free.
Conclusions—
The high reintervention rate notwithstanding, EVT was an effective treatment for Japanese critical limb ischemia patients with infrainguinal disease, with satisfactory AFS and major adverse limb event-free rates. The results of this study will be helpful for the future evaluation of critical limb ischemia therapy.
Clinical Trial Registration—
URL:
http://www.umin.ac.jp/ctr
. Unique identifier: UMIN000002830.
Collapse
Affiliation(s)
- Osamu Iida
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Masato Nakamura
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yasutaka Yamauchi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Daizo Kawasaki
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yoshiaki Yokoi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Hiroyoshi Yokoi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yoshimistu Soga
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Kan Zen
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Keisuke Hirano
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Nobuhiro Suematsu
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Naoto Inoue
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Kenji Suzuki
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yoshiaki Shintani
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yusuke Miyashita
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Kazushi Urasawa
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Ikuro Kitano
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Terutoshi Yamaoka
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Takashi Murakami
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Michitaka Uesugi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Taketsugu Tsuchiya
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Toshiro Shinke
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yasuhiro Oba
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Norihiko Ohura
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Toshimitsu Hamasaki
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Shinsuke Nanto
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| |
Collapse
|
17
|
Schamp KB, Meerwaldt R, Reijnen MM, Geelkerken RH, Zeebregts CJ. The Ongoing Battle Between Infrapopliteal Angioplasty and Bypass Surgery for Critical Limb Ischemia. Ann Vasc Surg 2012; 26:1145-53. [DOI: 10.1016/j.avsg.2012.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
|
18
|
Zeller T, Kambara AM, Moreira SM, Atar E, Chulsky A, Turgeman Y, Sixt S, Tepe G, Rastan A, Buchbinder M. Recanalization of Femoropopliteal Chronic Total Occlusions Using the ENABLER-P Balloon Catheter System. J Endovasc Ther 2012; 19:131-9. [DOI: 10.1583/11-3664.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
19
|
Sigala F, Kontis E, Hepp W, Filis K, Melissas J, Mirilas P. Long-term outcomes following 282 consecutive cases of infrapopliteal PTA and association of risk factors with primary patency and limb salvage. Vasc Endovascular Surg 2012; 46:123-30. [PMID: 22344984 DOI: 10.1177/1538574411432161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to determine the long-term results after infrapopliteal PTA (primary patency, limb salvage, survival) and examine for association with risk factors (e.g. diabetes, infection, etc). We studied 268 patients with 282 critically ischemic limbs treated with PTA of at least one crural artery during a six-year period. Data included TASC II morphological classification of lesions and risk factors. Technical success rate was 97.2%, and overall mortality 0.7%. Patients with milder TASC lesions preserved primary patency longer than patients with more severe lesions. Similar results were obtained for limb salvage and survival. Fontaine stage, TASC class and postoperative infection of operated limb increased the risk for loss of primary patency and major amputation. Concomitant carotid stenosis was associated with loss of primary patency. Diabetes mellitus, preoperative ulcer or gangrene were associated with need of major amputation. PTA was a safe and effective treatment for CLI due to lesions of infrapopliteal vessels.
Collapse
Affiliation(s)
- Fragiska Sigala
- Division of Vascular Surgery, 1st Department of Propaedeutic Surgery, University of Athens Medical School, Athens, Greece
| | | | | | | | | | | |
Collapse
|
20
|
Gutzeit A, Sutter R, Froehlich JM, Roos JE, Sautter T, Schoch E, Giger B, Wyss M, Graf N, von Weymarn C, Jenelten R, Binkert CA, Hergan K. ECG-triggered non-contrast-enhanced MR angiography (TRANCE) versus digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease of the lower extremities. Eur Radiol 2011; 21:1979-87. [PMID: 21533632 DOI: 10.1007/s00330-011-2132-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/18/2011] [Accepted: 03/27/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To prospectively determine the diagnostic value of electrocardiography-triggered non-contrast-enhanced magnetic resonance angiography (TRANCE) of the lower extremities including the feet versus DSA. METHODS All 43 patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent TRANCE before DSA. Quality of MRA vessel depiction was rated by two independent radiologists on a 3-point scale. Arterial segments were graded for stenoses using a 4-point scale (grade 1: no stenosis; grade 2: moderate stenosis; grade 3: severe stenosis; grade 4: occlusion). Findings were compared with those of DSA. RESULTS In the 731 vessel segments analysed, intra-arterial DSA revealed 283 stenoses: 33.6% moderate, 16.6% severe and 49.8% occlusions. TRANCE yielded a mean sensitivity, specificity, positive and negative predictive value and diagnostic accuracy to detect severe stenoses or occlusions of 95.6%, 97.4%, 87.2%, 99.2%, 97.1% for the thigh segments and 95.2%, 87.5%, 83.2%, 96.6%, 90.5% for the calf segments. Excellent overall image quality was observed for TRANCE in 91.4% versus 95.7% (DSA) for the thigh and in 60.7% versus 91.0% for the calves, while diagnostic quality of the pedal arteries was rated as insufficient. CONCLUSION TRANCE achieves high diagnostic accuracy in the thigh and calf regions, whereas the pedal arteries showed limited quality.
Collapse
Affiliation(s)
- Andreas Gutzeit
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ultrasound-guided antegrade femoral access: comparison between the common femoral artery and the superficial femoral artery. Eur Radiol 2010; 21:1323-8. [DOI: 10.1007/s00330-010-2032-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/10/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
|
22
|
Gutzeit A, Schoch E, Sautter T, Jenelten R, Graf N, Binkert CA. Antegrade Access to the Superficial Femoral Artery with Ultrasound Guidance: Feasibility and Safety. J Vasc Interv Radiol 2010; 21:1495-500. [DOI: 10.1016/j.jvir.2010.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/22/2009] [Accepted: 03/12/2010] [Indexed: 10/19/2022] Open
|
23
|
Germani A, Di Campli C, Pompilio G, Biglioli P, Capogrossi MC. Regenerative therapy in peripheral artery disease. Cardiovasc Ther 2010; 27:289-304. [PMID: 19903190 DOI: 10.1111/j.1755-5922.2009.00105.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Patients with peripheral artery disease (PAD) and critical limb ischemia are the main candidates for limb amputations and have a poor life expectancy. Frequently, these patients are not eligible for either surgical or percutaneous interventions aimed at mechanical revascularization. Therefore, new strategies need to be identified to offer these patients a viable therapeutic option. Gene and cell therapy hold great promise for the treatment of peripheral vascular diseases because, in animal models, local delivery of growth factors and endothelial progenitor cells result in new blood vessel formation and regeneration of ischemic tissues. In this article, are reviewed phase I and phase II gene, and cell therapy clinical trials in patients with PAD.
Collapse
|
24
|
Abstract
Abstract Chronic critical limb ischemia (CLI), defined as > 2 weeks of rest pain, ulcers, or tissue loss attributed to arterial occlusive disease, is associated with great loss of both limb and life. Therapeutic goals in treating patients with CLI include reducing cardiovascular risk factors, relieving ischemic pain, healing ulcers, preventing major amputation, improving quality of life and increasing survival. These aims may be achieved through medical therapy, revascularization, or amputation. Medical therapy includes administration of analgesics, local wound care and pressure relief, treatment of infection, and aggressive therapy to modify atherosclerotic risk factors. For patients who are not candidates for revascularization, and who are unwilling or unable to undergo amputation, treatments such as intermittent pneumatic compression or spinal cord stimulation may offer symptom relief and promote wound healing. Revascularization offers the best option for limb salvage. The decision to perform surgery, endovascular therapy, or a combination of the two modalities (‘hybrid’ therapy) must be individualized. Patients who are relatively fit and able to withstand the rigors of an open procedure may benefit from the long-term durability of surgical repair. In contrast, frail patients with a limited life expectancy may experience better outcomes with endovascular reconstruction. Hybrid therapy is an attractive option for patients with limited autologous conduit, as it permits complete revascularization with a less extensive procedure, shorter duration of operation, and decreased risk of peri-operative complications. Amputation should be considered for patients who are non-ambulatory, demented, or unfit to undergo revascularization.
Collapse
Affiliation(s)
| | - Timothy M Sullivan
- Vascular and Endovascular Surgery, Minneapolis Heart Institute, Minneapolis, MN, USA
| |
Collapse
|