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Farber A, Menard MT, Conte MS, Rosenfield K, Schermerhorn M, Schanzer A, Powell RJ, Chaar CIO, Hicks CW, Doros G, Strong MB, Leers SA, Motaganahalli R, Stangenberg L, Siracuse JJ. Prosthetic Conduits have Worse Outcomes compared to Great Saphenous Vein Conduits in Femoropopliteal and Infrapopliteal Bypass in Patients with Chronic Limb Threatening Ischemia. J Vasc Surg 2024:S0741-5214(24)01897-4. [PMID: 39321895 DOI: 10.1016/j.jvs.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/12/2024] [Accepted: 09/15/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVES Single segment great saphenous vein (SSGSV) has traditionally been considered the gold standard conduit for infrainguinal bypass. There are data supporting similar outcomes with prosthetic femoral-popliteal bypass. Moreover, some have advocated for prosthetic conduit for femoral tibial bypass when GSV is inadequate or unavailable. We sought to evaluate long-term outcomes of infrainguinal bypass based on conduit type for treating chronic limb threatening ischemia (CLTI). METHODS Data from the Best Endovascular versus Best Surgical Therapy of Patients with CLTI (BEST-CLI) multicenter, prospective, randomized controlled trial, comparing infrainguinal bypass with endovascular therapy in patients with CLTI, were evaluated. In this as-treated analysis, we compared outcomes of infrainguinal bypass using prosthetic, alternative autogenous vein (AAV), and cryopreserved vein (Cryo) with SSGSV bypass. Kaplan-Meier and multivariable analyses were performed to examine the associations of conduit type with major adverse limb event (MALE) events, reinterventions, above-ankle amputations, and all-cause death. RESULTS In total, 784 bypasses were analyzed (120 prosthetic, 33 AAV, 21 Cryo, 610 SSGSV). For prosthetic and SSGSV, the distribution was 357 femoropopliteal (93 prosthetic and 264 GSV) and 373 infrapopliteal (27 prosthetic and 346 GSV). Mean age for the overall cohort was 67.1 years; 27.4% were female gender, 29.9% were non-White, and 11.5% were of Hispanic ethnicity. Patients undergoing prosthetic bypass were older (69.2 vs. 66.7 years), more likely to have chronic obstructive pulmonary disease (22.5% vs. 14%), prior coronary artery bypass grafting (88.9% vs. 66.5%), prior stroke (23.3% vs. 14%), but less often were of Hispanic ethnicity (5.8% vs. 12.6%) and had diabetes (59.2% vs. 71.3%) (P<.05 for all). For femoropopliteal bypass, use of prosthetic conduit was associated with increased major reinterventions at 3 years overall (19% vs. 11.5%, P=.06) and on risk adjusted analysis (HR 2.13, 95% CI 1.09 - 4.2, P=.028). No significant differences in MALE or death, above-ankle amputation, or death were observed. Outcomes were similar for bypasses to above knee popliteal targets and below knee popliteal targets. For infrapopliteal bypass, use of prosthetic conduit was associated with increased major reintervention (25.3% vs. 10.3%, P=.005), death (68.6% vs. 34.8%, P<.001), MALE or death (90% vs. 48.1%, P<.001) at 3 years. After risk adjustment, infrapopliteal bypass with prosthetic conduit was associated with higher major reintervention (HR 4.14, 95% CI 1.36 - 12.6, P=.012), above-ankle amputation (HR 4.64, 95% CI 1.59 - 13.5, P=.005), death (HR 2.96, 95% CI 1.4 - 6.2, P=.004), and MALE or death (HR 3.59, 95% CI 1.64 - 7.86, P=.001) compared to bypass with SSGSV. Overall, AAV had similar outcomes at 3 years to SSGSV, however Cryo had significantly higher above ankle amputation (50% vs 12.8%) (HR 4.2, 95% CI 1.68 - 10.5, P=.002), major reintervention (41.9% vs. 10.7%) (HR 3.12, 95% CI 1.18 - 8.22, P=.02), and MALE/death (88.8% vs. 37.8%) (HR 2.96, 95% CI 1.43-6.14, P=.004). CONCLUSIONS Use of prosthetic conduit in infrainguinal bypass is associated with inferior outcomes compared to bypass using SSGSV, particularly for bypass to infrapopliteal targets. Cryo grafts were infrequent and also demonstrated inferior outcomes. SSGSV remains the preferred conduit of choice for infrainguinal bypass.
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Affiliation(s)
- Alik Farber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA.
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA
| | - Kenneth Rosenfield
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Andres Schanzer
- Division of Vascular and Endovascular Surgery, UMass Chan Medical School, Worcester, MA
| | - Richard J Powell
- Division of Vascular and Endovascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - Caitlin W Hicks
- Division of Vascular and Endovascular Surgery, Johns Hopkins, Baltimore, MD
| | - Gheorghe Doros
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael B Strong
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA
| | - Steven A Leers
- Division of Vascular and Endovascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Raghu Motaganahalli
- Division of Vascular and Endovascular Surgery, Indiana University, Bloomington, IN
| | - Lars Stangenberg
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA
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Sayfo S, Salih M, Moubarak G, Ibrahim R, Apala D, Das T, Banerjee S, Potluri S. Safety and Efficacy of Radial Artery Access for Peripheral Vascular Intervention: A Single-Center Experience. Am J Cardiol 2024; 226:59-64. [PMID: 38945347 DOI: 10.1016/j.amjcard.2024.06.025] [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: 02/23/2024] [Revised: 06/13/2024] [Accepted: 06/23/2024] [Indexed: 07/02/2024]
Abstract
Radial artery (RA) access has been increasingly utilized for coronary procedures because of lower rates of access-site complications and improved patient satisfaction. However, limited data are available for RA access for peripheral vascular intervention (PVI). We performed a retrospective review of 143 patients who underwent PVI through RA access from February 2020 to September 2022 at a single institution. Baseline characteristics and follow-up data were ascertained from a prospectively maintained institutional database. Of 491 PVI, 156 (31.8%) were performed through the RA. Anatomical locations for intervention were the femoral (44.8%), iliac (31.1%), popliteal (9.6%) peroneal (2.7%), tibial (9.9%), and subclavian (1.9%) arteries. Procedural access was obtained through the right RA (92.9%), left RA (4.5%), or right ulnar artery (2.6%) using the 6 French R2P Destination Slender sheath in 85, 105, and 119 cm lengths. Atherectomy was used in 34.7%. Mean contrast volume was 105.5 ml and the average fluoroscopy time was 18.5 minutes. Conversion to femoral access occurred in 3 cases (1.9%) because of arterial spasm and noncrossable lesions. Concomitant pedal access occurred in 2 cases (1.3%). Periprocedural complication rate was 3.84%, of which access-site hematoma was most common (3.2%); none required blood transfusion, surgical intervention, or additional hospital stay. There was 1 case (0.64%) of in-hospital stroke. The mortality rate at 30-day, 6-month, and 1-year was 1.4%, 2.8%, and 4.2%, respectively. In conclusion, RA access is feasible for diverse PVI, and future studies are needed to assess safety and benefit compared with femoral artery access.
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Affiliation(s)
- Sameh Sayfo
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Mohammed Salih
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Ghadi Moubarak
- Department of Research, Baylor Scott and White Research Institute The Heart Hospital, Plano, Texas.
| | - Ramzi Ibrahim
- Department of Internal Medicine, University of Arizona-Banner University Medical Center, Tucson, Arizona
| | - Dinesh Apala
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Tony Das
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Subhash Banerjee
- Division of Cardiology, Baylor University Medical Center, Dallas, Texas
| | - Srini Potluri
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
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Nasr B, Raux M, Dubosq-Lebaz M, Bamde CC, Coscas R, Gouëffic Y. The specificities of the common femoral artery anatomy, calcification and endovascular treatment. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:330-338. [PMID: 38994547 DOI: 10.23736/s0021-9509.24.13129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Atherosclerotic lesions of the femoral artery bifurcation are one of the most complex lesion subsets commonly encountered in peripheral artery disease. Common femoral endarterectomy remains the standard of care in this location due to the bulky, eccentric, heavily calcified nature of the plaques, the frequent involvement of the femoral bifurcation, and the risk of compromising future femoral approaches. Recent studies have reported high rates of technical success and low rates of complications with endovascular treatment of the femoral artery bifurcation. This is related to improvements of endovascular equipment and the technical skills of operators. The aim of this manuscript was to provide a comprehensive review of the peculiarities of common femoral artery anatomy, calcification and treatment.
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Affiliation(s)
- Bahaa Nasr
- Department of Vascular and Endovascular Surgery, CHU Brest, Brest, France
| | - Maxime Raux
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Maxime Dubosq-Lebaz
- Centre de l'Aorte, Department of Vascular and Endovascular Surgery, CHU Lille, Lille, France
| | - Camil-Cassien Bamde
- Cardio-vascular and Thoracic Surgery Department, Dijon University Hospital, Dijon, France
| | - Raphaël Coscas
- Department of Vascular and Endovascular Surgery, CHU Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Yann Gouëffic
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France -
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Nugteren MJ, Welling RHA, Bakker OJ, Ünlü Ç, Hazenberg CEVB. Vessel Preparation in Infrapopliteal Arterial Disease: A Systematic Review and Meta-Analysis. J Endovasc Ther 2024; 31:191-202. [PMID: 36062761 PMCID: PMC10938478 DOI: 10.1177/15266028221120752] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Infrapopliteal lesions are generally complex to treat due to small vessel diameter, long lesion length, multilevel disease, and severe calcification. Therefore, different vessel preparation devices have been developed to contribute to better peri- and postprocedural outcomes. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug-coated balloon (DCB) angioplasty with POBA or DCB alone in infrapopliteal arterial disease. METHODS Medline, EMBASE, and Cochrane databases were searched for studies published between 2000 and 2022 assessing the value of adjunctive vessel preparation in infrapopliteal arterial disease. The primary outcomes were 12-month primary patency and limb salvage. RESULTS A total of 1685 patients with 1913 lesions were included in 11 POBA studies. Methodological quality was assessed as poor to moderate in these studies. Only 2 studies with 144 patients assessed vessel preparation in conjunction with DCB angioplasty. These randomized trials were assessed as high quality and found no significant benefit of adjunctive atherectomy to DCB angioplasty. The pooled Kaplan-Meier estimates of 12-month primary patency and limb salvage in the POBA studies were 67.8% and 80.9% for POBA, 62.1% and 86.4% for scoring balloons, 67.9% and 79.6% for mechanical atherectomy (MA), and 79.7% and 82.6% for laser atherectomy, respectively. Within the pooled data only scoring balloons and MA demonstrated significantly improved 12-month limb salvage compared to POBA. CONCLUSIONS Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and MA. However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation. CLINICAL IMPACT Infrapopliteal arterial disease is associated with chronic limb-threatening ischemia (CLTI) and generally complex to treat due to small vessel diameter, long lesion length, multilevel disease and severe calcification. A wide range of vessel preparation devices have been developed to contribute to improved peri- and postprocedural outcomes in these complex lesions. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug coated balloon (DCB) angioplasty with POBA or DCB angioplasty alone in infrapopliteal arterial disease. Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and mechanical atherectomy (MA). However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation.
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Affiliation(s)
- Michael J. Nugteren
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger H. A. Welling
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Olaf J. Bakker
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
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Farber A, Siracuse JJ, Giles K, Jones DW, Laskowski IA, Powell RJ, Rosenfield K, Strong MB, White CJ, Doros G, Menard MT. Investigator attitudes on equipoise and practice patterns in the BEST-CLI trial. J Vasc Surg 2024; 79:865-874. [PMID: 38056700 DOI: 10.1016/j.jvs.2023.11.045] [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: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES There has been significant variability in practice patterns and equipoise regarding treatment approach for chronic limb-threatening ischemia (CLTI). We aimed to assess treatment preferences of Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) investigators prior to and following the trial. METHODS An electronic 60-question survey was sent to 1180 BEST-CLI investigators in 2022, after trial conclusion and before announcement of results. Investigators' preferences were assessed across clinical scenarios for both open (OPEN) and endovascular (ENDO) revascularization strategies. Vascular surgeon (VS) surgical and ENDO preferences were compared with a 2010 survey administered to prospective investigators before trial funding. RESULTS For the 2022 survey, the response rate was 20.2% and was comprised of VSs (76.3%), interventional cardiologists (11.4%) and interventional radiologists (11.6%). The majority (72.6%) were in academic practice and 39.1% were in practice for >20 years. During initial CLTI work-up, 65.8%, 42.6%, and 55.9% of respondents always or usually ordered an arterial duplex, computed tomography angiography, and vein mapping, respectively. The most common practice distribution between ENDO and OPEN procedures was 70/30. Postoperatively, a majority reported performing routine duplex surveillance of vein bypass (99%), prosthetic bypass (81.9%), and ENDO interventions (86%). A minority reported always or usually using the wound, ischemia, and foot infection (WIfI) criteria (25.8%), GLASS (8.3%), and a risk calculator (14.8%). More than one-half (52.9%) agreed that the statement "no bridges are burned with an ENDO-first approach" was false. Intervention choice was influenced by availability of the operating room or ENDO suite, personal schedule, and personal skill set in 30.1%, 18.0%, and 45.9% of respondents, respectively. Most respondents reported routinely using paclitaxel-coated balloons (88.1%) and stents (67.5%); however, 73.3% altered practice when safety concerns were raised. Among surgeons, 17.8%, 2.9%, and 10.3% reported performing >10 annual alternative autogenous vein bypasses, composite vein composite vein bypasses, and bypasses to pedal targets, respectively. Among all interventionalists, 8%, 24%, and 8% reported performing >10 annual radial access procedures, pedal or tibial access procedures, and pedal loop revascularizations. The majority (89.1%) of respondents felt that CLTI teams improved care; however, only 23.2% had a defined team. The effectiveness of the teamwork at institutions was characterized as highly effective in 42.5%. When comparing responses by VSs to the 2010 survey, there were no changes in preferred treatment based on Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II classification or conduit preference. In 2022, OPEN surgery was preferred more for a popliteal occlusion. For clinical scenarios, there were no differences except a decreased proportion of respondents who felt there was equipoise for major tissue loss for major tissue loss (43.8% vs 31.2%) and increased ENDO choice for minor tissue loss (17.6% vs 30.8%) (P < .05). CONCLUSIONS There is a wide range of practice patterns among vascular specialists treating CLTI. The majority of investigators in BEST-CLI had experience in both advanced OPEN and ENDO techniques and represent a real-world sample of technical expertise. Over the course of the decade of the BEST-CLI trial, there was overall similar equipoise among VSs.
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Affiliation(s)
- Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Kristina Giles
- Division of Vascular and Endovascular Surgery, Maine Medical Center, Portland, ME
| | - Douglas W Jones
- Division of Vascular Surgery, UMass Memorial Health, Worcester, MA
| | - Igor A Laskowski
- Division of Vascular and Endovascular Surgery, Westchester Medical Center, Valhalla, NY; Department of Surgery, Section of Vascular Surgery, New York Medical College, Valhalla, NY
| | - Richard J Powell
- Dartmouth Hitchcock Medical Center, Heart and Vascular Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Kenneth Rosenfield
- Section of Vascular Medicine and Intervention Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael B Strong
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher J White
- Department of Cardiovascular Diseases, The Ochsner Clinical School, University of Queensland, Queensland, Australia
| | | | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Kokkinidis DG, Schizas D, Pargaonkar S, Karamanis D, Mylonas KS, Hasemaki N, Palaiodimos L, Varrias D, Tzavellas G, Siasos G, Klonaris C, Kharawala A, Chlorogiannis DD, Georgopoulos S, Bakoyiannis C. Differences between Lower Extremity Arterial Occlusion vs. Stenosis and Predictors of Successful Endovascular Interventions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2029. [PMID: 38004078 PMCID: PMC10673017 DOI: 10.3390/medicina59112029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: In patients with peripheral artery disease, there is insufficient understanding of characteristics that predict successful revascularization of the lower extremity (LE) chronic total occlusions (CTOs) and baseline differences in demographic, clinical, and angiographic characteristics in patients with LE CTO vs. non-CTO. We aim to explore these differences and predictors of successful revascularization among CTO patients. Materials and Methods: Two vascular centers enrolled LE-CTO patients who underwent endovascular revascularization. Data on demographics, clinical, angiographic, and interventional characteristics were collected. LE non-CTO arterial stenosis patients were compared. A total of 256 patients with LE revascularization procedures were studied; among them, 120 had CTOs and 136 had LE stenosis but no CTOs. Results: Aspirin use (Odds ratio, OR: 3.43; CI 1.32-8.88; p = 0.011) was a positive predictor whereas a history of malignancy (OR: 0.27; CI 0.09-0.80; p = 0.018) was a negative predictor of successful crossing in the CTO group. The CTO group had a higher history of myocardial infarction (29.2 vs. 18.3%, p = 0.05), end-stage renal disease (19.2 vs. 9.6%, p = 0.03), and chronic limb-threatening ischemia as the reason for revascularization (64.2 vs. 22.8%, p < 0.001). They were more likely to have advanced TransAtlantic Inter-Society Consensus (TASC) stages, multi-vessel revascularization procedures, longer lesions, and urgent treatment. Conclusions: The use of aspirin is a positive predictor whereas a history of malignancy is a negative predictor for successful crossing in CTO lesions. Additionally, LE-CTO patients have a higher incidence of comorbidities, which is expected given their higher disease burden. Successful endovascular re-vascularization can be associated with baseline clinical variables.
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Affiliation(s)
- Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sumant Pargaonkar
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Dimitrios Karamanis
- Department of Economics, University of Piraeus, 18534 Piraeus, Greece
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA
| | - Konstantinos S Mylonas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Natasha Hasemaki
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Georgios Tzavellas
- Department of Vascular Surgery, Ball Memorial Hospital, Muncie, IN 47303, USA
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Klonaris
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Amrin Kharawala
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | | | - Sotirios Georgopoulos
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Alonso AG, Kobzeva-Herzog A, Siracuse JJ. Alternative access for peripheral vascular interventions. J Vasc Surg Cases Innov Tech 2023; 9:101232. [PMID: 37408940 PMCID: PMC10319322 DOI: 10.1016/j.jvscit.2023.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023] Open
Abstract
Percutaneous endovascular interventions for advanced lower extremity peripheral arterial disease are becoming increasingly used, often as first-line treatment of chronic limb threatening ischemia. Advancements in endovascular techniques have provided safe and effective alternative revascularization options, especially for high-risk surgical patients. Although the classic transfemoral approach results in high technical success and patency rates, an estimated 20% of lesions remain challenging to access via an antegrade approach. As such, alternative access sites are important in the endovascular armamentarium for the management of chronic limb threatening ischemia. The goal of this review is to discuss alternative access sites, specifically the transradial, transpopliteal, and transpedal approaches, in addition to transbrachial and transaxillary access, and their outcomes in peripheral arterial disease and limb salvage.
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Affiliation(s)
- Andrea G. Alonso
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Anna Kobzeva-Herzog
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jeffrey J. Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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8
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Cheng TW, Farber A, Kalish JA, King EG, Rybin D, Siracuse JJ. The Effect of Chronic and End Stage Renal Disease on Long-term Outcomes after Infrainguinal Bypass. Ann Vasc Surg 2023:S0890-5096(23)00241-8. [PMID: 37149216 DOI: 10.1016/j.avsg.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES Patients undergoing infrainguinal bypass for chronic limb threatening ischemia (CLTI) with renal dysfunction are at an increased risk for perioperative and long-term morbidity and mortality. Our goal was to examine perioperative and 3-year outcomes after lower extremity bypass for CLTI stratified by kidney function. METHODS A retrospective, single-center analysis of lower extremity bypass for CLTI was performed between 2008 and 2019. Kidney function was categorized as normal (estimated glomerular filtration rate (eGFR) ≥60ml/min/1.73m2), chronic kidney disease (CKD) (eGFR15-59ml/min/1.73m2), and end stage renal disease (ESRD) (eGFR<15ml/min/1.73m2). Kaplan-Meier and multivariable analysis were performed. RESULTS There were 221 infrainguinal bypasses performed for CLTI. Patients were classified by renal function as normal (59.7%), CKD (24.4%), and ESRD (15.8%). Average age was 66 years and 65% were male. Overall, 77% had tissue loss with 9%, 45%, 24%, and 22% being Wound, Ischemia, and foot Infection (WIfI) stages 1-4, respectively. The majority (58%) of bypass targets were infrapopliteal and 58% used ipsilateral greater saphenous vein. The 90-day mortality and readmission rates were 2.7% and 49.8%, respectively. ESRD, compared to CKD and normal renal function, respectively, had the highest 90-day mortality (11.4% vs. 1.9% vs. .8%, P=.002) and 90-day readmission (69% vs. 55% vs. 43%, P=.017). On multivariable analysis, ESRD, but not CKD, was associated with higher 90-day mortality (OR 16.9, 95% CI 1.83-156.6, P=.013) and 90-day readmission (OR 3.02, 95% CI 1.2-7.58, P=.019). Kaplan Meier 3-year analysis showed no difference between groups for primary patency or major amputation, however ESRD, compared to CKD and normal renal function, respectively, had worse primary-assisted patency (60% vs. 76% vs. 84%, P=.03) and survival (72% vs. 96% vs. 94%, P=.001). On multivariable analysis, ESRD and CKD were not associated with 3-year primary patency loss/death, but ESRD was associated with higher primary-assisted patency loss (HR 2.61, 95% CI 1.23-5.53, P=.012). ESRD and CKD were not associated with 3-year major amputation/death. ESRD was associated with higher 3-year mortality (HR 4.95, 95% CI 1.52-16.2, P=.008) while CKD was not. CONCLUSION ESRD, but not CKD, was associated with higher perioperative and long-term mortality after lower extremity bypass for CLTI. Although ESRD was associated with lower long-term primary-assisted patency, there were no differences in loss of primary patency or major amputation.
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Affiliation(s)
- Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jeffrey A Kalish
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Elizabeth G King
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Denis Rybin
- Department of Biostatistics, Boston University, School of Public Health, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
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Haraguchi T, Fujita T, Kashima Y, Tsujimoto M, Otake R, Kasai Y, Sato K. Fracking compared to conventional balloon angioplasty alone for calcified common femoral artery lesions using intravascular ultrasound analysis: 12-month results. CVIR Endovasc 2023; 6:27. [PMID: 37079141 PMCID: PMC10119351 DOI: 10.1186/s42155-023-00373-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Fracking is a novel technique to crack calcified lesions by hydraulic pressure. This study aimed to compare the performance of fracking and conventional balloon angioplasty without stenting for calcified common femoral artery (CFA) lesions using intravascular ultrasound (IVUS) analysis. METHODS This retrospective, single-center, comparative observational study included 59 patients (67 limbs) with calcified CFA lesions treated with either fracking (n = 30) or balloon angioplasty (n = 29) between January 2018 and December 2020. The primary endpoint was 1-year primary patency. The secondary endpoints included procedure success, freedom from target lesion revascularization (TLR), procedure-related complications, and freedom from major adverse limb events (MALE). Predictors of restenosis were identified using multivariate Cox proportional hazards analysis. RESULTS The mean follow-up duration was 403 ± 236 days. The fracking group had significantly higher incidence of 1-year primary patency (89.8% versus 49.2%, P < 0.001), procedure success (96.9% versus 74.3%, P = 0.009), and freedom from TLR (93.5% versus 74.2%, P = 0.038) than the balloon group. The rate of freedom from MALE was significantly higher in the fracking group than in the balloon group (76.9% versus 48.6%, P = 0.033). The groups had no significant difference in procedure-related complications (6.2% versus 5.7%, P = 0.928). A larger postprocedural IVUS-estimated minimum lumen area (MLA) was associated with a lower risk of restenosis (hazard ratio, 0.78; 95% confidence interval, 0.67-0.91; P < 0.001), with a cut-off value of 16.0 mm2 determined using receiver operating characteristics curve analysis. The incidence of 1-year primary patency in patients with a postprocedural MLA ≥16.0 mm2 (n = 37) was significantly higher than that in those with a postprocedural MLA < 16.0 mm2 (n = 30) (87.8% versus 44.6%, P < 0.001). CONCLUSION This study demonstrated the superior procedural efficacy of fracking compared to balloon angioplasty in treating calcified CFA lesions. The safety outcomes after fracking were comparable to those after balloon angioplasty. Large postprocedural MLA was an independent positive predictor of patency.
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Affiliation(s)
- Takuya Haraguchi
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo City, Hokkaido, 007-0849, Japan.
| | - Tsutomu Fujita
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo City, Hokkaido, 007-0849, Japan
| | - Yoshifumi Kashima
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo City, Hokkaido, 007-0849, Japan
| | - Masanaga Tsujimoto
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo City, Hokkaido, 007-0849, Japan
| | - Ryo Otake
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo City, Hokkaido, 007-0849, Japan
| | - Yuhei Kasai
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo City, Hokkaido, 007-0849, Japan
| | - Katsuhiko Sato
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo City, Hokkaido, 007-0849, Japan
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10
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Volteas P, Giannopoulos S, Aljobeh AZ, Koudounas G, Pesce AR, Virvilis D. Superficial Femoral Artery Remote Endarterectomy: A Systematic Review And Meta-analysis. Ann Vasc Surg 2023:S0890-5096(23)00124-3. [PMID: 36868461 DOI: 10.1016/j.avsg.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Objective: Remote Superficial Femoral Artery Endarterectomy (RSFAE) is a hybrid procedure with low risk for peri-operative complications and promising patency rates over time. The aim of this study was to summarize current literature and to determine the role of RSFAE in limb salvage with regards to technical success, limitations, patency rates and long-term outcomes. METHODS This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Overall 19 studies were identified, comprising 1,200 patients with extensive femoropopliteal disease among whom 40% presented with chronic limb threatening ischemia. The average technical success rate was 96%, with a 7% rate for peri-operative distal embolization and 13% rate for SFA perforation. The primary patency was 64% and 56%, primary assisted patency was 82% and 77% and secondary patency was 89% and 72% at 12 and 24 months follow up respectively. CONCLUSION For long femoropopliteal TASC C/D lesions, RSFAE appears to be a minimally invasive hybrid procedure with acceptable perioperative morbidity, low mortality, and acceptable patency rates. RSFAE should be considered an alternative to open surgery or a bridge to bypass procedure.
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Affiliation(s)
- Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ahmad Z Aljobeh
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Alexa Rae Pesce
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Dimitrios Virvilis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA.
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11
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Giannopoulos S, Strobel A, Rudofker E, Kovach C, Kokkosis AA, Armstrong EJ. Outcomes of Stented vs Nonstented Femoropopliteal Lesions Treated With Drug-Coated Balloon Angioplasty. J Endovasc Ther 2022; 30:194-203. [PMID: 35179065 DOI: 10.1177/15266028221079770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Drug-coated balloon (DCB) angioplasty has been increasingly used for the treatment of lower limb peripheral artery disease (PAD). However, bail-out stenting may be necessary in cases of suboptimal angioplasty. This study investigated the outcomes of femoropopliteal disease treated with DCB with/without bail-out stenting. MATERIALS AND METHODS This was a single-center retrospective study enrolling 166 consecutive patients (DCB+stent: n=81 vs DCB: n=85) with 253 femoropopliteal lesions (DCB+stent: n=99 vs DCB: n=154) treated with DCB with/without stenting. Bail-out stenting was performed at the operator discretion for postangioplasty dissections or otherwise suboptimal angiographic result (>30% residual stenosis). Cox regression analysis was performed to examine the outcomes of DCB with/without stenting during 2-year follow-up. RESULTS The baseline clinical characteristics were similar between the 2 groups. About half of the patients presented with critical limb ischemia, with most of the lesions located at the superficial femoral artery. The overall mean lesion length was 147±67 mm. The most frequent bail-out stent types were bare metal stents (BMS) (53.5%) followed by drug-eluting stents (DES) (41.4%). Lesions requiring bail-out stenting were on average longer (177±67 mm vs 127±59 mm; p<0.01) and on average had higher prevalence of flow-limiting postangioplasty dissections. The overall procedural success rate was 94% without any differences between the 2 groups. Both the stented and nonstented treatment modalities were effective and safe, demonstrating similar rates of 2-year freedom from major adverse limb event (stented: 71.3% vs nonstented: 64.4%) and 2-year freedom from target lesion revascularization (stented: 77.1% vs nonstented: 72.3%) during following up. The use of DES as bail-out therapy was associated with a lower risk of 2-year death compared with the use of BMS (DES: 97.2% vs BMS: 75.8%; p=0.01). CONCLUSION Drug-coated balloon with bail-out stenting is a viable treatment option for cases of suboptimal DCB results, promising similar efficacy with DCB-alone procedures. However, as the patency of stents at the femoropopliteal segment may be a challenge due to the biomechanical stress of the artery, the efficacy of DCB+bail-out stenting should be further evaluated. In addition, future studies are needed to determine which grades of post-DCB dissections should be treated and optimize current bail-out strategies.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Aaron Strobel
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Eric Rudofker
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Christopher Kovach
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Angela A Kokkosis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA.,Adventist Health St. Helena, St. Helena, CA, USA
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12
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Percutaneous Radial Artery Access for Peripheral Vascular Interventions Is a Safe Alternative for Upper Extremity Access. J Vasc Surg 2021; 76:174-179.e2. [PMID: 34954273 DOI: 10.1016/j.jvs.2021.11.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Percutaneous radial artery access is increasingly being used for peripheral vascular interventions (PVI). Our goal was to characterize practice patterns and perioperative outcomes among patients treated using PVI performed via radial artery access. METHODS The Vascular Quality Initiative was queried from 2016-2020 for PVI performed via upper extremity access. Univariable and multivariable analyses evaluated peri-procedure outcomes of radial artery access cases. A separate sample of brachial artery access cases was used as a comparator. RESULTS There were 520 radial artery access cases identified. Mean age was 69 ± 10 years and 41.3% were female sex. The majority were performed in the hospital outpatient setting (71.7%). Sheath sizes were ≤ 5 Fr (10%), 6 Fr (78%), and 7 Fr (12%). Ultrasound-guided access and protamine were used in 68.3% and 17.3% of cases, respectively. Interventions were aortoiliac (55%), femoropopliteal (55%), and infrapopliteal (9%). Stenting and atherectomy were performed in 55% and 19% of cases, respectively, and more often with 7 Fr sheaths. Access site complications were any hematoma (4.8%), including hematomas resulting in intervention (0.8%), pseudoaneurysms (1%), and access stenosis/occlusion (0.8%). On multivariable analysis, sheath size was not associated with access site complications. Percutaneous brachial artery access (n=1135) compared to radial access was independently associated with more overall hematomas (OR 1.73, 95% CI 1.06-2.81, P=.03), but access type was not associated with hematomas resulting in intervention (OR 2.15, 95% CI .69-6.72, P=.19). CONCLUSIONS Peripheral vascular interventions via radial artery access exhibit a low prevalence of post-procedural access site complications and are associated with fewer minor hematoma complications than interventions performed using brachial artery access. Radial artery access compared with brachial artery access is the preferred technique for peripheral vascular interventions.
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13
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Krishnan P, Tarricone A, Chen S, Sharma S. The role of directional atherectomy in critical-limb ischemia. Ther Adv Cardiovasc Dis 2021; 135:17539447211046953. [PMID: 34796770 PMCID: PMC8606915 DOI: 10.1177/17539447211046953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Our aim was to review the current literature of the use of directional
atherectomy (DA) in the treatment of lower extremity critical-limb
ischemia. Methods: A search for relevant literature was performed in PubMed and PubMed Central
on 16 April 2020, sorted by best match. Three searches across two databases
were performed. Articles were included that contained clinical and
procedural data of DA interventions in lower extremity critical-limb
ischemia patients. All studies that were systematic reviews were
excluded. Results: Eleven papers were included in this review. Papers were examined under
several parameters: primary patency and secondary patency, limb
salvage/amputation, technical/procedural success,
complications/periprocedural events, and mean lesion length. Primary and
secondary patency rates ranged from 56.3% to 95.0% and 76.4% to 100%,
respectively. Limb salvage rates ranged from 69% to 100%. Lesion lengths
were highly varied, representing a broad population, ranging from 30 ± 33 mm
to 142.4 ± 107.9 mm. Conclusions: DA may be a useful tool in the treatment of lower extremity critical-limb
ischemia.
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Affiliation(s)
- Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
| | - Arthur Tarricone
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simon Chen
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Samin Sharma
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Participation in a Chronic Limb Threatening Ischemia Randomized Trial Is Inversely Correlated With Regional Amputation Rate in Limb Threatening Ischemia Patients. Ann Surg 2021; 274:621-626. [PMID: 34506317 DOI: 10.1097/sla.0000000000005058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The National Health Service demonstrated that regions of the United Kingdom with the highest number of patients enrolled in research studies had the lowest risk-adjusted mortality when patients were admitted to the hospital. Our goal was to investigate if this correlation was evident for patients with chronic limb threatening ischemia (CLI) treated in the United States (US). Accordingly, we examined correlations among sites participating in the Best Endovascular versus best Surgical Therapy in patients with Critical (BEST-CLI) trial, a multicenter, National Institute of Health-sponsored, international randomized controlled trial (RCT) comparing revascularization strategies in patients with CLI, and regional rates of major amputation from CLI. METHODS We measured regional participation in the BEST-CLI trial by evaluating trial participation and enrollment rosters. To determine regional rates of lower limb amputation, we queried the Medicare database (2007-2016) for patients with concurrent peripheral arterial disease (PAD) and diabetes, then assessed how many had lower extremity amputations. Correlation of regional amputation rates with distribution of BEST-CLI sites in four US geographical regions was calculated using Pearson's correlation coefficients. Simple regression equations were used to calculate the significance of these correlation coefficients. RESULTS Of 9,231,909 CLI patients, 342,406 underwent amputation in the Medicare dataset. Amputation rates per 1000 CLI patients differed by region (South 40.42, Midwest 40.12, West 34.81, Northeast 31.14). There were 116 US vascular centers, selected by volume and expertise that participated in BEST-CLI with the following distribution: South (n = 30, 26%), Midwest (n = 26, 22%), West (n = 29, 25%), and Northeast (n = 31, 27%). There was a negative correlation between the number of amputations per 1000 for Medicare CLI patients with diabetes and PAD and the number of BEST-CLI sites in the region which trended toward significance (Pearson R= -0.61, P = 0.39). CONCLUSIONS Amputation rate among Medicare CLI patients is inversely correlated with US BEST-CLI site distribution. Higher participation in clinical research, especially within large RCTs, may be a marker of optimal PAD management.
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15
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Investigation of ultrasonic chronic total occlusion system on a rabbit model. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.936595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Giannopoulos S, Strobel A, Rudofker E, Kovach C, Schneider PA, Armstrong EJ. Association of Postangioplasty Femoropopliteal Dissections With Outcomes After Drug-Coated Balloon Angioplasty in the Femoropopliteal Arteries. J Endovasc Ther 2021; 28:593-603. [PMID: 34002659 DOI: 10.1177/15266028211016441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Balloon angioplasty for the treatment of femoropopliteal lesions is often complicated by postangioplasty dissections. While dissections are known to affect patency and reintervention after balloon angioplasty, the association between dissections and major adverse limb event (MALE) after drug-coated balloon (DCB) angioplasty remains uncertain. Thus, the postangioplasty dissection and bailout stenting patterns were investigated. MATERIALS AND METHODS This was a single-center retrospective study enrolling patients with de novo femoropopliteal lesions treated with DCB with/without stenting. Postangioplasty target vessel dissection was graded based to the coronary artery classification grades A-F, with grade C-F considered "severe." Cox regression analysis was performed to examine the association of dissection severity with outcomes during 2-year follow up, among nonstented cases. RESULTS In 85.3% of the cases (N=203/238) a postangioplasty dissection was observed. The average dissection length was 55.57 mm (SD 36.71 mm), with 1 dissection present in 91.8% (N=180/196) and 2 or more dissections present in 8.2% (N=16/196). Dissection severity was grade A (19.8%), B (20.6%), C (23.1%), D (10.9%), E (10.1%), and F (0.8%). Bailout stenting was required in 40.4% of the patients, being more prevalent among grade C and grade E cases. Among 142 nonstented cases, dissections were present in 85.2%. A total of 75 (52.8%) of these dissections were grade A and B, while 46 (32.4%) were grade C to F. Among nonstented cases, grade C (hazard ratio [HR] 5.83; 95% CI 1.25 to 27.31; p=0.025) and grade D (HR 6.32; 95% CI 1.39 to 28.86; p=0.017) vs grade A dissections were associated with a higher risk for 2-year MALE. Multivariate analysis adjusting for several lesion characteristics demonstrated a statistically significant higher risk for 2-year MALE among the severe dissection group (HR 2.94; 95% CI 1.27 to 6.79; p = 0.012). Interestingly, the risks of limb loss (HR 1.30; 95% CI 0.22 to 7.79; p=0.774) and repeat revascularization (HR 0.95; 95% CI 0.40 to 2.26; p=0.905) during follow-up were similar between the 2 groups. CONCLUSION This study indicated that nonstented moderate and severe postangioplasty dissections after DCB angioplasty were associated with higher risk for MALE. Future studies are needed to validate our results and determine other dissection characteristics (eg, total dissection length, lumen area, total number of dissections) that may affect the efficacy of DCB.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Aaron Strobel
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Eric Rudofker
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Christopher Kovach
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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17
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Yi M, Guo J, Gao Y, Ren J, Bi Y, Han X. Comparison of Percutaneous Transluminal Angiography With or Without Catheter-Directed Thrombolysis for Chronic Femoropopliteal Occlusive Disease. Clin Appl Thromb Hemost 2021; 27:10760296211005025. [PMID: 33783253 PMCID: PMC8013675 DOI: 10.1177/10760296211005025] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Catheter-directed thrombolysis (CDT) is seldom used for chronic femoropopliteal occlusive disease. METHODS Patients with chronic femoropopliteal occlusive disease enrolled between January, 2011 and April, 2017. Hospitalization expense, limb salvage rate and survival rate were calculated. RESULTS Twenty-nine patients were treated with CDT (CDT group) and 31 patients without CDT (Non-CDT group).The mean hospitalization expense (5.2 ± 0.5), balloon catheter (1.0 ± 0.2) and stents number (0.8 ± 0.2) in CDT group were significantly less compared to Non-CDT group (P < 0.05). The short-term and long-term effect scales showed similar in both groups. The incidences of perioperative complications (10.3% vs. 19.4%), primary patency and second patency rate, limb salvage rate (14.8% vs. 16.1%) and survival rate were also similar (P > 0.05). Six patients died in each group and only 2 disease related deaths were found in Non-CDT group. CONCLUSION CDT is a safe and economic strategy for patients with chronic femoropopliteal occlusive disease, and should be served as blanket treatment for every patient without thrombolytic contradictions or a remedy for failure PTA to achieve a comparable clinical effect.
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Affiliation(s)
- Mengfei Yi
- Department of Interventional Radiology, 571884the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianjun Guo
- Department of Emergency, 571884the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanxia Gao
- Department of Emergency, 571884the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, 571884the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yonghua Bi
- Department of Interventional Radiology, 571884the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, 571884the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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18
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Engin AY, Saydam O. Rotational atherectomy with adjunctive balloon angioplasty in calcified chronic total occlusions of superficial femoral artery. Vascular 2020; 29:682-692. [DOI: 10.1177/1708538120970817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The aim was to report the mid-term outcomes of Jetstream™ rotational atherectomy device in complex femoropopliteal lesions. Methods Between November 2016 and April 2018, 55 patients who were treated with rotational atherectomy and adjunctive balloon angioplasty due to complex femoropopliteal lesions were retrospectively scanned. Results Fifty-five patients who underwent endovascular treatment with rotational atherectomy for chronic total occlusive femoropopliteal lesions were included in the study. Technical success rate was 100%. The mean age was 63 (±10.5) years. The cohort included 25 (45.4%) diabetics and 45 (81.8%) current smokers. The mean length of the lesions was 20.8 ± 11.2 cm. Chronic total occlusive lesions were detected in 35 (63.6%) patients, and mixed-type steno-occlusive lesions were detected in 20 patients (36.4%). Thirty-three (60%) lesions were moderate or severely calcified. Adjunctive balloon angioplasty was performed with plain old balloon angioplasty (POBA) on 31 (56.4%) patients and with drug-coated balloon angioplasty on 24 (43.6%) patients. After adjunctive balloon angioplasty, flow limiting dissection was observed in 20 (36.3%) patients, and 17 (30.9%) patients needed stent implantation. The Kaplan–Meier analysis method estimated that the overall primary patency rates at 12 and 24 months were 81.8% and 70.9%, respectively. Overall, secondary patency rates at 12 and 24 months were 94.5% and 80%. No statistically significant differences of 24-month primary patency and secondary patency rates were found between patients treated with drug-coated balloon angioplasty and POBA as an adjunctive therapy, even though primary patency (83.3% vs. 61.3%, p = .06) and secondary patency (91.7% vs. 71%, p = .56) rates of drug-coated balloon angioplasty were slightly higher than POBA. Patients with claudication had better primary patency (90.5% vs. 58.8%, p = .001) and secondary patency (100% vs. 67.6%, p = .004) rates than patients with critical limb ischemia at 24 months. Significant differences between patients who did and did not stop smoking were found in 24-month primary patency (57% vs. 88%, p = .007) and secondary patency (67% vs. 96%, p = .007). Six patients underwent unplanned amputation. There were eight (14.5%) mortalities during follow-up. Conclusions Rotational atherectomy with adjunctive balloon angioplasty has satisfactory technical success rates and mid-term outcomes. As an adjunctive method, there was no difference between drug-coated balloon angioplasty s and POBAs. Smoking cessation is always the first-step treatment to improve mid-term patency results. Patients with critical limb ischemia have worse patency results compared to the patients with claudication.
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Affiliation(s)
- Aysen Y Engin
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Onur Saydam
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
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19
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Chae IH, Yoon CH, Ko YG, Min PK, Lee JH, Yu CW, Lee SW, Lee SR, Choi SH, Koh YS, Choi D. Differential efficacy between stenting and plain balloon angioplasty for femoropopliteal disease with or without total occlusion. Korean J Intern Med 2020; 35:1114-1124. [PMID: 32088945 PMCID: PMC7487302 DOI: 10.3904/kjim.2019.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/02/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIMS Whether the presence of chronic total occlusion (CTO) affects patency after stenting in femoropopliteal lesions is unknown. We determined the effects of plain balloon angioplasty (POBA) in comparison with those of stenting on patency for femoropopliteal CTO and stenosis (non-CTO). METHODS We analyzed data from the Korean Vascular Intervention Society Endovascular Therapy in Lower-Limb Artery Diseases Registry, a multicenter cohort of patients with lower extremity peripheral arterial disease. Data from 1,329 patients and 1558 limbs treated with endovascular intervention for at least one femoropopliteal lesion were evaluated. RESULTS Among the 1,558 limbs, 345, 432, 275, and 506 were in the non-CTO-POBA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. During follow-up, loss of clinical primary patency, a composite of freedom from restenosis or clinically driven target lesion revascularization, occurred in 65 (18.8%), 68 (15.7%), 62 (22.5%), and 113 limbs (22.3%) in the non-CTO-POBA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. The patients in the non-CTO-stent group showed a significantly better clinical primary patency than those in the no-CTO-POBA group, whereas those in the CTO-stent and CTO-POBA groups showed no significant differences. After inverse probability of treatment weighting to balance the differences among covariates between the non-CTO-stent and non-CTO-POBA groups, the non-CTO-stent group still showed superior clinical primary patency as compared with the non-CTO-POBA group. CONCLUSION In the patients with femoropopliteal stenosis without CTO, stenting resulted in better clinical outcomes than balloon angioplasty. The presence of CTO in the femoropopliteal lesion should be considered when selecting a suitable device for performing endovascular procedures.
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Affiliation(s)
- In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea
- Correspondence to Chang-Hwan Yoon, M.D. Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7052 Fax: +82-31-787-4052 E-mail:
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Ki Min
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Seok Koh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Karpenko AA, Rabtsun AA, Popova IV, Cheban AV, Gostev AA, Saaya SB, Starodubtsev VB. Intermediate results of the prospective randomized study on the effect of lamina vastoadductoria dissection after superficial femoral artery stenting on the restenosis incidence in TASC-II type C and D lesions. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2019-2224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To compare the effectiveness of superficial femoral artery (SFA) stenting with/without lamina vastoadductoria dissection.Material and methods. The study included are 70 patients with TASCII type C and D lesions. All patients were divided onto 2 groups: group 1 (n=35) — conventional SFA stenting, group 2 (n=35) — SFA stenting with lamina vastoadductoria dissection. The average lesion length in group 1 was 22,92±5,62 cm, in group 2 — 21,2±5,42 cm. The primary endpoint was the absence of binary restenosis and reocclusion. Secondary composite endpoint was procedural success, limb salvage, secondary patency of the operated segment, intraoperative complications. The groups were comparable in age, sex, risk factors and comorbidities.Results. The procedural success in both groups was 100%. Primary patency after 24 months was 28,5% in group 1 and 60% in group 2. During the 24-month follow-up period, we recorded 1 death in group 2 due to myocardial infarction. In group 1, 2 deaths due to myocardial infarction and pancreatic cancer metastasis were recorded. Limb salvage was 100% in both groups. There were no intraoperative complications in both groups.Conclusion. Lamina vastoadductoria dissection is safe and does not lead to limb functional limitations. Biomechanical changes in the distal SFA segment contribute to the improvement of primary patency after stenting of SFA long lesions. Preliminary results of the single-center pilot study demonstrate the safety and efficacy of SFA stenting with lamina vastoadductoria dissection, emphasizing the need for further larger studies to compare it with conventional stenting and to assess the effectiveness during the long-term follow-up.
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21
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Giannopoulos S, Lyden SP, Bisdas T, Micari A, Parikh SA, Jaff MR, Schneider PA, Armstrong EJ. Endovascular Intervention for the Treatment of Trans-Atlantic Inter-Society Consensus (TASC) D Femoropopliteal Lesions: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:52-65. [PMID: 32563709 DOI: 10.1016/j.carrev.2020.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Advancements in the endovascular treatment of femoropopliteal atherosclerotic lesions have led to treatment of more complex lesions, particularly long lesions. The aim of this study was to determine the meta-analytic primary patency and need for re-intervention among patients treated for very long lesions (>200 mm) at the femoropopliteal segment and to identify potential risk factors for loss of patency. METHODS This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted, and the I-square was used to assess heterogeneity. RESULTS Fifty-one studies comprised of 3029 patients were included. The mean lesion length was 269 mm. The primary patency rate at 30 days, 6 m, 1-, 2- and 5-years of follow-up was 98%, 76%, 62%, 55%, and 39% respectively. The incidence of TLR was 16% at one year and 32% at two years. The secondary patency rate at 1, 2, 3 and 5 years was 85%, 71%, 64%, and 64% respectively. Heparin bonded ePTFE covered stents (69%) and paclitaxel eluting stents (73%) demonstrated higher 1-year primary patency rates than self-expanding nitinol stents (55%) or uncoated percutaneous transluminal angioplasty (PTA) with provisional stenting (54%). Lesions treated with a heparin bonded ePTFE covered stent had statistically significant higher odds of remaining patent at 1-year of follow-up (OR: 2.74; 95%CI: 1.63-4.61; p < 0.001) than lesions treated with BMS or PTA. Patients with long femoropopliteal lesions causing critical limb ischemia (CLI) developed restenosis or occlusion more often than patients treated for claudication (HR: 1.63; 95%CI: 1.06-2.49; p = 0.026) during an average follow-up of 26 months. CONCLUSION Primary stenting of femoropopliteal TASC D lesions using drug eluting stents or covered stents results in sustained patency over time. PTA or uncoated nitinol stents demonstrated lower patency rates. However, additional comparative studies are needed to determine the efficacy of newer technologies for the treatment of complex femoropopliteal lesions and provide evidence for the most optimal treatment approach.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic and Foundation, Cleveland, OH, USA
| | | | - Antonio Micari
- Division of Cardiology, Huamitas Gavazzeni, Bergamo, Italy
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy, NY Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
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22
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Lamaina M, Childers CP, Liu C, Mak SS, Booth MS, Conte MS, Maggard-Gibbons M, Shekelle PG. Clinical Effectiveness and Resource Utilization of Surgery versus Endovascular Therapy for Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2020; 68:510-521. [PMID: 32439522 DOI: 10.1016/j.avsg.2020.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical effectiveness of surgical versus endovascular therapy for chronic limb-threatening ischemia (CLTI) continues to be debated, and the resources required for each therapy are unclear. METHODS Systematic review of randomized controlled trials (RCTs) and observational studies comparing surgery with endovascular therapy for CLTI, which reported clinical effectiveness and resource utilization. Short-term and long-term clinical outcomes were examined. RESULTS The search yielded 4,231 titles, of which 17 publications met our inclusion criteria. Five publications were all from 1 RCT, and 12 publications were observational studies. In the RCT, the surgical approach had greater resource use in the first year (total hospital days across all admissions for surgery versus angioplasty: 46.14 ± 53.87 vs. 36.35 ± 51.39; P < 0.001; also true for days in high-dependency and intensive therapy units), but differences were not statistically significant in subsequent years. All-cause mortality presented a nonsignificant difference favoring angioplasty in the first 2 years (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [95% CI], 0.75-2.15), but after 2 years, it favored surgical treatment (aHR, 0.34; 95% CI, 0.17-0.71). The observational studies reported short-term effectiveness and resource utilization favoring endovascular therapy, but most differences were not statistically significant. Long-term outcomes were more mixed; in particular, mortality outcomes generally favored surgery, although concluding that cause and effect is not possible as endovascularly treated patients tended to be older and may have had a shorter life expectancy regardless of therapy. CONCLUSIONS The clinical effectiveness and resource utilization of surgery compared with endovascular therapy for CLTI is not known with certainty and will not be known until ongoing trials report results. It is likely that findings will vary by the time horizon, where initial outcomes and utilization tend to favor endovascular interventions, but long-term outcomes favor surgical revascularization.
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Affiliation(s)
- Margherita Lamaina
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Charles Liu
- Department of Surgery, Stanford University, Stanford, CA; David Geffen School of Medicine, National Clinician Scholars Program, University of California Los Angeles, Los Angeles, CA; Department of Surgery, Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Selene S Mak
- Department of Surgery, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
| | | | - Michael S Conte
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, CA
| | | | - Paul G Shekelle
- Department of Surgery, Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA
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23
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Cantu D, Jawaid O, Kokkinidis D, Giannopoulos S, Valle JA, Waldo SW, Singh GD, Armstrong EJ. Outcomes of Drug-Coated Balloon Angioplasty vs. Conventional Balloon Angioplasty for Endovascular Treatment of Common Femoral Artery Atherosclerotic Disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:867-874. [PMID: 31761636 DOI: 10.1016/j.carrev.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Atherosclerotic disease of the common femoral artery (CFA), commonly associated with multilevel disease affecting the femoropopliteal segment, can cause claudication or contribute to critical limb ischemia. Although endovascular therapy for the management of peripheral arterial disease (PAD) has been increasingly utilized, its role in CFA lesions remains controversial. The aim of this study was to investigate the safety and efficacy of drug (DCB) vs non drug coated balloon angioplasty (BA) at the CFA segment. METHODS In this two-center study, we identified 154 patients treated either with DCB (n = 47) or BA (n = 107) for CFA lesions. Hazard ratios (HR) and the respective 95% confidence interval (CI) were synthesized to examine the association between the two groups in terms of target lesion revascularization (TLR), limb loss, and major adverse limb event (MALE) at 12 and 24 months of follow up. RESULTS This real-world population included a high percentage of patients with critical limb ischemia (43%) and moderate to severe lesion calcification (75%). Adjunctive atherectomy was performed in 97.9% of DCB cases (N = 46/47) and 44.7% of BA cases (N = 51/114). The overall procedural success rate was 95% without any differences between the two groups. Post-angioplasty dissections were observed in 15 cases [DCB: 8.5% (N = 4/47) vs BA: 9.7% (N = 11/113); p = .81], while distal embolization occurred in one patient in the DCB group and one in the BA group (p = .52). Provisional stenting was more commonly necessary in BA vs. DCB cases (12.3% vs 2.13%, p = .044). Physiologic assessment during follow up demonstrated a better mean 2-year ABI for the DCB group (mean: 0.9; SD: 0.2) vs BA group (mean: 0.6; SD: 0.4), although statistical significance was not reached (p = .06). No difference between the two groups was detected in terms of freedom from TLR (DCB: 75.5% vs BA: 86.8%; HR: 1.31; 95% CI: 0.46-3.67; p = .61), freedom from limb loss (DCB: 83.8% vs BA: 83.6%; HR: 1.04; 95% CI: 0.36-2.99; p = .94) or freedom from MALE (DCB: 83.5% vs BA: 78%; HR: 0.73; 95% CI: 0.26-1.99; p = .53) at 24 m of follow up. However, at the end of follow up more deaths were observed in patients treated with BA than DCB (DCB: 14.9% vs BA: 31.7%; p = .03). Patients who required provisional stenting were at higher risk for limb loss 2 years after the initial procedure (multivariate: HR: 4.54; 95% CI: 1.09-18.85; p = .04). CONCLUSIONS Both DCB and non-DCB strategies are effective modalities for revascularization of patients with CFA lesions. Larger prospective studies are necessary to determine the relative benefit, if any, of drug-eluting technologies for the treatment of common femoral artery disease.
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Affiliation(s)
- David Cantu
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Omar Jawaid
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Damianos Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Javier A Valle
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Stephen W Waldo
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Gagan D Singh
- Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
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24
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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.
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25
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Kim JH, So BJ, Byun SJ, Kim KY. The Advantage of Common Femoral Endarterectomy Alone or Combined with Endovascular Treatment. Vasc Specialist Int 2018; 34:65-71. [PMID: 30310809 PMCID: PMC6175571 DOI: 10.5758/vsi.2018.34.3.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/28/2018] [Accepted: 07/29/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose Although common femoral artery endarterectomy (CFAE) is regarded as the standard treatment modality for common femoral artery (CFA) disease, availability of advanced endovascular techniques has resulted in an increased number of CFA disease being treated. We evaluated clinical outcomes in a contemporary series of patients who were treated for CFA disease using endarterectomy alone or combined with endovascular treatment. Materials and Methods We retrospectively reviewed 46 patients from November 2001 through December 2007. The treated lesions were divided into 4 groups based on operative procedure: group I (n=11), CFAE alone; group II (n=15), CFAE and iliac artery (IA) endovascular treatment; group III (n=6), CFAE and superficial femoral artery (SFA) endovascular treatment; group IV (n=14), CFAE and IA and SFA endovascular treatment or bypass surgery. Results The degree of CFA steno-occlusion was not different among the groups. The 3-year primary patency rates of each group were 88.9±10.5%, 60.0±14.5%, 62.5±21.3%, and 83.9±10.4%, respectively. The 3-year primary assisted patency rates were 100%, 70.0±13.0%, 62.5±21.3%, and 89.3±10.4%, while 3-year secondary patency rates were 100%, 80.0±13.0%, 62.5±21.3%, and 92.3±7.4%, respectively. There was no procedure-related mortality. Significant improvement of ankle-brachial index was achieved in all groups. Conclusion CFAE alone is the treatment of choice for excellent patency and clinical improvement in steno-occlusive lesions confined to the CFA. In multiple steno-occlusive diseases, this procedure could be combined with endovascular procedures to reduce the operative risk in conditions with high morbidity.
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Affiliation(s)
- Jun Hyung Kim
- Division of Vascular Surgery, Department of Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Byung Jun So
- Division of Vascular Surgery, Department of Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Seung Jae Byun
- Division of Vascular Surgery, Department of Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Kyung Yun Kim
- Division of Vascular Surgery, Department of Surgery, Wonkwang University Hospital, Iksan, Korea
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Davis T, Ramaiah V, Niazi K, Martin Gissler H, Crabtree T. Safety and effectiveness of the Phoenix Atherectomy System in lower extremity arteries: Early and midterm outcomes from the prospective multicenter EASE study. Vascular 2017; 25:563-575. [PMID: 28950783 PMCID: PMC5714160 DOI: 10.1177/1708538117712383] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the novel Phoenix Atherectomy System as percutaneous treatment of de novo and restenotic infrainguinal arterial lesions. Methods This prospective, multicenter, nonrandomized investigational device exemption trial was conducted across 16 US and German centers between August 2010 and April 2013. Intention-to-treat enrollment was 128 patients (mean age: 71.8 years, 59% male) with 149 lesions (mean length: 34 mm, mean diameter stenosis: 89.5%), and the primary analysis per-protocol population consisted of 105 patients with 123 lesions. The primary efficacy endpoint, technical success, was the achievement of acute debulking with a post-atherectomy residual diameter stenosis ≤50% (before adjunctive therapy). The primary safety endpoint was the major adverse event (MAE) rate through 30 days. Results For the primary analysis per-protocol population, the rate of lesion technical success was 95.1% (117/123), with the lower limit of the 95% CI 90.6%, meeting the prospectively established target performance goal of ≥86%. After post-atherectomy adjunctive therapy, residual stenosis was ≤30% for 99.2% (122/123) of lesions (mean final diameter stenosis 10.5%). Improvement of ≥1 Rutherford class occurred for 74.5% of patients through 30 days and for 80% through six months. MAEs were experienced by 5.7% (6/105) of patients through 30 days (with the upper limit of the 95% CI 11.0%, meeting the target performance goal of <20%), and 16.8% through six months. Six-month freedom from TLR and TVR was 88.0% and 86.1%, respectively. Conclusions Based on the high rate of technical success and the low rates of MAEs through six months, the Phoenix Atherectomy System is safe and effective for the debulking of lower-extremity arterial lesions. ClinicalTrials.gov identifier NCT01541774
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Affiliation(s)
- Thomas Davis
- 1 Interventional Cardiology, St. John Hospital and Medical Center, Detroit, MI, USA
| | - Venkatesh Ramaiah
- 2 Department of Vascular Surgery, Arizona Heart Institute, Phoenix, AZ, USA
| | - Khusrow Niazi
- 3 Peripheral Vascular Intervention, 1371 Emory University, Emory Heart and Vascular, 1371 Emory University , Atlanta, GA, USA
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Schreuder SM, Hendrix YMGA, Reekers JA, Bipat S. Predictive Parameters for Clinical Outcome in Patients with Critical Limb Ischemia Who Underwent Percutaneous Transluminal Angioplasty (PTA): A Systematic Review. Cardiovasc Intervent Radiol 2017; 41:1-20. [PMID: 28924874 PMCID: PMC5735197 DOI: 10.1007/s00270-017-1796-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/06/2017] [Indexed: 01/27/2023]
Abstract
Purpose To identify possible risk factors in predicting clinical outcome in critical limb ischemia (CLI) patients undergoing percutaneous transluminal angioplasty (PTA). Materials and Methods PubMed and EMBASE were searched for studies analyzing CLI and clinical outcome after PTA from January 2006 to April 2017. Outcome measures were ulcer healing, amputation free survival (AFS)/limb salvage and overall survival. Data on predictive factors for ulcer healing, AFS/limb salvage and survival were extracted. Results Ten articles with a total of 2448 patients were included, all cohorts and based on prospective-designed databases. For ulcers, it seems that complete healing can be achieved in most of the patients within 1 year. No significant predictive factors were found. AFS/limb salvage: AFS rates for 1, 2 and 3 years ranged from 49.5 to 75.2%, 37 to 58% and 22 to 59%, respectively. Limb salvage rates for 1, 2 and 3 years ranged from 71 to 95%, 54 to 93.3% and 32 to 92.7%, respectively. All studies had different univariate and multivariate outcomes for predictive factors; however, age and diabetes were significant predictors in at least three studies. Survival: Survival rates for 1, 2 and 3 years ranged from 65.4 to 91.5%, 45.7 to 76% and 37.3 to 83.1%, respectively. Different predictive factors were found; however, age was found in 2 out of 5 studies reporting on predictive factors. Conclusions In several studies two factors, age and diabetes, were found as predictive factors for AFS/limb salvage and survival in patients with CLI undergoing PTA. Therefore, we believe that these factors should be taken into account in future research. Level of Evidence Level 2a.
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Affiliation(s)
- Sanne M Schreuder
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Yvette M G A Hendrix
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jim A Reekers
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Siracuse JJ, Farber A. Is Open Vascular Surgery or Endovascular Surgery the Better Option for Lower Extremity Arterial Occlusive Disease? Adv Surg 2017; 51:207-217. [PMID: 28797341 DOI: 10.1016/j.yasu.2017.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA.
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29
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Bildirici U, Aktas M, Dervis E, Celikyurt U. Mid-Term Outcomes of Stent Overlap in Long Total Occluded Lesions of Superficial Femoral Artery. Med Sci Monit 2017. [PMID: 28649980 PMCID: PMC5498130 DOI: 10.12659/msm.902413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Superficial femoral artery chronic total occlusion (SCTO) is a common type of peripheral arterial disease (PAD). Endovascular therapy is a treatment approach that has a poor long-term success rate in this group. The aim of this study was to compare the mid-term results of two different uses of nitinol stents in long SCTO lesions (>100 mm): the use of one long stent or two shorter stents. Material/Methods Of 154 patients who underwent percutaneous infrainguinal interventions from 2011 to 2014, a total of 170 CTO lesions were selected for this retrospective study analysis. The mean age of the study population was 63.4±10.4 years (range 29–89 years); 71.8% of the patients were male. Results Patients were divided into two groups according to the number of stents used. Patients treated with a single stent were placed into group A and patients treated with two stents were placed into group B. The stent fracture rate was significantly higher in group B compared to group A (29.2% vs. 42%). Type 1 and 2 fracture rates were higher in group A, but type 3 and 5 fracture rates were significantly higher in group B. The rate of stent restenosis was significantly higher in group B compared to group A (45.1% vs. 54.5%, p=0.05). Conclusions Mid-term patency rate was low in patients with long totally occluded superficial femoral artery (SFA) lesions. Using a long single stent had an acceptable mid-term patency rate compared to using a two stent strategy. Stent fracture seemed to be the main reason for in-stent restenosis in cases of multiple stenting. A long single stent strategy may be more appropriate and reasonable than a two stent strategy in the treatment of long SFA lesions.
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Affiliation(s)
- Ulas Bildirici
- Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey
| | - Mujdat Aktas
- Department of Cardiology, Eregli State Hospital, Zonguldak, Turkey
| | - Emir Dervis
- Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey
| | - Umut Celikyurt
- Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey
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The effect of ambulatory status on outcomes of percutaneous vascular interventions and lower extremity bypass for critical limb ischemia in the Vascular Quality Initiative. J Vasc Surg 2017; 65:1706-1712. [DOI: 10.1016/j.jvs.2016.12.104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/06/2016] [Indexed: 11/18/2022]
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Komshian SR, Lu K, Pike SL, Siracuse JJ. Infrainguinal open reconstruction: a review of surgical considerations and expected outcomes. Vasc Health Risk Manag 2017; 13:161-168. [PMID: 28507439 PMCID: PMC5428788 DOI: 10.2147/vhrm.s106898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infrainguinal arterial occlusive disease can lead to potentially disabling and limb-threatening conditions. Revascularization may be indicated for claudication, rest pain, or tissue loss. Although endovascular interventions are becoming more prevalent, open surgeries such as endarterectomy and bypass are still needed and performed regularly. Open reconstruction has been associated with postoperative morbidity, both at the local and at the systemic levels. Local complications include surgical site infections (SSIs 0-5.3%), graft failure (12-60%), and amputation (5.7-27%), and more systemic issues include cardiac (2.6-18.4%), respiratory (2.5%), renal (4%), neurovascular (1.5%), and thromboembolic (0.2-1%) complications. While such outcomes present an additional challenge to the postoperative management of surgical patients, it may be possible to minimize their occurrence through careful risk stratification and preoperative assessment. Therefore, individualized selection of candidates for open repair requires weighing the need for intervention against the likelihood of adverse outcomes based on preoperative risk factors. This review provides an overview of open reconstruction, focusing on identifying the clinical indications for surgery and perioperative morbidity and mortality.
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Affiliation(s)
- Sevan R Komshian
- Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA
| | - Kimberly Lu
- Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA
| | - Steven L Pike
- Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA
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Mallios A, Blebea J, Buster B, Messiner R, Taubman K, Ma H. Laser Atherectomy for the Treatment of Peripheral Arterial Disease. Ann Vasc Surg 2017; 44:269-276. [PMID: 28479446 DOI: 10.1016/j.avsg.2017.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the study was to investigate the clinical results of laser atherectomy in the treatment of peripheral arterial disease. METHODS Retrospective analysis of consecutive patients underwent laser atherectomy at a single institution during a 7-year period by vascular surgeons and interventional cardiologists in a tertiary university-affiliated hospital. Clinical data were retrieved from patient charts and hospital electronic medical records along with the associated arteriograms. RESULTS A total of 461 lesions in 343 limbs were treated in 300 patients with a mean age of 70 years. The indication was critical limb ischemia (CLI) with rest pain or tissue loss in 227 (66%) of interventions and claudication in 116 (34%). All procedures included an associated balloon angioplasty, while stenting was performed in 33%. Technical success was achieved in 99% with only 2 (<1%) cases with an acute procedure-related complication requiring surgical intervention. At a mean follow-up of 28 months (range, 1-87 months; median 24 months), 156 patients (45%) became asymptomatic or achieved significant clinical improvement (resolution of tissue loss or rest pain), 60 (17%) remained with CLI, 30 (9%) had a major proximal amputation, and 18 (5%) had a minor amputation. Freedom from major amputation was 90% at 5 years by life-table analysis. Univariate statistical analysis demonstrated the risk of a major amputation to be associated with diabetes, hemodialysis, and tissue loss (P < 0.05 to P < 0.005), while multivariate logistic regression analysis indicated diabetes to be overwhelmingly important (RR: 4.84; 95% confidence interval [CI]: 1.1-21.3; P < 0.05). In a similar manner, multivariate analysis indicated dialysis (RR: 2.46; 95% CI: 1.01-5.98; P < 0.05) and CLI (RR: 2.27; 95% CI: 1.42-3.65; P < 0.01) were associated with higher likelihood for lack of clinical improvement. There was no difference in major amputation rates between surgeons and interventional cardiologists (RR: 1.5; 95% CI: 0.7-2.1; P < 0.1) although it was 3 times more likely for the patients treated by surgeons to suffer from CLI (odds ratio: 3.2; 95% CI: 1.9-5.4; P < 0.0001). CONCLUSIONS Laser atherectomy is a safe and useful adjunct in limb salvage. Diabetics have much higher probability of requiring a proximal amputation, while those on dialysis and with CLI are least likely to gain clinical benefit.
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Affiliation(s)
- Alexandros Mallios
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK; Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
| | - John Blebea
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Bryan Buster
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Ryan Messiner
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Kevin Taubman
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
| | - Harry Ma
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK
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Siracuse JJ, Van Orden K, Kalish JA, Eslami MH, Schermerhorn ML, Patel VI, Rybin D, Farber A. Endovascular treatment of the common femoral artery in the Vascular Quality Initiative. J Vasc Surg 2017; 65:1039-1046. [DOI: 10.1016/j.jvs.2016.10.078] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
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Astarcıoglu MA, Kılıt C, Sen T, Durmus HI, Kalcık M, Gursoy MO, Yesın M, Asarcıklı LD, Gozubuyuk G, Amasyalı B. One-year results of primary stenting for TASC II D lesions of the superficial femoral and popliteal arteries. Acta Cardiol 2017; 72:36-40. [PMID: 28597743 DOI: 10.1080/00015385.2017.1281521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective This study aimed to evaluate the safety and the efficacy of primary stenting to treat Trans-Atlantic Inter-Society Consensus II (TASC) D femoropopliteal lesions. Background Advances in wire, balloon and stent design have been reported to improve the durability of stenting of longer femoropopliteal lesions. Methods A total of 57 limbs of 53 patients with Rutherford stage 3 to 6 due to TASC D femoropopliteal lesions were treated with a self-expanding nitinol stent in a prospective, single-centre, observational study. End points of interest included primary and secondary patency, target lesion revascularization, in-stent restenosis, major adverse cardiovascular events, Rutherford class improvement and change in walking capacity at 1 year. Results A total of 53 patients (57 lesions) were treated with a self-expanding nitinol stent and final procedural success was 91.2%. The median length of the treated segment was 330 ± 96 mm. The median stented segment was 366 ± 71 mm and the mean number of the stents was 2.1 ± 0.9. At 1 year, primary and secondary patency rates were 63.9% and 82.1%, respectively. Major adverse cardiovascular events occurred in 11 patients (22.9%), and[[strike_start]] [[strike_end]]significant benefits were observed in Rutherford class and walking distance (both P < 0.001). Conclusions Primary implantation of self-expanding nitinol stents for the treatment of TASC D femoropopliteal lesions appears to be safe and effective, especially in patients who have multiple co-morbidities and a high risk for surgical bypass. The risk of restenosis was higher when long stenting was extended to the popliteal artery.
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Affiliation(s)
| | - Celal Kılıt
- Department of Cardiology, Dumlupinar University, Kutahya, Turkey
| | - Taner Sen
- Department of Cardiology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Halil Ibrahim Durmus
- Department of Cardiology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Macit Kalcık
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gursoy
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Yesın
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Lale Dinc Asarcıklı
- Department of Cardiology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Gokhan Gozubuyuk
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Basri Amasyalı
- Department of Cardiology, Dumlupinar University, Kutahya, Turkey
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Meltzer AJ, Sedrakyan A, Isaacs A, Connolly PH, Schneider DB. Comparative effectiveness of peripheral vascular intervention versus surgical bypass for critical limb ischemia in the Vascular Study Group of Greater New York. J Vasc Surg 2016; 64:1320-1326.e2. [DOI: 10.1016/j.jvs.2016.02.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/14/2016] [Indexed: 11/16/2022]
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Krishnan P, Tarricone A, Ali Z, Purushothaman KR, Overbey J, Vasquez M, Wiley J, Kapur V, Gujja K, Atallah RT, Nasiadko K, Kini A, Sharma S. Intravascular Ultrasound Is an Effective Tool for Predicting Histopathology-Confirmed Evidence of Adventitial Injury Following Directional Atherectomy for the Treatment of Peripheral Artery Disease. J Endovasc Ther 2016; 23:672-3. [PMID: 27413065 DOI: 10.1177/1526602816647364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Prakash Krishnan
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Arthur Tarricone
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Ziad Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | | | - Jessica Overbey
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Miguel Vasquez
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Jose Wiley
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Vishal Kapur
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Karthik Gujja
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | | | | | - Annapoorna Kini
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Samin Sharma
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
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Siracuse JJ, Menard MT, Eslami MH, Kalish JA, Robinson WP, Eberhardt RT, Hamburg NM, Farber A. Comparison of open and endovascular treatment of patients with critical limb ischemia in the Vascular Quality Initiative. J Vasc Surg 2016; 63:958-65.e1. [DOI: 10.1016/j.jvs.2015.09.063] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
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Shammas NW. Commentary: The Adluminal Origin of Restenosis in Peripheral Artery Interventions and Its Implications for the Development of Future Treatment Strategies. J Endovasc Ther 2015; 22:716-8. [DOI: 10.1177/1526602815600712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tarricone A, Ali Z, Rajamanickam A, Gujja K, Kapur V, Purushothaman KR, Purushothaman M, Vasquez M, Zalewski A, Parides M, Overbey J, Wiley J, Krishnan P. Histopathological Evidence of Adventitial or Medial Injury Is a Strong Predictor of Restenosis During Directional Atherectomy for Peripheral Artery Disease. J Endovasc Ther 2015. [DOI: 10.1177/1526602815597683] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the impact on restenosis rates of deep injury to the adventitial layer during directional atherectomy. Methods: Between 2007 and 2010, 116 consecutive patients (mean age 69.6 years; 56 men) with symptomatic femoropopliteal stenoses were treated with directional atherectomy at a single center. All patients had claudication and TASC A/B lesions in the superficial femoral or popliteal arteries. Histopathology analysis of atherectomy specimens was performed to identify adventitial injury. Clinical follow-up included physical examination and duplex ultrasound scans at 3, 6, and 12 months in all patients. The primary endpoint was the duplex-documented 1-year rate of restenosis, which was determined by a peak systolic velocity ratio <2.4. Patients were dichotomized by the presence or absence of adventitial or medial cuts as evaluated by histopathology. Results: Adventitial injury were identified in 62 (53%) of patients. There were no differences in baseline demographic and clinical features (p>0.05), lesion length (58.7±12.8 vs 56.2±13.6 mm, p=0.40), or vessel runoff (1.9±0.6 vs 2.0±0.6, p=0.37) between patients with and without adventitial injury, respectively. The overall 1-year incidence of restenosis was 57%, but the rate was significantly higher (p<0.0001) in patients with adventitial or medial injury (97%, 60/62) as compared with those without (11%, 6/54). Conclusion: Lack of adventitial injury after atherectomy for femoropopliteal stenosis is strongly related to patency at 1 year.
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Affiliation(s)
- Arthur Tarricone
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Ziad Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | | | - Karthik Gujja
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Vishal Kapur
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | | | | | - Miguel Vasquez
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Adrian Zalewski
- Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - Micheal Parides
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Jessica Overbey
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Jose Wiley
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Prakash Krishnan
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
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Shimada Y. Commentary: Novel Crossing Devices vs the Skill of Artisans: Is It a Tie Thus Far? J Endovasc Ther 2015; 22:535-7. [PMID: 26187976 DOI: 10.1177/1526602815590971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yoshihisa Shimada
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
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CT angiography and magnetic resonance angiography findings after surgical and interventional radiology treatment of peripheral arterial obstructive disease. J Cardiovasc Comput Tomogr 2015; 9:165-82. [DOI: 10.1016/j.jcct.2015.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/10/2014] [Accepted: 01/07/2015] [Indexed: 11/20/2022]
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Hishikari K, Hikita H, Sugiyama T, Oumi T, Kimura S, Takahashi A, Isobe M. Intravenous intravascular ultrasound using the AcuNav ultrasound catheter for guiding recanalization of aortoiliac chronic total occlusions. J Endovasc Ther 2015; 22:269-71. [PMID: 25809374 DOI: 10.1177/1526602815575486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Keiichi Hishikari
- Yokosuka Kyosai Hospital, Yokosuka, Japan Tokyo Medical and Dental University, Tokyo, Japan
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Bosiers M, Diaz-Cartelle J, Scheinert D, Peeters P, Dawkins KD. Revascularization of lower extremity chronic total occlusions with a novel intraluminal recanalization device: results of the ReOpen study. J Endovasc Ther 2014; 21:61-70. [PMID: 24502485 DOI: 10.1583/12-4083r.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report outcomes of a multicenter, nonrandomized study evaluating the safety and effectiveness of a guidewire-mounted mechanical recanalization device with a rotating distal tip (TruePath) in facilitating the crossing of infrainguinal chronic total occlusions (CTOs). METHODS Eligible patients had lower extremity ischemia and an angiographically confirmed occlusion, with no antegrade flow for at least 30 days, in an infrainguinal artery. Enrollment occurred when a previous or concurrent attempt to cross the CTO with a conventional guidewire had failed. A total of 85 patients with 85 lesions were enrolled; 61 (71.8%) target lesions were in the superficial femoral artery and 68 (80%) were considered moderately or heavily calcified. Clinical evaluations were assessed immediately post procedure and at 30-day follow-up. RESULTS Freedom from clinical perforation at the time of the procedure was achieved in 98.8% of patients. The device facilitated CTO crossing into the distal true lumen (technical success) in 68 (80.0%) patients, with subsequent distal guidewire positioning in 65 (76.5%). The average ABI (n=58) improved from 0.65 (range 0.35-1.20) at baseline to 1.00 (range 0.50-2.00) through 30-day follow-up. Symptoms improved in 70 (82.4%) patients upon treatment, and improvement was maintained in 57/70 (81.4%) through 30 days. CONCLUSION The ReOpen Study demonstrated that the TruePath device is safe and effective for facilitating crossing of CTOs resistant to conventional guidewire maneuvers.
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Abstract
Critical limb ischemia (CLI) is the most severe and debilitating form of peripheral arterial disease and is associated with high rates of limb loss and cardiovascular mortality. The unique physical environment of tibial occlusive disease underlying most CLI cases limits treatment options and long-term durability, with resulting frequent rates of persistent obstruction, restenosis, and reintervention. Atherectomy represents a potential strategy to improve acute and late results when treating patients with CLI. Available atherectomy devices each have specific performance characteristics, evidentiary rationale, and limitations that mandate a clear understanding of the optimal albeit evolving use of this category of interventional tools.
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Affiliation(s)
- John H Rundback
- Interventional Institute, Holy Name Medical Center, Teaneck, NJ.
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45
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Loss of bifurcation patency after cross-over stenting of ostial lesions in superficial femoral artery: possible causes, prevention and reintervention. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Siracuse JJ, Huang ZS, Gill HL, Parrack I, Schneider DB, Connolly PH, Meltzer AJ. Defining risks and predicting adverse events after lower extremity bypass for critical limb ischemia. Vasc Health Risk Manag 2014; 10:367-74. [PMID: 25018636 PMCID: PMC4075947 DOI: 10.2147/vhrm.s54350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Successful treatment of patients with critical limb ischemia (CLI), hinges on the adequacy of revascularization. However, CLI is associated with a severe burden of systemic atherosclerosis, and patients often suffer from multiple cardiovascular comorbidities. Therefore, CLI patients in general represent a cohort at increased risk for procedural complications and adverse events. Although endovascular therapy represents a minimally invasive alternative to open surgical bypass, the durability of surgical reconstruction is superior, and it remains the "gold standard" approach to revascularization in CLI. Therefore, selection of the optimal treatment modality for individual patients requires careful consideration of the procedural risks and likelihood of adverse events associated with surgery. Individualized decision-making with regard to revascularization strategy requires a comprehensive understanding of the likelihood of adverse outcomes after major surgery. Here we review the risks of surgical bypass in patients with CLI, with particular emphasis on the identification of preoperative variables that predict poor outcome.
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Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Zhen S Huang
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Heather L Gill
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Inkyong Parrack
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Darren B Schneider
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Peter H Connolly
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Andrew J Meltzer
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Siracuse JJ, Gill HL, Cassidy SP, Messina MD, Catz D, Egorova N, Parrack I, McKinsey JF. Endovascular treatment of lesions in the below-knee popliteal artery. J Vasc Surg 2014; 60:356-61. [PMID: 24650745 DOI: 10.1016/j.jvs.2014.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Endovascular interventions are increasing; however, there are little data regarding outcomes of complex interventions involving the below-knee popliteal/P3 artery. This study evaluated the short-term and long-term results and predictors of success of below-knee popliteal artery endovascular interventions. METHODS This was a retrospective review of a prospectively maintained endovascular lower extremity database of all patients with below-knee popliteal interventions from 2004 to 2012. Patient demographics, angiographic findings, interventions, primary and secondary patency, limb loss, and mortality were recorded. Analysis was performed using Kaplan-Meier life-table and multivariate analysis, with P < .05 indicating significance. RESULTS There were 221 patients (56% male) with below-knee popliteal/P3 artery lesions. Mean age was 73 ± 11.2 years. Claudication was present in 22% and critical limb ischemia (CLI) in 78%. Mean lesion length was 10 ± 8.5 cm, with 45% having total occlusions. Treatment included percutaneous transluminal angioplasty (PTA) with or without a stent (47%), atherectomy (ATH) with or without PTA/stent (52%), and stenting with PTA and ATH (3%). Complications included embolization (0.4%), hematoma (2.7%), pseudoaneurysm (1.3%), and dissection (7%). Freedom from restenosis (peak systolic velocity ratio >2.4) was 65% at 1 year. Independent predictors of restenosis were CLI (hazard risk [HR], 4.4; 95% confidence interval [CI], 1.9-9.9) and stenting combined with PTA and ATH (HR, 2.7; 95% CI, 1.01-7.4). Primary assisted and secondary patencies were 95% and 85% at 1 year. ATH with PTA had lower short-term restenosis in diabetic patients compared with nondiabetic patients (95% vs 78% at 4 months). Limb loss was 18% at 4 years. Mortality was 24% at 4 years. Statin use was protective against primary restenosis (HR, 0.39; 95% CI, 0.23-0.67) and death (HR, 0.5; 95% CI, 0.28-1.0). CONCLUSIONS Endovascular intervention for lesions involving the below-knee popliteal artery is a safe and effective therapy for claudication and CLI. Diabetic patients benefit most from ATH with PTA. Statin use is protective against restenosis and mortality and should be the standard of care in patients undergoing peripheral endovascular interventions.
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Affiliation(s)
- Jeffrey J Siracuse
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY.
| | - Heather L Gill
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Stephen P Cassidy
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Mark D Messina
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Diana Catz
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Natalia Egorova
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Inkyong Parrack
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - James F McKinsey
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
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48
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Baumann F, Fust J, Engelberger RP, Hügel U, Do DD, Willenberg T, Baumgartner I, Diehm N. Early Recoil After Balloon Angioplasty of Tibial Artery Obstructions in Patients With Critical Limb Ischemia. J Endovasc Ther 2014; 21:44-51. [DOI: 10.1583/13-4486mr.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Siracuse JJ, Gill HL, Schneider DB, Graham AR, Connolly PH, Jones DW, Meltzer AJ. Assessing the Perioperative Safety of Common Femoral Endarterectomy in the Endovascular Era. Vasc Endovascular Surg 2013; 48:27-33. [DOI: 10.1177/1538574413508827] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Common femoral endarterectomy (CFE) has historically been the preferred treatment for atherosclerotic lesions involving the common femoral artery. The objectives of this study are to delineate the safety of this open procedure in the endovascular era, establish contemporary benchmarks for morbidity and mortality after CFE, and identify the subgroup of patients at increased risk of postoperative adverse events. Methods: Patients undergoing elective CFE in the 2007 to 2010 National Surgical Quality Improvement Project database were examined. Univariate analyses were used to identify the factors associated with major morbidity and mortality. Significant variables by univariate analysis were used to create multivariate logistic regression models for morbidity and mortality. Results: A total of 1513 patients underwent elective CFE. The 30-day mortality rate was 1.5%. Postoperative morbidities included cardiac (1.0%), pulmonary (1.9%), renal (0.4%), urinary tract infection (1.7%), thromboembolic (0.5%), neurologic (0.4%), sepsis (2.7%), superficial (6.3%), and deep surgical site complications (2.0%). At least 1 complication, including major and minor, was seen in 7.9% of the patients. By multivariate analysis, partial- and total-dependent functional status (odds ratio [OR] 9.0, 95% confidence interval [CI] 2.8-28.4 and OR 21.3, 95% CI 3.3-139.4) and dyspnea at rest (OR 8.2, 95% 1.2-58.8) predicted mortality. Independent predictors of morbidity include steroid use (OR 2.4, 95% 1.4-4.1), diabetes (OR 1.8, 95% CI 1.3-2.4), and obesity (OR 1.6, 95% CI 1.1-2.4). Discussion: Overall, CFE is tolerated well by the majority of patients with peripheral arterial disease. These results affirm the safety of CFE and can still be used as standard first-line therapy in most patients. Long-term results for endovascular interventions need to be studied to see whether high-risk patients that we identified for CFE would benefit more from an endovascular approach.
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Affiliation(s)
- Jeffrey J. Siracuse
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Heather L. Gill
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Darren B. Schneider
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Ashley R. Graham
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Peter H. Connolly
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Douglas W. Jones
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Andrew J. Meltzer
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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50
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Peruzzi M, Biondi-Zoccai G, Frati G. Aortoiliac arteries: another Waterloo for transcatheter vs. open surgical therapy after aorta, cardiac valves, carotids, coronaries, femorals, and tibials? J Endovasc Ther 2013; 20:456-60. [PMID: 23914851 DOI: 10.1583/13-4242c.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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