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Latz CA, Deluca E, Lella S, Waller HD, DeCarlo C, Dua A. Rates of Conversion from Dry to Wet Gangrene Conversion Following Lower Extremity Revascularization. Ann Vasc Surg 2022; 83:20-25. [DOI: 10.1016/j.avsg.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
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García-Domínguez LJ, Falcón M, Ribé L, Hernández A, Miralles M. Trans-popliteal hybrid retrograde technique for revascularization of chronic total occlusions of the superficial femoral artery. Vascular 2020; 29:582-588. [PMID: 33086943 DOI: 10.1177/1708538120966130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We present the technical description and preliminary results of a hybrid approach for the treatment of chronic total occlusions of superficial femoral artery in the setting of critical limb-threatening ischemia (CLTI). METHODS A retrospective analysis of selected case series was performed. A trans-popliteal hybrid technique was carried out in seven limbs (six patients). Open exposure of above-the-knee popliteal artery was performed over its maximum calcification zone. After retrograde recanalization and graft-stenting of the entire superficial femoral artery, endarterectomy of the popliteal artery was performed for debulking and widening of the distal landing zone of the endoprosthesis. The latter is included in the bovine patch suture to avoid leaving a segment untreated. RESULTS Technical success, haemodynamic and clinical improvement were achieved in all procedures. Median length of treated occlusion was 19.8 cm. After a mean follow-up of 12 months (range 6-26 months), the primary patency was 85.7% (only one asymptomatic occlusion occurred). There were no major cardiovascular or limb adverse events. No re-interventions were required. CONCLUSION This less-invasive, one-incision technique is safe and effective for the restoration of in-line flow from groin to ankle, currently recommended in CLTI revascularization. It could be especially useful in highly calcified popliteal artery lesions, hostile groins or those at high risk of infection and in cases of vein absence for bypass surgery.
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Affiliation(s)
- Luis J García-Domínguez
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Moisés Falcón
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Lucas Ribé
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Ana Hernández
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Manuel Miralles
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
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Nakamura M, Jaff MR, Settlage RA, Kichikawa K. Nitinol Self-Expanding Stents for the Treatment of Obstructive Superficial Femoral Artery Disease: Three-Year Results of the RELIABLE Japanese Multicenter Study. Ann Vasc Dis 2018; 11:324-334. [PMID: 30402183 PMCID: PMC6200612 DOI: 10.3400/avd.oa.18-00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: To assess the use of a nitinol stent to treat symptomatic stenoses or occlusions of the native superficial femoral artery (SFA). Materials and Methods: Seventy-four patients were treated at 12 Japanese sites. The primary endpoint, freedom from target-limb failure (TLF), was a composite of device- or procedure-related death, target-limb amputation, target-vessel revascularization (TVR), or restenosis compared to an objective performance goal (OPG) at 12 months. Secondary endpoints, including primary patency, freedom from TVR/target-lesion revascularization (TLR), improvements in clinical parameters, and major adverse events (MAEs) were evaluated through 36 months. Results: The mean overall lesion length was 80.7±38.9 mm (mean stented length: 98.8±46.1 mm). Freedom from TLF was 81.2% (p<0.001 compared to OPG) with a Kaplan–Meier estimate of 84.2% [95% confidence interval (95%CI) 73.3%, 90.9%] at 12 months. Primary patency was 71.0% at 12 months and 67.8% at 36 months. A total of 94.7% of patients improved by at least one Rutherford category and 70.2% of patients improved ankle–brachial indices ≧0.10 from baseline to 36 months. Freedom from TVR/TLR (Kaplan–Meier) was 90% at 12 months and 79.5% at 36 months. Four MAEs were reported; none were found to be device or procedure related. Conclusion: A self-expanding stent was used safely to treat stenotic and occlusive lesions of the SFA in a Japanese patient population. The composite endpoint, freedom from TLF, was superior to an historical control at one year, with low rates of revascularization and good functional and clinical outcomes through three years.
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Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Michael R Jaff
- Vascular Core Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University Hospital, Kashihara, Nara, Japan
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Wei LM, Zhu YQ, Zhang PL, Lu HT, Zhao JG. Integrated application of antegrade and retrograde recanalization for femoral-popliteal artery chronic total occlusions: outcomes compared with antegrade recanalization. Quant Imaging Med Surg 2018; 8:568-578. [PMID: 30140619 DOI: 10.21037/qims.2018.07.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the efficacy of retrograde recanalization for chronic total occlusion (CTO) of femoral-popliteal artery in patients with peripheral arterial disease. Methods In this single-center retrospective study, all patients who had undergone endovascular recanalization for femoral-popliteal CTOs at our center from June 2011 to October 2014 were included. Patients' demographics, immediate and follow-up outcomes were analyzed. Results A total of 205 patients with 238 CTOs were enrolled. In total, successful recanalization was achieved in 228 CTOs (95.8%). The antegrade procedure was successful in 196 CTOs. The retrograde procedure was successfully performed in 32 CTOs after failed antegrade procedure. Ankle-brachial index increased from 0.48±0.18 to 0.79±0.16 in antegrade group vs. 0.41±0.13 to 0.76±0.13 in retrograde group (P=0.438). Pulse score increased from 0.48±0.50 to 2.30±0.76 in antegrade group vs. 0.48±0.51 to 2.30±0.79 in retrograde group (P=0.771). At 12 and 24 months, primary patency rate was 86.2% (169/196) and 51.5% (101/196) in the antegrade group, and 75.0% (24/32) and 43.8% (14/32) in the retrograde group, respectively (P=0.346). Kaplan-Meier analysis showed limb salvage rates of 85.7% in the antegrade group vs. 78.1% in the retrograde group (P=0.198). Conclusions Retrograde recanalization is effective for CTO of femoral-popliteal artery after the failure of an antegrade procedure; immediate outcomes and mid-term patency and limb salvage rate are comparable with that of antegrade procedure.
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Affiliation(s)
- Li-Ming Wei
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yue-Qi Zhu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Pei-Lei Zhang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Hai-Tao Lu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jun-Gong Zhao
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Schwindt AG, Bennett JG, Crowder WH, Dohad S, Janzer SF, George JC, Tedder B, Davis TP, Cawich IM, Gammon RS, Muck PE, Pigott JP, Dishmon DA, Lopez LA, Golzar JA, Chamberlin JR, Moulton MJ, Zakir RM, Kaki AK, Fishbein GJ, McDaniel HB, Hezi-Yamit A, Simpson JB, Desai A. Lower Extremity Revascularization Using Optical Coherence Tomography-Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study. J Endovasc Ther 2017; 24:355-366. [PMID: 28393673 DOI: 10.1177/1526602817701720] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of a novel optical coherence tomography (OCT)-guided atherectomy catheter in treating patients with symptomatic femoropopliteal disease. METHODS The VISION trial ( ClinicalTrials.gov identifier NCT01937351) was a single-arm, multicenter, global investigational device exemption study enrolling 158 subjects (mean age 67.2±10.5 years; 87 men) across 20 participating sites. In this cohort, 198 lesions were treated with an average length of 53±40 mm using the Pantheris catheter alone or Pantheris + adjunctive therapy. The primary safety endpoint was the composite of major adverse events (MAEs) through 6 months (objective performance goal 43.2%). Technical success (primary efficacy outcome) was defined as the percent of target lesions with a residual diameter stenosis ≤50% after treatment with the Pantheris device alone (objective performance goal 87.0%). Procedural success was defined as reduction in stenosis to ≤30% after Pantheris ± adjunctive therapy. Tissue specimens retrieved from each treated lesion were histologically analyzed to evaluate the accuracy and precision of OCT image guidance. RESULTS The primary efficacy outcome was achieved in 192 (97.0%) of the 198 lesions treated with the Pantheris catheter. Across all lesions, mean diameter stenosis was reduced from 78.7%±15.1% at baseline to 30.3%±11.8% after Pantheris alone (p<0.001) and to 22.4%±9.9% after Pantheris ± adjunctive therapy (p<0.001). Of the 198 target lesions, 104 (52.5%) were treated with the Pantheris alone, 84 (42.4%) were treated with Pantheris + adjunctive angioplasty, and 10 (5.1%) with Pantheris + angioplasty + stenting. The composite MAE outcome through 6 months occurred in 25 (16.6%) of 151 subjects. There were no clinically significant perforations, 1 (0.5%) catheter-related dissection, 4 (2%) embolic events, and a 6.4% clinically driven target lesion revascularization rate at 6 months. The 40-lesion chronic total occlusion (CTO) subset (mean lesion length 82±38 mm) achieved a similar significant reduction in stenosis to 35.5%±13.6% after Pantheris alone (p<0.001). Histological analysis of atherectomy specimens confirmed <1% adventitia in 82.1% of the samples, highlighting the precision of OCT guidance. Characterization of the OCT-guided lesions revealed evidence of an underestimation of disease burden when using fluoroscopy. CONCLUSION OCT-guided atherectomy for femoropopliteal disease is safe and effective. Additionally, the precision afforded by OCT guidance leads to greater removal of plaque during atherectomy while sparing the adventitia.
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Affiliation(s)
- Arne G Schwindt
- 1 Department of Vascular Surgery, St Franziskus-Hospital Münster, Germany
| | - J Gray Bennett
- 2 St Dominic-Jackson Memorial Hospital, Jackson, MI, USA
| | | | - Suhail Dohad
- 3 Cedars Sinai Medical Center, West Hollywood, CA, USA
| | | | - Jon C George
- 5 Deborah Heart and Lung Center, Brown Mills, NJ, USA
| | - Barry Tedder
- 6 St Bernards Medical Center, Jonesboro, AR, USA
| | | | | | | | | | - John P Pigott
- 11 Jobst Vascular Institute Promedica Toledo Hospital, Toledo, OH, USA
| | | | - Lou A Lopez
- 13 St Joseph's Hospital, Fort Wayne, IN, USA
| | - Jaafer A Golzar
- 14 Advocate Christ Hospital and Medical Center, Oak Lawn, IL, USA
| | | | | | - Ramzan M Zakir
- 17 St Peters University Hospital, New Brunswick, NJ, USA
| | - Amir K Kaki
- 18 DMC Cardiovascular Institute Harper-Hutzel Hospital, Detroit, MI, USA
| | | | | | | | - John B Simpson
- 21 Avinger Inc, Redwood City, CA, USA.,22 Sequoia Hospital, Redwood City, CA, USA
| | - Arjun Desai
- 21 Avinger Inc, Redwood City, CA, USA.,23 Stanford University Medical Center, Stanford, CA, USA
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Kim MH, Ahn S, Kim JY, Jun KW, Yun SS, Won YS. Current trends of major arterial diseases in Korea: based on data from the Health Insurance Review and Assessment Service. Ann Surg Treat Res 2016; 90:218-23. [PMID: 27073793 PMCID: PMC4826985 DOI: 10.4174/astr.2016.90.4.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/01/2015] [Accepted: 11/30/2015] [Indexed: 01/19/2023] Open
Abstract
Purpose This study aims to figure out the changes of the prevalence and management of carotid arterial occlusive diseases (CAOD), abdominal aortic diseases (AAA), and arterial diseases of the lower extremities (LAOD) in Korea over the past 5 years. Methods Data were extracted from the Health Insurance Review and Assessment Service during the period from 2008 to 2012. Results The number of patients with CAOD increased by about 30% every year. From the year 2008, the number of open surgeries (OS) and endovascular treatments (ET) increased by more than 20% during each of the first 2 years and by 10% every year for 3 years thereafter for CAOD. ET was preferred to OS and occupied 77%–79% of the total number of procedures. The number of patients with AAA increased by 11%–17% every year. ET for AAA occupied 52% of the total number of procedures in 2008 and gradually increased to 70% in 2012. The number of patients who were diagnosed with LAOD fluctuated over the five years. The total number of procedures to treat LAOD increased each year by 20%–25%. ET for LAOD constantly increased by 18%–24% each year and occupied 80%–95% of the total number of procedures. Conclusion It is evident that the incidence of vascular diseases will be increasing as our society ages, not to mention its care costs. The need for long-range plans and guidelines are urgent.
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Affiliation(s)
- Mi-Hyeong Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jang-Yong Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Woong Jun
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Seop Yun
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Sung Won
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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