Head-to-Head Comparison of 2 Paclitaxel-Coated Balloons for Femoropopliteal Lesions

BACKGROUND

There is a scarcity of published head-to-head comparisons between different paclitaxel-coated angioplasty balloons. More prospective safety data to support the health care economic reimbursement processes are needed.

OBJECTIVES

The aim of this study was to report the safety and efficacy of the Passeo-18 Lux drug-coated balloon (DCB) (Biotronik AG) for the treatment of symptomatic peripheral artery disease caused by stenosis, restenosis, or occlusion of the femoral and/or popliteal arteries.

METHODS

A total of 302 patients were randomized 1:1 and assigned to the Passeo-18 Lux DCB (study device) group or the IN.PACT Admiral DCB (control device, Medtronic Vascular) group for testing of noninferiority. The primary efficacy endpoint was freedom from clinically driven target lesion revascularization at 12 months. The primary safety endpoint was a composite of freedom from device-/procedure-related death through 30 days postindex procedure, major target limb amputation, and clinically driven target vessel revascularization at 12 months.

RESULTS

At 12 months, 130 of 134 patients in the IN.PACT Admiral group had freedom from clinically driven target lesion revascularization (97.0%) compared with 137 of 141 patients in the Passeo-18 Lux group (97.2%). The primary safety endpoint showed 96.3% in the control group vs 95.7% in the study device group. The null hypothesis of inferiority on both efficacy and safety was rejected. The Kaplan-Meier estimate of primary patency at 1 year was 88.7% in the control arm vs 91.5% in the study device arm.

CONCLUSIONS

The Passeo-18 Lux and the IN.PACT Admiral DCBs demonstrate comparable results with excellent effectiveness and safety through 12 months for femoropopliteal interventions.

Technique for introducing large composite mesh while performing laparoscopic incisional hernioplasty

BACKGROUND

Incisional hernias are treated laparoscopically in an increasing number of cases. The simplest technique is the peritoneal onlay technique. Composite mesh, consisting of one layer of polypropylene mesh, destined to face the abdominal wall, and one layer of less adhesion-inducing material, destined to face the bowel, has been developed in an effort to avoid intraperitoneal adhesion formation and viscus erosion. While probably superior, this type of mesh is very bulky, easily damaged, and hence extremely difficult to be safely introduced through conventional trocars.

METHODS

We present a simple technique to safely introduce intraperitoneally large sheets of composite mesh, without the need for larger-bore cannulas. After temporarily removing one of the 10 mm trocars, the mesh is rolled as tightly as possible and placed in a sterile bag, which is then easily introduced intraperitoneally through the trocar opening.

RESULTS

Between September 1999 and January 2000 the technique was successfully used in 12 patients.

CONCLUSION

This simple trick protects the mesh while making its intraperitoneal introduction straightforward. It is quick, cheap, and easily reproducible.