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Hoppe H, Hirschle D, Schumacher MC, Schönhofen H, Glenck M, Kalka C, Willenberg T, Sixt S, Müller D, Gutzeit A, Christe A, Mohan V, Diehm N. Erectile dysfunction: role of computed tomography cavernosography in the diagnosis and treatment planning of venous leak. CVIR Endovasc 2023; 6:56. [PMID: 37975993 PMCID: PMC10656380 DOI: 10.1186/s42155-023-00403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Venous leak appears to be the most common cause of vasculogenic erectile dysfunction (ED), which can be treated with venous embolization. Traditionally, conventional cavernosography was used for the diagnosis and treatment planning of venous leak. Recently, computed tomography (CT) cavernosography was introduced as a novel cross-sectional imaging method proposed to be advantageous over conventional cavernosography. We created a novel management algorithm for diagnosing venous leak including CT cavernosography as an imaging modality. In order to provide a broader basis for our management algorithm, a systematic literature review was conducted. MAIN BODY In this article we systematically review relevant literature on using CT cavernosography for the diagnosis and treatment planning in ED patients with venous leak following the PRISMA selection process. Nine full-text articles were included in the review and assigned a level of evidence grade (all grade II). Two studies (2/9) compared the results of conventional cavernosography with those of CT cavernosography which was superior for site-specific venous leak identification (19.4% vs. 100%, respectively). CT cavernosography is a more detailed imaging method that is faster to perform, exposes the patient to less radiation, and requires less contrast material. In one study (1/9), CT cavernosography was used for diagnostic purposes only. Eight studies (8/9) cover both, diagnostic imaging and treatment planning including embolization (1/9) and sclerotherapy (2/9) of venous leak in patients with venogenic ED. Three studies (3/9) describe anatomical venous leak classifications that were established based on CT cavernosography findings for accurate mapping of superficial and/or deep venous leak and identification of mixed or more complex forms of venous leak present in up to 84% of patients. In addition to treatment planning, one study (1/9) used CT cavernosography also for follow-up imaging post treatment. CONCLUSION CT cavernosography is superior to conventional cavernosography for diagnosis and treatment planning in patients with ED caused by venous leak (grade II levels of evidence). Consequently, CT cavernosography should be included in management algorithms for ED patients with suspected venous leak.
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Affiliation(s)
- Hanno Hoppe
- University of Bern, Bern, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
- Microtherapy Center Bern, Lindenhofspital, Bern, Switzerland.
- Campus Stiftung Lindenhof Bern, Bern, Switzerland.
| | | | | | | | - Michael Glenck
- Microtherapy Center Bern, Lindenhofspital, Bern, Switzerland
| | | | - Torsten Willenberg
- University of Bern, Bern, Switzerland
- Vascular Center Bern, Lindenhofspital, Bern, Switzerland
| | | | | | - Andreas Gutzeit
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Andreas Christe
- Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Vignes Mohan
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Nicolas Diehm
- University of Bern, Bern, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany
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Teichgräber U, Lehmann T, Ingwersen M, Aschenbach R, Zeller T, Brechtel K, Blessing E, Lichtenberg M, von Flotow P, Heilmeier B, Sixt S, Brucks S, Erbel C, Beschorner U, Werk M, Riambau V, Wienke A, Klumb C, Thieme M, Scheinert D. Long-Term Effectiveness and Safety of Femoropopliteal Drug-Coated Balloon Angioplasty : 5-Year Results of the Randomized Controlled EffPac Trial. Cardiovasc Intervent Radiol 2022; 45:1774-1783. [DOI: 10.1007/s00270-022-03265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/21/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Purpose
This study aimed to assess 5-year effectiveness and safety of femoropopliteal angioplasty with the Luminor® 35 drug-coated balloon (DCB).
Materials and Methods
The EffPac trial was a prospective, multicenter, randomized controlled trial that enrolled 171 patients of Rutherford category 2 to 4 with medium length femoropopliteal lesions. Patients were allocated 1:1 to either Luminor® 35 DCB angioplasty or plain old balloon angioplasty (POBA). Assessment at 5 years included primary patency, freedom from clinically driven target lesion revascularization (CD-TLR), clinical improvement, and target limb amputation. Long-term vital status was ascertained in 97.1% of the participants.
Results
Kaplan–Meier curves at 5 years demonstrate a primary patency of 61.4% after DCB angioplasty and 53.5% after POBA (log-rank p = 0.040) with a decreasing difference throughout the observation period. Freedom from TLR was 82.1% and 73.7%, respectively (log-rank p = 0.050). Incidence of primary clinical improvement was similar between groups (61% DCB vs. 64% POBA, p = 0.94). Major target limb amputation was necessary in one POBA-group participant. Freedom from all-cause death at 5 years was 88.5% after DCB and 86.0% after POBA (log-rank p = 0.34).
Conclusions
Primary patency after femoropopliteal DCB angioplasty remained superior to POBA throughout 5 years, however, with decreasing difference. Clinical improvement, freedom from TLR, and all-cause mortality were similar between groups over the long term. (Effectiveness of Paclitaxel-Coated Luminor® Balloon Catheter Versus Uncoated Balloon Catheter in the Superficial Femoral Artery [EffPac]; NCT02540018).
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Teichgräber U, Lehmann T, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Blessing E, Lichtenberg M, von Flotow P, Heilmeier B, Sixt S, Brucks S, Erbel C, Beschorner U, Werk M, Riambau V, Wienke A, Klumb CT, Thieme M. Drug-coated Balloon Angioplasty of Femoropopliteal Lesions Maintained Superior Efficacy over Conventional Balloon: 2-year Results of the Randomized EffPac Trial. Radiology 2020; 295:478-487. [DOI: 10.1148/radiol.2020191619] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Teichgräber U, Lehmann T, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Blessing E, Lichtenberg M, Sixt S, Brucks S, Beschorner U, Klumb CT, Thieme M. Efficacy and safety of a novel paclitaxel-nano-coated balloon for femoropopliteal angioplasty: one-year results of the EffPac trial. EUROINTERVENTION 2020; 15:e1633-e1640. [PMID: 31687933 DOI: 10.4244/eij-d-19-00292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS Although paclitaxel drug-coated balloon (DCB) angioplasty is an established endovascular treatment for peripheral artery disease, restenosis remains a major concern. Thus, we compared a novel paclitaxel-coated DCB with nano-coating technology with uncoated plain old balloon angioplasty (POBA). METHODS AND RESULTS This multicentre trial randomly assigned 171 patients with stenotic and occlusive lesions of the femoropopliteal artery to angioplasty with a novel DCB or uncoated POBA. The primary endpoint, late lumen loss at six months, was 0.92 mm lower in the DCB group (95% CI: -1.36 to -0.49 mm, p<0.001). Patients showed improved walking after DCB treatment at six months (p=0.021). In the DCB group, 44.6% and 50% of the patients improved by three Rutherford-Becker classification stages after six to 12 months, respectively (POBA: 27.8% and 36.8%, respectively). Only one patient needed TLR (1.3%) in the DCB group, compared to 14 patients (18.7%) in the POBA group after 12 months (relative risk [RR]=0.08, 95% CI: 0.01-0.53, p<0.001). Primary patency was 90.3% (DCB group) versus 65.3% (POBA group) after 12 months (RR=1.38, 95% CI: 1.14-1.67, p<0.001). CONCLUSIONS The novel DCB was effective and safe for inhibiting restenosis. Moreover, it demonstrated a better improvement in walking than POBA and showed no mortality concerns due to paclitaxel application after 12 months. Clinical Trials Identifier: NCT02540018
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Affiliation(s)
- Ulf Teichgräber
- Department of Radiology, University Hospital Jena, Jena, Germany
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Lichtenberg M, Breuckmann F, Kramer V, Betge S, Sixt S, Hailer B, Nikol S, Arjumand J, Wittenberg G, Teßarek J, Nolte-Ernsting C. Effectiveness of the Pulsar-18 self-expanding stent with optional drug-coated balloon angioplasty in the treatment of femoropopliteal lesions – the BIOFLEX PEACE All-Comers Registry. VASA 2019; 48:425-432. [DOI: 10.1024/0301-1526/a000785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Summary. Background: Previous studies showed favorable results after treatment of femoropopliteal lesions with the Pulsar-18 self-expanding (SE) nitinol stent. The objective of this registry was to evaluate whether these results will be confirmed in a real-world setting with varying stenting strategies. Patients and methods: In this prospective, observational trial, 160 patients with 186 femoropopliteal lesions were treated with the Pulsar-18 SE nitinol stent at 9 German sites. Mean lesion length was 116 ± 103 mm, and 41.9 % of the lesions were moderately or heavily calcified. Eighty lesions were concomitantly treated with drug-coated balloon (DCB). Main effectiveness outcome was primary patency at 12 months, and main safety outcome was freedom from the composite of device or procedure related death, major target limb amputation, and clinically driven target lesion revascularization (TLR) at 30 days and 6 months. Results: Kaplan-Meier estimate of primary patency was 89.1 %, 67.3 %, and 57.1 % at 6, 12, and 24 months. Freedom from TLR was 95.5 %, 91.4 %, and 85.2 % at 6, 12, and 24 months, respectively. Lesions, which were additionally treated with DCB (plus DCB-group), were longer (150 versus 82 mm on average, p < 0.0001), and associated with lower primary patency estimates than those without DCB angioplasty (stent-only-group) (log-rank p = 0.006). However, there was no difference in freedom from TLR between groups (log-rank p = 0.542). Improvement by ≥ 1 Rutherford category was achieved in 84.8 %, 81.0 %, and 81.7 % of patients at 6, 12, and 24 months, respectively. Walking distance and patient-reported pain improved persistently through 24 months (p < 0.001). Hemodynamic improvement was achieved in 68.2 %, 73.7 %, and 70.7 % of the patients at 6, 12, and 24 months, respectively. Conclusions: The Pulsar-18 self-expanding nitinol stent with optional drug-coated balloon angioplasty can be considered an efficacious and safe therapy option for endovascular treatment of femoropopliteal artery disease.
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Affiliation(s)
| | | | | | - Stefan Betge
- Angiology Clinic, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
| | | | - Birgit Hailer
- Cardiovascular Clinic, Katholisches Klinikum Essen, Essen, Germany
| | - Sigrid Nikol
- Angiology Clinic, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Jawed Arjumand
- Angiology Clinic, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany
| | | | - Jörg Teßarek
- Vascular Surgery Clinic, Bonifatius Hospital Lingen, Lingen, Germany
| | - Claus Nolte-Ernsting
- Radiology Clinic, Evangelisches Krankenhaus Mülheim, Mülheim an der Ruhr, Germany
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Akhyari P, Minol JP, Hiroyuki H, Sugimura Y, Aubin H, Sixt S, Rellecke P, Saeed D, Boeken U, Albert A, Lichtenberg A. A Standardized Technique of Repair of the Mitral Valve in Barlow Disease: Results in a Series of 41 Consecutive Patients. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- P. Akhyari
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - J.-P. Minol
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - H. Hiroyuki
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Y. Sugimura
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - H. Aubin
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - S. Sixt
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - P. Rellecke
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - D. Saeed
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - U. Boeken
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - A. Albert
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - A. Lichtenberg
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Rodrigues SG, Sixt S, Abraldes JG, De Gottardi A, Klinger C, Bosch J, Baumgartner I, Berzigotti A. Systematic review with meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis. Aliment Pharmacol Ther 2019; 49:20-30. [PMID: 30450634 DOI: 10.1111/apt.15044] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/23/2018] [Accepted: 10/10/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt has been increasingly used in patients with portal vein thrombosis to obtain patency, but evidenced-based decisions are challenging. AIM To evaluate published data on efficacy and safety of endovascular therapy in portal vein thrombosis. METHODS Systematic search of PubMed, ISI, Scopus, and Embase for studies (in English, until October 2017) reporting feasibility, safety, 12-month portal vein recanalisation, transjugular intrahepatic portosystemic shunt patency, and survival in patients with benign portal vein thrombosis undergoing endovascular treatment. An independent extraction of articles using predefined data fields and quality indicators was used; pooled analyses based on random-effects models; heterogeneity assessment by Cochran's Q, I2 statistic, subgroup analyses, and meta-regression. RESULTS Thirteen studies including 399 patients (92% cirrhosis; portal vein thrombosis: complete 46%, chronic 87%, cavernous transformation 17%, superior mesenteric vein involvement 55%) were included. Transjugular intrahepatic portosystemic shunt was technically feasible in 95% (95% CI: 89%-98%) with heterogeneity (I2 = 57%, P < 0.001) explained by cavernous transformation. Major complications occurred in 10% (95% CI: 6.0%-18.0%; I2 = 52%, P = 0.55). Additional catheter-directed thrombolysis was associated with more complications compared to transjugular intrahepatic portosystemic shunt alone or plus thrombectomy (17.6% vs 3.3%). Twelve-month portal vein recanalisation was 79% (95% CI: 67%-88%; I2 = 78%, P < 0.01). Shunt patency at 12 months was 84% (95% CI: 76%-90%; I2 = 62%, P < 0.01). Overall 12-month survival rate was 89%, with no heterogeneity. CONCLUSIONS Transjugular intrahepatic portosystemic shunt for portal vein thrombosis recanalisation was highly feasible, effective, and safe. Cavernous transformation was the main determinant of technical failure. Additional catheter-directed thrombolysis was associated with higher risk of severe complications.
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Affiliation(s)
- Susana G Rodrigues
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland
| | - Sebastian Sixt
- Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Berne, Switzerland
| | - Juan G Abraldes
- Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), CEGIIR, University of Alberta, Edmonton, Canada
| | - Andrea De Gottardi
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland
| | - Christoph Klinger
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Ludwigsburg, Germany
| | - Jaime Bosch
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland.,Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Ciberehd, University of Barcelona, Barcelona, Spain
| | - Iris Baumgartner
- Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Berne, Switzerland
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland
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Groot Jebbink E, Holewijn S, Versluis M, Grimme F, Hinnen JW, Sixt S, Angle JF, Dorigo W, Reijnen MMPJ. Meta-analysis of Individual Patient Data After Kissing Stent Treatment for Aortoiliac Occlusive Disease. J Endovasc Ther 2018; 26:31-40. [PMID: 30499352 PMCID: PMC6330696 DOI: 10.1177/1526602818810535] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate short- and long-term technical and clinical outcomes after kissing stent treatment of aortoiliac occlusive disease (AIOD) based on an individual participant data (IPD) meta-analysis. MATERIALS AND METHODS A search of the Scopus database identified 156 articles on KS treatment of AIOD; of these 22 met the inclusion criteria. Authors of 19 articles with contact information were approached to join an IPD consortium. Eight author groups responded and 5 provided anonymized data for merging into an IPD database. The number of included procedures was equal before and after 2005. The primary study outcome was the cumulative patency at 24 months. Secondary outcomes were patency at up to 60 months, complications, and changes in Rutherford category and ankle-brachial index. The predictive value of stent protrusion length, pre-/postdilation, stent type, and patient demographics on primary patency were examined with Cox proportional hazard modeling; outcomes are reported as the hazard ratio (HR). The Kaplan-Meier method was employed to estimate patency rates. RESULTS In total, 605 (40.9%) of 1480 patients presented in the literature were included in the IPD analysis. The indication for intervention was intermittent claudication in 84.2% and critical limb ischemia in 15.8%. Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) A or B in 52.8% and TASC C and D in 47.2%. The overall primary patency estimate was 81% at 24 months. Primary patency significantly increased after 2005 (p=0.005). Cox regression analysis revealed only age as a significant predictor of sustained primary patency (HR 0.60, p<0.005). Any previous endovascular intervention (HR 2.52, p=0.02) was the main predictor for loss of secondary patency; history of cardiovascular disease (HR 0.27, p=0.04) was the main predictor of sustained secondary patency. CONCLUSION The kissing stent technique has a good safety profile and acceptable patency rates up to 2 years, even in TASC C and D lesions, supporting an endovascular-first approach for AIOD.
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Affiliation(s)
- Erik Groot Jebbink
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.,2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands.,3 Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Suzanne Holewijn
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel Versluis
- 2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands.,3 Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Frederike Grimme
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jan Willem Hinnen
- 4 Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Sebastian Sixt
- 5 Cardiovascular Center, Hamburg University, Hamburg, Germany
| | - John F Angle
- 6 Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Walter Dorigo
- 7 Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy
| | - Michel M P J Reijnen
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.,2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands
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Polzin A, Dannenberg L, Naguib D, Achilles A, Mourikis P, Zako S, Helten C, Konsek D, M'pembele R, Hohlfeld T, Kelm M, Zeus T, Sixt S, Albert A, Hoffmann T. P4189Effects of coagulase reaction on aggregation in patients with endocarditis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Polzin
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - L Dannenberg
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - D Naguib
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - A Achilles
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - P Mourikis
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - S Zako
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - C Helten
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - D Konsek
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - R M'pembele
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - T Hohlfeld
- Heinrich-Heine-University, Institute of Pharmacology and Clinical Pharmacology, Düsseldorf, Germany
| | - M Kelm
- Heinrich-Heine-University, CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - T Zeus
- Heinrich-Heine-University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - S Sixt
- Heinrich-Heine-University, Medical Center, Department of Anesthesiology, Düsseldorf, Germany
| | - A Albert
- Heinrich-Heine-University, Medical Center, Clinic for Cardiovascular Surgery, Düsseldorf, Germany
| | - T Hoffmann
- Heinrich-Heine-University, Medical Center, Transfusion Medicine and Clinical Hemostaseology, Düsseldorf, Germany
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10
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Schürch KA, Sixt S, Jeanneret C, Canova CR. Update über die aktuelle Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (pAVK). Therapeutische Umschau 2018; 75:478-488. [DOI: 10.1024/0040-5930/a001028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Die Prävalenz der peripheren arteriellen Verschlusskrankheit (pAVK) steigt mit zunehmendem Alter an und nimmt aufgrund der demographischen Entwicklung insgesamt zu. Die Symptome schränken die Lebensqualität ein. Die 5-Jahresmortalität der pAVK-Patienten ist doppelt so hoch wie bei Patienten ohne pAVK und liegt höher als diejenige von Patienten mit einer isolierten koronaren oder zerebrovaskulären Verschlusskrankheit. Die Diagnosestellung ist bereits klinisch (Pulspalpation) oder mit einfachen apparatetechnischen Mitteln (Knöchel-Arm-Index = Ankle-Brachial-Index (ABI)) durch jeden Arzt zur Diagnosestellung – nicht zum Ausschluss – möglich. Fachärztliche Zusatzuntersuchungen sollen stufenweise eingesetzt werden. Die Behandlung der PAVK ist stadienabhängig. Wichtigster Therapiepfeiler in allen Stadien der pAVK ist die Behandlung der kardiovaskulären Risikofaktoren mit strengen Ziel-Blutdruck und Zielcholesterinwerten für diese Hochrisikopatienten. Zusätzlich stehen Antiaggregations- und Antikoagulationsmöglichkeiten zur Diskussion. Als aktive Massnahmen wie das konservative Gehtraining sind heute kathetertechnische Verfahren häufig Therapie der ersten Wahl. Zudem steigt auch die Zahl kombinierter chirurgisch-kathetertechnischer Verfahren, sog. Hybrideingriffe. Gute Indikationen für chirurgische Verfahren stellen weiterhin langstreckige femorale bis popliteale Verschlüsse bei operablen jüngeren Patienten und Verschlussprozesse in der Femoralbifurkation dar. Die invasive Therapiewahl soll interdisziplinär getroffen werden.
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Zeller T, Langhoff R, Rocha-Singh KJ, Jaff MR, Blessing E, Amann-Vesti B, Krzanowski M, Peeters P, Scheinert D, Torsello G, Sixt S, Tepe G. Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004848. [PMID: 28916599 PMCID: PMC5610565 DOI: 10.1161/circinterventions.116.004848] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Background— Studies assessing drug-coated balloons (DCB) for the treatment of femoropopliteal artery disease are encouraging. However, challenging lesions, such as severely calcified, remain difficult to treat with DCB alone. Vessel preparation with directional atherectomy (DA) potentially improves outcomes of DCB. Methods and Results— DEFINITIVE AR study (Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency—A Pilot Study of Anti-Restenosis Treatment) was a multicenter randomized trial designed to estimate the effect of DA before DCB to facilitate the development of future end point-driven randomized studies. One hundred two patients with claudication or rest pain were randomly assigned 1:1 to DA+DCB (n=48) or DCB alone (n=54), and 19 additional patients with severely calcified lesions were treated with DA+DCB. Mean lesion length was 11.2±4.0 cm for DA+DCB and 9.7±4.1 cm for DCB (P=0.05). Predilation rate was 16.7% for DA+DCB versus 74.1% for DCB; postdilation rate was 6.3% for DA+DCB versus 33.3% for DCB. Technical success was superior for DA+DCB (89.6% versus 64.2%; P=0.004). Overall bail-out stenting rate was 3.7%, and rate of flow-limiting dissections was 19% for DCB and 2% for DA+DCB (P=0.01). One-year primary outcome of angiographic percent diameter stenosis was 33.6±17.7% for DA+DCB versus 36.4±17.6% for DCB (P=0.48), and clinically driven target lesion revascularization was 7.3% for DA+DCB and 8.0% for DCB (P=0.90). Duplex ultrasound patency was 84.6% for DA+DCB, 81.3% for DCB (P=0.78), and 68.8% for calcified lesions. Freedom from major adverse events at 1 year was 89.3% for DA+DCB and 90.0% for DCB (P=0.86). Conclusions— DA+DCB treatment was effective and safe, but the study was not powered to show significant differences between the 2 methods of revascularization in 1-year follow-up. An adequately powered randomized trial is warranted. Clinical Trial Registration— http://www.clinicaltrials.gov. Unique Identifier: NCT01366482.
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Affiliation(s)
- Thomas Zeller
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe).
| | - Ralf Langhoff
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Krishna J Rocha-Singh
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Michael R Jaff
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Erwin Blessing
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Beatrice Amann-Vesti
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Marek Krzanowski
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Patrick Peeters
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Dierk Scheinert
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Giovanni Torsello
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Sebastian Sixt
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Gunnar Tepe
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
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Weber A, Lageveen L, Lee Y, Rellecke P, Assmann A, Sixt S, Horn P, Cortese-Krott M, Albert A, Lichtenberg A, Akhyari P. Evaluation of Circulating Microparticles and Exosomes as Potential Biomarkers for Left Ventricular Hypertrophy in the Course of Aortic Valve Replacement. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Weber
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - L. Lageveen
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Y. Lee
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - P. Rellecke
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - A. Assmann
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - S. Sixt
- Clinic for Anesthesiology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - P. Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - M. Cortese-Krott
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - A. Albert
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - A. Lichtenberg
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - P. Akhyari
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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Weber A, Cardone L, Liu S, Büttner A, Rellecke P, Sixt S, Lichtenberg A, Akhyari P. Evaluation of Circulating Exosomes to Predict Emerging Valve Prosthesis-patient Mismatches after Surgical Aortic Valve Replacement. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Weber
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - L. Cardone
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - S. Liu
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - A. Büttner
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - P. Rellecke
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - S. Sixt
- Clinic for Anesthesiology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - A. Lichtenberg
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - P. Akhyari
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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Weber A, Büttner A, Cardone L, Schmidt V, Rellecke P, Sixt S, Lichtenberg A, Akhyari P. Evaluation of OPN as a Marker to Predict Adverse Outcomes after Aortic Valve Replacement. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Weber
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - A. Büttner
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - L. Cardone
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - V. Schmidt
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - P. Rellecke
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - S. Sixt
- Clinic for Anesthesiology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - A. Lichtenberg
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - P. Akhyari
- Department of Cardiovascular Surgery, Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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Teichgräber U, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Thieme M, Blessing E, Treitl M, Lichtenberg M, von Flotow P, Vogel B, Werk M, Riambau V, Wienke A, Lehmann T, Sixt S. Erratum to: The effectiveness of the paclitaxel-coated Luminor® balloon catheter versus an uncoated balloon catheter in superficial femoral and popliteal arteries in preventing vessel restenosis or reocclusion: study protocol for a randomized controlled trial. Trials 2017; 18:193. [PMID: 28446251 PMCID: PMC5405525 DOI: 10.1186/s13063-017-1884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
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Krankenberg H, Zeller T, Ingwersen M, Schmalstieg J, Gissler HM, Nikol S, Baumgartner I, Diehm N, Nickling E, Müller-Hülsbeck S, Schmiedel R, Torsello G, Hochholzer W, Stelzner C, Brechtel K, Ito W, Kickuth R, Blessing E, Thieme M, Nakonieczny J, Nolte T, Gareis R, Boden H, Sixt S. Self-Expanding Versus Balloon-Expandable Stents for Iliac Artery Occlusive Disease. JACC Cardiovasc Interv 2017; 10:1694-1704. [DOI: 10.1016/j.jcin.2017.05.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 01/18/2023]
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Kamiya H, Akhyari P, Minol JP, Ites AC, Weinreich T, Sixt S, Rellecke P, Boeken U, Albert A, Lichtenberg A. Simple technique of repair for Barlow syndrome with posterior resection and chordal transfer via minimally invasive approach: primary experience in a consecutive series of 22 patients. Gen Thorac Cardiovasc Surg 2017; 65:374-380. [DOI: 10.1007/s11748-017-0767-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
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Boeken U, Akhyari P, Weber A, Lee Y, Sixt S, Rellecke P, Lichtenberg A. Rapid Deployment Aortic Valve Replacement via Partial Sternotomy: A Reasonable Option in Times of TAVI? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- U. Boeken
- Kardiovaskuläre Chirurgie, Uni-Klinik Düsseldorf, Düsseldorf, Germany
| | - P. Akhyari
- Kardiovaskuläre Chirurgie, Uni-Klinik Düsseldorf, Düsseldorf, Germany
| | - A. Weber
- Kardiovaskuläre Chirurgie, Uni-Klinik Düsseldorf, Düsseldorf, Germany
| | - Y.M. Lee
- Kardiovaskuläre Chirurgie, Uni-Klinik Düsseldorf, Düsseldorf, Germany
| | - S. Sixt
- Anästhesiologie, Uni-Klinik Düsseldorf, Düsseldorf, Germany
| | - P. Rellecke
- Kardiovaskuläre Chirurgie, Uni-Klinik Düsseldorf, Düsseldorf, Germany
| | - A. Lichtenberg
- Kardiovaskuläre Chirurgie, Uni-Klinik Düsseldorf, Düsseldorf, Germany
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Weber A, Liu S, Lageveen L, Rellecke P, Assmann A, Sixt S, Akhyari P, Lichtenberg A. Evaluation of Circulating Exosomes as a Potential Biomarker in the Setting of Surgical Aortic Valve Replacement. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Weber
- Cardiovascular Surgery, Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - S.S. Liu
- Cardiovascular Surgery, Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - L. Lageveen
- Cardiovascular Surgery, Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - P. Rellecke
- Clinic for Anesthesiology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - A. Assmann
- Cardiovascular Surgery, Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - S. Sixt
- Clinic for Anesthesiology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - P. Akhyari
- Cardiovascular Surgery, Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - A. Lichtenberg
- Cardiovascular Surgery, Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Assmann A, Albert A, Dierksen A, Roussel E, Sixt S, Lichtenberg A, Hoffmann T. Very Low-Dose Recombinant Activated Factor VIIa: A Paradigm Shift in Major Bleeding Therapy? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Assmann
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - A. Albert
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - A. Dierksen
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - E. Roussel
- Heinrich Heine University, Medical Faculty, Institute of Haemostaseology, Haemotherapy and Transfusion Medicine, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - S. Sixt
- Heinrich Heine University, Medical Faculty, Department of Anaesthesiology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - A. Lichtenberg
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - T. Hoffmann
- Heinrich Heine University, Medical Faculty, Institute of Haemostaseology, Haemotherapy and Transfusion Medicine, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
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Teichgräber U, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Thieme M, Blessing E, Treitl M, Lichtenberg M, von Flotow P, Vogel B, Werk M, Riambau V, Wienke A, Lehmann T, Sixt S. The effectiveness of the paclitaxel-coated Luminor® balloon catheter versus an uncoated balloon catheter in superficial femoral and popliteal arteries in preventing vessel restenosis or reocclusion: study protocol for a randomized controlled trial. Trials 2016; 17:528. [PMID: 27793175 PMCID: PMC5084407 DOI: 10.1186/s13063-016-1657-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this investigator-initiated trial is to evaluate the safety and efficacy of the novel Luminor® paclitaxel-coated drug-eluting balloon (DEB) catheter (iVascular, S.L.U., Barcelona, Spain) in inhibiting restenosis and in ensuring long-term vascular patency. METHODS/DESIGN This is a multicenter randomized controlled trial to evaluate the Luminor® paclitaxel-coated DEB catheter for stenotic or occlusive lesions (length ≤15 cm) in the superficial femoral artery (SFA) and the popliteal artery (PA) up to the P1 segment compared to the noncoated, plain old balloon angioplasty (POBA) catheter. In total 172 subjects will be treated with either the DEB catheter or the POBA catheter in 11 German study centers in a 1:1 randomization study design. The primary endpoint is late lumen loss (LLL) at 6 months. Secondary endpoints are patency rate, target lesion/vessel revascularization, quality of life (assessed with the Walking Impairment Questionnaire (WIQ) and the EQ-5D), change of Rutherford stage and ankle-brachial index, major and minor amputation rate at the index limb, number of dropouts and all-cause mortality. DISCUSSION EffPac represents a randomized controlled trial that will provide evidence on the effectiveness of the Luminor® paclitaxel-coated DEB catheter for the reduction of restenosis compared to the POBA catheter for the SFA and the PA. The results of EffPac will allow direct comparison to other already-completed RCTs applying paclitaxel-coated DEBs from different manufacturers with different coating technologies in the same target vessel. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02540018 , registered on 17 August 2015. Protocol version: CIP Version Final04, 11 February 2016. EUDAMED No: CIV-15-03-013204.
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Affiliation(s)
- U Teichgräber
- Universitätsklinikum Jena, Institut für Diagnostische und Interventionelle Radiologie, Am Klinikum 1, 07747, Jena, Germany.
| | - R Aschenbach
- Universitätsklinikum Jena, Institut für Diagnostische und Interventionelle Radiologie, Am Klinikum 1, 07747, Jena, Germany
| | - D Scheinert
- Universitätsklinikum Leipzig, Abteilung für Interventionelle Angiologie, Philipp-Rosenthal-Straße 27 C, 04103, Leipzig, Germany
| | - T Zeller
- Herzzentrum Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - K Brechtel
- Ihre-Radiologen Berlin Gemeinschaftspraxis für Radiologie, Budapester Straße 15-19, 13347, Berlin, Germany
| | - M Thieme
- Medinos Kliniken Sonneberg Angiologie/Kardiologie/Diabetologie, Neustadter Str. 61, 96515, Sonneberg, Germany
| | - E Blessing
- SRH Klinikum Karlsbad-Langensteinbach, Guttmannstr. 1, 76307, Karlsbad, Germany
| | - M Treitl
- Klinikum der Ludwig Maximilians Universität München - Campus Innenstadt, Institut für Klinische Radiologie, Pettenkoferstraße 8a, 80336, München, Germany
| | - M Lichtenberg
- Klinikum Arnsberg Angiologie, Stolte Ley 5, 59759, Arnsberg, Germany
| | - P von Flotow
- Westpfalz-Klinikum GmbH Standort II Kusel, Im Flur 1, 66869, Kusel, Germany
| | - B Vogel
- Ruprecht-Karls-Universität Heidelberg, Analysezentrum III/Innere Medizin III, Im Neuenheimer Feld 669, 69120, Heidelberg, Germany
| | - M Werk
- Martin-Luther-Krankenhausbetrieb GmbH, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - V Riambau
- Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - A Wienke
- Martin-Luther-Universität Halle-Wittenberg, Institut für Medizinische Epidemiologie, Biometrie und Informatik, 06097, Halle (Saale), Germany
| | - T Lehmann
- Universitätsklinikum Jena, Zentrum für Klinische Studien (ZKS), Postfach, 07740, Jena, Germany
| | - S Sixt
- Angiologikum Hamburg, Wördemanns Weg 25-27, 22527, Hamburg, Germany
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Steidle-Kloc E, Schönfelder M, Müller E, Sixt S, Schuler G, Patsch W, Niebauer J. Does exercise training impact clock genes in patients with coronary artery disease and type 2 diabetes mellitus? Eur J Prev Cardiol 2016; 23:1375-82. [DOI: 10.1177/2047487316639682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/27/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Eva Steidle-Kloc
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
| | - Martin Schönfelder
- Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Austria
| | - Edith Müller
- Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Austria
| | | | - Gerhard Schuler
- Heart Center, Department of Cardiology, University of Leipzig, Germany
| | - Wolfgang Patsch
- Institute of Pharmacology and Toxicology, Paracelsus Medical University, Salzburg, Austria
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
- Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Austria
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Zeller T, Sixt S, Schwarzwälder U, Schwarz T, Frank U, Bürgelin K, Pochert V, Müller C, Noory E, Krankenberg H, Hauswald K, Neumann FJ, Rastan A. Two-Year Results after Directional Atherectomy of Infrapopliteal Arteries with the SilverHawk Device. J Endovasc Ther 2016; 14:232-40. [PMID: 17484535 DOI: 10.1177/152660280701400216] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the 12- and 24-month results after directional atherectomy (DA) of below-the-knee (BTK) arterial lesions with the SilverHawk device. Methods: Forty-nine BTK lesions in 36 patients (58% men; mean age 70611 years) with peripheral occlusive disease of the lower limbs were treated with DA; 19 (53%) of the limbs were classified with Rutherford-Becker 4 or 5 ischemia. Target lesions were in the popliteal artery (n=6, 12%), tibioperoneal trunk (n=25, 51%), peroneal artery (n=10, 20%), anterior tibial artery (n=5, 10%), and posterior tibial artery (n=3, 6%). Nine (18%) lesions were located in a stent. Twelve lesions extended to 2 artery segments. The average degree of diameter stenosis was 89%±10% (range 70%–100%); there were 11 (22%) occlusions. The mean lesion length was 48±28 mm. Results: Sixteen (33%) lesions were treated after predilation; 33 (67%) lesions were treated with primary DA. All but 1 (2%) lesion could be treated with DA. In 19 (39%) lesions, additional balloon angioplasty was performed, and 2 (4%) lesions required stent implantation as a result of dissection. The mean stenosis diameter after DA was 12%±18% (range 0%–100%). After additional therapy, the mean stenosis diameter was 8%±9% (range 0%–100%). A residual stenosis ≤30% was achieved in 48 (98%) lesions. The mean ankle-brachial index significantly increased from 0.48±0.26 to 0.81±0.32 (p<0.05) before discharge and remained improved during follow-up. Primary and secondary patency rates were 67% and 91% after 1 year and 60% and 80% after 24 months. The 12-and 24-month cumulative event-free survival rates (primary patency) by Kaplan-Meier analysis were 58%±8% and 46%±9%; at the same time intervals, the cumulative survival rates (secondary patency) were 88%±6% and 73%±9%, respectively. Conclusion: BTK lesions can be treated successfully and safely with DA. Midterm clinical results are encouraging.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Heart Center Bad Krozingen, Germany.
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Scheinert D, Schmidt A, Zeller T, Müller-Hülsbeck S, Sixt S, Schröder H, Weiss N, Ketelsen D, Ricke J, Steiner S, Rosenfield K. German Center Subanalysis of the LEVANT 2 Global Randomized Study of the Lutonix Drug-Coated Balloon in the Treatment of Femoropopliteal Occlusive Disease. J Endovasc Ther 2016; 23:409-16. [DOI: 10.1177/1526602816644592] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report a subanalysis of the German centers enrolling patients in the prospective, global, multicenter, randomized LEVANT 2 pivotal trial ( ClinicalTrials.gov identifier NCT01412541) of the Lutonix drug-coated balloon (DCB) for the treatment of femoropopliteal occlusive disease. Methods: Among the 476 patients in LEVANT 2, 126 patients (mean age 67.1±9.6 years; 79 men) were enrolled at the 8 participating German sites between August 2011 and July 2012 and were randomized 2:1 to treatment with the Lutonix DCB (n=83) vs an uncoated balloon during percutaneous transluminal angioplasty (PTA, n=43). All patients had intermittent claudication or rest pain (Rutherford categories 2–4). Average lesion length was 58 mm and average treated length was 100 mm. Severe calcification was present in 11% of lesions, and 23% were total occlusions. The efficacy outcome was primary patency at 12 months, and the safety outcome was 12-month freedom from a composite of perioperative death, index limb–related death, amputation (below or above the ankle), and index limb revascularization. Secondary endpoints included target lesion revascularization (TLR), major adverse events, and functional outcomes. Results: Demographic, clinical, and lesion characteristics were matched between Lutonix DCB and PTA groups, as were the final percent diameter stenosis (19%) and procedure success (91%). By Kaplan-Meier analysis, the 12-month primary patency rate was 80% vs 58% (p=0.015) and the composite safety endpoint rate was 94% vs 72% (p=0.001), respectively. Freedom from TLR was higher for DCBs (96%) vs PTA (82%, p=0.012). Major adverse events were similar for both groups. The benefit favoring DCB over PTA was observed in German men and women. Compared to the non-German LEVANT 2 cohort, there was a shorter time between insertion and inflation of treatment balloons (21.8 vs 39.5 seconds, p<0.001) in the German cohort. Balloons were inflated to higher pressures (9.0 vs 7.7 atm, p<0.001) but for a shorter period of time (130 vs 167 seconds, p<0.001), and although treated lesions in the German cohort had a higher baseline stenosis, final postprocedure diameter stenosis was lower (19% vs 22%, p=0.04) than in the non-German patients. Conclusion: Superiority of DCB over PTA in the German cohort of LEVANT 2 was demonstrated for primary patency, composite safety, and freedom from TLR. The benefit of DCB was also consistent for both genders. Geographic or regional differences in procedural variables may account for the different outcomes between the German and non-German cohorts.
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Affiliation(s)
- Dierk Scheinert
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | - Andrej Schmidt
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | - Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | | | - Sebastian Sixt
- Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Henrik Schröder
- Center for Diagnostic Radiology and Minimally Invasive Therapy, Jewish Hospital, Berlin, Germany
| | - Norbert Weiss
- Center for Vascular Medicine, Universitaetsklinikum Carl Gustav Carus, Dresden, Germany
| | - Dominik Ketelsen
- Deptartment of Diagnostic & Interventional Radiology, University of Tuebingen, Germany
| | - Jens Ricke
- Clinic for Radiology and Nuclear Medicine, University Magdeburg, Germany
| | - Sabine Steiner
- Division of Interventional Angiology, University Hospital Leipzig, Germany
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Krankenberg H, Tübler T, Ingwersen M, Schlüter M, Scheinert D, Blessing E, Sixt S, Kieback A, Beschorner U, Zeller T. Drug-Coated Balloon Versus Standard Balloon for Superficial Femoral Artery In-Stent Restenosis: The Randomized Femoral Artery In-Stent Restenosis (FAIR) Trial. Circulation 2015; 132:2230-6. [PMID: 26446728 DOI: 10.1161/circulationaha.115.017364] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug-coated balloon angioplasty (DCBA) was shown to be superior to standard balloon angioplasty (POBA) in terms of restenosis prevention for de novo superficial femoral artery disease. For in-stent restenosis, the benefit of DCBA over POBA remains uncertain. METHODS AND RESULTS One hundred nineteen patients with superficial femoral artery in-stent restenosis and chronic limb ischemia were recruited over 34 months at 5 German clinical sites and prospectively randomized to either DCBA (n=62) or POBA (n=57). Mean lesion length was 82.2±68.4 mm. Thirty-four (28.6%) lesions were totally occluded; 30 (25.2%) were moderately or heavily calcified. Clinical and duplex ultrasound follow-up was conducted at 6 and 12 months. The primary end point of recurrent in-stent restenosis assessed by ultrasound at 6 months was 15.4% (8 of 52) in the DCBA and 44.7% (21 of 47) in the POBA group (P=0.002). Freedom from target lesion revascularization was 96.4% versus 81.0% (P=0.0117) at 6 months and 90.8% versus 52.6% (P<0.0001) at 12 months, respectively. At 12 months, clinical improvement by ≥1 Rutherford category without the need for target lesion revascularization was observed in 35 of 45 DCBA patients (77.8%) and 23 of 44 POBA patients (52.3%; P=0.015). No major amputation was needed. Two patients in the DCBA and 3 patients in the POBA group died. No death was procedure related. CONCLUSIONS DCBA for superficial femoral artery in-stent restenosis is associated with less recurrent restenosis and a better clinical outcome than POBA without an apparent difference in safety. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01305070.
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Affiliation(s)
- Hans Krankenberg
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.).
| | - Thilo Tübler
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Maja Ingwersen
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Michael Schlüter
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Dierk Scheinert
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Erwin Blessing
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Sebastian Sixt
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Arne Kieback
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Ulrich Beschorner
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
| | - Thomas Zeller
- From the Department of Angiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany (H.K., M.I.); Medtronic, Meerbusch, Germany (T.T.); Asklepios Proresearch, Hamburg, Germany (M.S.); University of Leipzig Heart Center, Leipzig, Germany (D.S.); Department of Internal Medicine, SHR Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany (E.B.); Hamburg University Cardiovascular Center, Hamburg, Germany (S.S.); Department of Angiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.K.); and Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany (U.B., T.Z.)
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Macharzina RR, Schmid SF, Beschorner U, Noory E, Rastan A, Vach W, Schwarzwälder U, Sixt S, Bürgelin K, Neumann FJ, Zeller T. Duplex Ultrasound Assessment of Native Stenoses in the Superficial Femoral and Popliteal Arteries. J Endovasc Ther 2015; 22:254-60. [DOI: 10.1177/1526602815576094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate duplex ultrasonography (DUS) in the assessment of femoropopliteal stenoses comparing a single native stenosis (SNS) to multisegmental native stenoses (MNS). Methods: Among the 1284 patients treated for atherosclerotic occlusive disease involving the femoropopliteal segment between November 2002 and November 2012, 139 patients (97 men; mean age 68±8 years) with 142 SNS or 143 MNS in 79 and 60 patients, respectively, were eligible for this retrospective analysis. The peak systolic velocity ratios with proximal (PSVRprox) and distal (PSVRdist) reference for the 285 lesions were compared with their respective angiographic stenosis grade as measured by 2 independent readers using quantitative vascular analysis to ensure objectivity. Receiver operating characteristic curve analysis was used to evaluate sensitivity, specificity, and the optimal thresholds of PSV and PSVR for detection of stenoses by grade (>50%, >70%, or >80% diameter stenosis). The area under the curve (AUC) values of dependent and independent receiver operating characteristic curves were compared. Results: For SNS, correlation of PSVRprox to diameter stenosis (R=0.88) was higher (p<0.001) than the correlation for MNS (R=0.78). In the SNS group, the AUC for detecting a >50% (0.99±0.01), >70% (0.98±0.01), and >80% (0.96±0.01) stenosis with PSVRprox was significantly higher than in the MNS group [AUC50% 0.93±0.02 (p=0.01), AUC70% 0.92±0.02 (p=0.02), and AUC80% 0.87±0.03 (p=0.003)]. The optimal thresholds for detecting >50%, >70%, and >80% stenoses for SNS using PSVRprox were 2.6, 3.3, and 3.9, respectively. For MNS, the optimal thresholds of PSVRprox were 2.6, 3.4, and 3.9, respectively, with respective sensitivities of 87%, 81%, and 75%; respective specificities of 93%, 90%, and 82%; negative predictive values of 45%, 64%, and 74%; and positive predictive values of 99%, 95%, and 83%. Conclusion: DUS is an optimal tool for quantification of SNS. However, a multisegment setting has a significant negative impact on the quantification of femoropopliteal artery stenosis.
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Affiliation(s)
| | - Simon F. Schmid
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ulrich Beschorner
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Elias Noory
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Aljoscha Rastan
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Werner Vach
- Center for Medical Biometry and Medical Informatics, University Freiburg, Germany
| | - Uwe Schwarzwälder
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Sebastian Sixt
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | - Thomas Zeller
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Krankenberg H, Tübler T, Sixt S, Fischer M, Schmiedel R, Schulte KL, Balzer JO, Kieback A, Fiehn E, Wittenberg G, Ali T, Tiefenbacher C, Jahnke T, Steinkamp HJ, Wegscheider K, Treszl A, Ingwersen M, Zeller T. German Multicenter Real-World Registry of Stenting for Superficial Femoral Artery Disease: Clinical Results and Predictive Factors for Revascularization. J Endovasc Ther 2014; 21:463-71. [DOI: 10.1583/13-4625r.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hoffmann T, Dücker C, Albert A, Rellecke P, Lichtenberg A, Scharf R, Sixt S. C0511: Cardiac Surgery: Another Example for the Multilinguality of D-dimers. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Linnemann B, Sutter T, Herrmann E, Sixt S, Rastan A, Schwarzwaelder U, Noory E, Buergelin K, Beschorner U, Zeller T. Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease. J Am Coll Cardiol 2014; 63:1529-38. [DOI: 10.1016/j.jacc.2013.05.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/18/2013] [Accepted: 05/05/2013] [Indexed: 10/26/2022]
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Sixt S, Krankenberg H, Möhrle C, Kaspar M, Tübler T, Rastan A, Brechtel K, Macharzina R, Neumann FJ, Zeller T. Endovascular treatment for extensive aortoiliac artery reconstruction: a single-center experience based on 1712 interventions. J Endovasc Ther 2013; 20:64-73. [PMID: 23391085 DOI: 10.1583/12-4014.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the clinical and technical outcomes following endovascular therapy for aortoiliac occlusive disease, including complex reconstruction of the aortic bifurcation. METHODS A retrospective database search identified 1184 consecutive patients (864 men; mean age 64±10 years) who underwent 1712 procedures to treat target lesions in the distal aorta and iliac arteries from September 1996 to December 2006. The intended strategy was to open only one femoral access site primarily, so a second puncture was needed only for the kissing balloon technique at the aortic bifurcation. The primary endpoint was a 1-year duplex-based primary patency; secondary endpoints included acute technical success (residual stenosis <30%), secondary patency, and target lesion revascularization (TLR). Results were stratified by lesion morphology, which was classified according to the TransAtlantic Inter-Society Consensus (TASC II) document. RESULTS Most of the interventions were done in the iliac arteries (n=1337); 292 cases involved the aortic bifurcation, and 83 cases were in the distal aorta/aortic bifurcation. The mean follow-up was 3.24 years (range 0-12.7). In the entire study cohort, the 12- and 24-month restenosis, TLR, and primary/secondary patency rates did not differ among TASC II A-D subgroups. The symptom-driven TLR in the entire cohort was 8% and 9% at the 12- and 24-month follow-up, leading to secondary patency rates of 96% and 91% in the entire cohort. Outcomes for complex interventions in the distal aorta or aortic bifurcation did not differ significantly compared to the total cohort. The overall survival without restenosis, amputation, or surgery in TASC II subgroups A+B was higher (69.6%±1.5%) compared to TASC II C+D lesions (62.8%±1.9%, p=0.001). CONCLUSION The indication for percutaneous intervention in aortoiliac occlusive disease can be extended to complex TASC C and D lesions in experienced endovascular centers, even if complex reconstruction of the distal aorta or the aortic bifurcation is indicated.
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Affiliation(s)
- Sebastian Sixt
- Department of Angiology, Heart Center Bad Krozingen, Germany.
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Sixt S, Carpio Cancino OG, Treszl A, Beschorner U, Macharzina R, Rastan A, Krankenberg H, Neumann FJ, Zeller T. Drug-coated balloon angioplasty after directional atherectomy improves outcome in restenotic femoropopliteal arteries. J Vasc Surg 2013; 58:682-6. [PMID: 23755977 DOI: 10.1016/j.jvs.2013.02.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/14/2013] [Accepted: 02/12/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Restenosis remains an unresolved problem despite different treatment modalities and new stent technology in femoropopliteal arteries. No standard therapy has proven to provide acceptable outcome data for this entity. Directional atherectomy alone did not result in satisfactory long-term patency rates. The outcome might be improved in conjunction with drug-coated balloon angioplasty. METHODS In this retrospective study, restenotic lesions of the femoropopliteal arteries were treated with directed atherectomy in 89 lesions of consecutive patients (58% male; mean age, 69 ± 11 years). All patients received adjunctive treatment with conventional balloon percutaneous angioplasty (PTA; n = 60) or drug-coated balloon angioplasty (DCB; n = 29). RESULTS Lesion location was in the stent (DCB [n = 27] vs PTA [n = 36]) and in native restenotic vessels (DCB [n = 2] vs PTA [n = 25]). The 1-year Kaplan-Meier freedom from restenosis estimates (95% confidence intervals) in the DCB and PTA groups were 84.7% (70.9%-98.5%) and 43.8% (30.5%-57.1%), respectively. In a multivariable Cox model for restenosis, DCB treatment had a hazard ratio (95% confidence interval) of 0.28 (0.12-0.66; P = .0036) compared with the PTA group. In the multivariable model for procedural success, the effect of treatment did not differ between PTA and DCB (P = .134). CONCLUSIONS The combination of directed atherectomy with adjunctive DCB is associated with a better event-free survival at 12 months of follow-up compared with PTA after directed atherectomy.
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Affiliation(s)
- Sebastian Sixt
- Department of Angiology, Heart Center, Bad Krozingen, Germany.
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Zeller T, Schmidt A, Rastan A, Noory E, Brechtel K, Sixt S, Scheinert D, Tepe G. New Approach to Protected Percutaneous Transluminal Angioplasty in the Lower Limbs. J Endovasc Ther 2013; 20:409-19. [DOI: 10.1583/13-4221.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Beschorner U, Krankenberg H, Scheinert D, Sievert H, Tübler T, Sixt S, Noory E, Rastan A, Macharzina R, Zeller T. Rotational and aspiration atherectomy for infrainguinal in-stent restenosis. VASA 2013; 42:127-33. [PMID: 23485840 DOI: 10.1024/0301-1526/a000256] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND To report feasibility and safety of the Pathway PV™ Atherectomy System during percutaneous peripheral vascular interventions of in-stent restenosis. PATIENTS AND METHODS 33 patients (66.7 % men; mean age 68.7 years; 39.4 % diabetics) with symptomatic infrainguinal in-stent restenosis were enrolled at 5 study sites. Primary study endpoint was the 30-day serious adverse event (SAE) rate. At one study site a subgroup of 13 patients was scheduled for additional follow-up examinations with duplex. RESULTS Forty lesions with a mean lesion length of 85.7 mm (range 6 - 370 mm) were treated including total occlusions (20 %) and infrapopliteal lesions (5 %). In sixteen target lesions (40 %) procedural success was reached with atherectomy alone, 23 lesions (57.5 %) received adjunctive percutaneous transluminal angioplasty to obtain a sufficient angiographic result. Freedom from device-related SAEs was 100 %. Overall there were 11 unexpected adverse events in 11 patients, two of which were serious (retroperitoneal bleeding and access site infection). The ankle-brachial index increased significantly from 0.65 ± 0.13 at baseline to 0.82 ± 0.15 at 30 days. Mean Rutherford category improved from 2.8 ± 0.7 at baseline to 1.0 ± 1.2. In the subgroup with longer follow- up primary patency was 33 % after 12 months and 25 % after 24 months. Secondary patency was 92 % after 12 and 24 months. CONCLUSIONS The use of the Pathway PV™ System during percutaneous peripheral vascular interventions of in-stent restenosis appears to be feasible and safe but does not seem to offer a sustainable solution regarding long term patency. A combination with drug eluting balloon angioplasty could be an interesting option and should be evaluated in further clinical trials.
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Zeller T, Schmidt A, Rastan A, Noory E, Sixt S, Scheinert D. Re: "Initial experience with the 5×300-mm Proteus Embolic Capture Angioplasty balloon in the treatment of peripheral vascular disease". Reply. J Endovasc Ther 2013; 20:252-3. [PMID: 23581774 DOI: 10.1583/1545-1550-20.2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Krankenberg H, Bader R, Sixt S, Tübler T, Schwencke C, Kivelitz D, Rad A, Caspary M, Zeller T. Endovascular Repair of Ascending Aortic Aneurysm by Transapical Approach and Periscope Technique. J Endovasc Ther 2013; 20:13-7. [DOI: 10.1583/12-4082.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zeller T, Schmidt A, Rastan A, Noory E, Sixt S, Scheinert D. Initial Experience With the 5×300-mm Proteus Embolic Capture Angioplasty Balloon in the Treatment of Peripheral Vascular Disease. J Endovasc Ther 2012; 19:826-33. [DOI: 10.1583/jevt-12-3960mr.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rastan A, Brechtel K, Krankenberg H, Zahorsky R, Tepe G, Noory E, Schwarzwälder U, Macharzina R, Schwarz T, Bürgelin K, Sixt S, Tübler T, Neumann FJ, Zeller T. Sirolimus-eluting stents for treatment of infrapopliteal arteries reduce clinical event rate compared to bare-metal stents: long-term results from a randomized trial. J Am Coll Cardiol 2012; 60:587-91. [PMID: 22878166 DOI: 10.1016/j.jacc.2012.04.035] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/12/2012] [Accepted: 04/16/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The study investigated the long-term clinical impact of sirolimus-eluting stents (SES) in comparison with bare-metal stents (BMS) in treatment of focal infrapopliteal lesions. BACKGROUND There is evidence that SES reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. No data from randomized trials are available concerning the clinical impact of this finding during long-term follow-up. METHODS The study extended the follow-up period of a prospective, randomized, multicenter, double-blind trial comparing polymer-free SES with placebo-coated BMS in the treatment of focal infrapopliteal de novo lesions. The main study endpoint was the event-free survival rate defined as freedom from target limb amputation, target vessel revascularization, myocardial infarction, and death. Secondary endpoints include amputation rates, target vessel revascularization, and changes in Rutherford-Becker class. RESULTS The trial included 161 patients. The mean target lesion length was 31 ± 9 mm. Thirty-five (23.3%) patients died during a mean follow-up period of 1,016 ± 132 days. The event-free survival rate was 65.8% in the SES group and 44.6% in the BMS group (log-rank p = 0.02). Amputation rates were 2.6% and 12.2% (p = 0.03), and target vessel revascularization rates were 9.2% and 20% (p = 0.06), respectively. The median (interquartile range) improvement in Rutherford-Becker class was -2 (-3 to -1) in the SES group and -1 (-2 to 0) in the BMS group, respectively (p = 0.006). CONCLUSIONS Long-term event-free survival, amputation rates, and changes in Rutherford-Becker class after treatment of focal infrapopliteal lesions are significantly improved with SES in comparison with BMS. (YUKON-Drug-Eluting Stent Below the Knee-Randomised Double-Blind Study [YUKON-BTX]; NCT00664963).
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Affiliation(s)
- Aljoscha Rastan
- Angiologie, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
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Kaempf M, Ketelsen D, Syha R, Sixt S, Mangold S, Thomas C, Claussen CD, Heuschmid M, Brechtel K. CT angiography of various superficial femoral artery stents: An in vitro phantom study. Eur J Radiol 2012; 81:1584-8. [PMID: 21546182 DOI: 10.1016/j.ejrad.2011.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 04/06/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Kaempf
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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Schmalstieg J, Zeller T, Tübler T, Sixt S, Schwencke C, Sandstede J, Krankenberg H. Long term data of endovascularly treated patients with severe and complex aortoiliac occlusive disease. J Cardiovasc Surg (Torino) 2012; 53:291-300. [PMID: 22695261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM This paper presents the recent data of the largest series (20 patients) of endovascularly treated patients and the first long term data of 9 patients with severe aortoiliac occlusive disease. METHODS Between 2003 and 2012, 20 consecutive patients (14 men; 70 %) with Leriche syndrome underwent recanalization with solely endovascular means at our centre. The treatment strategy comprised the antegrade (transbrachial) recanalization of the occluded segments followed by retrograde (transfemoral) angioplasty with selective stent placement in the infrarenal aorta and primary stent placement in the iliac arteries. Before discharge, after 30 days and every year after the procedure, a clinical, as well as a duplex ultrasonographic examination including measurement of the ankle-brachial index was done. RESULTS Bilateral success was achieved in 17 patients (85%). Unilateral success was achieved in three patients (15%). In one patient (5%) an early reocclusion of the stented segments occurred, necessitating bypass grafting. In nine patients long term data were evaluated. Here, the ankle brachial index (ABI) significantly increased (0.85 ± 0.15 vs. 0.51 ± 0.11 at baseline; P=0.002). Compared to baseline, the difference in the distribution of Rutherford category and the improvement of walking capacity were statistically significant (P=0.0006, P=0.01, respectively). CONCLUSION This study shows the feasibility of solely endovascular management of severe aortoiliac occlusive disease with a high rate of success and low rate of complications. Significant clinical improvement of patients in long term follow up makes the endovascular approach a viable alternative to open surgery.
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Affiliation(s)
- J Schmalstieg
- Medical Care Center Prof. Mathey, Prof. Schofer, MVZ Mathey Schofer, Hamburg, Germany.
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Zeller T, Kambara AM, Moreira SM, Atar E, Chulsky A, Turgeman Y, Sixt S, Tepe G, Rastan A, Buchbinder M. Recanalization of Femoropopliteal Chronic Total Occlusions Using the ENABLER-P Balloon Catheter System. J Endovasc Ther 2012; 19:131-9. [DOI: 10.1583/11-3664.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rastan A, Tepe G, Krankenberg H, Zahorsky R, Beschorner U, Noory E, Sixt S, Schwarz T, Brechtel K, Böhme C, Neumann FJ, Zeller T. Sirolimus-eluting stents vs. bare-metal stents for treatment of focal lesions in infrapopliteal arteries: a double-blind, multi-centre, randomized clinical trial. Eur Heart J 2011; 32:2274-81. [PMID: 21622669 DOI: 10.1093/eurheartj/ehr144] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS Preliminary reports indicate that sirolimus-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. We conducted a prospective, randomized, multi-centre, double-blind trial comparing a polymer-free sirolimus-eluting stent with a placebo-coated bare-metal stent in patients with either intermittent claudication or critical limb ischaemia who had a de-novo lesion in an infrapopliteal artery. METHODS AND RESULTS 161 patients were included in this trial. The mean target lesion length was 31 ± 9 mm. The main study endpoint was the 1-year primary patency rate, defined as freedom from in-stent-restenosis (luminal narrowing of ≥50%) detected with duplex ultrasound if not appropriate with angiography. Secondary endpoints included the 6-month primary patency rate, secondary patency rate, and changes in Rutherford-Becker classification after 1 year. Twenty-five (15.5%) patients died during the follow-up period. One hundred and twenty-five patients reached the 1-year examinations. The 1-year primary patency rate was significantly higher in the sirolimus-eluting stent group (80.6%) than in the bare-metal stent group (55.6%, P= 0.004), and the 1-year secondary patency rates were 91.9 and 71.4% (P= 0.005), respectively. The median (interquartile range) change in Rutherford-Becker classification after 1 year was -2 (-3 to -1) in the sirolimus-eluting stent group and -1 (-2 to 0) in the bare-metal stent group, respectively (P= 0.004). CONCLUSION Mid-term patency rates of focal infrapopliteal lesions are substantially improved with sirolimus-eluting stent compared with bare-metal stent. Corresponding to the technical results, the changes in Rutherford-Becker classification reveal a significant advantage for the sirolimus-eluting stent.
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Affiliation(s)
- Aljoscha Rastan
- Abteilung Angiologie, Herz-Zentrum Bad Krozingen, Südring 15, Bad Krozingen, Germany.
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Sixt S, Rastan A, Scheinert D, Krankenberg H, Steinkamp H, Schmidt A, Sievert H, Minar E, Bosiers M, Peeters P, Balzer JO, Tübler T, Wissgott C, Cancino OGC, Schwarzwälder U, Zeller T. The 1-Year Clinical Impact of Rotational Aspiration Atherectomy of Infrainguinal Lesions. Angiology 2011; 62:645-56. [DOI: 10.1177/0003319711403300] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study was carried out to provide information about outcome of the Jetstream atherectomy device for treatment of infrainguinal arteries. From February 2006 to February 2007, 172 patients with Rutherford class 1 to 5 lower limb ischemia were enrolled at 9 study sites. The endpoints were evaluation of quality of life according to the walking impairment questionnaire (WIQ) besides technical parameters. In the total study cohort, the WIQ scale maintained improved up to 12-month follow-up. Furthermore, target lesion revascularization rate was 26% (42/162), ankle-brachial index (ABI) increased from 0.59 ± 0.21 at baseline to 0.82 ± 0.27 ( P < 0.05), and mean Rutherford class dropped from 3.0 ± 0.9 at baseline to 1.5 ± 1.3 at 1 year ( P < .05). The results of this prospective, multicenter, clinical study demonstrate that the Jetstream atherectomy device is a potential treatment alternative for the endovascular management to improve clinical outcome in patients with peripheral arterial occlusive disease.
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Affiliation(s)
- Sebastian Sixt
- Department of Angiology, Heart-Centre Bad Krozingen, Germany
| | - Aljoscha Rastan
- Department of Angiology, Heart-Centre Bad Krozingen, Germany
| | - Dierk Scheinert
- Department of Angiology, Heart Centre & Park Clinic, Leipzig, Germany
| | | | | | - Andrej Schmidt
- Department of Angiology, Heart Centre & Park Clinic, Leipzig, Germany
| | - Horst Sievert
- Cardio-vascular Centre Department, CardioVascular Center Clinic, Frankfurt, Germany
| | - Erich Minar
- Department of Angiology, University Hospital Wien, Austria
| | - Marc Bosiers
- Department of Vascular and Endovascular Surgery, AZ Sint-Blasius Dendermonde, Belgium
| | - Patrick Peeters
- Department of Vascular and Endovascular Surgery, Imelda Cardiovascular Center, Bonheiden, Belgium
| | - Jörn O. Balzer
- Department of Radiology, University Hospital Frankfurt, Germany
| | - Thilo Tübler
- Cardiovascular University Centre, Hamburg, Germany
| | | | | | | | - Thomas Zeller
- Department of Angiology, Heart-Centre Bad Krozingen, Germany
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Cai M, Sixt S, Bonella F, Anlasik T, Mori T, Guzman J, Costabel U. Up-regulated expression of immunoproteasome subunit LMP7 in alveolar macrophages of hypersensitivity pneumonitis. Pneumologie 2011. [DOI: 10.1055/s-0031-1271995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bonella F, Sixt S, Anlasik T, Bauer P, Guzman J, Costabel U. Extrazelluläres Proteasom in der BAL von Patienten mit Alveolarproteinose. Pneumologie 2011. [DOI: 10.1055/s-0031-1272154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Freyhardt P, Zeller T, Kröncke T, Schwarzwaelder U, Schreiter N, Stiepani H, Sixt S, Rastan A, Werk M. Plasma Levels Following Application of Paclitaxel-Coated Balloon Catheters in Patients with Stenotic or Occluded Femoropopliteal Arteries. ROFO-FORTSCHR RONTG 2011; 183:448-55. [DOI: 10.1055/s-0029-1246028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Winterhalter M, Malinski P, Danzeisen O, Sixt S, Monaca E, Jüttner T, Peiper M, Kienbaum P, Koester A, Rahe-Meyer N. Prospective observational study for perioperative volume replacement with 6% HES 130/0,42, 4% gelatin and 6% HES 200/0,5 in cardiac surgery. Eur J Med Res 2010; 15:383-9. [PMID: 20952347 PMCID: PMC3351905 DOI: 10.1186/2047-783x-15-9-383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The constantly growing amount of different kinds of colloid fluids necessitates comparative investigations with regards to the safety and effectivity in clinical use of these preparations. Hence we compared three colloid fluids in an observational study. The objective was the exploration of the influence of these three colloids on blood coagulation, hemodynamics and renal function of the cardiac surgical patient. Methods We included 90 patients undergoing an elective open-heart surgery with the use of the heart-lung machine and observed them consecutively. Group 1 [gelatin 4% (n = 30)], Group 2 [HES 200/0,5 (n = 30)] and Group 3 [HES 130/0,42 (n = 30)]. We measured the perioperative volume replacement, the administration of blood- and coagulation-products, the application of catecholamines, the renal function, blood gas and the platelet aggregation using multiplate electrode analyzer (Multiplate®, Dynabyte medical, Munich, Germany). Results The gelatin-group needed significantly more norepinephrine than the HES 130/0.42 group. The responsible surgeon considered the blood coagulation in the HES 200/0.5 group most frequently as impaired. Furthermore we saw a significant decrease in platelet function in the HES 200/0.5 group when performing the multiplate®-analysis (ADP-and COL-test). HES 130/0.4 as well as gelatin 4% showed no significant change in platelet function. The gelatin-group and the HES 200/0.5 needed significantly more aprotinine than the HES 130/0.4 group. We saw no significant difference with regards to administration of blood and coagulation products between the three groups. The urinary excretion during the intervention was significantly higher in the HES 200/0.5 group and in the gelatin group than in the HES 130/0.4 group. Conclusions Our results confirm the lower stabilizing effect of gelatin on circulation during fluid resuscitation. The blood coagulation was mostly impaired due to HES 200/0.5 confirmed by the multiplate®-analysis as well as by different clinical findings.
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Affiliation(s)
- Michael Winterhalter
- University of Düsseldorf, Department of Anaesthesiology, Moorenstr.5, 40225 Düsseldorf, Germany.
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Desch S, Sonnabend M, Niebauer J, Sixt S, Sareban M, Eitel I, de Waha S, Thiele H, Blüher M, Schuler G. Effects of physical exercise versus rosiglitazone on endothelial function in coronary artery disease patients with prediabetes. Diabetes Obes Metab 2010; 12:825-8. [PMID: 20649635 DOI: 10.1111/j.1463-1326.2010.01234.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted a three-arm, parallel-group, randomized, controlled trial to compare the effects of rosiglitazone and physical exercise on endothelial function in patients with coronary artery disease and impaired fasting glucose or impaired glucose tolerance over a 6-month period. Group A received rosiglitazone tablets 8 mg daily (n = 16), group B underwent a structured physical exercise programme (n = 15) and group C served as a control group (n = 12). At baseline and after 6 months, brachial artery ultrasound imaging was performed to assess reactive flow-mediated dilation (FMD). Rosiglitazone treatment and exercise both led to significant improvements in insulin resistance at 6 months, whereas no change was observed in control patients. FMD improved significantly in physical exercise patients, whereas no change could be observed in patients receiving rosiglitazone or in the control group. Between-group comparisons also showed a significant relative improvement in FMD in exercise patients compared with rosiglitazone.
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Rastan A, Schwarzwälder U, Noory E, Taieb FH, Beschorner U, Sixt S, Bürgelin K, Amantea P, Neumann FJ, Zeller T. Primary Use of Sirolimus-Eluting Stents in the Infrapopliteal Arteries. J Endovasc Ther 2010; 17:480-7. [DOI: 10.1583/10-3073.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fixed stenoses or occlusion of, in most conditions, at least two visceral arteries. If only one of the three major bowel-providing arteries — the celiac trunk, and the superior and inferior mesenteric arteries — is affected, the patient is usually asymptomatic due to a tight collateral network. The only exception is the celiac artery compression syndrome which represents primarily a compression syndrome of celiac plexus nerves by the arcuate ligament in conjunction with a compression of the celiac trunk. CMI of atherosclerotic origin is associated with a high morbidity and mortality. During the last decade, endovascular revascularization has replaced surgical revascularization as the therapy of choice in most centers. This article reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI.
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