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Tan Q, Chen Z, Wu H, Wang H, Chen J, Lai K, Zhang F, Kang T, Zheng J. A Systematic Review and Meta-Analysis of Efficacy and Safety of Cilostazol Prescription in Patients With Femoropopliteal Peripheral Artery Disease After Endovascular Therapy. J Endovasc Ther 2024:15266028241241248. [PMID: 38590247 DOI: 10.1177/15266028241241248] [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] [Indexed: 04/10/2024]
Abstract
PURPOSE The purpose of this study is to assess the efficacy and safety of cilostazol prescription in patients with femoropopliteal peripheral artery disease (PAD) after endovascular therapy (EVT). MATERIALS AND METHODS We conducted a systematic review and meta-analysis of all studies reporting the outcomes of cilostazol after femoropopliteal EVT of PAD up to September 2022. Clinical outcomes of interest included primary patency, in-stent restenosis (ISR), vessel re-occlusion, freedom from target lesion revascularization (TLR), repeat revascularization, all-cause mortality, amputation, major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs), and bleeding complication. RESULTS A total of 4 randomized controlled trials (RCTs) and 8 observational studies containing a total of 4898 patients met the inclusion criteria and were included in this systematic review and meta-analysis. We found that the use of cilostazol was associated with higher primary patency after femoropopliteal artery EVT (odds ratio [OR]=1.67, 95% confidence interval [CI]=1.50-1.87, p<0.001, I2=33.2%), a lower risk of ISR (OR=0.43, 95% CI=0.29-0.63, p<0.001, I2=37.6%), repeat revascularization (OR=0.43, 95% CI=0.24-0.76, p<0.005, I2=27.4%), and vessel re-occlusion (OR=0.59, 95% CI=0.38-0.93, p<0.05, I2=0%). There was an increase in freedom from TLR rate (OR=2.19, 95% CI=1.58-3.05, p<0.001, I2=0%), as well as a reduction in the occurrence of MALEs (OR=0.50, 95% CI=0.29-0.85, p<0.05, I2=0%). However, there was no significant difference in amputation, MACEs, all-cause mortality, and major bleeding complications. Subgroup analysis showed that cilostazol treatment in patients with femoropopliteal drug-eluting stents (DES) implantation remained associated with higher primary patency and a lower risk of ISR. CONCLUSIONS After EVT of femoropopliteal artery lesions, additional oral cilostazol enhances primary patency, reduces the occurrences of ISR and vessel re-occlusion, diminishes the risks associated with MALEs, lowers the need for repeat revascularization, and increases freedom from TLR rates. However, it does not impact amputation, MACEs, all-cause mortality, or major bleeding complications. These findings suggest cilostazol as a potentially safe and effective adjunct therapy in patients with femoropopliteal PAD after EVT. CLINICAL IMPACT After undergoing endovascular therapy (EVT) for femoropopliteal artery lesions, the addition of cilostazol to antiplatelet therapy can significantly improve primary patency, reducing the incidence of in-stent restenosis, repeat revascularization, vessel re-occlusion, and major adverse limb events while increasing freedom from target lesion revascularization rate. The simultaneous use of drug-eluting stents in the femoropopliteal artery lesions, combined with cilostazol, potentially results in a synergistic anti-stenotic effect. This therapeutic approach does not appear to be associated with an increased risk of major bleeding events or all-cause mortality. These findings provide additional evidence supporting the treatment of anti-stenosis in patients with femoropopliteal artery lesions after EVT.
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Affiliation(s)
- Qiang Tan
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhilong Chen
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Huaping Wu
- Department of Cardiovascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Haifei Wang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingquan Chen
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kun Lai
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fuzhao Zhang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tengyao Kang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jianghua Zheng
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Lukacs RA, Weisshaar LI, Tornyos D, Komocsi A. Comparing Endovascular Approaches in Lower Extremity Artery Disease: Insights from a Network Meta-Analysis. J Clin Med 2024; 13:1024. [PMID: 38398337 PMCID: PMC10889479 DOI: 10.3390/jcm13041024] [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: 12/21/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Endovascular therapy offers an alternative for treating femoropopliteal (FP) and infrapopliteal (IP) lesions related to occlusive lower extremity artery disease. Despite numerous trials, the effectiveness of restenosis prevention using local drug delivery devices remains a topic of debate. OBJECTIVES An updated systematic review and network meta-analysis was conducted. Our overall aim was to summarize the most recent clinical evidence regarding endovascular approaches for FP and IP atherosclerotic lesions. METHODS We conducted a search for randomized trials in the MEDLINE database, and extracted data related to clinical endpoints. Our primary focus was on the rate of major adverse events (MAEs), including mortality, amputation, and target lesion revascularization (TLR). A multiple treatment network meta-analysis supplemented with component network analyses was performed to examine the impact of combined treatment. RESULTS Our search yielded 33 randomized controlled trials encompassing 5766 patients. This included 19 studies focused on femoropopliteal and 14 on IP lesions, accounting for 3565 and 2201 patients, respectively. Drug-coated balloons (DCBs) and drug-eluting stents (DESs) displayed a reduced MAE risk in comparison to plain old balloon angioplasty (POBA)-RR for DCB: 0.64 (95% CI: 0.52-0.77) and for DES: 0.71 (95% CI: 0.51-0.99). The bare-metal stent (BMS) group manifested the most substantial MAE risk, being 59% higher relative to the DCB cohort (BMS vs. DCB RR: 1.59; 95% CI: 1.03-2.47). For FP lesions, DES was the standout performer, curtailing MAE risk by 55% relative to POBA. Within IP lesions, DES mitigated the MAE risk by 25% versus POBA. DCB did not exhibit any notable MAE reduction when pitted against POBA. CONCLUSION In FP arteries, both DESs and DCBs yielded significantly diminished MAEs, thus outpacing other techniques. Regarding IP arteries, only DESs resulted in significantly fewer MAEs. In alignment with contemporary research, our findings revealed no signs of elevated mortality in patients undergoing treatment with drug-eluting apparatuses.
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Affiliation(s)
- Reka Aliz Lukacs
- Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.A.L.); (D.T.)
| | | | - Daniel Tornyos
- Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.A.L.); (D.T.)
| | - Andras Komocsi
- Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.A.L.); (D.T.)
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Shehada Y, Bisdas T, Argyriou A, Torsello G, Tsilimparis N, Beropoulis E, Stavroulakis K. Efficacy analysis following polymer coated drug eluting stent and bare metal stent deployment for femoropopliteal arterial disease. Vascular 2024; 32:102-109. [PMID: 36070428 PMCID: PMC10838477 DOI: 10.1177/17085381221126217] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective is to assess the performance of the Eluvia polymer coated drug eluting stent (DES) compared to a bare metal stent (BMS) platform in patients with femoropopliteal arterial disease. METHODS This is a retrospective, single-center analysis. Patients treated with the Eluvia DES (group Eluvia) or the EverFlex BMS (group BMS) for femoropopliteal disease between January 2013 and December 2019 were included. Primary measure outcome of this analysis was the overall mortality. The PTX specific mortality, the primary patency, the amputation free survival (AFS), and the target lesion revascularization (TLR) rates were additionally evaluated. RESULTS A total of 124 patients were treated by BMS deployment, while the Eluvia platform was preferred in 75 subjects. In both groups the majority presented with lifestyle limiting claudication (BMS: 84% vs Eluvia: 73%, p = 0.73). Chronic total occlusions were more frequent in patients treated by BMS (BMS: 71% vs Eluvia: 84%, p = 0.027), whereas the calcification burden (BMS: 81% vs Eluvia: 76%, p = 0.43) and the median lesion length (in mm, IQR) (BMS: 160 (100 to 240) vs Eluvia: 140 (80 to 229), p = 0.17) were comparable. At 24 months, the overall survival (BMS: 93% vs Eluvia: 89%, hazard ratio (HR): 1.20, 95% confidence interval (CI): 0.55 to 2.64, p = 0.64) and the PTX specific survival (BMS: 95% vs Eluvia: 95%, HR: 1.28, 95% CI: 0.41 to 4.02, p = 0.67) did not differ significantly between the two platforms. No significant difference was observed regarding the 24 months primary patency rate (BMS: 66% vs Eluvia: 78%, HR: 0.65, 95% CI: 0.37 to 1.15, p = 0.18), the freedom from TLR (BMS: 83% vs Eluvia: 89%, HR: 0.81, 95% CI: 0.39 to 1.68, p = 0.572), and the AFS (BMS: 93 vs Eluvia: 89%, HR: 1.20, 95% CI: 0.55 to 2.64). The Cox regression analysis revealed a higher mortality risk among patients with chronic limb-threatening ischemia (CLTI) (HR: 3.14, 95% CI: 1.61 to 6.14, p = 0.008), chronic obstructive pulmonary disease (COPD) (HR: 4.65, 95% CI: 2.14 to 10.09, p = 0.001), in octagenerians (HR: 4.40, 95% CI: 1.92 to 10.44, p = 0.005), and in patients not on statins at baseline (HR: 2.44, 95% CI: 1.19 to 4.99, p=0.014). CONCLUSIONS In this cohort, the use of the Eluvia DES did not increase the risk for mortality compared to BMS deployment. CLTI, COPD, advanced age, and the lack of statin therapy at baseline were associated with a higher risk for death.
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Affiliation(s)
- Yousef Shehada
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, Athens Medical Center, Athens Greece
| | - Angeliki Argyriou
- Department of Vascular and Endovascular Surgery, Augusta Hospital Duesseldorf, Germany
| | - Giovanni Torsello
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany
- Department of Vascular and Endovascular Surgery, Augusta Hospital Duesseldorf, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | - Efthymios Beropoulis
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
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Van Meirvenne E, Reyntjens P, Tielemans Y. Self-expanding interwoven nitinol stent in severe femoropopliteal arterial disease. Real life results of the Supera Peripheral Stent System ®. Acta Chir Belg 2023; 123:463-472. [PMID: 35485637 DOI: 10.1080/00015458.2022.2072457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/27/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The excellent performance of the Supera Peripheral Stent System® by Abbott Vascular in femoropopliteal interventions has already been proven through several trials. This retrospective study aims to evaluate the durability and long-term patency of the Supera stent for the treatment of severe femoropopliteal lesions in a real-world population. METHODS A retrospective analysis was conducted of 136 consecutive limbs from 128 patients with atherosclerotic disease in the femoropopliteal region, treated with Supera stents between September 2010 and September 2017. As primary endpoints patency rates and freedom from target lesion revascularization (TLR) were calculated and presented using Kaplan-Meier analysis. RESULTS Fifty-five percent were treated for claudication (IC), 45% for chronical limb threatening ischemia (CLTI). The mean treated lesion length was 143 mm (±77.8). The majority of lesions (63%) were Trans-Atlantic Inter-Society Consensus Criteria II (TASC II) C/D lesions. The overall primary patency rates at 12 and 24 months of follow-up were 72.6% and 60.8% respectively. The primary patency at 12 and 24 months for TASC II A/B lesions was respectively 86% and 75.4%. For TASC II C/D lesions primary patency at 12 and 24 months was 64% and 51.1% respectively (p = 0.001). Overall freedom from TLR after 12 and 24 months was 73.8% and 62.8% respectively. No significant patency differences were observed based on calcification rate. CONCLUSION Endovascular treatment of femoropopliteal disease with Supera Stent is safe, even in extensive, highly calcified lesions. Patency rates and freedom from TLR are acceptable in a real-life population.
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Affiliation(s)
| | | | - Yves Tielemans
- Department of Vascular Surgery, AZ Sint-Maarten, Mechelen, Belgium
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Dubosq-Lebaz M, Fels A, Chatellier G, Gouëffic Y. Systematic Review and Meta-analysis of Clinical Outcomes After Endovascular Treatment in Patients With Femoropopliteal Lesions Greater Than 150 mm. J Endovasc Ther 2023:15266028231202709. [PMID: 37776300 DOI: 10.1177/15266028231202709] [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] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Indications for endovascular treatment of femoropopliteal (FP) lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased but the choice of the best endovascular treatment remains to be defined. The aim of this meta-analysis was to summarize all studies investigating endovascular treatment of FP lesions greater than 150 mm from 2010 to 2021. METHODS Articles were searched using PubMed, Scopus, and Cochrane. Included studies were randomized controlled trials (RCTs), cohort studies, and case series (prospective and retrospective) that evaluated any endovascular procedure in patients with long FP lesions classified TASC (Trans-Atlantic Inter-Society Consensus document II on management of peripheral arterial disease) C and/or D, and a mean length >150 mm, primary outcome had to be the 1-year primary patency. Overall estimate of primary patency, secondary patency, and freedom from target lesion revascularization (TLR) at 1 year depending on the different devices were investigated. The meta-analysis was conducted following the requirements of the MOOSE (Meta-analysis of Observational Studies in Epidemiology) checklist. RESULTS Forty-four papers comprising 4847 patients and 5282 treated limbs were included. Mean lesions length ranged from 150.5 to 330 mm. The pooled 1-year primary and secondary patencies, and freedom from TLR rates were 0.71 (95% CI: 0.67-0.74), 0.87 (95% CI: 0.83-0.91), and 0.79 (95% CI: 0.74-0.84), respectively. Primary permeability at 1 year were 0.68 (95% CI: 0.62-0.73), 0.67 (95% CI: 0.60-0.74), 0.74 (95% CI: 0.64-0.84), and 0.83 (95% CI: 0.78-0.88) for bare metal stents, covered stents (CSs), drug-eluting stents, and drug-coated balloons (DCBs), respectively. Lesions treated with DCB had the highest 1-year primary patency rate. CONCLUSIONS At 1-year, endovascular procedures for FP lesions greater than 150 mm obtain satisfactory results. High primary patency rates were obtained with drug-coated devices, while CSs obtained less favorable results. Randomized studies comparing different devices in the treatment of long FP lesions remain necessary to determine the most optimal approach for the management of these patients. CLINICAL IMPACT This paper highlights on the one hand the satisfactory results of endovascular treatment on complex femoropopliteal lesions formerly reserved for conventional surgery. On the other hand, among the available devices, paclitaxel-eluting devices seem to show superior results which should make them recommended as first-line treatment.
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Affiliation(s)
- Maxime Dubosq-Lebaz
- Vascular & Endovascular Surgery, Aortic Center, Institut Coeur-Poumon, CHU de Lille, Lille, France
| | - Audrey Fels
- Clinical Research Department, Groupe Hospitalier Paris St Joseph, Paris, France
| | - Gilles Chatellier
- Clinical Research Department, Groupe Hospitalier Paris St Joseph, Paris, France
| | - Yann Gouëffic
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris St Joseph, Paris, France
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Salamaga S, Stępak H, Żołyński M, Kaczmarek J, Błaszyk M, Stanišić MG, Krasiński Z. Three-Year Real-World Outcomes of Interwoven Nitinol Supera Stent Implantation in Long and Complex Femoropopliteal Lesions. J Clin Med 2023; 12:4869. [PMID: 37510984 PMCID: PMC10381725 DOI: 10.3390/jcm12144869] [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: 06/16/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective in limb salvage. The Supera is able to withstand increased compression, biomechanical stress and to have higher radial force. The objective of this study is to evaluate performance, durability and 3-year patency of Supera stent implantation in severe femoropopliteal disease. METHODS A retrospective real-world analysis was performed with consideration of 77 patients that had a Supera stent implanted with femoropopliteal atherosclerotic disease at a single center. Among the 77 individuals, 92 Supera stents were implanted. Analysis of patients' demographics, lesions characteristics, reintervention rates and patency rates was performed. RESULTS The median follow-up was 33 months and ranged from 0 to 84 months. Chronic limb-threatening ischemia was observed among 43 patients. Mean lesion length was 152.8 ± 94.6 mm. Chronic total occlusions were observed in a majority of lesions. Overall, primary patency rates at 6, 12, 24 and 36 months were 85.0%, 73.6%, 59.2% and 53.2%, respectively. CONCLUSIONS The Supera stent is effective in the management of long and complex lesions. The results of patency rates were evaluated to be worse among lesions extending to the popliteal artery.
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Affiliation(s)
- Szymon Salamaga
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
| | - Hubert Stępak
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
| | - Mikołaj Żołyński
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Ul. Przybyszewskiego 49, 60-355 Poznan, Poland
| | - Jagoda Kaczmarek
- Faculty of Medicine, Poznan University of Medical Sciences, 1/2 Długa Street, 61-848 Poznan, Poland
| | - Maciej Błaszyk
- Department of Radiology, Poznan University of Medical Sciences, 1/2 Długa Street, 61-848 Poznan, Poland
| | - Michał-Goran Stanišić
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
| | - Zbigniew Krasiński
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
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Altin SE, Parise H, Hess CN, Rosenthal NA, Creager MA, Aronow HD, Curtis JP. Long-Term Patient Outcomes After Femoropopliteal Peripheral Vascular Intervention in Patients With Intermittent Claudication. JACC Cardiovasc Interv 2023; 16:1668-1678. [PMID: 37438035 DOI: 10.1016/j.jcin.2023.05.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND In patients with intermittent claudication (IC), short-term amputation rates from clinical trial data following lower extremity femoropopliteal (FP) peripheral vascular intervention (PVI) are <1% with unknown longer-term rates. OBJECTIVES The aim of this study was to identify revascularization and amputation rates following PVI in the FP segment and to assess 4-year amputation and revascularization rates after FP PVI for IC. METHODS From 2016 to 2020, 19,324 patients undergoing FP PVI for IC were included from the PINC AI Healthcare Database and evaluated by treatment level (superficial femoral artery [SFA], popliteal artery [POP], or both). The primary outcome was index limb amputation (ILA) assessed by Kaplan-Meier estimate. The secondary outcomes were index limb major amputation and repeat revascularization. HRs were estimated using Cox proportional hazard regression. RESULTS The 4-year index limb amputation rate following FP PVI was 4.3% (95% CI: 4.0-4.7), with a major amputation rate of 3.2% (95% CI: 2.9-3.5). After POP PVI, ILA was significantly higher than SFA alone (7.5% vs 3.4%) or both segment PVI (5.5%). In multivariate analysis, POP PVI was associated with higher ILA rates at 4 years compared with isolated SFA PVI (HR: 2.10; 95% CI: 1.52-2.91) and index limb major amputation (HR: 1.98; 95% CI: 1.32-2.95). Repeat FP revascularization rates were 15.2%; they were highest in patients undergoing both SFA and POP PVI (18.7%; P < 0.0001) compared with SFA (13.9%) and POP (17.1%) only. CONCLUSIONS IC patients undergoing FP PVI had 4-year rates of index limb repeat revascularization of 16.7% and ILA rates of 4.3%. Further risk factors for amputation requires further investigation.
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Affiliation(s)
- S Elissa Altin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA.
| | - Helen Parise
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Connie N Hess
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Colorado Prevention Center Clinical Research, Aurora, Colorado, USA
| | - Ning A Rosenthal
- Premier, Inc, PINC AI Applied Sciences, Charlotte, North Carolina, USA
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | | | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
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Volteas P, Giannopoulos S, Aljobeh AZ, Koudounas G, Pesce AR, Virvilis D. Superficial Femoral Artery Remote Endarterectomy: A Systematic Review And Meta-analysis. Ann Vasc Surg 2023:S0890-5096(23)00124-3. [PMID: 36868461 DOI: 10.1016/j.avsg.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Objective: Remote Superficial Femoral Artery Endarterectomy (RSFAE) is a hybrid procedure with low risk for peri-operative complications and promising patency rates over time. The aim of this study was to summarize current literature and to determine the role of RSFAE in limb salvage with regards to technical success, limitations, patency rates and long-term outcomes. METHODS This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Overall 19 studies were identified, comprising 1,200 patients with extensive femoropopliteal disease among whom 40% presented with chronic limb threatening ischemia. The average technical success rate was 96%, with a 7% rate for peri-operative distal embolization and 13% rate for SFA perforation. The primary patency was 64% and 56%, primary assisted patency was 82% and 77% and secondary patency was 89% and 72% at 12 and 24 months follow up respectively. CONCLUSION For long femoropopliteal TASC C/D lesions, RSFAE appears to be a minimally invasive hybrid procedure with acceptable perioperative morbidity, low mortality, and acceptable patency rates. RSFAE should be considered an alternative to open surgery or a bridge to bypass procedure.
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Affiliation(s)
- Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ahmad Z Aljobeh
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Alexa Rae Pesce
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Dimitrios Virvilis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA.
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Stavroulakis K, Bisdas T, Torsello G, Tsilimparis N, Damerau S, Argyriou A. Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Femoropopliteal Arterial Disease. J Endovasc Ther 2023; 30:106-113. [PMID: 35130782 PMCID: PMC9896408 DOI: 10.1177/15266028221075563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The combination of intravascular lithotripsy (IVL) and drug-coated balloon (DCB) angioplasty for calcified peripheral lesions is associated with promising short-term results. However, data regarding the 12 months performance of this treatment option is missing. This study reports on the outcomes of IVL and DCB angioplasty for calcified femoropopliteal disease. METHODS Patients treated with IVL and DCB for calcified femoropopliteal lesions between February 2017 and September 2020 were included into this study. The primary outcome measure of this analysis was primary patency. Secondary patency, freedom from target lesion revascularization (TLR) and overall mortality were additionally analyzed. RESULTS Fifty-five (n = 55) patients and 71 lesions were analyzed. Most patients presented with long-term limb-threatening ischemia (n = 31, 56%), 47% (n = 26) were diabetics, and 66% (n = 36) had long-term kidney disease. The median lesion length was 77 mm (interquartile range: 45-136), and 20% (n = 14) of the lesions were chronic total occlusions (CTOs). Eccentric calcification was found in 23% of the vessels (n = 16), and circumferential calcium (peripheral arterial calcium scoring system [PACSS] Class 3 and 4) was present in 78% (n = 55) of the treated lesions.The technical success after IVL amounted to 87% (n = 62) and the procedural success to 97% (n = 69). A flow-limiting dissection was observed in 2 cases (3%). Both the rates of target lesion perforation and distal embolization were 1% (n = 1). A bail-out scaffold was deployed in 5 lesions (7%). At 12 months the Kaplan-Meier estimate of primary patency was 81%, the freedom from TLR was 92% and the secondary patency 98%. The overall survival amounted to 89%, while the freedom from major amputation to 98%. The presence of eccentric disease, CTOs, or PACSS Class 4 did not increase the risk for loss of patency or TLR. CONCLUSIONS In this challenging cohort of patients, the use of IVL and DCB for calcified femoropopliteal lesions was associated with promising 12 months outcomes and an excellent safety profile.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany,Department of Vascular Surgery,
Ludwig-Maximilians-University Hospital Munich, Munchen, Germany,Konstantinos Stavroulakis, Department of
Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Marchioninistr.
15, Munich 81377, Germany.
| | - Theodosios Bisdas
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany,Department of Vascular and Endovascular
surgery, Athens Medical Center, Athens, Greece
| | - Giovanni Torsello
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery,
Ludwig-Maximilians-University Hospital Munich, Munchen, Germany
| | - Sarah Damerau
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany
| | - Angeliki Argyriou
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany,Department of Vascular and Endovascular
Surgery, Augusta Hospital, Duesseldorf, Germany
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10
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Shammas NW, Shammas G, Christensen L, Jones-Miller S. Jetstream Atherectomy with Paclitaxel-Coated Balloons: Two-Year Outcome of the Prospective Randomized JET-RANGER Study. Vasc Health Risk Manag 2023; 19:133-137. [PMID: 36936551 PMCID: PMC10015974 DOI: 10.2147/vhrm.s403177] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
Background The JET-RANGER study (NCT03206762) was a multicenter (11 US centers) randomized trial, core lab adjudicated, designed to demonstrate the superiority of Jetstream + Paclitaxel coated balloon (JET+PCB) versus angioplasty (PTA) + PCB in treating femoropopliteal (FP) arterial disease. The one-year primary endpoint of JET-RANGER has been recently published. The 2-year outcome data are presented in this report. Methods There were 43 patients who completed the 1-year follow-up. Two were lost to follow-up and one died prior to the 2-year follow-up, resulting in 40 patients. Fifteen patients were randomized to PTA+PCB and 25 patients to JET +PCB. Kaplan Meier Survival analysis was performed to estimate the freedom from TLR. Bailout stenting was not considered a TLR in this analysis. Statistical significance was determined by a p-value < 0.05. Results Freedom from TLR was similar between the 2 groups at 2 years. There was also no significant difference in the change of ABI between the PTA + PCB and JET + PCB from baseline at 6-months, (p-value = 0.7890), 1-year (p-value = 0.4070), and 2-year (p-value=0.7410). There was also no statistical difference between the JET + PCB and PTA + PCB arms for RCC improvement by one or more category, (p-value= 1.000). There were no minor or major amputations for either arm throughout the 2-year follow up. One JET + PCB patient died before the 2-year specified window. Conclusion JET + PCB had similar freedom from TLR and improvement in ABI and RCC at 2-year follow-up when compared to PTA + PCB with no difference in amputation or mortality between the 2 arms. Clinical Trial Registration NCT03206762.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
- Correspondence: Nicolas W Shammas, Research Director, Midwest Cardiovascular Research Foundation, 630 E 4th Street, Suite A, Davenport, IA, 52801, USA, Email
| | - Gail Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
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11
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Stella J, Stausberg J, Lichtenberg M, Hoffmann U, Malyar NM. Clinical Characteristics and Current Practice of Endovascular Revascularization in Aorto-Iliac, Femoropopliteal and Infra-Popliteal Lower Extremity Artery Disease-Insights from the RECCORD Registry. J Clin Med 2022; 11:jcm11206074. [PMID: 36294394 PMCID: PMC9605640 DOI: 10.3390/jcm11206074] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/19/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Endovascular revascularization (EVR) is a pillar of therapeutic management in patients with symptomatic lower extremity artery disease (LEAD). Due to lack of scientific evidence, the approach of EVR type and the devices used at the different anatomic vascular segments of the lower limbs vary substantially between operators and centers. We analyzed data from the RECcording COurses of vasculaR Diseases (RECCORD) registry to assess the current real-world EVR treatment patterns in relation to anatomic vascular segments in symptomatic LEAD patients in Germany. PATIENTS AND METHODS RECCORD is an ongoing, prospective, multicenter, all-comers and entirely web-based registry platform. Baseline demographic and periprocedural data of patients undergoing EVR for symptomatic LEAD were assessed and performed EVRs were grouped according to the intervened anatomic vascular segment. We analyzed four EVR groups comprising either the aorto-iliac, femoropopliteal, or infrapopliteal segments (all these EVRs with or without a further intervention in another anatomic segment) or the infrapopliteal segment alone. RESULTS A total of 2210 EVR segments (in 1639 patients) were analyzed. Of those 616 (27.9%) were aorto-iliacal, 1346 (60.9%) femoropopliteal, 248 (11.2%) infrapopliteal and 104 (4.7%) only infrapopliteal segments. Aorto-iliac EVR was associated with younger age, smoking, claudication and simple lesions, while the distal infrapopliteal EVRs were related to advanced age, diabetes, multiple comorbidities, limb threatening ischemia and complex lesions. The use of different EVR devices at the aorto-iliac, femoropopliteal, infrapopliteal and only infrapopliteal segments were: only ballon-angioplasty: 8.3%, 12.9%, 58.1% and 63.5%; stenting: 82.3%, 45.3%, 16.9% and 12.5%; drug-coated balloon: 11.2%, 55.0%, 19.4% and 19.2%. CONCLUSION The RECCORD registry data demonstrate that in LEAD clinical and lesion characteristics are related to anatomic vascular segments. Despite the clear relationship between vascular segments and the current use of device types, prospective, segment-specific clinical studies are warranted to establish a consistent, evidence-based path for EVR in LEAD.
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Affiliation(s)
- Jacqueline Stella
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | | | | | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Nasser M. Malyar
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
- Correspondence:
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12
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Giannopoulos S, Secemsky EA, Schneider PA, Armstrong EJ. Concomitant Drug-Coated Balloon Angioplasty With Bail-Out Use of Eluvia Drug-Eluting Stent: Is There Any Downside to a Double Dose of Paclitaxel? J Invasive Cardiol 2022; 34:E469-E476. [PMID: 35652710] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The application of 2 distinct and simultaneously applied drug-delivery platforms for the treatment of peripheral artery disease (PAD) has not been studied. This study investigated the outcomes of femoropopliteal disease treated with drug-coated balloon (DCB) followed by placement of drug-eluting stent (DES) when a bail-out procedure is required. METHODS This was a single-center, retrospective study enrolling 22 consecutive patients (23 limbs) treated with DCB + DES. Bail-out stenting was performed for flow-limiting postangioplasty dissections and/or suboptimal angiographic result, such as residual stenosis. Procedural success (<30% residual stenosis) and the incidence of major adverse limb event (MALE) during an average follow-up of 15.2 months were estimated. RESULTS Among the 22 patients (23 limbs), 14 presented with claudication and 8 with critical limb ischemia. The majority of the lesions were Trans-Atlantic Inter-Society Consensus class C/D, with a mean lesion length of 321 ± 130 mm. DCB angioplasty was performed with Stellarex (Philips) in 6 cases and In.Pact DCB (Medtronic) in 16 cases. Eluvia DES (Boston Scientific) was used for bail-out stenting in all cases (in 10 limbs for flow-limiting dissection and in 13 limbs for suboptimal angiographic result due to significant residual stenosis and/or recoil). A single Eluvia DES was used in 15 cases, while multiple Eluvia DESs were used in 8 cases. Procedural success was achieved in all but 1 case where persistent recoil occurred in a heavily calcified lesion. During an average follow-up of 15 months, restenosis or reocclusion of the target vessel was observed in 6 cases (26.1%), although only 3 patients required repeat revascularization (13.0%). During follow-up, 1 death and 1 major amputation occurred, both in patients who had originally presented with critical limb ischemia. Additionally, on routine duplex ultrasound, there were no cases of aneurysm formation at the sites of Eluvia stent placement. CONCLUSION DCB with provisional DES implantation could be a viable treatment option for cases of suboptimal DCB results, without apparent additional cardiovascular or limb-related risks. Additional studies are needed to determine the risks and benefits of double-dose paclitaxel approach, especially for those patients with significant residual stenosis after DCB.
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Affiliation(s)
| | | | | | - Ehrin J Armstrong
- University of Colorado, 1600 N Wheeling Street, Aurora, CO 80045 USA.
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13
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Groot Jebbink E, van Wijck I, Holewijn S, Iida O, Spinelli D, Saxon RR, Zeller T, Okhi T, Bosiers M, Reijnen MMPJ. Individual patient data meta-analysis of patients treated with a heparin-bonded Viabahn in the femoropopliteal artery for chronic limb-threatening ischemia. Catheter Cardiovasc Interv 2022; 99:1714-1722. [PMID: 35253348 PMCID: PMC9540662 DOI: 10.1002/ccd.30152] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Abstract
Objectives The aim of the study was to analyze available data on patients treated for chronic limb‐threatening ischemia (CLTI) with the heparin‐bonded Viabahn endoprosthesis. Background The patency of self‐expanding covered stents in patients with complex femoropopliteal lesions is encouraging. However, data were mostly derived in patients with intermittent claudication. Patients with CLTI often have more advanced disease and worse outcome. Methods After the abstract screening, full‐text papers were checked. Authors were approached to consider joining the consortium. Data were sent anonymously, databases were merged and an individual patient data meta‐analysis was performed. Kaplan–Meier curves were used to calculate the freedom from amputations, the amputation‐free survival, and patency rates. Results Seven studies were enrolled, representing 161 limbs that were treated for CLTI. Median lesion length was 28.0 cm (interquartile range 25.0–33.0 cm) and 82.7% were chronic total occlusions. The technical success rate was 98.1% and the 30‐day mortality 1.9%. Through 2‐year follow‐up, the freedom‐from‐major‐amputations was 99.3%, with an amputation‐free survival of 78.8%. The freedom‐from‐loss‐of primary, primary‐assisted, and secondary patency was 70.4%, 71.8%, and 88.2%, respectively, at 1‐year and 59.5%, 62.7%, and 86.1% at 2‐year follow‐up, respectively. The reintervention‐free survival was 62.2% at a 2‐year follow‐up. Conclusions Treatment of femoropopliteal disease in CLTI patients with the use of the heparin‐bonded Viabahn is safe and effective with favorable clinical outcomes and low amputation rates. Reinterventions are needed in a subset of the population to maintain endoprosthesis patency. Close follow‐up using duplex is recommended to detect potential edge stenosis, allowing treatment before device occlusion.
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Affiliation(s)
- Erik Groot Jebbink
- Department of Surgery, Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Iris van Wijck
- Department of Surgery, Rijnstate, Arnhem, The Netherlands
| | | | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Domenico Spinelli
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Richard R Saxon
- Interventional Radiology, San Diego Medical Imaging Group, Inc., San Diego, USA
| | - Thomas Zeller
- Department Angiology, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Takao Okhi
- Department of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Marc Bosiers
- Foundation for Cardiovascular Research and Education, Münster, Germany
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, TechMed Center, University of Twente, Enschede, The Netherlands
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14
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Gray WA, Griffiths RI, Elroy PWM, Amorosi SL, McGovern AM, Jaff MR, Akehurst R, Müller-Hülsbeck S. Cost-effectiveness of a paclitaxel-eluting stent (Eluvia) compared to Zilver PTX for endovascular femoropopliteal intervention. J Med Econ 2022; 25:880-887. [PMID: 35703041 DOI: 10.1080/13696998.2022.2088965] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Antiproliferative therapies based on paclitaxel have been developed to extend the durability of endovascular interventions for lower-extremity atherosclerotic peripheral artery disease, resulting in improved primary vessel patency and fewer target lesion revascularizations. This study evaluated the cost-effectiveness of the sustained-release, paclitaxel-eluting Eluvia stent (Boston Scientific, Marlborough, MA) versus the paclitaxel-coated Zilver PTX stent (Cook Medical, Bloomington, IN) for endovascular intervention in the superficial femoral or proximal popliteal artery. DESIGN A microsimulation model was constructed from a United States Medicare perspective with a 24-month time horizon. Patients entering the model were assigned to initial endovascular intervention with either Eluvia or Zilver PTX. Each month patients were exposed to the risks of primary vessel patency loss, target lesion revascularization, amputation, and death. Clinical input parameters were taken from a randomized trial (IMPERIAL) comparing the two interventions at 24-months follow-up. Cost parameters were obtained from analyses of Medicare administrative and claims data. Cost-effectiveness analysis entailed sampling a complete set of clinical and cost parameters from their respective distributions, and then running cohorts of 10,000 patients through each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed. RESULTS In the base case microsimulation, at 24 months, the modeled target lesion revascularization was 11.6% for Eluvia and 19.0% for Zilver PTX, and the mean total direct costs were $20,010 and $21,356, respectively (Eluvia average savings=$1,346). In probabilistic sensitivity analyses, Eluvia was cost-effective in 87.8% of all simulations at a willingness-to-pay threshold of $10,000 per target lesion revascularization prevented. Eluvia was more effective and less costly (dominant) than Zilver PTX in 73.6% of simulations. CONCLUSIONS In this comparison of a paclitaxel-eluting to a paclitaxel-coated stent for endovascular femoropopliteal intervention, Eluvia was more effective and less costly (dominant) than Zilver PTX from a US Medicare perspective. These findings should be considered when formulating reimbursement policy and clinical practice guidelines.
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Affiliation(s)
- William A Gray
- Division of Cardiovascular Diseases, Lankenau Heart Institute, Philadelphia, PA, USA
| | | | | | | | | | | | - Ron Akehurst
- BresMed Health Solutions, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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15
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Choke E, Tang TY, Peh E, Damodharan K, Cheng SC, Tay JS, Finn AV. MagicTouch PTA Sirolimus Coated Balloon for Femoropopliteal and Below the Knee Disease: Results From XTOSI Pilot Study Up To 12 Months. J Endovasc Ther 2021; 29:780-789. [PMID: 34911383 DOI: 10.1177/15266028211064816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Sirolimus coated balloon (SCB) is a promising treatment option to prevent restenosis for peripheral arterial occlusive disease (PAOD). This is a pilot first-in-human study of MagicTouch percutaneous transluminal angioplasty (PTA) SCB for treatment of PAOD for both femoropopliteal and below the knee arteries (BTK). MATERIAL AND METHODS Xtreme Touch-Neo [MagicTouch PTA] Sirolimus Coated Balloon (XTOSI) pilot study is a prospective, single-arm, open-label, single-center trial evaluating MagicTouch PTA SCB for symptomatic PAOD. Primary endpoint was defined as primary patency at 6 months (duplex ultrasound peak systolic velocity ratio ≤2.4). Secondary endpoints included clinically driven target lesion revascularization (CD-TLR), amputation free survival (AFS), all-cause mortality, and limb salvage success. RESULTS Fifty patients were recruited. The mean age was 67 (n=31 [62%] males). SCB was applied to femoropopliteal in 20 patients (40%) and BTK in 30 patients (60%). Majority of treatments (94%) were performed for limb salvage indications (Rutherford scores 5 or 6). This was a high risk cohort, in which 90% had diabetes, 36% had coronary artery disease, 20% had end stage renal failure, and American Society of Anaesthesiologists (ASA) score was 3 or more in 80%. Mean lesion length treated was 227±81 mm, of which 36% were total occlusions. Technical and device success were both 100%. At 30 days, mortality was 2% and major limb amputation was also 2%. Six-month primary patency was 80% (88.2% for femoropopliteal; 74% for BTK). At 12 months, freedom from CD-TLR was 89.7% (94.1% for femoropopliteal; 86.3% for BTK), AFS was 81.6% (90.0% for femoropopliteal; 75.9% for BTK), all-cause mortality was 14.3% (10.0% for femoropopliteal; 17.2% for BTK), and limb salvage success was 92.9% (94.4% for femoropopliteal; 91.7% for BTK). There was a statistically significant increase between baseline and 6-month toe pressures for both femoropopliteal (57.3±23.3 mm Hg vs 82.5±37.8 mm Hg; p<.001) and BTK lesions (52.8±19.2 mm Hg vs 70.7±37 mm Hg; p<.037). At 12 months, wound healing rate was 33/39 (84.6%). CONCLUSIONS MagicTouch PTA SCB in the XTOSI study showed promising 6-month primary patency and encouraging 12-month freedom from CD-TLR, AFS, and limb salvage rates. No early safety concerns were raised. Randomized trials are needed to investigate the safety and efficacy of SCB for treatment of PAOD.
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Affiliation(s)
| | - Tjun Yip Tang
- Sengkang General Hospital, Singapore.,Singapore General Hospital, Singapore
| | | | | | | | | | - Aloke V Finn
- CVPath Institute Inc., Gaithersburg, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
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16
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Abstract
Background: The MIMICS-3D study aimed to assess the safety and effectiveness of the BioMimics 3D Vascular Stent System for the treatment of symptomatic femoropopliteal artery disease in a real-world patient population. Patients and methods: Consecutive participants who were scheduled for implantation of the BioMimics 3D stent were enrolled in the prospective, observational, multicenter study. The primary effectiveness outcome was freedom from clinically driven target lesion revascularization at 12 months and the primary safety outcome was a composite of major adverse events comprising death, major target limb amputation, or clinically driven target lesion revascularization at 30 days. Outcomes through 24 months are reported. Results: A total of 507 patients (70±10 years, 65.5% male sex) were enrolled and treated with the study stent. 24.0% had critical limb-threatening ischemia, lesion length was 127±92 mm, and 56.8% of lesions were totally occluded. The Kaplan-Meier (KM) estimate of freedom from clinically driven target lesion revascularization at twelve-months was 90.6% (95% CI: 87.9%-93.3%) and the 30-day primary safety outcome occurred in 1.2% (95% CI: 0.5%-2.7%) of participants. At 24 months, clinical improvement was achieved in 86.6% and the KM estimate of freedom from clinically driven target lesion revascularization was 82.8% (95% CI: 79.4%-86.4%). The KM estimate of freedom from loss of primary patency according to PSVR >2.4 was 78.6% (95% CI: 74.7%-82.4%). Survival distribution functions regarding primary patency were lower with long lesions (>150 mm; log-rank p<0.001) but did not differ significantly between participants with or without critical limb-threatening ischemia (log-rank p=0.07). Conclusions: Endovascular treatment of atherosclerotic femoropopliteal lesions with the BioMimics 3D Vascular Stent System is efficacious and safe in a real-world setting.
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Affiliation(s)
| | - Thomas Zeller
- Universitätsklinikum Freiburg Herzzentrum, Bad Krozingen, Germany
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17
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Stavroulakis K, Torsello G, Bosiers M, Argyriou A, Tsilimparis N, Bisdas T. 2-Year Outcomes of the Eluvia Drug-Eluting Stent for the Treatment of Complex Femoropopliteal Lesions. JACC Cardiovasc Interv 2021; 14:692-701. [PMID: 33736776 DOI: 10.1016/j.jcin.2021.01.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 11/16/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the 2-year performance of a polymer-based drug-eluting stent (DES) for the treatment of complex femoropopliteal lesions. BACKGROUND Despite the promising early outcomes of the Eluvia DES, the long-term safety and efficacy of the device in a real-world scenario remain unclear. METHODS Between March 2016 and December 2018, 130 patients (137 lesions) with symptomatic femoropopliteal disease were included in this study. The primary outcome measure of this analysis was primary patency. Secondary patency, freedom from target lesion revascularization, freedom from surgical conversion, and overall mortality and morbidity were additionally analyzed. RESULTS The majority of patients presented with lifestyle-limiting claudication (n = 90 [69%]). The mean lesion length was 194 ± 108 mm, 74% of the lesions (n = 101) were chronic total occlusions, and 72% (n = 99) were calcified. Moderate to severe calcification (Peripheral Arterial Calcium Scoring Scale score 3 or 4) was observed in 48% of the treated vessels (n = 67). At 24 months, the Kaplan-Meier estimate of primary patency was 71%, whereas both the secondary patency rate and freedom from target lesion revascularization were 80%. Overall survival amounted to 85%. Freedom from major amputation was 98%, while freedom from surgical conversion was 89%. Degeneration of the vessel wall was observed in 27 lesions (20%). CONCLUSIONS In this study, use of the Eluvia polymer-based DES for the treatment of complex femoropopliteal disease showed promising 2-year results. Nonetheless, a relatively high rate of vessel wall degeneration was observed after DES deployment.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany
| | - Michel Bosiers
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany
| | - Angeliki Argyriou
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany; Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
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Ichihashi S, Takahara M, Iida O, Suzuki K, Yamaoka T, Maeda K, Tobita K, Kobayashi T, Nakama T, Shingaki M, Ozaki S, Akagi D, Soga Y, Iwakoshi S, Fujimura N, Kichikawa K. Clinical Impact of Stent Graft Thrombosis in Femoropopliteal Arterial Lesions. JACC Cardiovasc Interv 2021; 14:1137-47. [PMID: 34016412 DOI: 10.1016/j.jcin.2021.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to elucidate the clinical impact and prognosis of stent graft (SG) thrombosis. BACKGROUND The VIABAHN SG offers a favorable outcome in long peripheral artery occlusive disease (PAOD) lesions in the femoropopliteal artery. One concern after SG deployment is the incidence of stent thrombosis and consequent acute limb ischemia (ALI). METHODS In this retrospective multicenter study, we collected the clinical data of PAOD patients treated with VIABAHN SG who subsequently experienced SG thrombosis. The clinical symptoms of SG thrombosis, patency after reintervention, and predictors of loss of patency after reintervention were examined. RESULTS VIABAHN SGs were used for 1,215 patients; SG thrombosis occurred in 159 (13%) patients at a median of 6.4 months (interquartile range: 2.8 to 13.5 months) after SG implantation; 21 (13%) patients presented with ALI. A total of 131 (82%) patients underwent reintervention for SG thrombosis, whereas 2 (1%) underwent primary major amputation and the remaining 26 (16%) were treated conservatively. The patency rate 1 year after reintervention, freedom from major adverse limb events, and limb salvage after reintervention were 54.9%, 73.6%, and 92.5%, respectively. Critical limb-threatening ischemia at SG implantation and ALI presentation at SG thrombosis were positively associated with an increased risk of rethrombosis, whereas distal stent diameter was negatively associated with the risk of rethrombosis. CONCLUSIONS SG thrombosis is associated with a considerable risk of ALI, but the risk of primary major amputation was not high. Clinical outcomes after reinterventions for thrombosed SGs were suboptimal.
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Langhoff R, Arjumand J, Waliszewski M, Reimer P, Härtel D, Hohl C, Raut W, Romani S, Alós J, Martínez E, Schmidt A, Yahya SA, Riazi H, Korosoglou G. The Real-World CONSEQUENT ALL COMERS Study: Predictors for Target Lesion Revascularization and Mortality in an Unselected Patient Population. Angiology 2021; 72:724-732. [PMID: 33779291 DOI: 10.1177/0003319721997314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We evaluated the safety and efficacy of a resveratrol-paclitaxel-coated peripheral balloon catheter in an all-comer patient cohort undergoing endovascular treatment of above-the-knee and below-the-knee peripheral artery disease. CONSEQUENT ALL COMERS (Clinical Post-Market Clinical Follow-up [PMCF] on Peripheral Arteries treated with SeQuent Please OTW [Over-the Wire]) is a prospective, single-arm, multicenter observational study (ClinicalTrials Identifier: NCT02460042). The primary end point was the 12-month target lesion revascularization (TLR) rate. Secondary end points included vessel patency, target vessel revascularization, and all-cause mortality. A total of 879 lesions in 784 consecutive patients (71.3 ± 10.4 years old, 57.7% male) were analyzed; 53.3% had claudication, whereas the remaining 46.7% exhibited critical limb ischemia (CLI). Substantial comorbidities were present, including diabetes mellitus (41.2%), smoking (66.1%), and coronary artery disease (33.9%). Lesion length (879 lesions) was 12.0 ± 9.3 cm and 31.8% were Transatlantic Inter-Society Consensus II C/D lesions. The overall technical success rate of the 1269 drug-coated balloon (DCB)'s used was 99.6% (1.60 ± 0.79 DCB's/patient). At 12 months, the TLR rates were 6.3% in patients with CLI and 9.6% in claudicants, with a primary patency rate of 89.9% and 87.1%, respectively. All-cause mortality was 4.3% (28/658). The most important predictors for TLR were female gender, in-stent restenosis at baseline and lesion length.
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Affiliation(s)
- Ralf Langhoff
- Department of Angiology, 155840Sankt-Gertrauden-Krankenhaus, Berlin, Germany.,Brandenburg Medical School Theodor Fontane, Campus Clinic Brandenburg, Deutsche Angiologie Zentrum Brandenburg-Berlin, Department for Angiology, Center for Internal Medicine I, Brandenburg an der Havel, Germany
| | | | - Matthias Waliszewski
- Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany.,Department of Internal Medicine and Cardiology, 14903Charité-Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | | | | | | | | | | | - Jesús Alós
- 16380Hospital de Mataró, Barcelona, Spain
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Kum S, Ipema J, Huizing E, Tan YK, Lim D, Lok IY, Hazenberg CE, Ünlü Ç. Outcomes of the paclitaxel-eluting Eluvia stent for long femoropopliteal lesions in Asian patients with predominantly chronic limb-threatening ischemia. Vasc Med 2021; 26:267-272. [PMID: 33733963 DOI: 10.1177/1358863x20987894] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The fluoropolymer-coated, paclitaxel-eluting Eluvia stent has shown promising results for the endovascular treatment of femoropopliteal artery lesions in patients with claudication. The aim of the current study was to evaluate efficacy and safety outcomes of the Eluvia stent for the treatment of long femoropopliteal lesions in Asian patients. This is a single-center, retrospective study. The primary endpoint was primary patency at 1 year. Secondary outcomes were 30-days complication rate, technical success, 1-year freedom from clinically driven target lesion revascularization (CD-TLR), limb salvage, survival, amputation-free survival (AFS), wound healing, and clinical improvement. A total of 64 patients with 67 femoropopliteal lesions were included; 78% suffered from diabetes and 84% had chronic limb-threatening ischemia (CLTI). Of those with ischemic wounds, 79% did not have run-off to the foot. Mean lesion length was 193 ± 128 mm and 52% were severely calcified. Primary patency at 1 year was 84% in the overall cohort and 91% in patients with complete lesion coverage with the Eluvia stent. Technical success was achieved in 100% of the cases and 30-day complications occurred in six patients. Twelve-month freedom from CD-TLR, limb salvage, survival, and AFS were 92%, 93%, 85%, and 80%, respectively. In 80% of patients, complete wound healing was experienced and 84% had clinical improvement after 1 year. The Eluvia stent showed promising 12-month patency and clinical results for femoropopliteal treatment in this CLTI-dominant patient population with severely calcified, long lesions. Patient numbers were, however, small; larger trials are required to validate these findings. Aneurysmal change seen in some cases also needs further investigation.
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Affiliation(s)
- Steven Kum
- Department of Surgery, Changi General Hospital, Singapore
| | - Jetty Ipema
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Eline Huizing
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Yih K Tan
- Department of Surgery, Changi General Hospital, Singapore
| | - Darryl Lim
- Department of Surgery, Changi General Hospital, Singapore
| | - Ian Yh Lok
- University of New South Wales, Sydney, NSW, Australia
| | - Constantijn Evb Hazenberg
- Department of Surgery, Division of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, The Netherlands
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21
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Al-Zoubi NA, Shatnawi NJ, Bakkar L, Al-Sabah M. Endovascular Treatment for Critical Limb Ischemia in Type II Diabetes Mellitus Involving Femoropopliteal and Infrapopliteal Segments: Revascularization Strategy. Vasc Health Risk Manag 2021; 17:69-76. [PMID: 33692625 PMCID: PMC7939491 DOI: 10.2147/vhrm.s298435] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine if further endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization improves the clinical outcomes regarding major amputation rate, rate of secondary interventions, and mortality in diabetic type-II patients presented with critical lower limb ischemia (CLI). Patients and Methods This is a retrospective study in which all type-II diabetic patients with CLI at King Abdullah University Hospital between October 2015 and September 2019 were identified. Patients with concomitant femoropopliteal and infrapopliteal vessels atherosclerotic lesions (total occlusion or more than 50% stenosis) who received successful endovascular treatment were included. Patients were divided into 2 groups. Group-I included patients treated for femoropopliteal segment alone, while Group-II included patients treated for both femoropopliteal and infrapopliteal segments. The outcomes of the two groups were compared regarding major amputation rate, rate of secondary interventions, and mortality. In addition, demographic data, atherosclerotic lesions distributions and cardiovascular risk factors were also collected and analyzed. Results In all, 90 patients (65 males and 25 females) with a mean age of 67.5±12 years were included. In Group-I; 44 patients (48.9%) were included (36 males and 8 females) with a mean age of 67±12 years. In group-II; 46 patients (51.1%) were included (29 males and 17 females) with a mean age of 68±13 years. The major amputation rate was higher and statistically significant in Group-I (38.6% vs 17.4%, p-value = 0.034). However, the secondary interventions and the mortality rates showed no statistically significant differences (56.8% vs 39.1%, p-value = 0.139) and (22.7% vs 28.3%, p-value = 0.632), respectively. Conclusion Endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization in diabetic type-II patients with CLI improves the clinical outcome regarding major amputation rate. However, there were no significant differences regarding the rate of secondary interventions and the mortality rate.
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Affiliation(s)
- Nabil A Al-Zoubi
- Department of Surgery, Vascular Surgery, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Nawaf J Shatnawi
- Department of Surgery, Vascular Surgery, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Lujain Bakkar
- Department of Surgery, Vascular Surgery, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammad Al-Sabah
- Department of Surgery, Vascular Surgery, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Shammas NW, Jones-Miller S, Shammas GA, Shammas WJ. Jetstream Atherectomy in Treating Femoropopliteal In-Stent Restenosis: Meta-Analysis of the JETSTREAM-ISR and JET-ISR Trials. J Invasive Cardiol 2020; 32:289-294. [PMID: 32737264] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND We present the results of a patient-level meta-analysis of the two currently completed and core-lab adjudicated prospective trials of Jetstream atherectomy system (Boston Scientific) in femoropopliteal in-stent restenosis (FP-ISR) and compare the findings to a published, prespecified 6-month performance goal of target-lesion revascularization (TLR) with angioplasty alone. METHODS The JETSTREAM-ISR (n = 29 patients; n = 32 lesions) was a two-center feasibility study that evaluated Jetstream atherectomy in FP-ISR. The JET-ISR (n = 60 patients; n = 60 lesions) was a 10-center investigational device exemption study that evaluated the same. Both trials were investigator-initiated, prospective, single-arm designs, with core lab assessments of stent-device interaction and with nearly identical inclusion/exclusion criteria and data definitions. The primary endpoint was TLR, which was analyzed using proportional and Kaplan-Meier analyses. RESULTS A total of 92 lesions were treated in 89 patients. Kaplan-Meier freedom from TLR at 6 months was 78.5% (95% confidence interval, 69.9-87.1). Proportional TLR was 21.2% (18/85 limbs). The performance goal of TLR (bailout stent included as TLR) was set at 37.9% at 6 months with balloon angioplasty alone. TLR rate derived from the meta-analysis was significantly lower than the TLR rate set for the historic control accounting for the 95% confidence interval lower bound (P<.01). There was no device-stent interaction and no amputation. Distal embolization occurred in 11/92 (12.0%) (filters used in 76.1% of all cases) and bailout stenting was performed in 8.7%. CONCLUSION In this meta-analysis, Jetstream atherectomy in treating FP-ISR had a high freedom from TLR despite no adjunctive drug-coated balloon use. Randomized trials are needed to confirm these findings.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, 1622 E. Lombard Street, Davenport, IA 52803 USA.
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23
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Linehan V, Doyle M, Barrett B, Gullipalli R. A Single-Center Experience of Paclitaxel in the Treatment of Femoropopliteal Disease-No Evidence for an Association With Mortality. Vasc Endovascular Surg 2020; 54:400-405. [PMID: 32319355 DOI: 10.1177/1538574420920994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Paclitaxel-coated devices have been increasingly used in endovascular treatment of femoropopliteal disease as they limit recurrence of lesions and improve patient outcomes. However, a recent meta-analysis reported that these devices increase mortality risk at 2 years post-intervention but did not account for confounding variables. Therefore, our goal was to evaluate mortality after paclitaxel treatment of femoropopliteal disease using patient-level data. METHODS We performed a retrospective review of all patients who received endovascular treatment for femoropopliteal lesions at our center between December 2009 and July 2017. There were 388 patients in the paclitaxel group and 314 control patients. RESULTS Survival analysis with hazard ratios showed no difference between mortality in the paclitaxel and control groups. Age, renal insufficiency, and chronic limb-threatening ischemia were significant predictors of mortality. We also used logistic regression to evaluate mortality at 1, 2, and 5 years post-intervention and found no difference between the paclitaxel and control groups at any time point, while age, renal insufficiency, and chronic limb-threatening ischemia at the time of intervention were all associated with the risk of death. Finally, we tallied the causes of death in our cohort and found no difference in the distribution of causes between groups. CONCLUSION Our single-center, retrospective study provides no evidence of increased risk of death with paclitaxel treatment in femoropopliteal disease. Contrastingly, age, renal insufficiency, and chronic limb-threatening ischemia were the most important factors contributing to mortality and therefore should be included as potential confounders in future studies assessing mortality in femoropopliteal disease.
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Affiliation(s)
- Victoria Linehan
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Maria Doyle
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Brendan Barrett
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Ravindra Gullipalli
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
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Enzmann FK, Nierlich P, Aspalter M, Hitzl W, Dabernig W, Hölzenbein T, Ugurluoglu A, Seitelberger R, Linni K. Nitinol Stent Versus Bypass in Long Femoropopliteal Lesions: 2-Year Results of a Randomized Controlled Trial. JACC Cardiovasc Interv 2019; 12:2541-2549. [PMID: 31786218 DOI: 10.1016/j.jcin.2019.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/01/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study sought to compare patency rates and clinical outcomes of nitinol stents and primary vein bypass in long femoropopliteal lesions. BACKGROUND An endovascular-first strategy for long femoropopliteal lesions is widely recommended without sufficient data comparing it with bypass surgery. Nitinol stents are widely used as the standard endovascular therapy. METHODS A single-center randomized controlled trial was performed with the primary endpoints of technical success, primary and secondary patency. Secondary endpoints were limb salvage, survival, complications, and clinical improvement. RESULTS A total of 110 limbs (55 per group) in 103 patients were treated. Baseline and lesion characteristics were similar, with a mean lesion length of 276 mm. Critical limb threatening ischemia was the indication for treatment in 49% of limbs in both groups. Technical success was achieved in 87% in the stent group. During a 2-year follow-up, patency rates, limb salvage, survival and complications showed no significant differences between both groups. At 24 months, primary and secondary patency rates for the stent group were 60% and 72% versus 56% and 73% in the bypass group, respectively. Clinical improvement was significantly better in the bypass group. CONCLUSIONS There were no significant differences regarding patency rates, limb salvage, survival, or complications after 2 years. Technical success and clinical improvement in the bypass group were significantly better, but the promising results of the stent group suggest that an endovascular-first strategy for femoropopliteal lesions up to 30 cm may be reasonable. Mid- as well as long-term results need to be awaited.
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Affiliation(s)
- Florian K Enzmann
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - Patrick Nierlich
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Manuela Aspalter
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria; Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria; Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Werner Dabernig
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Hölzenbein
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Ara Ugurluoglu
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Rainald Seitelberger
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Klaus Linni
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
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Katsanos K. More Evidence and More Questions About Paclitaxel-Coated Balloons in the Femoropopliteal Segment. JACC Cardiovasc Interv 2018; 11:942-944. [PMID: 29730372 DOI: 10.1016/j.jcin.2018.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 11/17/2022]
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Krishnan P, Faries P, Niazi K, Jain A, Sachar R, Bachinsky WB, Cardenas J, Werner M, Brodmann M, Mustapha JA, Mena-Hurtado C, Jaff MR, Holden AH, Lyden SP. Stellarex Drug-Coated Balloon for Treatment of Femoropopliteal Disease: Twelve-Month Outcomes From the Randomized ILLUMENATE Pivotal and Pharmacokinetic Studies. Circulation 2017; 136:1102-1113. [PMID: 28729250 PMCID: PMC5598919 DOI: 10.1161/circulationaha.117.028893] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [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: 04/12/2017] [Accepted: 06/21/2017] [Indexed: 12/03/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Drug-coated balloons (DCBs) are a predominant revascularization therapy for symptomatic femoropopliteal artery disease. Because of the differences in excipients, paclitaxel dose, and coating morphologies, varying clinical outcomes have been observed with different DCBs. We report the results of 2 studies investigating the pharmacokinetic and clinical outcomes of a new DCB to treat femoropopliteal disease. Methods: In the ILLUMENATE Pivotal Study (Prospective, Randomized, Single-Blind, U.S. Multi-Center Study to Evaluate Treatment of Obstructive Superficial Femoral Artery or Popliteal Lesions With A Novel Paclitaxel-Coated Percutaneous Angioplasty Balloon), 300 symptomatic patients (Rutherford class 2–4) were randomly assigned to DCB (n=200) or standard angioplasty (percutaneous transluminal angioplasty [PTA]) (n=100). The primary safety end point was freedom from device- and procedure-related death through 30 days, and freedom from target limb major amputation and clinically driven target lesion revascularization through 12 months. The primary effectiveness end point was primary patency through 12 months. In the ILLUMENATE PK study (Pharmacokinetic Study of the Stellarex Drug-Coated Angioplasty Balloon), paclitaxel plasma concentrations were measured after last DCB deployment and at prespecified times (at 1, 4, 24 hours and at 7 and 14 days postprocedure) until no longer detectable. Results: In the ILLUMENATE Pivotal Study, baseline characteristics were similar between groups: 50% had diabetes mellitus, 41% were women, mean lesion length was 8.3 cm, and 44% were severely calcified. The primary safety end point was met (92.1% for DCB versus 83.2% for PTA, P=0.025 for superiority) and the primary patency rate was significantly higher with DCB (76.3% for DCB versus 57.6% for PTA, P=0.003). Primary patency per Kaplan-Meier estimates at day 365 was 82.3% for DCB versus 70.9% for PTA (P=0.002). The rate of clinically driven target lesion revascularization was significantly lower in the DCB cohort (7.9% versus 16.8%, P=0.023). Improvements in ankle-brachial index, Rutherford class, and quality of life were comparable, but the PTA cohort required twice as many revascularizations. Pharmacokinetic outcomes showed that all patients had detectable paclitaxel levels after DCB deployment that declined within the first hour (54.4±116.9 ng/mL to 1.4±1.0 ng/mL). Conclusions: The data demonstrate superior safety and effectiveness of the Stellarex DCB in comparison with PTA, and plasma levels of paclitaxel fall to low levels within 1 hour. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifiers: NCT01858428 and NCT01912937.
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Affiliation(s)
- Prakash Krishnan
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.).
| | - Peter Faries
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Khusrow Niazi
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Ash Jain
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Ravish Sachar
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - William B Bachinsky
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Joseph Cardenas
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Martin Werner
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Marianne Brodmann
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - J A Mustapha
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Carlos Mena-Hurtado
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Michael R Jaff
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Andrew H Holden
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
| | - Sean P Lyden
- From Icahn School of Medicine at Mount Sinai, New York City (P.K., P.F.); Division of Cardiovascular Medicine, Emory University Hospital, Atlanta, GA (K.N.); Mission Cardiovascular Research Institute, Fremont, CA (A.J.); North Carolina Heart and Vascular, UNC-Rex Healthcare, Raleigh (R.S.); Pinnacle Health Cardiovascular Institute, Harrisburg, PA (W.B.B.); Yuma Cardiology Associates, Yuma Regional Medical Center, AZ (J.C.); Department of Angiology, Hanusch Hospital, Vienna, Austria (M.W.); Division of Angiology, Medical University Graz, Austria (M.B.); Metro Health University of Michigan Health, Wyoming, MI (J.A.M.); Yale University School of Medicine, New Haven, CT (C.M.-H.); VasCore, Massachusetts General Hospital, Boston (M.R.J.); Department of Interventional Radiology, Auckland City Hospital, New Zealand (A.H.H.); and Department of Vascular Surgery, Cleveland Clinic, OH (S.P.L.)
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27
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Abstract
The femoropopliteal artery is the most common site of disease in patients with peripheral arterial disease and presents some of the greatest challenges for interventional radiology. Many patients can be managed with medical treatment combined with supervised exercise alone. However, a significant proportion, especially those suffering from severe intermittent claudication or critical limb ischemia, will require some form of endovascular or surgical revascularization procedure. During the past few years an endovascular-first approach has gained support from all vascular specialties. Today, even complex lesions can be treated successfully with an endovascular approach. Unfortunately, the unique bio-mechanical properties of this vascular segment have limited long-term patency rates and clinical value of the endovascular options. In this review, the authors discuss the methods and techniques for treatment of femoropopliteal lesions and review the current evidence for commercially available devices on patency outcomes following successful recanalization.
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Affiliation(s)
- Athanasios Diamantopoulos
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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28
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Radvany MG, Kiesz RS. Plaque Excision in Management of Lower Extremity Peripheral Arterial Disease with the SilverHawk Atherectomy Catheter. Semin Intervent Radiol 2011; 25:11-9. [PMID: 21326488 DOI: 10.1055/s-2008-1052301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Atherectomy, the removal of plaque from diseased vessels, is theoretically appealing with respect to various procedures used for revascularization of lower extremity vessels. Instead of damaging the native vessel by pushing aside plaque with a balloon or stent, the plaque is removed. Many atherectomy devices have been designed in attempts to achieve this goal. The SilverHawk device is the latest percutaneous device employing this treatment strategy. We discuss patient selection, technical considerations, and strategies for both above and below the knee revascularization, as well as pitfalls in each location based on our experience with over 200 patients.
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Affiliation(s)
- Martin G Radvany
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, Texas
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