1
|
Zhou Y, Wang T, He H, Li Q, Wan Z, Lu P, Shu C. Comparative effectiveness of endovascular treatment modalities for de novo femoropopliteal lesions at long-term follow-up: A network meta-analysis of randomized controlled trials. Int J Cardiol 2024; 404:131977. [PMID: 38508322 DOI: 10.1016/j.ijcard.2024.131977] [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: 10/06/2023] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate the best endovascular treatment for de novo femoropopliteal lesions at long-term follow-up through network meta-analysis of randomized controlled trials. METHODS Medical databases were searched on September 17, 2023. 17 trials and 7 treatments were selected. Outcomes were primary patency, target lesion revascularization (TLR), major amputation and all-cause mortality at 3 and/or 5 years. RESULTS Regarding 3-year primary patency, drug-eluting stents (DES) was the best and better than balloon angioplasty (BA; odds ratio [OR], 4.96; 95% confidence interval [CI], 2.68-9.18), bare metal stents (BMS; OR, 2.81; 95% CI, 1.45-5.46), cryoplasty (OR, 6.75; 95% CI, 2.76-16.50), covered stents (CS; OR, 3.25; 95% CI, 1.19-8.87) and drug-coated balloons (DCB; OR, 2.04; 95% CI, 1.14-3.63). Regarding 5-year primary patency, DES was the best and better than BMS (OR, 2.34; 95% CI, 1.10-4.99). Regarding 3-year TLR, DES was the best and better than BA (OR, 0.24; 95% CI, 0.13-0.44). Regarding 5-year TLR, DES was the best and better than BA (OR, 0.20; 95% CI, 0.09-0.42) and balloon angioplasty with brachytherapy (OR, 0.21; 95% CI, 0.06-0.74). Regarding 3- and 5-year major amputation, DCB was the best. Regarding 3-year mortality, DES was the best and better than CS (OR, 0.09; 95% CI, 0.01-0.67). CONCLUSIONS DES was the best treatment regarding 3-year primary patency, TLR and mortality, and DCB was the best regarding major amputation. DES was the best treatment regarding 5-year TLR, and DCB was the best regarding primary patency and major amputation. DES and DCB should be given priority in treating femoropopliteal lesions.
Collapse
Affiliation(s)
- Yang Zhou
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Zicheng Wan
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Peng Lu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China; Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| |
Collapse
|
2
|
Nwachukwu C, Ratner M, Rockman C, Cayne N, Siracuse JJ, Johnson W, Chang H, Jacobowitz G, Veith F, Shariff S, Garg K. Outcomes and predictors of amputation-free survival in patients undergoing below-knee popliteal-distal bypass. J Vasc Surg 2024; 79:1163-1169.e2. [PMID: 38244642 DOI: 10.1016/j.jvs.2023.12.035] [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] [Received: 10/04/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The infrageniculate popliteal artery is a potential source for inflow in lower extremity bypass surgery in patients with isolated tibial artery disease. The objective of our study was to assess the short- and long-term outcomes of popliteal-distal bypasses using data from the Vascular Quality Initiative (VQI). METHODS The VQI registry was queried between 2003 and 2021 for patients undergoing surgical revascularizations with the below-knee popliteal artery serving as inflow. Demographics, comorbidities, intraoperative characteristics, and postoperative complications were analyzed. Kaplan-Meier models were used to estimate amputation-free survival, survival, and freedom from amputation. Cox regression analysis was conducted to determine factors associated with major amputation or death. RESULTS A total of 1884 procedures were analyzed. The mean age of the included patients was 67.7 years. The most frequently observed preoperative comorbidities included insulin-dependent diabetes (52.3%), coronary disease (32.4%), and end-stage renal disease (14.4%). Of all the patients, 670 (35.6%) had a history of ipsilateral endovascular intervention. The procedures were performed for a variety of indications, including tissue loss (84.3%), rest pain (10.9%), and claudication (4.8%). Intraoperatively, the outflow targets were the dorsalis pedis (31.4%), the posterior tibial (24.4%), and the anterior tibial arteries (15.6%). Vein conduit was used in 92.1% of cases. The rate of perioperative myocardial infarction (MI) was 2.4%, and the 30-day mortality was 1.9%. The median length of follow up was 371 days. Amputation-free survival was found to be 85.6% (95% confidence interval [CI], 84.0%-87.2%) at 6 months and 78.6% (95% CI, 76.6%-80.4%) at 12 months. Survival was found to be 93.4% (95% CI, 92.2%-94.5%) at 6 months and 88.6% (95% CI, 87.1%-90.0%) at 12 months. Freedom from amputation was found to be 92.0% (95% CI, 90.7%-93.3%) at 6 months and 89.0% (95% CI, 87.3%-90.4%) at 12 months. Cox regression analysis demonstrated that age greater than 65 years, congestive heart failure, coronary artery disease, and end-stage renal disease were associated with a higher risk of major amputation or death (P < .05). CONCLUSIONS Below-knee popliteal-distal bypass is a safe and effective approach to treat severe tibial vessel occlusive disease in this challenging patient cohort. Patients exhibited low perioperative complication rates and good amputation-free survival at 1 year.
Collapse
Affiliation(s)
- Chukwuma Nwachukwu
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Molly Ratner
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Caron Rockman
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Neal Cayne
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA
| | - William Johnson
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Heepeel Chang
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Glenn Jacobowitz
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Frank Veith
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Saadat Shariff
- Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Karan Garg
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
| |
Collapse
|
3
|
Leinweber ME, Geisbuesch P, Balzer K, Schmandra T, Karl T, Popp S, Hoffmann J, Schmitz-Rixen T, Jung G, Oikonomou K, Storck M, Balzer K, Kugelmann U, Schneider C, Engelhardt M, Petzold M, Weis-Mueller B, Wortmann M, Popp S, Grotemeyer D, Wenk H, Shayesteh-Kheslat R, Torsello G, Böckler D, Meisenbacher K, Hoffmann J, Schelzig H, Roopa Y, Strohschneider T, Noppeney T, Reichert V, Lorenz U, Pfister K, Damirchi S, Stojanovic T, Oberhuber A, Lobenstein B, Sagban TA, Pfeiffer T, Koller J, Sprenger C, Kruschwitz T, Schmedt CG, Marquardt F, Schmandra T, Bail D. Sex disparities in popliteal artery aneurysms. J Vasc Surg 2024; 79:1179-1186.e1. [PMID: 38145634 DOI: 10.1016/j.jvs.2023.12.036] [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] [Received: 11/01/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Only 5% of patients with popliteal artery aneurysms (PAAs) are female. Evidence on PAA treatment and outcomes in women is therefore scarce. The POPART Registry provides one of Europe's largest data collections regarding PAA treatment. Data on clinical presentation, aneurysm morphology, and perioperative outcomes after open surgical PAA repair in women will be presented. METHODS POPART is a multicenter, noninterventional registry for open and endovascular PAA repair, with 42 participating centers in Germany and Luxembourg. All patients aged >18 years who have been treated for PAA since 2010 are eligible for study inclusion. Data collection is based on an online electronic case report form. RESULTS Of the 1236 PAAs, 58 (4.8%) were in women. There were no significant differences in age or cardiopulmonary comorbidities. However, female patients had a lower prevalence of contralateral PAAs and abdominal aortic aneurysms (P < .05). PAAs in women were more likely to be symptomatic before surgery (65.5% vs 49.4%; P = .017), with 19% of women presenting with acute limb ischemia (vs 11%; P = .067). Women had smaller aneurysm diameters than men (22.5 mm vs 27 mm; P = .004) and became symptomatic at smaller diameters (20 mm vs 26 mm; P = .002). Only 8.6% of women and 11.6% of men underwent endovascular aneurysm repair (P > .05); therefore, the perioperative outcome analysis focused on open surgical repair. In total, 23.5% of women and 16.9% of men developed perioperative complications (P > .05). There were no differences in major cardiovascular events (P > .05), but women showed a higher incidence of impaired wound healing (15.7% vs 7.2%; P = .05) and major amputation (5.9% vs 1.1%; P = .027). Female sex was significantly associated with the need for nonvascular reinterventions within 30 days after surgery (odds ratio: 2.48, 95% confidence interval: 1.26-4.88), whereas no significant differences in the odds for vascular reinterventions were observed (odds ratio: 1.98, 95% confidence interval: 0.68-5.77). In the multiple logistic regression model, female sex, symptomatic PAAs, poor quality of outflow vessels, and graft material other than vein graft were independently associated with perioperative reinterventions. CONCLUSIONS Women have smaller PAAs, are more likely to be symptomatic before treatment, and are more often affected by nonvascular reinterventions in the perioperative course. As our understanding of aneurysmatic diseases in women continues to expand, sex-specific treatment strategies and screening options for women in well-selected cohorts with modified screening protocols should be continuously re-evaluated.
Collapse
Affiliation(s)
| | - Phillip Geisbuesch
- Department of Vascular and Endovascular Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Kai Balzer
- Department of Vascular and Endovascular Surgery, St. Marien-Hospital, GFO-Kliniken, Bonn, Germany
| | - Thomas Schmandra
- Department of Vascular Surgery, Sana Klinikum Offenbach, Offenbach, Germany
| | - Thomas Karl
- Department of Vascular and Endovascular Surgery, Klinikum am Plattenwald, SLK-Kliniken Heilbronn GmbH, Bad Friedrichshall, Germany
| | - Sebastian Popp
- Department of Vascular Surgery, RoMed Klinik Wasserburg am Inn, Wasserburg am Inn, Germany
| | - Johannes Hoffmann
- Department of Vascular Surgery and Phlebology, Contilia Herz und Gefaeßzentrum, Essen, Germany
| | | | - Georg Jung
- Department of Vascular and Endovascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Campana F, Spath P. Stent Graft Bridge to Surgery in Bleeding Popliteal Artery. Eur J Vasc Endovasc Surg 2024; 67:619. [PMID: 37952633 DOI: 10.1016/j.ejvs.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Federica Campana
- Department of Vascular Surgery, Hospital "Infermi" Rimini, AUSL Romagna, Rimini, Italy; Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Spath
- Department of Vascular Surgery, Hospital "Infermi" Rimini, AUSL Romagna, Rimini, Italy; Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| |
Collapse
|
5
|
Trinh SY, Boggs HK, Kiang SC, Tran Z, Abou-Zamzam AM, Tomihama RT. The Order of Operative Repair Does Not Influence Outcomes in Patients with Concomitant Popliteal Artery and Orthopedic Injuries. Ann Vasc Surg 2024; 101:23-28. [PMID: 38122977 DOI: 10.1016/j.avsg.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 09/23/2023] [Accepted: 10/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The most challenging lower extremity traumatic injuries involve concomitant vascular and orthopedic injuries with amputation rates approaching 50%. Controversy exists as to how to prioritize the vascular and orthopedic repairs. We reviewed patients with popliteal artery and lower extremity orthopedic injuries to analyze the sequence of the vascular and orthopedic repairs on outcomes. METHODS All adult patients with a diagnosis of concomitant popliteal artery and lower extremity fracture or dislocation were identified through a review of an institutional trauma registry performed at a level 1 trauma center from 2014 to 2019. Patient demographics, timing of presentation, injury severity score (ISS), surgical interventions, and limb outcome data were collected and examined. The sequence of operative repairs and factors influencing the operative order were analyzed. RESULTS Twenty-nine patients were treated for popliteal artery injuries. Twelve of these 29 patients had concomitant popliteal artery and orthopedic fractures requiring surgical repair. Injury mechanisms included both blunt (50%, 6/12) and penetrating trauma (50%, 6/12); the majority involved femur fractures (58%, 7/12). Vascular repair included arterial bypass (75%, 9/12) or interposition grafts (25%, 3/12). Orthopedic repair included external fixation (83%, 10/12) and open reduction internal fixation (17%, 2/12). Vascular repair was performed first in 7/12 limbs (58%). Patients having vascular repair first had a trend toward lower blood pressure on arrival (P = 0.068). There was no significant difference in emergency department to operating room (OR) time, OR time, ISS, mangled extremity severity score, estimated blood loss, or blood transfusion for the sequence of operative repair. Fasciotomy was nearly ubiquitous, present in 11/12 patients (92%). There were no graft complications related to orthopedic manipulation, and there were no reported limb-length to graft-length discrepancies. Early limb salvage trended lower in the cohort with revascularization first (71% vs. 100%, P = 0.19). Of the remaining limbs available for follow-up, limb salvage at 4.25 years is 100%. CONCLUSIONS In this small study of patients with concomitant lower extremity popliteal artery and orthopedic injuries, the order of operative repair does not appear to influence the success of revascularization.
Collapse
Affiliation(s)
- Shauna Y Trinh
- Department of Surgery, Riverside University Health System, Moreno Valley, CA
| | - Hans K Boggs
- Division of Vascular Surgery, Department of Surgery, Linda University School of Medicine, Loma Linda, CA
| | - Sharon C Kiang
- Division of Vascular Surgery, Department of Surgery, Linda University School of Medicine, Loma Linda, CA; Division of Vascular Surgery, Department of Surgery, VA Loma Linda Healthcare System, Loma Linda, CA.
| | - Zachary Tran
- Division of Trauma Surgery/Critical Care, Department of Surgery, Linda University School of Medicine, Loma Linda, CA
| | - Ahmed M Abou-Zamzam
- Division of Vascular Surgery, Department of Surgery, Linda University School of Medicine, Loma Linda, CA
| | - Roger T Tomihama
- Department of Radiology, Section of Vascular and Interventional Radiology, Linda University School of Medicine, Loma Linda, CA
| |
Collapse
|
6
|
Kumar A, Gajanana D, Sharma N, Nanjundappa A, Kalra A. Surgical revascularization versus best endovascular therapy for chronic limb-threatening ischemia with infrapopliteal disease. Cardiovasc Revasc Med 2024; 61:111-112. [PMID: 37951759 DOI: 10.1016/j.carrev.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH, USA
| | - Deepakraj Gajanana
- Department of Cardiology, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH, USA
| | - Navneet Sharma
- Department of Cardiology, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | | | - Ankur Kalra
- Department of Cardiology, Franciscan Health, 3900 St. Francis Way, Suite 200, Lafayette, IN, USA.
| |
Collapse
|
7
|
Taneva GT, Pitoulias AG, Avranas K, Kazemtash M, Bakr NA, Dahi F, Donas KP. Midterm outcomes of rotational atherectomy-assisted endovascular treatment of severe peripheral arterial disease. J Vasc Surg 2024; 79:887-892. [PMID: 38128846 DOI: 10.1016/j.jvs.2023.12.030] [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] [Received: 09/27/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE We evaluated the midterm results of atherectomy-assisted angioplasty for the treatment of femoropopliteal lesions and the identification of possible subgroups of patients with superior outcomes. METHODS We conducted a single-center, physician-initiated, nonindustry-sponsored retrospective analysis of patients with Rutherford category ranging from II to V and de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries treated with atherectomy-assisted angioplasty (Jetstream rotational atherectomy + drug-eluting ballooning). In cases of subintimal recanalization or patients without an SFA stamp, with previous ipsilateral bypass surgery, systemic coagulopathy, end-stage renal disease requiring hemodialysis, life expectancy of <12 months, and intolerance to aspirin, clopidogrel, and/or heparin were excluded. RESULTS In a total of 103 enrolled patients, the median SFA and/or popliteal lesion length was 80 mm (interquartile range, 61.2 mm) with 73 lesions being occlusive (70.9%) and 84 (81.5%) classified as Fanelli calcification score 3 and 4. Technical success was met in 96.1% of cases (n = 99) at a median operative time of 108 minutes. Adjunctive stenting was needed in 10 patients (9.8%). At a median follow-up of 18.0 ± 10.8 months, Rutherford class clinical improvement was present in 77 patients (74.8%), and 7 patients (6.79%) presented target lesion occlusion needing reintervention in 6 cases (5.82%). The primary patency rates were 97% at 12 months and 83% at 24 months with secondary patency rates of 99% at 12 months and 91% at 24 months of follow-up. There were no significant differences when treating differently located lesions, diabetic vs nondiabetic patients, or comparing experienced vs nonexperienced operators. CONCLUSIONS The use of rotational atherectomy and drug-eluting balloons for the treatment of severe femoropopliteal disease showed relatively low need for bailout stenting and good midterm primary patency rates. The influence of lesion location, diabetes mellitus, or operator experience did not show statistically different results in terms of patency. Longer term outcomes and comparative analysis are needed to consolidate further clinical evidence.
Collapse
Affiliation(s)
- Gergana T Taneva
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Langen, Germany.
| | - Apostolos G Pitoulias
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Langen, Germany
| | - Konstantinos Avranas
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Langen, Germany
| | - Majid Kazemtash
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Langen, Germany
| | - Nizar Abu Bakr
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Langen, Germany
| | - Firouza Dahi
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Langen, Germany
| | - Konstantinos P Donas
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Langen, Germany
| |
Collapse
|
8
|
Kawamura K, Okada H, Maegawa N, Hasegawa H, Omokawa S, Mahakkanukrauh P, Tanaka Y. Anatomical quantitative evaluation of popliteal artery visualization during medial approach in supine position. Eur J Orthop Surg Traumatol 2024; 34:1497-1501. [PMID: 38260989 DOI: 10.1007/s00590-023-03831-4] [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] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE The medial approach to the popliteal artery has been less commonly used than the posterior approach in surgical repair of traumatic popliteal injury. This study was performed to quantitatively evaluate the visual field of the popliteal artery obtained by staged myotendotomy in the medial approach to the popliteal artery. METHODS Twenty legs of fresh-frozen adult cadavers were dissected using the medial approach to the popliteal artery. In stage 1, the popliteal artery was exposed between the vastus medialis and sartorius muscles without myotendotomy. In stage 2, the medial head of the gastrocnemius muscle was dissected. In stage 3, the tendons of the sartorius and semimembranosus muscles were dissected. In stage 4, the tendons of the gracilis and semitendinosus muscles were dissected to fully expose the popliteal artery. The length of the popliteal artery that could be visualized in each stage was measured. RESULTS The anatomical length of the popliteal artery from the hiatus of the adductor magnus to the tendinous arch of soleus muscle ranged from 15 to 20 cm (mean, 16.3 cm). On average, 45%, 59%, 72%, and 100% of the popliteal artery were visualized in stage 1, 2, 3, and 4, respectively. CONCLUSIONS The medial approach to the popliteal artery has the advantage of being performed in the supine position, but it requires multiple myotendotomies around the knee. The results of this study may serve as a reference for myotendotomy depending on the site of injury to the popliteal artery.
Collapse
Affiliation(s)
- Kenji Kawamura
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Hiroshi Okada
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara, 634-8522, Japan
| | - Naoki Maegawa
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Japan
| | - Hideo Hasegawa
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Kashihara, Japan
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara, 634-8522, Japan
| |
Collapse
|
9
|
Higashitani M, Ueshima D, Suzuki K, Yamauchi Y, Hirokami M, Tsubakimoto Y, Takahashi A, Kato T, Ando H, Nakamura M. Comparison of the Pre-Established and Finally Selected Treatment Strategies for Endovascular Treatment in Femoropopliteal Artery Lesions. Int Heart J 2024; 65:230-236. [PMID: 38479851 DOI: 10.1536/ihj.23-167] [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: 04/02/2024]
Abstract
This study aimed to compare lower limb events associated with preplanned and finally selected treatment strategies-the validity and usefulness of the physician-chosen strategy were verified.We examined the data of 1003 patients in the registry of multicenter endovascular treatment for superficial femoral and popliteal artery disease study and prospectively enrolled patients who underwent endovascular treatment (EVT) of the femoropopliteal (FP) artery between February 2017 and June 2018 from 67 Japanese institutes. The outcome measures were major adverse limb events (MALE) and target vessel revascularization.The EVT strategies were classified into balloon angioplasty-alone (37.3%), primary stenting (26.7%), and provisional stenting (36.0%) groups. In the initial strategy analysis for the balloon angioplasty-alone, primary stenting, and provisional stenting groups, two-year rates of freedom from MALE (95% confidence interval) were 0.680 (0.620-0.732), 0.754 (0.688-0.808), and 0.798 (0.746-0.840), respectively. Additionally, the rate of MALE was significantly higher among patients in the balloon angioplasty-alone group than among those in the primary or provisional stenting groups in the initial strategy analysis (P = 0.007). Changes in treatment strategy were more frequent in the primary stenting group than in the other groups. Furthermore, the rate of MALE did not significantly differ among the three groups in the final strategy analysis (P = 0.56).Limb outcomes for the final applied strategy did not differ among the three strategies. Additionally, the physician's selection bias was mostly appropriate in the EVT of the FP artery.
Collapse
Affiliation(s)
| | | | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital
| | | | | | | | | | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital
| | - Hiroshi Ando
- Department of Cardiology, Kasukabe Chuo General Hospital
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| |
Collapse
|
10
|
Yu Q, Chen C, Cao J, Xu J, Lu J, Yuan L. Efficiency and safety of dual pathway inhibition for the prevention of femoropopliteal artery restenosis in repeated endovascular interventions. J Vasc Surg 2024; 79:623-631.e2. [PMID: 37951514 DOI: 10.1016/j.jvs.2023.11.005] [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] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE There is a lack of consensus regarding the optimal strategy for evaluating the efficiency and safety of dual-pathway inhibition (DPI) in preventing femoropopliteal restenosis in patients undergoing repeated endovascular interventions. Despite several therapeutic interventions available for preventing femoropopliteal restenosis post repeated endovascular interventions, the ideal strategy, particularly evaluating the efficacy and safety of DPI, remains a matter of debate. METHODS From January 2015 to September 2021, patients who underwent repeated endovascular interventions for femoropopliteal restenosis were compared with those who underwent DPI or dual antiplatelet therapy (DAPT) after surgery using a propensity score-matched analysis. The primary outcome was clinically driven target lesion revascularization (CD-TLR). The principal safety outcome was a composite of major bleeding and clinically relevant non-major (CRNM) bleeding. To further enhance the rigor, Kaplan-Meier plots, Cox proportional hazards modeling, and sensitivity analyses, as well as subgroup analyses were employed, reducing potential confounders. RESULTS A total of 441 patients were included in our study, of whom 294 (66.7%) received DAPT and 147 (33.1%) received DPI, with 114 matched pairs (mean age, 72.21 years; 84.2% male). Cumulative probability of CD-TLR at 36 months in the DPI group (17%) trended lower than that in the DAPT group (32%) (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.26-0.78; P =.004). The cumulative probability of freedom from CD-TLR at 36 months in the DPI group was 83%. No significant difference was observed in the composite outcome of major or CRNM bleeding between the DPI and DAPT groups (HR, 1.26; 95% CI, 0.34 to 4.69; P = .730). The DPI group was associated with significantly lower rates of CD-TLR in the main subgroup analyses of diabetes (P = .001), previous smoking history (P = .008), longer lesion length (>10 cm) (P = .003), and treatment with debulking strategy (P = .003). CONCLUSIONS In our investigation focused on CD-TLR, we found that DPI exhibited a significant reduction in the risk of reintervention compared with other treatment modalities. This underscores the potential of DPI as a viable therapeutic strategy in preventing reinterventions. Moreover, our assessment of safety outcomes revealed that the bleeding risks associated with DPI were on par with DAPT, thereby not compromising patient safety. These findings pave the way for potential broader clinical implications, emphasizing the effectiveness and safety of DPI in the context of reducing reintervention risks.
Collapse
Affiliation(s)
- Qingyuan Yu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Cheng Chen
- ChangZheng Hospital, Navy Military Medical University, Shanghai, China
| | - Jingzhu Cao
- Department of Endocrinology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Jinyan Xu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Jin Lu
- Department of Endocrinology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Liangxi Yuan
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China.
| |
Collapse
|
11
|
Dündar A, İpek D, Yalvaç M, Kaya Ş. Comparison of the popliteal artery and the capsule of the posterior knee (IPACK) block and the genicular nerve block in primary total knee arthroplasty: A prospective randomized trial. Saudi Med J 2024; 45:279-287. [PMID: 38438218 DOI: 10.15537/smj.2024.45.3.20230432] [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] [Received: 06/10/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To compare the efficacy of genicular block and interspace between the popliteal artery and the posterior capsule (IPACK) block in the reduction of postoperative pain, the need for rescue analgesics, and the effects on a range of motion (ROM) in patients with TKA. METHODS This prospective randomized controlled study was carried out between February and May 2023. Based on the block method, 60 participants were divided into three equal groups. These groups included the IPACK block group (n=20), the genicular block group (n=20), and control group (n=20). Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Society score (KSS) and Oxford Knee score (OKS) were used for clinical evaluation in the postoperative period. RESULTS The KSS and OKS scores of the IPACK and GNB were significantly lower than the control group (p<0.001, p<0.001). The timed up and go (TUG) values of the IPACK and GNB groups at 12th and 24th hour were significantly lower than the control group (p<0.001, p<0.001). The Tramadol rescue values of the IPACK block and control groups were significantly higher than the GNB group (p=0.028, p=0.001, respectively). The ROM values of the IPACK and GNB groups were significantly higher than the control group (p<0.001, p<0.001). CONCLUSION Both GNB and IPACK blocks had a significant positive impact on postoperative pain scores within the initial 24 hours following total knee arthroplasty (TKA). In comparison with IPACK, GNB had lower opioid consumption in the early postoperative period while also promoting better mobilization.
Collapse
Affiliation(s)
- Abdulrahim Dündar
- From the Department of Orthopaedics and Traumatology (Dündar, İpek) and from the Department of department of Anesthesiology (Yalvaç), Hitit University Erol Olçok Training and Research Hospital, Çorum; and from the Department of Orthopedics' and Traumatology (Kaya), Van Yüzüncüyıl University, Van Turkey
| | - Deniz İpek
- From the Department of Orthopaedics and Traumatology (Dündar, İpek) and from the Department of department of Anesthesiology (Yalvaç), Hitit University Erol Olçok Training and Research Hospital, Çorum; and from the Department of Orthopedics' and Traumatology (Kaya), Van Yüzüncüyıl University, Van Turkey
| | - Mehmet Yalvaç
- From the Department of Orthopaedics and Traumatology (Dündar, İpek) and from the Department of department of Anesthesiology (Yalvaç), Hitit University Erol Olçok Training and Research Hospital, Çorum; and from the Department of Orthopedics' and Traumatology (Kaya), Van Yüzüncüyıl University, Van Turkey
| | - Şehmuz Kaya
- From the Department of Orthopaedics and Traumatology (Dündar, İpek) and from the Department of department of Anesthesiology (Yalvaç), Hitit University Erol Olçok Training and Research Hospital, Çorum; and from the Department of Orthopedics' and Traumatology (Kaya), Van Yüzüncüyıl University, Van Turkey
| |
Collapse
|
12
|
Rebelo A, Partsakhashvili J, Ronellenfitsch U, John E, Kleeff J, Ukkat J. Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair. Vascular 2024; 32:32-41. [PMID: 38308424 DOI: 10.1177/17085381221126318] [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: 02/04/2024]
Abstract
BACKGROUND Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA. METHODS A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg. RESULTS We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group. CONCLUSION Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.
Collapse
Affiliation(s)
- Artur Rebelo
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jumber Partsakhashvili
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Endres John
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jörg Ukkat
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| |
Collapse
|
13
|
Gabrielli R, Siani A, Smedile G, Rizzo AR, De Vivo G, Accrocca F, Bartoli S. Isolated popliteal artery lesion due to giant cell vasculitis post COVID-19 mRNA vaccine and COVID-19 asymptomatic infection. Vascular 2024; 32:226-230. [PMID: 36200437 PMCID: PMC9535462 DOI: 10.1177/17085381221126234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is a rare granulomatous vasculitis, affecting medium and large vessels, usually in old patients. The incidence of GCA has been higher during current COVID-19 pandemia and COVID-19 is recognized for its immune dysregulation. Lower limbs involvement is uncommon but can be limb threatening, resulting in limb loss. METHOD A 43-year-old man presented with a sudden pain in his right calf and foot associated with pallor and hypothermia, and there was objective evidence of ischemia. Symptoms began few days after he received the first dose of a COVID-19 mRNA vaccine and COVID-19 asymptomatic infection 20 days after vaccination. He had no history of any signs of claudication pre-COVID or limb trauma and was very fit.Enhanced computed tomography and magnetic resonance imaging (MRI)suggest diagnosis of popliteal artery cystic adventitial disease. We resected the affected popliteal artery with interposition using a right great saphenous vein graft, through a posterior approach. On the fourth postoperative day, he was discharged.Histopathological examination revealed patchy intramural inflammatory infiltrates composed of lymphocytes and rare multinucleated giant cells at the internal lamina and adventitia consistent with a diagnosis of GCA. CONCLUSION AND RESULT Our case represents the first reported case of isolated popliteal GCA following vaccination with a COVID-19 mRNA vaccine and COVID-19 infection. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing risk factors and recurrent and repetitive microtrauma in popliteal fossa (the patient is a professional runner). Our case suggests the need for further studies about real world incidence of GCA associated vaccination and COVID-19 infection. Currently, data is limited regarding this relationship. We continue to encourage COVID-19 vaccination, even in elderly patients because the benefits of vaccination far outweigh any theoretical risk of immune dysregulation following administration.
Collapse
Affiliation(s)
- Roberto Gabrielli
- Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy
| | - Andrea Siani
- Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy
| | - Gianluca Smedile
- Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy
| | - Anna Rita Rizzo
- Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy
| | - Gennaro De Vivo
- Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy
| | - Federico Accrocca
- Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy
| | - Stefano Bartoli
- Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy
| |
Collapse
|
14
|
Izawa Y, Futamura K, Murakami H, Shirakawa T, Nishida M, Suzuki T, Tsuchida Y. Cross-Limb Vascular Shunting for Traumatic Popliteal Artery Injury. Ann Vasc Surg 2024; 99:305-311. [PMID: 37858669 DOI: 10.1016/j.avsg.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Popliteal artery injury (PAI) is a challenging trauma that requires prompt and accurate treatment since the probability of lower-limb amputation increases with the ischemic time. Intravascular shunting and cross-limb vascular shunting (CLS) are used as temporary vascular shunting (TVS) methods to shorten the ischemic time for limb vascular injury. CLS involves sending blood from an artery in a healthy body part to a peripheral vessel in an injured part to immediately resume blood flow to the injured limb. For closed injuries including PAI, CLS may be performed without exploring and identifying the arterial stumps and it enables early reperfusion to the ischemic limb. We report the case series of traumatic PAI treated using CLS and verify the usefulness of CLS. METHODS All patients with traumatic PAI treated with CLS at our institution between August 2013 and December 2021 were included. Demographic and clinical patient characteristics were extracted from the medical records. Comorbid injuries, severity of acute limb ischemia based on the Rutherford grading scale, time from injury to reperfusion by CLS, time from injury to completion of artery, and the use of fasciotomy were investigated. As outcomes, we investigated the presence or absence of lower extremity amputation during the course of treatment. RESULTS We used CLS as treatment for 5 cases with traumatic PAI. Based on the Rutherford grading scale for acute limb ischemia, there were one limb with grade 2B and 4 with grade 3. Amputation of the lower extremities was avoided except for 1 extremity in which arterial reconstruction was not achieved due to unexplained cardiac arrest during surgery. CONCLUSIONS CLS enables early reperfusion of the injured limb and is effective as a TVS method for traumatic PAI with severe ischemia or soft tissue damage.
Collapse
Affiliation(s)
- Yuta Izawa
- Department of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, Japan.
| | - Kentaro Futamura
- Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Hiroko Murakami
- Department of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, Japan
| | - Tetsuya Shirakawa
- Department of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, Japan
| | - Masahiro Nishida
- Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takafumi Suzuki
- Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yoshihiko Tsuchida
- Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| |
Collapse
|
15
|
Isik R, Balaban O, Nas K. Comment on: Comparison of Analgesic Efficacies of the iPACK (Interspace Between the Popliteal Artery and Capsule of the Posterior Knee) and Genicular Nerve Blocks Used in Combination With the Continuous Adductor Canal Block After Total Knee Arthroplasty: A Randomized Clinical Trial. J Arthroplasty 2024; 39:e3. [PMID: 38182327 DOI: 10.1016/j.arth.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Ridvan Isik
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Onur Balaban
- Department of Anesthesiology and Reanimation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Kemal Nas
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| |
Collapse
|
16
|
Zhou Z, Guo P, Zhang J, Cai F, Liu X, Dai Y. Efficacy Analysis of Drug-Coated Balloons in the Treatment of Ultra-Long Segment Lesions of Femoral Popliteal Artery. Ann Vasc Surg 2024; 99:82-88. [PMID: 37952569 DOI: 10.1016/j.avsg.2023.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/19/2023] [Accepted: 09/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND To evaluate the midterm clinical efficacy of paclitaxel drug-coated balloons (DCBs) in the treatment of femoral artery TransAtlantic Inter-Society Consensus (TASC) grades C/D lesions. METHODS The clinical data of 73 cases with TASC grades C/D lesions of femoral artery treated with paclitaxel DCBs at the Department of Vascular Surgery, the First Hospital of Fujian Medical University from August 2016 to January 2020 were retrospectively analyzed. The primary endpoint was the primary patency rate. The secondary endpoints were freedom from reintervention, Rutherford classification, ankle-brachial index (ABI), amputation events, and all-cause death. RESULTS A total of 73 cases of limb lesions received endoluminal treatment. The mean age of the patients including 49 males and 24 females was (72.66 ± 11.1) years, with an initial Rutherford classification of 2-5 and an ABI of 0.4 ± 0.1. The mean Rutherford classification was 3.70 ± 0.95. The mean lesion length was (25.75 ± 9.67) cm, including 61.64% chronic occlusive lesions and 27.39% stenotic lesions, the remaining 10.97% were mixed lesions, containing multiple segments of stenosis and chronic total occlusion lesions. 43.8% of the lesions were associated with severe calcification. Stent implantation rate was 8%. Overall mortality at follow-up was 4% at 1 year and 8% at 2 years, and no amputations seen. The ABI was 0.83 ± 0.07 at 1-year follow-up and 0.78 ± 0.05 at 2-year follow-up. The Kaplan-Meier survival curve predicted the 1-year phase I patency rate was 75.3% ± 5% and the 2-year patency rate was 63.3% ± 5.7%. Freedom from target lesion revascularization was 78.4 ± 4.9% at 1 year and 69.2% ± 3.6% at 2 years. Logistic regression analysis showed that diabetes mellitus, severe calcification, chronic renal insufficiency, and restenosis were the significant factors affecting the patency of target lesions. CONCLUSIONS Paclitaxel DCBs in the treatment of femoral artery with TASC grades C/D lesions can achieve relatively satisfactory midterm clinical safety and efficacy results, provided there is an acceptable result on completion angiogram.
Collapse
Affiliation(s)
- Zhiwei Zhou
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Pingfan Guo
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jinchi Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fanggang Cai
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xueqiang Liu
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yiquan Dai
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
17
|
Kampitak W, Kertkiatkachorn W, Ngarmukos S, Tanavalee A, Tanavalee C, Tangkittithaworn C. Reply to Letter to the Editor on "Comparison of Analgesic Efficacies of the iPACK (Interspace Between the Popliteal Artery and Capsule of the Posterior Knee) and Genicular Nerve Blocks Used in Combination With the Continuous Adductor Canal Block After Total Knee Arthroplasty: A Randomized Clinical Trial". J Arthroplasty 2024; 39:e4-e5. [PMID: 38182328 DOI: 10.1016/j.arth.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Wirinaree Kampitak
- The Thai Red Cross Society and Faculty of Medicine, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Wannida Kertkiatkachorn
- The Thai Red Cross Society and Faculty of Medicine, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Srihatach Ngarmukos
- King Chulalongkorn Memorial Hospital and Faculty of Medicine, Department of Orthopedics, Chulalongkorn University, Bangkok, Thailand
| | - Aree Tanavalee
- King Chulalongkorn Memorial Hospital and Faculty of Medicine, Department of Orthopedics, Chulalongkorn University, Bangkok, Thailand
| | - Chotetawan Tanavalee
- King Chulalongkorn Memorial Hospital and Faculty of Medicine, Department of Orthopedics, Chulalongkorn University, Bangkok, Thailand
| | - Chonruethai Tangkittithaworn
- The Thai Red Cross Society and Faculty of Medicine, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
18
|
Bellomo TR, Goudot G, Gaston B, Lella S, Jessula S, Sumetsky N, Beardsley J, Patel S, Fischetti C, Zacharias N, Dua A. Popliteal artery aneurysm ultrasound criteria for reporting characteristics. Vasc Med 2024; 29:58-63. [PMID: 38131163 DOI: 10.1177/1358863x231215781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/23/2023]
Abstract
INTRODUCTION Duplex ultrasound (DUS) is the modality of choice for surveillance of popliteal artery aneurysms (PAAs). However, noninvasive vascular laboratories have no standard guidelines for reporting results. This study assessed reports of PAA DUS for inclusion of information pertinent to operative decision-making and timing of surveillance. METHODS This study was a retrospective review of a multi-institutional repository that was queried for all patients with a PAA from 2008 to 2022 and confirmed via manual chart review. DUS reports were abstracted and images were individually annotated for features of interest including dimensions, flow abnormalities, and percent thrombus burden. RESULTS A total of 166 PAAs in 130 patients had at least one DUS available for viewing. Postoperative surveillance of PAAs was performed at several intervals: the first at 30 months (IQR 3.7-113, n = 44), the second at 64 months (IQR 20-172, n = 31), and the third at 152 months (IQR 46-217, n = 16) after the operation. The largest diameter of operative PAAs (median 27.5 mm, IQR 21.8-38.0) was significantly greater than nonoperative PAAs (median 20.9 mm, IQR 16.7-27.3); p < 0.01. Fewer than 33 (21%) reports commented on patency of distal runoff. We calculated an average percent thrombus of 60% (IQR 19-81) in nonoperative PAAs, which is significantly smaller than 75% (IQR 58-89) in operative PAAs; p < 0.01. CONCLUSION In this multi-institutional retrospective study, PAAs are often not followed at intervals recommended by the Society for Vascular Surgery guidelines and do not include all measurements necessary for clinical decision-making in the multi-institutional repository studied. There should be standardization of PAA DUS protocols performed by all noninvasive vascular laboratories to ensure completeness of PAA DUS images and inclusion of characteristics pertinent to clinical decision-making in radiology reports.
Collapse
Affiliation(s)
- Tiffany R Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Guillaume Goudot
- Noninvasive Cardiac Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Brandon Gaston
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Srihari Lella
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel Jessula
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Natalie Sumetsky
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jenna Beardsley
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Shiv Patel
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chanel Fischetti
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
19
|
Vossen RJ, Fokkema TM, Vahl AC, Balm R. Systematic review and meta-analysis comparing the autogenous vein bypass versus a prosthetic graft for above-the-knee femoropopliteal bypass surgery in patients with intermittent claudication. Vascular 2024; 32:91-101. [PMID: 36066001 DOI: 10.1177/17085381221124701] [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: 12/24/2022]
Abstract
OBJECTIVES According to guidelines, the autogenous saphenous vein (ASV) is the preferred conduit for femoropopliteal bypass surgery in all patients with peripheral artery disease. However, in contrast to patients with critical limb ischemia (CLI), patients with intermittent claudication (IC) only, tend to have milder disease, and thus a prosthetic graft may be as good as a vein conduit. The objective of this study was to compare patency rates of the ASV and a prosthetic graft in femoropopliteal bypass surgery in patients with IC. METHODS A systematic literature search was performed in the PubMed, Embase, and Cochrane databases to identify randomized controlled trials comparing prosthetic graft versus ASV in patients with IC. Articles with a mixed IC and CLI study population were included if more than 50% of the study cohort was treated for IC. Primary analysis was performed on IC patients only. Secondary analysis was performed on the mixed group. The primary endpoint was short- and long-term patency and secondary endpoints were complications, limb salvage, and mortality. RESULTS In total, six studies with 524 patients were included. Only two studies reported solely on patients with IC. All these patients underwent above-the-knee bypasses and average patency rates at one and 5 years were 88% and 76% vs 81% and 68% in the ASV and the PTFE groups, respectively. One and five-year patency was not statistically different between the groups (OR 5.21; 95% CI 0.60-45.36 and OR 2.10; 95% CI 0.88-5.01). In a mixed population of patients with IC and CLI (84% IC patients), 1 year patency was comparable (OR 1.40; 95% CI 0.87-2.25). However, after a follow-up of over 3 years, this mixed group had significantly higher patency rates in favour of the ASV (OR 2.06; 95 % CI 1.30-3.26). Complication and amputation rates were comparable in both groups. CONCLUSIONS Limited data are available for patients receiving above-the-knee femoropopliteal bypass for intermittent claudication. The ASV remains the conduit of choice for femoropopliteal bypass surgery. However, the prosthetic conduit seems a feasible alternative for patients with intermittent claudication in whom the ASV is not present or unsuitable.
Collapse
Affiliation(s)
- R J Vossen
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
- Department of Anesthesiology, Erasmus Medical Center, The Netherlands
| | - T M Fokkema
- Department of Vascular Surgery, Länssjukhuset Ryhov, Jönköping, Sweden
| | - A C Vahl
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
- Clinical Epidemiology, OLVG Amsterdam, Amsterdam, The Netherlands
| | - R Balm
- Department of Surgery, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Cai J, Zhang ZX, Qiao T, Li XQ, Wang W. [To investigate the role of the AAC-8 scoring in predicting restenosis or occlusion of lower extremity arteries after dilatation and angioplasty with DCB]. Zhonghua Yi Xue Za Zhi 2024; 104:332-336. [PMID: 38281800 DOI: 10.3760/cma.j.cn112137-20231007-00659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Objective: To investigate the role of the Abdominal Aortic Calcification-8 (AAC-8) scoring system in predicting restenosis or occlusion of lower extremity arteries after dilatation and angioplasty with drug-coated balloon (DCB). Methods: In this retrospective study, 62 patients who underwent dilatation and angioplasty with DCB for lower limb atherosclerotic obliterans (ASO) were enrolled from September 2018 to June 2022 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. Among them who aged (73.9±11.3) years, 37 were males and 25 were females. Patients were divided into two groups according to the condition of the lower extremity arteries after dilatation and angioplasty with DCB: recurrence group (n=26) and patency group (n=36). Logistic regression was used to analyze the factors associated with restenosis or occlusion of lower extremity arteries after dilatation and angioplasty with DCB. The predictive value of the AAC-8 score for restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB was analyzed using the receiver operating characteristic curves (ROC curves). Results: The postoperative follow-up was 16.30 (10.97, 24.10) months in the patency group and 9.03 (6.98, 15.31) months in the recurrence group. The results of multifactorial logistic regression analysis showed that an elevated AAC-8 score (OR=1.388, 95%CI: 1.067-1.806, P=0.015) was an associated factor of restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB. The ROC curve analysis showed that the area under the curve (AUC) of the AAC-8 score for predicting restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB was 0.687 (95%CI: 0.550-0.824, P=0.013), with a cut-off value of 5.5 points, a sensitivity of 65.4% and a specificity of 69.5%. Conclusions: Elevated AAC-8 score is associated with restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB. When the cut-off value is 5.5, the AAC-8 score predicts restenosis or occlusion of the lower extremity arteries after DCB dilation and angioplasty with a sensitivity of 65.4% and a specificity of 69.5%.
Collapse
Affiliation(s)
- J Cai
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Z X Zhang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - T Qiao
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - X Q Li
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - W Wang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| |
Collapse
|
21
|
Varcoe RL, DeRubertis BG, Kolluri R, Krishnan P, Metzger DC, Bonaca MP, Shishehbor MH, Holden AH, Bajakian DR, Garcia LA, Kum SWC, Rundback J, Armstrong E, Lee JK, Khatib Y, Weinberg I, Garcia-Garcia HM, Ruster K, Teraphongphom NT, Zheng Y, Wang J, Jones-McMeans JM, Parikh SA. Drug-Eluting Resorbable Scaffold versus Angioplasty for Infrapopliteal Artery Disease. N Engl J Med 2024; 390:9-19. [PMID: 37888915 DOI: 10.1056/nejmoa2305637] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Among patients with chronic limb-threatening ischemia (CLTI) and infrapopliteal artery disease, angioplasty has been associated with frequent reintervention and adverse limb outcomes from restenosis. The effect of the use of drug-eluting resorbable scaffolds on these outcomes remains unknown. METHODS In this multicenter, randomized, controlled trial, 261 patients with CLTI and infrapopliteal artery disease were randomly assigned in a 2:1 ratio to receive treatment with an everolimus-eluting resorbable scaffold or angioplasty. The primary efficacy end point was freedom from the following events at 1 year: amputation above the ankle of the target limb, occlusion of the target vessel, clinically driven revascularization of the target lesion, and binary restenosis of the target lesion. The primary safety end point was freedom from major adverse limb events at 6 months and from perioperative death. RESULTS The primary efficacy end point was observed (i.e., no events occurred) in 135 of 173 patients in the scaffold group and 48 of 88 patients in the angioplasty group (Kaplan-Meier estimate, 74% vs. 44%; absolute difference, 30 percentage points; 95% confidence interval [CI], 15 to 46; one-sided P<0.001 for superiority). The primary safety end point was observed in 165 of 170 patients in the scaffold group and 90 of 90 patients in the angioplasty group (absolute difference, -3 percentage points; 95% CI, -6 to 0; one-sided P<0.001 for noninferiority). Serious adverse events related to the index procedure occurred in 2% of the patients in the scaffold group and 3% of those in the angioplasty group. CONCLUSIONS Among patients with CLTI due to infrapopliteal artery disease, the use of an everolimus-eluting resorbable scaffold was superior to angioplasty with respect to the primary efficacy end point. (Funded by Abbott; LIFE-BTK ClinicalTrials.gov number, NCT04227899.).
Collapse
Affiliation(s)
- Ramon L Varcoe
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Brian G DeRubertis
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Raghu Kolluri
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Prakash Krishnan
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - David C Metzger
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Marc P Bonaca
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Mehdi H Shishehbor
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Andrew H Holden
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Danielle R Bajakian
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Lawrence A Garcia
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Steven W C Kum
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - John Rundback
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Ehrin Armstrong
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Jen-Kuang Lee
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Yazan Khatib
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Ido Weinberg
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Hector M Garcia-Garcia
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Karine Ruster
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Nutte T Teraphongphom
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Yan Zheng
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Jin Wang
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Jennifer M Jones-McMeans
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| | - Sahil A Parikh
- From the Prince of Wales Hospital and University of New South Wales, Randwick, Australia (R.L.V.); New York Presbyterian-Weill Cornell Medical Center (B.G.D.), Mount Sinai Hospital (P.K.), and Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons (D.R.B., S.A.P.), New York, and Catholic Health Services, St. Francis Hospital and Heart Center, Roslyn (L.A.G.) - all in New York; Syntropic Core Lab and OhioHealth Heart and Vascular, Columbus (R.K.), and University Hospitals Harrington Heart and Vascular Institute, Cleveland (M.H.S.) - both in Ohio; Ballad Health, Kingsport, TN (D.C.M.); CPC Clinical Research, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.P.B.), and Advanced Heart and Vein Center, Denver (E.A.) - both in Colorado; Auckland Hospital and Auckland University, Grafton, Auckland, New Zealand (A.H.H.); the Department of Surgery, Changi General Hospital, Singapore (S.W.C.K.); Advanced Interventional and Vascular Services, Teaneck, NJ (J.R.); National Taiwan University Hospital, Taipei City, Taiwan (J.-K.L.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); VasCore, Boston (I.W.); MedStar Washington Hospital Center, Washington, DC (H.M.G.-G.); and Abbott Vascular, Santa Clara, CA (K.R., N.T.T., Y.Z., J.W., J.M.J.-M.)
| |
Collapse
|
22
|
Yang L, Quan J, Dong J, Ding N, Han Y, Cong L, Lin Y, Liu J. Comparison of mid-outcome among bare metal stent, atherectomy with or without drug-coated balloon angioplasty for femoropopliteal arterial occlusion. Sci Rep 2024; 14:63. [PMID: 38167567 PMCID: PMC10761798 DOI: 10.1038/s41598-023-50511-8] [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] [Received: 08/26/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
This study evaluated the outcomes of a bare metal stent (BMS), DCB alone, atherectomy plus a drug-coated balloon (AT + DCB) and AT alone for the treatment of femoropopliteal artery occlusion. Four groups were included in this retrospective cohort study: 119 patients underwent the BMS procedure, 89 patients underwent DCB alone, 52 patients underwent AT + DCB, and 61 patients underwent AT alone. Patients were followed-up at 1, 6, 12 and 24 months after the procedure, the clinical outcomes and complications were assessed, and the primary outcomes were primary patency and restenosis. AT + DCB showed a lower bailout stent, and BMS displayed a higher retrograde puncture, flow-limiting dissection and postdilation (p < 0.05). For all procedures, the walking distance, ABI and pain score post-procedure were significantly improved compared with the pre-procedure values (p < 0.001). The restenosis rate was higher in BMS (21.0%) and AT alone (24.6%) than in DCB (10.1%) alone and AT + DCB (11.5%) (p = 0.04); there was no difference in amputation or clinically driven target lesion revascularization among procedures. The primary patency rates were 77.7%, 89.4%, 88.0% and 73.7% in the BMS, DCB alone, AT + DCB and AT alone groups at 24 months, respectively (p = 0.03), while the secondary patency and main adverse events (stroke, MI and death) were similar. Proximal concavity, proximal target vessel diameter ≥ 5 mm, runoff number ≥ 2 and DCB use were protective factors for primary patency. Our results suggested that AT + DCB and DCB alone were associated with higher primary patency, and DCB devices (combined with/without AT) should be the preferred choice for FP lesions.
Collapse
Affiliation(s)
- Lin Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Jianjun Quan
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Department of Vascular Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Jian Dong
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ningning Ding
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Han
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Longlong Cong
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yuhao Lin
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jianlin Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| |
Collapse
|
23
|
Kim Y, Loanzon RS, Southerland KW, Long CA, Williams ZF, Mohapatra A. Prosthetic Conduit Use Does Not Adversely Impact Outcomes after Open Repair of Popliteal Artery Aneurysms. Ann Vasc Surg 2024; 98:124-130. [PMID: 37858670 DOI: 10.1016/j.avsg.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Single segment, greater saphenous vein (GSV) conduit is considered the optimal bypass conduit among patients undergoing bypass surgery for peripheral artery disease (PAD). While this data has been extrapolated to patients undergoing bypass for popliteal artery aneurysms (PAAs), the pathophysiology of PAA is inherently different when compared to PAD, and the impact of conduit type on long-term outcomes after open repair of PAA remains unclear. METHODS A multicenter database of five regional hospitals was retrospectively reviewed for all patients with PAA undergoing open surgical repair. Data were collected on demographic information, operative details, medications, and postoperative outcomes. Kaplan-Meier curves were used to compare freedom from major adverse limb events (MALE) following GSV versus prosthetic bypass. Cox proportional hazards model was used to identify patient-level characteristics associated with MALE, which was defined as major ipsilateral limb amputation or reintervention for graft patency. RESULTS From 1999 to 2020, a total of 101 patients with PAA underwent open exclusion and bypass surgery. Median follow-up period was 4.2 years (interquartile range, 1.3-7.4 years), and complete data were available for 99 (98.0%) patients. The majority of patients were male (99.0%) and Caucasian (93.9%). Only 11.1% of procedures were emergent, with the remainder (88.9%) being elective. All patients underwent medial exposure with a below-knee popliteal bypass target (100%). Bypass conduits included GSV (69.7%), prosthetic conduit (28.3%), and 2 (2.0%) alternative conduits (one spliced arm vein, one cryopreserved vein). Patients undergoing prosthetic bypass were older (72 vs. 66 years, P = 0.001) and had similar rates of medical comorbidities. Compared with the GSV group, patients with prosthetic conduits were more frequently placed on postoperative anticoagulation (60.7% vs. 23.2%, P < 0.001). Conduit type did not impact postoperative complication rates (P = NS each). MALE rates were low overall (19.2% at 2 years), and similar when stratified by conduit type (log rank P = 0.47). On multivariable analysis, emergent bypass was associated with MALE (hazard ratio [HR] 5.73, 95% confidence interval [CI] 2.07-15.85, P < 0.001). Prosthetic conduit usage (HR 1.00, 95% CI, 0.40-2.51, P = 0.99) and postoperative anticoagulation (HR 1.02, 95% CI 0.42-2.50, P = 0.97) were not associated with MALE. CONCLUSIONS Open repair of PAA is associated with excellent long-term outcomes. Prosthetic bypass is a comparable alternative to autogenous conduit for below-knee popliteal bypass targets, and lack of suitable GSV should not prohibit open surgical repair when indicated.
Collapse
Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
| | - Roberto S Loanzon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Kevin W Southerland
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Abhisekh Mohapatra
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
24
|
Alban A, Meroni M, Fuchs B, Scaglioni MF. Combined use of lower medial thigh perforator (LMTP) flap and pedicled medial sural artery perforator flap (MSAP) for lateral knee defects coverage after sarcoma resection: A case report and literature review of soft tissue defect around knee reconstruction. Microsurgery 2024; 44:e31125. [PMID: 37830398 DOI: 10.1002/micr.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/08/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Reconstruction of knee defects still represents a challenge for reconstructive surgeons. After an extensive resection, the primary aim is to reach a stable result, while maintaining a good range of motion and aesthetic unity. The use of pedicled perforator-based flaps makes it possible to achieve these goals. Many are the flaps that can be used in this region, and the pedicle medial sural artery perforator (mSAP) flap is considered among one of the first-choice techniques. The purpose of this case report is to describe for the first time the use of pedicled mSAP flap to cover a lateral knee defect. A 79-year-old patient underwent extensive excision of sarcoma on the lateral side of the left knee, with removal of distal portion of the vastus lateralis muscle and portion of the biceps femoris tendon. The resulting defect from the excision measured 10 cm × 10 cm. To cover the postero-inferior part of the defect we decided to use a mSAP flap, with a skin paddle 10 cm × 5 cm, which was tunneled posteriorly to the popliteal artery and vein in order to reach the affected site. We then used a lower medial thigh perforator (pLMT) flap with a 15 cm × 5 cm skin paddle, rotated by 90° in a propeller fashion to cover the antero-superior portion of the defect. The decision to use two flaps was justified by the fact we wanted to close the donor areas with direct suturing for a better aesthetic result. The post-operative course was regular with only a small wound dehiscence that had healed by secondary intention. At 6 months postoperatively, the patient showed a complete active range of motion of the knee joint and absolute aesthetic satisfaction with flaps donor site and knee shape. A review of literature is also provided, with a specific focus on the different procedures for soft tissue defects reconstruction around the knee. According to our experience, the pedicle of the MSAP flap may be safely used as an additional reconstructive option for lateral knee defects.
Collapse
Affiliation(s)
- Alice Alban
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Orthopedic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mario F Scaglioni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
25
|
Armando C, Sherbondy P, Simoni E, Cole S. Type III Popliteal Artery Entrapment Syndrome with Concurrent Chronic Exertional Compartment Syndrome: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00035. [PMID: 38422191 DOI: 10.2106/jbjs.cc.23.00602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
CASE The patient, a 21-year-old female Division I track and field athlete, presents with bilateral calf pain, tightness, numbness, and swelling during activity. Initially diagnosed with chronic exertional compartment syndrome (CECS), she underwent bilateral four-compartment fasciotomies. After 4 months, she experienced persistence of some of her prefasciotomy symptoms and was referred to vascular surgery. A fibrous band was compressing the popliteal artery, making the diagnosis of popliteal artery entrapment syndrome (PAES). She underwent bilateral popliteal artery decompressions. She had a successful recovery with no recurrence of numbness, weakness, or pain. CONCLUSION Recognize that structural PAES may coexist with CECS.
Collapse
Affiliation(s)
- Chenée Armando
- Penn State College of Medicine, University Park, Pennsylvania
| | - Paul Sherbondy
- Department of Orthopedic Surgery, Penn State College of Medicine, University Park, Pennsylvania
| | - Eugene Simoni
- Division of Vascular Surgery, Penn State College of Medicine, University Park, Pennsylvania
| | - Sandra Cole
- Vascular Surgery, Muskegon Surgical Associates, Muskegon, Michigan
| |
Collapse
|
26
|
Worrall A, Corrigan AE, Slim H. Unusual approach to popliteal vein bypass graft stenosis following failed angioplasty in popliteal entrapment syndrome. BMJ Case Rep 2023; 16:e258021. [PMID: 38103905 PMCID: PMC10728922 DOI: 10.1136/bcr-2023-258021] [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: 12/19/2023] Open
Abstract
Popliteal artery entrapment syndrome (PAES) is where the popliteal artery is compressed-typically by the medial head of the gastrocnemius muscle. PAES is typically treated surgically with popliteal artery release with or without bypass. Graft stenosis is a recognised complication of vein grafts. These are normally treated endovascularly. Endarterectomy of venous graft stenosis may be a useful tool in selected cases, where an endovascular approach was unsuccessful. Long-term follow-up of graft stenosis endarterectomy will allow us to determine effectiveness of this method of treatment where other options have failed.
Collapse
Affiliation(s)
- Alice Worrall
- Vascular Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Hani Slim
- Vascular Surgery, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
27
|
Speziali S, Fargion AT, Giacomelli E, Esposito D, DI Domenico R, DE Blasis S, Piffaretti G, Pratesi C, Dorigo W, Pulli R. Early and long-term results of surgical treatment of popliteal artery aneurysms using a heparin-bonded expanded polytetrafluorethilene graft. J Cardiovasc Surg (Torino) 2023; 64:645-652. [PMID: 37870827 DOI: 10.23736/s0021-9509.23.12782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND The aim of the present study was to assess early and long-term results of open surgical interventions for popliteal artery aneurysms (PAAs) with the use of heparin-bonded expanded polytetrafluorethylene (HePTFE) in a single center, retrospective, non-comparative cohort study. METHODS A retrospective analysis of a prospectively maintained dataset, including 207 open interventions for PAAs between 2002 and 2022, was performed and 170 procedures carried on with the use of a HePTFE graft were found. Perioperative results were analyzed in terms of mortality, graft thrombosis and amputation rates. Follow-up results were analyzed in terms of survival, primary and secondary patency, freedom from amputation, freedom from reintervention with life-table analysis and Kaplan Meier curves. Follow-up results were considered as primary outcomes, whereas perioperative results were considered as secondary outcomes. RESULTS In 82 interventions (48%) the PAA was asymptomatic. In 140 cases a medial approach was used, while in 30 cases a posterior approach was preferred. The level of the distal anastomosis was the p3 tract of the popliteal artery in 89% of the cases. One perioperative death occurred; early thromboses occurred in eight cases and the overall perioperative amputation rate was 2.8%. The median duration of follow-up was 48 months (range 1-251). Estimated survival rate at 10 years was 55% (standard error, SE, 0.065). The 10-year rates of primary and secondary patency and freedom from amputation were 40.8% (SE 0.06), 47.6% (SE 0.065) and 93.4% (SE 0.04), respectively. The estimated freedom from reintervention rate at 10 years was 57% (SE 0.05). CONCLUSIONS The results of this large monocentric experience showed that open surgical repair of PAAs with HePTFE is a safe procedure, with low rates of perioperative complications, and excellent results in the long-term setting.
Collapse
Affiliation(s)
- Sara Speziali
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Aaron T Fargion
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elena Giacomelli
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Davide Esposito
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rossella DI Domenico
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena DE Blasis
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gabriele Piffaretti
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Carlo Pratesi
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Walter Dorigo
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy -
| | - Raffaele Pulli
- Section of Vascular Surgery, Department of Excellence of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
28
|
Power Foley M, Alawy M, Tubassam M. Acute limb ischaemia due to thrombosed persistent sciatic artery aneurysm presents a surgical challenge in a frail octogenarian. Vascular 2023; 31:1124-1127. [PMID: 35737445 DOI: 10.1177/17085381221111016] [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: 11/15/2022]
Abstract
OBJECTIVES Persistent sciatic artery (PSA) is a rare congenital anomaly, whereby the embryonic sciatic artery remains patent with associated degrees of femoral axis hypoplasia. Aneurysmal degeneration and distal ischaemia from thromboembolic complications are common. Revascularisation strategies include embolectomy, bypass or interposition grafting and catheter-directed thrombolysis. METHODS We describe a sedentary 88-year-old woman with right acute limb ischaemia secondary to a thrombosed PSA aneurysm and concurrent occlusive thrombus at the femoral bifurcation. RESULTS The patient presented with a 3-day history of a cold, painful right foot. Examination revealed Rutherford IIb ischaemia. CT-angiography demonstrated no continuity between the hypoplastic superficial femoral and popliteal arteries, complete occlusion of the right PSA distal to the thrombosed aneurysm and occlusive thrombus in the right profunda. As she was too frail for femoral-distal bypass, we restored femoral axis inflow via profunda embolectomy. Her prognosis remained guarded as we deliberately did not reconstruct the PSA. However, she was discharged pain-free and mobilising with aids 2 weeks later. CONCLUSION Limb ischaemia in frail, high-risk patients is an ever-increasing challenge for vascular surgeons and requires complex decision-making, balancing comorbidities against desired outcomes. This case illustrates that a selective approach can be sufficient to maintain function despite complex anatomy.
Collapse
Affiliation(s)
- Megan Power Foley
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - Mahmoud Alawy
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - Muhammad Tubassam
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
- National University of Ireland, Galway
| |
Collapse
|
29
|
Wang YM, Zhang MQ, Chen ZP, Ji R, Cai J, Qiao T. [Correlation between C-reactive protein to albumin ratio and restenosis after femoral popliteal stenting in patients with lower extremity arteriosclerotic obliterans]. Zhonghua Wai Ke Za Zhi 2023; 61:1058-1064. [PMID: 37932141 DOI: 10.3760/cma.j.cn112139-20230815-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Objective: To investigate the study of the correlation between C-reactive protein to albumin ratio (CAR) and restenosis after stenting in patients with lower extremity atherosclerotic occlusive disease(LEASO). Methods: The clinical data of 95 patients with LEASO admitted to the Department of Vascular Surgery of Nanjing Drum Tower Hospital from June 2020 to December 2022 were retrospectively analyzed. There were 67 males and 28 females,aged (73.1±9.4) years (range:51 to 92 years). The patients were classified into the restenosis group (n=61) and the patency group (n=34) according to the CT angiography results. Independent sample t test,Mann-Whitney U test and χ2 test were used to compare the data between two groups. Risk factors for restenosis after femoropopliteal artery stenting in patients with LEASO were analyzed using multivariate Cox regression. The relationship between preoperative CAR level and restenosis after stent placement was analyzed. Subject operating characteristic(ROC) curves of CAR were plotted to assess the predictive value of CAR for restenosis after stenting,and the results were expressed as area under the curve (AUC). Results: The aortoiliac calcification grade,number of stents,length of stents,C-reactive protein and CAR levels in restenosis group were higher than those in the patency group,and the serum albumin level was lower than that in the patency group(all P<0.05). And the results of multifactorial Cox regression analysis showed that higher pre-procedure CAR level and lower ABI value was an independent risk factor for in-stent restenosis. The AUC of the ROC curve for restenosis was 0.737(95%CI:0.617 to 0.856),the AUC of the ROC curve for 12-month restenosis was 0.709(95%CI:0.602 to 0.815), and the AUC of the ROC curve for 24-month restenosis was 0.702(95%CI:0.594 to 0.811). Conclusion: Higher pre-procedural CAR levels in patients with LEASO is risk factor for in-stent restenosis,and CAR has a predictive value for restenosis after lower extremity arterial stent dilatation and angioplasty.
Collapse
Affiliation(s)
- Y M Wang
- Department of Vascular Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Traditional Chinese Medicine,Nanjing 210008,China
| | - M Q Zhang
- Department of Vascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China
| | - Z P Chen
- Department of Vascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China
| | - R Ji
- Department of Vascular Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Traditional Chinese Medicine,Nanjing 210008,China
| | - J Cai
- Department of Vascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China
| | - T Qiao
- Department of Vascular Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Traditional Chinese Medicine,Nanjing 210008,China
| |
Collapse
|
30
|
Migliara B. Intravascular Ultrasound Guided Totally Percutaneous Femoropopliteal Bypass (PiPer bypass). Eur J Vasc Endovasc Surg 2023; 66:883. [PMID: 37717812 DOI: 10.1016/j.ejvs.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Bruno Migliara
- Vascular and Endovascular Unit, Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy.
| |
Collapse
|
31
|
Zeller T. Treatment of Complex Femoro-popliteal Lesions: Time to Revise the Guidelines According to Clinical Reality. Cardiovasc Intervent Radiol 2023; 46:1769-1771. [PMID: 37935842 PMCID: PMC10695878 DOI: 10.1007/s00270-023-03589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Thomas Zeller
- Department Angiology, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany.
| |
Collapse
|
32
|
Liesker DJ, Gareb B, Speijers MJ, VAN DER Vorst JR, Salemans PB, Tutein Nolthenius RP, Zeebregts CJ, Saleem BR. Outcomes of Omniflow® II prosthesis used for revascularization in the femoral tract both in infected and non-infected setting. J Cardiovasc Surg (Torino) 2023; 64:634-644. [PMID: 37306682 DOI: 10.23736/s0021-9509.23.12692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence regarding the outcomes of Omniflow® II prosthesis in peripheral arterial revascularization at different anatomical sites and for different indications is scarce. Therefore, the aim of this study was to evaluate the outcomes of the Omniflow® II used at various positions within the femoral tract both in infected and non-infected setting. METHODS Patients who underwent reconstructive lower leg vascular surgery with implantation of an Omniflow® II from 2014 until 2021 at five medical centers were retrospectively included (N.=142). Patients were subdivided into the following categories: femoro-femoral crossover (N.=19), femoral interposition (N.=18), femoro-popliteal (above-the-knee [N.=25; AK] or below-the-knee [N.=47; BK]), and femoro-crural bypass grafts (N.=33). Primary outcome was primary patency and secondary outcomes included primary assisted patency, secondary patency, major amputation, vascular graft infection, and mortality. Outcomes were compared according to different subgroups and the surgical setting (infected versus non-infected). RESULTS The median follow-up was 35.0 (17.5-54.3) months. Three years primary patency of 58% was observed for femoro-femoral crossover bypass, 75% for femoral interposition graft, 44% for femoro-popliteal above-the-knee bypass, 42% for femoro-popliteal below-the-knee bypass, and 27% in the femoro-crural position (P=0.006). Freedom from major amputation at three years were 84% for femoro-femoral crossover bypass, 88% for femoral interposition bypass, 90% for femoro-popliteal AK bypass, 83% for femoro-popliteal BK bypass, and 50% for femoro-crural bypass (P<0.001). CONCLUSIONS This study demonstrates the safety and feasibility of the use of Omniflow® II for femoro-femoral crossover-, femoral interposition-, and femoro-popliteal (AK and BK) bypass. Omniflow® II seems to be less suitable for femoro-crural bypass with a significantly lower patency compared to other positions.
Collapse
Affiliation(s)
- David J Liesker
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands -
| | - Barzi Gareb
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maarten J Speijers
- Division of Vascular Surgery, Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands
| | - Joost R VAN DER Vorst
- Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter B Salemans
- Division of Vascular Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Rudolf P Tutein Nolthenius
- Division of Vascular Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ben R Saleem
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
33
|
Li Y, Shen X, Zhuang H. Comparation of drug-eluting stents and control therapy for the treatment of infrapopliteal artery disease: a Bayesian analysis. Int J Surg 2023; 109:4286-4297. [PMID: 37720942 PMCID: PMC10720840 DOI: 10.1097/js9.0000000000000736] [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] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Critical limb-threatening ischaemia is a life-threatening disease which often combines with infrapopliteal arterial disease. Percutaneous transluminal angioplasty (PTA) is recommended as the first-line treatment for infrapopliteal arterial disease. Drug-eluting stent (DES) is another widely used option; however, its long-term therapeutic effect is controversial. The effectiveness of different DES for infrapopliteal arterial disease needs further exploration. METHODS AND RESULTS The PubMed, EMBASE, Cochrane Library and Clinical trials were systematically searched from inception to 1 February 2023. Literatures were included if the study was original, peer-reviewed, published in English or Chinese, and contained patients diagnosed with simple infrapopliteal arterial disease or with properly treated combined inflow tract lesions before or during the study procedure. A total of 953 patients, 504 in the DES group and 449 in the PTA/bare-metal stenting (BMS) group, from 12 randomised controlled trials were included in the meta-analysis. The results showed that DES is superior to control group for improving clinical patency, reducing the restenosis rate, and reducing the amputation rate at 6 months, 1 year, and 3 years post-treatment [at 3 years, risk ratio (RR): 1.90, 95% CI 1.23-2.93; RR: 0.87, 95% CI 0.79-0.96; RR: 0.60, 95% CI 0.36-1.00, P =0.049]. In addition, subgroup analyses suggested that DES is superior to BMS and PTA in improving clinical patency and reducing target lesion revascularisation and restenosis rates at 6-month and 1-year post-treatment. The network meta-analysis indicated that sirolimus-eluting stent was superior for improving clinical patency (at 1 year, RR: 0.23, 95% CI 0.08-0.60) and reducing the restenosis rate (at 6 months, RR: 31.58, 95% CI 4.41-307.53, at 1 year, RR: 3.80, 95% CI 1.84-8.87) significantly. However, according to the cumulative rank probabilities test, everolimus-eluting stent may have the lowest target lesion revascularisation rates and amputation rates at 1-year post-treatment (the cumulative rank probability was 77% and 49%, respectively). CONCLUSIONS This systematic review and network meta-analysis showed that DES was associated with more clinical efficacy than PTA/BMS significantly. In addition, sirolimus-eluting stent and everolimus-eluting stent may have better clinical benefits.
Collapse
Affiliation(s)
| | | | - Hui Zhuang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen City, Fujian Province, China
| |
Collapse
|
34
|
Liu X, Xiao Y, Yang H. A new attempt at the popliteal artery and knee posterior capsule space block. Asian J Surg 2023; 46:5489-5490. [PMID: 37544780 DOI: 10.1016/j.asjsur.2023.07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Affiliation(s)
- Xinzhe Liu
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China
| | - Yu Xiao
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China
| | - Haitao Yang
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China.
| |
Collapse
|
35
|
Parker M, Penton A, McDonnell S, Kolde G, Babrowski T, Blecha M. Investigation of center-specific saphenous vein utilization rates in femoral popliteal artery bypass and associated impact of conduit on outcomes. J Vasc Surg 2023; 78:1497-1512.e3. [PMID: 37648090 PMCID: PMC10756644 DOI: 10.1016/j.jvs.2023.08.123] [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: 07/13/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate variation in great saphenous vein (GSV) use among the various centers participating in the Vascular Quality Initiative infrainguinal bypass modules. Further, differences in outcomes in femoral-popliteal artery bypass with single segment GSV conduit vs prosthetic conduit will be documented. Center GSV use rate impact on outcomes will be investigated. METHODS Primary exclusions were patients undergoing redo bypass, urgent or emergent bypass, and those in whom prosthetic graft was used while having undergone prior coronary artery bypass grafting. The distribution of GSV use across the 260 centers participating in Vascular Quality Initiative infrainguinal bypass module was placed into histogram and variance in mean GSV use evaluated with analysis of variance analysis. Centers that used GSV in >50% of bypasses were categorized as high use centers and centers that used the GSV in <30% of cases were categorized as low use centers. Baseline differences in patient characteristics and comorbidities in those undergoing bypass with GSV vs prosthetic conduit were analyzed with χ2 testing and the Student t test, as were those undergoing treatment in high vs low use centers. Multivariable time-dependent Cox regression analyses were then performed for the primary outcomes of major amputation ipsilateral to the operative side and mortality in long-term follow-up. High vs low use center was a dichotomous variable in these regressions. Secondary outcomes of freedom from graft infection and freedom from loss of primary patency were performed with Kaplan-Meier analysis. RESULTS Among centers with >50 patients meeting inclusion criteria for this study, GSV use ranged from 15% to 93% (analysis of variance P < .001). When considering all centers irrespective of number of patients, the range was 0% to 100%. On Kaplan-Meier analysis, GSV conduit use was associated with improved freedom from loss of primary or primary assisted patency, improved freedom from major amputation after index hospitalization, improved freedom from graft infection after the index hospitalization, and improved freedom from mortality in long-term follow-up (log-rank P < .001 for all four outcomes). Both low use center (hazard ratio, 1.35; P < .001) and prosthetic graft use (hazard ratio, 1.24; P < .001) achieved multivariable significance as risks for mortality in long-term follow-up. Other variables with a multivariable mortality association are presented in the manuscript. Low use center and prosthetic bypass were significant univariable but not multivariable risks for major amputation after index hospitalization. CONCLUSIONS There is remarkably wide variation in GSV use for femoral popliteal artery bypass among various medical centers. GSV use is associated with enhanced long-term survival as well as freedom from loss of bypass patency and graft infection. The data herein indicate institutional patterns of prosthetic conduit choice, which has the potential to be altered to enhance outcomes.
Collapse
Affiliation(s)
- Michael Parker
- Loyola University Chicago, Stritch School of Medicine, Loyola University Health System, Division of Vascular Surgery and Endovascular Therapy, Chicago, IL
| | - Ashley Penton
- Loyola University Chicago, Stritch School of Medicine, Loyola University Health System, Division of Vascular Surgery and Endovascular Therapy, Chicago, IL
| | - Shannon McDonnell
- Loyola University Chicago, Stritch School of Medicine, Loyola University Health System, Division of Vascular Surgery and Endovascular Therapy, Chicago, IL
| | - Grant Kolde
- Loyola University Chicago, Stritch School of Medicine, Loyola University Health System, Division of Vascular Surgery and Endovascular Therapy, Chicago, IL
| | - Trissa Babrowski
- University of Chicago Medical Center, Pritzker School of Medicine, Section of Vascular Surgery and Endovascular Therapy, Chicago, IL
| | - Matthew Blecha
- Loyola University Chicago, Stritch School of Medicine, Loyola University Health System, Division of Vascular Surgery and Endovascular Therapy, Chicago, IL.
| |
Collapse
|
36
|
Shazly T, Uline M, Webb C, Pederson B, Eberth JF, Kolachalama VB. Novel Payloads to Mitigate Maladaptive Inward Arterial Remodeling in Drug-Coated Balloon Therapy. J Biomech Eng 2023; 145:121004. [PMID: 37542712 PMCID: PMC10578076 DOI: 10.1115/1.4063122] [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: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
Drug-coated balloon therapy is a minimally invasive endovascular approach to treat obstructive arterial disease, with increasing utilization in the peripheral circulation due to improved outcomes as compared to alternative interventional modalities. Broader clinical use of drug-coated balloons is limited by an incomplete understanding of device- and patient-specific determinants of treatment efficacy, including late outcomes that are mediated by postinterventional maladaptive inward arterial remodeling. To address this knowledge gap, we propose a predictive mathematical model of pressure-mediated femoral artery remodeling following drug-coated balloon deployment, with account of drug-based modulation of resident vascular cell phenotype and common patient comorbidities, namely, hypertension and endothelial cell dysfunction. Our results elucidate how postinterventional arterial remodeling outcomes are altered by the delivery of a traditional anti-proliferative drug, as well as by codelivery with an anti-contractile drug. Our findings suggest that codelivery of anti-proliferative and anti-contractile drugs could improve patient outcomes following drug-coated balloon therapy, motivating further consideration of novel payloads in next-generation devices.
Collapse
Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Mechanical Engineering, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208
| | - Mark Uline
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Chemical Engineering, University of South Carolina, Columbia, SC 29208
| | - Clinton Webb
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; School of Medicine, Department of Cell Biology and Anatomy, University of South Carolina, Columbia, SC 29208
| | - Breanna Pederson
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208
| | - John F. Eberth
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118; Department of Computer Science and Faculty of Computing and Data Sciences, Boston University, Boston, MA 02115
| |
Collapse
|
37
|
Gratl A, Kluckner M, Gruber L, Klocker J, Wipper S, Enzmann FK. The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury. Eur J Trauma Emerg Surg 2023; 49:2363-2371. [PMID: 36449024 PMCID: PMC10728240 DOI: 10.1007/s00068-022-02179-4] [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: 07/24/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Vascular injuries in lower extremity trauma, especially with involvement of the popliteal artery, are associated with considerably high rates of limb loss, especially with blunt trauma mechanisms. The aim of this study was to evaluate the risk of amputation in patients with traumatic popliteal artery lesions with special focus on the validity of the Mangled Extremity Severity Score (MESS). METHODS In this retrospective study, all patients treated for isolated lesions of the popliteal artery following trauma between January 1990 and December 2020 at a high-volume level I trauma center were included. Primary outcome was limb salvage dependent on MESS and the influence of defined parameters on limb salvage was defined as secondary outcome. The extent of trauma was assessed by the MESS. RESULTS A total of 50 patients (age 39.2 ± 18.6 years, 76% male) with most blunt injuries (n = 47, 94%) were included. None of the patients died within 30 days and revascularization was attempted in all patients with no primary amputation and the overall limb salvage rate was 88% (44 patients). A MESS ≥ 7 was observed in 28 patients (56%) with significantly higher rates of performed fasciotomies (92.9% vs. 59.1%; p < 0.01) in those patients. MESS did not predict delayed amputation within our patient cohort (MESS 8.4 ± 4.1 in the amputation group vs. 8.1 ± 3.8 in the limb salvage group; p = 0.765). CONCLUSION Revascularization of limbs with isolated popliteal artery injuries should always be attempted. MESS did not predict delayed amputation in our cohort with fasciotomy being an important measure to increase limb salvage rates.
Collapse
Affiliation(s)
- Alexandra Gratl
- Department of Vascular Surgery, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michaela Kluckner
- Department of Vascular Surgery, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Josef Klocker
- Department of Vascular Surgery, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Sabine Wipper
- Department of Vascular Surgery, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Florian Karl Enzmann
- Department of Vascular Surgery, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| |
Collapse
|
38
|
Ghaffarian AA, Hemingway J, Quiroga E, Tran N, Starnes BW, Singh N. Dynamic Imaging is the Ideal Modality for the Diagnosis of Popliteal Artery Entrapment Syndrome. Ann Vasc Surg 2023; 97:106-112. [PMID: 37356661 DOI: 10.1016/j.avsg.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Popliteal Artery Entrapment Syndrome (PAES) is a rare vascular condition with significant equipoise on how to properly diagnose and evaluate relevant imaging. This can lead to misdiagnosis and delay in surgical management. The objective of this study is to describe and compare distinct imaging features of dynamic versus static images to help determine the ideal imaging modality for diagnosis of PAES. METHODS This is a retrospective review of patients referred for PAES at a single institution. We reviewed noninvasive imaging studies, diagnostic arteriograms, and cross-sectional images which include computed tomography angiography (CTA) or magnetic resonance angiography (MRA). For each affected and unaffected extremity, the characteristic collaterals for PAES were named and measured on arteriogram using Picture Archiving and Communication Software. Available cross-sectional images were also analyzed and compared with arteriogram and intraoperative findings during surgical exploration. RESULTS There were 23 patients referred for PAES who underwent diagnostic evaluation and surgical management between 2013 and 2022. All patients had a duplex ultrasound that revealed a mean popliteal peak systolic velocity of 78 cm/sec at rest. With forced plantar flexion, the peak systolic velocity increased to a mean 175 cm/sec. A total of 12 extremities had complete loss of flow with provocation during duplex ultrasound. All patients underwent diagnostic angiography of 46 extremities. All limbs with PAES (n = 35) exhibited complete popliteal artery occlusion during angiography with forced plantar flexion. Distinct angiographic findings on resting images included a well-developed medial sural artery in 100% of limbs with PAES with a mean diameter of 2.7 mm. In limbs without PAES, only 80% had a visualized medial sural artery on arteriogram with a mean diameter of 2.0 mm (P = 0.1). A lateral sural artery was seen in 85% of affected extremities (mean diameter of 1.8 mm), while an anterior tibial recurrent artery was seen in 59% of affected extremities (mean diameter of 1.3 mm). In unaffected limbs, there were no visible lateral sural or anterior tibial recurrent arteries. The mean contrast used with diagnostic arteriograms was 58 milliliters (range 10-100 milliliters). Axial imaging was available for 9 affected extremities. Five had a previous MRA with only 1 being truly positive for arterial compression. Four extremities had previous CTA with 3 being falsely negative despite having type 3 PAES discovered during surgical exploration. CONCLUSIONS Dynamic imaging with angiography provides immediate surgeon feedback by visualizing popliteal artery compression and enlarged sural collaterals during resting arteriography. The medial sural collateral is enlarged in patients with PAES and often the lateral sural and anterior tibial recurrent arteries can be visualized as well. CTA and MRA are associated with high false-negative rates, and therefore cause delays in diagnosis and surgical management of PAES. Dynamic imaging should, therefore, be the gold standard for the diagnosis of PAES.
Collapse
Affiliation(s)
- Amir A Ghaffarian
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Jake Hemingway
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Elina Quiroga
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Nam Tran
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Benjamin W Starnes
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA.
| |
Collapse
|
39
|
Naazie IN, Willie-Permor D, Haykal T, Harris LM, Hughes K, Malas MB. Association Between Conduit Type and Outcomes After Open Repair of Popliteal Artery Aneurysms. J Surg Res 2023; 291:670-676. [PMID: 37562228 DOI: 10.1016/j.jss.2023.06.021] [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] [Received: 09/19/2022] [Revised: 04/20/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Prior studies have demonstrated acceptable midterm outcomes with prosthetic conduits for above-knee bypass for occlusive disease in patients with inadequate segment great saphenous vein (GSV). In this study we aimed to investigate whether this holds true for open repair of popliteal artery aneurysms (PAA). METHODS We queried the Vascular Quality Initiative data for patients who underwent open PAA repair (OPAR). We divided the cohort into three groups based on the conduit used: GSV, other autologous veins, or prosthetic graft. Study outcomes included primary patency, freedom from major amputation, amputation-free survival, and overall survival at 1 y. Kaplan-Meier survival estimates, log-rank tests and multivariable Cox regression were used to compare outcomes between study groups. RESULTS A total of 4016 patients underwent bypass for PAA from January 2010 to October 2021. The three cohorts were significantly different in many demographic and clinical characteristics. The adjusted odds of postoperative amputation among symptomatic patients were 3-fold higher for prosthetic conduits compared to the GSV (odds ratio, 3.20; 95% CI, 1.72-5.92; P < 0.001). For the 1-y outcomes, the adjusted risk of major amputation was almost 3-fold higher for patients with symptomatic disease undergoing bypass with prosthetic conduits (hazard ratio [HR], 2.97; 95% CI, 1.35-6.52; P = 0.007). When compared with GSV, prosthetic conduits were associated with 96% increased risk of death when used for repair in symptomatic patients (adjusted hazard ratio (aHR), 1.96; 95% CI, 1.29-2.97; P = 0.002) but no significant association with mortality in asymptomatic patients (aHR, 0.83; 95% CI, 0.37-1.87; P = 0.652). When compared with GSV, prosthetic conduits were associated with a 2-fold increased risk of 1-y major amputation or death when used for repair in symptomatic patients (aHR, 2.03; 95% CI, 1.40-2.94; P < 0.001) but no significant association with mortality in asymptomatic patients (aHR, 0.91; 95% CI, 0.42-1.98; P = 0.816). Comparing bypass with other veins to the GSV among patients with symptomatic disease, there was no statistically significant difference in major amputation risk (HR; 2.44; 95% CI, 0.55-10.82; P = 0.242) and no difference in the adjusted risk of all-cause mortality (aHR, 0.77; 95% CI, 0.26-2.44; P = 0.653). There were no differences in the adjusted risk of loss of primary patency comparing other veins to GSV (HR, 1.53; 95% CI, 0.85-2.76; P = 0.154) and prosthetic conduits to GSV (HR, 0.85; 95% CI, 0.57-1.26; P = 0.422). CONCLUSIONS This large study shows that among patients undergoing OPAR, 1-y primary patency does not differ between conduit types. However, prosthetic conduits are associated with significantly higher risk of amputation and death compared to GSV among symptomatic patients. Though non-GSV autologous veins are less often used for OPAR, they have comparably acceptable outcomes as GSV.
Collapse
Affiliation(s)
- Isaac N Naazie
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California; Division of Vascular and Endovascular Surgery, Department of Surgery, University at Buffalo, Buffalo, New York
| | - Daniel Willie-Permor
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Tony Haykal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Linda M Harris
- Division of Vascular and Endovascular Surgery, Department of Surgery, University at Buffalo, Buffalo, New York
| | - Kakra Hughes
- Division of Cardiothoracic and Vascular Surgery, Howard University Hospital, Washington, District of Columbia
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California.
| |
Collapse
|
40
|
Pratt B, Thompson J, Peshel EC, Herur-Raman A, Nguyen BN, Lala S. Common Iliac Artery to Below-Knee Popliteal Artery Bypass via Obturator Foramen in a Third-Time Reoperative Groin for Limb Salvage in Chronic Limb-Threatening Ischemia. Vasc Endovascular Surg 2023; 57:905-908. [PMID: 37225280 DOI: 10.1177/15385744231178134] [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: 05/26/2023]
Abstract
This case report presents the management of a 69-year-old man with an extensive history of peripheral vascular disease including 2 previous failed right femoral to distal bypasses and a left above-the-knee amputation who presented with right lower extremity rest pain and non-healing shin ulcers. A redo bypass was performed for limb salvage via the obturator foramen to avoid his extensively scarred femoral region. The postoperative course was uneventful and the bypass remained patent in the early period. This case demonstrates the usefulness of the obturator bypass to provide revascularization and avoid amputation in a patient with chronic limb-threatening ischemia and multiple failed bypasses.
Collapse
Affiliation(s)
- Brittaney Pratt
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Jamie Thompson
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Emanuela C Peshel
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Aalap Herur-Raman
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Bao-Ngoc Nguyen
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Salim Lala
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| |
Collapse
|
41
|
Müller AM, Löhn-Kannengießer L, Bradaric C, Dirschinger R, Koppara T, Bergmann K, Kehl V, Cassese S, Xhepa E, Kastrati A, Laugwitz KL, Ibrahim T. Outcomes of endovascular treatment for popliteal artery disease. VASA 2023; 52:386-393. [PMID: 37840269 DOI: 10.1024/0301-1526/a001096] [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: 10/17/2023]
Abstract
Background: Finding the appropriate endovascular revascularization strategy for patients with peripheral artery disease and a popliteal artery lesion remains particulary challenging. Data regarding predictors for a beneficial outcome are scarce. Patients and methods: All endovascular procedures of popliteal artery lesions (n=227) performed in 197 patients between February 2009 and May 2018 at our institution were retrospectively analyzed. Hemodynamically relevant restenosis represented the primary endpoint. Results: The overall technical success rate was 98% and yielded 99% for stenoses (n=145) and 97% for occlusions (n=82). In a median follow-up of 10 months, the overall rate of restenosis was 23%. After 1 and 2 years, the primary patency rates were 76% and 55% and the secondary patency rate was 100%, respectively. The estimated probability of restenosis was significantly higher in stented lesions (stent vs. no stent; 36.0% vs. 19.1%; p=0.030). Multivariate analysis identified stent implantation (hazard ratio: 2.4; overall P=0.010) and diabetes (hazard ratio 2.0; P=0.023) as significant predictors for the development of restenosis. Conclusions: Endovascular therapy for popliteal artery disease was associated with high technical success rates and accompanied with a promising mid-term outcome, particularly in lesions treated with balloon angioplasty alone.
Collapse
Affiliation(s)
- Arne M Müller
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Leoni Löhn-Kannengießer
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Christian Bradaric
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Ralf Dirschinger
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Tobias Koppara
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Katharina Bergmann
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Victoria Kehl
- Institut für KI und Informatik in der Medizin, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| |
Collapse
|
42
|
Qiao H, Chang CH, Wang AYC, Li S, Yang W, Li G, Cen X, Wang R, Lin H. Safety and efficacy of drug coated balloon angioplasty for intracranial atherosclerotic disease. J Neurointerv Surg 2023; 15:e172-e177. [PMID: 36171100 DOI: 10.1136/jnis-2022-019122] [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] [Received: 06/02/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drug coated balloon (DCB) angioplasty can provide sustained anti-restenotic efficacy without the limitations of permanent vascular implantation and is presumably ideal for treating intracranial atherosclerotic disease. However, the safety of paclitaxel in the neurovasculature remains a concern. METHODS 242 patients with angiographically verified symptomatic stenosis >70% in intracranial arteries treated with DCB angioplasty were reviewed divided into two groups: group A, patients with stenotic intracranial arteries; and group B, patients with acute, subacute, or chronic occluded intracranial arteries. The primary endpoint was any stroke or death within 30 days. The secondary endpoint was arterial restenosis of >50% during follow-up. RESULTS 16 major and 12 minor complications occurred among 245 procedures (6.5% and 4.9%, respectively). Five patients died within 30 days after the procedure (2.1%, 5/242). 12 major and 12 minor complications occurred among 211 procedures in group A (5.7% and 5.7%). In group B, four major complications occurred among 34 procedures (11.8%). Hyperperfusion and perforator stroke accounted for half of all complications (53.6%, 15/28). Restenosis >50% was present in eight lesions during the follow-up period (4.8%, 8/167). CONCLUSIONS After treatment with DCB angioplasty, complications were no different from those after standard balloon angioplasty or stenting. This study suggests that DCB angioplasty may be a safe and effective procedure for intracranial arterial stenosis.
Collapse
Affiliation(s)
- Hanzi Qiao
- Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chien-Hung Chang
- Neurology, Chang Gung Memorial Hospital Linkou Branch, Gueishan, Taoyuan, Taiwan
| | - Alvin Yi-Chou Wang
- Department of Neurosurgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Shaoxue Li
- Neurosurgical Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weilin Yang
- Brain Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Guoming Li
- Neurology Department, Second Clinical Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuecheng Cen
- Neurosurgical Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Rongfei Wang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Lin
- Neurological Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
43
|
Mori S, Yamawaki M, Fukagawa T, Yamaguchi K, Mizusawa M, Shirai S, Honda Y, Tsutsumi M, Kobayashi N, Ito Y. Impact of "black rock" on clinical outcomes after endovascular therapy for de novo calcified femoropopliteal lesions. Heart Vessels 2023; 38:1356-1363. [PMID: 37369857 DOI: 10.1007/s00380-023-02284-3] [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: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
The relationship between severity of calcification and clinical outcomes after endovascular therapy (EVT) for femoropopliteal lesions is well known. We often encounter dense calcifications in our daily practice, which are darker than normal calcifications on angiography. Accordingly, we named it "black rock" (BR), and investigated its impact on clinical outcomes after EVT. We retrospectively analyzed 677 lesions in 495 patients who underwent EVT for de novo calcified femoropopliteal lesions at our hospital between April 2007 and June 2020. BR is defined as a calcification which is 1 cm or more in length, occupies more than half of the vessel diameter, and appears darker than the body of the femur on angiography. Propensity score matching analysis was performed to compare clinical outcomes between lesions with BR [BR (+) group] and without BR [BR (-) group]. A total of 119 matched pairs of lesions were analyzed. Primary patency at 2 years was significantly lower in the BR (+) group than in the BR (-) group (48% vs. 75%, p = .0007). Multivariate analysis revealed that the presence of BR [hazard ratio (HR) = 2.23, 95% confidence interval (CI); 1.48-3.38, p = .0001], lesion length (HR = 1.03, 95%CI; 1.00-1.06, p = .0244), and no scaffold use (HR = 1.58, 95%CI; 1.06-2.36, p = .0246) were predictors of restenosis. The presence of BR is independently associated with clinical outcomes after EVT for de novo calcified femoropopliteal lesions.
Collapse
Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan.
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Tomoya Fukagawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Kohei Yamaguchi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Masafumi Mizusawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Shigemitsu Shirai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| |
Collapse
|
44
|
Nagar HJ, Bungay P, Podlasek A, Pollock JG. Endovascular Popliteal Artery Aneurysm Repair Using an "Off-Label" Abdominal Endograft Limb-Module with Nitinol-Ring Structure: A Single Centre Experience. Cardiovasc Intervent Radiol 2023; 46:1562-1570. [PMID: 37759089 DOI: 10.1007/s00270-023-03541-8] [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: 03/29/2023] [Accepted: 08/12/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE To evaluate endovascular popliteal artery aneurysm repair using a an "off-label" abdominal endograft limb-module with nitinol-ring structure. MATERIALS AND METHODS Retrospective observational study of 14 popliteal artery aneurysms in 12 male patients (mean age 76 years and median ASA grade 3) treated electively using the Anaconda™ endograft limb (Terumo Aortic) at a single teaching hospital. Eight limbs were treated percutaneously and 6 limbs required surgical arterial exposure. The mean popliteal artery aneurysm diameter treated was 3.6 cm (range 2.1-5.3 cm). Stent-graft diameters and lengths used were 10-15 and 60-140 mm, respectively. The median covered stented length was 218 mm (range 160-270 mm) and median duration of follow-up was 3.7 years. Outcomes assessed included technically successful aneurysm exclusion, primary patency, re-intervention and survival. RESULTS All patients had successful stent-graft deployment and aneurysm exclusion, with no early complications or mortality at 30 days. Primary stent-graft patency at 1, 3 and 4 years was 93%, 75%, and 64%. By 8 years, patency had declined with 29% (2/14) stent-grafts patent. 7/14 limbs occluded; 3 underwent re-intervention (2 surgical, 1 endovascular). There were no deaths related to the procedure. Freedom from re-intervention and survival at 1/5 years was 93%/84% and 93%/67%, respectively. CONCLUSION The Anaconda™ endograft limb for endovascular popliteal artery aneurysm repair offers good mid-term patency and acceptable long-term patency up to 4 years when compared with other grafts and open surgery. It may be considered in older comorbid patients unfit for surgery and can be performed percutaneously under local anaesthesia when anatomically feasible.
Collapse
Affiliation(s)
- H J Nagar
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK
| | - P Bungay
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK
| | - A Podlasek
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK
| | - J G Pollock
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK.
| |
Collapse
|
45
|
Deveze E, Bruneau A, Raimondeau D, Henni S, Abraham P, Picquet J. Long-Term Functional Outcomes After Surgery of Functional Popliteal Artery Entrapment Syndrome. Ann Vasc Surg 2023; 97:405-409. [PMID: 37244483 DOI: 10.1016/j.avsg.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Functional popliteal artery entrapment syndrome (fPAES) is a subtype of PAES without anatomic abnormalities entrapment of the popliteal artery. One of the management of symptomatic fPAES is surgical exploration of the popliteal region with popliteal artery release with lysis of fibrous bands. There is a lack of data regarding the long-term functional results of this surgery, most of the studies focusing on vascular patency in anatomical PAES. The aim of this study was to assess the efficacy of surgery in functional PAES, focusing on long-term physical activity return after surgery with the Tegner activity scale. METHODS All patients who underwent surgery for fPAES from January 1, 2010, to December 31, 2020, were searched. After ethical approval, all patients were called to evaluate physical activity since surgery. The Tegner activity scale is a numerical scale with each value (0 to 10) representing specific activity. The aim was to evaluate everyday activity limitations and participation restriction after surgery. The results for each patient were recorded: "before symptoms," "before surgery," and "after surgery." RESULTS Over the study period, 33 patients were included with 61 symptomatic legs. The mean time between surgery and phone call was 38.6 ± 21.9 months. The median score of the Tegner activity scale "before symptoms" was 7 (4-7), the median score "before surgery" was 3 (2-3), and the median score at the time of the phone call "after surgery" was 5 (3-7). P value was <0.0001 by comparing results "before surgery" and "after surgery." CONCLUSIONS Results demonstrated that the sport activity and intensity level is significantly higher after surgery even if patients did not reach their initial sport activity level.
Collapse
Affiliation(s)
- Eva Deveze
- Vascular and Thoracic Surgery, University Hospital, Angers, France.
| | | | | | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | - Jean Picquet
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| |
Collapse
|
46
|
Yamaguchi K, Mori S, Fukagawa T, Kishida T, Nakano T, Shirai S, Mizusawa M, Makino K, Honda Y, Tsutsumi M, Kobayashi N, Yamawaki M, Ito Y. Two-year clinical outcomes of drug-coated balloon angioplasty and angiographic predictors of restenosis among patients with de novo femoropopliteal lesions. Indian Heart J 2023; 75:403-408. [PMID: 37739220 PMCID: PMC10774568 DOI: 10.1016/j.ihj.2023.09.002] [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] [Received: 12/13/2022] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES We analyzed the 2-year clinical outcomes of patients with de novo femoropopliteal (FP) lesions who underwent drug-coated balloon (DCB) angioplasty and the angiographic predictors of restenosis. METHODS This single-center, retrospective, and observational study evaluated 129 de novo FP lesions treated with DCB angioplasty without bailout stenting. Clinical outcomes and risk factors for loss of primary patency were analyzed using univariate and multivariate Cox proportional hazards regression models. RESULTS The participants were aged 48-93 (mean: 73.6 ± 9.8) years, and 31% were women. Approximately 33% of the patients were receiving regular dialysis, and 35% of the affected limbs had critical ischemia. The mean lesion length was 132 ± 96 mm, and the mean reference vessel diameter (RVD) was 4.7 ± 0.8 mm. Forty-three (33%) limbs had chronic total occlusion of the target artery segment. Fifty-seven (44%) and 72 (56%) lesions were treated with DCB angioplasty using IN.PACT Admiral and Lutonix, respectively. The primary patency and amputation-free survival at 2 years were 59.3% and 89.5%, respectively. RVD was found to be an independent predictor of loss of primary patency. Based on the receiver operating characteristic analysis, an RVD of 4.2 mm was the best predictor of loss of primary patency at 2 years. CONCLUSIONS The short-term clinical outcome of DCB angioplasty for de novo FP lesions was acceptable. Moreover, an RVD of <4.2 mm was an independent predictor of restenosis after DCB angioplasty.
Collapse
Affiliation(s)
- Kohei Yamaguchi
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan.
| | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Tomoya Fukagawa
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Toshihiko Kishida
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Takahide Nakano
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Shigemitsu Shirai
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Masafumi Mizusawa
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Kenji Makino
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| |
Collapse
|
47
|
Han X, Zhao P, Wang Z, Ji X, Zhao M. Acute lower extremity arterial thrombosis associated with nephrotic syndrome in adults: case series and literature review. BMC Nephrol 2023; 24:318. [PMID: 37884862 PMCID: PMC10605977 DOI: 10.1186/s12882-023-03374-0] [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] [Received: 03/15/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) is a condition associated with hypercoagulability. Thromboembolic events are a well-recognized complication of NS. Venous thrombosis is well known, while arterial thrombosis, which is more severe, occurs less frequently and is mainly reported in children in the literature. The aim of this study was to understand these rare adult cases of NS associated with acute lower extremity arterial thrombosis and draw attention to them to prevent misdiagnosis and delayed treatment. METHODS From January 2011 and October 2022, we conducted a retrospective study of patients with NS and arterial thrombosis. Their clinical manifestations, imaging characteristics, treatments and outcomes were analyzed and compared, and a literature review was performed. RESULTS Nine adults with NS and acute lower limb arterial thrombosis were described. In seven of these patients, six had fresh thrombi that preceded the NS diagnosis, while one had a history of NS for 14 years and previously underwent an emergency thrombectomy. Three of the seven patients eventually underwent above-knee amputations, and the other four underwent arterial revascularization with satisfactory recovery of lower-extremity perfusion. In addition to the seven patients mentioned above, the other two received successful anticoagulant treatment, as the thrombosis was present only in the popliteal artery. CONCLUSION Acute lower extremity arterial thrombosis is a rare but serious and potentially lethal complication in patients with NS, and early recognition and appropriate management are crucial for good patient outcomes.
Collapse
Affiliation(s)
- Xinqiang Han
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China
| | - Peng Zhao
- Department of Minimally Invasive Interventional Therapy Center, Qingdao Municipal Hospital, 256600, Qingdao, Shandong, China
| | - Zhu Wang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China
| | - Xingang Ji
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China
| | - Mengpeng Zhao
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China.
| |
Collapse
|
48
|
Jheun A, Cutmore C, Lee K, Rajendran S. Cystic adventitial disease of the popliteal artery. ANZ J Surg 2023; 93:2535-2536. [PMID: 37209372 DOI: 10.1111/ans.18519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/11/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Angela Jheun
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Carina Cutmore
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Vascular Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Kenneth Lee
- Anatomical Pathology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Department of Medicine, The University of Sydney Medical School, New South Wales, Sydney, Australia
| | - Saissan Rajendran
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Vascular Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
49
|
Kumar M, Long GW, Rimar SD, Studzinski DM, Callahan RE, Brown OW. Indications for a "Surgery-First" Approach for the Treatment of Lower Extremity Arterial Disease. Ann Vasc Surg 2023; 96:241-252. [PMID: 37023923 DOI: 10.1016/j.avsg.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/24/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND In recent years, there has been a tendency toward an "endovascular-first" approach for the treatment for femoropopliteal arterial disease. The purpose of this study is to determine if there are patients that are better served with an initial femoropopliteal bypass (FPB) rather than an endovascular attempt at revascularization. METHODS A retrospective analysis of all patients undergoing FPB between June 2006 - December 2014 was performed. Our primary endpoint was primary graft patency, defined as patent using ultrasound or angiography without secondary intervention. Patients with <1-year follow-up were excluded. Univariate analysis of factors significant for 5-year patency was performed using χ2 tests for binary variables. A binary logistic regression analysis incorporating all factors identified as significant by univariate analysis was used to identify independent risk factors for 5-year patency. Event-free graft survival was evaluated using Kaplan-Meier models. RESULTS We identified 241 patients undergoing FPB on 272 limbs. FPB indication was disabling claudication in 95 limbs, chronic limb-threatening ischemia (CLTI) in 148, and popliteal aneurysm in 29. In total, 134 FPB were saphenous vein grafts (SVG), 126 were prosthetic grafts, 8 were arm vein grafts, and 4 were cadaveric/xenografts. There were 97 bypasses with primary patency at 5 or more years of follow-up. Grafts patent at 5 years by Kaplan-Meier analysis were more likely to have been performed for claudication or popliteal aneurysm (63% 5-year patency) as compared with CLTI (38%, P < 0.001). Statistically significant predictors (using log rank test) of patency over time were use of SVG (P = 0.015), surgical indication of claudication or popliteal aneurysm (P < 0.001), Caucasian race (P = 0.019) and no history of COPD (P = 0.026). Multivariable regression analysis confirmed these 4 factors as significant independent predictors of 5-year patency. Of note, there was no statistical correlation between FPB configuration (above or below knee anastomosis, in-situ versus reversed saphenous vein) and 5-year patency. There were 40 FPBs in Caucasian patients without a history of COPD receiving SVG for claudication or popliteal aneurysm that had a 92% estimated 5-year patency by Kaplan-Meier survival analysis. CONCLUSIONS Long-term primary patency that was substantial enough to consider open surgery as a first intervention was demonstrated in Caucasian patients without COPD, having good quality saphenous vein, and who underwent FPB for claudication or popliteal artery aneurysm.
Collapse
Affiliation(s)
- Mohineesh Kumar
- Department of Surgery, Section of Vascular Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI
| | - Graham W Long
- Department of Surgery, Section of Vascular Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI.
| | - Steven D Rimar
- Department of Surgery, Section of Vascular Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI
| | - Diane M Studzinski
- Department of Surgery, Section of Vascular Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI
| | - Rose E Callahan
- Department of Surgery, Section of Vascular Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI
| | - O William Brown
- Department of Surgery, Section of Vascular Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI.
| |
Collapse
|
50
|
Teng L, Zhang Y, Fang J, Liu X, Shi T, Qu C, Li J, Shen C. A Bayesian network meta-analysis for acute thrombosis after lower extremity artery endovascular treatment. Catheter Cardiovasc Interv 2023; 102:731-742. [PMID: 37592400 DOI: 10.1002/ccd.30803] [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: 04/18/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Various endovascular treatment devices have been widely used in the lower extremity arterial disease (LEAD). Their patency efficiency for target lesions has been well studied and reported. Comparison of the risk of acute thrombosis events between the different endovascular treatment devices is unclear. AIMS To rank the risk of acute thrombosis events when bare metal stents (BMSs), covered stents (CSs), drug-eluting stents (DESs), drug-coated balloons (DCBs), and conventional percutaneous transluminal balloon angioplasty (PTA) are used to treat LEAD through Bayesian network meta-analysis. METHODS We performed a network meta-analysis of randomized controlled trials comparing the risk of 1-year postoperative acute thrombosis between BMSs, CSs, DESs, DCBs, and PTA for treating LEAD. Bayesian random models were used for pooled endovascular treatment modality comparisons. We ranked these treatment modalities via the Bayesian method according to their surface under the cumulative ranking curve (SUCRA) and estimated probabilities. RESULTS Nineteen studies (38 study arms; 2758 patients) were included. The Bayesian network ranking of treatments indicated that DCB had the lowest risk of acute thrombosis, PTA had the second-lowest risk of thrombosis, and CS, BMS, and DES had the highest risk of thrombosis. Regarding the treatment efficacy, the OR values of the loss of primary patency were significantly lower for DCB (OR = 0.44, 95% CI: 0.30-0.62), DES (OR = 0.36, 95% CI: 0.14-0.94), and CS (OR = 0.31, 95% CI: 0.18,0.56) than for PTA. When BMS was used as a reference, only the OR for CS was significantly lower (OR = 0.41, 95% CI = 0.21-0.82). Correspondingly, the Bayesian ranking of treatments from better to worse target lesion primary patency was CS, DES, DCB, BMS, and PTA. CONCLUSION With the available research evidence and according to the network analysis ranking, DES appears to have the highest risk of acute thrombosis and DCB appears to have the lowest risk.
Collapse
Affiliation(s)
- Lequn Teng
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Yongbao Zhang
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jie Fang
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xinnong Liu
- Vascular Surgery Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Shi
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chengjia Qu
- Vascular Surgery Department, Beijing Jishuitan Hospital, Beijing, China
| | - Jialiang Li
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chenyang Shen
- Vascular Surgery Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|