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Kleiss SF, van Mierlo-van den Broek PAH, Vos CG, Fioole B, Bloemsma GC, de Vries-Werson DAB, Bokkers RPH, de Vries JPPM. Outcomes and Patency of Endovascular Infrapopliteal Reinterventions in Patients With Chronic Limb-Threatening Ischemia. J Endovasc Ther 2023:15266028221147457. [PMID: 36609175 DOI: 10.1177/15266028221147457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Endovascular revascularization is the preferred treatment to improve perfusion of the lower extremity in patients with chronic limb-threatening ischemia (CLTI). Patients with CLTI often present with stenotic-occlusive lesions involving the infrapopliteal arteries. Although the frequency of treating infrapopliteal lesions is increasing, the reintervention rates remain high. This study aimed to determine the outcomes and patency of infrapopliteal endovascular reinterventions. METHODS This retrospective, multicenter cohort study of 3 Dutch hospitals included patients who underwent an endovascular infrapopliteal reintervention in 2015 up to 2021 after a primary infrapopliteal intervention for CLTI. The outcome measures after the reintervention procedures included technical success rate, the mortality rate and complication rate (any deviation from the normal postinterventional course) at 30 days, overall survival, amputation-free survival (AFS), freedom from major amputation, major adverse limb event (MALE), and recurrent reinterventions (a reintervention following the infrapopliteal reintervention). Cox proportional hazard models were used to determine risk factors for AFS and freedom from major amputation or recurrent reintervention. RESULTS Eighty-one patients with CLTI were included. A total of 87 limbs underwent an infrapopliteal reintervention in which 122 lesions were treated. Technical success was achieved in 99 lesions (81%). The 30-day mortality rate was 1%, and the complication rate was 13%. Overall survival and AFS at 1 year were 69% (95% confidence interval [CI], 55%-79%) and 54% (95% CI, 37%-67%), respectively, and those at 2.5 years were 45% (95% CI, 33%-56%) and 21% (95% CI, 11%-33%), respectively. Freedom from major amputation, MALE, and recurrent reinterventions at 1 year and 2.5 years were 59% (95% CI, 46%-70%) and 41% (95% CI, 25%-56%); 54% (95% CI, 41%-65%) and 36% (95% CI, 21%-51%); and 68% (95% CI, 55%-78%) and 51% (95% CI, 33%-66%), respectively. A Global Limb Anatomic Staging System score of III showed an increased hazard ratio of 2.559 (95% CI, 1.078-6.072; p=0.033) for freedom of major amputation or recurrent reintervention. CONCLUSIONS The results of this study indicate that endovascular infrapopliteal reinterventions can be performed with acceptable 30-day mortality and complication rates. However, outcomes and patency were moderate to poor, with low AFS, high rates of major amputations, and recurrent reinterventions. CLINICAL IMPACT This multicenter retrospective study evaluating outcome and patency of endovascular infrapopliteal reinterventions for CLTI, shows that endovascular infrapopliteal reinterventions can be performed with acceptable 30-day mortality and complication rates. However, the short- and mid-term outcomes of the infrapopliteal reinterventions were moderate to poor, with low rates of AFS and a high need for recurrent reinterventions. While the frequency of performing infrapopliteal reinterventions is increasing with additional growing complexity of the disease, alternative treatment options such as venous bypass grafting or deep venous arterialization may be considered and should be studied in randomized controlled trials.
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Affiliation(s)
- Simone F Kleiss
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Cornelis G Vos
- Department of Surgery, Martini Hospital, Groningen, The Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Gijs C Bloemsma
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Debbie A B de Vries-Werson
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Singh N, Ding L, Magee GA, Shavelle DM. Contemporary treatment of below‐the‐knee peripheral arterial disease in patients with chronic limb threatening ischemia: Observations from the Vascular Quality Initiative. Catheter Cardiovasc Interv 2022; 99:1289-1299. [DOI: 10.1002/ccd.30063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/27/2021] [Accepted: 12/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nikhil Singh
- Section of Cardiology, Department of Medicine University of Chicago Chicago Illinois USA
| | - Li Ding
- Department of Population and Public Health Sciences University of Southern California Keck School of Medicine Los Angeles California USA
| | - Gregory A. Magee
- Division of Vascular Surgery and Endovascular Therapy University of Southern California Keck School of Medicine Los Angeles California USA
| | - David M. Shavelle
- MemorialCare Heart and Vascular Institute Long Beach Memorial Medical Center Long Beach California USA
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Tang TY, Yap CJ, Chan SL, Soon SX, Lee CT, Chong TT, Leong CR. Physician initiated, prospective, non-randomized Multi-center trial, Investigating the safety and Efficacy of the TReatment with the LuminorTM Drug Coated Balloon and the AngioliteTM Drug Eluting Stent of IVascular in TASC C and D Tibial Occlusive disease iN patients with critical limb ischemia: 12-month results. INT ANGIOL 2021; 40:335-344. [PMID: 34056892 DOI: 10.23736/s0392-9590.21.04690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of MERLION (NCT04073121) was to evaluate the outcomes of the mono or combination therapy of the iVascular LuminorTM drug coated balloon (DCB) and AngioliteTM drug eluting stent for treatment of TASC II C/D tibial occlusive lesions in Asian patients presenting with chronic limb threatening ischemia (CLTI) from Singapore. METHODS MERLION was a prospective, non-randomized, single arm, observational, multicenter clinical study. Complication-free survival at one month was the safety endpoint. Immediate technical success, 12-month primary vessel patency, limb salvage, freedom from target lesion revascularization (TLR) and amputation free survival (AFS) were the efficacy endpoints of interest. RESULTS 50 patients were included. There were 32 males (64% males; mean age 66.4±8.9 years). Majority were Rutherford 5 severity (41/50; 82%). Co-morbidities included diabetes mellitus (47/50; 94.0%), end-stage renal failure (25/50; 50.0%), and hypertension (44/50; 88%). 66 atherosclerotic lesions were treated (47 de novo and 19 restenotic; 60.6% TASC C and 39.4% TASC D). Mean lesion length treated was 13.7±9.5cm. There was 100% technical success. There were 3/66 (4.5%) bailout stenting for severe flow limiting dissections. 12-month primary tibial patency was 34/49 (69.4%) and freedom from TLR was 40/49 (81.5%). AFS was 74.0% (37/50). At 12 months, mean Rutherford scores improved from 100% (Rutherford score>3) at baseline to 31% at 12 months (p<0.05) and wound healing rate was 65.7%. CONCLUSIONS The iVascular LuminorTM DCB is safe and efficacious in treating highly complex infra-popliteal atherosclerotic lesions in an otherwise challenging frail population of CLTI patients from Singapore.
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Affiliation(s)
- Tjun Y Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore - .,Duke-NUS Graduate Medical School, Singapore -
| | - Charyl J Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Sze L Chan
- Health Services Research Center, SingHealth, Singapore
| | - Shereen X Soon
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Chok T Lee
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Tze T Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Chuo R Leong
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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Mori M, Sakamoto A, Kawakami R, Sato Y, Jinnouchi H, Kawai K, Cornelissen A, Virmani R, Finn AV. Paclitaxel- and Sirolimus-coated Balloons in Peripheral Artery Disease Treatment: Current Perspectives and Concerns. VASCULAR AND ENDOVASCULAR REVIEW 2021. [DOI: 10.15420/ver.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Drug-coated balloons (DCBs) have become an established therapy for the treatment of above-the-knee peripheral artery disease. The paclitaxel DCB has shown clinical benefit in terms of patency and freedom from re-intervention in multiple randomised trials. However, a recent meta-analysis has suggested an association between mortality and the use of paclitaxel-coated devices. Sirolimus is another potential choice of anti-proliferative agent for use in DCBs because of its wider therapeutic index and lower risk for dose-dependent toxicity. More recently, encapsulating sirolimus in micro-reservoirs or polymers has facilitated the development of effective sirolimus DCBs, some of which are available in Europe and Asia. In this review, the authors focus on paclitaxel and sirolimus DCB technologies from the standpoint of drug characteristics and clinical trials.
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Affiliation(s)
| | | | | | - Yu Sato
- CVPath Institute, Gaithersburg, MD, US
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Brodmann M, Moscovic M, Wang JCC, Nano G, Dahm J, Zeller T, Christensen JK, Keirse K, Ghotbi R, Corpataux JM, Tepe G. Real-World Experience With a Paclitaxel-Coated Balloon in Critical Limb Ischemia: 24-Month Subgroup Outcomes of BIOLUX P-III. JACC Cardiovasc Interv 2020; 13:2289-2299. [PMID: 32950415 DOI: 10.1016/j.jcin.2020.06.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of the BIOLUX P-III (A Prospective, International, Multi-Centre, Post-Market All-Comers Registry to Assess the Clinical Performance of the Passeo-18 Lux Paclitaxel Releasing Balloon Catheter in Infrainguinal Arteries - III) registry was to collect real-world data on the Passeo-18 Lux paclitaxel-coated balloon. BACKGROUND Critical limb ischemia (CLI) is a severe condition associated with high morbidity and mortality. Prospective data are needed to provide further insights on drug-eluting devices. METHODS BIOLUX P-III is a prospective, post-market, all-comers registry assessing the safety and performance of the Passeo-18 Lux. Clinical information was collected at 6, 12, and 24 months. The authors report 24-month outcomes of the CLI subgroup with patients in Rutherford classes 4 to 6. RESULTS The CLI subgroup included 328 patients with 422 lesions. Patients were 71.1 ± 10.5 years of age, and 61.0% had diabetes. Femoropopliteal lesions were present in 53.8% (n = 227), below-the-knee lesions were present in 27.0% (n = 114), and lesions were moderate or heavily calcified in 45.0% (n = 190). Major adverse events, defined as 30-day device- or procedure-related mortality, major target limb amputation, and clinically driven target lesion revascularization, occurred in 9.8% of patients through 6 months, in 14.9% through 12 months, and in 19.4% through 24 months. Clinically driven target lesion revascularization occurred in 4.4%, 8.5%, and 12.1%, major amputation in 4.9%, 5.2%, and 6.1%, and mortality in 8.1%, 11.1%, and 20.1%, respectively. Predictors of mortality were age ≥75 years and higher Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease class, and higher Rutherford class was associated with increased mortality and amputation rates. CONCLUSIONS In a large, multimorbid patient population with complex lesions and CLI, the safety and performance of the Passeo-18 Lux paclitaxel-coated balloon has been confirmed, with low rates of major amputation and target lesion revascularization.
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Affiliation(s)
| | - Matej Moscovic
- Angiology Clinic, Institute of Cardiovascular Diseases, Kosice, Slovakia
| | | | - Giovanni Nano
- 1st Vascular Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Johannes Dahm
- Department of Angiology and Cardiology, Herz- und Gefäßzentrum Neu-Bethlehem, Göttingen, Germany
| | - Thomas Zeller
- Clinic Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | | | - Koen Keirse
- Department of Vascular Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Reza Ghotbi
- Klinik für Gefäßchirurgie, Helios Klinikum München West, Munich, Germany
| | - Jean-Marc Corpataux
- Department of Thoracic and Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Gunnar Tepe
- Department of Interventional Radiology, Klinikum Rosenheim, Rosenheim, Germany
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Giannopoulos S, Ghanian S, Parikh SA, Secemsky EA, Schneider PA, Armstrong EJ. Safety and Efficacy of Drug-Coated Balloon Angioplasty for the Treatment of Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis. J Endovasc Ther 2020; 27:647-657. [PMID: 32508220 DOI: 10.1177/1526602820931559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the safety and efficacy of drug-coated balloons (DCB) for the treatment of femoropopliteal or infrapopliteal lesions in patients with chronic limb-threatening ischemia (CLTI). Materials and Methods: A systematic literature search was conducted in PubMed, Scopus, and Cochrane Central up to January 2020 to identify randomized trials and observational studies presenting data on the effectiveness and safety of DCBs in the treatment of femoropopliteal or infrapopliteal lesions. A meta-analysis utilizing random effects modeling was conducted to investigate primary patency and all-cause mortality at 12 months; the results are reported as the odds ratios (ORs) and 95% confidence intervals (CIs). Secondary outcomes were procedural success, bailout stenting, target lesion revascularization (TLR), reocclusion, major amputation, wound healing, and major adverse limb events. Results: Twenty-six studies, 12 retrospective and 14 prospective, comprising 2108 CLTI patients treated with DCBs for femoropopliteal (n=1315) or infrapopliteal (n=793) lesions were analyzed. The average lesion lengths were 121±44 and 135±53 mm, respectively. The overall 12-month all-cause mortality and major amputation rates were 9% (95% CI 6% to 13%) and 5% (95% CI 2% to 8%), respectively. Primary patency rates were 82% (95% CI 76% to 87%) and 64% (95% CI 58% to 70%), respectively. A sensitivity analysis of the infrapopliteal lesions demonstrated no difference between DCB and balloon angioplasty in terms of primary patency, TLR, major amputation, or mortality over 12 months. However, patients with infrapopliteal lesions undergoing DCB angioplasty did have a significantly lower risk for reocclusion (10% vs 25%; OR 0.38, 95% CI 0.21 to 0.70, p=0.002). Conclusion: DCB angioplasty of femoropopliteal and infrapopliteal lesions in patients with CLTI results in acceptable 12-month patency rates, although comparative data have not shown a patency benefit for infrapopliteal lesions. The 12-month mortality rate of DCB vs balloon angioplasty was not significantly different, but studies with longer-term outcomes are necessary to determine any association between DCB use and mortality in patients with CLTI.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Sheila Ghanian
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric A Secemsky
- Division of Cardiology, Beth Israel Medical Center, Boston, MA, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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