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Barabino E, Nivolli A, Pittaluga G, Arnò M, Gazzo P, Tosques M, Ivaldi D. Endovascular Treatment of TASC C and D Femoropopliteal Arterial Disease With Heparin-Bonded Covered Stents: The Impact of Distal Run-Off Vessels. J Endovasc Ther 2023:15266028231219659. [PMID: 38140721 DOI: 10.1177/15266028231219659] [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: 12/24/2023]
Abstract
INTRODUCTION In the last 2 decades, several studies in the literature evaluated the possible role of covered stents in the treatment of TransAtlantic Inter-Society Consensus (TASC) C and D femoropopliteal lesions but, despite the encouraging results, the employment of these devices was never included in clinical guidelines. The aim of this study is to evaluate the role of the technical aspects in patients with TASC C or D lesions that were treated with the GORE VIABAHN endoprosthesis and to elaborate a computerized method to objectively estimate the post-stent run-off and predict stent-graft failure. MATERIALS AND METHODS In this monocentric retrospective study, we collected the patients who were treated in our department from December 2014 to May 2021. Inclusion criteria comprised: (1) patients who underwent endovascular treatment of a TASC C or D femoropopliteal lesions using one or more heparin-bonded covered stent(s) and (2) clinical follow-up >2 years. Exclusion criteria were clinical follow-up <2 years or missing. An in-house computerized analysis to estimate the post-stent run-off, CEVERO (Computerized Estimation of VEssel Run-Off), was elaborated. RESULTS Sixty-six patients were enrolled in the study. Eleven patients had a TASC type C lesion, and 55 patients presented a type D lesion. The median follow-up time was 2.6 years. Twenty-nine patients (43.9%) experienced a major adverse limb event. Primary patency after 6, 12 and 24 months was 74.2%, 60.6%, and 57.6%; primary-assisted patency was 78.8%, 65.2%, and 59.1%. The presence of <2 run-off vessels (p<0.001) was correlated with stent-graft failure. The CEVERO analysis demonstrated an accuracy of 90.0% in predicting stent-graft failure. CONCLUSIONS The treatment of TASC C and D femoropopliteal lesions remains technically challenging. Our study supported the hypothesis that run-off is the most critical factor in determining the outcome of the procedure and that concomitant angioplasty of the tibial vessels might improve the patency of the covered stent. The CEVERO analysis could permit a real-time, objective estimation of the distal run-off using conventional angiographic images, and it might be employed as a tool in the intraprocedural decision-making process, but its clinical applicability should be evaluated on external validation cohorts. CLINICAL IMPACT The endovascular treatment of TASC C and D femoropopliteal lesions is technically challenging and run-off seems to be the most critical factor in determining the outcome. Concurrent angioplasty of the tibial vessels can create adequate run-off to avoid stent failure. The CEVERO analysis is a computerized estimation of run-off that might be a useful tool in the decision-making process.
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Affiliation(s)
- Emanuele Barabino
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Arianna Nivolli
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Giulia Pittaluga
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Matteo Arnò
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Paolo Gazzo
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Michele Tosques
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Diego Ivaldi
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
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Zhu Q, Ye P, Wang J, Chang Z. Inhibition of edge stenosis of endografts in swine iliac arteries by a novel endograft with biodegradable coating at both ends. JVS Vasc Sci 2021; 2:207-218. [PMID: 34761240 PMCID: PMC8567203 DOI: 10.1016/j.jvssci.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Objective This study evaluated the effectiveness and safety of a novel endograft with a biodegradable coating at both ends in preventing edge stenosis in swine iliac arteries. The biodegradable coating was composed of polylactide and paclitaxel. Methods Four types of endograft were implanted in the iliac arteries of healthy swine: an endograft without coating (control group) and endografts with polylactide and paclitaxel coating containing 0.1, 0.3, or 3.6 μg/mm2 of paclitaxel. The edge stenosis of these endografts in swine iliac arteries was assessed using angiographic image data at 30, 90, and 180 days after the operation. After terminal angiography, histologic evaluation of the treated arteries was performed. The treated sections of iliac arteries and blood samples were obtained at 1, 7, 30, 90, and 180 days for pharmacokinetic analysis. Results The results of angiographic and histologic evaluation demonstrated that intimal hyperplasia contributed to edge stenosis and polylactide-paclitaxel coating effectively inhibited edge stenosis. At 30 days, edge stenosis was observed at both the proximal and distal edges of the endograft without coating. At 90 days, edge stenosis was detected for the endograft coated with 0.1 μg/mm2 paclitaxel, and ectasia dilation occurred at the proximal and distal edges of the endograft coated with 3.6 μg/mm2 paclitaxel. No edge stenosis or other adverse effects were observed at 90 and 180 days for the endograft coated with 0.3 μg/mm2 paclitaxel. In addition, for the endograft coated with 0.3 μg/mm2 paclitaxel, a pharmacokinetic analysis showed that the paclitaxel concentration of treated segments decreased from 14 264 ± 1020 ng/g at day 1 to 80 ± 70 ng/g at day 90, and 20 ± 40 ng/g at day 180. The plasma paclitaxel concentration was low at day 1 and no longer detected after 7 days. Conclusions Polylactide and paclitaxel coating containing 0.3 μg/mm2 paclitaxel at both ends of endografts effectively and safely inhibits edge stenosis in swine iliac arteries.
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Affiliation(s)
- Qing Zhu
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China.,Shanghai MicroPort Endovascular MedTech (Group) Co., Ltd, Shanghai, PR China
| | - Ping Ye
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Jinyao Wang
- Shanghai MicroPort Endovascular MedTech (Group) Co., Ltd, Shanghai, PR China
| | - Zhaohua Chang
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China.,Shanghai MicroPort Endovascular MedTech (Group) Co., Ltd, Shanghai, PR China
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Giannopoulos S, Lyden SP, Bisdas T, Micari A, Parikh SA, Jaff MR, Schneider PA, Armstrong EJ. Endovascular Intervention for the Treatment of Trans-Atlantic Inter-Society Consensus (TASC) D Femoropopliteal Lesions: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:52-65. [PMID: 32563709 DOI: 10.1016/j.carrev.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Advancements in the endovascular treatment of femoropopliteal atherosclerotic lesions have led to treatment of more complex lesions, particularly long lesions. The aim of this study was to determine the meta-analytic primary patency and need for re-intervention among patients treated for very long lesions (>200 mm) at the femoropopliteal segment and to identify potential risk factors for loss of patency. METHODS This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted, and the I-square was used to assess heterogeneity. RESULTS Fifty-one studies comprised of 3029 patients were included. The mean lesion length was 269 mm. The primary patency rate at 30 days, 6 m, 1-, 2- and 5-years of follow-up was 98%, 76%, 62%, 55%, and 39% respectively. The incidence of TLR was 16% at one year and 32% at two years. The secondary patency rate at 1, 2, 3 and 5 years was 85%, 71%, 64%, and 64% respectively. Heparin bonded ePTFE covered stents (69%) and paclitaxel eluting stents (73%) demonstrated higher 1-year primary patency rates than self-expanding nitinol stents (55%) or uncoated percutaneous transluminal angioplasty (PTA) with provisional stenting (54%). Lesions treated with a heparin bonded ePTFE covered stent had statistically significant higher odds of remaining patent at 1-year of follow-up (OR: 2.74; 95%CI: 1.63-4.61; p < 0.001) than lesions treated with BMS or PTA. Patients with long femoropopliteal lesions causing critical limb ischemia (CLI) developed restenosis or occlusion more often than patients treated for claudication (HR: 1.63; 95%CI: 1.06-2.49; p = 0.026) during an average follow-up of 26 months. CONCLUSION Primary stenting of femoropopliteal TASC D lesions using drug eluting stents or covered stents results in sustained patency over time. PTA or uncoated nitinol stents demonstrated lower patency rates. However, additional comparative studies are needed to determine the efficacy of newer technologies for the treatment of complex femoropopliteal lesions and provide evidence for the most optimal treatment approach.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic and Foundation, Cleveland, OH, USA
| | | | - Antonio Micari
- Division of Cardiology, Huamitas Gavazzeni, Bergamo, Italy
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy, NY Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, 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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Kokkinidis DG, Katsaros I, Jonnalagadda AK, Avner SJ, Chaitidis N, Bakoyiannis C, Kakkar A, Secemsky EA, Giri JS, Armstrong EJ. Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Femoropopliteal Chronic Total Occlusions: A Systematic Review of 87 Studies and 4,665 Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:34-45. [DOI: 10.1016/j.carrev.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
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Lin TC, Huang CY, Chen PL, Lee CY, Shih CC, Chen IM. Edge Stenosis After Covered Stenting for Long Superficial Femoral Artery Occlusive Disease: Risk Factor Analysis and Prevention With Drug-Coated Balloon Angioplasty. J Endovasc Ther 2018; 25:313-319. [DOI: 10.1177/1526602818771345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report a retrospective analysis of risk factors for edge restenosis after Viabahn stent-graft treatment of superficial femoral artery (SFA) occlusive disease and determine any protective effect of drug-coated balloons (DCBs) used at the time of stent-graft implantation. Methods: Between October 2011 and July 2016, 110 patients (mean age 73.3±7.6 years; 78 men) were treated with the Viabahn stent-graft for long SFA occlusions. Thirty-eight (34.5%) patients had DCB reinforcement at the distal edge of the stent-graft. For analysis, the population was divided into groups of no edge stenosis patients (n=88; mean lesion length 22.4±4.2 cm) and edge stenosis patients (n=22; mean lesion length 23.5±5.7 cm). The clinical outcomes, ankle-brachial indices, computed tomography angiography findings, and patency were compared at a minimum of 12 months. Logistic regression analysis was employed to determine risk factors for edge stenosis; the results are presented as the odds ratio (OR) and 95% confidence interval. Results: No differences in clinical or procedural characteristics were identified except the higher incidence of diabetes (p=0.008) and greater need for retrograde access (p=0.033) in the edge stenosis group. DCB reinforcement reduced the incidence of edge stenosis (p=0.021) and target lesion revascularization (TLR; p=0.010) and resulted in a significantly higher 1-year primary patency rate (92.1% vs 76.4%, p=0.042). However, multivariate analysis revealed only poor distal runoff (OR 0.31, 95% CI 0.11 to 0.83, p=0.020) as a predictor of edge stenosis. Conclusion: The risk of edge stenosis after Viabahn implantation was higher in patients with poor distal runoff. DCB reinforcement over the distal edge reduced edge stenosis, decreased 1-year TLR, and improved 1-year primary patency.
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Affiliation(s)
- Ting-Chao Lin
- Division of Cardiovascular Surgery, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yang Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Lin Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Yang Lee
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Ming Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Zhang L, Bao J, Zhao Z, Lu Q, Zhou J, Jing Z. Effectiveness of Viabahn in the Treatment of Superficial Femoral Artery Occlusive Disease. J Endovasc Ther 2015; 22:495-505. [PMID: 26018400 DOI: 10.1177/1526602815588274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the effectiveness of the Viabahn stent-graft in the treatment of superficial femoral artery (SFA) occlusive disease. Methods: A systematic review and meta-analysis of published studies was performed to evaluate the efficacy of the Viabahn for SFA lesions. Studies were stratified according to controlled vs uncontrolled design and analyzed using random-effects models. Outcomes are reported as the risk ratio (RR) and 95% confidence interval (CI). Four prospective randomized controlled trials, one retrospective controlled study, and 9 uncontrolled studies were identified. Results: In controlled studies, primary patency with the Viabahn was superior to other interventions at 1 year (RR 0.63, 95% CI 0.49 to 0.82, p<0.001) and ankle-brachial index (ABI) improvement was greater at 6 months (mean difference 0.05, 95% CI 0.01 to 0.09, p=0.01) compared with other interventions. Subgroup analysis demonstrated a lower incidence of stent fracture in lesions with >15-cm stented lengths. In uncontrolled studies, ABI improvement was consistently superior at all measurement points during follow-up. Conclusions: Current evidence suggests that the Viabahn stent-graft is a safe and effective option for symptomatic SFA lesions. Prospective multicenter randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy of the Viabahn device.
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Affiliation(s)
- Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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Risk factors for clinical failure after stent graft treatment for femoropopliteal occlusive disease. J Vasc Surg 2012; 56:998-1006, 1007.e1; discussion 1006-7. [DOI: 10.1016/j.jvs.2012.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/28/2012] [Accepted: 03/01/2012] [Indexed: 11/23/2022]
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Lensvelt MM, Fritschy WM, van Oostayen JA, Holewijn S, Zeebregts CJ, Reijnen MM. Results of heparin-bonded ePTFE-covered stents for chronic occlusive superficial femoral artery disease. J Vasc Surg 2012; 56:118-25. [DOI: 10.1016/j.jvs.2011.12.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/30/2011] [Accepted: 12/24/2011] [Indexed: 11/28/2022]
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Kovacs F, Pollock JG, DeNunzio M. Endovascular Stent Graft Repair of Iatrogenic Popliteal Artery Injuries—A Report of 2 Cases. Vasc Endovascular Surg 2012; 46:269-72. [DOI: 10.1177/1538574411434163] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Popliteal artery injury during total knee replacement (TKR) is rare. We report 2 cases of post-TKR popliteal artery occlusions treated endovascularly with Viabahn stent grafts. Long-term duplex follow-up and secondary re-intervention may be necessary.
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Affiliation(s)
- Flora Kovacs
- Clinical Radiology, Country Durham and Darlington NHS Foundation Trust, Darlington, UK
| | | | - Mario DeNunzio
- Department of Radiology, Royal Derby Hospital, Derby, UK
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Schneider J, Patel N, Hashemi F, Kim S, Verta M. Infected Viabahn Stent Graft in the Superficial Femoral Artery. Eur J Vasc Endovasc Surg 2011; 42:699-703. [DOI: 10.1016/j.ejvs.2011.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/08/2011] [Indexed: 11/25/2022]
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Schneider JR, Verta MJ, Alonzo MJ, Hahn D, Patel NH, Kim S. Results With Viabahn-Assisted Subintimal Recanalization for TASC C and TASC D Superficial Femoral Artery Occlusive Disease. Vasc Endovascular Surg 2011; 45:391-7. [DOI: 10.1177/1538574411405548] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Many investigators including TransAtlantic Inter-Society Consensus (TASC) recommend against primary endovascular treatment for severe (TASC C and D) superficial femoral artery (SFA) disease. Vein bypass is preferable but may not be appropriate due to comorbidities or lack of suitable vein. This study reviews our results with Viabahn stent graft-assisted subintimal recanalization (VASIR) for TASC C and D SFA atherosclerosis. Methods: In all, 13 males and 14 females, mean age 72 ± 11 years underwent 28 VASIR for severe (TASC C 8 of 28, TASC D 20 of 28, and 5 of 28 no continuous infrapopliteal runoff artery) SFA disease. Indications were claudication (14 of 28 limbs), ischemic rest pain (6 of 28), and tissue loss (8 of 28). Viabahn stent graft-assisted subintimal recanalization was chosen instead of bypass due to comorbidities or lack of vein. Patients received aspirin and, if not already taking warfarin, they also received clopidogrel. Patients were examined with Ankle-brachial Index (ABI) and duplex scan at 1 month, then every 3 months after VASIR. Results Viabahn stent graft-assisted subintimal recanalization was technically successful in all. Ankle-brachial Index averaged 0.47 ± 0.17 preprocedure, 0.89 ± 0.20 postprocedure, and increased by 0.15 or more in every case. Median follow-up is 20 months. There were 3 perioperative (<30 days) and 7 later failures including revision prior to any thrombosis. One patient required amputation. Four have died, 2 with patent grafts, none from causes related to VASIR, all more than 30 days post-VASIR. Estimated 1-year primary and secondary patency were 70% ± 11% and 73% ± 10%. Failure was not significantly associated with indications, comorbidities, or runoff status. There was a clear distinction between patients with early failure and the rest of the patients. None of the 8 patients with failure in the first 8 months after surgery has a patent graft. However, of 17 grafts primarily patent at 8 months, only 2 have failed (1 thrombosed and 1 required preemptive balloon angioplasty). There was a strong trend toward better patency with 6 and 7 mm diameter compared to 5 mm diameter stent grafts. Furthermore, although warfarin was not prescribed as part of the protocol, no patient taking warfarin before and who resumed warfarin after VASIR (n = 4) suffered failure. Conclusions: Despite significant early failures, we found VASIR to be durable in those who did not have early failure. Viabahn stent graft-assisted subintimal recanalization is an acceptable alternative to vein bypass in selected patients with severe SFA disease. Smaller arterial or stent graft diameter may be associated with poorer results. Warfarin may be valuable to reduce the risk of failure after VASIR.
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Affiliation(s)
- Joseph R. Schneider
- Vascular and Interventional Program of Central DuPage Hospital, Winfield, IL, USA,
| | - Michael J. Verta
- Vascular and Interventional Program of Central DuPage Hospital, Winfield, IL, USA
| | - Marc J. Alonzo
- The Endovascular Center of NorthShore University HealthSystem, Evanston, IL, USA
| | - David Hahn
- The Endovascular Center of NorthShore University HealthSystem, Evanston, IL, USA
| | - Nilesh H. Patel
- Vascular and Interventional Program of Central DuPage Hospital, Winfield, IL, USA
| | - Stanley Kim
- Vascular and Interventional Program of Central DuPage Hospital, Winfield, IL, USA
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Management of Flush Superficial Femoral Artery Occlusions With Combined Open Femoral Endarterectomy and Endovascular Femoral–Popliteal Angioplasty and Stent-Grafting. Ann Vasc Surg 2011; 25:559.e19-23. [DOI: 10.1016/j.avsg.2011.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/07/2010] [Accepted: 02/08/2011] [Indexed: 11/21/2022]
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Kawarada O, Yokoi Y. Native chronic total occlusion recanalization after lower limb bypass graft occlusion: a series of nine cases. Catheter Cardiovasc Interv 2010; 76:214-9. [PMID: 20665865 DOI: 10.1002/ccd.22445] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion. BACKGROUND There is no consensus on the best approach for threatened limbs in patients with graft occlusion. METHODS The subjects were nine consecutive patients with limb-threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents. RESULTS The mean age of the bypass grafts was 6.7 +/- 7.3 (range: 1-24) months and the mean number of previous lower limb bypass surgeries was 1.4 +/- 0.5 (range: 1-2). Native CTO recanalization was performed in the iliofemoral (n = 2), iliac (n = 2), superficial femoral (n = 3), popliteal (n = 1), and popliteal-tibial (n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle-brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 +/- 1.1-->0.9 +/- 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow-up time of 25 +/- 20 months (range: 9-60). CONCLUSIONS In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada city, Osaka, Japan.
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McQuade K, Gable D, Pearl G, Theune B, Black S. Four-year randomized prospective comparison of percutaneous ePTFE/nitinol self-expanding stent graft versus prosthetic femoral-popliteal bypass in the treatment of superficial femoral artery occlusive disease. J Vasc Surg 2010; 52:584-90; discussion 590-1, 591.e1-591.e7. [PMID: 20598480 DOI: 10.1016/j.jvs.2010.03.071] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/28/2010] [Accepted: 03/30/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND This is a randomized prospective study comparing the treatment of superficial femoral artery occlusive disease percutaneously with an expanded polytetrafluoroethylene (ePTFE)/nitinol self-expanding stent graft (stent graft) versus surgical femoral to above-knee popliteal artery bypass with synthetic graft material. METHODS One hundred limbs in 86 patients with superficial femoral artery occlusive disease were evaluated from March 2004 to May 2005. Patient symptoms included both claudication and limb threatening ischemia with or without tissue loss. Trans-Atlantic InterSociety Consensus (TASC II) A (n = 18), B (n = 56), C (n = 11), and D (n = 15) lesions were included. Patients were randomized prospectively into one of two treatment groups; a percutaneous treatment group (group A; n = 50) with angioplasty and placement of one or more stent grafts, or a surgical treatment group (group B; n = 50) with a femoral to above-knee popliteal artery bypass using synthetic conduit (Dacron or ePTFE). Patients were followed for 48 months. Follow-up evaluation included clinical assessment, physical examination, ankle-brachial indices, and color flow duplex sonography at 3, 6, 9, 12, 18, 24, 36, and 48 months. RESULTS Mean total lesion length of the treated arterial segment in the stent graft group was 25.6 cm (SD = 15 cm). The stent graft group demonstrated a primary patency of 72%, 63%, 63%, and 59% with a secondary patency of 83%, 74%, 74%, and 74% at 12, 24, 36, and 48 months, respectively. The surgical femoral-popliteal group demonstrated a primary patency of 76%, 63%, 63%, and 58% with a secondary patency of 86%, 76%, 76%, and 71% at 12, 24, 36, and 48 months, respectively. No statistical difference was found between the two groups with respect to primary (P = .807) or secondary (P = .891) patency. CONCLUSION Management of superficial femoral artery occlusive disease with percutaneous stent grafts exhibits similar primary patency at 4-year (48 month) follow up when compared with conventional femoral-popliteal artery bypass grafting with synthetic conduit. This treatment method may offer an alternative to treatment of the superficial femoral artery segment for revascularization when prosthetic bypass is being considered or when autologous conduit is unavailable.
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Affiliation(s)
- Karen McQuade
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX 75226, USA
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Lin PH, Weakley SM, Kougias P. How to Interpret Data from the Superficial Femoral Artery Stenting Trials and Registries. Semin Vasc Surg 2010; 23:138-47. [DOI: 10.1053/j.semvascsurg.2010.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kawarada O, Yokoi Y. Retrograde 3-French popliteal approach in the supine position after failed antegrade angioplasty for chronic superficial femoral artery occlusion. J Endovasc Ther 2010; 17:255-8. [PMID: 20426650 DOI: 10.1583/09-2966.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report use of a retrograde 3-F popliteal approach performed in a supine patient by lifting the heel after failed antegrade angioplasty for chronic total occlusion (CTO) in the superficial femoral artery (SFA). CASE REPORT During subintimal angioplasty for a calcified 10-cm CTO in the distal left SFA of 65-year-old man with digital tissue loss, inability to re-enter the true lumen prompted us to place a 3-F sheath in a retrograde popliteal approach by lifting the heel so the patient could remain supine. The occlusive lesion was crossed retrogradely using a 0.014-inch floppy guidewire and serially dilated with a 4.0x40-mm monorail balloon through the 3-F popliteal sheath. Subsequent procedures (stenting and postdilation) were performed in an antegrade manner facilitated by a through-and-through wire. After the successful procedure, the 3-F sheath was removed in the catheterization laboratory, and a hemostasis device was left in place for 30 minutes, achieving hemostasis without any complication. During the 9-month follow-up, the patient remained asymptomatic and without evidence of restenosis. CONCLUSION A retrograde 3-F popliteal approach without the need for patient position change could be a convenient option for failed antegrade angioplasty of chronic SFA occlusions.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan.
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Donas KP, Rancic Z, Lachat M, Pfammatter T, Frauenfelder T, Veith FJ, Mayer D. Novel sutureless telescoping anastomosis revascularization technique of supra-aortic vessels to simplify combined open endovascular procedures in the treatment of aortic arch pathologies. J Vasc Surg 2010; 51:836-41. [PMID: 20347679 DOI: 10.1016/j.jvs.2009.09.054] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 09/10/2009] [Accepted: 09/19/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND We report our clinical experience with the use of a sutureless telescoping anastomosis, initially described as the VORTEC (Viabahn Open Rebranching TEChnique) revascularization technique, for debranching of supra-aortic vessels. METHODS Between May 2005 and December 2008, 20 patients (15 men) with an aortic arch lesion underwent trans-sternal debranching with sutureless telescoping anastomosis performed with a Viabahn (diameter, 5-8 mm; length, 5-15 cm) or Hemobahn (diameter, 9-13 mm; length, 10-15 cm), followed by endovascular aneurysm repair. Initially, the Viabahn/Hemobahn was sutured to a feeding graft after deployment. Since 2008, the Viabahn/Hemobahn has been deployed within an interposition graft, rendering unnecessary the anastomosis. The underlying aortic pathology was (1) isolated aortic arch aneurysm in 10, (2) aortic arch aneurysm extending to the ascending or descending aorta in 6, (3) floating thrombus within the aortic arch in 1, (4) acute aortic arch dissection in 1, and (5) Crawford II thoracoabdominal aortic aneurysm extending into the aortic arch in 2. Postprocedural duplex ultrasound imaging showed normal flow profiles in all patients. Follow-up included computed tomography angiography at 1, 3, and 6 months postoperatively, and then annually. RESULTS Overall, 56 supra-aortic vessels in the 20 patients were debranched by sutureless telescoping anastomosis, including the carotid artery in 18, subclavian artery in 13, and left vertebral artery in 1. Technical success was 100%. The mean ischemia time was 3 minutes (range, 1-9 minutes) for the debranching procedure vs 6 minutes (range, 5-16 minutes) for a conventional suture anastomosis. The 30-day mortality rate was 15% (3 if 20); 28.5% (2 of 7) in urgent cases and 7.6% (1 of 12) in elective patients. Three patients (15%) had neurologic deficits after debranching in the conventionally-sutured anastomosis territories. No early (<30 days) occlusion occurred. During a mean follow-up of 14 +/- 9 months (range, 1-39 months), one patient with Takayasu disease showed asymptomatic occlusion of a Viabahn implanted into the left common carotid artery. Stenosis in the aortic anastomosis of the bypass graft in another patient was successfully treated by angioplasty and stent placement through the right brachial artery. CONCLUSIONS Sutureless telescoping anastomosis with a Viabahn or a Hemobahn in supra-aortic debranching seems to be a safe and reliable alternative to sutured anastomosis. It enables safe and fast-track revascularizations, especially in anatomically challenging situations, and requires a very short ischemia time. Questions about long-term results and the technique reproducibility must be addressed.
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Affiliation(s)
- Konstantinos P Donas
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
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Schneider JR. Comments regarding 'Predictive risk factors for restenosis after remote superficial femoral artery endarterectomy'. Eur J Vasc Endovasc Surg 2010; 39:604-5. [PMID: 20346710 DOI: 10.1016/j.ejvs.2010.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
Affiliation(s)
- J R Schneider
- Vascular and Interventional Program of Central DuPage Hospital, 25 North Winfield Road, Northwestern University, Winfield, IL 60190, USA.
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Lepäntalo M, Laurila K, Roth WD, Rossi P, Lavonen J, Mäkinen K, Manninen H, Romsi P, Perälä J, Bergqvist D. PTFE bypass or thrupass for superficial femoral artery occlusion? A randomised controlled trial. Eur J Vasc Endovasc Surg 2009; 37:578-84. [PMID: 19231250 DOI: 10.1016/j.ejvs.2009.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 01/12/2009] [Indexed: 11/16/2022]
Abstract
UNLABELLED Early results of a thrupass endograft in the treatment of femoral lesions are promising. Less morbidity and better cost-effectiveness are suggested to be achieved in the treatment of chronic lower limb ischaemia with endovascular treatment compared to surgical treatment. PATIENTS AND METHODS This randomised multicentre trial aimed to enroll a group of 60+60 patients for the treatment of 5-25-cm occlusions of superficial femoral artery (SFA) to be followed up for 3 years. Patients were treated either with endoluminal PTFE thrupass (WL Gore & Ass) or with surgical polytetrafluoroethylene (PTFE) bypass to proximal popliteal artery. Primary patency at 3 years was scheduled to be the primary end-point and secondary patency, functional success, costs and quality of life the secondary end-points. RESULTS A sample of 100 consecutive SFA occlusions in one of the centres revealed that only 4% of the lesions were amenable for the study. The trial was prematurely terminated due to the results of an interim analysis at the time when 44 patients were recruited: the 1-year primary patency (excluding technical failures) was 48% for thrupass and 95% for bypass (p=0.02). The patency difference in favour of surgical bypass over endovascular thrupass was also sustained after completion of 1-year follow-up, the primary patencies being 46% and 84% at 1 year with grossly equilinear life-table curves thereafter (p=0.18), respectively. The corresponding secondary patencies were 63% and 100% (p=0.05) when excluding technical failures and 58% and 100% (p=0.02) according to intention-to-treat analysis. Secondary outcomes were thus not analysed. CONCLUSION Treatment of SFA occlusions (TASC IIB and C or Imelda Ia and II) should be done by PTFE bypass rather than by PTFE thrupass, as thrupass is connected with worse early outcome. These results represent only a small category of femoral disease.
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Affiliation(s)
- M Lepäntalo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Abstract
With the proliferation of devices and techniques for lower extremity endovascular revascularization, treatment decisions become increasingly difficult as only limited experience with these new technologies is available for review. This monograph attempts to define the current state of the literature available to guide endovascular treatment of superficial artery disease, and to provide a baseline for future studies.
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Affiliation(s)
- George H Meier
- University of Cincinnati College of Medicine, Vascular Division, Cincinnati, Ohio 45267, USA.
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