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Kobayashi T, Takahara M, Fujimura N, Yamaoka T, Matsuda D, Okazaki T, Mochizuki S, Nagatomi S, Shingaki M, Endo M, Hosokawa K, Furuyama T, Shintani T, Sekimoto Y, Uchiyama H, Kyuragi R, Watada S, Morisaki K, Mitsuoka H, Kawai Y, Hayashi K, Shibata T, Kamei S, Obara H, Ichihashi S. Clinical outcomes in patients with chronic limb-threatening ischemia after femoropopliteal intervention with a drug-coated balloon or stenting. J Vasc Surg 2025:S0741-5214(25)00335-0. [PMID: 39978489 DOI: 10.1016/j.jvs.2025.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 02/07/2025] [Accepted: 02/07/2025] [Indexed: 02/22/2025]
Abstract
OBJECTIVE Endovascular treatment (EVT) for patients with an occlusive lesion of the femoropopliteal artery is performed worldwide due to its effectiveness. However, lesions in chronic limb-threatening ischemia (CLTI) are complex and a major concern in superficial femoral artery (SFA) EVT. Despite this, a detailed study of SFA EVT, and especially selection of the final device as a drug-coated balloon (DCB) or a stent, has not been performed in patients with CLTI. The aim of this stud was to compare the clinical outcomes of SFA EVT using a DCB or a stent in patients with CLTI. METHODS A multicenter retrospective observational study was performed at 21 Japanese centers. Comparisons were made between patients undergoing initial SFA EVT with a DCB or stenting after inverse probability of treatment weighting using the propensity score to control for potential confounding (patient demographics, comorbidities, medications, and procedural details). The primary outcome measure was major adverse limb events (MALE). We adopted cause-specific hazard models, using Fine and Gray's proportional hazards model in which death was treated as a competing risk. Secondary outcome measures were also evaluated: (1) technical success; (2) slow flow; (3) death within 30 days; (4) major adverse events within 30 days; (5) restenosis; (6) target lesion revascularization; (7) acute occlusion; (8) wound healing; (9) major amputation; and (10) all-cause mortality. RESULTS The study included 900 CLTI cases that underwent EVT with a DCB (n = 458) or stenting (n = 442) and had a median follow-up period of 17.5 months (interquartile range, 6.2-31.9 months). The DCB group had a lower risk of MALE than the stent group, with a hazard ratio of 0.68 (95% confidence interval, 0.52-0.89; P = .005). Subsequent analysis for the secondary outcome measures demonstrated that the DCB group had a higher prevalence of postprocedural slow flow and a lower incidence rate of acute occlusion (both P < .005 after Bonferroni correction). CONCLUSIONSS DCB angioplasty had a lower risk of MALE than stenting. These results suggest that a DCB might be more beneficial in initial SFA intervention in patients with CLTI.
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Affiliation(s)
- Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima, Japan.
| | - Mitsuyoshi Takahara
- Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoki Fujimura
- Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Daisuke Matsuda
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima, Japan
| | - Shingo Mochizuki
- Department of Cardiovascular Surgery, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
| | - Satoru Nagatomi
- Department of Radiology, Sumitomo Hospital, Kita-ku, Osaka, Japan
| | - Masami Shingaki
- Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Masayuki Endo
- Department of Radiology, Tottori University Hospital, Yonago, Tottori, Japan
| | - Kyosuke Hosokawa
- Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Tadashi Furuyama
- Department of Vascular Surgery, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan
| | - Tsunehiro Shintani
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Aoi-ku, Shizuoka, Japan
| | - Yasuhito Sekimoto
- Department of Surgery, Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ryoichi Kyuragi
- Department of Surgery, Saiseikai Karatsu Hospital, Karatsu, Saga, Japan
| | - Susumu Watada
- Department of Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Hiroki Mitsuoka
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yohei Kawai
- Department of Vascular and Endovascular Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Keita Hayashi
- Department of Vascular Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Shunsuke Kamei
- Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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Soga Y, Takahara M, Iida O, Tomoi Y, Kawasaki D, Fujihara M, Kozuki A, Tanaka A, Yamauchi Y, Tobita K, Yamaoka T, Ichihashi S, Ando K. High-Dose Drug-Coated Balloon Versus Polymer-Based Drug-Eluting Stent for Femoropopliteal Artery Disease Treatment. J Endovasc Ther 2024:15266028241267759. [PMID: 39148336 DOI: 10.1177/15266028241267759] [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: 08/17/2024]
Abstract
PURPOSE Clinical trials have demonstrated that high-dose drug-coated balloon (HD-DCB) and polymer-based drug-eluting stent (PB-DES) treatments for femoropopliteal (FP) artery disease have favorable outcomes. However, which one would be better remained unrevealed. METHODS This study used the databases of 2 large-scale multicenter prospective drug-coated balloon (DCB) and drug-eluting stent (DES) registries. The study included 2470 patients with symptomatic FP lesion treated with IN.PACT Admiral DCB or Eluvia DES at 69 centers. A propensity-score-based paired analysis was conducted. Primary endpoint was 1-year restenosis rate. Secondary endpoints were 1-year reocclusion rate, target lesion revascularization (TLR), acute thrombosis, bypass conversion, major amputation, major adverse limb event (MALE), and all-cause death. RESULTS A total of 1535 patients were treated with HD-DCB, and 935 patients were treated with PB-DES. The propensity-score matching extracted 678 pairs, with no remarkable intergroup difference in baseline characteristics. The 1-year restenosis rate was significantly lower in the PB-DES group than in the HD-DCB group (16.0% vs 22.0%, p=0.016). The other endpoints (reocclusion rate, TLR, acute thrombosis, bypass conversion, major amputation, MALE, and all-cause death) did not differ between the groups. No baseline characteristics had any significant interaction effect on the association of HD-DCB vs PB-DES with restenosis risk (all p>0.05). CONCLUSIONS This study demonstrated that the 1-year TLR, reocclusion rate, and other endpoints did not differ between the PB-DES group and the HD-DCB group despite the lower restenosis in the PB-DES group. CLINICAL IMPACT One-year restenosis rate was significantly lower in the polymer-based DES group than in the high-dose DCB group for foemoropopliteal disease. However, there is no difference in the other endpoints between two groups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Kenji Ando
- Kokura Memorial Hospital, Kitakyushu, Japan
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Seyferth ER, Song H, Vance AZ, Clark TWI. Association between statin intensity and femoropopliteal stent primary patency in peripheral arterial disease. CVIR Endovasc 2024; 7:60. [PMID: 39096322 PMCID: PMC11297851 DOI: 10.1186/s42155-024-00472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/24/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Statins are widely used in coronary and peripheral arterial disease, but their impact on patency of stents placed for peripheral arterial disease is not well-studied. The purpose of this study was to evaluate femoropopliteal stent primary patency according to statin intensity at the time of stent placement and compare this effect to other covariates that may influence stent patency. MATERIALS AND METHODS A retrospective review identified 278 discrete femoropopliteal stent constructs placed in 216 patients over a 10-year period; Rutherford categories were 2 (3.6%), 3 (12.9%), 4 (21.2%), 5 (49.6%), and 6 (12.6%). Stent locations were common femoral (1.8%), common femoral/superficial femoral (0.7%), superficial femoral (50.7%), superficial femoral/popliteal (32.7%) and popliteal (14.0%) arteries; 63.3% of stents were paclitaxel-eluting. Primary patency of each stent construct was determined with duplex ultrasound, angiography, or computed tomographic angiography. Greater than 50% restenosis or stent occlusion was considered loss of patency. Cox proportional hazard and Kaplan-Meier modeling were used to assess the effect of statin use and additional covariates on stent patency. RESULTS Patients on any statin at the time of stent placement were half as likely to undergo loss of primary unassisted patency as patients on no statin therapy (hazard ratio, 0.53; 95% confidence interval, 0.19-0.87; P = .004). Moderate/high intensity statin therapy conferred 17 additional months of median stent patency compared to the no statin group. Antiplatelet therapy, anticoagulant therapy, drug-eluting stents (versus bare metal or covered stents), and Rutherford class were not predictive of stent patency (P = 0.52, 0.85, 0.58, and 0.82, respectively). CONCLUSION Use of statin therapy at the time of femoropopliteal stent placement was the most predictive examined variable influencing primary unassisted patency.
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Affiliation(s)
- Elisabeth R Seyferth
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Helen Song
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ansar Z Vance
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Timothy W I Clark
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, Philadelphia, PA, 19104, USA.
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Kapetanios D, Torsello G, Tsilimparis N, Stavroulakis K. Directional atherectomy with anti-restenotic therapy versus open repair in patients with restenotic disease after surgical revascularization of the common femoral artery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:339-345. [PMID: 39008277 DOI: 10.23736/s0021-9509.24.13126-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
BACKGROUND This study evaluated the performance of directional atherectomy with anti-restenotic therapy (DAART) compared to surgery in patients with restenosis of the groin arteries after endarterectomy or femoral bypass anastomosis. METHODS Consecutive patients with restenotic lesions from two vascular surgery units were retrospectively evaluated. Detailed medical history, type of previous reconstruction, anatomical and perioperative data, 30-day mortality and morbidity as well as data during follow-up were documented. The primary outcome measure was primary patency, whereas technical success, secondary patency, target lesion revascularization (TLR), freedom from major amputation, overall morbidity and mortality were additionally evaluated. RESULTS The endovascular (25 patients) and surgical (17 patients) groups were comparable regarding the initial surgical reconstruction, demographics, comorbidities and medication. In the DAART group technical success was 100% without any residual stenosis >30%, distal embolization, perforation or bailout stenting. Hospital stay was shorter after DAART (medial 2 vs. 7 days, P<0.001), while more wound complications were documented in the surgical group within the first 30-days (29.4% vs. 0%, P=0.004). Primary patency, secondary patency and TLR were comparable between the groups (66.7% vs. 64.7%, HR 0.95, 95% CI 0.3-2.9, P=0.93, 86.4% vs. 93.8%, HR 0.65, 95% CI 0.65-6.6, P=0.71, 68% vs. 70.6%, HR 0.95, 95% CI 0.3-2.9, P=0.93, respectively). During follow-up no major amputation was observed, the improvement of the Rutherford class was comparable between the two groups and there were two deaths in the surgical group. CONCLUSIONS In this study, DAART for restenotic atherosclerotic disease of the common femoral artery and its branches is a safe alternative to redo surgery and is associated with shorter hospital stay, fewer wound complications, comparable patency and freedom from TLR rates.
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Affiliation(s)
- Dimitrios Kapetanios
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
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Schöfthaler C, Troisi N, Torsello G, Jehn A, Lichtenberg M, Karcher JC, Stavroulakis K, D'Oria M, Saratzis A, Zayed H, Andrassy M, Korosoglou G. Safety and effectiveness of the Phoenix atherectomy device for endovascular treatment of common femoral and popliteal arteries: Results of the EN-MOBILE trial. Vasc Med 2024; 29:405-415. [PMID: 38493349 DOI: 10.1177/1358863x241231943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Background: This study aimed to assess the peri- and postprocedural outcomes of atherectomy-assisted endovascular treatment of the common femoral (CFA) and popliteal arteries. Methods: Phoenix atherectomy was used for the treatment of 73 and 53 de novo CFA and popliteal artery lesions, respectively, in 122 consecutive patients. Safety endpoints encompassed perforation and peripheral embolization. Postprocedural endpoints included freedom from clinically driven target lesion revascularization (CD-TLR) and clinical success (an improvement of ⩾ 2 Rutherford category [RC]). In addition, 531 patients treated for popliteal artery stenosis or occlusion without atherectomy were used as a comparator group. Results: Procedural success (residual stenosis < 30% after treatment) was 99.2%. The need for bail-out stenting was 2 (2.7%) and 3 (5.7%) in CFA and popliteal artery lesions, respectively. Only one (1.4%) embolization occurred in the CFA, which was treated by catheter aspiration. No perforations occurred. After 1.50 (IQR = 1.17-2.20) years, CD-TLR occurred in seven (9.2%) and six (14.6%) patients with CFA and popliteal artery lesions, respectively, whereas clinical success was achieved in 62 (91.2%) and 31 (75.6%), respectively. Patients treated with atherectomy and DCB in the popliteal artery after matching for baseline RC, lesion calcification, length, and the presence of chronic total occlusion, exhibited higher freedom from CD-TLR compared to the nondebulking group (HR = 3.1; 95% CI = 1.1-8.5, p = 0.03). Conclusion: Atherectomy can be used safely and is associated with low rates of bail-out stenting in CFA and popliteal arteries. CD-TLR and clinical success rates are clinically acceptable. In addition, for the popliteal artery, atherectomy combined with DCB demonstrates lower CD-TLR rates compared to a DCB alone strategy. (German Clinical Trials Register: DRKS00016708).
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Affiliation(s)
- Christoph Schöfthaler
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Nicola Troisi
- Department of Translational Research and New Technologies in Medicine and Surgery, Vascular Surgery Unit, University of Pisa, Pisa, Italy
| | - Giovanni Torsello
- University Hospital Münster, Institute for Vascular Research, Franziskus Hospital, Münster, Germany
| | - Amila Jehn
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Jan C Karcher
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Mario D'Oria
- Cardiovascular Department, Division of Vascular and Endovascular Surgery, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Martin Andrassy
- Department of Cardiology and Vascular Medicine, Fürst-Stirum Klinikum Bruchsal, Bruchsal, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
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Korosoglou G, Feld J, Langhoff R, Lichtenberg M, Stausberg J, Hoffmann U, Rammos C, Malyar N. Safety and Effectiveness of Debulking for the Treatment of Infrainguinal Peripheral Artery Disease. Data From the Recording Courses of vascular Diseases Registry in 2910 Patients. Angiology 2024:33197241263381. [PMID: 38904281 DOI: 10.1177/00033197241263381] [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: 06/22/2024]
Abstract
We investigated the safety and efficacy of debulking infrainguinal lesions in patients with peripheral artery disease (PAD) undergoing endovascular revascularization (EVR) as part of the RECording Courses of vascular Diseases (RECCORD) registry. Patient and lesion specific characteristics, including the lesion complexity score (LCS) were analyzed. The primary endpoint encompassed: (i) clinical improvement in Rutherford categories, (ii) index limb re-interventions, and (iii) major amputations during follow-up. The secondary endpoint included the need for bail-out stenting. Overall, 2910 patients were analyzed; 2552 without and 358 with debulking-assisted EVR. Patients were 72 (interquartile range (IQR) = 15) years old and 1027 (35.3%) had diabetes. Overall complication rates were similarly low in the debulking vs the non-debulking group (4.7 vs 3.2%, P = .18). However, peripheral embolizations rates were low but more frequent with debulking vs. non-debulking procedures (3.9 vs 1.1%, P < .001). After adjustment for clinical and lesion-specific parameters, including LCS, no differences were noted for the primary endpoint (odds ration (OR) = 0.99, 95%CI = 0.69-1.41, P = .94). Bail-out stenting was less frequently performed in patients with debulking-assisted EVR (OR = 0.5, 95%CI = 0.38-0.65, P < .0001). Debulking-assisted EVR is currently used in ∼12% of EVR with infrainguinal lesions and is associated with lower bail-out stent rates but higher peripheral embolization rates; no differences were found regarding index limb re-intervention and amputation rates.
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Affiliation(s)
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Ralf Langhoff
- Department of Angiology, Sankt-Gertrauden-Krankenhaus, Berlin, Germany
| | | | | | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital Munich, Munich, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Duisburg, Germany
| | - Nasser Malyar
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiology, Münster, Germany
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Trenkler C, Blessing E, Jehn A, Karcher J, Schoefthaler C, Schmidt A, Korosoglou G. Retrospective Case Control Matched Comparison of the Antegrade Versus Retrograde Strategy After Antegrade Recanalisation Failure in Complex de novo Femoropopliteal Occlusive Lesions. Eur J Vasc Endovasc Surg 2024; 67:799-808. [PMID: 38182107 DOI: 10.1016/j.ejvs.2023.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/04/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To investigate dissection severity, need for bailout stenting and limb outcomes in patients undergoing antegrade vs. retrograde revascularisation. METHODS Consecutive patients who underwent either antegrade or retrograde revascularisation after failed antegrade recanalisation of long femoropopliteal chronic total occlusion (CTO) due to symptomatic peripheral artery disease between January 2017 and June 2022 were studied. Retrospective case control matching was used to adjust for lesion length and calcification using the peripheral artery calcification scoring system (PACSS). Procedural outcomes included severity of dissection (Type A to F dissections, numerically graded on a scale from 0 - 6 with increasing severity) after angioplasty and number and location of stents needed to be implanted during the index procedure. Additionally, clinically driven target lesion revascularisation (CD-TLR) and major (above ankle) amputation rates were assessed during follow up. RESULTS A total of 180 patients were analysed who underwent antegrade (n = 90) or retrograde after failed antegrade (n = 90) recanalisation. The median patient age was 76.0 (interquartile range [IQR] 67.0, 82.0) years and 76 (42.2%) were female. Moreover, 78 patients (43.3%) had intermittent claudication, whereas 102 (56.7%) had chronic limb threatening ischaemia (CLTI). The mean lesion length was 30.0 (IQR 24.0, 36.0) cm with moderate to severe (3.0 [IQR 2.0, 4.0]) lesion calcification. Dissection severity after angioplasty was higher in the antegrade than retrograde after failed antegrade recanalisation group (4.0 [IQR 3.0, 4.0] vs. 3.0 [IQR 2.0, 4.0]; p < .001). Additionally, the number of stents in all segments and the rate of bailout stenting in popliteal segments was significantly higher with the antegrade strategy (2.0 [IQR 1.0, 3.0] vs. 1.0 [IQR 0, 2.0], p < .010; and 37% vs. 14%, p < .001). During a median follow up of 1.48 (IQR 0.63, 3.09) years, CD-TLR rates (p = .90) and amputation rates in patients with CLTI (p = .15) were not statistically significant. CONCLUSION In complex femoropopliteal CTOs, retrograde after failed antegrade recanalisation, is safe for endovascular revascularisation, which in experienced hands may result in less severe dissections and lower rates of stent placement. However, considering the relatively short follow up, CD-TLR and amputation rates were not statistically different between the two approaches. [German Clinical Trials Register: DRKS00015277.].
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Affiliation(s)
- Christian Trenkler
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Erwin Blessing
- Department of Angiology, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Amila Jehn
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Jan Karcher
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Christoph Schoefthaler
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Andrej Schmidt
- Department of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany.
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