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Channane H, Shaporov A, Sandica A, Atay S, Snopok I, Frunza T, Viebahn R. Popliteal endarterectomy at the leg level with venous enlargement patch: about 14 cases. J Surg Case Rep 2023; 2023:rjad398. [PMID: 37426043 PMCID: PMC10329460 DOI: 10.1093/jscr/rjad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
The incidence of lesions of the popliteal artery below the knee constitutes one of the greatest problems in revascularization of the lower limb. Firstly, this segment constitutes the departure of the leg tripod, decisive crossroads for a subsequent endovascular intervention. On the other hand, it constitutes a fairly used relay point in the event of an indication for a pedal bypass. It is assumed that the performance of a popliteal endarterectomy with an enlargement by medial approach in patients with a localized lesion at this level constitutes an effective therapeutic approach and can facilitate any gesture of crural bypass or endovascular dilation later. We present a retrospective review of all patients who underwent popliteal endarterectomy with venous patch plasty for localized popliteal disease in our institution over the past 3 years.
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Affiliation(s)
- Hamid Channane
- Correspondence address. Department of General and Vascular Surgery, Ruhr University, In der Schornau, 23–25, 88492 Bochum, Germany. Tel: +4923429980097; Fax: +492342993209; E-mail:
| | - A Shaporov
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - A Sandica
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - S Atay
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - I Snopok
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - T Frunza
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - R Viebahn
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
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Koeckerling D, Raguindin PF, Kastrati L, Bernhard S, Barker J, Quiroga Centeno AC, Raeisi-Dehkordi H, Khatami F, Niehot C, Lejay A, Szeberin Z, Behrendt CA, Nordanstig J, Muka T, Baumgartner I. Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis. Eur Heart J 2023; 44:935-950. [PMID: 36721954 PMCID: PMC10011342 DOI: 10.1093/eurheartj/ehac722] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 02/02/2023] Open
Abstract
AIMS Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy. METHODS AND RESULTS Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints. CONCLUSION Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
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Affiliation(s)
- David Koeckerling
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland.,Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse, 36002 Lucerne, Switzerland
| | - Lum Kastrati
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Joseph Barker
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicestershire LE1 7RH, UK
| | | | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Community Medicine Department, Tehran University of Medical Sciences, PourSina St., Tehran 1417613151, Iran
| | - Christa Niehot
- Literature Searches Support, 3314SC Dordrecht, the Netherlands
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, XII. Városmajor u. 68., 1122 Budapest, Hungary
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Alphonsstraße 14, 22043 Hamburg, Germany
| | - Joakim Nordanstig
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Epistudia, 3011 Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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3
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Tacke J, Müller-Hülsbeck S, Schröder H, Lammer J, Schürmann K, Gross-Fengels W, Fischbach R, Textor J, Boguth L, Loewe C, Häuser H, Gschwendtner M, Tepe G, von Strandmann RP, Stahnke S, Dambach J, Hausegger K. The Randomized Freeway Stent Study: Drug-Eluting Balloons Outperform Standard Balloon Angioplasty for Postdilatation of Nitinol Stents in the SFA and PI Segment. Cardiovasc Intervent Radiol 2019; 42:1513-1521. [PMID: 31432220 PMCID: PMC6775030 DOI: 10.1007/s00270-019-02309-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/06/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The prospective randomized multicenter Freeway study evaluated the possible hemodynamic and clinical benefits of primary stent insertion followed by percutaneous transluminal angioplasty (PTA) with drug-eluting balloons (DEB) over post-stent insertion PTA with standard balloons in the treatment of symptomatic femoropopliteal arteriosclerotic lesions. METHODS In total, 204 patients in 13 centers in Germany and Austria were enrolled and randomized to primary stenting followed by either FREEWAY™ drug-eluting balloon or standard PTA balloon angioplasty. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) at 6 months; the secondary endpoints include TLR rate at 12 months and primary patency, shift in Rutherford classification, ankle-brachial index (ABI) and major adverse events (MAE) at 6 and 12 months. Lesion characteristics and vessel patency were analyzed by an independent and blinded corelab. RESULTS At 6-month and 12-month follow-up, TLR rate was lower in the DEB arm compared to standard PTA but did not reach statistical significance (4.1% vs. 9.0% p = 0.234 and 7.9% vs. 17.7% p = 0.064, respectively). Primary patency was significantly better for patients treated with the DEB at 6 months (90.3% vs. 69.8% p = 0.001) and 12 months (77.4% vs. 61.0% p = 0.027). Improvement in Rutherford classifications was likewise significantly better for patients in the DEB group at 6 (94.9% vs. 84.3% p = 0.027) and 12 months (95.5% vs. 79.9% p = 0.003). The percentage of patients with an improved ABI of 1.0-1.2 was significantly higher in the DEB group compared to the PTA group at 6 months (55.3% vs. 35.3%; p = 0.015) but without significant difference at 12 months (48.2% vs. 32.9%; p = 0.055). At 6 months, rate of major adverse events (MAE) was 1% in both arms, and at 12 months 2.2% for the DEB and 3.8% for the PTA group. CONCLUSION The Freeway Stent Study shows that the usage of DEB as a restenosis prophylaxis seems to be safe and feasible. The 12-month follow-up results give a clear sign in favor of the DEB group.
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Affiliation(s)
- Josef Tacke
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Passau, Innstraße 76, 94036, Passau, Germany
| | | | - Henrik Schröder
- Jüdisches Krankenhaus Berlin, Gemeinschaftspraxis für Radiologie, Neuroradiologie & Zentrum für Minimal Invasive Therapie am Jüdischen Krankenhaus Berlin, Heinz-Galinski-Str. 1, 13347, Berlin, Germany
| | - Johannes Lammer
- Kardiovaskuläre und Interventionelle Radiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Karl Schürmann
- Institut für Diagnostische und Interventionelle Radiologie St.-Johannes-Hospital Dortmund, Johannesstraße 9-17, 44137, Dortmund, Germany
| | - Walter Gross-Fengels
- Radiologie und Nuklearmedizin, Asklepios Klinik Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Roman Fischbach
- Radiologie, Neuroradiologie und Nuklearmedizin, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Jochen Textor
- Abteilung für Radiologie Gemeinschaftskrankenhaus Bonn, St. Elisabeth/St. Petrus/St. Johannes gGmbH, Bonner Talweg 4-6, 53113, Bonn, Germany
| | - Lothar Boguth
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Idar-Oberstein GmbH, Dr.-Ottmar-Kohler Str. 2, 55743, Idar-Oberstein, Germany
| | - Christian Loewe
- Kardiovaskuläre und Interventionelle Radiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hannes Häuser
- Klinik für Diagnostische und Interventionelle Radiologie, Klinikum St. Elisabeth Straubing GmbH, St.-Elisabeth-Str. 23, 94315, Straubing, Germany
| | - Manfred Gschwendtner
- Institut für Diagnostische und Interventionelle Radiologie, KH Elisabethinen Linz, Fadingerstrasse 1, 4010, Linz, Austria
| | - Gunnar Tepe
- Radiologie, Klinikum Rosenheim, Pettenkoferstr. 10, 83022, Rosenheim, Germany
| | | | | | | | - Klaus Hausegger
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Austria
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Megaly M, Abraham B, Saad M, Mekaiel A, Soukas P, Banerjee S, Shishehbor MH. Outcomes with cilostazol after endovascular therapy of peripheral artery disease. Vasc Med 2019; 24:313-323. [PMID: 31023156 DOI: 10.1177/1358863x19838327] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The role of cilostazol after endovascular therapy (EVT) of peripheral artery disease (PAD) remains unclear. We conducted a meta-analysis for all studies reporting the outcomes of cilostazol after EVT of PAD from January 2000 through November 2018 with the outcomes of interest including primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation. We included eight studies (three randomized controlled trials (RCTs) and five observational studies) with a total of 3846 patients (4713 lesions). During a mean follow-up duration of 12.5 ± 5 months, the use of cilostazol was associated with higher primary patency (OR 2.28, 95% CI (1.77, 2.94), p < 0.001, I2 = 24%), lower risk of TLR (OR 0.37, 95% CI (0.26, 0.52), p < 0.001, I2 = 0%), and lower risk of major amputation (OR 0.15, 95% CI (0.04, 0.62), p = 0.008, I2 = 0%). The use of cilostazol in RCTs was associated with significantly higher odds of primary patency compared with observational studies (OR 3.37 vs 2.28, p-interaction = 0.03). After further subgroup analysis, cilostazol remained associated with higher primary patency regardless of the use of anticoagulants (warfarin) (p-interaction = 0.49). We conclude that the use of cilostazol after EVT of femoropopliteal and iliac lesions is associated with improved primary patency and lower risk of major amputation and TLR. The favorable impact of cilostazol is independent of the use of warfarin. PROSPERO identifier: CRD42018092715.
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Affiliation(s)
- Michael Megaly
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.,2 Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Bishoy Abraham
- 3 Department of Medicine, Ascension St John Hospital, Detroit, MI, USA
| | - Marwan Saad
- 4 Department of Cardiovascular Medicine, Department of Medicine, University of Arkansas, Little Rock, AR, USA.,5 Department of Cardiovascular Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Andrew Mekaiel
- 6 Department of Medicine, Jamaica Hospital Medical Center, Queens, NY, USA
| | - Peter Soukas
- 7 Division of Cardiovascular Medicine, Department of Medicine, Warren Alpert Medical School at Brown University, RI, USA
| | - Subhash Banerjee
- 8 Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mehdi H Shishehbor
- 9 Harrington Heart and Vascular Institute, Case Western Reserve University (CWRU) School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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5
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Chowdhury MM, McLain AD, Twine CP. Angioplasty versus bare metal stenting for superficial femoral artery lesions. Cochrane Database Syst Rev 2014; 2014:CD006767. [PMID: 24959692 PMCID: PMC6544814 DOI: 10.1002/14651858.cd006767.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower limb peripheral arterial disease (PAD) is a common, important manifestation of systemic atherosclerosis. Stenoses or occlusions in the superficial femoral artery may result in intermittent claudication or even critical ischaemia, which may be treated by balloon angioplasty with or without stenting. This is the first update of a review published in 2009. OBJECTIVES The primary aim was to determine the effect of percutaneous transluminal angioplasty (PTA) compared with PTA with bare metal stenting for superficial femoral artery (SFA) stenoses on vessel patency in people with symptomatic (Rutherford categories1 to 6; Fontaine stages II to IV) lower limb peripheral vascular disease.In addition, we assessed the efficacy of PTA and stenting in improving quality of life, ankle brachial index and treadmill walking distance. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 6). SELECTION CRITERIA Randomised trials of angioplasty alone versus angioplasty with bare metal stenting for the treatment of superficial femoral artery stenoses. DATA COLLECTION AND ANALYSIS Two review authors (MC, CT) independently selected suitable trials, assessed trial quality and extracted data. Furthermore, these two review authors performed assessments of methodological quality and wrote the final manuscript. The third review author (ADM) cross-checked all stages of the review process. MAIN RESULTS We include three new studies in this update, making a total of 11 included trials with 1387 participants. The average age was 69 years and all trials included men and women. Participants were followed for up to two years. There was an improvement in primary duplex patency at six and 12 months in participants treated with PTA plus stent over lesions treated with PTA alone (six months: odds ratio (OR) 2.90, 95% confidence interval (CI) 1.17 to 7.18, P = 0.02, six studies, 578 participants; 12 months: OR 1.78, 95% CI 1.02 to 3.10, P = 0.04, nine studies, 858 participants). This was lost by 24 months (P = 0.06). There was a significant angiographic patency benefit at six months (OR 2.49, 95% CI 1.49 to 4.17, P = 0.0005, four studies, 329 participants) which was lost by 12 months (OR 1.30, 95% CI 0.84 to 2.00, P = 0.24, five studies, 384 participants). Ankle brachial index (ABI) and treadmill walking distance showed no improvement at 12 months (P = 0.49 and P = 0.57 respectively) between participants treated with PTA alone or PTA with stent insertion. Three trials (660 participants) reported quality of life, which showed no significant difference between participants treated with PTA alone or PTA with stent insertion at any time interval. Antiplatelet therapy protocols and inclusion criteria regarding affected arteries between trials showed marked heterogeneity. AUTHORS' CONCLUSIONS Although there was a short-term gain in primary patency there was no sustained benefit from primary stenting of lesions of the superficial femoral artery in addition to angioplasty. Future trials should focus on quality of life for claudication and limb salvage for critical ischaemia.
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Affiliation(s)
- Mohammed M Chowdhury
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation TrustCambridge Vascular UnitHills RoadCambridgeUKCB20QQ
| | - Alexander D McLain
- Royal Gwent HospitalSouth East Wales Regional Vascular NetworkCardiff RoadNewportUKNP20 2UB
| | - Christopher P Twine
- Royal Gwent HospitalSouth East Wales Regional Vascular NetworkCardiff RoadNewportUKNP20 2UB
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6
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Randomized Trials for Endovascular Treatment of Infrainguinal Arterial Disease: Systematic Review and Meta-analysis (Part 1: Above the Knee). Eur J Vasc Endovasc Surg 2014; 47:524-35. [DOI: 10.1016/j.ejvs.2014.02.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/12/2014] [Indexed: 11/23/2022]
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7
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Schmehl J, Tepe G. Current status of bare and drug-eluting stents in infrainguinal peripheral vascular disease. Expert Rev Cardiovasc Ther 2014; 6:531-8. [DOI: 10.1586/14779072.6.4.531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Soga Y, Yokoi H, Urakawa T, Iwabuchi M, Nobuyoshi M. Clinical impact of self-expandable stent diameter after femoropopliteal stenting. Cardiovasc Interv Ther 2010; 26:38-44. [DOI: 10.1007/s12928-010-0032-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 07/30/2010] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Endovascular stents have been suggested as a means to improve the patency of arteries after angioplasty in patients with intermittent claudication. This is an update of a Cochrane review published in 2002. OBJECTIVES The null hypothesis to be tested by this review is that for individuals with claudication the use of an endovascular stent, in addition to percutaneous transluminal angioplasty, does not improve symptoms of life-style limiting claudication when compared to percutaneous angioplasty alone. SEARCH STRATEGY For this update the Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched August 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2009, Issue 3). SELECTION CRITERIA Randomised trials comparing angioplasty alone versus angioplasty with endovascular stents in patients with intermittent claudication. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted the data. Only published trial data were used but unpublished data were sought for the update. Effectiveness was measured by the pre-defined primary outcome measures restenosis or reocclusion rates and maximum walking distance. MAIN RESULTS Two studies were included involving a total of 104 participants. Both studies included only individuals with femoro-popliteal disease. They compared angioplasty and stenting with the Palmaz stent against angioplasty alone. Although one study showed a slight statistical advantage in arterial patency after angioplasty alone, this was not found when the two studies were combined. No differences in the secondary outcomes were detected in either study. AUTHORS' CONCLUSIONS The small number of relevant studies identified together with the small sample sizes and methodological weaknesses severely limit the usefulness of this review in guiding practice. The results from larger multicentre trials are needed.
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Affiliation(s)
- Paul Bachoo
- Aberdeen Royal infirmaryWard 36, Vascular SurgeryForesterhillAberdeenScotlandUK
| | - P A Thorpe
- Aberdeen Royal InfirmaryDepartment of RadiologyForesterhillAberdeenUKAB25 2ZA
| | - Heather Maxwell
- University of EdinburghPublic Health SciencesTeviot PlaceEdinburghUKEH8 9AG
| | - Karen Welch
- University of EdinburghPublic Health SciencesTeviot PlaceEdinburghUKEH8 9AG
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10
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Twine CP, Coulston J, Shandall A, McLain AD. Angioplasty versus stenting for superficial femoral artery lesions. Cochrane Database Syst Rev 2009:CD006767. [PMID: 19370653 DOI: 10.1002/14651858.cd006767.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower limb peripheral arterial disease (PAD) is a common, important manifestation of systemic atherosclerosis. Stenoses or occlusions in the superficial femoral artery may result in intermittent claudication as an early consequence, which may be treated by balloon angioplasty with or without stenting. OBJECTIVES The objective was to determine the effect of percutaneous transluminal angioplasty (PTA) when compared with PTA with stenting for lesions of the superficial femoral artery, for people with intermittent claudication or critical limb ischaemia. SEARCH STRATEGY The Cochrane Peripheral Vascular Diseases (PVD) Group searched their trials register (last searched February 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2009, Issue 1) for publications describing randomised controlled trials (RCTs) of percutaneous angioplasty with or without stenting. SELECTION CRITERIA Randomised trials of angioplasty alone versus angioplasty with stenting for the treatment of superficial femoral artery stenoses. DATA COLLECTION AND ANALYSIS Two authors (CT, JC) independently selected suitable trials,assessed trial quality and extracted data. A third author (AS) ranked the concealment of allocation and checked the final manuscript. The fourth author (DM) cross checked all stages of the review process. MAIN RESULTS Eight trials with 968 participants were included. The average age was 67 and all trials included men and women. Participants were followed for up to two years.There was a small but statistically significant improvement in primary angiographic and duplex patency at six months in patients treated with PTA plus stent over lesions treated with PTA alone (three trials and four trials, respectively). However, primary angiographic patency was non-significant 12 months (five trials, P = 0.23) and 24 months (two trials, P = 0.45). A similar but lesser effect was seen for ankle brachial pressure index (ABPI), while a more pronounced improvement in treadmill walking distance in patients with PTA plus stent insertion was observed at six and 12 (P < 0.0001), but not 24 months (P = 0.81). Only one trial reported quality of life, which showed no significant difference between patients treated with PTA alone or PTA with stent insertion at any time interval. Antiplatelet therapy protocols and inclusion criteria between trials showed marked heterogenicity. AUTHORS' CONCLUSIONS There is limited benefit to stenting lesions of the superficial femoral artery in addition to angioplasty, however this cannot be recommended routinely based on the results of this analysis.
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Affiliation(s)
- Christopher P Twine
- General and Vascular Surgery, Royal Gwent Hospital, Cardiff Road, Newport, UK, NP20 2UB.
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11
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Kasapis C, Henke PK, Chetcuti SJ, Koenig GC, Rectenwald JE, Krishnamurthy VN, Grossman PM, Gurm HS. Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials. Eur Heart J 2008; 30:44-55. [PMID: 19028778 DOI: 10.1093/eurheartj/ehn514] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS We performed a meta-analysis of randomized controlled trials comparing routine stenting (ST) with percutaneous transluminal angioplasty (PTA) for symptomatic superficial femoral-popliteal artery (SFPA) disease. METHODS AND RESULTS Ten trials were pooled randomizing patients to ST (n = 724 limbs) or PTA with provisional stenting (n = 718 limbs) with a follow-up period of 9-24 months. The mean lesion length was similar in the two groups (45.8 mm in the ST group and 43.3 mm in the PTA group). We calculated the summary risk ratios (RRs) for immediate technical failure, restenosis, and target vessel revascularization (TVR) using random-effects models. The immediate technical failure was higher in the PTA group than in the ST group [17.1 vs. 5.9%, respectively, RR = 0.28, 95% confidence interval (CI) = 0.15-0.54, P < 0.001], with 10.3% of the PTA patients undergoing stenting because of suboptimal result. There was a trend for lower restenosis in the ST group (37.6% in ST vs. 45.3% in PTA, RR = 0.85, 95% CI = 0.69-1.06, P = 0.146), but no difference in the need for TVR (20% in ST vs. 20.2% in PTA, RR = 0.98, 95% CI = 0.78-1.23, P = 0.89). In an analysis restricted to nitinol stents, there was a trend towards reduction in TVR (RR = 0.79, 95% CI = 0.59-1.06, P = 0.12). CONCLUSION Despite the higher immediate success, routine stenting was not associated with a significant reduction in the rate of restenosis or TVR. Our data do not support use of routine stenting as the primary endovascular treatment for short SFPA lesions.
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Affiliation(s)
- Christos Kasapis
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI 48109-5853, USA
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Reekers JA. Endoluminal arterial stents below the inguinal ligament. Br J Surg 2008; 95:1433-4. [PMID: 18991251 DOI: 10.1002/bjs.6392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Twisted literature
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Affiliation(s)
- J A Reekers
- Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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E Y, He N, Wang Y, Fan H. Percutaneous transluminal angioplasty (PTA) alone versus PTA with balloon-expandable stent placement for short-segment femoropopliteal artery disease: a metaanalysis of randomized trials. J Vasc Interv Radiol 2008; 19:499-503. [PMID: 18375292 DOI: 10.1016/j.jvir.2007.12.446] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 12/12/2007] [Accepted: 12/17/2007] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate and compare the results of percutaneous transluminal angioplasty (PTA) and stent placement to treat femoropopliteal artery occlusive disease. MATERIALS AND METHODS Published data of randomized clinical trials comparing the results of PTA and stent placement for femoropopliteal artery occlusive disease were analyzed. Proportions were combined, and the odds ratio (OR) with its 95% CI was used as the effect size estimate. RESULTS Seven studies published in 1999 or later (614 limbs in 519 patients) were included in this metaanalysis, in which 323 limbs underwent PTA and 291 limbs underwent PTA followed by balloon-expandable stent placement. In the combined results of PTA versus PTA plus stent placement, a significant difference in primary patency at 6 months (OR, 0.47; 95% CI, 0.27-0.84; P < .05) was found, but no significant difference could be found in primary patency at 12 months (OR, 1.27; 95% CI, 0.87-1.86; P > .05) or 24 months (OR, 1.22; 95% CI, 0.81-1.82; P > .05) or in secondary patency at 12 months (OR, 1.34; 95% CI, 0.78-2.30; P > .05). CONCLUSIONS In the treatment of femoropopliteal artery occlusive disease (< or =10 cm), higher primary patency rates can be expected at 6 months with PTA followed by implantation of balloon-expandable stents versus PTA alone, but PTA with stent placement does not produce better long-term primary results and secondary patency rates than PTA alone.
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Affiliation(s)
- Yajun E
- Radiology Department, Tianjin Medical University General Hospital, Tianjin Institute of Radiology, Tianjin, China
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Balloon angioplasty compared with stenting for treatment of femoropopliteal occlusive disease: a meta-analysis. J Vasc Surg 2007; 47:461-9. [PMID: 17950563 DOI: 10.1016/j.jvs.2007.07.059] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 07/25/2007] [Accepted: 07/28/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND The goal of this study was to review the currently available literature and to compare the short and long-term results of primary stenting and angioplasty of femoropopliteal occlusive disease by performing a meta-analysis review. METHODS A systematic review of the literature that was published between September 2000 and January 2007 was performed. All studies that reported data on the long-term results after balloon dilatation or stent implantation were included if at least one-year primary patency or restenosis rate was presented; the study follow-up was at least 1 year and the number of subjects at the start of study was at least 20 patients. Three investigators independently extracted the data. The Pooled survival curves were then constructed for graft patency according to a random-effects protocol for meta-analysis. RESULTS Twenty-four articles were initially identified but only seven were selected and included in this meta-analysis: seven were RCTs publications and one was a retrospective study comparing the outcome of angioplasty and stenting of the femoropopliteal segment. In our meta-analysis, there were a total of 934 patients with 452 patients who underwent balloon angioplasty (273 patients were male) and 482 patients who underwent stenting (297 patients were male). Primary patency at 1-year and postoperative ABI post intervention was used to evaluate the pooled odds ratio (OR) of all studies. The pooled OR of all studies estimate for the 12-month patency rates was 0.989 (95% confidence interval [CI], 0.623 to 1.570, P = .962) showing no difference in outcome between the two groups (SE 0.269% to 1.025%). The pooled OR estimate for the postoperative ABI was 0.869 (95% CI, 0.557 to 1.357, P = .561) showing a slight advantage in favor of the angioplasty group but the P value was not statistically significant (SE 0.282% to 1.326%). The 1-year primary patency rates following balloon angioplasty ranged from 45% to 84.2% and at 2 years it varied from 25% to 77.2%. In the stent implantation group, the 1-year primary patency rates varied from 63% to 90%, and 2-year primary patency ranged from 46% to 87%. Heterogeneity was seen among studies, and publication bias could not be excluded. CONCLUSIONS The results of our meta-analysis suggest that stent placement in the femoropopliteal occlusive disease does not increase the patency rate when compared with angioplasty alone at 1 year. This conclusion should be viewed in the light of study-design considerations and all limitations in this meta-analysis that may have an impact of the outcome of stenting and angioplasty after a 1-year follow-up.
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Albrecht T, Speck U, Baier C, Wolf KJ, Böhm M, Scheller B. Reduction of Stenosis Due to Intimal Hyperplasia After Stent Supported Angioplasty of Peripheral Arteries by Local Administration of Paclitaxel in Swine. Invest Radiol 2007; 42:579-85. [PMID: 17620941 DOI: 10.1097/rli.0b013e31804f5a60] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess if local intra-arterial administration of paclitaxel using drug-coated balloons or an admixture of paclitaxel to contrast medium inhibits stenosis after percutanous transluminal angioplasty (PTA) of peripheral arteries in a porcine overstretch model. METHODS Neointimal proliferation and stenosis were induced by overstretch and stenting of 40 peripheral arteries in 20 pigs. Paclitaxel was administered locally during PTA using coated balloons (n = 20) or dissolved in contrast medium (n = 10). Conventional balloons and contrast medium were used in a control group (n = 10). Reangiography with quantitative analysis was performed after 5 weeks. RESULTS On reangiography diameter stenosis and late lumen loss were significantly reduced by both methods of local drug delivery compared with control group; minimal luminal diameter was significantly larger in the treatment groups. CONCLUSIONS Local short-term administration of paclitaxel during PTA of peripheral arteries using balloons or contrast medium as drug carriers reduced stenosis due to intimal hyperplasia.
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Affiliation(s)
- Thomas Albrecht
- Department of Radiology and Nuclear Medicine, Campus Benjamin Franklin, Charité, Free University und Humboldt University Berlin, Berlin, Germany.
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Tepe G, Zeller T, Heller S, Wiskirchen J, Fischmann A, Coerper S, Balletshofer B, Beckert S, Claussen CD. Self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty. Eur Radiol 2006; 17:2088-95. [PMID: 17186245 DOI: 10.1007/s00330-006-0526-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Revised: 10/15/2006] [Accepted: 11/03/2006] [Indexed: 11/29/2022]
Abstract
The feasibility of self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty was assessed. Options for lower limb percutaneous revascularization are limited, especially for complex vessel obstruction. Depending on the lesion and the experience of the interventionalist, the failure rate of balloon angioplasty (PTA) ranges between 10 and 40%. Until recently, no self-expanding stent for the use in the infragenicular arteries was available. This is the first report of the results for 18 consecutive patients who received 4F sheath compatible self-expanding nitinol stents following unsuccessful PTA or early restenosis. Twenty-four stents were implanted in 21 lesions for various indications residual stenosis >50% due to heavy calcification, flow-limiting dissection, occluding thrombus resistant to thrombolyis, thrombaspiration, and PTA, and early restenosis after previous PTA. Stent implantation was feasible in all cases. No complications occurred. After the stent implantation, all primarily unsuccessful interventions could be transformed into successful procedures with no residual stenosis >30% in any case. After 6 +/- 2 months, two of the 18 patients died, and 14 of the 16 remaining patients improved clinically. At follow-up, the patency could be assessed in 14 stented arteries. Three stents were occluded, one stent showed some neointimal hyperplasia (50-70% restenosis), the remaining ten stents showed no restenosis (0-30%). The use of self-expanding nitinol stents in tibioperoneal and popliteal arteries is a safe and feasible option for the treatment of unsuccessful PTA. The 6-months patency is high.
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Affiliation(s)
- Gunnar Tepe
- Department of Diagnostic Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
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Abstract
High restenosis rate is still the major limitation of peripheral arterial interventions. Within the last years, drug-eluting stents have gained wide acceptance in the coronary arteries, however, these devices are not currently available for arteries outside the coronary vasculature. This article summarizes the special role of the superficial femoral artery in restenosis, with efforts being made to reduce the restenosis rate in this artery, focusing on stents and drug-eluting stents.
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Affiliation(s)
- Gunnar Tepe
- Department of Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany.
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Rieger J, Treitl M, Reiser M, Ruppert V. [Stenting of the SFA--indications, techniques, results]. Radiologe 2006; 46:955-61. [PMID: 17043755 DOI: 10.1007/s00117-006-1425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aggressive risk factor modification, change of eating habits, exercise programs, and forceful antiplatelet therapy are the most important tools for the treatment of PAOD in symptomatic patients suffering from intermittent claudication. There are however no guidelines for revascularization at this stage. Endovascular treatment has been increasingly utilized over the last decade and increasingly displaced vascular surgery. Amongst numerous endovascular techniques beside PTA, stents meanwhile play the most important role due to constant technical progress. Results regarding the rate of restenosis or patency rates still remain worse compared to other vascular beds. This paper gives a review over recent results, currently available stent techniques, and possible indications for the endovascular therapy of an artery, which has turned out to be the biggest ordeal for material and construction of stents.
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Affiliation(s)
- J Rieger
- Institut für Klinische Radiologie, Klinikum Innenstadt der Ludwigs-Maximilians-Universität, Pettenkoferstrasse 8a, 80336 Munich.
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Müller-Hülsbeck S. [Rational minimally invasive treatment of pAOD: when should a conservative approach, PTA, or stent be chosen?]. Radiologe 2006; 46:973-9. [PMID: 17033776 DOI: 10.1007/s00117-006-1430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In order to obtain optimal results and satisfied patients, rational therapy of pAOD should strictly follow national and international society guidelines. In particular cases an individual therapeutic concept seems justified beyond these guidelines. Based on clinical data and driven by costs, aortic and iliac lesions may be treated by PTA or selective stent placement with equal results; however, long-term data justify also primary, direct stenting. For treatment of infrainguinal and popliteal stenotic lesions primary stenting should be restricted to PTA failure (dissection, recoil, occlusion); except for treatment of extended lesions, primary stenting compared to PTA alone seems beneficial in terms of midterm patency. Endovascular procedures below the knee and at the toe should be limited to existing limb-threatening ischemia in order to save the extremity; whether PTA or stenting is advantageous has not yet determined.
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Affiliation(s)
- S Müller-Hülsbeck
- Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein der Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
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Speck U, Scheller B, Abramjuk C, Breitwieser C, Dobberstein J, Boehm M, Hamm B. Neointima Inhibition: Comparison of Effectiveness of Non–Stent-based Local Drug Delivery and a Drug-eluting Stent in Porcine Coronary Arteries. Radiology 2006; 240:411-8. [PMID: 16864669 DOI: 10.1148/radiol.2402051248] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the inhibition of neointimal proliferation by using non-stent-based local drug delivery and a drug-eluting stent in porcine coronary arteries. MATERIALS AND METHODS Experiments were conducted with permission of the animal protection committee of the local government. Paclitaxel was either dissolved in a nonionic contrast medium or coated on balloons. Stents were crimped on the coated balloons. Effectiveness was tested in 22 pigs. Two coronary stents were placed in each pig, and slight overstretch was applied. The animals were treated as follows: group A (control group), uncoated balloons, bare stents, and "plain" contrast medium; group B, same treatment as group A, but with paclitaxel in the contrast medium; group C, paclitaxel-coated balloons, with premounted bare stents and plain contrast medium; and group D, sirolimus-eluting stents, noncoated balloons, and plain contrast medium. Stenosis was assessed 4 weeks later at angiography and histomorphometry. For exploratory purposes, continuous variables of quantitative coronary angiography and histomorphometry were compared by using analysis of variance. RESULTS Results at follow-up angiography indicated a mean of 1.00 mm +/- 0.18 (standard deviation) lumen diameter loss in the control group and 0.14 mm +/- 0.18 loss in the group treated with the paclitaxel-coated balloon (group C; P < .001). Findings at histomorphometry confirmed the effectiveness of drug delivery, with the most impressive inhibition of neointimal proliferation from coated balloons-the neointimal area was 2.4 mm2 +/- 0.3 (P < .01 vs all other groups), compared with 5.2 mm2 +/- 0.3 in group A (control group), 4.3 mm2 +/- 0.3 in group B, and 3.8 mm2 +/- 0.3 in group D. CONCLUSION In spite of the short intima contact time, paclitaxel coated on the balloon inhibits neointimal formation in the porcine model of coronary stent placement.
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Affiliation(s)
- Ulrich Speck
- Department of Radiology, Charité Humboldt-University Berlin, Schumannstr 20-21, D 10117 Berlin, Germany.
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Iida O, Nanto S, Uematsu M, Morozumi T, Kotani JI, Awata M, Onishi T, Ito N, Sera F, Minamiguchi H, Akahori H, Nagata S. Effect of exercise on frequency of stent fracture in the superficial femoral artery. Am J Cardiol 2006; 98:272-4. [PMID: 16828607 DOI: 10.1016/j.amjcard.2006.01.091] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 01/19/2006] [Accepted: 01/19/2006] [Indexed: 10/24/2022]
Abstract
Stent fracture has emerged as a new problem in the percutaneous transluminal angioplasty of the superficial femoral artery (SFA). The aim of our study was to delineate the factors influencing nitinol stent fracture in the SFA. Forty consecutive patients with peripheral artery disease who underwent rescue stenting with a nitinol stent (Luminexx, Bard) in the SFA were enrolled between May 2004 and January 2005. Follow-up angiography was performed 13.6+/-1.0 months later to detect stent fracture. Stent fracture occurred in 11 patients (28%). Lesion length>100 mm, the number of stents used, the lesion involving the distal SFA, chronic total occlusion, and walking>5,000 steps per day were more frequently observed in those with stent fracture than in those without fracture. Of these variables, walking>5,000 steps per day was the strongest independent determinant associated with stent fracture by discriminant analysis (p=0.0027). Vigorous exercise adversely affects stent fracture in patients implanted with a nitinol stent in the SFA.
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Affiliation(s)
- Osamu Iida
- Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
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Duraiswamy N, Jayachandran B, Byrne J, Moore JE, Schoephoerster RT. Spatial distribution of platelet deposition in stented arterial models under physiologic flow. Ann Biomed Eng 2006; 33:1767-77. [PMID: 16389525 DOI: 10.1007/s10439-005-7598-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 07/25/2005] [Indexed: 12/27/2022]
Abstract
This paper presents dynamic flow experiments with fluorescently labeled platelets to allow for spatial observation of wall attachment in inter-strut spacings, to investigate their relationship to flow patterns. Human blood with fluorescently labeled platelets was circulated through an in vitro system that produced physiologic pulsatile flow in a parallel plate flow chamber that contained three different stent designs that feature completely recirculating flow, partially recirculating flow (intermediate strut spacing), and completely reattached flow. Highly resolved spatial distribution of platelets was obtained by imaging fluorescently labeled platelets between the struts. Platelet deposition was higher in areas where flow is directed towards the wall, and lower in areas where flow is directed away from the wall. Flow detachment and reattachment points exhibited very low platelet deposition. Platelet deposition within intermediate strut spacing continued to increase throughout the experimental period, indicating that the deposition rate had not plateaued unlike other strut spacings. The spatial uniformity and temporal increase in platelet deposition for the intermediate strut spacing confirms and helps explain our previous finding that platelet deposition was highest with this strut spacing. Further experimental investigations will include more complex three-dimensional geometries.
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Affiliation(s)
- Nandini Duraiswamy
- Department of Biomedical Engineering, Florida International University, Miami, FL 33199, USA
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Tepe G, Schmehl J, Heller S, Wiesinger B, Claussen CD, Duda SH. Superficial femoral artery: current treatment options. Eur Radiol 2006; 16:1316-22. [PMID: 16489440 DOI: 10.1007/s00330-005-0111-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 11/24/2005] [Accepted: 11/29/2005] [Indexed: 11/29/2022]
Abstract
Treatment of the superficial femoral artery (SFA) has been among the least effective of all endovascular procedures in terms of long-term patency. The relatively small vessel lumen, in conjunction with a high plaque burden, slow flow, and a high frequency of primary occlusions, contributes to a considerable rate of acute technical failures. Because of these technical limitations a much effort has been made during the past years. This manuscript should summarize the hopes and limitations of different approaches such as brachytherapy, cutting balloons, stents and stent grafts, drug-eluting stents, and drug-coated balloons.
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Affiliation(s)
- Gunnar Tepe
- Department of Diagnostic Radiology, University of Tuebingen, Hoppe-Seyler Strasse 3, 72076 Tuebingen, Germany.
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Scientific Surgery. Br J Surg 2005. [DOI: 10.1002/bjs.5112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Richter GM, Stampfl U, Stampfl S, Rehnitz C, Holler S, Schnabel P, Grunze M. A New Polymer Concept for Coating of Vascular Stents Using PTFEP (poly(bis(trifluoroethoxy)phosphazene) to Reduce Thrombogenicity and Late In-Stent Stenosis. Invest Radiol 2005; 40:210-8. [PMID: 15770139 DOI: 10.1097/01.rli.0000156195.74967.47] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to evaluate the new polymer PTFEP (poly(bis(trifluoroethoxy)phosphazene) for (1) its ability to reduce thrombogenicity and late in-stent stenosis and (2) its effect on endothelialization in a rabbit iliac artery model. MATERIALS AND METHODS Nanocoated ( approximately 50 nm) and bare stainless-steel stents were implanted bilaterally in the iliac arteries of 30 New Zealand White rabbits (1, 4, 8, 12, and 16 weeks follow-up) and evaluated by angiography, light, and scanning electron microscopy. RESULTS Bilateral stent placement was successful in 27 of 30 rabbits. Thrombus depositions occurred in none of the 27 coated but in 4 of the 27 bare stents (P=0.037). A normal angiogram was obtained in 18 of 22 coated stents at risk for restenosis (follow-up >or=4 weeks) but only in 13 of 22 bare stents (P=0.023). Marked restenosis (luminal loss >30%) was found in 6 bare stents (P=0.011) but not in any coated stents. The neointima was 47.7-73.9 mum on coated and 66.9-115.2 mum on bare stents (statistically significant at 4, 8, and 16 weeks). Scanning electron microscopy detected full endothelialization in all stents from 4 weeks on (22 stents in both groups). CONCLUSION PTFEP nanocoating successfully showed thromboresistance and reduced late in-stent stenosis. Endothelialization was equal in both stent types. Studies in more human-like models and human feasibility studies in human arteries are encouraged.
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Affiliation(s)
- Goetz M Richter
- Department of Diagnostic Radiology, Institute for Applied Physical Chemistry, University Heidelberg, Heidelberg, Germany.
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