1
|
Fakhry F, Rouwet EV, Spillenaar Bilgen R, van der Laan L, Wever JJ, Teijink JAW, Hoffmann WH, van Petersen A, van Brussel JP, Stultiens GNM, Derom A, den Hoed PT, Ho GH, van Dijk LC, Verhofstad N, Orsini M, Hulst I, van Sambeek MRHM, Rizopoulos D, Moelker A, Hunink MGM. Endovascular Revascularization Plus Supervised Exercise Versus Supervised Exercise Only for Intermittent Claudication: A Cost-Effectiveness Analysis. Circ Cardiovasc Interv 2021; 14:e010703. [PMID: 34253049 DOI: 10.1161/circinterventions.121.010703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Farzin Fakhry
- Department of Epidemiology (F.F., R.S.B., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (F.F., A.M., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ellen V Rouwet
- Department of Public Health (E.V.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Reinier Spillenaar Bilgen
- Department of Epidemiology (F.F., R.S.B., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lijckle van der Laan
- Department of Vascular Surgery, Amphia Hospital, Breda, the Netherlands (L.v.d.L., G.H.H.)
| | - Jan J Wever
- Interventional Radiology, Haga Hospital, The Hague, the Netherlands (J.J.W., L.C.v.D.)
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands (N.V., J.A.W.T., M.R.H.M.v.S.)
| | - Wolter H Hoffmann
- Department of Vascular Surgery, Reinier de Graaf Hospital, Delft, the Netherlands (W.H.H., M.O.)
| | - Andre van Petersen
- Department of Vascular Surgery, Bernhoven Hospital, Uden, the Netherlands (A.v.P.)
| | - Jerome P van Brussel
- Department of Vascular Surgery, Sint Franciscus Hospital, Rotterdam, the Netherlands (J.P.v.B.)
| | | | - Alex Derom
- Department of Vascular Surgery, Zorgsaam Hospital, Terneuzen, the Netherlands (A.D.)
| | - P Ted den Hoed
- Department of Vascular Surgery, Ikazia Hospital, Rotterdam, the Netherlands (P.T.d.H.)
| | - Gwan H Ho
- Department of Vascular Surgery, Amphia Hospital, Breda, the Netherlands (L.v.d.L., G.H.H.)
| | - Lukas C van Dijk
- Interventional Radiology, Haga Hospital, The Hague, the Netherlands (J.J.W., L.C.v.D.)
| | - Nicole Verhofstad
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands (N.V., J.A.W.T., M.R.H.M.v.S.)
| | - Mariella Orsini
- Department of Vascular Surgery, Reinier de Graaf Hospital, Delft, the Netherlands (W.H.H., M.O.)
| | | | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands (N.V., J.A.W.T., M.R.H.M.v.S.)
| | - Dimitris Rizopoulos
- Department of Biostatistics (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Radiology (F.F., A.M., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M G Myriam Hunink
- Department of Epidemiology (F.F., R.S.B., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (F.F., A.M., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (M.G.M.H.)
| |
Collapse
|
2
|
Thomas Manapurathe D, Moxon JV, Krishna SM, Rowbotham S, Quigley F, Jenkins J, Bourke M, Bourke B, Jones RE, Golledge J. Cohort Study Examining the Association Between Blood Pressure and Cardiovascular Events in Patients With Peripheral Artery Disease. J Am Heart Assoc 2020; 8:e010748. [PMID: 30845872 PMCID: PMC6475052 DOI: 10.1161/jaha.118.010748] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Hypertension is an important risk factor for cardiovascular events in patients with peripheral artery disease; however, optimal blood pressure targets for these patients are poorly defined. This study investigated the association between systolic blood pressure ( SBP ) and cardiovascular events in a prospectively recruited patient cohort with peripheral artery disease. Methods and Results A total of 2773 patients were included and were grouped according to SBP at recruitment (≤120 mm Hg, n=604; 121-140 mm Hg, n=1065; and >140 mm Hg, n=1104). Adjusted Cox proportional hazards analyses suggested that patients with SBP ≤120 mm Hg were at greater risk of having a major cardiovascular event (myocardial infarction, stroke, or cardiovascular death) than patients with SBP of 121-140 mm Hg (adjusted hazard ratio, 1.36; 95% CI, 1.08-1.72; P=0.009). Patients with SBP >140 mm Hg had an adjusted hazard ratio of 1.23 (95% CI, 1.00-1.51; P=0.051) of major cardiovascular events compared with patients with SBP of 121-140 mm Hg. These findings were similar in sensitivity analyses only including patients receiving antihypertensive medications or focused on patients with a minimum of 3 months of follow-up. Conclusions This cohort study suggests that patients with peripheral artery disease and SBP ≤120 mm Hg are at increased risk of major cardiovascular events. The findings suggest caution in intensive SBP lowering in this patient group.
Collapse
Affiliation(s)
- Diana Thomas Manapurathe
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Joseph Vaughan Moxon
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Smriti Murali Krishna
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Sophie Rowbotham
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,4 School of Medicine University of Queensland Brisbane Australia.,5 Department of Vascular and Endovascular Surgery Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Frank Quigley
- 6 Department of Vascular and Endovascular Surgery Mater Hospital Townsville Australia
| | - Jason Jenkins
- 5 Department of Vascular and Endovascular Surgery Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Michael Bourke
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,7 Gosford Vascular Services Gosford New South Wales Australia
| | - Bernard Bourke
- 7 Gosford Vascular Services Gosford New South Wales Australia
| | - Rhondda E Jones
- 3 Division of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Jonathan Golledge
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia.,8 The Department of Vascular and Endovascular Surgery The Townsville Hospital Townsville Queensland Australia
| |
Collapse
|
3
|
Noukeu LC, Wolf J, Yuan B, Banerjee S, Nguyen KT. Nanoparticles for Detection and Treatment of Peripheral Arterial Disease. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2018; 14:e1800644. [PMID: 29952061 DOI: 10.1002/smll.201800644] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Indexed: 06/08/2023]
Abstract
Peripheral arterial disease (PAD) is defined as a slow, progressive disorder of the lower extremity arterial vessels characterized by chronic narrowing that often results in occlusion and is associated with loss of functional capacity. Although the PAD occurrence rate is increasing in the elderly population, outcomes with current treatment strategies are suboptimal. Hence, there is an urgent need to develop new technologies that overcome limitations of traditional modalities for PAD detection and therapy. In this Review, the application of nanotechnology as a tool that bridges the gap in PAD diagnosis and therapy is in focus. Several materials including synthetic, natural, biodegradable, and biocompatible materials are used to develop nanoparticles for PAD diagnostic and/or therapeutic applications. Moreover, various recent research approaches are being explored to diagnose PAD through multimodality imaging with different nanoplatforms. Further efforts include targeted delivery of various therapeutic agents using nanostructures as carriers to treat PAD. Last, but not least, despite being a fairly new field, researchers are exploring the use of nanotheranostics for PAD detection and therapy.
Collapse
Affiliation(s)
- Linda C Noukeu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
- Joint Biomedical Engineering Program, University of Texas Southwestern, Dallas, TX, 75235, USA
| | - Joseph Wolf
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
- Joint Biomedical Engineering Program, University of Texas Southwestern, Dallas, TX, 75235, USA
| | - Baohong Yuan
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
- Joint Biomedical Engineering Program, University of Texas Southwestern, Dallas, TX, 75235, USA
| | - Subhash Banerjee
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, 75235, USA
| | - Kytai T Nguyen
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
- Joint Biomedical Engineering Program, University of Texas Southwestern, Dallas, TX, 75235, USA
| |
Collapse
|
4
|
Fakhry F, Fokkenrood HJP, Spronk S, Teijink JAW, Rouwet EV, Hunink MGM, Cochrane Vascular Group. Endovascular revascularisation versus conservative management for intermittent claudication. Cochrane Database Syst Rev 2018; 2018:CD010512. [PMID: 29518253 PMCID: PMC6494207 DOI: 10.1002/14651858.cd010512.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intermittent claudication (IC) is the classic symptomatic form of peripheral arterial disease affecting an estimated 4.5% of the general population aged 40 years and older. Patients with IC experience limitations in their ambulatory function resulting in functional disability and impaired quality of life (QoL). Endovascular revascularisation has been proposed as an effective treatment for patients with IC and is increasingly performed. OBJECTIVES The main objective of this systematic review is to summarise the (added) effects of endovascular revascularisation on functional performance and QoL in the management of IC. SEARCH METHODS For this review the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (February 2017) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1). The CIS also searched trials registries for details of ongoing and unpublished studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing endovascular revascularisation (± conservative therapy consisting of supervised exercise or pharmacotherapy) versus no therapy (except advice to exercise) or versus conservative therapy (i.e. supervised exercise or pharmacotherapy) for IC. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data, and assessed the methodological quality of studies. Given large variation in the intensity of treadmill protocols to assess walking distances and use of different instruments to assess QoL, we used standardised mean difference (SMD) as treatment effect for continuous outcome measures to allow standardisation of results and calculated the pooled SMD as treatment effect size in meta-analyses. We interpreted pooled SMDs using rules of thumb (< 0.40 = small, 0.40 to 0.70 = moderate, > 0.70 = large effect) according to the Cochrane Handbook for Systematic Reviews of Interventions. We calculated the pooled treatment effect size for dichotomous outcome measures as odds ratio (OR). MAIN RESULTS We identified ten RCTs (1087 participants) assessing the value of endovascular revascularisation in the management of IC. These RCTs compared endovascular revascularisation versus no specific treatment for IC or conservative therapy or a combination therapy of endovascular revascularisation plus conservative therapy versus conservative therapy alone. In the included studies, conservative treatment consisted of supervised exercise or pharmacotherapy with cilostazol 100 mg twice daily. The quality of the evidence ranged from low to high and was downgraded mainly owing to substantial heterogeneity and small sample size.Comparing endovascular revascularisation versus no specific treatment for IC (except advice to exercise) showed a moderate effect on maximum walking distance (MWD) (SMD 0.70, 95% confidence interval (CI) 0.31 to 1.08; 3 studies; 125 participants; moderate-quality evidence) and a large effect on pain-free walking distance (PFWD) (SMD 1.29, 95% CI 0.90 to 1.68; 3 studies; 125 participants; moderate-quality evidence) in favour of endovascular revascularisation. Long-term follow-up in two studies (103 participants) showed no clear differences between groups for MWD (SMD 0.67, 95% CI -0.30 to 1.63; low-quality evidence) and PFWD (SMD 0.69, 95% CI -0.45 to 1.82; low-quality evidence). The number of secondary invasive interventions (OR 0.81, 95% CI 0.12 to 5.28; 2 studies; 118 participants; moderate-quality evidence) was also not different between groups. One study reported no differences in disease-specific QoL after two years.Data from five studies (n = 345) comparing endovascular revascularisation versus supervised exercise showed no clear differences between groups for MWD (SMD -0.42, 95% CI -0.87 to 0.04; moderate-quality evidence) and PFWD (SMD -0.05, 95% CI -0.38 to 0.29; moderate-quality evidence). Similarliy, long-term follow-up in three studies (184 participants) revealed no differences between groups for MWD (SMD -0.02, 95% CI -0.36 to 0.32; moderate-quality evidence) and PFWD (SMD 0.11, 95% CI -0.26 to 0.48; moderate-quality evidence). In addition, high-quality evidence showed no difference between groups in the number of secondary invasive interventions (OR 1.40, 95% CI 0.70 to 2.80; 4 studies; 395 participants) and in disease-specific QoL (SMD 0.18, 95% CI -0.04 to 0.41; 3 studies; 301 participants).Comparing endovascular revascularisation plus supervised exercise versus supervised exercise alone showed no clear differences between groups for MWD (SMD 0.26, 95% CI -0.13 to 0.64; 3 studies; 432 participants; moderate-quality evidence) and PFWD (SMD 0.33, 95% CI -0.26 to 0.93; 2 studies; 305 participants; moderate-quality evidence). Long-term follow-up in one study (106 participants) revealed a large effect on MWD (SMD 1.18, 95% CI 0.65 to 1.70; low-quality evidence) in favour of the combination therapy. Reports indicate that disease-specific QoL was comparable between groups (SMD 0.25, 95% CI -0.05 to 0.56; 2 studies; 330 participants; moderate-quality evidence) and that the number of secondary invasive interventions (OR 0.27, 95% CI 0.13 to 0.55; 3 studies; 457 participants; high-quality evidence) was lower following combination therapy.Two studies comparing endovascular revascularisation plus pharmacotherapy (cilostazol) versus pharmacotherapy alone provided data showing a small effect on MWD (SMD 0.38, 95% CI 0.08 to 0.68; 186 participants; high-quality evidence), a moderate effect on PFWD (SMD 0.63, 95% CI 0.33 to 0.94; 186 participants; high-quality evidence), and a moderate effect on disease-specific QoL (SMD 0.59, 95% CI 0.27 to 0.91; 170 participants; high-quality evidence) in favour of combination therapy. Long-term follow-up in one study (47 participants) revealed a moderate effect on MWD (SMD 0.72, 95% CI 0.09 to 1.36; P = 0.02) in favour of combination therapy and no clear differences in PFWD between groups (SMD 0.54, 95% CI -0.08 to 1.17; P = 0.09). The number of secondary invasive interventions was comparable between groups (OR 1.83, 95% CI 0.49 to 6.83; 199 participants; high-quality evidence). AUTHORS' CONCLUSIONS In the management of patients with IC, endovascular revascularisation does not provide significant benefits compared with supervised exercise alone in terms of improvement in functional performance or QoL. Although the number of studies is small and clinical heterogeneity underlines the need for more homogenous and larger studies, evidence suggests that a synergetic effect may occur when endovascular revascularisation is combined with a conservative therapy of supervised exercise or pharmacotherapy with cilostazol: the combination therapy seems to result in greater improvements in functional performance and in QoL scores than are seen with conservative therapy alone.
Collapse
Affiliation(s)
- Farzin Fakhry
- Erasmus MCDepartments of Epidemiology & RadiologyDr Molewaterplein 40PO Box 2040RotterdamNetherlands3015 GD
| | | | - Sandra Spronk
- Erasmus MCDepartments of Epidemiology & RadiologyDr Molewaterplein 40PO Box 2040RotterdamNetherlands3015 GD
- Dutch Health Care InspectorateDepartment of Research and InnovationUtrechtNetherlands
| | - Joep AW Teijink
- Catharina HospitalDepartment of Vascular Surgeryvisiting address: Michelangelolaan 2, 5623 EJ, Eindhovenpostal address: P.O. Box 1350EindhovenNetherlands5602 ZA
| | - Ellen V Rouwet
- Erasmus MCDepartment of Vascular SurgeryRotterdamNetherlands
| | - M G Myriam Hunink
- Erasmus MCDepartment of EpidemiologyPO Box 2040RotterdamNetherlands3000 CA
| | | |
Collapse
|
5
|
Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:47-52. [PMID: 28344617 PMCID: PMC5364282 DOI: 10.5114/aic.2017.66186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/28/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Fifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO) of the superficial femoral artery (SFA). Ten-fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown. AIM To assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA. MATERIAL AND METHODS We included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months. RESULTS The study included 17 patients (7 females, 10 males) who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5%) patients and after a previously failed attempt in 13 (76.5%) patients. The procedure was successful in 15 (88.2%) patients, and unsuccessful in 2 (11.8%) patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy), 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death). The primary patency rate at 12 months was 88.2% and secondary patency 100%. CONCLUSIONS The retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications.
Collapse
|
6
|
Fakhry F, Fokkenrood HJP, Rouwet EV, Teijink JAW, Spronk S, Hunink MGM. Endovascular revascularisation versus conservative management for intermittent claudication. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Farzin Fakhry
- Erasmus MC; Departments of Epidemiology & Radiology; Dr Molewaterplein 40 PO Box 2040 Rotterdam Netherlands 3015 GD
| | - Hugo JP Fokkenrood
- Catharina Hospital; Department of Vascular Surgery; Michelangelolaan 2 Eindhoven Netherlands 5623 EJ
| | - Ellen V Rouwet
- Erasmus MC; Department of Vascular Surgery; Rotterdam Netherlands
| | - Joep AW Teijink
- Catharina Hospital; Department of Vascular Surgery; Michelangelolaan 2 Eindhoven Netherlands 5623 EJ
| | - Sandra Spronk
- Erasmus MC; Departments of Epidemiology & Radiology; Dr Molewaterplein 40 PO Box 2040 Rotterdam Netherlands 3015 GD
- Dutch Health Care Inspectorate; Department of Research and Innovation; Utrecht Netherlands
| | - M G Myriam Hunink
- Erasmus MC; Departments of Epidemiology & Radiology; Dr Molewaterplein 40 PO Box 2040 Rotterdam Netherlands 3015 GD
| |
Collapse
|
7
|
Krishnamurthy VN, Eliason JL, Henke PK, Rectenwald JE. Intravascular ultrasound-guided true lumen reentry device for recanalization of unilateral chronic total occlusion of iliac arteries: technique and follow-up. Ann Vasc Surg 2010; 24:487-97. [PMID: 20363107 DOI: 10.1016/j.avsg.2009.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 10/20/2009] [Accepted: 12/20/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endovascular revascularization of chronic total occlusion (CTO) of the iliac arteries is rapidly becoming first-line treatment, with surgical aortofemoral bypass procedures reserved for failure of endovascular treatment. Percutaneous subintimal recanalization is the most common endovascular revascularization technique for CTO of the iliac arteries. The primary reason for failure of the subintimal recanalization technique is failure to reenter the true lumen. This report describes the benefits of using true lumen reentry devices to improve the success and safety of conventional subintimal recanalization for revascularization of CTO of the iliac arteries. METHODS This is a retrospective review of 11 patients with CTO of the iliac arteries in whom true lumen reentry was not successful using conventional subintimal recanalization. An intravascular ultrasound (IVUS)-guided true lumen reentry device was used in all patients to assist true lumen reentry. Clinical records, procedural records, angiographic imaging, and follow-up data were analyzed. Indications for intervention, length and location of the lesion treated, access site(s), location of true lumen reentry, stent use, procedural times, technical success, and complications were analyzed in all patients. RESULTS The technical success of true lumen reentry at the desired point was 100%. Total procedure time from the start of reentry device manipulation to achieve reentry was <10 min (routinely <5 min). Mean patient follow-up was 10.5 months. At follow-up, all patients had palpable femoral pulses. The ankle-brachial index normalized (>0.9) in six patients and improved significantly in the remaining five patients. Rest pain resolved and claudication improved in all patients. Out of seven patients who had foot ulcers, the ulcers healed completely in five and demonstrated improved healing in two, with the clinical manifestation of osteomyelitis resolved in two. No procedure-related complications were noted. The amputation-free survival was 100%. CONCLUSION True lumen reentry devices greatly improve the technical success and safety of percutaneous recanalization procedures in CTO of the iliac arteries. There are significant reductions in procedure time and complication rates associated with the use of these devices.
Collapse
Affiliation(s)
- Venkataramu N Krishnamurthy
- Section of Vascular and Interventional Radiology, Ann Arbor VA Health System, Ann Arbor, MI 48109-5030, USA.
| | | | | | | |
Collapse
|
8
|
Smolderen K, Hoeks S, Aquarius A, Scholte op Reimer W, Spertus J, van Urk H, Denollet J, Poldermans D. Further Validation of the Peripheral Artery Questionnaire: Results from a Peripheral Vascular Surgery Survey in the Netherlands. Eur J Vasc Endovasc Surg 2008; 36:582-91. [DOI: 10.1016/j.ejvs.2008.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
|