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Cerrud-Rodriguez RC, Romain G, Hussain Y, Cleman J, Callegari S, Scierka L, Smolderen K, Mena-Hurtado C. Impact of Early Intervention on Health Status Outcomes in Peripheral Artery Disease Patients with Chronic Total Occlusion Lesions Using the PORTRAIT Registry. J Vasc Surg 2024:S0741-5214(24)01087-5. [PMID: 38735596 DOI: 10.1016/j.jvs.2024.04.061] [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: 11/29/2023] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES To analyze the impact of non-invasive and early invasive treatments on health status in patients with lower extremity peripheral arterial disease (PAD) without and with chronic total occlusions (CTO) after 12 months of follow-up. METHODS Using the international (U.S., Netherlands, and Australia) observational longitudinal PORTRAIT registry, we included patients with recent PAD symptoms between June 2011 and December 2015. We assessed the PAD-specific health status at initial visit, 3-, 6- and 12-month follow-up using the Peripheral Arterial Questionnaire (PAQ). On a propensity matched-weighted cohort, we compared patients' characteristics by CTO status and treatment groups as early invasive (revascularization in the 3 months) vs. non-invasive (exercise, medical therapies, or smoking cessation). We then assessed the health status trajectory over 12 months, as 3-way interaction between CTO status, and treatment groups, and months, using a multilevel generalized linear regression model for repeated measures adjusted for baseline health status with random effects at sites- and patients-level. RESULTS We included 581 participants, with mean age of 66.62±9.33 years, 34.3% female, and 90.8% White, of whom 353 (60.8%) without and 228 (39.2%) with a CTO lesion. Respectively, 96 (27.2%) and 70 (30.7%) patients underwent early invasive treatment (d=0.07). While patients with CTO were more likely to have lower resting ABI, multilevel disease, and to experience severe claudication vs. their counterparts (|d|≥0.20); the patients' health status at baseline with CTO was not different from those without CTO, with mean Summary scores of 45.14±20.26 vs. 45.90±21.24 (d=0.04), respectively. The trajectory did not differ by CTO status (interaction CTO status*month: p=0.517) and was higher in early invasive vs. non-invasive treatment (treatment*month: p<0.001), regardless of CTO status (CTO status*treatment: p=0.981 and CTO status*treatment*month: p=0.264). The score increased over time with the largest improvement occurring at 3 months in both non-invasive (non-CTO: +7.82 95%CI 4.03;11.60 and CTO: +9.27 95%CI 4.45;14.09) and early invasive (non-CTO: +26.17 95%CI 20.06; 32.28 and CTO: +24.52 95%CI 17.40;31.64) groups. The mean score in CTO vs. non-CTO did not differ at each timepoint, with the 12-month mean score of 70.26 (95%CI 67.87; 74.65) vs. 71.17 (95% CI 65.91; 76.44) (p=0.99) in the non-invasive treatment and 84.93 (95%CI 78.90;90.97) vs. 79.20 (95%CI 72.77;86.14) (p=0.31) in the early invasive treatment. CONCLUSIONS Patients with symptomatic PAD undergoing early revascularization exhibited higher health status over time vs. those undergoing non-invasive treatment strategy, irrespective of the presence of CTOs. The degree of the improvement was greater in the 3 months following the initial visit, especially in patients undergoing early revascularization.
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Affiliation(s)
- Roberto C Cerrud-Rodriguez
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; The Panama Clinic, Panama City, Republic of Panama; Facultad de Medicina, Universidad de Panama, Panama City, Republic of Panama
| | - Gaëlle Romain
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Yasin Hussain
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Jacob Cleman
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Santiago Callegari
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lindsey Scierka
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kim Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
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Korosoglou G, Torsello G, Saratzis A, Isernia G, Kontopodis N, González TM, Jacobs K, Van Herzeele I, Zayed H, Stavroulakis K. Editor's Choice - Endovascular Versus Surgical Treatment for All Comer Patients With Prosthetic Bypass Graft Occlusion: The Multicentre ENSUPRO Study. Eur J Vasc Endovasc Surg 2024; 67:786-796. [PMID: 37543355 DOI: 10.1016/j.ejvs.2023.07.054] [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] [Received: 09/03/2022] [Revised: 06/10/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Bypass surgery plays a key role in complex lower limb lesions. However, there is a lack of evidence regarding the management of symptomatic prosthetic bypass graft (PBG) occlusion. This study aimed to report outcomes following open, hybrid, or endovascular management of patients presenting with symptomatic PBG occlusion. METHODS A multicentre, retrospective cohort study was conducted, including patients presenting with PBG occlusion between January 2014 and December 2021 from 18 centres. It assessed the comparative value of treatment strategies, including (1) recanalisation of native vessels, (2) endovascular treatment of the failed PBG, (3) hybrid treatment, and (4) open surgery. The primary outcome measure was amputation free survival (AFS, time to major amputation and or death), whereas all cause mortality, major amputation, PBG re-occlusion, target lesion revascularisation (TLR), and Rutherford category (RC) improvement during follow up were considered as secondary endpoints. RESULTS Of 260 patients with occluded PBGs, 108 (41.5%) were treated endovascularly (24 [22.2%] by recanalisation of native vessels and 84 [77.7%] by PBG re-opening), 57 (21.9%) underwent hybrid revascularisation, and 58 (22.3%) had surgery. In addition, 27 (10.4%) were treated conservatively and 10 (3.8%) received systemic thrombolysis. With a median follow up of 1.4 (0.6 - 3.0) years, AFS was 95.5%, 76.4%, 45.5%, and 37.1%, respectively in Groups 1 - 4 (p = .007). Older age and non-endovascular treatment (HR 1.05 and 1.70; p < .01 for both) were independent predictors of poor AFS. Endovascular treatment was associated with lower rates of major amputation (p = .04), PBG re-occlusion (p < .001), and TLR (p = .037), and higher RC improvements (p < .001), whereas all cause mortality was comparable between treatment groups (p = .21). CONCLUSION Endovascular treatment is associated with higher rates of AFS and RC improvement and lower rates of PBG re-occlusion and TLR in patients with PBG occlusion.
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Affiliation(s)
| | - Giovanni Torsello
- University Hospital Münster, Institute for Vascular Research, Franziskus Hospital, Münster, Germany
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Giacomo Isernia
- Department of Vascular and Endovascular Surgery, University Hospital of Perugia, Perugia, Italy
| | | | | | - Karen Jacobs
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Nie L, Yang Q, Song Q, Zhou Y, Zheng W, Xu Q. Sarcopenia in peripheral arterial disease: Establishing and validating a predictive nomogram based on clinical and computed tomography angiography indicators. Heliyon 2024; 10:e28732. [PMID: 38590906 PMCID: PMC10999995 DOI: 10.1016/j.heliyon.2024.e28732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To establish, validate, and clinically evaluate a nomogram for predicting the risk of sarcopenia in patients with peripheral arterial disease (PAD) based on clinical and lower extremity computed tomography angiography (LE-CTA) imaging characteristics. Methods Clinical data and CTA imaging features from 281 PAD patients treated between January 1, 2019, and May 1, 2023, at two hospitals were retrospectively analyzed using binary logistic regression to identify the independent risk factors for sarcopenia. These identified risk factors were used to develop a predictive nomogram. The nomogram's effectiveness was assessed through various metrics, including the receiver operating characteristic (ROC) curve, area under the curve (AUC), concordance index (C-index), Hosmer-Lemeshow (HL) test, and calibration curve. Its clinical utility was demonstrated using decision curve analysis (DCA). Results Several key independent risk factors for sarcopenia in PAD patients were identified, namely age, body mass index (BMI), history of coronary heart disease (CHD), and white blood cell (WBC) count, as well as the severity of luminal stenosis (P < 0.05). The discriminative ability of the nomogram was supported by the C-index and an AUC of 0.810 (95% confidence interval: 0.757-0.862). A robust concordance between predicted and observed outcomes was reflected by the calibration curve. The HL test further affirmed the model's calibration with a P-value of 0.40. The DCA curve validated the nomogram's favorable clinical utility. Lastly, the model underwent internal validation. Conclusions A simple nomogram based on five independent factors, namely age, BMI, history of CHD, WBC count, and the severity of luminal stenosis, was developed to assist clinicians in estimating sarcopenia risk among PAD patients. This tool boasts impressive predictive capabilities and broad utility, significantly aiding clinicians in identifying high-risk individuals and enhancing the prognosis of PAD patients.
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Affiliation(s)
- Lu Nie
- Department of Intervention Vascular, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
- Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Qifan Yang
- Department of Gastroenterology, People's Hospital Affiliated with Jiangsu University, Zhenjiang, China
| | - Qian Song
- Department of Intervention Vascular, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
- Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Yu Zhou
- Department of Intervention Vascular, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
- Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Weimiao Zheng
- Department of Intervention Vascular, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
- Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Qiang Xu
- Department of Intervention Vascular, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
- Wujin Clinical College of Xuzhou Medical University, Changzhou, China
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Changzhou, China
- Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Changzhou, China
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4
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Patrone L, Pasqui E, Conte MS, Farber A, Ferraresi R, Menard M, Mills JL, Rundback J, Schneider P, Ysa A, Abhishek K, Adams GL, Ahmad N, Ahmed I, Alexandrescu VA, Amor M, Alper D, Andrassy M, Attinger C, Baadh A, Barakat H, Biasi L, Bisdas T, Bhatti Z, Blessing E, Bonaca MP, Bonvini S, Bosiers M, Bradbury AW, Beasley R, Behrendt CA, Brodmann M, Cabral G, Cancellieri R, Casini A, Chandra V, Chisci E, Chohan O, Choke ETC, Chong PFS, Clerici G, Coscas R, Costantino M, Dalla Paola L, Dand S, Davies RSM, D'Oria M, Diamantopoulos A, Debus S, Deloose K, Del Giudice C, Donato GD, Rubertis BD, Paul De Vries J, Dias NV, Diaz-Sandoval L, Dick F, Donas K, Dua A, Fanelli F, Fazzini S, Foteh M, Gandini R, Gargiulo M, Garriboli L, Genovese EA, Gifford E, Goueffic Y, Goverde P, Chand Gupta P, Hinchliffe R, Holden A, Houlind KC, Howard DP, Huasen B, Isernia G, Katsanos K, Katzen B, Kolh P, Koncar I, Korosoglou G, Krishnan P, Kroencke T, Krokidis M, Kumarasamy A, Hayes P, Iida O, Alejandre Lafont E, Langhoff R, Lecis A, Lessne M, Lichaa H, Lichtenberg M, Lobato M, Lopes A, Loreni G, Lucatelli P, Madassery S, Maene L, Manzi M, Maresch M, Santhosh Mathews J, McCaslin J, Micari A, Michelagnoli S, Migliara B, Morgan R, Morelli L, Morosetti D, Mouawad N, Moxey P, Müller-Hülsbeck S, Mustapha J, Nakama T, Nasr B, N'dandu Z, Neville R, Noory E, Nordanstig J, Noronen K, Mariano Palena L, Parlani G, Patel AS, Patel P, Patel R, Patel S, Pena C, Perkov D, Portou M, Pratesi G, Rammos C, Reekers J, Riambau V, Roy T, Rosenfield K, Antonella Ruffino M, Saab F, Saratzis A, Sbarzaglia P, Schmidt A, Secemsky E, Siah M, Sillesen H, Simonte G, Sirvent M, Sommerset J, Steiner S, Sakr A, Scheinert D, Shishebor M, Spiliopoulos S, Spinelli A, Stravoulakis K, Taneva G, Teso D, Tessarek J, Theivacumar S, Thomas A, Thomas S, Thulasidasan N, Torsello G, Tripathi R, Troisi N, Tummala S, Tummala V, Twine C, Uberoi R, Ucci A, Valenti D, van den Berg J, van den Heuvel D, Van Herzeele I, Varcoe R, Vega de Ceniga M, Veith FJ, Venermo M, Vijaynagar B, Virdee S, Von Stempel C, Voûte MT, Khee Yeung K, Zeller T, Zayed H, Montero Baker M. The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia. J Endovasc Ther 2024:15266028241231745. [PMID: 38523459 DOI: 10.1177/15266028241231745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Lorenzo Patrone
- West London Vascular and Interventional Center, London North West University Healthcare NHS Trust, London, UK
| | - Edoardo Pasqui
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA
| | - Alik Farber
- Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Roberto Ferraresi
- Diabetic Foot Unit, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - Matthew Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joseph L Mills
- Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | - John Rundback
- Advanced Interventional and Vascular Services, LLP, Teaneck, New Jersey
| | - Peter Schneider
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA, USA
| | - August Ysa
- Department of Vascular Surgery, Hospital Universitario Cruces, Barakaldo, Spain
| | - Kumar Abhishek
- Department of Radiology, University Hospital, Newark, NJ
| | | | - Naseer Ahmad
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Irfan Ahmed
- Department of Interventional Radiology, Guys' and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vlad A Alexandrescu
- Department of Thoracic and Vascular Surgery, Princess Paola Hospital, MarcheenFamenne, Belgium
| | - Max Amor
- Department of Interventional Cardiology, U.C.C.I. Polyclinique d'Essey, Nancy, France
| | | | | | - Christopher Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, United States
| | - Andy Baadh
- Regions Hospital, Saint Paul, Minnesota, USA
| | - Hashem Barakat
- University Hospitals Plymouth NHS Trust; Plymouth; United Kingdom
| | - Lukla Biasi
- Cardiovascular Division, Academic Department of Surgery, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - Theodosios Bisdas
- Department of Vascular Surgery, Athens Medical Center, Athens, Greece
| | | | | | - Marc P Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Stefano Bonvini
- Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
| | - Michel Bosiers
- Department of Vascular Surgery, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom
| | | | - Christian-Alexander Behrendt
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center HamburgEppendorf, Hamburg, Germany
| | | | | | | | - Andrea Casini
- Diabetic Foot Unit, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - Venita Chandra
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA, United States
| | - Emiliano Chisci
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Omar Chohan
- Great Lakes Medical Imaging, Buffalo, NY, United States
| | - Edward T C Choke
- Department of Vascular Surgery, Seng Kang General Hospital, Singapore
| | | | | | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance PubliqueHôpitaux de Paris, BoulogneBillancourt, France
| | | | | | - Sabeen Dand
- Los Angeles Imaging and Interventional Consultants, PIH Health, Whittier, CA
| | - Robert S M Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, CardioThoracoVascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guys' and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University Heart & Vascular Center, University of HamburgEppendorf, Hamburg, Germany
| | - Koen Deloose
- Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium
| | - Costantino Del Giudice
- Department of Radiology, Interventional Radiology, Institut Mutualiste Montsouris, Paris, France
| | - Gianmarco de Donato
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Brian De Rubertis
- New York Presbyterian Weill Cornell Medical Center, Mount Sinai Hospital, Columbia University Irving Medical Center and Columbia Vagelos College of Physicians and Surgeons, New York, United States
| | - Jean Paul De Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nuno V Dias
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden
| | | | - Florian Dick
- Kantonsspital St. Gallen, St. Gallen, and University of Bern, Bern, Switzerland
| | - Konstantinos Donas
- Department of Vascular Surgery, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Anahita Dua
- Division of Vascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Fabrizio Fanelli
- Interventional Radiology Unit, Azienda OspedalieroUniversitaria Careggi, Florence, Italy
| | - Stefano Fazzini
- Division of Vascular Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Mazin Foteh
- Baylor Scott & White Heart Hospital, Plano, TX, United States
| | - Roberto Gandini
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS Sant'OrsolaMalpighi Hospital, Bologna, Italy
| | - Luca Garriboli
- Vascular Surgery Divisoin, IRCCS Sacro Cuore Don Calabria" Negrar, Verona, Italy
| | - Elizabeth A Genovese
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, United States
| | - Edward Gifford
- Division of Vascular Surgery, Hartford Hospital, Hartford, CT, United States
| | - Yann Goueffic
- Vascular Center, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Peter Goverde
- Department of Vascular Surgery, ZNA Stuivenberg, Antwerp, Belgium
| | - Prem Chand Gupta
- Department of Vascular and Endovascular Surgery, Care Hospitals, Banjara Hills, Hyderabad, India
| | - Robert Hinchliffe
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Andrew Holden
- Auckland City Hospital, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Kim C Houlind
- Department of Vascular Surgery, Hospital Lillebaelt, University of Southern Denmark, Odense, Denmark
| | - Dominic Pj Howard
- Nuffield Department of Clinical Neurosciences, Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, United Kingdom
| | - Bella Huasen
- Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, United Kingdom
| | - Giacomo Isernia
- Vascular and Endovascular Surgery Unit, S. Maria Della Misericordia University Hospital, Perugia, Italy
| | | | - Barry Katzen
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University of Liège, Liège, Belgium
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Academic Teaching Hospital Weinheim, Weinheim, Germany
| | - Prakash Krishnan
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas Kroencke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Miltiadis Krokidis
- National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Arun Kumarasamy
- European Vascular Centre AachenMaastricht, Department of Vascular Surgery, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Paul Hayes
- St John's Innovation Centre, Cambridge, United Kingdom
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Hyogo, Amagasaki, Japan
| | | | - Ralf Langhoff
- Department of Angiology, St. Gertrauden Hospital, Berlin, Germany
| | | | - Mark Lessne
- Vascular and Interventional Specialists, Charlotte Radiology, Charlotte, NC, United States
| | - Hady Lichaa
- Ascension Saint Thomas Heart, Ascension Saint Thomas Rutherford, Murfreesboro, TN, United States
| | | | - Marta Lobato
- Department of Vascular Surgery, Hospital Universitario Cruces, Barakaldo, Spain
| | - Alice Lopes
- Department of Vascular Surgery, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Giorgio Loreni
- UOC Radiologia Interventistica, ASL Roma 2, Ospedale S. Pertini, Rome, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and AnatomoPathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Lieven Maene
- Department of Vascular and Thoracic Surgery, OnzeLieveVrouwziekenhuis Aalst, Aalst, Belgium
| | | | - Martin Maresch
- Department of Vascular and Endovascular Surgery, BDF Hospital Royal Medical Services, Bahrain
| | - Jay Santhosh Mathews
- Bradenton Cardiology Center, Manatee Memorial Hospital, Bradenton, FL, United States
| | - James McCaslin
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Stefano Michelagnoli
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Bruno Migliara
- Vascular and Endovascular Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Robert Morgan
- Diagnostic, Vascular & Interventional Radiology, St George's University Hospitals NHS Foundation Trust and St George's, University of London, United Kingdom
| | - Luis Morelli
- Diabetic Foot Unit and Limb Salvage, Hospital San Juan de Dios, San Jose, Costa Rica
| | | | - Nicolas Mouawad
- Department of Surgery, McLaren Health System, Grand Blanc, MI, United States
| | - Paul Moxey
- St George's Vascular Institute, St George's University Hospital, London, United Kingdom
| | | | - Jihad Mustapha
- Advanced Cardiac and Vascular Centers for Amputation Prevention, Grand Rapids, MI, United States
| | - Tatsuya Nakama
- Jikei University Hospital, Department of Surgery, Division of Vascular Surgery, Tokyo, Japan
| | - Bahaa Nasr
- CHU Cavale Blanche Brest, Vascular and Endovascular Surgery Department, Brest, France
| | | | - Richard Neville
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Elias Noory
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Bad Krozingen, Germany
| | - Joakim Nordanstig
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Göteborg, Sweden
| | - Katariina Noronen
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Luis Mariano Palena
- Department of Vascular and Thoracic Surgery, OnzeLieveVrouwziekenhuis Aalst, Aalst, Belgium
| | - Gianbattista Parlani
- Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, United Kingdom
| | - Ashish S Patel
- Cardiovascular Division, Academic Department of Surgery, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - Parag Patel
- Department of Radiology, Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Rafiuddin Patel
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, United Kingdom
| | - Sanjay Patel
- Cardiovascular Division, Academic Department of Surgery, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | | | - Drazen Perkov
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mark Portou
- Royal Free Vascular, Division of Surgery and Interventional Science, Royal Free Campus, UCL, London, UK
| | - Giovanni Pratesi
- Unit of Vascular and Endovascular Surgery-IRCCS Ospedale Policlinico San Martino, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of DuisburgEssen, Germany
| | - Jim Reekers
- Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Vicente Riambau
- Vascular Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Trisha Roy
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Kenneth Rosenfield
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Maria Antonella Ruffino
- Department of Interventional Radiology, Ticino Vascular Center, Institute of Imaging of Southern Switzerland, Lugano Regional Hospital, Lugano, Switzerland
| | - Fadi Saab
- ACV Centers, Grand Rapids, MI, United States
| | - Athanasios Saratzis
- University Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Paolo Sbarzaglia
- Interventional cardiology, Maria Cecilia Hospital, Ravenna, Italy
| | - Andrej Schmidt
- Department of Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Eric Secemsky
- Smith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Henrik Sillesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gioele Simonte
- Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, United Kingdom
| | - Marc Sirvent
- Department General, University Hospital of Granollers, CIBERCV, ISCIII, Granollers, Spain
| | | | - Sabine Steiner
- Department of Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Ahmed Sakr
- Saudi German Hospital, Jeddah, Saudi Arabia
| | - Dierk Scheinert
- Department of Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Mehdi Shishebor
- University Hospitals Cleveland Medical Centre and Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, Attikon, University General Hospital, Athens, Greece
| | | | | | - Gergana Taneva
- Kantonsspital St. Gallen, St. Gallen, and University of Bern, Bern, Switzerland
| | | | - Joerg Tessarek
- Department Vascular and Endovascular Surgery, Bonifatius Hospital, Lingen, Germany
| | - Selva Theivacumar
- West London Vascular and Interventional Center, London North West University Healthcare NHS Trust, London, UK
| | - Anish Thomas
- Mercy Clinic Heart And Vascular LLC, Saint Louis, MO
| | | | - Narayan Thulasidasan
- Department of Interventional Radiology, Guys' and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Giovanni Torsello
- University Hospital Münster, Institute for Vascular Research, Franziskus Hospital, Münster, Germany
| | | | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Srini Tummala
- Department of Interventional Radiology, University of Miami Health System, UM Miller School of Medicine, Miami, FL, United States
| | | | - Christopher Twine
- Bath and Weston Vascular Network, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Raman Uberoi
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Alessandro Ucci
- Unit of Vascular Surgery, Department of Medicine and Surgery, Azienda OspedalieroUniversitaria di Parma, Parma, Italy
| | - Domenico Valenti
- Department of Vascular Surgery, King's College Hospital, London, United Kingdom
| | - Jos van den Berg
- Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | | | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ramon Varcoe
- Prince of Wales Hospital, Sydney, NSW, Australia
| | - Melina Vega de Ceniga
- Department of Angiology and Vascular Surgery, University Hospital of GaldakaoUsansolo, Bizkaia, Spain
| | - Frank J Veith
- New York University Medical Centre, New York, NY and The Cleveland Clinic, Cleveland, OH, United States
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Sanjiv Virdee
- The University of Rochester Medical Faculty Group, NY, United States
| | - Conrad Von Stempel
- Department of Radiology, University College London Hospitals, London, United Kingdom
| | - Michiel T Voûte
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Thomas Zeller
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Bad Krozingen, Germany
| | - Hany Zayed
- Cardiovascular Division, Academic Department of Surgery, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
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Ramses R, Kennedy S, Good R, Oldroyd KG, Mcginty S. Performance of drug-coated balloons in coronary and below-the-knee arteries: Anatomical, physiological and pathological considerations. Vascul Pharmacol 2024; 155:107366. [PMID: 38479462 DOI: 10.1016/j.vph.2024.107366] [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: 09/17/2023] [Revised: 02/24/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
Below-the-knee (infrapopliteal) atherosclerotic disease, which presents as chronic limb-threatening ischemia (CLTI) in nearly 50% of patients, represents a treatment challenge when it comes to the endovascular intervention arm of management. Due to reduced tissue perfusion, patients usually experience pain at rest and atrophic changes correlated to the extent of the compromised perfusion. Unfortunately, the prognosis remains unsatisfactory with 30% of patients requiring major amputation and a mortality rate of 25% within 1 year. To date, randomized multicentre trials of endovascular intervention have shown that drug-eluting stents (DES) increase patency rate and lower target lesion revascularization rate compared to plain balloon angioplasty and bare-metal stents. The majority of these trials recruited patients with focal infrapopliteal lesions, while most patients requiring endovascular intervention have complex and diffuse atherosclerotic disease. Moreover, due to the nature of the infrapopliteal arteries, the use of long DES is limited. Following recent results of drug-coated balloons (DCBs) in the treatment of femoropopliteal and coronary arteries, it was hoped that similar effective results would be achieved in the infrapopliteal arteries. In reality, multicentre trials have failed to support the proposed hypothesis and no advantage was found in using DCBs in comparison to plain balloon angioplasty. This review aims to explore anatomical, physiological and pathological differences between lesions of the infrapopliteal and coronary arteries to explain the differences in outcome when using DCBs.
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Affiliation(s)
- Rafic Ramses
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy; Division of Biomedical Engineering, University of Glasgow, United Kingdom
| | - Simon Kennedy
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Richard Good
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom; West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Keith G Oldroyd
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom; West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Sean Mcginty
- Division of Biomedical Engineering, University of Glasgow, United Kingdom.
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Zielke T, Korepta L, Wesolowski M, D'Andrea M, Aulivola B. The association of comorbid depression with mortality and amputation risk in patients with chronic limb-threatening ischemia. J Vasc Surg 2024; 79:96-101.e1. [PMID: 37704093 DOI: 10.1016/j.jvs.2023.09.001] [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] [Received: 05/18/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE There is increasing evidence that depression is a risk factor for worse outcomes in patients with peripheral artery disease. The association of depression in patients with chronic limb-threatening ischemia (CLTI) is not well described, nor is the impact of medical treatment for depression in this patient population. The objective of this study was to investigate the prevalence of depression in patients with CLTI, its association on major amputation and all-cause mortality, and whether medical antidepressant treatment is associated with improvement in these outcomes in patients with depression. METHODS A retrospective review of all adult patients (≥18 years old) diagnosed with CLTI from January 1, 2007, to December 31, 2018, at a single academic medical center was performed. Collected data included patient demographics, comorbidities, and diagnosis of depression within 6 months of initial CLTI diagnosis. We also collected data on use of antidepressant medications. Outcomes evaluated were need for major lower extremity amputation and all-cause mortality. Multivariable logistic regression models estimated the adjusted effects of comorbid depression and antidepressant medication use on major amputation and all-cause mortality. Kaplan-Meier survival curves illustrated the probabilities of survival and limb salvage over time, stratified by diagnosis of comorbid depression. Multivariable Cox proportional hazards models estimated the adjusted effects of comorbid depression on time to major amputation and all-cause mortality, and the adjusted effect of antidepressant treatment on time to all-cause mortality. RESULTS A total of 2987 patients with CLTI were identified. Mean age was 68.6 years (standard deviation, 12.9 years); 56.5% were male, and 43.5% were female. Comorbid depression within 6 months of CLTI diagnosis was present in 7.1% of the cohort (212 patients). In multivariable analysis, comorbid depression was associated with a 68% increase in the odds of major amputation (adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.19-2.37; P < .01), a 164% increase in the odds of all-cause mortality among patients not taking antidepressants (aOR, 2.64; 95% CI, 1.31-5.32; P = .03), and only a 6% increase in the odds of all-cause mortality among patients taking antidepressants (aOR, 1.06; 95% CI, 0.72-1.55; P = .99). The effect of comorbid depression on mortality varied significantly by whether or not the patient was taking an antidepressant medication (P = .02). CONCLUSIONS Comorbid depression in the patient population with CLTI is associated with a worse prognosis for major lower extremity amputation overall, and a worse prognosis for all-cause mortality among patients not taking an antidepressant. Furthermore, antidepressant treatment in the presence of comorbid depression in this patient population is associated with an improvement in the odds of all-cause mortality, illustrating the potential importance of medical management of depression.
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Affiliation(s)
- Tara Zielke
- Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Lindsey Korepta
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Michael Wesolowski
- Loyola University of Chicago Clinical Research Office Biostatistics Core, Maywood, IL
| | | | - Bernadette Aulivola
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, IL.
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Csore J, Drake M, Roy TL. Peripheral arterial disease treatment planning using noninvasive and invasive imaging methods. J Vasc Surg Cases Innov Tech 2023; 9:101263. [PMID: 37767348 PMCID: PMC10520537 DOI: 10.1016/j.jvscit.2023.101263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 09/29/2023] Open
Abstract
With the growing prevalence and mortality of peripheral arterial disease, preoperative assessment, risk stratification, and determining the correct indication for endovascular and open surgical procedures are essential for therapeutic decision-making. The effectiveness of interventional procedures is significantly influenced by the plaque composition and calcification pattern. Therefore, the identification of patients for whom endovascular treatment is the most appropriate therapeutic solution often remains a challenge. The most commonly used imaging techniques have their own limitations and do not provide findings detailed enough for specific, personalized treatment planning. Using state-of-the-art noninvasive and invasive imaging modalities, it is now possible to obtain a view, not only of the complex vascular anatomy and plaque burden of the lower extremity arterial system, but also of complex plaque structures and various pathologic calcium distribution patterns. In the future, as these latest advancements in diagnostic methods become more widespread, we will be able to obtain more accurate views of the plaque structure and anatomic complexity to guide optimal treatment planning and device selection. We reviewed the implications of the most recent invasive and noninvasive lower extremity imaging techniques and future directions.
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Affiliation(s)
- Judit Csore
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Madeline Drake
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Trisha L. Roy
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
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Kretzschmar M, Okaro U, Schwarz M, Reining M, Lesser T. Spinal Neuromodulation for Peripheral Arterial Disease of Lower Extremities: A Ten-Year Retrospective Analysis. Neuromodulation 2023:S1094-7159(23)00937-6. [PMID: 38165292 DOI: 10.1016/j.neurom.2023.10.186] [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: 07/15/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This long-term retrospective study evaluated the survival and amputation outcome of subjects who received neuromodulation therapy for the management of peripheral arterial disease (PAD). MATERIALS AND METHODS The study reviews the health data of a single cohort of 51 patients who received spinal neuromodulation (spinal cord stimulation [SCS] or dorsal root ganglion stimulation [DRG-S]) for PAD from 2007 to 2022 in a single German center. Survival rate and major amputation rate were determined. Pain, quality of life, walking distance, and opioid usage were assessed before implantation (baseline), one, six, and 12 months (M) after implantation, and then annually (during a follow-up visit). Implant-related complications also were documented. RESULTS In total, 51 patients (37 men [mean age 68.9 ± 10.2 years], 14 women [mean age (68.7 ± 14.6 years]) underwent SCS (n = 49) or DRG-S (n = 2) implantation owing to persistent ischemic pain. The follow-up mean years ± SD is 4.04 ± 2.73. At baseline, patients were classified as Rutherford's category 3 (n = 23), category 4 (n = 15) or category 5 (n = 9). At 24 M, 42 of 47 patients did not require a major amputation after the implant. All the patients reported nearly complete pain relief from pain at rest. A total of 75% of patients were able to walk >200 m, and 87% of patients who used opioids at baseline were off this medication at 24 M. Overall, 93% of patients reported an improvement in their overall health assessment. These improved outcomes were sustained through years three to 10 for patients who have reported outcomes. CONCLUSIONS Our single-center data support the efficacy of spinal neuromodulation for improvements in limb salvage, pain relief, mobility, and quality of life. The data also show that neuromodulative therapy has a long-term therapeutic effect in patients with chronic limb pain with Rutherford category 3, 4, and 5 PAD.
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Affiliation(s)
- Michael Kretzschmar
- Department of Pain Medicine and Palliative Care, SRH Wald-Klinikum Gera, Gera, Germany; SRH University of Applied Health Sciences Gera, Campus Gera, Gera, Germany.
| | | | - Marcus Schwarz
- SRH University of Applied Health Sciences Gera, Campus Gera, Gera, Germany
| | - Marco Reining
- Department of Pain Medicine and Palliative Care, SRH Wald-Klinikum Gera, Gera, Germany
| | - Thomas Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Gera, Germany
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Yokoi M, Ito T, Kawada Y, Mizoguchi T, Yamamoto J, Mori K, Nakasuka K, Kikuchi S, Fujita H, Kitada S, Goto T, Seo Y. Malondialdehyde-Modified Low-Density Lipoprotein as a Predictor of Major Adverse Limb Events after Endovascular Therapy in Patients with Lower Extremity Arterial Disease. J Atheroscler Thromb 2023; 30:1612-1621. [PMID: 36889737 PMCID: PMC10627766 DOI: 10.5551/jat.64091] [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] [Received: 11/26/2022] [Accepted: 02/05/2023] [Indexed: 03/10/2023] Open
Abstract
AIM Adverse limb events after endovascular therapy (EVT) are a major concern. This study aimed to investigate the relationship between serum malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, a potentially potent indicator of atherosclerosis, and clinical outcomes after EVT in patients with lower extremity arterial disease (LEAD). METHODS A total of 208 LEAD patients who underwent EVT and MDA-LDL measurements were retrospectively analyzed. Those with chronic limb-threatening ischemia (CLTI) were included in the CLTI subgroup (n=106). Patients were further categorized into the High or Low MDA-LDL groups according to the cut-off value calculated by receiver operating characteristic analysis. Major adverse limb events (MALE), a composite of cardiovascular death, limb-related death, major amputation, and target-limb revascularization, were evaluated. RESULTS MALE occurred in 73 (35%) patients. The median follow-up interval was 17.4 months. The MDA-LDL cut-off values were 100.5 U/L (area under the curve [AUC] 0.651) in the overall population and 98.0 U/L (AUC 0.724) in the CLTI subgroup. Overall, the High MDA-LDL group showed significantly higher total cholesterol (189.7±37.5 mg/dL vs. 159.3±32.0 mg/dL, p<0.01), low-density lipoprotein cholesterol (114.3±29.7 mg/dL vs. 87.3±25.3 mg/dL, p<0.01), and triglyceride (166.9±91.1 mg/dL vs. 115.8±52.3 mg/dL, p<0.01) than the Low MDA-LDL group. Multivariate Cox regression analyses revealed that MDA-LDL and C-reactive protein were independent predictors of MALE. In the CLTI subgroup, MDA-LDL was an independent predictor of MALE. The High MDA-LDL group showed worse MALE-free survival rates than the Low MDA-LDL group in overall (p<0.01) and in the CLTI subgroup (p=0.01). CONCLUSIONS Serum MDA-LDL level was associated with MALE after EVT.
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Affiliation(s)
- Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yu Kawada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kento Mori
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kosuke Nakasuka
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Müller AM, Löhn-Kannengießer L, Bradaric C, Dirschinger R, Koppara T, Bergmann K, Kehl V, Cassese S, Xhepa E, Kastrati A, Laugwitz KL, Ibrahim T. Outcomes of endovascular treatment for popliteal artery disease. VASA 2023; 52:386-393. [PMID: 37840269 DOI: 10.1024/0301-1526/a001096] [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: 10/17/2023]
Abstract
Background: Finding the appropriate endovascular revascularization strategy for patients with peripheral artery disease and a popliteal artery lesion remains particulary challenging. Data regarding predictors for a beneficial outcome are scarce. Patients and methods: All endovascular procedures of popliteal artery lesions (n=227) performed in 197 patients between February 2009 and May 2018 at our institution were retrospectively analyzed. Hemodynamically relevant restenosis represented the primary endpoint. Results: The overall technical success rate was 98% and yielded 99% for stenoses (n=145) and 97% for occlusions (n=82). In a median follow-up of 10 months, the overall rate of restenosis was 23%. After 1 and 2 years, the primary patency rates were 76% and 55% and the secondary patency rate was 100%, respectively. The estimated probability of restenosis was significantly higher in stented lesions (stent vs. no stent; 36.0% vs. 19.1%; p=0.030). Multivariate analysis identified stent implantation (hazard ratio: 2.4; overall P=0.010) and diabetes (hazard ratio 2.0; P=0.023) as significant predictors for the development of restenosis. Conclusions: Endovascular therapy for popliteal artery disease was associated with high technical success rates and accompanied with a promising mid-term outcome, particularly in lesions treated with balloon angioplasty alone.
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Affiliation(s)
- Arne M Müller
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Leoni Löhn-Kannengießer
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Christian Bradaric
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Ralf Dirschinger
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Tobias Koppara
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Katharina Bergmann
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Victoria Kehl
- Institut für KI und Informatik in der Medizin, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
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11
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Van Meirvenne E, Reyntjens P, Tielemans Y. Self-expanding interwoven nitinol stent in severe femoropopliteal arterial disease. Real life results of the Supera Peripheral Stent System ®. Acta Chir Belg 2023; 123:463-472. [PMID: 35485637 DOI: 10.1080/00015458.2022.2072457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/27/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The excellent performance of the Supera Peripheral Stent System® by Abbott Vascular in femoropopliteal interventions has already been proven through several trials. This retrospective study aims to evaluate the durability and long-term patency of the Supera stent for the treatment of severe femoropopliteal lesions in a real-world population. METHODS A retrospective analysis was conducted of 136 consecutive limbs from 128 patients with atherosclerotic disease in the femoropopliteal region, treated with Supera stents between September 2010 and September 2017. As primary endpoints patency rates and freedom from target lesion revascularization (TLR) were calculated and presented using Kaplan-Meier analysis. RESULTS Fifty-five percent were treated for claudication (IC), 45% for chronical limb threatening ischemia (CLTI). The mean treated lesion length was 143 mm (±77.8). The majority of lesions (63%) were Trans-Atlantic Inter-Society Consensus Criteria II (TASC II) C/D lesions. The overall primary patency rates at 12 and 24 months of follow-up were 72.6% and 60.8% respectively. The primary patency at 12 and 24 months for TASC II A/B lesions was respectively 86% and 75.4%. For TASC II C/D lesions primary patency at 12 and 24 months was 64% and 51.1% respectively (p = 0.001). Overall freedom from TLR after 12 and 24 months was 73.8% and 62.8% respectively. No significant patency differences were observed based on calcification rate. CONCLUSION Endovascular treatment of femoropopliteal disease with Supera Stent is safe, even in extensive, highly calcified lesions. Patency rates and freedom from TLR are acceptable in a real-life population.
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Affiliation(s)
| | | | - Yves Tielemans
- Department of Vascular Surgery, AZ Sint-Maarten, Mechelen, Belgium
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12
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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13
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Smith JA, Yang L, Chen L, Kumins N, Cho JS, Harth K, Wong V, Kashyap V, Colvard B. Trends and outcomes associated with intravascular ultrasound use during femoropopliteal revascularization in the Vascular Quality Initiative. J Vasc Surg 2023; 78:209-216.e1. [PMID: 36944390 DOI: 10.1016/j.jvs.2023.03.028] [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] [Received: 11/11/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Intravascular ultrasound (IVUS) use in lower extremity interventions is growing in popularity owing to its imaging in the axial plane, superior detail in imaging lesion characteristics, and its enhanced ability to delineate lesion severity and extent compared with catheter angiograms. However, there are conflicting data regarding whether IVUS affects outcomes. The purpose of this study was to assess the effect associated with IVUS implementation in femoropopliteal interventions. METHODS This retrospective cohort study used Vascular Quality Initiative data. Patients undergoing an index endovascular femoropopliteal revascularization from 2016 to 2021 were included. Patients were differentiated by whether or not IVUS was used to assess the femoropopliteal segment during intervention (no IVUS, IVUS). Propensity score matching, based on preoperative demographics and measures of disease severity was used. Primary outcomes were major amputation-free survival (AFS), femoropopliteal reintervention-free survival (RFS), and primarily patent survival (PPS) at 12 months. RESULTS IVUS use grew steadily throughout the study period, comprising 0.6% of interventions in 2016 and increasing to 8.2% of interventions by 2021; growth was most dramatic in ambulatory surgical center or office-based laboratory settings where IVUS use grew from 4.4% to 43% to 47% of interventions. In unmatched cohorts, patients receiving interventions using IVUS tended to have lower prevalence of multiple cardiovascular comorbidities (eg, congestive heart failure, hypertension, diabetes, and dialysis dependence) and presented more often with claudication and less often with chronic limb-threatening ischemia (CLTI). Intraoperatively, IVUS was used more often in complex femoropopliteal lesions (Transatlantic Intersociety grade D vs A), and more often in conjunction with stenting and/or atherectomy. IVUS use was associated with improved AFS, but similar RFS and PPS at 12 months. However, in multivariable analysis IVUS was not associated with any of the primary outcomes independently; rather, all outcomes were influenced primarily by CLTI, dialysis dependence, and prior major amputation status; technical outcomes (ie, RFS and PPS loss) were further driven by complexity of lesion (worse in Transatlantic Intersociety grade D vs A lesions) and treatment setting (ie, ambulatory surgical center or office-based laboratory setting associated with increased hazard for RFS and PPS loss). CONCLUSIONS IVUS implementation in femoropopliteal interventions is growing, with rapid adoption among interventions in ambulatory surgical centers and office-based laboratories. IVUS was not associated with an effect on technical outcomes at 12 months; improvement in major AFS was observed; however, multivariable analysis suggests this finding may be an effect of confounding by multiple factors highly associated with IVUS use, namely, in patients with lower prevalence of CLTI, dialysis dependence, and prior major amputations, thus conveying baseline lower risk for major amputation and death.
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Affiliation(s)
- Justin A Smith
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Lucy Yang
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lin Chen
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Norman Kumins
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Karem Harth
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Virginia Wong
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Vikram Kashyap
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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14
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Parwani D, Ahmed MA, Mahawar A, Gorantla VR. Peripheral Arterial Disease: A Narrative Review. Cureus 2023; 15:e40267. [PMID: 37448414 PMCID: PMC10336185 DOI: 10.7759/cureus.40267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral arterial disease (PAD) describes the partial or complete occlusion of blood flow in the distal arteries of the body. A decreased arterial patency may occur due to a reduction in the elasticity or diameter of the vessel. The goal of interventions is to decrease incidence and reduce complications by identifying and minimizing the primary causes. This paper discusses PAD affecting the aortoiliac, common femoral, and femoropopliteal arteries. In a significant portion of the population, PAD may lack usual symptoms such as limb pain, claudication, and diminished pulses. Imaging techniques become crucial to ensuring timely diagnosis, monitoring treatment effectiveness, and preventing recurrence. Duplex ultrasound (DUS) is a cheap and non-invasive preliminary technique to detect atherosclerotic plaques and grade arterial stenosis. Magnetic resonance angiography (MRA) provides the added advantage of minimizing artifacts. Digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis but is only employed second-line to DUS or MRA due to the high dose of nephrotoxic contrast. Computed tomography angiography (CTA) is able to overcome the anatomical limitations of DUS and MRA and proves to be a suitable alternative to DSA in patients with renal disease. Preventative measures involve monitoring blood pressure, cholesterol levels, and tobacco usage. First-line treatment options include endovascular procedures as well as surgical interventions in cases of significant arterial involvement. Endovascular treatments involve the use of balloon angioplasty, drug-coated balloons, and drug-coated stents, to name a few, that serve as minimally invasive techniques to manage PAD. Surgical procedures, although more complex, are considered gold-standard treatment options for long and intricate lesions. Endovascular methods are generally preferred over surgical options as the complication risk is severely reduced and the rates of reintervention are comparable to surgical options.
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Affiliation(s)
- Divya Parwani
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
| | - Mohamed A Ahmed
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Anmol Mahawar
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
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15
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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16
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Rouwenhorst KB, Abdelbaqy OMA, van der Veen D, van Rijswijk RE, Holewijn S, Reijnen MMPJ. Long-Term Outcomes of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique in Patients With Aorto-Iliac Occlusive Disease. J Endovasc Ther 2023:15266028231166539. [PMID: 37114939 DOI: 10.1177/15266028231166539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) reconstruction is an endovascular technique, developed to reconstruct the aortic bifurcation in the most optimal anatomical and physiological manner. Short-term data were promising, but long-term data are still lacking. The objective was to report the long-term outcomes of CERAB for extensive aorto-iliac occlusive disease and to identify predictors for loss of primary patency. METHODS Consecutive electively treated patients with CERAB for aorto-iliac occlusive disease in a single hospital were identified and analyzed. Baseline and procedural data and follow-up were collected at 6-weeks, 6 months, 12 months, and annually thereafter. Technical success, procedural, and 30-day complications were evaluated, as well as overall survival. Patency and freedom from target lesion revascularization rates were analyzed using Kaplan Meier curves. Uni- and multivariate analysis were performed to identify possible predictors of failure. RESULTS One hundred and sixty patients were included (79 male). Indication for treatment was intermittent claudication for 121 patients (75.6%) and 133 patients (83.1%) had a TASC-II D lesion. Technical success was obtained in 95.6% of patients and the 30-day mortality rate was 1.3%. The 5-year primary, primary-assisted, and secondary patency rates were 77.5%, 88.1%, and 95.0%, respectively, with a freedom-from clinically driven target lesion revascularization (CD-TLR) rate of 84.4%. The strongest predictor of loss of primary patency of CERAB was a previous aorto-iliac intervention (odds ratio [OR]=5.36 (95% confidence interval [CI]: 1.30; 22.07), p=0.020). In patients not previously treated in the aorto-iliac tract, 5-year primary, primary assisted, and secondary patency rates were 85.1%, 94.4%, and 96.9%, respectively. At 5-year follow-up, an improved Rutherford was found in 97.9% of patients and the freedom from major amputation rate was 100%. CONCLUSION The CERAB technique is related to good long-term outcomes, particularly in primary cases. In patients that had prior treatment for aorto-iliac occlusive disease, there were more reinterventions and therefore surveillance should likely be more intense. CLINICAL IMPACT The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) reconstruction was designed to improve outcomes of endovascular treatment of extensive aorto-iliac occlusive disease. At 5-year follow-up clinical improvement was found in 97.9% of patients without major amputations. The 5-year overall primary, primary-assisted, and secondary patency rates were 77.5%, 88.1%, and 95.0%, respectively, with a freedom-from clinically driven target lesion revascularization rate of 84.4%. Significantly better patency rates were observed for patients that were never treated before in the target area. The data implicate that CERAB are a valid treatment option for patients with extensive aorto-iliac occlusive disease. For patients previously treated in the target area, other treatment options might be considered, or more intensive follow-up surveillance is warranted.
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Affiliation(s)
| | - Omar M A Abdelbaqy
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Vascular Surgery, Assiut University Hospital, Assiut, Egypt
| | | | - Rianne E van Rijswijk
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Suzanne Holewijn
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Center, University of Twente, Enschede, The Netherlands
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17
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Müller A, Bradaric C, Kafka A, Joner M, Cassese S, Xhepa E, Kufner S, Kastrati A, Laugwitz KL, Ibrahim T, Koppara T. Prevalence and patterns of in-stent neoatherosclerosis in lower extremity artery disease. EUROINTERVENTION 2023; 18:1462-1470. [PMID: 36714952 PMCID: PMC10111128 DOI: 10.4244/eij-d-22-00615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/12/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND In-stent restenosis (ISR) is responsible for a rapid decline of vessel patency after stenting. To date, little is known about the role of in-stent neoatherosclerosis (NA) in stent failure in lower limb arteries. AIMS This study aimed to determine the prevalence and patterns of in-stent NA in patients with symptomatic ISR of the lower extremity vasculature using intravascular optical coherence tomography (OCT) imaging. METHODS Patients underwent endovascular revascularisation for ISR including angiography and OCT imaging. NA was defined as the presence of at least 1 fibroatheroma or fibrocalcific plaque within the neointima of a stented segment. RESULTS Using OCT, we imaged 24 symptomatic patients with lower extremity artery disease (LEAD), with a total of 30 ISR in the lower limbs, prior to their scheduled endovascular interventions. NA formation was observed in 23 (76.7%) lesions, while all stents with an implant duration >5 years (n=8) showed signs of NA. The time from stent implantation to OCT was significantly increased in lesions with NA (p=0.002). Lesions without NA had a significantly shorter duration from index procedure to OCT than those with ≥50 percent (n=9; p=0.003) or <50 percent (n=14; p=0.015) of frames exhibiting signs of NA. NA was predominantly characterised by fibroatheroma with thick fibrous caps with or without calcification. CONCLUSIONS In-stent NA is frequently identified by OCT imaging after endovascular therapy in lower limb arteries; this increased both in frequency and extent the longer the duration since implantation. Our findings indicate an active atherosclerotic process that may need tailored mitigation strategies.
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Affiliation(s)
- Arne Müller
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andre Kafka
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Koppara
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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18
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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19
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Donas KP, Psyllas A, Pitoulias AG, Kazemtash M, Dahi F, Abu Bakr N, Korosoglou G. Periprocedural Outcomes of Rotational Atherectomy-Assisted Balloon Angioplasty in Isolated Atherosclerotic Popliteal Artery Lesions: The ISO-POP Trial. J Clin Med 2023; 12:jcm12082797. [PMID: 37109133 PMCID: PMC10144177 DOI: 10.3390/jcm12082797] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Treatment of calcified popliteal artery lesions represents an ongoing challenge for vascular specialists. Biomechanical forces of external compression, torsion and elongation that occur with locomotion in the popliteal segment can lead to stent fractures and occlusions. The aim of our study was to assess the procedural success rate of atherectomy in combination with balloon angioplasty for isolated calcified popliteal artery lesions. METHODS Between January 2020 and December 2022, 62 patients with isolated atherosclerotic lesions of the popliteal artery underwent endovascular treatment by use of rotational atherectomy (Phoenix, Philips USA, (subgroup A) or Jetstream, Boston USA, (subgroup B), atherectomy systems) and additional balloon angioplasty in two vascular centers. The primary outcome measures were: 1. periprocedural clinical and technical success (<30% residual stenosis and no need for bailout stenting due to flow-limiting dissection) and 2. postprocedural increase in the ankle brachial index of more than 0.1. RESULTS The overall rate of bailout stenting was 4.8%, whereas the procedural success rate was 98.4%. The rate of procedural complications included 3.7% and 5.7% peripheral embolizations in the subgroups A and B, respectively, and no vessel perforations were noted. All embolizations were successfully treated by catheter aspiration or capture in the pre-treatment placed filter system. In addition, 1 (3.7%) pseudoaneurysm in the groin was reported in subgroup A and treated by surgical means. Median ABI of the affected limbs improved from 0.55 (0.2) to 0.70 (0.2) in subgroup A and from 0.50 (0.2) to 0.95 (0.1) in subgroup B (DABI of 0.15 versus 0.45, p < 0.001). CONCLUSIONS The combination of rotational atherectomy and balloon angioplasty in the popliteal artery showed reproducible outcomes in 2 centers, with low incidence of complications and low rates of bail-out stenting. These findings may contribute to more liberal use of such devices especially in segments with high risk for stent factures and occlusions.
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Affiliation(s)
- Konstantinos P Donas
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Anastasios Psyllas
- Department of Vascular and Endovascular Surgery, Marienhospital Wesel, 46483 Wesel, Germany
| | - Apostolos G Pitoulias
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Majid Kazemtash
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Firouza Dahi
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Nizar Abu Bakr
- Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany
| | - Grigorios Korosoglou
- Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, 69469 Weinheim, Germany
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20
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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21
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Helou B, Bel-Brunon A, Dupont C, Ye W, Silvestro C, Rochette M, Lucas A, Kaladji A, Haigron P. Patient-specific finite element simulation of peripheral artery percutaneous transluminal angioplasty to evaluate the procedure outcome without stent implantation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3685. [PMID: 36645263 DOI: 10.1002/cnm.3685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/16/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
The purpose of this work is to present a patient-specific (PS) modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment and assessing the balloon sizing influence on short-term outcomes in peripheral arteries, i.e. without stent implantation. Two 3D PS stenosed femoral artery models, one with a dominant calcified atherosclerosis while the other with a lipidic plaque, were generated from pre-operative computed tomography angiography images. Elastoplastic constitutive laws were implemented within the plaque and artery models. Implicit finite element method (FEM) was used to simulate the balloon inflation and deflation for different sizings. Besides vessel strains, results were mainly evaluated in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) attained immediately after PTA. Higher LGR values were shown within the stenosed region of the lipidic patient. Simulated results also showed a direct and quantified correlation between balloon sizing and LGR and ERR for both patients after PTA, with a more significant influence on the lumen gain. The max principal strain values in the outer arterial wall increased at higher balloon sizes during inflation as well, with higher rates of increase when the plaque was calcified. Results show that our model could serve in finding a compromise for each stenosis type: maximizing the achieved lumen gain after PTA, but at the same time without damaging the arterial tissue. The proposed methodology can serve as a step toward a clinical decision support system to improve angioplasty balloon sizing selection prior to the surgery.
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Affiliation(s)
- Bernard Helou
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | | | - Claire Dupont
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | | | - Claudio Silvestro
- Medtronic, Aortic Peripheral & Venous (APV) Group, Santa Rosa, California, USA
| | | | - Antoine Lucas
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Adrien Kaladji
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Pascal Haigron
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
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Akiyoshi K, Arakawa M, Matsumoto H, Adachi K, Nakata H. Successful Crossover Bypass Using a Lateral Femoral Circumflex Artery as an Outflow Vessel for Indirect Revascularization in Critical Limb Ischemia: A Case Report. Ann Vasc Dis 2022; 15:333-336. [PMID: 36644271 PMCID: PMC9816025 DOI: 10.3400/avd.cr.22-00059] [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: 05/23/2022] [Accepted: 08/22/2022] [Indexed: 12/25/2022] Open
Abstract
A 78-year-old man presented with severe stage 3 (Fontaine IV, Rutherford 5, W1 I3 FI0) right limb ischemia. Although his artery was completely occluded from below the right external iliac to the popliteal artery, collateral circulation from the right lateral femoral circumflex artery was well developed and supplied the lower extremity arteries. We selected an uncommon crossover bypass strategy with the left common femoral artery to the right lateral femoral circumflex artery to improve lower extremity perfusion via indirect revascularization. Bypass using the lateral femoral circumflex artery as an outflow is an option for patients with major lower extremity artery occlusions.
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Affiliation(s)
- Kei Akiyoshi
- Department of Cardiovascular Surgery, Yokosuka Uwamachi Hospital, Yokosuka, Kanagawa, Japan,Corresponding author: Kei Akiyoshi, MD. Department of Cardiovascular Surgery, Yokosuka Uwamachi Hospital, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan Tel: +81-46-823-2630, Fax: +81-46-827-1305, E-mail:
| | - Mamoru Arakawa
- Department of Cardiovascular Surgery, Yokosuka Uwamachi Hospital, Yokosuka, Kanagawa, Japan
| | - Harunobu Matsumoto
- Department of Vascular Surgery, Saitama Medical University Hospital, Saitama, Saitama, Japan
| | - Koichi Adachi
- Department of Cardiovascular Surgery, Yokosuka Uwamachi Hospital, Yokosuka, Kanagawa, Japan
| | - Hiroko Nakata
- Department of Cardiovascular Surgery, Yokosuka Uwamachi Hospital, Yokosuka, Kanagawa, Japan
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23
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Gunawardena M, Salami M, Howard A, Awupetu A. Does the Mode of Anaesthesia (General or Regional) Affect Survival and Complications Following Femoropopliteal and Femorodistal Bypass? Cureus 2022; 14:e32104. [DOI: 10.7759/cureus.32104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
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24
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Mulawardi, Jancung, Adriani TC, Lie H, Faruk M. Femorofemoral artery bypass grafting in aortoiliac occlusive disease patients: A case report. Int J Surg Case Rep 2022; 99:107689. [PMID: 36150331 PMCID: PMC9568772 DOI: 10.1016/j.ijscr.2022.107689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/17/2022] [Accepted: 09/18/2022] [Indexed: 11/27/2022] Open
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Choudhry AJ, Shaw PM. Endovascular Aorto-Iliac Reconstruction vs. Aortobifemoral Bypass as First Choice for a Durable Revascularization for Aorto-Iliac Occlusive Disease. Vasc Endovascular Surg 2022; 57:88-92. [PMID: 36172836 DOI: 10.1177/15385744221130870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Aortoiliac occlusive disease (AIOD) is defined as atherosclerotic obstruction of the distal abdominal aorta and iliac arteries. Multiple options exist for management of AIOD including endovascular aortoiliac reconstruction and aortobifemoral bypass. As new technologies are developed, the best approach to manage this condition is evolving. METHODS We performed a literature review to assess the current state of endovascular aortoiliac reconstruction and aortobifemoral bypass as options for revascularization of aortoiliac occlusive disease. CONCLUSION Endovascular aortoiliac reconstruction and aortobifemoral bypass are both feasible and clinically effective options for management of aortoiliac occlusive disease. No randomized controlled trial has been performed to show one option to be more effective than the other. Recent literature demonstrates comparable long-term patency, limb salvage and survival among endovascular approaches to the treatment of AIOD with quicker recovery, lower costs and improved quality of life when compared to open aortobifemoral bypass (ABF) surgery. Selection of procedure should be tailored to the individual patient in order to develop an effective long-term successful strategy for management of aortoiliac occlusive disease. Further study is warranted to define durability of these endovascular approaches as well as patient specific characteristics that influence outcomes.
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Affiliation(s)
- Asad J Choudhry
- Division of Vascular and Endovascular Surgery, 12302SUNY Upstate Medical UniversityHospital, Syracuse, NY, USA
| | - Palma M Shaw
- Division of Vascular and Endovascular Surgery, 12302SUNY Upstate Medical UniversityHospital, Syracuse, NY, USA
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Blitzer DN, Rolle NP, Abdou H, Berg L, Nagarsheth KH. Open Proximal Endarterectomy with Retrograde Access and Stenting: A Novel Technique for Lower Extremity Revascularization. Vasc Endovascular Surg 2022; 57:5-10. [PMID: 35968814 DOI: 10.1177/15385744221120203] [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: 11/15/2022]
Abstract
BACKGROUND Treatment of chronic limb threatening ischemia (CLTI) poses a significant clinical challenge despite recent medical advancements. Chronic total occlusion (CTO) lesions make endovascular approaches to CLTI particularly challenging. Open proximal exposure with retrograde access and stenting (OPERAS) aims to solve this challenge through retrograde subintimal crossing of a CTO with direct visualization of proximal re-entry into the true lumen. We describe this novel technique and present its efficacy in eight patients. METHODS We conducted a retrospective case series at a single tertiary academic center. Data for patients who received OPERAS intervention included demographics, peri-operative details, and follow-up information. Statistical analysis was performed on length of stay, major post-operative complications, further intervention, clinical progression at 1 year, and amputation-free survival at 1 year. Immediate technical failure (ITF) and limb-based patency (LBP) at 1 year were calculated. RESULTS Nine limbs underwent OPERAS between January 2019 and March 2020. Inflow was achieved with common femoral artery endarterectomy. All limbs underwent balloon angioplasty and stenting of the SFA, and seven underwent the same procedure in the popliteal artery. ITF was 0% for all nine cases. There were no major post-operative complications, and ankle-brachial index significantly improved pre-and post-operatively (P < .001). Eight limbs (88.9%) sustained amputation-free survival at 1 year, and overall LBP was 67% at 1 year. CONCLUSION Our study presents a hybrid revascularization option to address severe, anatomically complex limbs (GLASS III) that lack a single autogenous conduit for open surgical revascularization. OPERAS addresses a main point of technical failure of subintimal techniques by directly visualizing the wire in the true lumen. Our data suggest that OPERAS can be effective to: (1) improve technical success of luminal re-entry following a subintimal approach; (2) address inflow concurrently with severe femoropopliteal disease; and (3) can be utilized when distal tissue loss is involved.
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Affiliation(s)
- David N Blitzer
- Division of Vascular Surgery, Department of Surgery, 21668University of Maryland Medical Center, Baltimore, MD, USA.,12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicholas P Rolle
- 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hossam Abdou
- 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lars Berg
- 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Khanjan H Nagarsheth
- Division of Vascular Surgery, Department of Surgery, 21668University of Maryland Medical Center, Baltimore, MD, USA.,12264University of Maryland School of Medicine, Baltimore, MD, USA
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Wong CWT, Sawhney A, Wu Y, Mak YW, Tian XY, Chan HF, Blocki A. Sourcing of human peripheral blood-derived myeloid angiogenic cells under xeno-free conditions for the treatment of critical limb ischemia. Stem Cell Res Ther 2022; 13:419. [PMID: 35964057 PMCID: PMC9375284 DOI: 10.1186/s13287-022-03095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Critical limb ischemia (CLI) is the most severe form of peripheral artery disease and exhibits a high risk of lower extremity amputations. As even the most promising experimental approaches based on mesenchymal stem cells (MSCs) demonstrated only moderate therapeutic effects, we hypothesized that other cell types with intrinsic roles in angiogenesis may exhibit a stronger therapeutic potential. We have previously established a protocol to source human peripheral blood-derived angiogenic cells (BDACs). These cells promoted revascularization and took perivascular location at sites of angiogenesis, thus resembling hematopoietic pericytes, which were only described in vivo so far. We thus hypothesized that BDACs might have a superior ability to promote revascularization and rescue the affected limb in CLI. METHODS As standard BDAC sourcing techniques involve the use of animal-derived serum, we sought to establish a xeno- and/or serum-free protocol. Next, BDACs or MSCs were injected intramuscularly following the ligation of the iliac artery in a murine model. Their ability to enhance revascularization, impair necrosis and modulate inflammatory processes in the affected limb was investigated. Lastly, the secretomes of both cell types were compared to find potential indications for the observed differences in angiogenic potential. RESULTS From the various commercial media tested, one xeno-free medium enabled the derivation of cells that resembled functional BDACs in comparable numbers. When applied to a murine model of CLI, both cell types enhanced limb reperfusion and reduced necrosis, with BDACs being twice as effective as MSCs. This was also reflected in histological evaluation, where BDAC-treated animals exhibited the least muscle tissue degeneration. The BDAC secretome was enriched in a larger number of proteins with pro-angiogenic and anti-inflammatory properties, suggesting that the combination of those factors may be responsible for the superior therapeutic effect. CONCLUSIONS Functional BDACs can be sourced under xeno-free conditions paving the way for their safe clinical application. Since BDACs are derived from an easily accessible and renewable tissue, can be sourced in clinically relevant numbers and time frame and exceeded traditional MSCs in their therapeutic potential, they may represent an advantageous cell type for the treatment of CLI and other ischemic diseases.
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Affiliation(s)
- Christy Wing Tung Wong
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Apurva Sawhney
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yalan Wu
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yi Wah Mak
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiao Yu Tian
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Hon Fai Chan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anna Blocki
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. .,School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. .,Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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Baram A, Taha AY, Muhamed RG. Outcomes of Popliteal Endarterectomy and Infrapopliteal Angioplasty for Short Atherosclerotic Popliteal Artery Occlusion: Single Center Case Series. Ann Vasc Surg 2022; 88:145-153. [PMID: 35872211 DOI: 10.1016/j.avsg.2022.06.100] [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: 04/16/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Localized popliteal artery occlusion (LPAO) is a rare entity with a challenging therapy. In selected patients, open popliteal endarterectomy (OPE) with infrapopliteal balloon angioplasty (IPA) can be limb-saving. The aim of this retrospective study from Iraq-Kurdistan is to assess the procedure outcomes. METHODS Over 5 years, ending at 2020, 28 patients with atherosclerotic LPAO unsuitable for femoropopliteal bypass or endovascular intervention received OPE+IPA through a medial approach under spinal anesthesia. Perioperative data were obtained from patients' records and entered into an Access database. Results were retrieved and statistically analyzed. RESULTS There were 18 (64.3%) males. The mean age was 66.4 ± 6.53 years (range 52-79). Seventy-five percent of patients had obesity, diabetes mellitus and smoking. Twenty-six (92.9%) of patients were in Rutherford category 5 and 6 with an ankle-brachial index <0.40. Popliteal and pedal pulses were absent in 23 of 24 (95.8%) patients. Doppler ultrasound showed a good distal runoff in one (3.6%) patient. CT angiography revealed 20 (71.4%) femoropopliteal and 16 (57.1%) infrapopliteal lesions of types A and B as per TASC II document. Mean endarterectomy length was 5.1 cm (range 3-7), patched with a vein in (17, 60.7%) and primarily closed in (11, 39.3%) patients. Early complications were none in (18, 64.3%) patients whereas one leg was amputated on day 30. On average, follow-up lasted 3.4 years. Twenty-seven (96.4%) vessels remained patent and two (7.1%) patients died. CONCLUSIONS Our study confirms safety and efficacy of OPE+IPA for selected patients with critical limb ischemia due to LPAO.
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Affiliation(s)
- Aram Baram
- Department of Thoracic and Cardiovascular Surgery/College of Medicine/University of Sulaimani/Sulaymaniyah/Region of Kurdistan/Iraq.
| | - Abdulsalam Yaseen Taha
- Department of Thoracic and Cardiovascular Surgery/College of Medicine/University of Sulaimani/Sulaymaniyah/Region of Kurdistan/Iraq.
| | - Rzgar Ghareeb Muhamed
- Department of Thoracic and Cardiovascular Surgery/Sulaymaniyah Teaching Hospital/ Sulaymaniyah/Region of Kurdistan/Iraq.
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A Novel Marker Indicating Restenosis in Superficial Femoral Artery: C Reactive Protein to Albumin Ratio. Ann Vasc Surg 2022; 86:158-167. [PMID: 35568327 DOI: 10.1016/j.avsg.2022.04.041] [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: 01/29/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022]
Abstract
AIM In this study, we aimed to investigate the prognostic value of CAR for predicting restenosis in SFA lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention. METHODS The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. RESULTS According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs 10.3%, p<0.05) and mortality (31.3% vs 12.9%, p<0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs 3%, p<0.05). With respect to ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% CI: 0.611-0.706; p<0.01). CONCLUSION Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.
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30
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Steiner S, Schmidt A. [Endovascular interventions for peripheral arterial disease]. Internist (Berl) 2022; 63:584-590. [PMID: 35532802 DOI: 10.1007/s00108-022-01351-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 12/24/2022]
Abstract
Successful revascularization of patients with peripheral arterial disease (PAD) requires a comprehensive understanding of the risk population and the available treatment options. Even the urgency of revascularization varies widely depending on the clinical presentation. Patients with intermittent claudication should undergo a structured exercise program before revascularization may become necessary, whereas acute limb ischemia is a medical emergency and must be revascularized within a few hours. Endovascular treatment techniques have evolved rapidly over the past 20 years. New technologies and procedural techniques allow even complex lesions to be successfully treated with endovascular techniques, and most patients can now be treated minimally invasively in line with an "endovascular first" strategy. Bypass surgery remains an important option for patients with advanced disease. The techniques used vary depending on the clinical presentation, location, and complexity of the lesion. Although the evidence for different techniques is limited, a variety of clinical and lesion factors are known to be critical for acute technical success and long-term patency rates. The use of paclitaxel-coated balloons and stents has been shown to significantly reduce restenosis and reintervention rates after femoropopliteal interventions. However, a late mortality signal associated with the use of these devices continues to be debated. After successful intervention, appropriate drug therapy and standardized follow-up should be established to prevent adverse limb events and reduce the high rate of cardiovascular events.
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Affiliation(s)
- Sabine Steiner
- Klinik und Poliklinik für Angiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig (AöR), Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Andrej Schmidt
- Klinik und Poliklinik für Angiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig (AöR), Liebigstr. 20, 04103, Leipzig, Deutschland
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Simons MV, Groen MHA, de Borst GJ, Leiner T, Doevendans PAF, Ebbini E, Slieker FJB, van Es R, Hazenberg CEVB. Safety and feasibility study of non-invasive robot-assisted high-intensity focused ultrasound therapy for the treatment of atherosclerotic plaques in the femoral artery: protocol for a pilot study. BMJ Open 2022; 12:e058418. [PMID: 35501090 PMCID: PMC9062820 DOI: 10.1136/bmjopen-2021-058418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is an atherosclerotic disease leading to stenosis and/or occlusion of the arterial circulation of the lower extremities. The currently available revascularisation methods have an acceptable initial success rate, but the long-term patency is limited, while surgical revascularisation is associated with a relatively high perioperative risk. This urges the need for development of less invasive and more effective treatment modalities. This protocol article describes a study investigating a new non-invasive technique that uses robot assisted high-intensity focused ultrasound (HIFU) to treat atherosclerosis in the femoral artery. METHODS AND ANALYSIS A pilot study is currently performed in 15 symptomatic patients with PAD with a significant stenosis in the common femoral and/or proximal superficial femoral artery. All patients will be treated with the dual-mode ultrasound array system to deliver imaging-guided HIFU to the atherosclerotic plaque. Safety and feasibility are the primary objectives assessed by the technical feasibility of this therapy and the 30-day major complication rate as primary endpoints. Secondary endpoints are angiographic and clinical success and quality of life. ETHICS AND DISSEMINATION Ethical approval for this study was obtained in 2019 from the Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands. Data will be presented at national and international conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NL7564.
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Affiliation(s)
- Michelle V Simons
- Department of Vascular Medicine, University Medical Centre, Utrecht, The Netherlands
| | - Marijn H A Groen
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Gert J de Borst
- Vascular Surgery, University Medical Centre Speciality Surgery, Utrecht, The Netherlands
| | - Tim Leiner
- Radiology, University Medical Center Imaging Division, Utrecht, The Netherlands
| | - Pieter A F Doevendans
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
- Netherlands Heart Institue, Utrecht, The Netherlands
| | - Emad Ebbini
- Electrical and Computer Engineering, University of Minnesota College of Science and Engineering, Minneapolis, Minnesota, USA
| | - Fons J B Slieker
- Department of Oral Surgery, University Medical Centre, Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
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Stretched reconstruction based on 2D freehand ultrasound for peripheral artery imaging. Int J Comput Assist Radiol Surg 2022; 17:1281-1288. [PMID: 35486303 DOI: 10.1007/s11548-022-02636-w] [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: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Endovascular revascularization is becoming the established first-line treatment of peripheral artery disease (PAD). Ultrasound (US) imaging is used pre-operatively to make the first diagnosis and is often followed by a CT angiography (CTA). US provides a non-invasive and non-ionizing method for the visualization of arteries and lesion(s). This paper proposes to generate a 3D stretched reconstruction of the femoral artery from a sequence of 2D US B-mode frames. METHODS The proposed method is solely image-based. A Mask-RCNN is used to segment the femoral artery on the 2D US frames. In-plane registration is achieved by aligning the artery segmentation masks. Subsequently, a convolutional neural network (CNN) predicts the out-of-plane translation. After processing all input frames and re-sampling the volume according to the vessel's centerline, the whole femoral artery can be visualized on a single slice of the resulting stretched view. RESULTS 111 tracked US sequences of the left or right femoral arteries have been acquired on 18 healthy volunteers. fivefold cross-validation was used to validate our method and achieve an absolute mean error of 0.28 ± 0.28 mm and a median drift error of 8.98%. CONCLUSION This study demonstrates the feasibility of freehand US stretched reconstruction following a deep learning strategy for imaging the femoral artery. Stretched views are generated and can give rich diagnosis information in the pre-operative planning of PAD procedures. This visualization could replace traditional 3D imaging in the pre-operative planning process, and during the pre-operative diagnosis phase, to identify, locate, and size stenosis/thrombosis lesions.
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Mathlouthi A, Zarrintan S, Khan MA, Malas MB. Contemporary outcomes of open femoropopliteal bypass by autogenous vein graft in infra-inguinal arterial occlusive disease. Ann Vasc Surg 2022; 86:184-189. [PMID: 35470046 DOI: 10.1016/j.avsg.2022.04.023] [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: 08/29/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although the majority of patients presenting with symptomatic peripheral arterial disease (PAD) are treated with the endovascular first approach, a significant number of these patients still require open bypass because of the extent of atherosclerotic burden or failure of the endovascular therapy. However, data available on the outcomes of femoropoliteal bypass in the contemporary era of PAD management is scarce. In this study, we evaluate real-world mid-term outcomes of femoropopliteal bypass for PAD. METHODS We identified all patients who underwent open femoropopliteal revascularization with autogenous vein conduits for PAD at one institution between January 2012 and December 2017. Main endpoints included primary patency, amputation-free survival, overall survival and limb salvage at two years. Outcomes were defined per the Society for Vascular Surgery standards. Descriptive statistics were performed using univariable analyses including mean and standard deviation for continuous variables and frequency and percentage for categorical variables. Event-free survival rates were estimated using Kaplan-Meier (KM) methods. RESULTS There were 129 patients who received autogenous vein grafts. Median follow-up was 19 months (IQR 11-26). Patients were predominantly male (59.7%), white (72.9%) with a mean age of 65±11 years. The indications for surgery were disabling claudication in 36.4% of patients (N=47) and chronic limb threatening ischemia (CLTI) in 63.6% (N=82). Most patients had TASC C or D lesions (N=81, 62.8%). Seventeen cases (16.3%) were redo bypasses. Arm veins and spliced vein conduits were used in 12% and 7%, respectively. In 66% of procedures the distal anastomosis was below the knee. Primary patency estimates at 6 months, 1 year and 2 years were 81.3%, 68.6% and 59.2%, respectively. Amputation-free survival rates were 93.4%, 88% and 82.1% at 6 months, 1 year and 2 years, respectively. Limb salvage rates among patients with CLTI were 93.4%, 90.4% and 87.2% at 6 months, 1 year and 2 years, respectively. Overall survival was 97.5%, 92.1% and 87.8% at 6 months, 1 year and 2 years, respectively. CONCLUSIONS In this contemporary cohort of patients, femoropopliteal bypass showed lower patency than previously described. The fact that bypass surgery is performed on sicker patients with more extensive disease in the endovascular era might explain this discrepancy. However, our results demonstrated satisfactory patency and limb salvage rates and suggest that vein should always be used if available.
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Affiliation(s)
- Asma Mathlouthi
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, California, The United States of America
| | - Sina Zarrintan
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, California, The United States of America
| | - Maryam Ali Khan
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, California, The United States of America
| | - Mahmoud B Malas
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, California, The United States of America.
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Feldman ZM, Mohapatra A. Endovascular Management of Complex Tibial Lesions. Semin Vasc Surg 2022; 35:190-199. [DOI: 10.1053/j.semvascsurg.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022]
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Ahmad FA, Hennessy MM, Nath AF. Fate of Asymptomatic Limb after Kissing Stents in Aortoiliac Occlusive Disease. Vasc Specialist Int 2022; 38:7. [PMID: 35361742 PMCID: PMC8971782 DOI: 10.5758/vsi.210074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/19/2021] [Accepted: 03/05/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Kissing stent angioplasty is an established endovascular treatment strategy for stenosis at the aortic bifurcation but not without its detractors. This study aimed to analyze the outcomes of kissing stents with regard to stent occlusion and complications in which an asymptomatic limb was treated. Methods Materials and A total of 106 patients undergoing aortic bifurcation intervention from January 2015 to November 2020 were retrospectively reviewed. Only patients with at least one common iliac artery (CIA) ostium and undergoing bilateral CIA intervention were included in the study.Results: Patients were followed up for a median period of 26 months (interquartile range, 21-51 months). The TransAtlantic InterSociety Consensus (TASC)-II classification of lesions was as follows: A, 49%; B, 41%; C, 6%; and D, 5%. The treatment indication was limited to one side in 53% of patients. Technical and procedural success rates were 99% and 90%, respectively. Ischemic events in an asymptomatic limb occurred in 6% of cases, 3% due to late stent thrombosis >30 days, and 3% due to progression of downstream infrainguinal disease. Primary and secondary patency rates at 1, 3, and 5 years were 98%, 87%, and 85%, and 99%, 94%, and 94%, respectively. Periprocedural mortality developed in two patients with no amputation. Conclusion Kissing stent deployment is a safe and effective strategy for the treatment of aortoiliac bifurcation disease. Unfavorable outcomes due to stenting in the asymptomatic iliac artery are very rare. Long-term surveillance is necessary due to the risk of late thrombosis or downstream disease progression.
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Affiliation(s)
- Faheem Asem Ahmad
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Martin Michael Hennessy
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alexander Fredrik Nath
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Schropp L, de Kleijn RJCMF, Vonken EJ, van Laanen J, Teijink J, Ünlu Ç, Vos FAW, van Hattum ES, Petri BJ, de Borst GJ. Multicenter Case Series and Literature Review on Durability of Stents in the Thoracic Outlet. J Endovasc Ther 2022; 30:355-363. [PMID: 35255758 DOI: 10.1177/15266028221081078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this paper was to report our experience with arterial and venous endovascular stent placement in the thoracic outlet (TO) and review available literature. METHODS All patients that underwent arterial or venous stent placement in the TO between 2013 and 2020 in 5 Dutch vascular teaching-hospitals were retrospectively identified. Primary endpoint was symptomatic stent failure due to stenosis, chronic or posture dependent compression, fracture, or occlusion of the stent. Secondary endpoints were symptoms at last follow-up and re-interventions. For the literature review, we searched studies reporting on stenting in the TO. RESULTS Twenty-six patients were included with 11 arterial and 15 venous stents implanted to treat angioplasty resistant stenosis in arterial or venous TO syndrome, iatrogenic or traumatic vascular injury, radiotherapy fibrosis, or arterial dissection. Median follow-up was 19 and 14 months in the arterial and venous-group, respectively. Eight (73%) patients in the arterial, and 9 (60%) in the venous-group suffered symptomatic stent failure. Seven (64%) patients in the arterial, and 9 (60%) in the venous-group required at least 1 re-intervention. When comparing all patients with stent placement after TO decompression (TOD) to patients without, there were substantially more symptomatic stent failures and re-interventions required in the patients without TOD. Six patients (54%) in the arterial-group and 11 (73%) in the venous-group were symptom-free at last follow-up. Five articles describing 51 patients with arterial and 6 articles describing 81 patients with venous stents were included in the literature review. In the arterial-group, no TOD prior to stent placement was performed, while in the venous-group all but 1 article performed TOD prior to stent placement. Results showed comparable rates of symptomatic stent failure (24% vs 30%), and patients requiring re-interventions (29% vs 21%) between groups. CONCLUSION Based on our multicenter series and review, stents in the TO have a considerable risk of failure, both in the venous and the arterial territory. Especially in patients without TOD: the need for re-interventions is high and half the patients eventually undergo TOD. Based on the currently available data, stenting in the TO should be applied cautiously while TOD should be considered.
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Affiliation(s)
- Ludo Schropp
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Evert-Jan Vonken
- Department of Interventional Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorinde van Laanen
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joep Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Çagdas Ünlu
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Floris A W Vos
- Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Eline S van Hattum
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart-Jeroen Petri
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Pu H, Jiang Y, Wu Z, Lei J, Hu J, Qiu P, Zhang X, Huang Q, Lu X, Yin M, Zhao Z. Endovascular Excimer Laser-Assisted Balloon Angioplasty for Infrapopliteal Arteries in Thromboangiitis Obliterans: A Treatment for Acute-Phase TAO. Front Cardiovasc Med 2022; 9:831340. [PMID: 35310987 PMCID: PMC8931023 DOI: 10.3389/fcvm.2022.831340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThromboangiitis obliterans (TAO, Buerger's disease) is an inflammatory and obstructive vasculopathy, which leads to limb ischemic rest pain and ulcerations in the acute stage.ObjectivesThis study aimed to assess the feasibility of excimer laser-assisted balloon angioplasty (BA) for patients with acute infrapopliteal TAO.MethodThis was a single-center retrospective cohort study. In this study, 220 patients with 210 target limbs between January 2012 and September 2021 were involved. Among them, 52 target limbs have received endovascular excimer laser-assisted balloon angioplasty from January 2017. The ankle brachial index (ABI), rest pain score, ulcer, Rutherford classification, and TASC II classification were assessed. The follow-up time was 6 months.ResultsThe technical success rate of laser + BA and BA groups was 71.15 and 65.82% (p = 0.5021), respectively. After intervention, the ABI of two groups were 0.85 ± 0.20 and 0.77 ± 0.20 (p = 0.0419), and the rest pain score was 1.00 ± 1.43 and 1.71 ± 2.25 (p = 0.0449). During the 6 months follow-up, the ABI of two groups was 0.76 ± 0.17 and 0.75 ± 0.23 (p = 0.8539), the rest pain score was 1.43 ± 1.82 and 2.24 ± 2.06 (p = 0.0783), and the ulcer rate was 23.68 and 40.98% (p = 0.0867), respectively. The proportion of patients who were assessed as TASC II C/D or Rutherford 4–6 in laser +BA group was significantly lower than that in BA group, indicating that the former had better efficacy. The rate of critical limb ischemia and restenosis in the laser +BA group was lower than that in the BA group (47.36 vs. 67.22%; 21.05 vs. 34.43%) during follow-up. In the laser + BA group, the reintervention rate was lower than that in the BA group (2.70 vs. 8.20%, p = 0.0425). No serious adverse events (AEs) occurred.ConclusionExcimer laser debulking-assisted angioplasty is a feasible, effective, and safe method to treat acute infrapopliteal TAO.
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Gahide G, Banine A, Cossette M, Budimir M, Chen L, Lefebvre J, Phaneuf SC, Haddad I, Vendrell JF, Beland M, Despatis MA, Maghsoudloo K. Reporting Peripheral Artery Disease in Claudicants: Lessons Learned From the TASC-Ability Study. J Endovasc Ther 2022; 30:259-268. [PMID: 35236151 DOI: 10.1177/15266028221081093] [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: 11/16/2022]
Abstract
BACKGROUND The Trans-Atlantic Inter-Society Consensus Document (TASC II) aims to comprehensively describe the case scenarios of aortoiliac and femoropopliteal lesions to suggest an endovascular or a surgical approach. Over time, it has become a guide for describing the gravity of arterial lesions. PURPOSE To assess the revised TASC II system for classifying arterial lesions in a large database of patients presenting with claudication. MATERIALS AND METHODS This study was a retrospective review of the arteriograms of patients with intermittent claudication. Aortoiliac and femoropopliteal lesions were classified according to the TASC II. When no consensus was reached, the lesion was rated as unTASCable. RESULTS In total, 1454 patients were included (male: 62.1%, 66.8±9.3 years). There were 39% aortoiliac lesions (n=960/2462) and 61% femoropopliteal lesions (n=1502/2462); 33.6% of the patients (n=489/1454) were associated with aortoiliac and femoropopliteal lesions. In addition, 20% of the lesions (n=493/2462) were unTASCable, and 26.7% of the patients (n=388/1454) had at least 1 unTASCable lesion. There were 4 categories of unTASCable lesions: (1) association with a common femoral artery lesion in 53.1% (n=262/493); (2) iliac artery lesions in 23.1% (n=114/493); (3) femoropopliteal lesions whose lengths did not fit into any category in 16.6% (n=82/493); and (4) association with an aortic lesion in 7.1% (n=35/493). The interobserver agreement was 0.97 for anatomically describing the infrarenal arterial tree and 0.85 for TASCing, with the lesions lowering to 0.69 for aortoiliac lesions. CONCLUSION Using the revised TASC II case scenario, 26.7% of the patients had at least 1 unTASCable lesion. Reporting peripheral artery disease using a comprehensive anatomical description of the infrarenal arterial tree showed better interobserver reproducibility.
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Affiliation(s)
- Gérald Gahide
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.,Centre de Recherche du CHUS, Etienne Le Bel, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Amine Banine
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Lois Chen
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Samuel C Phaneuf
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Iskandar Haddad
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Francois Vendrell
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mathieu Beland
- Département de Radiologie, Centre Hospitalier Universitaire de Québec, Quebec City, Canada
| | - Marc-Antoine Despatis
- Centre de Recherche du CHUS, Etienne Le Bel, Université de Sherbrooke, Sherbrooke, QC, Canada.,Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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van den Houten MML, Jansen S, van der Laan L, Vriens PWHE, Willigendael EM, Koelemay MJW, Scheltinga MRM, Teijink JAW. The Effect of Arterial Disease Level on Outcomes of Supervised Exercise Therapy for Intermittent Claudication: A Prospective Cohort Study. Ann Surg 2022; 275:609-616. [PMID: 32740230 DOI: 10.1097/sla.0000000000004073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether level of arterial obstruction determines the effectiveness of SET in patients with IC. BACKGROUND DATA Guidelines advocate SET before invasive treatment for IC, but early revascularization remains widespread, especially in patients with aortoiliac disease. METHODS Patients were recruited from 10 Dutch centers between October 2017 and October 2018. Participants received SET first, followed by endovascular or open revascularization in case of insufficient effect. They were grouped according to level of stenosis (aortoiliac, femoropopliteal, multilevel, or rest group with no significant stenosis). Changes from baseline walking performance (maximal and functional walking distance on a treadmill test, 6-minute walk test) and vascular quality of life questionnaire-6 at 3 and 6 months were compared, after multivariate adjustment for possible confounders. Freedom from revascularization was estimated with Kaplan-Meier analysis. RESULTS Some 267 patients were eligible for analysis (aortoiliac n = 70, 26%; femoropopliteal n = 115, 43%; multilevel n = 69, 26%; rest n = 13, 5%). No between group differences in walking performance or vascular quality of life questionnaire-6 were found. Mean improvement in maximal walking distance after 6 months was 439 m [99% confidence interval (CI) 297-581], 466 m (99% CI 359-574), 353 m (99% CI 210-496), and 403 m (99% CI 58-749), respectively (P = 0.40). Freedom from intervention was 73.9% for aortoiliac disease and 88.6% for femoropopliteal disease (hazard ratio 2.46, 99% CI 0.96 - 6.30, P = 0.013). CONCLUSIONS Short-term effectiveness of SET for IC is not determined by the location of stenosis. Although aortoiliac disease patients improved walking performance and health-related quality of life similarly compared to other arterial disease level groups, they underwent revascularization more often.
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Affiliation(s)
- Marijn M L van den Houten
- Catharina Hospital, Department of Surgery, Eindhoven, The Netherlands
- Maastricht University, CAPHRI Research School, Maastricht, The Netherlands
| | - Sandra Jansen
- Catharina Hospital, Department of Surgery, Eindhoven, The Netherlands
- Maastricht University, CAPHRI Research School, Maastricht, The Netherlands
| | - Lijckle van der Laan
- Amphia Hospital, Department of Vascular Surgery, Breda, The Netherlands
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Patrick W H E Vriens
- Elisabeth Twee Steden Hospital, Department of Vascular Surgery, Tilburg, The Netherlands
| | - Edith M Willigendael
- Medical Spectrum Twente, Department of Vascular Surgery, Enschede, The Netherlands
| | - Mark J W Koelemay
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Marc R M Scheltinga
- Maxima Medical Centre, Department of Vascular Surgery, Veldhoven, The Netherlands
| | - Joep A W Teijink
- Catharina Hospital, Department of Surgery, Eindhoven, The Netherlands
- Maastricht University, CAPHRI Research School, Maastricht, The Netherlands
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Tran AT, Spertus JA, Mena-Hurtado CI, Jones PG, Aronow HD, Safley DM, Malik AO, Peri-Okonny PA, Shishehbor MH, Labrosciano C, Smolderen KG. Association of Disease-Specific Health Status With Long-Term Survival in Peripheral Artery Disease. J Am Heart Assoc 2022; 11:e022232. [PMID: 35132874 PMCID: PMC9245831 DOI: 10.1161/jaha.121.022232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD‐specific health status around the time of diagnosis may prognosticate long‐term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3‐month, and change from baseline to 3‐month follow‐up. Kaplan‐Meier using 3‐month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5‐year all‐cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3‐month, respectively), 141 (19.8%) died over a median follow‐up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per‐10‐point increment; 95% CI, 0.84–0.97; P=0.008), 3‐month (HR [95% CI], 0.87 [0.82–0.93]; P<0.001) and change in PAQ (HR [95% CI], 0.92 [0.85–0.99]; P=0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3‐month PAQ was more strongly associated with mortality than either baseline (3‐month HR [95% CI], 0.85 [0.78–0.92]; P<0.001; C‐statistic, 0.77) or change (3‐month HR [95% CI], 0.79 [0.72–0.87]; P<0.001). Conclusions PAD‐specific health status is independently associated with 5‐year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.
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Affiliation(s)
- Andy T Tran
- Department of Medicine University of California Irvine School of Medicine Orange CA
| | - John A Spertus
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Carlos I Mena-Hurtado
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University New Haven CT
| | - Philip G Jones
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Herbert D Aronow
- Department of Medicine Alpert Medical School of Brown University Providence RI
| | - David M Safley
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Ali O Malik
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Poghni A Peri-Okonny
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Mehdi H Shishehbor
- Interventional Cardiovascular Center Case Western Reserve University School of Medicine Cleveland OH
| | - Clementine Labrosciano
- The Queen Elizabeth Hospital Adelaide Medical School University of Adelaide SA Australia
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University New Haven CT.,Department of Psychiatry School of Medicine, Yale University New Haven CT
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Feshchenko DA, Zasypkin GS, Rudenko BA, Vasiliev DK, Shukurov FB, Shanoyan АS, Drapkina OM. Reconstruction of infrarenal abdominal aortic occlusion using the Culotte stenting technique: a case report. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2021-3086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Patients with clinically significant infrarenal abdominal aortic atherosclerosis are often encountered in the clinical practice of vascular and endovascular surgeons. In the absence of timely treatment, the ability to work and life quality of patients are sharply reduced, and in some cases, patients require limb amputation. Until recently, the only treatment option for such a lesion was an open surgery. However, a good skill level of endovascular surgeons and the device availability allow today to perform minimally invasive operations with comparable effectiveness and greater safety in comparison with open surgery. We present a case report of successful endovascular treatment of aortic occlusion involving the right and left common and external iliac arteries using Culotte stenting technique with further 12-month follow-up.
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Affiliation(s)
- D. A. Feshchenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - G. S. Zasypkin
- National Medical Research Center for Therapy and Preventive Medicine
| | - B. A. Rudenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. K. Vasiliev
- National Medical Research Center for Therapy and Preventive Medicine
| | - F. B. Shukurov
- National Medical Research Center for Therapy and Preventive Medicine
| | - А. S. Shanoyan
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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42
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Lenzen-Großimlinghaus R. [Pressure sores-A multilayered challenge]. Z Gerontol Geriatr 2022; 55:61-72. [PMID: 34994853 DOI: 10.1007/s00391-021-02002-6] [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] [Received: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022]
Abstract
Pressure sores occur when soft tissue of the skin, subcutaneous fat tissue or musculature is exposed to pressure or friction over a long period of time, which leads to local ischemia with subsequent necrosis. All areas of the skin lying over bones with only a thin layer of soft tissue are predilection sites. In older patients the risk factors for the development of a pressure sore must be systematically documented at admission and during the course of the disease. Accordingly, the necessary prophylactic procedures must be initiated. The classification of the European Pressure Ulcer Advisory Panel (EPUAP) is used to describe a pressure sore. For the differential diagnosis, incontinence-associated dermatitis and a manifest peripheral artery occlusive disease must be excluded. The treatment consists of positioning procedures and local and systemic supportive wound treatment. In cases of deep pressure sores, coverage by plastic surgery can effectively accelerate healing. The multiprofessional geriatric team has the appropriate prerequisites for comprehensive treatment of pressure sores.
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Thomas M, Dawkins C, Shelmerdine L. Antithrombotics after infra-inguinal bypass grafting. Hippokratia 2021. [DOI: 10.1002/14651858.cd015141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Matthew Thomas
- Department of Vascular Surgery; Freeman Hospital; Newcastle upon Tyne UK
| | - Claire Dawkins
- Department of Vascular Surgery; Freeman Hospital; Newcastle upon Tyne UK
| | - Lauren Shelmerdine
- Department of Vascular Surgery; Freeman Hospital; Newcastle upon Tyne UK
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Foley MP, Aherne TM, Dooley C, Mulkern E, McDonnell CO, O'Donohoe MK. Eversion Endarterectomy - an alternative approach to occlusive External Iliac Artery disease. Ann Vasc Surg 2021; 83:290-297. [PMID: 34954032 DOI: 10.1016/j.avsg.2021.12.005] [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] [Received: 09/03/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES While endovascular intervention is the recommended first option for management of common iliac artery (CIA) lesions, it lacks durable patency for Trans-Atlantic Inter-Society Consensus (TASC)-II C and D lesions involving the external iliac artery (EIA). Aorto-femoral bypass is a durable option but is unsuitable in patients with significant co-morbidities. Eversion endarterectomy provides an alternative to both endovascular and extensive open aortoiliac reconstruction for occlusive EIA disease. MATERIALS & METHODS A single-centre, retrospective review (2000-2020) of all patients undergoing eversion endarterectomy for EIA disease was undertaken. Demographic, clinical, operative and follow-up data were recorded. RESULTS Fifty eversion endarterectomies were performed in 47 patients. The median age was 65.0 years (46-82) and 66.6% were male. Sixty-eight percent (n=34) were ASA grade 3. Indications for intervention were disabling claudication (44%) and critical limb ischaemia (56%). Angiography demonstrated 22 TASC C and 28 TASC D lesions. The median follow-up was 18.5 months (range 0-149 months). The technical success rate was 100% and 84% (n=42) experienced an immediate symptomatic improvement. Primary and primary-assisted patency at one, three and five years was 86%, 82% and 74%, and 100%, 96% and 92%, respectively. The five-year limb salvage rate was 96%. Eight limbs required reintervention to maintain patency, either by open (n=2), endovascular (n=3) or hybrid approach (n=3). Thirty-day mortality was 2% (n=1) with 10% (n=5) experiencing a procedure-related morbidity. All-cause mortality was 38% (n=19) during the follow-up period. CONCLUSION Eversion endarterectomy is a safe, effective alternative treatment for occlusive EIA disease. This study reports durable patency at five years and low perioperative morbidity and mortality.
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Affiliation(s)
- Megan Power Foley
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Republic of Ireland.
| | - Thomas M Aherne
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Conor Dooley
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Edward Mulkern
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Ciaran O McDonnell
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Martin K O'Donohoe
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
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Wong CP, Chan LP, Au DM, Chan HWC, Chan YC. Efficacy and Safety of Intravascular Lithotripsy in Lower Extremity Peripheral Artery Disease: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 63:446-456. [PMID: 34887206 DOI: 10.1016/j.ejvs.2021.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/21/2021] [Accepted: 10/09/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Intravascular lithotripsy (IVL) is a novel technique for plaque modification during endovascular revascularisation for peripheral artery disease (PAD) with severe calcification. The aim of this paper was to perform a systematic review and meta-analysis of contemporary data to elucidate the efficacy and safety of IVL in lower extremity PAD. DATA SOURCES A systematic literature search with pre-defined search terms was performed using PubMed, Web of Sciences, OvidSP, and EMBASE. REVIEW METHODS A meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Patient characteristics, lesion calcification, pre-IVL and post-IVL diameter stenosis, complications, and stent rates were evaluated. RESULTS Nine studies were included, encompassing a total of 681 patients (769 lesions) with IVL performed for PAD, of which 75.53% (95% confidence interval [CI] 66.08% - 83.03%) of the lesions were reported to have severe calcification. Comparison between pre-IVL and post-IVL diameter stenosis demonstrated a diameter stenosis reduction of 59.3% (95% CI 53.30% - 65.31%). Vascular complications were rare, with flow limiting or type D/E/F dissection occurring in only 1.25% (95% CI 0.60% - 2.61%) of cases. The overall pooled event rate for stent placement was 15.89% (95% CI 5.22% - 39.34%). CONCLUSION This meta-analysis supports IVL as an effective and safe approach for calcified plaque modification in lower extremity PAD, achieving a diameter stenosis reduction of 59.3% (95% CI 53.30% - 65.31%) with minimal vascular complications. Routine use of this device is not recommended; further high quality evidence is required to elucidate the efficacy of IVL with respect to different clinical characteristics such as lesion location and length, and in comparison with other treatment modalities such as atherectomy.
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Affiliation(s)
- Cheuk Pang Wong
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Lok Pong Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Danise M Au
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Hui Wah Clarence Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
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Nakata A, Fukunaga M, Kawasaki D. The impact of plaque morphology in patients with peripheral artery disease on vessel dissection: an intravascular ultrasound observational study. Heart Vessels 2021; 37:961-968. [PMID: 34799790 DOI: 10.1007/s00380-021-01994-w] [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] [Received: 07/12/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Drug-coated balloon (DCB) is now available for endovascular treatment (EVT) of superficial femoral arteries (SFA). Although it has been reported that severe vessel dissection after balloon angioplasty was risk of restenosis, it is difficult to predict the vessel dissection patterns before balloon angioplasty. We investigated the correlation between plaque morphology and vessel dissection pattern after balloon angioplasty using the intravascular ultrasound (IVUS). A total of 73 de novo SFA lesions were enrolled in this study. IVUS examinations were measured at the minimum lumen area in the control angiogram. Plaque morphology, minimum lumen area (MLA) and vessel diameter at the same point were evaluated before and after the initial balloon angioplasty. Vessel dissection patterns after the initial balloon angioplasty were classified into 7 types (A to F). There were no severe dissection patterns which were more than type D dissection in this study. All patients were treated with DCB without any bailout stenting. No dissection was found in 35.6% (26/73). Type A, B and C dissections were seen in 17.8% (13/73), 40% (27/73) and 9.6% (7/73), respectively. Although there were no relations between plaque morphology and vessel dissection patterns (p = 0.547), the MLA with dissection was larger than that without dissection (5.78 mm2 versus 4.63 mm2, p = 0.032). Although the dissection patterns could not be predicted in non-severe (Non or A to C) dissection, our result might suggest that IVUS image has the potential to reduce severe dissection.
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Affiliation(s)
- Aya Nakata
- Department of Medical Engineering, Morinomiya Hospital, Osaka, Japan
| | - Masashi Fukunaga
- Cardiovascular Division, Morinomiya Hospital, 2-1-88 Morinomiya Joto-ku, Osaka, Osaka, 5360025, Japan.
| | - Daizo Kawasaki
- Cardiovascular Division, Morinomiya Hospital, 2-1-88 Morinomiya Joto-ku, Osaka, Osaka, 5360025, Japan
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Doshi R, Shah P, Majmundar M, Kumar A, Vallabhajosyula S. Comparison of supervised exercise therapy with or without revascularization for the management of intermittent claudication: SET in PAD. Eur J Intern Med 2021; 92:131-133. [PMID: 34253449 DOI: 10.1016/j.ejim.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, St Joseph's University Medical Center, 703 Main St, Paterson, NJ 07601, USA.
| | - Priyank Shah
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, GA, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Medical Center, New York, NY, USA
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Rickel AP, Deng X, Engebretson D, Hong Z. Electrospun nanofiber scaffold for vascular tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 129:112373. [PMID: 34579892 DOI: 10.1016/j.msec.2021.112373] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022]
Abstract
Due to the prevalence of cardiovascular diseases, there is a large need for small diameter vascular grafts that cannot be fulfilled using autologous vessels. Although medium to large diameter synthetic vessels are in use, no suitable small diameter vascular graft has been developed due to the unique dynamic environment that exists in small vessels. To achieve long term patency, a successful tissue engineered vascular graft would need to closely match the mechanical properties of native tissue, be non-thrombotic and non-immunogenic, and elicit the proper healing response and undergo remodeling to incorporate into the native vasculature. Electrospinning presents a promising approach to the development of a suitable tissue engineered vascular graft. This review provides a comprehensive overview of the different polymers, techniques, and functionalization approaches that have been used to develop an electrospun tissue engineered vascular graft.
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Affiliation(s)
- Alex P Rickel
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America
| | - Xiajun Deng
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America
| | - Daniel Engebretson
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America
| | - Zhongkui Hong
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America.
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Helou B, Bel-Brunon A, Dupont C, Ye W, Silvestro C, Rochette M, Lucas A, Kaladji A, Haigron P. Influence of balloon design, plaque material composition, and balloon sizing on acute post angioplasty outcomes: An implicit finite element analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3499. [PMID: 33998779 DOI: 10.1002/cnm.3499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
In this work we propose a generic modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment, and evaluating the influence of balloon design, plaque composition, and balloon sizing on acute post-procedural outcomes right after PTA, without stent implantation. Clinically-used PTA balloons were classified into two categories according to their compliance characteristics, and were modeled correspondingly. Self-defined elastoplastic constitutive laws were implemented within the plaque and artery models, after calibration based on experimental and clinical data. Finite element method (FEM) implicit solver was used to simulate balloon inflation and deflation. Besides balloon profile at max inflation, results are mainly assessed in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) obtained immediately after PTA. No variations in ERR nor LGR values were detected when the balloon design changed, despite the differences observed in their profile at max inflation. Moreover, LGR and ERR inversely varied with the augmentation of calcification level within the plaque (-11% vs. +4% respectively, from fully lipidic to fully calcified plaque). Furthermore, results showed a direct correlation between balloon sizing and LGR and ERR, with noticeably higher rates of change for LGR (+18% and +2% for LGR and ERR respectively for a calcified plaque and a balloon pressure increasing from 10 to 14 atm). However a larger LGR comes with a higher risk of arterial rupture. This proposed methodology opens the way for evaluation of angioplasty balloon selections towards clinical procedure optimization.
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Affiliation(s)
- Bernard Helou
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Aline Bel-Brunon
- Univ Lyon, INSA-Lyon, CNRS UMR5259, LaMCoS, Villeurbanne, France
| | - Claire Dupont
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | | | - Claudio Silvestro
- Medtronic, Aortic Peripheral & Venous (APV) Group, Santa Rosa, California, USA
| | | | - Antoine Lucas
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Adrien Kaladji
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Pascal Haigron
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
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The Global Anatomic Staging System Does Not Predict Limb Based Patency of Tibial Endovascular Interventions. Ann Vasc Surg 2021; 75:79-85. [PMID: 33905854 PMCID: PMC9807072 DOI: 10.1016/j.avsg.2021.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Anatomic grading systems have historically been poor predictors of patency after endovascular tibial interventions. The Global Vascular Guidelines proposed a new Global Anatomic Staging System (GLASS) to estimate one-year limb-based patency (LBP). The purpose of this study was to determine the association of GLASS with LBP following endovascular tibial interventions. METHODS We included all patients presenting to our multidisciplinary diabetic limb preservation service between 01/2012 and 8/2020 who underwent first-time endovascular tibial revascularization for chronic limb-threatening ischemia. Diagnostic angiograms were reviewed to define the preferred target artery pathway and assign a GLASS stage to each treated limb. One-year LBP was calculated and compared across GLASS stages using Kaplan-Meier curves with log-rank tests and Cox proportional hazards models. RESULTS We performed tibial revascularization in 96 limbs (5.2% rest pain, 56.3% ulcer, 37.5% gangrene), including isolated tibial interventions in 61.5% and tibial + femoropopliteal interventions in 38.5%. 15.6% of limbs were GLASS stage 1, 28.1% were GLASS stage 2, and 56.3% were GLASS stage 3. Overall, one-year LBP was 43.2 ± 6.3%, and did not differ significantly across GLASS stages (P = 0.42). The hazard ratio for failed LBP was 1.94 (95% CI 0.70-5.41) for GLASS stage 2 and 1.49 (95% CI 0.56-3.94) for GLASS stage 3 limbs (versus GLASS stage 1). When analyzed excluding the calcium modifier, LBP remained similar across GLASS stages (P = 0.72). Major amputation was uncommon, occurring in 9.3 ± 3.4% of limbs at one year, and did not significantly differ by GLASS stage (P = 0.98). CONCLUSION The Global Anatomic Staging System did not predict limb-based patency following tibial endovascular interventions. Given the low major amputation rates in this cohort, anatomic complexity should not preclude endovascular limb salvage efforts below the knee.
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