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Marulanda K, Genovese EA. Adjunctive Utilization of Intravascular Ultrasound in Peripheral Arterial Disease Treatment. Ann Vasc Surg 2024:S0890-5096(24)00163-8. [PMID: 38582216 DOI: 10.1016/j.avsg.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/17/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The utility and benefit of intravascular ultrasound (IVUS) has been well established in coronary interventions, however widespread adoption for peripheral interventions has lagged. The objectives of this review article were to discuss the technical components of IVUS, describe key learning pearls for IVUS utilization, and review the literature describing the clinical outcomes of endovascular peripheral arterial interventions using IVUS. METHODS A scoping review of the current literature utilizing Pubmed. Terms used to search the literature included "intravascular ultrasound (IVUS)" in conjunction with "peripheral arterial disease (PAD)," "endovascular interventions," "chronic limb threatening ischemia," "balloon angioplasty" "stenting," "percutaneous coronary intervention," and "outcomes." All types of articles were reviewed including review articles, retrospective reviews, meta-analyses, and prospective observational and randomized studies. RESULTS Published literature regarding IVUS use in peripheral arterial interventions is heterogeneous and limited to mainly retrospective studies, registry analyses and metanalyses. Outcomes are generally favorable with the adjunct of IVUS compared to traditional angiography-driven peripheral interventions. The addition of IVUS improves stent expansion, stent patency, and reduces reintervention rates, particularly in infrainguinal arterial lesions. Long-term costs may also be lower with IVUS-guided procedures. CONCLUSIONS Expert consensus largely supports the implementation of IVUS in endovascular interventions for peripheral arterial disease. However, more robust high-quality data evaluating the efficacy, durability, and cost of IVUS in peripheral arterial disease are still needed.
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Woods MA, Knavel Koepsel EM, Swietlik JF, Shin DS, Chick JFB, Weaver JJ, Watts MM, Laeseke P, Kleedehn MG, Monroe EJ. Intravascular US: Applications in Interventional Radiology. Radiographics 2022; 42:1742-1757. [PMID: 36190846 DOI: 10.1148/rg.220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interventional radiology applications of intravascular US (IVUS) continue to expand, complementing intraprocedural angiography and providing a unique vantage from which to guide endovascular interventions. Vascular pathologic conditions become sonographically visualized rather than inferred from the planar appearance of the opacified vascular lumen. Perivascular targets become sonographically visualized rather than approximated on the basis of fluoroscopic landmarks. The authors introduce broad categories of IVUS catheters, namely radial and side-firing varieties, as well as prevailing options for each and their technical specifications. Common applications within interventional radiology are covered in a systems approach, including deep venous thrombosis, May-Thurner syndrome, nutcracker syndrome, transjugular intrahepatic portosystemic shunts, aortic interventions, peripheral arterial disease, and endovascular or perivascular biopsy. Discussions are accompanied by technical pearls from the authors, and summarized evidence where IVUS has been shown to reduce procedural time, intravascular contrast agent dose, radiation exposure, and morbidity in each space is presented. Finally, emerging applications and future directions are discussed. ©RSNA, 2022.
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Affiliation(s)
- Michael A Woods
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Erica M Knavel Koepsel
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - John F Swietlik
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - David S Shin
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Jeffrey Forris Beecham Chick
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - John J Weaver
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Micah M Watts
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Paul Laeseke
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Mark G Kleedehn
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Eric J Monroe
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
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Secemsky EA, Parikh SA, Kohi M, Lichtenberg M, Meissner M, Varcoe R, Holden A, Jaff M, Chalyan D, Clair D, Hawkins B, Rosenfield K. Intravascular ultrasound guidance for lower extremity arterial and venous interventions. EUROINTERVENTION 2022; 18:598-608. [PMID: 35438078 PMCID: PMC10331977 DOI: 10.4244/eij-d-21-00898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
Abstract
This review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease. The purpose of this document is to provide an update in the use of IVUS in peripheral arterial and venous pathology and demonstrate the use of IVUS as a practical diagnostic imaging procedure to evaluate and treat peripheral vascular disorders. IVUS, a diagnostic tool that relies on sound waves to produce precise images of the vessel being evaluated, was originally introduced to the medical community for the purposes of peripheral artery imaging, though it was quickly adapted for coronary interventions with positive outcomes. The utility of IVUS includes vessel measurement, pre- and post-procedural planning, treatment optimisation, and detection of thrombus, dissection or calcium severity. While angiography remains the standard imaging approach during peripheral intervention, multiple observational studies and small prospective trials have shown that in comparison, IVUS provides more accurate imaging detail, which may improve procedural outcomes. IVUS can also address limitations of angiography, including the need to administer contrast medium and eliminate the ambiguity associated with other forms of imaging. This review provides contemporary examples of where IVUS is being used during peripheral intervention as well as representative imaging to serve as a resource for the practising clinician.
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Affiliation(s)
- Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy and Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Maureen Kohi
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramon Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | | | - David Chalyan
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
- Philips Healthcare, Amsterdam, the Netherlands
| | - Daniel Clair
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beau Hawkins
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Chen WP, Berman SS, Rainwater J, Pacanowski JP, Leon LR. The Use of Re-Entry Devices Through Pedal Arterial Access in the Management of Chronic Limb-Threatening Ischemia. Vasc Endovascular Surg 2022; 56:432-438. [PMID: 35209763 DOI: 10.1177/15385744221075122] [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: 11/17/2022]
Abstract
Infra-inguinal arterial chronic total occlusions remain a challenging scenario for the endovascular practitioner. Retrograde access has quickly become an essential tool in approaching such lesions, increasing the chances of crossing success. When antegrade and retrograde access techniques fail in achieving lesion crossing, re-entry devices have proven to be useful. Their use is however, somewhat limited by the size of the sheaths required to accommodate their passage. As newer and slimmer profiled sheaths become available, the possibilities of interventions available from minimally invasive approaches increases. We present 2 complex arterial revascularization cases that required intravascular ultrasound-based re-entry devices utilizing a pedal retrograde access.
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Affiliation(s)
- Winsor P Chen
- Department of Vascular and Endovascular Surgery at Pima Vascular, University of Arizona, Tucson, AZ, USA
| | - Scott S Berman
- Department of Vascular and Endovascular Surgery at Pima Vascular, University of Arizona, Tucson, AZ, USA
| | | | - John P Pacanowski
- Department of Vascular and Endovascular Surgery at Pima Vascular, University of Arizona, Tucson, AZ, USA
| | - Luis R Leon
- Department of Vascular and Endovascular Surgery at Pima Vascular, University of Arizona, Tucson, AZ, USA
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Tsitsiou Y, Ekpe J, Harris L, Kashef E, Hamady M. Use and effectiveness of Pioneer re-entry device for subintimal true lumen re-entry: single-centre data and a review of the literature. CVIR Endovasc 2021; 4:81. [PMID: 34854997 PMCID: PMC8637523 DOI: 10.1186/s42155-021-00268-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION During subintimal angioplasty (SIA), it is not always possible to re-enter the vessel lumen due to a variety of factors. Recanalization using hydrophilic wires and catheters alone, apart from its potential technical failure, is also limited by minimal control over the re-entry point. This is frequently well beyond the point of occlusion, thus often compromising important collaterals. In order to bypass the obstruction and attain controlled re-entry into the lumen of the diseased vessel, a re-entry device (RED) may be required. This paper assesses our centre's experience with the safety and efficacy of the Pioneer re-entry system and systematically reviews the pertinent literature. METHOD A single centre retrospective study of subintimal angioplasty involving the use of the Pioneer Plus intravascular guided reentry catheter was performed. Patient demographics including age, gender, risk factors, comorbidities clinical indication and complications were recorded. Lesion characteristics, including location and severity of calcification were also assessed. A systematic literature review of all reported studies where the Pioneer RED was used for iliac and lower limb revascularization was conducted by 2 of the authors using the PubMed (MEDLINE) and EMBASE databases. RESULTS The study comprised 30 cases. Technical success was 97%. A small, quickly resolved extravasation was the only device related complication. These results are in line with the systematic review which identified 16 studies using the Pioneer RED, reporting a technical success rate of 87.4-100% (median = 100%) and complication rate of 0-25.8% (median = 0%). However, due to heterogeneity in definitions of technical success, data was not pooled.
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Affiliation(s)
- Yvonne Tsitsiou
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jadesola Ekpe
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Laura Harris
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elika Kashef
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mohamad Hamady
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
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Investigation of ultrasonic chronic total occlusion system on a rabbit model. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.936595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sheikh AB, Llanos-Chea F, Jelani QUA, Anantha-Narayanan M, Attaran R, Schneider M, Ionescu C, Regan C, Nagpal S, Smolderen KG, Mena-Hurtado C. Safety and efficacy outcomes of the Pioneer Plus catheter in endovascular revascularization of lower extremity chronic total occlusions. J Vasc Surg 2021; 74:746-755. [PMID: 33592298 DOI: 10.1016/j.jvs.2021.01.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our aim was to evaluate the efficacy and safety outcomes of the Pioneer Plus catheter (Philips, San Diego, Calif) and report the in-hospital and 30-day outcomes of lower extremity chronic total occlusion (CTO) interventions assisted by the Pioneer Plus catheter. In addition, we explored the factors associated with procedural success. METHODS We conducted a retrospective review of 135 consecutive procedures in 116 patients from July 2011 to September 2018 performed by eight operators with various levels of experience at a high-volume center where the Pioneer Plus catheter was used for lower extremity CTO. The patient demographics, preprocedural symptoms, preprocedural testing results, procedural setting, and angiography findings were abstracted. The outcomes were divided into device-related and procedure-related outcomes. Device-related efficacy outcome included procedural success. Device-related safety outcomes included device-related complications. Procedure-related outcomes included procedure-related complications, 30-day major adverse cardiovascular events, and 30-day major adverse limb events. We conducted univariate comparisons of the provider, patient, and procedural characteristics stratified by procedural success. RESULTS Procedural success was observed in 118 procedures overall (87.4%), and success rates ≤95.8% were observed for operators with an experience level of >25 devices deployed. No device-related complications, such as pseudoaneurysm formation, vessel perforation, or arteriovenous fistula formation, were observed. The Pioneer Plus catheter was mostly often used for CTO in the superficial femoral and popliteal arteries. Overall, the procedure-related complications included access site hematoma (5.2%), major bleeding (0.7%), pseudoaneurysm formation (0.7%), distal embolization (1.5%), and acute arterial thrombosis (1.5%). The 30-day major adverse limb events included index limb unplanned amputation (0.7%), index limb reintervention (4.4%), and index limb acute limb ischemia (0.7%) and occurred in 5.9% of the procedures. The only factor associated with procedural success was operator experience (P < .0001). CONCLUSIONS The results from the present study have shown that Pioneer Plus catheter use is safe and effective when used to cross lower extremity CTO. However, further investigation is needed to identify patient- and provider-level factors to optimize patient outcomes.
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Affiliation(s)
- Azfar Bilal Sheikh
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn.
| | - Fiorella Llanos-Chea
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Qurat-Ul-Ain Jelani
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Mahesh Anantha-Narayanan
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Robert Attaran
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Marabel Schneider
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Costin Ionescu
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Christopher Regan
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Sameer Nagpal
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Kim G Smolderen
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Carlos Mena-Hurtado
- Vascular Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Intravascular Ultrasound in the Endovascular Treatment of Patients With Peripheral Arterial Disease: Current Role and Future Perspectives. Front Cardiovasc Med 2020; 7:551861. [PMID: 33344512 PMCID: PMC7738328 DOI: 10.3389/fcvm.2020.551861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Over the last decade, intravascular ultrasound (IVUS) has emerged as a useful adjunctive tool to angiography in an increasing number of catheter-based procedures for peripheral arterial disease (PAD). IVUS catheters offer accurate cross-sectional imaging of arterial vessels with high dimensional accuracy and provide accurate information about lesion morphology. IVUS enables assessment of the plaque morphology, vessel diameter, and the presence of arterial dissections. Furthermore, IVUS is able to properly guide the best choice of appropriate percutaneous transluminal angioplasty (PTA) technique, guide the delivery of different devices, and assess the immediate result of any endovascular intervention. In the present review, the role of IVUS for PAD will be discussed, specifically the applications of IVUS technology during interventional procedures including PTA, stent sizing, crossing total occlusion, assessing residual narrowing and stent apposition and expansion, and atherectomy. Future perspectives of IVUS-guided treatments and cost-effectiveness of the systematic use of IVUS during endovascular interventions will be also discussed.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Léo Fréchier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Frédérik Ledan
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
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Laird JR, Mathews SJ, Brodmann M, Soukas PA, Schmidt A. Performance of the Wingman catheter in peripheral artery chronic total occlusions: Short-term results from the international Wing-It trial. Catheter Cardiovasc Interv 2020; 97:310-316. [PMID: 33211386 PMCID: PMC7984280 DOI: 10.1002/ccd.29366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the safety and effectiveness of a peripheral artery chronic total occlusion (CTO) crossing catheter following failed crossing attempts with standard guidewires. BACKGROUND CTO crossing remains a challenge during peripheral artery interventions. METHODS In this prospective, international, single-arm study, patients with a peripheral artery CTO that was uncrossable with standard guidewires were treated with a crossing catheter (Wingman, Reflow Medical). The primary efficacy endpoint of CTO crossing success was compared to a performance goal of 70.7%. The primary composite safety endpoint (major adverse event [MAE], clinically significant perforation or embolization, or grade C or greater dissection) was assessed over a 30-day follow-up period and compared to a performance goal of 13.0%. RESULTS A total of 85 patients were treated using the Wingman catheter for peripheral artery CTO crossing. Key patient characteristics were mean age of 71±9 years, 66% male, and mean lesion length of 188±94 mm in the superficial femoral artery (71%), popliteal artery (15%), or infrapopliteal arteries (14%). Both primary endpoints of the trial were met¾CTO crossing success was 90% (lower confidence limit=82.5%) and 5 primary safety events occurred in 4 (4.8%) patients (upper confidence limit=10.7%). Over 30 days of follow-up, Rutherford score decreased by at least 2 categories in 74% patients; the percentage of patients with normal hemodynamics assessed with the ankle-brachial index increased from 1% to 51%. CONCLUSIONS Among patients with a CTO that was unable to be crossed with a standard guidewire, the Wingman catheter was able to cross 90% of occlusions with a favorable safety profile.
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Affiliation(s)
- John R Laird
- Adventist Heart and Vascular Institute, Adventist St. Helena Hospital, St. Helena, California
| | | | | | - Peter A Soukas
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, Rhode Island
| | - Andrej Schmidt
- Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany
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Pua U, Quek LHH, Yong E, Tan GWL. Intravascular Ultrasound-Guided Revascularization of Chronic Juxtarenal Aortoiliac Occlusion. Ann Vasc Surg 2020; 69:441-446. [PMID: 32736023 DOI: 10.1016/j.avsg.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Abstract
Chronic juxtarenal aortoiliac occlusion (JRO) represents the most severe form of aortoiliac occlusive disease, classified under Trans-Atlantic Inter-Society Consensus (TASC II) as a TASC II D lesion with surgical treatment as the main recommendation. Although endovascular revascularization of other TASC II D lesions are routinely performed, JRO is often considered a contraindication for endovascular treatment due to the extensive nature, extending from the level of the renal arteries down to the iliac arteries. We hereby illustrate an intravascular ultrasound-guided re-entry based technique to facilitate endovascular reconstruction of a JRO. A 58-year-old man with JRO presented with an infected nonhealing forefoot ulcer. A transradial pigtail catheter was positioned at the level of the occlusion as an imaging catheter and landmark for re-entry. Subintimal wiring was performed through bilateral groin accesses to the level of the pigtail catheter. Intravascular-guided re-entry catheter was used to identify the true lumen guide firing of the needle catheter, allowing passage for a guidewire into the true lumen of the suprarenal aorta. The intimal fenestration was dilated using a 4-mm angioplasty balloon which allowed passage of the contralateral guidewire. Kissing stent grafts were deployed bilaterally, extending from the level of the infrarenal aorta down to the level of the distal external iliac arteries in overlapping fashion. Completion angiography showed brisk flow from the aorta through the stented portion into the femoral arteries. The patient underwent forefoot amputation 2 days later with successful wound healing and limb salvage at 6 months.
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Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Marteslo JP, Makary MS, Khabiri H, Flanders V, Dowell JD. Intravascular Ultrasound for the Peripheral Vasculature-Current Applications and New Horizons. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:216-224. [PMID: 31780239 DOI: 10.1016/j.ultrasmedbio.2019.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
Intravascular ultrasound (IVUS) is a proven and rapidly developing imaging modality that can be used for a multitude of both diagnostic and interventional purposes. By allowing for superior intraluminal characterization, compared with angiography, IVUS has emerged as a technically valuable tool in interventional procedures such as transjugular intrahepatic portosystemic shunt/direct intrahepatic portosystemic shunt, venous interventions (May Thurner stenting, inferior vena cava filter placement, recanalization in the setting of chronic venous thrombosis/insufficiency), percutaneous fenestration in the setting of aortic dissection and angioplasty. Additional applications evaluating coronary arteries and plaque morphology have been described, but are outside the scope of this review. In addition to IVUS's merit as a pre- and intra-procedural guidance modality, there are also several advantages compared to the gold standard of angiography which include decreased need for iodinated contrast, decreased radiation exposure and decreased procedural times in certain cases. With current research, such as that aimed at supraharmonic imaging, further improvements in imaging depth, resolution and contrast to noise ratio are on the horizon.
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Affiliation(s)
- Jeffrey P Marteslo
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Hooman Khabiri
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Vince Flanders
- Northwest Radiology, St. Vincent Health, Indianapolis, Indiana, USA
| | - Joshua D Dowell
- Northwest Radiology, St. Vincent Health, Indianapolis, Indiana, USA.
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Kokkinidis DG, Katsaros I, Jonnalagadda AK, Avner SJ, Chaitidis N, Bakoyiannis C, Kakkar A, Secemsky EA, Giri JS, Armstrong EJ. Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Femoropopliteal Chronic Total Occlusions: A Systematic Review of 87 Studies and 4,665 Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:34-45. [DOI: 10.1016/j.carrev.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
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13
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Kokkinidis DG, Katsaros I, Jonnalagadda AK, Papanastasiou CA, Katamreddy A, Schizas D, Bakoyannis C, Armstrong EJ. Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Iliac Artery Chronic Total Occlusions: A Systematic Review of 30 Studies and 1112 Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:334-341. [PMID: 31227394 DOI: 10.1016/j.carrev.2019.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/12/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Management of iliac artery occlusive disease has changed dramatically over the past few decades. Secondary to advancement in endovascular technologies and techniques, percutaneous interventions have gradually replaced open surgical approaches even for the most difficult cases. In difficult to cross chronic total occlusions (CTO) of the iliac artery, subintimal angioplasty (SIA) with or without the use of re-entry devices (RED) offers a valuable alternative to intra-luminal crossing. OBJECTIVE To systematically review the literature for studies reporting procedural or short- and long-term clinical outcomes after the use of SIA, with or without RED use for iliac CTOs. METHODS PRISMA guidelines were followed. Literature search (PubMed, Cochrane CENTRAL and EMBASE) and data extraction were performed by two independent researchers. Quantitative synthesis of the reported outcomes was applied when possible. RESULTS Thirty studies met the inclusion criteria and were selected as eligible for this systematic review, with a total of 1002 patients (61.3% males) and 1112 lesions treated with SIA. RED were used in 21.9% of the lesions. Critical limb ischemia was the indication in 51.4%. The overall procedural success rates were 85.8% for SIA and 88.5% for RED. The complication rate ranged from 0 to 10% among different series, but overall it was similar among the two groups (6.9% in the RED group and 6.7% among the SIA group). One year primary patency rates were around 60% in the RED. In the SIA only arm, there was a large heterogeneity, with patency rates ranging from 51.7% to 96.8%. CONCLUSION SIA with or without RED use is a safe and effective treatment for the treatment of iliac artery CTOs. Future studies are needed to delineate whether intraluminal crossing or SIA is more effective for endovascular treatment of iliac CTOs.
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Affiliation(s)
- Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, United States.
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | - Adarsh Katamreddy
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Christos Bakoyannis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ehrin J Armstrong
- Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, United States
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Mufty H, Rex S, Fourneau I, Maleux G. Echocardiography-Guided False Lumen Catheterization for “Cheese-Wire” Technique in Complicated Type A Aortic Dissection. Ann Vasc Surg 2019; 56:340-344. [DOI: 10.1016/j.avsg.2018.08.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 01/16/2023]
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Murata K, Yamauchi S, Kaneshiro Y, Urano Y, Yamagata K, Takami T. A novel technique to visualize true lumen in endovascular treatment of the occlusive carotid dissection and the usefulness of external-internal carotid collateral channel. Interv Neuroradiol 2018; 24:533-539. [PMID: 29788812 DOI: 10.1177/1591019918776915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Dissection of the internal carotid artery (ICA) can cause occlusion or severe stenosis and is known to be one of the major causes of ischemic stroke in the young. Endovascular treatment is one of the useful options for carotid dissections, but passing the guidewire through the occlusion (lesion-cross) and confirmation of the true lumen are sometimes difficult. Case presentation A 40-year-old right-handed man complaining of dysarthria and gait disturbance consulted our hospital. Magnetic resonance imaging and angiography revealed right ICA dissection. Because of worsening symptoms with conservative treatment, we performed endovascular treatment. Prior to the lesion-cross, a microcatheter was navigated to the third segment of the internal maxillary artery and a balloon-guiding catheter was navigated to the proximal ICA. Under balloon occlusion of the ICA, superselective angiography via the ipsilateral maxillary artery and slow evacuation from the balloon-guiding catheter were performed. Thereafter, the course of the true lumen was clearly visualized, and we were able to navigate another microcatheter without difficulty. Subsequently, angioplasty and stent placement were successfully accomplished. Conclusion We presented a case of ICA dissection and demonstrated a novel technique for a safe lesion-cross for occlusive ICA dissection.
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Affiliation(s)
- Keiji Murata
- 1 Department of Neurosurgery, Shimada Municipal Hospital, Shimada, Japan
| | - Shigeru Yamauchi
- 1 Department of Neurosurgery, Shimada Municipal Hospital, Shimada, Japan
| | - Yuta Kaneshiro
- 1 Department of Neurosurgery, Shimada Municipal Hospital, Shimada, Japan
| | - Yumiko Urano
- 1 Department of Neurosurgery, Shimada Municipal Hospital, Shimada, Japan
| | | | - Toshihiro Takami
- 3 Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Kokkinidis DG, Alvandi B, Cotter R, Hossain P, Foley TR, Singh GD, Waldo SW, Laird JR, Armstrong EJ. Long-term outcomes after re-entry device use for recanalization of common iliac artery chronic total occlusions. Catheter Cardiovasc Interv 2018. [PMID: 29521465 DOI: 10.1002/ccd.27583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the impact of re-entry device (RED) use on 1- and 5-year outcomes after endovascular treatment of common iliac artery (CIA) chronic total Occlusions (CTOs). BACKGROUND There are not enough data regarding the long-term safety and efficacy of RED. METHODS We performed a two-center retrospective study of 115 patients (140 lesions) undergoing CIA CTO endovascular intervention between 2006 and 2016. Baseline characteristics and long-term outcomes were described. A Cox proportional hazard model was developed to determine if REDs were associated with target lesion revascularization (TLR) or major adverse limb events (MALE) after 1 and 5 years. RESULTS Among 140 lesions, 43 (31%) required use of a RED. The mean age was 63.9 years and the majority (n = 80) of patients were male. An antegrade crossing approach and treatment of restenotic lesions were less common in the RED group (10% vs. 29%, P < .05 and 0% vs. 21%, P < .05, respectively). There were no significant differences in Rutherford class, pre-procedure ABI, or patient presentation. The procedural complication rates were similar between the two groups. The 1- and 5-year TLR rates for lesions treated with re-entry device vs. standard approaches were 11% vs. 9%; P = 0.8 and 29% vs. 29%; P = 0.9 respectively. The 1 and 5-year MALE rates for lesions treated with re-entry device were 5% vs. 6%; P = 0.8 and 11% vs. 11%; P = 0.9 respectively. CONCLUSIONS This retrospective analysis found that recanalization of CIA occlusions using a RED is safe and is associated with long-term clinical outcomes similar to that of standard crossing techniques.
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Affiliation(s)
- Damianos G Kokkinidis
- Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado
| | - Bejan Alvandi
- Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, California
| | - Ryan Cotter
- Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado
| | - Prio Hossain
- Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, California
| | - T Raymond Foley
- Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado
| | - Gagan D Singh
- Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, California
| | - Stephen W Waldo
- Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado
| | - John R Laird
- Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, California
| | - Ehrin J Armstrong
- Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado
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Mufty H, Katsargyris A, Houthoofd S, Fourneau I, Verhoeven E, Maleux G. Technical Note: Dissection Flap Perforation with Use of a TIPS-Needle During Fenestrated Endografting for Post-dissection Thoracoabdominal Aneurysms. Cardiovasc Intervent Radiol 2018; 41:964-967. [PMID: 29511868 DOI: 10.1007/s00270-018-1922-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Fenestrated/branched thoracic endovascular aneurysm repair (F/Br-TEVAR) is a new minimal invasive treatment option for patients with post-dissection thoracoabdominal aortic aneurysms. This specific pathology is challenging to F/Br-TEVAR, especially when target vessels originate from the false lumen. Crossing from the true lumen into the false lumen to catheterize such target vessels may prove cumbersome in the usually thickened dissection flap. TECHNIQUE We describe a bailout technique when standard catheterization techniques fail, by using a transjugular intrahepatic portosystemic shunt (TIPS)-needle to perforate the dissection flap. The fenestration is subsequently dilated using balloon angioplasty to allow for insertion and deployment of the bridging stent graft. CONCLUSION When other catheterization techniques fail in vessel originating from the false lumen, TIPS-needle perforation of the dissection flap is a useful bailout tool.
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Affiliation(s)
- Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, General Hospital Nuremberg, Breslauerstr. 201, 90471, Nuremberg, Germany
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Eric Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, General Hospital Nuremberg, Breslauerstr. 201, 90471, Nuremberg, Germany
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
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Bhatt H, Janzer S, George JC. Crossing techniques and devices in femoropopliteal chronic total occlusion intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:623-631. [DOI: 10.1016/j.carrev.2017.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
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Troisi N, Ercolini L, Chisci E, Frosini P, Barbanti E, Michelagnoli S. Midterm Results of Low-Profile Stents to Treat Atherosclerotic Iliac Artery Disease. J Endovasc Ther 2017; 24:349-354. [PMID: 28511618 DOI: 10.1177/1526602817704827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of low-profile 4-F stents for the treatment of atherosclerotic iliac artery lesions. METHODS Between January 2009 and December 2015, 63 patients (mean age 69.3 years; 42 men) received low-profile stents (Astron Pulsar or Pulsar-18) at the discretion of the operator to treat iliac artery occlusive disease. The majority of patients (40, 63.5%) had critical limb ischemia; 36 of 82 lesions were total occlusions. All procedures were performed with 4-F equipment. Outcomes evaluated included mortality, patency (primary, assisted primary, and secondary), absence of target lesion revascularization (TLR), and limb salvage. Associations of patient and procedure variables with patency and TLR outcomes were sought with univariate and multivariate analysis. RESULTS Via a brachial (n=46/63) or femoral (n=17/63) access, 82 stents were successfully deployed to treat the 82 lesions, with <30% residual stenosis. The overall access-related complication rate was 1.6% (brachial artery occlusion). Mean duration of follow-up was 24.1±22.3 months (range 1-72), during which 3 patients died and 1 major amputation occurred at 10 months. The 4-year Kaplan-Meier estimate of primary patency was 76.9% (95% CI 70.2% to 83.6%); the assisted primary and secondary patency estimates were 79.3% (95% CI 73% to 85.6%) and 91% (95% CI 84.5% to 97.5%). The 4-year freedom from TLR estimate was 73.8% (95% CI 67.4% to 80.2%). On multivariate analysis, the only associations confirmed involved Rutherford category 5/6 with primary patency (hazard ratio [HR] 5.7, 95% CI 4.4 to 7, p=0.02) and assisted primary patency (HR 6.1, 95% CI 4.9 to 7.3, p=0.01). CONCLUSION Use of a low-profile 4-F stent in atherosclerotic iliac lesions was safe and effective. At 4 years, the overall patency and the absence of TLR were good. Midterm outcomes were poor in patients with Rutherford category 5/6 ischemia. Finally, the use of stents with a ≥6-mm diameter and postdeployment balloon dilation are recommended in all cases.
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Affiliation(s)
- Nicola Troisi
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Leonardo Ercolini
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Emiliano Chisci
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Piefrancesco Frosini
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Enrico Barbanti
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Stefano Michelagnoli
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
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20
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Spiliopoulos S, Kitrou P, Katsanos K, Karnabatidis D. FD-OCT and IVUS intravascular imaging modalities in peripheral vasculature. Expert Rev Med Devices 2017; 14:127-134. [PMID: 28064551 DOI: 10.1080/17434440.2017.1280391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intra-Vascular Ultra-Sound (IVUS) and Frequency Domain-Optical Coherence Tomography (FD-OCT), in vivo, intra-vascular, imaging modalities, widely used in the field of coronary disease, have been recently implemented in peripheral endovascular procedures, for procedural assessment, plaque characterization and determination of predictors of treatment outcomes. Their unique characteristics have also been used in order to provide additional features and improve the performance of re-entry devices and atherotomes. Areas covered: Present review focuses on available literature regarding these two promising imaging technologies in the peripheral vasculature, highlighting the added value produced by their use in endovascular therapy, their limitations and their utilization in new endovascular devices. Authors also provide their future perspective and the possible benefits in understanding vascular behavior and lesion characterization in peripheral endovascular interventions. Expert commentary: By providing both quantitative but also qualitative data on vessel and lesion morphology, intravascular imaging modalities offer a valid solution for endovascular treatment evaluation and outcome presentation homogeneity.
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Affiliation(s)
- S Spiliopoulos
- a 2nd Department of Radiology, Division of Interventional Radiology , Attikon University General Hospital , Athens , Greece
| | - P Kitrou
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
| | - K Katsanos
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
- c Interventional Radiology Department , Guy's and St Thomas Hospitals, NHS Foundation Trust , London , UK
| | - D Karnabatidis
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
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Radeleff B, Sumkauskaite M, Kortes N, Gnutzmann D, Mokry T, Kauczor HU, Stampfl U. [Subintimal recanalization. Indications, technique and results]. Radiologe 2016; 56:266-74. [PMID: 26885652 DOI: 10.1007/s00117-016-0078-x] [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: 11/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE This article gives an overview of the current importance of so-called subintimal recanalization in the lower extremities. STANDARD RADIOLOGICAL METHODS The primary technical goal of endovascular interventions in the lower extremities is the endoluminal restoration of blood circulation from the iliac arteries into the feet. METHODICAL INNOVATIONS If endoluminal recanalization of e.g. high-grade flow-relevant stenoses or chronic total occlusion (CTO) is technically not possible, subintimal recanalization is a promising option and the only remaining minimally invasive alternative. During subintimal recanalization a channel is intentionally generated in the vessel wall (dissection) in order to bypass e. g. a chronic vascular occlusion over as short a distance as possible. PERFORMANCE The technical success rate for subintimal recanalization of CTO of the lower extremities is 65-100 %. Technical failure occurs in approximately 25 % using the catheter and wire technique and is caused in most cases by difficulties in reaching the true lumen after the subintimal passage (the so-called re-entry). ACHIEVEMENTS Compared to conventional subintimal recanalization, in recent years so-called re-entry devices have expanded the technical possibilities and depending on the medical experience and training level of the physician, provide an improvement in the technical success rate, a lower complication rate, a reduction of fluoroscopy time and the amount of necessary contrast medium but also result in higher costs. PRACTICAL RECOMMENDATIONS Subintimal recanalization, whether carried out conventionally with a catheter and wire or using re-entry devices, of high-grade stenoses or CTO in the lower extremities provides a high technical success rate but requires an experienced and trained physician who is capable of operating the elaborate materials and mastering any possible complications.
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Affiliation(s)
- B Radeleff
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - M Sumkauskaite
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - N Kortes
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - D Gnutzmann
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - T Mokry
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - H U Kauczor
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - U Stampfl
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Suzuki K, Mizutani Y, Soga Y, Iida O, Kawasaki D, Yamauchi Y, Hirano K, Koshida R, Kamoi D, Tazaki J, Higashitani M, Shintani Y, Yamaoka T, Okazaki S, Suematsu N, Tsuchiya T, Miyashita Y, Shinozaki N, Takahashi H, Inoue N. Efficacy and Safety of Endovascular Therapy for Aortoiliac TASC D Lesions. Angiology 2016; 68:67-73. [DOI: 10.1177/0003319716638005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Although there is increasing evidence of the effectiveness of endovascular therapy for complex aortoiliac (AI) occlusive disease, it is not universally applied to TASC D lesions. Methods: A total of 2096 patients, 2601 limbs with AI occlusive disease, were enrolled. The lesions were categorized as TASC D (395) or TASC A-C (2206), and we compared baseline data, procedure, and follow-up result between the 2 groups. Results: The success rate of the procedure was significantly lower in the TASC D group (91.6% vs 99.3%, P < .01), and more procedure complications occurred in the TASC D group (11.1% vs 5.2%, P < .01). The results of a 5-year follow-up revealed no significant difference in primary patency (77.9% vs 77.1%, P = .17) and major adverse cardiovascular and limb events (MACLE; 30.5% vs 33.4%, P = .42) between the 2 groups. A multivariate analysis revealed complications and critical limb ischemia are independent predictors of MACLE in the TASC D group. Conclusion: The success rate of the procedure was lower in the TASC D group. Complications were more frequent in the TASC D group, and they were related to MACLE.
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Affiliation(s)
- Kenji Suzuki
- Department of cardiology, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Yukiko Mizutani
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | | | - Osamu Iida
- Cardiovascular Division, Kansai Rosai Hospital, Nishinomiya, Hyogo, Japan
| | | | | | - Keisuke Hirano
- Saiseikai Yokohama-City Eastern Hospital, Yokohama, Kanagawa, Japan
| | | | | | | | | | | | | | - Shinya Okazaki
- Juntendo University Nerima Hospital, Nerima, Tokyo, Japan
| | | | | | | | | | | | - Naoto Inoue
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
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Choi WG, Rha SW, Choi CU, Kim EJ, Oh DJ, Cho YH, Park SH, Lee SJ, Hur AY, Ko YG, Park SM, Kim KC, Kim JH, Kim MW, Kim SM, Bae JH, Bong JM, Kang WY, Seo JB, Jung WY, Cho JH, Kim DH, Ahn JH, Kim SH, Jang JY. Study design and rationale of the 'Balloon-Expandable Cobalt Chromium SCUBA Stent versus Self-Expandable COMPLETE-SE Nitinol Stent for the Atherosclerotic ILIAC Arterial Disease (SENS-ILIAC Trial) Trial': study protocol for a randomized controlled trial. Trials 2016; 17:302. [PMID: 27344435 PMCID: PMC4920989 DOI: 10.1186/s13063-016-1435-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/08/2016] [Indexed: 11/14/2022] Open
Abstract
Background The self-expandable COMPLETE™ stent (Medtronic) has greater elasticity, allowing it to regain its shape after the compression force reduces, and has higher trackability, thus is easier to maneuver through tortuous vessels, whereas the balloon-expandable SCUBA™ stent (Medtronic) has higher radial stiffness and can afford more accurate placement without geographic miss, which is important in aortoiliac bifurcation lesions. To date, there have been no randomized control trials comparing efficacy and safety between the self-expanding stent and balloon-expandable stent in advanced atherosclerotic iliac artery disease. Methods/design The purpose of our study is to examine primary patency (efficacy) and incidence of stent fracture and geographic miss (safety) between two different major representative stents, the self-expanding nitinol stent (COMPLETE-SE™) and the balloon-expanding cobalt-chromium stent (SCUBA™), in stenotic or occlusive iliac arterial lesions. This trial is designed as a prospective, randomized, multicenter trial to demonstrate a noninferiority of SCUBA™ stent to COMPLETE-SE™ stent following balloon angioplasty in iliac arterial lesions, and a total of 280 patients will be enrolled. The primary end point of this study is the rate of primary patency in the treated segment at 12 months after intervention as determined by catheter angiography, computed tomography angiography, or duplex ultrasound. Discussion The SENS-ILIAC trial will give powerful insight into whether the stent choice according to deployment mechanics would impact stent patency, geographic miss, or stent fracture in patients undergoing stent implantation in iliac artery lesions. Trial registration National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT01834495), registration date: May 8, 2012 Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1435-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Woong Gil Choi
- Department of Internal Medicine, School of Medicine, Konkuk University, Chungju, Korea
| | - Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul, 152-703, Korea.
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul, 152-703, Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul, 152-703, Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul, 152-703, Korea
| | - Yoon Hyung Cho
- Cardiovascular Center, Myong-Ji General Hospital, Ilsan, Korea
| | - Sang Ho Park
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seung Jin Lee
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ae Yong Hur
- Cardiovascular Center, Kangwon University, Chuncheon, Korea
| | - Young Guk Ko
- Cardiovascular Center, Severance Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Ki Chang Kim
- Cardiovascular Center, Incheon Sa-Rang General Hospital, Incheon, Korea
| | - Joo Han Kim
- Cardiovascular Center, Chunnam University Hospital, Kwangu, Korea
| | - Min Woong Kim
- Department of Cardiology, Hanyang University Medical Center Hanmaeum Hospital, Changwon, Korea
| | - Sang Min Kim
- Cardiovascular Center, Chungbuk University, Cheongju, Korea
| | - Jang Ho Bae
- Cardiovascular Center, Konyang University Hospital, Daejon, Korea
| | - Jung Min Bong
- Cardiovascular Center, Incheon, Hanlim General Hospital, Incheon, Korea
| | - Won Yu Kang
- Cardiovascular Center, Kwanju Veterans General Hospital, Kwangju, Korea
| | - Jae Bin Seo
- Cardiovascular Center, Seoul University Boraemea Hospital, Seoul, Korea
| | - Woo Yong Jung
- Cardiovascular Center, Seoul University Boraemea Hospital, Seoul, Korea
| | - Jang Hyun Cho
- Department of Cardiology, St. Carollo Hospital, Suncheon, Korea
| | - Do Hoi Kim
- Cardiovascular Center, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Ji Hoon Ahn
- Cardiovascular Center, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Soo Hyun Kim
- Department of Internal Medicine, School of Medicine, Konkuk University, Chungju, Korea
| | - Ji Yong Jang
- Department of Internal Medicine, School of Medicine, Konkuk University, Chungju, Korea
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Lyden SP, Shimshak TM. Contemporary Endovascular Treatment for Disease of the Superficial Femoral and Popliteal Arteries: An Integrated Device-Based Strategy. J Endovasc Ther 2016; 13 Suppl 2:II41-51. [PMID: 16472010 DOI: 10.1177/15266028060130s208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endovascular therapy for disease of the superficial femoral artery (SFA) and the popliteal artery remains controversial. Percutaneous treatment of this arterial segment presents a particular technical challenge, as the extent of disease varies from short, focal, and stenotic to long, diffuse, and occluded lesions. Over the last 2 decades, multiple therapies have been evaluated, including simple balloon angioplasty, directional atherectomy, stenting (both balloon-expandable and self-expanding), and more recently, intra-arterial radiation, laser, and cryotherapy. Regardless of which modality is used, however, endovascular therapy as a revascularization strategy has the potential to improve symptoms and quality of life and, in selected patients, to avoid limb amputation. While percutaneous endovascular treatment has been historically associated with high procedural success and favorable short and intermediate-term patency rates, long-term clinical results have proven disappointing. Conventional balloon angioplasty is limited by elastic recoil, dissection, and restenosis. Balloon-expandable stents (particularly in the distal SFA) are associated with late stent deformation and mechanical compression, with resultant late clinical failure. Newer self-expanding stents have shown improved initial results but have been limited by late mechanical fatigue and associated restenosis. With the development of several newer endovascular techniques in recent years, the possibilities for treating this condition have increased dramatically. Currently, no long-term comparative data exist regarding the role of these alternative technologies. This article summarizes and compares important data about new endovascular options for intervention therapy in SFA and popliteal disease. In addition, based on this analysis, we propose a contemporary treatment strategy, integrating older and newer technologies into a real-world algorithm.
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Affiliation(s)
- Sean P Lyden
- Cleveland Clinic College of Medicine at Case Western Reserve University, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Schwindt A, Reimers B, Scheinert D, Selmon M, Pigott JP, George JC, Robertson G, Janzer S, McDaniel HB, Shrikhande GV, Torsello G, Schaefers J, Saccà S, Versaci F. Crossing chronic total occlusions with the Ocelot system: the initial European experience. EUROINTERVENTION 2016; 9:854-62. [PMID: 23838387 DOI: 10.4244/eijv9i7a139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to determine the safety, efficacy and feasibility of a new chronic total occlusion (CTO) device using optical coherence tomography (OCT) technology, the Ocelot catheter (Avinger, Inc., Redwood City, CA, USA), for crossing of SFA CTOs following guidewire failure. METHODS AND RESULTS Prospective, multicentre, market preference testing. Thirty-three patients with confirmed CTO (99-100% stenosis by visual estimate) of their superficial femoral artery (SFA) were treated between September 28, 2011, and December 9, 2011, at three European centres. Ocelot crossed 94% (31/33) of CTOs, allowing guidewire placement in the distal true lumen. All (100%) lesions were treated without any major adverse safety events. Procedural time and contrast dose were significantly reduced (p<0.0001) when compared with a similar, non-OCT-guided CTO crossing device (Wildcat catheter; Avinger, Inc.). Overall physician feedback on the catheter performance was positive with an 87% average rating of excellent or good across seven categories. Performance ratings of Ocelot's OCT imaging guidance were consistently positive with an 86% average rating of excellent or good across five OCT categories. CONCLUSIONS The Ocelot catheter combines advanced CTO crossing technology with real-time OCT guidance. When compared with a similar non-OCT-guided catheter, crossing efficacy and safety profile improved. Total procedure time and contrast volumes were significantly reduced. The Ocelot is a safe, efficient and effective tool for crossing CTOs.
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Wolfschmidt F, Hassold N, Goltz JP, Leyh R, Bley TA, Kickuth R. Aortic Dissection: Accurate Subintimal Flap Fenestration by Using a Reentry Catheter with Fluoroscopic Guidance-Initial Single-Institution Experience. Radiology 2015; 276:862-72. [PMID: 25902186 DOI: 10.1148/radiol.2015140520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility, effectiveness, and safety of using a commercially available reentry catheter with fluoroscopic guidance to gain controlled target lumen reentry for fenestration in patients with aortic dissection. MATERIALS AND METHODS This retrospective study was approved by the local institutional review board; informed consent was waived. Between April 2009 and December 2013, 13 consecutive patients (10 men and three women; mean age, 51.2 years; range, 30.0-77.0 years; mean age of women, 47.0 years; range, 30.0-69.0 years; mean age of men, 52.4 years; range, 35.0-77.0 years) with aortic dissection and spinal (n = 4), renal (n = 7), mesenteric (n = 2), and/or iliofemoral (n = 9) malperfusion syndrome were included. All patients received target lumen reentry by means of balloon fenestration of the aortic dissection flap. A reentry catheter was used for fluoroscopically guided puncture of the target lumen. Technical success, clinical outcome, Stanford type of dissection, procedure time, number of fenestrations of the intimal flap per patient, necessity of additional aortic stent-graft implantation and/or placement of a bare metal stent, complications, and follow-up images were evaluated. Pre- and postinterventional systolic blood pressure gradients between the true lumen and the false lumen were compared (Wilcoxon signed-rank test). Safety of the reentry catheter maneuver was estimated with the Clopper-Pearson method. RESULTS Use of the reentry catheter was technically successful in all 13 (100%) patients and clinically successful in 10 of 13 (77%) patients. Four patients had type A and nine had type B dissection. The mean clinical follow-up period was 14.2 months. Median procedure time was 71 minutes. In four patients, fenestration of the intimal flap was performed twice. Three patients underwent additional aortic stent grafting, four patients underwent placement of an iliofemoral stent, and one patient underwent placement of a carotid artery stent. Blood pressure gradients between the true lumen and the false lumen were significantly reduced (P = .0313). One patient who had a combination of syndromes died of multiorgan failure. CONCLUSION The applied commercially available reentry catheter seems to be a reliable and safe tool that may be useful for gaining target lumen reentry with reasonably good clinical outcomes.
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Affiliation(s)
- Franziska Wolfschmidt
- From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.)
| | - Nicole Hassold
- From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.)
| | - Jan Peter Goltz
- From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.)
| | - Rainer Leyh
- From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.)
| | - Thorsten Alexander Bley
- From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.)
| | - Ralph Kickuth
- From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.)
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Dominguez A, Bahadorani J, Reeves R, Mahmud E, Patel M. Endovascular therapy for critical limb ischemia. Expert Rev Cardiovasc Ther 2015; 13:429-44. [DOI: 10.1586/14779072.2015.1019472] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Baker AC, Humphries MD, Noll RE, Salhan N, Armstrong EJ, Williams TK, Clouse WD. Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions. Ann Vasc Surg 2015; 29:55-62. [PMID: 25449989 PMCID: PMC9886056 DOI: 10.1016/j.avsg.2014.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/28/2014] [Accepted: 10/18/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subintimal angioplasty is a common treatment for chronic total occlusions (CTOs) in the iliac and infrainguinal arteries. Although technical success has been described using intravascular ultrasound-guided reentry devices (IVUS-RED), outcomes are still not well defined. This report describes the technical aspects and longitudinal follow-up after intravascular ultrasound-guided reentry of iliac and infrainguinal CTOs. METHODS A retrospective review was performed of 20 patients with lower extremity CTO treated with IVUS-RED from 2011 to 2013. A matched cohort of patients who underwent lower extremity interventions without the use of IVUS-RED was also identified. Procedural success, patency estimates, ankle-brachial indices (ABIs), complications, and limb salvage were analyzed. RESULTS Twenty patients (mean age, 69 ± 13 years), including 11 men and 9 women, underwent attempted IVUS-RED-guided recanalization. Median follow-up was 4.3 months (range, 0.4-24). Eleven patients presented with critical limb ischemia (CLI), and 9 presented with claudication. Technical success was achieved in 18 (90%) patients. Ten common iliac arteries, 3 external iliac arteries, and 5 superficial femoral arteries (SFA) were treated. No intraoperative complications resulted from device use. After procedure, ABIs significantly increased (0.5-0.9; P < 0.01) in the 13 patients with follow-up. Primary patency for the entire cohort was 62% at 12 months. No patient treated for claudication required reintervention, whereas 3 (27%) of those treated for CLI required repeat interventions. During follow-up, 2 patients died unrelated to the procedure, 1 patient required an amputation, and 1 patient eventually required open revascularization. When the IVUS-RED group was compared with a cohort matched on Trans-Atlantic Inter-Society Consensus and age, no difference was found in runoff scores and patency between the 2 groups during follow-up (P > 0.05). CONCLUSIONS Recanalization of CTO using IVUS-RED is safe and effective. Use of IVUS-RED does not adversely impact outcomes in conjunction with other endovascular techniques. Early follow-up demonstrates acceptable patency, especially in patients with claudication, and freedom from reintervention.
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Affiliation(s)
- Aaron C. Baker
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Misty D. Humphries
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Robert E. Noll
- Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA
| | - Navjeet Salhan
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Ehrin J. Armstrong
- Division of Cardiology, VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO
| | - Timothy K. Williams
- Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA
| | - W. Darrin Clouse
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA.,Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA
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Bosiers M, Diaz-Cartelle J, Scheinert D, Peeters P, Dawkins KD. Revascularization of lower extremity chronic total occlusions with a novel intraluminal recanalization device: results of the ReOpen study. J Endovasc Ther 2014; 21:61-70. [PMID: 24502485 DOI: 10.1583/12-4083r.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report outcomes of a multicenter, nonrandomized study evaluating the safety and effectiveness of a guidewire-mounted mechanical recanalization device with a rotating distal tip (TruePath) in facilitating the crossing of infrainguinal chronic total occlusions (CTOs). METHODS Eligible patients had lower extremity ischemia and an angiographically confirmed occlusion, with no antegrade flow for at least 30 days, in an infrainguinal artery. Enrollment occurred when a previous or concurrent attempt to cross the CTO with a conventional guidewire had failed. A total of 85 patients with 85 lesions were enrolled; 61 (71.8%) target lesions were in the superficial femoral artery and 68 (80%) were considered moderately or heavily calcified. Clinical evaluations were assessed immediately post procedure and at 30-day follow-up. RESULTS Freedom from clinical perforation at the time of the procedure was achieved in 98.8% of patients. The device facilitated CTO crossing into the distal true lumen (technical success) in 68 (80.0%) patients, with subsequent distal guidewire positioning in 65 (76.5%). The average ABI (n=58) improved from 0.65 (range 0.35-1.20) at baseline to 1.00 (range 0.50-2.00) through 30-day follow-up. Symptoms improved in 70 (82.4%) patients upon treatment, and improvement was maintained in 57/70 (81.4%) through 30 days. CONCLUSION The ReOpen Study demonstrated that the TruePath device is safe and effective for facilitating crossing of CTOs resistant to conventional guidewire maneuvers.
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Kavaliauskienė Ž, Benetis R, Inčiūra D, Aleksynas N, Kaupas RS, Antuševas A. Factors affecting primary patency of stenting for TransAtlantic Inter-Society (TASC II) type B, C, and D iliac occlusive disease. Medicina (B Aires) 2014; 50:287-94. [DOI: 10.1016/j.medici.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/20/2014] [Indexed: 11/17/2022] Open
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Bez LG. Midterm results of endovascular treatment of iliac artery lesions: analysis of 59 cases. J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89). Thirty seven were male (62.72%) and 22 female (37.28%). The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84%) and rest pain or trophic lesions (critical ischemia) in 29 cases (49.15%). Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years), with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.
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Affiliation(s)
- Leonardo Ghizoni Bez
- Hospital Felicio Rocho, Brazil; Instituto de Previdencia dos Servidores do Estado de Minas Gerais, Brazil
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Liang GZ, Zhang FX. Novel devices and specialized techniques in recanalization of peripheral artery chronic total occlusions (CTOs) — A literature review. Int J Cardiol 2013; 165:423-9. [DOI: 10.1016/j.ijcard.2012.03.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 11/16/2011] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
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Pigott JP, Raja ML, Davis T. A multicenter experience evaluating chronic total occlusion crossing with the Wildcat catheter (the CONNECT study). J Vasc Surg 2012; 56:1615-21. [PMID: 22975332 DOI: 10.1016/j.jvs.2012.06.071] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 03/12/2012] [Accepted: 06/03/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Percutaneous techniques for crossing femoropopliteal chronic total occlusions (CTOs) offer an alternative to bypass surgery in patients deemed to be at increased risk due to advanced age or comorbidities. Recent reports document good success rates in catheters designed to reconstitute peripherally occluded arteries following failed guidewire passage. The Wildcat catheter (Avinger, Redwood City, Calif) is a novel device with a rotating distal tip and deployable wedges fashioned for channeling a passage through arterial occlusions. This report describes the results of a prospective, multicenter, nonrandomized trial evaluating the safety and efficacy of the Wildcat device when crossing de novo or restenotic femoropopliteal CTOs. METHODS Between August 2010 and April 2011, patients with peripheral arterial disease due to a femoropopliteal CTO>1 cm and ≤35 cm were evaluated for study enrollment at 15 U.S. sites. During treatment, the physician initially attempted to cross the CTO using conventional guidewires per protocol; if the guidewire successfully crossed, the patient was considered a screen failure and the Wildcat was not deployed. At 30 days, patients were reevaluated. The primary efficacy end point was successful crossing of the Wildcat into the distal true lumen as confirmed by angiography. Primary safety end points included no in-hospital or 30-day major adverse events, no clinically significant perforation or embolization, and no grade C or greater dissection. Additional data collected included lesion length, degree of calcification, and location. RESULTS Eighty-eight patients were enrolled in the trial. Of these, the Wildcat device was used in 84 patients (95%) per protocol. Successful CTO crossing was reported and confirmed by independent review in 89% (75/84) of cases with 5% (4/84) major adverse events as defined in the protocol (predominantly perforations sealed with balloon inflation). There were no clinically relevant events associated with any of the perforations. The mean CTO length was 174±96 mm (range, 15-350 mm). Approximately 57% (n=48) of all lesions were categorized as containing at least moderate calcification. Eighty-nine percent (n=75) of vessels recanalized were superficial femoral arteries. CONCLUSIONS In this multicenter study, the Wildcat catheter demonstrated an 89% crossing success rate with little associated morbidity. The Wildcat catheter is a viable device for crossing moderately calcified femoropopliteal CTOs.
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AL-AMERI HAZIM, CLAVIJO LEONARDO, MATTHEWS RAYV, KLONER ROBERTA, SHAVELLE DAVIDM. Devices to Treat Peripheral Chronic Total Occlusions. J Interv Cardiol 2012; 25:395-403. [DOI: 10.1111/j.1540-8183.2012.00727.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Critical limb ischemia (CLI) is primarily a disease of advanced atherosclerosis but may occur in the setting of other causes. It is essential for the treating physician to understand the complexity of patients with CLI and the appropriate and emerging treatment approaches in this patient population. The authors provide a comprehensive review of the percutaneous endovascular management of CLI in this article.
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Sharafuddin MJ, Hoballah JJ, Kresowik TF, Nicholson RM, Sharp WJ. Impact of Aggressive Endovascular Recanalization Techniques on Success Rate in Chronic Total Arterial Occlusions (CTOs). Vasc Endovascular Surg 2010; 44:460-7. [DOI: 10.1177/1538574410370375] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO). Methods: Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006. Results: There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents. Mean occlusion length was 8.7 ± 4.7 cm. Conventional recanalization was attempted first and was successful in 71 limbs (70%). Probing with the guidewire’s stiff end was attempted in 33 of the 41 procedures where conventional techniques failed and was successful in 18 (54%), improving the overall procedural success rate to 80%. For the remaining 15 limbs, home-made directional sharp needle recanalization was attempted in 11 and was successful in 9 (82%), further improving the overall recanalization success to 88%. Procedural complications were self-limited or managed nonoperatively. Conclusions: Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.
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Affiliation(s)
- Melhem J. Sharafuddin
- Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA, , Department of Radiology, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - Jamal J. Hoballah
- Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - Timothy F. Kresowik
- Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - Rachael M. Nicholson
- Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - William J. Sharp
- Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
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A Novel Device for True Lumen Re-Entry After Subintimal Recanalization of Superficial Femoral Arteries: First-in-Man Experience and Technical Description. Cardiovasc Intervent Radiol 2010; 34:166-9. [PMID: 20425110 DOI: 10.1007/s00270-010-9859-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
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Krishnamurthy VN, Eliason JL, Henke PK, Rectenwald JE. Intravascular ultrasound-guided true lumen reentry device for recanalization of unilateral chronic total occlusion of iliac arteries: technique and follow-up. Ann Vasc Surg 2010; 24:487-97. [PMID: 20363107 DOI: 10.1016/j.avsg.2009.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 10/20/2009] [Accepted: 12/20/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endovascular revascularization of chronic total occlusion (CTO) of the iliac arteries is rapidly becoming first-line treatment, with surgical aortofemoral bypass procedures reserved for failure of endovascular treatment. Percutaneous subintimal recanalization is the most common endovascular revascularization technique for CTO of the iliac arteries. The primary reason for failure of the subintimal recanalization technique is failure to reenter the true lumen. This report describes the benefits of using true lumen reentry devices to improve the success and safety of conventional subintimal recanalization for revascularization of CTO of the iliac arteries. METHODS This is a retrospective review of 11 patients with CTO of the iliac arteries in whom true lumen reentry was not successful using conventional subintimal recanalization. An intravascular ultrasound (IVUS)-guided true lumen reentry device was used in all patients to assist true lumen reentry. Clinical records, procedural records, angiographic imaging, and follow-up data were analyzed. Indications for intervention, length and location of the lesion treated, access site(s), location of true lumen reentry, stent use, procedural times, technical success, and complications were analyzed in all patients. RESULTS The technical success of true lumen reentry at the desired point was 100%. Total procedure time from the start of reentry device manipulation to achieve reentry was <10 min (routinely <5 min). Mean patient follow-up was 10.5 months. At follow-up, all patients had palpable femoral pulses. The ankle-brachial index normalized (>0.9) in six patients and improved significantly in the remaining five patients. Rest pain resolved and claudication improved in all patients. Out of seven patients who had foot ulcers, the ulcers healed completely in five and demonstrated improved healing in two, with the clinical manifestation of osteomyelitis resolved in two. No procedure-related complications were noted. The amputation-free survival was 100%. CONCLUSION True lumen reentry devices greatly improve the technical success and safety of percutaneous recanalization procedures in CTO of the iliac arteries. There are significant reductions in procedure time and complication rates associated with the use of these devices.
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Affiliation(s)
- Venkataramu N Krishnamurthy
- Section of Vascular and Interventional Radiology, Ann Arbor VA Health System, Ann Arbor, MI 48109-5030, USA.
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Endovascular Abdominal Aortic Stent Placement by a Videoscopic Ultrasound-guided Technique: Evaluation in a Porcine Model. Surg Laparosc Endosc Percutan Tech 2010; 20:e19-24. [DOI: 10.1097/sle.0b013e3181cc54c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Keeling AN, Khalidi K, Leong S, Given MF, McGrath FP, Athanasiou T, Lee MJ. Subintimal Angioplasty: Predictors of Long-term Success. J Vasc Interv Radiol 2009; 20:1013-22. [DOI: 10.1016/j.jvir.2009.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 05/06/2009] [Accepted: 05/06/2009] [Indexed: 11/24/2022] Open
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Mixon TA. Novel technique using the Outback LTD catheter for a common iliac artery occlusion. Catheter Cardiovasc Interv 2009; 73:415-8. [PMID: 19133688 DOI: 10.1002/ccd.21815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present a case of an unusual arterial--arterial anastamosis that resulted from an unsuccessful attempt at crossing a total occlusion of the common iliac artery. Subsequently, we were able to successful recanalize the artery using a modified technique with the Outback reentry catheter.
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Affiliation(s)
- Timothy A Mixon
- Scott & White Hospital and Clinic Texas A & M College of Medicine Temple, TX, USA.
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Beschorner U, Sixt S, Schwarzwälder U, Rastan A, Mayer C, Noory E, Macharzina R, Buergelin K, Bonvini R, Zeller T. Recanalization of chronic occlusions of the superficial femoral artery using the outback™ re-entry catheter: A single centre experience. Catheter Cardiovasc Interv 2009; 74:934-8. [DOI: 10.1002/ccd.22130] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Treitl M, Strube H, Helmberger T, Reiser M. [Peripheral arterial disease. Diagnosis and therapy according to current guidelines]. Radiologe 2009; 48:1022-8, 1030-1. [PMID: 18806988 DOI: 10.1007/s00117-008-1705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Guidelines conduce to establish consistent standards of therapy and contribute to the orientation and safeguard of the attending physician. Peripheral arterial disease (PAD) may be classified according to its stage as intermittent claudication, chronic critical limb ischemia or acute limb ischemia. Since these diseases are common and life-threatening, current guidelines are of major interest for the attending physician, not least because of forensic reasons. This overview describes the current principles of diagnosis and therapy as well as recent developments in peripheral endovascular intervention. Current national and international guidelines, particularly the Transatlantic Intersociety Consensus (TASC), were taken into account.
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Affiliation(s)
- M Treitl
- Institut für Klinische Radiologie, Poliklinik, Klinikum Innenstadt der Ludwig-Maximilians-Universität München, München, Deutschland.
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Hans SS, DeSantis D, Siddiqui R, Khoury M. Results of endovascular therapy and aortobifemoral grafting for Transatlantic Inter-Society type C and D aortoiliac occlusive disease. Surgery 2008; 144:583-9; discussion 589-90. [PMID: 18847642 DOI: 10.1016/j.surg.2008.06.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 06/26/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the outcomes of aortoiliac stenting (AIS) to those of aortobifemoral grafting (ABF) for patients with TransAtlantic Inter-Society Consensus (TASCII) C and D aortoiliac occlusive disease. METHODS From 1998 to 2007, 32 patients underwent ABF and 40 patients underwent AIS. Kaplan-Meier estimates for patency were used. RESULTS Patients undergoing AIS were older (66.6 years ABF vs 59.2 years AIS; P=.006). The ABF group had simultaneous profundoplasty (n = 8) and femoral-popliteal graft (n =1). Six patients had treatment for concomitant infrainguinal disease at the time of AIS. There was no mortality in either group. Average hospital stay in the ABF group was 7 +/- 2 days and 1 +/- 0.3 days for AIS (P = .0001). Pulmonary complications predominated in the ABF group (13%). Four patients in the AIS group (10%) developed intraprocedural complications. Primary patency at 48 months was 69 +/- .12% for AIS and 93 +/- .07% for ABF (P = .013). There was a significant increase in ankle-brachial indices after revascularization in both groups. CONCLUSIONS TASC type C and D lesions can be treated with either ABF or AIS with satisfactory results. Compared with ABF, AIS is associated with decreased primary patency, decreased perioperative morbidity, and shorter hospital stay.
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Bozlar U, Shih MCP, Harthun NL, Hagspiel KD. Outback catheter-assisted simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. Clin Imaging 2008; 32:236-40. [DOI: 10.1016/j.clinimag.2007.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 09/28/2007] [Indexed: 11/24/2022]
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Lederman RJ. Recanalization of chronic peripheral artery occlusions: moving forward by looking sideways. Catheter Cardiovasc Interv 2008; 71:734-5. [PMID: 18412068 DOI: 10.1002/ccd.21594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ramjas G, Thurley P, Habib S. The Use of a Re-Entry Catheter in Recanalization of Chronic Inflow Occlusions of the Common Iliac Artery. Cardiovasc Intervent Radiol 2008; 31:650-4. [PMID: 18253786 DOI: 10.1007/s00270-008-9297-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 12/23/2007] [Accepted: 01/04/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Greg Ramjas
- Department of Radiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG72UH, UK
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Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 Suppl S:S5-67. [PMID: 17223489 DOI: 10.1016/j.jvs.2006.12.037] [Citation(s) in RCA: 3853] [Impact Index Per Article: 226.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L Norgren
- Department of Surgery, University Hospital, Orebro, Sweden
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Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2006; 33 Suppl 1:S1-75. [PMID: 17140820 DOI: 10.1016/j.ejvs.2006.09.024] [Citation(s) in RCA: 1795] [Impact Index Per Article: 99.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 09/15/2006] [Indexed: 01/19/2023]
Affiliation(s)
- L Norgren
- Department of Surgery, University Hospital, Orebro, Sweden.
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Lee JT, Fang TD, White RA. Applications of Intravascular Ultrasound in the Treatment of Peripheral Occlusive Disease. Semin Vasc Surg 2006; 19:139-44. [PMID: 16996415 DOI: 10.1053/j.semvascsurg.2006.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intravascular ultrasound (IVUS) has emerged as a useful and often necessary adjunct in a rising number of catheter-based peripheral interventions. IVUS catheters enable luminal and transmural cross-sectional imaging of peripheral vessels with high dimensional accuracy and provide detailed information about lesion morphology. IVUS is able to guide the optimal choice of appropriate angioplasty technique, guide the delivery of endovascular devices, and assess the immediate outcome of an intervention. In this review we discuss the role of IVUS for peripheral occlusive diseases, specifically the application of IVUS technology during percutaneous transluminal angioplasty (PTA), intravascular stent placement, crossing total occlusions, and venous obstructive disease.
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Affiliation(s)
- Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA 94305, USA.
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