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Choinski KN, Rao AG, Krishnan P, Tadros RO, Sharma R, Faries PL. Single Center Outcomes of Percutaneous Deep Vein Arterialization in Patients with End-Stage Peripheral Artery Disease. Vasc Endovascular Surg 2024; 58:548-553. [PMID: 38164900 DOI: 10.1177/15385744231226047] [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: 01/03/2024]
Abstract
Background: Peripheral artery disease (PAD) can present as chronic limb threatening ischemia (CLTI) with ischemic pain and tissue loss. Progression of distal disease can lead to a "no option" or end-stage disease without traditional open or endovascular revascularization due to lack of pedal targets. Innovations in endovascular technology allow for the use of percutaneous deep vein arterialization (pDVA) to treat patients with CLTI. Purpose: We describe our experience and technique for treating four patients with end-stage PAD with pDVA. Research Design: Four patients with end-stage PAD were followed during and after pDVA creation. Technical success, complications, wound healing, and freedom from major amputation were analyzed. Data Collection and Analysis: Patient data and outcomes were collected via chart review and at time of follow up appointments in vascular surgery clinic. Results: Technical success was 100%, without post-procedural complications, and patients were continued on antiplatelet and anticoagulation. Three patients (75%) had successful wound healing, with 2 patients healing after transmetatarsal amputation (TMA), and 1 healing a distal foot ulceration that did not require surgery. One patient had worsening ischemic breakdown of a TMA, despite re-intervention on the pDVA, which required a below knee amputation (BKA). Freedom from major amputation was 75% overall, with an average follow-up time of 410 days post-procedure (Range: 113-563 days). Conclusions: Percutaneous deep vein arterialization attempts to provide blood flow to the preserved venous bed in patients with end-stage PAD. Exploration and utilization of this technique continues to expand in the modern vascular era. This case series highlights 4 patients with end-stage PVD who underwent pDVA, with 100% procedural success, and 75% limb salvage rate.
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Affiliation(s)
- Krystina N Choinski
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajit G Rao
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Prakash Krishnan
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raman Sharma
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter L Faries
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ravikumar N, Sreejith G, Law SHC, Anand P, Varghese N, Kagdi S, Kang N, Nashnoush M, Salam S, Ongidi I. Comparative Analysis of Endovascular Intervention and Endarterectomy in Patients with Femoral Artery Disease: A Systematic Review and Meta-Analysis. Hematol Rep 2022; 14:179-202. [PMID: 35735737 PMCID: PMC9222618 DOI: 10.3390/hematolrep14020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/25/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Abstract
Peripheral artery disease is a prevalent illness affecting more than 200 million people worldwide. A commonly used technique to manage the condition has been open endarterectomy. However, in recent times, a shift towards minimally invasive techniques has resulted in endovascular intervention as a popular alternative. This review aims to assess the safety and efficacy of endovascular intervention when compared with endarterectomy. A systematic review of the articles published in PubMed, Ovid, Embase, and Scopus within the last 10 years was conducted. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa and NICE quality assessment scales were used. A meta-analysis of proportions was performed using the RStudio software (RStudio Team (2021). RStudio: Integrated Development Environment for R, PBC, Boston, MA, USA). Twenty-six studies were included, with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). Technical success was greater for endarterectomy than endovascular intervention with an odds ratio of 0.38; 95% CI [0.27–0.54]. In terms of safety as well endovascular intervention was better than endarterectomy with an odds ratio of 0.22; 95% CI [0.15 to 0.31] for wound infection. Endovascular intervention is a safe and effective procedure; however, it cannot be considered superior to endarterectomy.
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Affiliation(s)
- Nidhruv Ravikumar
- Department of Medicine, School of Medicine, Queen’s University Belfast, Belfast BT7 1NN, UK;
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Correspondence: ; Tel.: +44-75135-44949
| | - Gopika Sreejith
- Department of Medicine, School of Medicine, Queen’s University Belfast, Belfast BT7 1NN, UK;
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
| | - Sharon Hiu Ching Law
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Prakhar Anand
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Medicine, National University of Ireland, Galway, H91 TK33 Galway, Ireland
| | - Noah Varghese
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Biochemistry, Western University, London, ON N6A 3K7, Canada
| | - Samrin Kagdi
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Biological Sciences and Health and Society, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Navneet Kang
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Mohamed Nashnoush
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- School of Health Sciences, Dalhousie University, Halifax, NS B3H 4R2, Canada
- IWK Health Center, Halifax, NS B3K 6R8, Canada
| | - Sihat Salam
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Biomedical science, York University, Toronto, ON M3J 1P3, Canada
| | - Ibsen Ongidi
- RadScholars Inc., Halifax, NS B3H 4R2, Canada; (S.H.C.L.); (P.A.); (N.V.); (S.K.); (N.K.); (M.N.); (S.S.); (I.O.)
- Department of Human anatomy, School of Medicine, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya
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