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Horie K, Takahara M, Nakama T, Tanaka A, Tobita K, Hayakawa N, Mori S, Iwata Y, Suzuki K. Retrospective Multicenter Comparison Between Viabahn Covered Stent-Grafts and Supera Interwoven Nitinol Stents for Endovascular Treatment in Severely Calcified Femoropopliteal Artery Disease: The ARMADILLO Study (Adjusted Retrospective coMparison of scAffolDs In caLcified LesiOns). J Endovasc Ther 2024; 31:400-409. [PMID: 36146948 DOI: 10.1177/15266028221124727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The previous single-arm registries showed the acceptable primary patency after endovascular therapy (EVT) using covered stent-graft (CSG) and Supera interwoven nitinol stent (Supera peripheral stent [SPS]) in calcified femoropopliteal lesions. The aim of this study was to compare the safety and efficacy between CSG and SPS in calcified femoropopliteal lesions in clinical practice. MATERIALS AND METHODS We retrospectively analyzed 341 cases who had Rutherford class 2 to 6 peripheral artery disease and underwent EVT with either CSG (n=137) or SPS (n=204) for femoropopliteal lesions with bilateral calcification in fluoroscopic image, based on the Peripheral Arterial Calcium Scoring System (PACSS) classification, between April 2017 and February 2021 at 7 cardiovascular centers in Japan. RESULTS After propensity score (PS) matching, the final study population consisted of 150 matched patients with no remarkable intergroup difference in baseline characteristics. The primary patency at 1 year was not statistically different between CSG and SPS groups (81.4% vs 71.2%, p=0.32). There was also no significant difference in freedom from target lesion revascularization (82.8% vs 77.6%, p=0.28) and overall survival rate (88.6% vs 87.2%, p=0.81). The stratification analysis demonstrated that advanced age, current smoking, diabetes mellitus, and PACSS grade 4 had a significant interaction on the association of CSG versus SPS implantation with restenosis (interaction p<0.05). CONCLUSIONS In patients with bilaterally calcified femoropopliteal lesions, 1-year primary patency was not significantly different between treatments using CSG and SPS after the PS matching. CLINICAL IMPACT Covered stent-graft (CSG) and Supera interwoven nitinol stent (SPS) are reliable endovascular devices in calcified femoropopliteal lesions. This retrospective multicenter study compared the clinical outcomes between the two devices. After propensity score matching, 150 matched patients with no remarkable intergroup difference in baseline characteristics. The primary patency at 1 year was not statistically different between the CSG and SPS group (81.4% vs. 71.2%, p=0.32). There was also no significant difference in freedom from target lesion revascularization (82.8% vs. 77.6%, p=0.28) and overall survival rate (88.6% vs 87.2%, p=0.81). The two devices showed the similar efficacy in calcified femoropopliteal lesions.
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Affiliation(s)
- Kazunori Horie
- Division of Cardiovascular Medicine, Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyobay UrayasuIchikawa Medical Center, Urayasu, Japan
| | - Akiko Tanaka
- Division of Cardiovascular Medicine, Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Japan
| | - Shinsuke Mori
- Department of Cardiology, Yokohama-City Tobu Hospital, Yokohama, Japan
| | - Yo Iwata
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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Yu C, Tang W, Ren T, Chen Q, Lu R, Gao Y. Network Meta-Analysis of All Available Regimens Based on Drug-Coated Balloon Angioplasty and Laser Atherectomy for Femoropopliteal In-Stent Restenosis. J Endovasc Ther 2024; 31:390-399. [PMID: 36189843 DOI: 10.1177/15266028221125581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Drug-coated balloon (DCB) angioplasty and laser atherectomy (LA) have been frequently utilized to treat femoropopliteal in-stent restenosis (ISR); however, no studies have concurrently compared available regimens, including DCB, LA+DCB, and LA + plain balloon angioplasty (PB). Therefore, we conducted this network meta-analysis to determine whether there were significant differences in outcomes among these regimens. MATERIALS AND METHODS A comprehensive search was conducted in PubMed, EMBASE, and the Cochrane library to identify all randomized controlled trials comparing DCB or LA-based regimes with POBA or each other for treating femoropopliteal in-stent restenosis (ISR) from their inception until March 2021. The primary outcome measure was binary restenosis, and secondary outcome measures were target lesion revascularization (TLR) and mortality, evaluated at 6 and 12 months, respectively. Statistical analysis was performed using Aggregate Data Drug Information System (ADDIS) 1.4 software, and all data were graphically summarized using Microsoft Excel software. RESULTS The final analysis included 11 studies, of which 6 studies compared DCB with PB, 2 studies compared PB vs LA+PB, 2 studies compared DCB vs LA+DCB, and 1 study compared LA+DCB with LA+PB. DCB was better than PB in decreasing binary restenosis at 6 (odds ratio [OR]: 0.22, 95% credible interval [CrI]: 0.04-0.91) and 12 (OR: 0.26, 95% CrI: 0.12-0.50) months. DCB was associated with lower TLR than PB at 6 months (OR: 0.31, 95% CrI: 0.13-0.69). LA+DCB was also superior to PB in treating binary restenosis at 12 months (OR: 6.10, 95% CrI: 1.94-24.41) and TLR at 6 months (OR: 5.32, 95% CrI: 1.43-28.06). There was no statistical difference in mortality between PB, DCB, and LA+PB. DCB and LA+DCB were the first 2 options for reducing binary restenosis and TLR. CONCLUSION The current network meta-analysis demonstrates that both DCB and LA+DCB are superior to PB alone, and that DCB and LA+DCB may be the preferred treatment options for reducing binary restenosis and TLR. CLINICAL IMPACT The treatment for femoropopliteal in-stent restenosis (ISR) remains challenging clinical practice. One important reason is that no optimal treatment strategy was available. Drug-coated balloon angioplasty (DCB) and laser atherectomy (LA) have been extensively utilized to treat ISR; however, different combinations of these treatments further confused the clinicians' choices. This network meta-analysis systematically investigated the difference between the currently available treatments regarding therapeutic effects and safety, indicating that DCB and LA+DCB may be the optimal treatment for decreasing the risk of binary restenosis and target lesion revascularization. The results of the current network meta-analysis help to resolve the confusion of clinicians in making the decision.
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Affiliation(s)
- Chaowen Yu
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Wenbo Tang
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Tiancai Ren
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Qiwei Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Ran Lu
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Yong Gao
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
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Jinnouchi H, Sakakura K, Yamamoto K, Taniguchi Y, Fujita H. A unique mechanism of restenosis after drug-coated balloon in peripheral artery: Insight from optical frequency domain imaging. Cardiovasc Revasc Med 2024; 62:119-122. [PMID: 38114363 DOI: 10.1016/j.carrev.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
Drug-coated balloons (DCBs) have been widely used in endovascular therapy for femoropopliteal arteries with atherosclerotic lesions. Vascular response after DCBs remains unclear. This mini-review proposes a possible mechanism of restenosis after the DCB strategy. Balloon dilatation including DCBs expands the vascular lumen by producing dissections, which is composed of the original vascular lumen and the cavity surrounded by dissected flaps. The cavity surrounded by dissected flaps is eventually replaced with the thrombus in the healing process after balloon dilatation. However, the thrombus may propagate to the expanded vascular lumen through the entry point of the dissection. Subsequently, the thrombus both in the cavity and the expanded lumen would be organized over time. The vascular lumen in the chronic-phase after DCBs may be influenced by the propagated thrombus from the cavity surrounded by dissected flaps.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan.
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
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Trenkler C, Blessing E, Jehn A, Karcher J, Schoefthaler C, Schmidt A, Korosoglou G. Retrospective Case Control Matched Comparison of the Antegrade Versus Retrograde Strategy After Antegrade Recanalisation Failure in Complex de novo Femoropopliteal Occlusive Lesions. Eur J Vasc Endovasc Surg 2024; 67:799-808. [PMID: 38182107 DOI: 10.1016/j.ejvs.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/04/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To investigate dissection severity, need for bailout stenting and limb outcomes in patients undergoing antegrade vs. retrograde revascularisation. METHODS Consecutive patients who underwent either antegrade or retrograde revascularisation after failed antegrade recanalisation of long femoropopliteal chronic total occlusion (CTO) due to symptomatic peripheral artery disease between January 2017 and June 2022 were studied. Retrospective case control matching was used to adjust for lesion length and calcification using the peripheral artery calcification scoring system (PACSS). Procedural outcomes included severity of dissection (Type A to F dissections, numerically graded on a scale from 0 - 6 with increasing severity) after angioplasty and number and location of stents needed to be implanted during the index procedure. Additionally, clinically driven target lesion revascularisation (CD-TLR) and major (above ankle) amputation rates were assessed during follow up. RESULTS A total of 180 patients were analysed who underwent antegrade (n = 90) or retrograde after failed antegrade (n = 90) recanalisation. The median patient age was 76.0 (interquartile range [IQR] 67.0, 82.0) years and 76 (42.2%) were female. Moreover, 78 patients (43.3%) had intermittent claudication, whereas 102 (56.7%) had chronic limb threatening ischaemia (CLTI). The mean lesion length was 30.0 (IQR 24.0, 36.0) cm with moderate to severe (3.0 [IQR 2.0, 4.0]) lesion calcification. Dissection severity after angioplasty was higher in the antegrade than retrograde after failed antegrade recanalisation group (4.0 [IQR 3.0, 4.0] vs. 3.0 [IQR 2.0, 4.0]; p < .001). Additionally, the number of stents in all segments and the rate of bailout stenting in popliteal segments was significantly higher with the antegrade strategy (2.0 [IQR 1.0, 3.0] vs. 1.0 [IQR 0, 2.0], p < .010; and 37% vs. 14%, p < .001). During a median follow up of 1.48 (IQR 0.63, 3.09) years, CD-TLR rates (p = .90) and amputation rates in patients with CLTI (p = .15) were not statistically significant. CONCLUSION In complex femoropopliteal CTOs, retrograde after failed antegrade recanalisation, is safe for endovascular revascularisation, which in experienced hands may result in less severe dissections and lower rates of stent placement. However, considering the relatively short follow up, CD-TLR and amputation rates were not statistically different between the two approaches. [German Clinical Trials Register: DRKS00015277.].
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Affiliation(s)
- Christian Trenkler
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Erwin Blessing
- Department of Angiology, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Amila Jehn
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Jan Karcher
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Christoph Schoefthaler
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Andrej Schmidt
- Department of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany.
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Upadhaya S, Upreti A, Madala S, Gaddam A, Upadhrasta S, Farhan S, Wiley J. Efficacy and safety of drug-eluting stents compared with bare metal stent for femoropopliteal artery lesions. Cardiovasc Revasc Med 2024; 62:130-132. [PMID: 38185593 DOI: 10.1016/j.carrev.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Sunil Upadhaya
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Alina Upreti
- Department of Biomedical Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Anurag Gaddam
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sireesha Upadhrasta
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Jose Wiley
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Allam AK, Salem AA, Ibrahim SG, Abd Elsamea AM, Afifi HS. Straight lateral thigh femoropopliteal-femoral arteriovenous graft an alternative vascular access for patients with exhausted upper limbs dialysis access. J Vasc Access 2024; 25:854-862. [PMID: 36447353 DOI: 10.1177/11297298221139060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The durability of hemodialysis vascular access remains a troublesome issue for the patients as well as vascular surgeons that requires frequent reinterventions to maintain the access function. AIM This study aimed to evaluate straight thigh polytetrafluethylene (PTFE) arteriovenous graft (AVG) in patients with exhausted upper extremities dialysis access. METHOD Our study was a retrospective analysis of prospectively collected data of 30 patients were operated upon for straight pattern lateral thigh PTFE AVG between 2016 and 2018. The primary outcome was efficacy and patency of AVG, and secondary outcome was procedure safety, including infection, thrombosis, ligation, lower limb functional status, and mortality. RESULTS A 30 patients with 30 Lower Limb AVG with maximum 30-month follow-up period. The mean age was 48 years. Males were (n = 15/30). Thrombophilia patients were (n = 7/30). Primary patency at 6 months was 100%. It declined to 93% at 12 months, 73% at 18 months, 47% at 24 months, and 40% at 30 months. The secondary patency was 97% at 18 months, 83% at 24 months, and 73% at 30 months. More than half of the patients showed complications (n = 18/30), the most frequent was thrombosis (n = 16/18). A secondary procedure was needed for 17 patients, the most frequent was thrombectomy (n = 11/17), adjunctive culprit lesion repair was the key for regaining graft patency. Graft removal was necessary in six patients due to infection (n = 4) and ruptured graft aneurysm (n = 2). CONCLUSION Lateral straight thigh PTFE AVG is a reliable and durable alternative modality with adequate dialysis efficacy in patients with exhausted upper extremities dialysis accesses. Secondary procedures due to complications were frequent but no significant major bleeding as regard patients with ruptured graft were non-significant and no distal threatening ischemia or related deaths were observed.
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Affiliation(s)
- Ahmed K Allam
- General Surgery Department, Benha University Hospitals, Benha, Egypt
| | - Atef A Salem
- General Surgery Department, Benha University Hospitals, Benha, Egypt
| | - Samia G Ibrahim
- General Surgery Department, Benha University Hospitals, Benha, Egypt
| | | | - Haitham S Afifi
- General Surgery Department, Benha University Hospitals, Benha, Egypt
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Taneva GT, Pitoulias GA, Abu Bakr N, Kazemtash M, Muñoz Castellanos J, Donas KP. Assessment of Sirolimus- vs. paCLitaxEl-coated balloon angioPlasty In atherosclerotic femoropopliteal lesiOnS (ASCLEPIOS Study): preliminary results. J Cardiovasc Surg (Torino) 2022; 63:8-12. [PMID: 35179337 DOI: 10.23736/s0021-9509.21.12169-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There appears to be an association between paclitaxel-coated devices and increased 5-year all-cause mortality. METHODS We are conducting a prospective, randomized, controlled, single-center, noninferiority study. All consecutive patients with femoropopliteal arterial disease who fulfilled the inclusion/exclusion criteria are sequentially and consecutively assigned to either paclitaxel (Ranger, Boston Scientific) or sirolimus (MagicTouch, Concept Medical) coated balloon angioplasty treatment. The primary outcome are procedural success and primary vessel patency at index procedure. The secondary outcomes are 30-day and 12-month freedom from MAEs (amputation, death, TLR/TVR, MI, distal embolization that requires a separate intervention or hospitalization), procedural success (≤30% residual diameter stenosis or occlusion after the procedure), Rutherford category improvement (reduction ≤1 category) and ABI improvement (increase ≥0.10 from baseline). RESULTS A total of six patients have been enrolled in the present study up to now. The mean age was 72.6 years old and five were male. All patients had angiographic evidence of isolated occlusion in the transition segment of the distal femoral superficial artery in the popliteal artery. The mean length was 109 mm. Three patients were treated by sirolimus-coated (group A) and three by paclitaxel coated balloon angioplasty (group B). The primary patency and procedural success was in two of three and three of three patients, for group A and B, respectively. CONCLUSIONS Preliminary results show safety and feasibility of the Sirolimus-coated balloon angioplasty. Further investigation and increase of sample size will allow for more sustained conclusions regarding patency and procedural success of this type of balloons for the endovascular treatment of peripheral arterial disease.
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Affiliation(s)
- Gergana T Taneva
- Department of Vascular Surgery, Research Vascular Center, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany -
| | - Georgios A Pitoulias
- Second Department of Surgery, Division of Vascular Surgery, School of Medicine Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Nizar Abu Bakr
- Department of Vascular Surgery, Research Vascular Center, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Majid Kazemtash
- Department of Vascular Surgery, Research Vascular Center, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Jaime Muñoz Castellanos
- Department of Vascular Surgery, Research Vascular Center, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Konstantinos P Donas
- Department of Vascular Surgery, Research Vascular Center, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
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Donas KP, Abu Bakr N. New insights in vessel preparation options by the use of atherectomy in the treatment of calcified femoropopliteal lesions. J Cardiovasc Surg (Torino) 2022; 63:1. [PMID: 35179335 DOI: 10.23736/s0021-9509.21.12202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Donas KP, Taneva GT, Pitoulias GA, Jomha A, Schröder M, Psyllas A, Scali S, Abu Bakr N. Technical performance and reproducibility following rotational atherectomy of femoropopliteal artery occlusive lesions: analysis of the multicenter MORPHEAS Registry. J Cardiovasc Surg (Torino) 2022; 63:13-19. [PMID: 35179338 DOI: 10.23736/s0021-9509.21.12159-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The purpose of this study was to define patient and anatomical factors associated with technical results specific to rotational atherectomy. Controversy exists surrounding appropriate utilization of atherectomy to treat femoral-popliteal atherosclerosis. Importantly, the existence of different atherectomy devices and lack of technical reports highlighting variables that impact outcomes obscures the ability to assess perioperative performance. METHODS The nonindustry sponsored, Multicentric National Registry on the use of rotational atherectomy in femoral-popliteal occlusive atherosclerotic disease (MORPHEAS) database was queried. The MORPHEAS investigators included experienced providers at four centers who previously had not utilized rotational atherectomy. The primary endpoint was flow-limiting dissection and/or >50% recoil resulting in stent-placement while a secondary endpoint included peripheral thromboembolism incidence. RESULTS One hundred thirteen patients were enrolled. Only femoropopliteal occlusions were included in the analysis and anatomic distribution and calcification severity were depicted separately. The most common adjunctive therapy was drug-coated balloon angioplasty (84%; N.=96). Flow-limiting dissection was identified in 16% (N.=18) and thromboembolism occurred in 4% (N.=4). Diabetes increased risk of thromboembolism (P=0.03) while lesion length ≥8.0 cm (P=0.07) and SFA-popliteal adductor canal location (P=0.01) were associated with flow-limiting dissection. In multivariable analysis, SFA-popliteal adductor canal occlusion had a 4.7-fold risk of perioperative complications (OR=4.7, 95%CI: 1.1-21.0; P=0.04). CONCLUSIONS Rotational atherectomy was characterized by reproducible performance among four centers; however, diabetic patients, as well as those with long-segment, heavily calcified SFA-popliteal adductor canal occlusion present greatest risk of complications.
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Affiliation(s)
- Konstantinos P Donas
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany -
| | - Gergana T Taneva
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany
| | - Georgios A Pitoulias
- School of Medicine, Division of Vascular Surgery, Second Department of Surgery, G. Gennimatas Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
| | | | - Martin Schröder
- Klinicum Bad Hersfeld, University of Giessen, Bad Hersfeld, Germany
| | - Anastasios Psyllas
- Clinic of Vascular Surgery, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Salvatore Scali
- Department of Vascular Surgery, Marien Hospital Wesel, University of Cologne, Wesel, Germany
| | - Nizar Abu Bakr
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany
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Bai H, Wu H, Wang Z, Li M, Zhang Q, Song Y, Zhao T, Liu Y, Bai T. Nonatheromatous Popliteal Artery Disease. Ann Vasc Surg 2021; 79:139-144. [PMID: 34644658 DOI: 10.1016/j.avsg.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Peripheral artery disease (PAD) is often caused by atherosclerosis. However, causes other than atherosclerosis is often overlooked. Popliteal artery entrapment syndrome (PAES) and popliteal artery adventitial cystic disease (PACD) are two common nonatheromatous causes of claudication and critical limb ischemia. The purpose of this study is to present early results of treatment of PAES and PACD involving the lower limbs. METHODS From December 2019 to February 2021, 10 patients with PAES underwent surgeries, and 1 patient with PAES received conservative treatment. 2 patients with PACD underwent surgery. Patient data including age, gender, etiology of vascular pathology, diseased vessel, surgical method, and hemodynamic status were collected retrospectively. RESULTS The mean follow-up duration was 5.64 ± 3.72 months (range, 1-12 months). All patients had their symptoms improved or resolved. The success rate of surgery was 100%, the rate of freedom from reintervention for any reason was 100%. There were no death, bleeding, embolism, or skin ulcers during late follow-up. CONCLUSIONS PAES and PACD require early diagnosis and intervention, and early surgery may lead to good early- and mid-term results.
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Affiliation(s)
- Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China; Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Henan, China.
| | - Haoliang Wu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhiwei Wang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Mingxing Li
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Qiang Zhang
- Department of Vascular Surgery, Anyang District Hospital, Henan, China; Department of Vascular Surgery, First Affiliated Hospital of Henan University of Science and Technology, Henan, China
| | - Yan Song
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Tiejun Zhao
- Department of Vascular Surgery, First Affiliated Hospital of Henan University of Science and Technology, Henan, China
| | - Yuanfeng Liu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China; Department of Vascular Surgery, Anyang District Hospital, Henan, China
| | - Tao Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
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Stupalkowska W, Badawy A, Chaudhuri A. Midterm Outcomes After Endovascular Repair of Popliteal Artery Aneurysms Demonstrate Satisfactory Patency Rates and Safety of Stent Grafts. Eur J Vasc Endovasc Surg 2021; 62:658-659. [PMID: 34452838 DOI: 10.1016/j.ejvs.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/23/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Weronika Stupalkowska
- Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Ayman Badawy
- Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Arindam Chaudhuri
- Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
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12
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Labed P, Gonzalez F, Jayet J, Javerliat I, Coggia M, Coscas R. Endovascular Treatment of Long Femoropopliteal Lesions with Contiguous Bare Metal Stents. Ann Vasc Surg 2021; 76:276-284. [PMID: 34175412 DOI: 10.1016/j.avsg.2021.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Recent controversies on the use of drug coated/eluting devices in the arteries of the lower extremities renewed the focus on the evaluation of more conventional techniques. The results of the stenting of short and/or intermediate femoro-popliteal lesions are well known, but little data relate to the endovascular treatment of long femoro-popliteal lesions with contiguous bare metal stents (ETLFBS). The objective of this study was to report our results of ETLFBS. MATERIAL AND METHODS Between January 2014 and December 2017, 1233 patients had an infrainguinal angioplasty in our center. The files of patients treated for femoropopliteal lesions longer than 250 mm using extensive stenting with contiguous bare metal stents were reviewed and analyzed. The primary outcome was the 12-month primary patency, defined by the absence of restenosis (≥50%) and/or reintervention on the target lesion. Continuous data were expressed as mean and standard deviation. Survival analysis was carried out according to Kaplan-Meier. RESULTS Overall, 64 patients aged 80 ± 11 years were included, with 49 (76.6%) presenting with critical limb ischemia. Lesions were classified as TASC D in 54.7% of the cases. The length of the lesions was 295 ± 64 mm and 3 ± 1 stents were implanted. The 30-day mortality was null but two patients (3.1%) presented nonvascular major complications. With a follow-up of 27 ± 17 months, 22 patients (34.3%) died including three of vascular causes. The healing of the trophic disorder was obtained in 77.5% of the cases. The rate of amputation was 10.9%. The 6-, 12-, and 24-month primary patency rates were 79.7%, 66.6%, and 60.9%, respectively. The 6-, 12-, and 24-month rates of freedom from target lesion revascularization were 96.3%, 73.9%, and 71.9%, respectively. The 6-, 12-, and 24-month survival rates were 90.3%, 83.6%, and 65.6%, respectively. CONCLUSIONS The 12-month primary patency rate of ETLFBS is acceptable. This strategy constitutes an acceptable alternative in patients presenting with critical limb ischemia and a limited life expectancy.
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Affiliation(s)
- Paul Labed
- Service de chirurgie vasculaire, CHU Ambroise Paré, 9, avenue Charles de Gaulle, Boulogne Billancourt, France
| | - Florian Gonzalez
- Service de chirurgie vasculaire, CHU Ambroise Paré, 9, avenue Charles de Gaulle, Boulogne Billancourt, France
| | - Jérémie Jayet
- Service de chirurgie vasculaire, CHU Ambroise Paré, 9, avenue Charles de Gaulle, Boulogne Billancourt, France; UMR 1018, Inserm-Paris11 - CESP, U.F.R. des Sciences de la Santé Simone Veil, Université de Versailles-Saint-Quentin-en-Yvelines et Paris-Saclay, France
| | - Isabelle Javerliat
- Service de chirurgie vasculaire, CHU Ambroise Paré, 9, avenue Charles de Gaulle, Boulogne Billancourt, France
| | - Marc Coggia
- Service de chirurgie vasculaire, CHU Ambroise Paré, 9, avenue Charles de Gaulle, Boulogne Billancourt, France
| | - Raphael Coscas
- Service de chirurgie vasculaire, CHU Ambroise Paré, 9, avenue Charles de Gaulle, Boulogne Billancourt, France; UMR 1018, Inserm-Paris11 - CESP, U.F.R. des Sciences de la Santé Simone Veil, Université de Versailles-Saint-Quentin-en-Yvelines et Paris-Saclay, France.
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13
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Martin G, Covani M, Saab F, Mustapha J, Malina M, Patrone L. A systematic review of the ipsilateral retrograde approach to the treatment of femoropopliteal arterial lesions. J Vasc Surg 2021; 74:1394-1405.e4. [PMID: 34019987 DOI: 10.1016/j.jvs.2021.04.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The endovascular treatment of femoropopliteal lesions is an integral part of managing peripheral arterial disease. The antegrade approach is the most widely used technique with good evidence for its safety and efficacy. However, crossing a lesion, particularly chronic total occlusions (CTO), can be technically challenging and so the retrograde approach is increasingly used to maximize the chances of procedural success. The objective of this systematic review was, therefore, to assess the safety and effectiveness of the ipsilateral retrograde approach to femoropopliteal lesions. METHODS A systematic review conforming to the PRISMA standards was undertaken. MEDLINE, EMBASE, and The Cochrane Register were searched between January 1, 1988, and January 1, 2020. Full-text, English-language, peer-reviewed articles pertaining to peripheral arterial disease, endovascular intervention and access site were included. RESULTS A total of 8599 articles were screened, of which 38, involving 1940 patients undergoing 2184 retrograde procedures, were included. The mean number of patients per study was 51.1, with three studies including fewer than 10 and four more than 100 patients. The reported follow-up ranged from 30 days to 3 years, and six articles did not report any long-term outcome data. A retrograde approach was used as the primary access route in 45.% of procedures (648/1438) with relevant data. Primary technical success was achieved in 88% (1920/2184; 64%-100%) with a reported complication rate of 11% (235/2117; 0%-27%). Overall, the quality of evidence was poor, with just seven articles deemed to be of high quality with a low risk of bias. A meta-analysis was not deemed appropriate owing to heterogeneity of data. CONCLUSIONS An ipsilateral retrograde approach to femoropopliteal lesions has good primary technical success and a low rate of complications. It has a promising role as a bailout, or even a primary access technique, in complex lesions. Patient positioning, puncture site and technique, lesion anatomy, and the size of catheters and devices used are important considerations to achieve the best outcomes. There remains a paucity of robust evidence for its superiority over traditional antegrade approaches, and further work is required to identify the optimal technique and those patients who would benefit most from the approach.
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Affiliation(s)
- Guy Martin
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Marco Covani
- Faculty of Medicine, University of Messina, Messina, Italy
| | - Fadi Saab
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Mich
| | - Jihad Mustapha
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Mich
| | - Martin Malina
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Lorenzo Patrone
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom
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14
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Canton G, Hippe DS, Chen L, Waterton JC, Liu W, Watase H, Balu N, Sun J, Hatsukami TS, Yuan C. Atherosclerotic Burden and Remodeling Patterns of the Popliteal Artery as Detected in the Magnetic Resonance Imaging Osteoarthritis Initiative Data Set. J Am Heart Assoc 2021; 10:e018408. [PMID: 33998279 PMCID: PMC8483503 DOI: 10.1161/jaha.120.018408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background An artificial intelligence vessel segmentation tool, Fully Automated and Robust Analysis Technique for Popliteal Artery Evaluation (FRAPPE), was used to analyze a large databank of popliteal arteries imaged through the OAI (Osteoarthritis Initiative) to study the impact of atherosclerosis risk factors on vessel dimensions and characterize remodeling patterns. Methods and Results Magnetic resonance images from 4668 subjects contributing 9189 popliteal arteries were analyzed using FRAPPE. Age ranged from 45 to 79 years (median, 61), and 58% were women. Mean lumen diameter, mean outer wall diameter, and mean wall thickness (MWT) were measured per artery. Their median values were 5.8 mm (interquartile range, 5.2–6.5 mm), 7.3 mm (interquartile range, 6.7–8.1 mm), and 0.78 mm (interquartile range, 0.73–0.84 mm) respectively. MWT was associated with multiple cardiovascular risk factors, with age (4.2% increase in MWT per 10‐year increase in age; 95% CI, 3.9%–4.5%) and sex (8.6% higher MWT in men than women; 95% CI, 7.7%–9.3%) being predominant. On average, lumen and outer wall diameters increased with increasing MWT until the thickness was 0.92 mm for men and 0.84 mm for women. After this point, lumen diameter decreased steadily, more rapidly in men than women (−7.9% versus −6.1% per 25% increase in MWT; P<0.001), with little change in outer wall diameter. Conclusions FRAPPE has enabled the analysis of the large OAI knee magnetic resonance imaging data set, successfully showing that popliteal atherosclerosis is predominantly associated with age and sex. The average vessel remodeling pattern consisted of an early phase of compensatory enlargement, followed by a negative remodeling, which is more pronounced in men.
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Affiliation(s)
- Gador Canton
- Department of RadiologyUniversity of WashingtonSeattleWA
| | | | - Li Chen
- Department of Electrical and Computer EngineeringUniversity of WashingtonSeattleWA
| | - John C. Waterton
- Centre for Imaging SciencesManchester Academic Health Science CentreThe University of ManchesterUnited Kingdom
| | - Wenjin Liu
- Department of RadiologyUniversity of WashingtonSeattleWA
| | - Hiroko Watase
- Department of SurgeryUniversity of WashingtonSeattleWA
| | - Niranjan Balu
- Department of RadiologyUniversity of WashingtonSeattleWA
| | - Jie Sun
- Department of RadiologyUniversity of WashingtonSeattleWA
| | | | - Chun Yuan
- Department of RadiologyUniversity of WashingtonSeattleWA
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15
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Pecoraro F, Dinoto E, Pakeliani D, Mirabella D, Ferlito F, Bajardi G. Efficacy and one-year outcomes of Luminor® paclitaxel-coated drug-eluting balloon in the treatment of popliteal artery atherosclerosis lesions. Ann Vasc Surg 2021; 76:370-377. [PMID: 33951533 DOI: 10.1016/j.avsg.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Reporting outcomes with a new generation paclitaxel eluting balloon (Luminor®; iVascular, Vascular, S.L.U., Barcelona, Spain) in the popliteal district. Endovascular treatment of popliteal artery atherosclerotic disease is still debated without definitive evidences. METHODS From January to June 2019, patients' data presenting popliteal artery atherosclerotic diseases and treated with the Luminor® (iVascular) drug eluting balloon (DEB) were prospectively collected. Critical limb ischemia (CLI) or severe claudication associated with popliteal artery stenosis >50% were the inclusion criteria. Measured outcomes were technical success, early and late results; including mortality, morbidity, symptoms recurrence, amputation, ankle-brachial index (ABI), survival, primary patency, secondary patency, freedom from restenosis. Median follow-up was 22.43 ± 4 (mean:21.58; IQR:20-24) months. RESULTS Of the 33 included patients, 28 (85%) were diagnosed with CLI, with a mean preoperative run-off score of 5.39 (r:0-10; SD:3) and a chronic popliteal occlusion in 21 (64%). Technical success was achieved in all cases. Perioperative mortality was observed in 1 (3%) patient and perioperative complications in 2 (6%). During the follow-up were reported 2 symptoms recurrence; a significant ABI increase (0.57; IQR:0.41-0.47 vs. 0.69; IQR:0.50-0.67; P < 0.01); 1 (3%) major and 2 (6%) minor amputations. Estimated 24 months survival, primary patency, secondary patency, and freedom from restenosis were 97%, 96.9%, 100%, and 93.8% respectively. CONCLUSIONS In this prospective study, the use of the Luminor® (iVascular) was safe and effective in addressing atherosclerotic popliteal artery lesions. Larger studies with longer term-outcomes are required to assess the durability of this device in the popliteal artery.
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Affiliation(s)
- Felice Pecoraro
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Vascular Surgery Unit, AOUP "P. Giaccone", Palermo, Italy.
| | - Ettore Dinoto
- Vascular Surgery Unit, AOUP "P. Giaccone", Palermo, Italy
| | - David Pakeliani
- Vascular Surgery Unit, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Francesca Ferlito
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Guido Bajardi
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Vascular Surgery Unit, AOUP "P. Giaccone", Palermo, Italy
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16
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Abdoli S, Mert M, Lee WM, Ochoa CJ, Katz SG. Network meta-analysis of drug-coated balloon angioplasty versus primary nitinol stenting for femoropopliteal atherosclerotic disease. J Vasc Surg 2021; 73:1802-1810.e4. [PMID: 33249205 PMCID: PMC8330618 DOI: 10.1016/j.jvs.2020.10.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Primary nitinol stenting (PNS) and drug-coated balloon (DCB) angioplasty are two of the most common endovascular interventions for femoropopliteal atherosclerotic disease. Although many prospective randomized controlled trials have compared PNS or DCB with plain balloon angioplasty (POBA), no studies have directly compared PNS against DCB therapy. The purpose of this network meta-analysis is to determine whether there is a significant difference in outcomes between PNS and DCB. METHODS The primary outcome measure was binary restenosis, the secondary outcome measures were target lesion revascularization (TLR) and change in the ankle-brachial index (ABI). Outcomes were evaluated at 6, 12, and 24 months. A literature review identified all randomized controlled trials published before March 2020 that compared DCB with POBA or PNS with POBA in the treatment of native atherosclerotic lesions of the femoropopliteal artery. Studies were excluded if they contained in-stent stenosis or tibial artery disease that could not be delineated out in a subgroup analysis. Network meta-analysis was performed using the network and mvmeta commands in STATA 14. RESULTS Twenty-seven publications covering 19 trials were identified; 8 trials compared PNS with POBA and 11 trials compared DCB with POBA. The odds of freedom from binary restenosis for patients treated with DCB compared with PNS at 6 months was 1.19 (95% confidence interval [CI], 0.63-2.22), at 12 months was 1.67 (95% CI, 1.04-2.68), and at 24 months was 1.36 (95% CI, 0.78-2.37). The odds of freedom from TLR for patients treated with DCB compared with PNS at 6 months was 0.66 (95% CI, 0.12-3.80), at 12 months was 1.89 (95% CI, 1.04-3.45), and at 24 months was 1.68 (95% CI, 0.82-3.44). The mean increase in ABI for patients treated with PNS compared with DCB at 6 months was 0.06 higher (95% CI, -0.03 to 0.15), at 12 months was 0.05 higher (95% CI, 0.00-0.09), and at 24 months was 0.07 higher (95% CI, -0.01 to 0.14). CONCLUSIONS Both DCB and PNS demonstrated a lower rate of binary restenosis compared with POBA at the 6-, 12-, and 24-month timepoints. When comparing DCB with PNS through network meta-analysis, DCB had a statistically lower rate of a binary restenosis and TLR at the 12-month timepoint. This network meta-analysis demonstrates that both DCB and PNS are superior to POBA, and that PNS is a satisfactory substitute for DCB when paclitaxel is not desirable.
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Affiliation(s)
- Sherwin Abdoli
- Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif.
| | - Melissa Mert
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - William M Lee
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Christian J Ochoa
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Steven G Katz
- Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif; Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, Calif
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17
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Zaghloul MS, Andraska EA, Leake A, Chaer R, Avgerinos ED, Hager ES, Makaroun MS, Eslami MH. Poor runoff and distal coverage below the knee are associated with poor long-term outcomes following endovascular popliteal aneurysm repair. J Vasc Surg 2021; 74:153-160. [PMID: 33347999 DOI: 10.1016/j.jvs.2020.12.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Reports of good short-term outcomes for endovascular repair of popliteal artery aneurysms have led to an increased use of the technique. However, data are lacking on long-term limb-related outcomes and factors associated with the failure of endovascular repair. METHODS All patients who underwent endovascular popliteal aneurysm repair (EPAR) at a single institution from January 2006 to December 2018 were included in the study. Demographics, indications, anatomic and operative details, and outcomes were reviewed. Long-term patency, major adverse limb event-free survival (MALE-FS) and graft loss/occlusion were analyzed with multivariable cox regression analysis and Kaplan-Meier curves. RESULTS We included 117 limbs from 101 patients with a mean follow-up of 55.6 months (range, 0.43-158 months). The average age was 73 ± 9.3 years. Thirty-two patients (29.1%) were symptomatic (claudication, rest pain, tissue loss, or rupture). The stent grafts crossed the knee joint in 91.4% of cases. In all, 36.8% of procedures used one stent graft, 41.0% used two stent grafts, and 22.2% of procedures used more than two stent grafts. The median arterial length covered was 100 mm, with an average length of stent overlap of 25 mm. Tapered configurations were used in 43.8% of cases. The majority of limbs (62.8%) had a three-vessel runoff, 20.2% had a two-vessel runoff, and 17% has a one-vessel runoff. The Kaplan-Meier estimates of graft occlusion at 1 and 3 years were 6.3% and 16.2%, respectively. The 1- and 3-year primary patency rates were 88.2% and 72.6%, and the 1- and 3-year major adverse limb event-free survival (MALE-FS) rates were 82% and 57.4%. The 1- and 3-year survival rates were 92.9% and 76.2%, respectively. On multivariable Cox regression, aneurysm size, one-vessel runoff, and coverage below the knee were associated with a lower 3-year MALE-FS. Coverage below the knee was also associated with a lower 3-year MALE-FS. Other anatomic or technical details were not associated with limb-related events or patency. CONCLUSIONS This study is the largest single center analysis to describe the predictors of poor outcomes after EPAR. EPAR is a safe and effective way to treat popliteal artery aneurysms. Factors associated with poor MALE-FS after EPAR include single-vessel tibial runoff and coverage below the knee.
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Affiliation(s)
- Mohamed S Zaghloul
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Elizabeth A Andraska
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Andrew Leake
- Vascular Surgery Associates of Richmond, PC, Richmond, Va
| | - Rabih Chaer
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Efthymios D Avgerinos
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Eric S Hager
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Michel S Makaroun
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Mohammad H Eslami
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa.
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Krawisz AK, Raja A, Secemsky EA. Femoral-popliteal peripheral artery disease: From symptom presentation to management and treatment controversies. Prog Cardiovasc Dis 2021; 65:15-22. [PMID: 33592208 PMCID: PMC8169531 DOI: 10.1016/j.pcad.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
Peripheral artery disease (PAD) is a common condition with increasing prevalence domestically and worldwide. Patients with PAD have a poor prognosis, as PAD is associated with high rates of myocardial infarction, ischemic stroke, and cardiovascular disease death. The primary symptom of PAD, claudication, significantly reduces quality of life and functional status and is associated with depression. In addition to several advances in medications for PAD over the last decade, endovascular device therapy has seen a significant breakthrough in the form of paclitaxel-coated devices (PCDs), which significantly reduce rates of restenosis relative to non-PCDs, a finding which has been demonstrated in numerous randomized clinical trials. After their introduction to the market in 2012 (paclitaxel-eluting stents) and 2014 (paclitaxel-coated balloons) their use surged as they replaced non-PCDs and were designated the first-line endovascular therapy by society guidelines. This trend was abruptly reversed, however, after a meta-analysis of summary-level data was published in December of 2018 that reported an elevated mortality associated with PCDs compared with non-PCDs 2-5 years after treatment. This meta-analysis has been criticized for considerable methodological flaws. The Food and Drug Administration conducted a review and concluded that insufficient data existed to make a definitive statement regarding the safety of PCDs. They called for restriction of the use of PCDs to the highest-risk patient populations. At the same time, the FDA deemed pursuing new RCTs to better evaluate PCDs unfeasible due to the high numbers of patients and long follow-up time that would be required. In this setting, real-world data emerged as a powerful source of information for the evaluation of PCDs. Real-world data offers advantages over randomized-controlled trials including expeditious access to and analysis of data and the availability of large numbers of patients. Several retrospective observational studies demonstrate no difference in long-term all-cause mortality in patients treated with PCDs relative to those treated with non-PCDs. This paclitaxel controversy has illustrated the critical role that real-world data is assuming in long-term safety monitoring of medical devices.
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Affiliation(s)
- Anna K Krawisz
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aishwarya Raja
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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19
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Zhang R, Ni L, Zeng R, Lai Z, Di X, Zhao Z, Xie Z, Wang X, Ma B, Liu C. An indirect comparison by Bayesian network meta-analysis of drug-coated devices versus saphenous vein graft bypass in femoropopliteal arterial occlusive disease. J Vasc Surg 2021; 74:478-486.e11. [PMID: 33600930 DOI: 10.1016/j.jvs.2020.11.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the efficacy and safety between drug-coated devices (DCDs) and bypass surgery with saphenous vein graft (BSV) in femoropopliteal arterial occlusive disease. METHODS A Bayesian network meta-analysis and indirect comparison were performed. Randomized controlled trials of BSV, bypass surgery with prosthetic graft, bare metal stents, endoluminal bypass (covered stent), percutaneous transluminal angioplasty, and DCDs treating femoropopliteal arterial occlusive disease were collected. The primary end point was target lesion revascularization/target vessel revascularization, and secondary end points were all-cause mortality, limb salvage, and early complications (PROSPERO registry number: CRD42019136530). RESULTS Forty-two trials and 6867 patients were included. The comparison of DCDs and BSV revealed no significant difference in the 1-year target lesion revascularization/target vessel revascularization (DCDs vs BSV: odds ratio [OR], 0.60; 95% credible interval [CrI], 0.16-2.39). Total early complications from BSV were significantly higher than those from DCDs (DCDs vs BSV: OR, 0.14; 95% CrI, 0.05-0.45), and the main complications of BSV were not death related. There was also no significant difference in systemic early complications (DCDs vs BSV: OR, 0.19; 95% CrI, 0.00-7.82) and 1-year amputation rate (DCDs vs BSV: OR, 2.81; 95% CrI, 0.16-89.53). The 30-day (DCDs vs BSV: OR, 0.38; 95% CrI, 0.00-110.46), 1-year (DCDs vs BSV: OR, 0.96; 95% CrI, 0.24-3.29), 2-year (DCDs vs BSV: OR, 1.60; 95% CrI, 0.64-4.95), and 5-year all-cause mortality rates (DCDs vs BSV: OR, 2.05; 95% CrI, 0.92-4.39) showed no significant differences between DCDs and BSV, although there was a noticeable tendency toward significant results of a higher 5-year mortality rate. CONCLUSIONS There is no significant difference between DCDs and BSV in short-term efficacy or short- and long-term mortality. Despite traditional BSV remaining the gold standard, DCDs provide a reasonable alternative therapy. In addition, the DCDs have a lower short-term morbidity associated with the procedure at the cost of the possible risk of higher long-term mortality. Clinical trials with more validity are required for a direct comparison between BSV and DCDs.
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Affiliation(s)
- Rui Zhang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Leng Ni
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Zeng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Di
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhewei Zhao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhibo Xie
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuebin Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Baitao Ma
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Xu Y, Liu J, Zhang J, Zhuang B, Jia X, Fu W, Wu D, Wang F, Zhao Y, Guo P, Bi W, Wang S, Guo W. Long-term safety and efficacy of angioplasty of femoropopliteal artery disease with drug-coated balloons from the AcoArt I trial. J Vasc Surg 2021; 74:756-762.e3. [PMID: 33600928 DOI: 10.1016/j.jvs.2021.01.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We evaluated the long-term safety and efficacy of treatment using drug-coated balloons (DCBs) in Chinese patients with severe femoropopliteal artery (FPA) disease (FPAD). METHODS In this prospective, multicenter, randomized controlled trial, 200 Chinese patients with FPAD were prospectively randomized to undergo percutaneous transluminal angioplasty with a DCB or an uncoated balloon (UCB). The clinical endpoints were all-cause mortality, clinically driven target lesion revascularization, and major amputation of the treated leg within 5 years after treatment. RESULTS During the 5-year follow-up period, freedom from all-cause mortality was 82.7% in the DCB group compared with 73.2% in the UCB group (log-rank P = .262). Freedom from clinically driven target lesion revascularization was 77.5% in the DCB group vs 59.1% in the UCB group (log-rank P < .001). No device- or procedure-related deaths occurred in either group. Cox regression analysis revealed that coronary heart disease and provisional FPA lesion stenting were associated with an increased mortality risk and the nominal paclitaxel dose was not associated with mortality during the 5-year follow-up period. CONCLUSIONS We found no significant differences in 5-year mortality between patients with FPAD treated with DCBs vs UCBs. The clinical benefit of DCBs vs UCBs in terms of clinically driven target lesion revascularization persisted for the 5-year period.
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Affiliation(s)
- Yongle Xu
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jie Liu
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jiwei Zhang
- Department of Vascular Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Baixi Zhuang
- Department of Peripheral Vascular Disease, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Danming Wu
- Department of Vascular Surgery, The People's Hospital of Liaoning Province, Shenyang, Shenyang, China
| | - Feng Wang
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Zhao
- Department of Vascular Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pingfan Guo
- Department of Vascular Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wei Bi
- Department of Vascular Surgery, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shenming Wang
- Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China.
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21
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DeCarlo C, Boitano LT, Latz CA, Png CYM, Lee S, Dua A, Patel V, Schwartz SI. Patients with failed femoropopliteal covered stents are more likely to present with acute limb ischemia than those with failed femoropopliteal bare metal stents. J Vasc Surg 2021; 74:161-169.e1. [PMID: 33548436 DOI: 10.1016/j.jvs.2021.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Covered stents (CS) to treat superficial femoral artery (SFA) occlusive disease have become more common. However, concerns about patients presenting with acute limb ischemia (ALI) after failure due to coverage of important collaterals have been raised. Herein, we determine if CS are associated with ALI after failure. METHODS Vascular Quality Initiative peripheral vascular intervention and infrainguinal bypass datasets were queried from 2010 to 2020 for patients who underwent SFA stenting with a bare metal stent (BMS) or CS and who also had a subsequent ipsilateral SFA endovascular reintervention or bypass recorded in the Vascular Quality Initiative. The initial SFA stenting procedure will be referred to as the index procedure and the subsequent procedure will be referred to as the reintervention. Patients with aneurysmal pathology, prior infrainguinal bypass, and ALI at the index procedure were excluded. Patients with pre-index inflow/outflow procedures were not excluded. The primary outcome was ALI at reintervention. Other outcomes included higher degree of ischemia (claudication vs rest pain vs tissue loss vs ALI) and reoperative factors. Predictors of the primary outcome were determined with multivariable logistic regression. The index treatment length and pre-index ankle-brachial index were forced into the model. RESULTS There were 3721 patients: 3338 with index BMS, 383 with index CS. The mean patients age was 66.3 ± 11.0 years and 59.2% were male. Baseline covariates were similar between the groups; during the index procedure, more patients with BMS underwent plain balloon angioplasty (68.7% vs 62.1%; P = .001) and had shorter total index treatment length (median, 15.0 cm [interquartile range, 10.0-25.0 cm] vs 20.0 cm [interquartile range, 12.0-30.0 cm]; P < .001). At reintervention, ALI was the presenting symptom for 12.0% of the CS cohort vs 6.3% of the BMS cohort (P < .001). More patients with an index CS underwent major amputation at the time of reintervention (2.6% vs 1.0%; P = .006). Reinterventions for the patients with a CS more often used bypass, pharmacologic thrombolysis, and mechanical thrombolysis. CS at the index procedure was a predictor of ALI at reintervention (odds ratio, 1.87; 95% confidence interval, 1.31-2.65; P = .001) while controlling for age, time difference between procedures, body mass index, chronic obstructive pulmonary disorder, preoperative anticoagulation and antiplatelet, prior carotid intervention and major amputation, index procedure fluoroscopy time and treatment length, and pre-index ankle-brachial index. CONCLUSIONS In patients undergoing reintervention for failed SFA stents, CS are more likely to present with ALI than those with failed SFA BMS.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Laura T Boitano
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Chris A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Sujin Lee
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Virendra Patel
- Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian, Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Samuel I Schwartz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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22
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Torsello G, Stavroulakis K, Brodmann M, Micari A, Tepe G, Veroux P, Benko A, Choi D, Vermassen FEG, Jaff MR, Guo J, Dobranszki R, Zeller T. Three-Year Sustained Clinical Efficacy of Drug-Coated Balloon Angioplasty in a Real-World Femoropopliteal Cohort. J Endovasc Ther 2020; 27:693-705. [PMID: 32583749 PMCID: PMC7545651 DOI: 10.1177/1526602820931477] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: To report the 36-month outcomes from the prospective, multicenter, single-arm IN.PACT Global Study (ClinicalTrials.gov identifier NCT01609296) evaluating the performance of the IN.PACT Admiral drug-coated balloon (DCB) in real-world patients with femoropopliteal occlusive disease. Materials and Methods: The IN.PACT Global Study was conducted at 64 international sites and enrolled 1535 patients with complex lesions, which included bilateral disease, multiple lesions, de novo in-stent restenosis, long lesions, and chronic total occlusions. The predefined full clinical cohort included 1406 patients (mean age 68.6 years; 67.8% men) with claudication or rest pain treated with the study DCB. Mean lesion length was 12.09±9.54 cm; 18.0% had in-stent restenosis, 35.5% were totally occluded, and 68.7% were calcified. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated through 36 months. The safety composite endpoint was freedom from device- and procedure-related death through 30 days and freedom from major target limb amputation and clinically-driven target vessel revascularization within 36 months. All safety and revascularization events were reviewed by an independent clinical events committee. Results: The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was 76.9%. The composite safety endpoint was achieved in 75.6% of patients. The 36-month all-cause mortality rate was 11.6%, and the major target limb amputation rate was 1.0%. The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was significantly lower in patients with chronic limb-threatening ischemia (CLTI) compared with claudicants (67.6% vs 78.0%; p=0.003). Lesions affecting both the superficial femoral artery (SFA) and popliteal artery had lower Kaplan-Meier freedom from CD-TLR through 36 months (69.2%) than either isolated SFA (79.7%) or popliteal artery lesions (76.5%; log- rank p<0.001). Predictors of CD-TLR through 36 months included increased lesion length, reference vessel diameter ≤4.5 mm, in-stent restenosis, bilateral disease, CLTI, and hyperlipidemia. Conclusion: DCB angioplasty with the IN.PACT Admiral DCB for femoropopliteal disease in a diverse and complex real-world population is associated with sustained clinical efficacy and low rates of reinterventions at 3 years after the initial procedure.
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Affiliation(s)
- Giovanni Torsello
- Department of Vascular Surgery, St Franziskus-Hospital Münster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, St Franziskus-Hospital Münster, Germany
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | | | - Antonio Micari
- Department of Cardiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Gunnar Tepe
- Institute of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany
| | | | - Andrew Benko
- Division of Interventional Radiology, Faculté de Medecine, Université de Sherbrooke, Quebec, Canada
| | - Donghoon Choi
- Department of Internal Medicine, Yonsei University Hospital, Seoul, South Korea
| | | | | | - Jia Guo
- Medtronic, Minneapolis, MN, USA
| | - Reka Dobranszki
- Medtronic, Bakken Research Center BV, Maastricht, Netherlands
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
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Levin SR, Farber A, Osborne NH, Beck AW, McFarland GE, Rybin D, Cheng TW, Siracuse JJ. Tibial bypass in patients with intermittent claudication is associated with poor outcomes. J Vasc Surg 2020; 73:564-571.e1. [PMID: 32707381 DOI: 10.1016/j.jvs.2020.06.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/19/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Given that intermittent claudication (IC) rarely progresses to chronic limb-threatening ischemia and limb loss, safety and durability of elective interventions for IC are essential. Whether patients with IC benefit from tibial intervention is controversial, and data supporting its utility are limited. Despite endovascular therapy expansion, surgical bypass is still commonly performed. We sought to assess outcomes of bypass to tibial arteries for IC. METHODS The Vascular Quality Initiative (2003-2018) was queried for infrainguinal bypasses performed for IC. Perioperative and 1-year outcomes were compared between bypasses constructed to tibial and popliteal arteries. RESULTS Of 5347 infrainguinal bypasses, 1173 (22%) and 4184 (78%) were tibial and popliteal bypasses, respectively. Overall, mean age was 65 ± 10 years, and patients were often men (72%) and current smokers (42%). Tibial bypasses commonly targeted posterior tibial (40%), tibioperoneal trunk (23%), and anterior tibial (19%) arteries. Great saphenous vein was more often used for tibial bypass than for popliteal bypass (78% vs 54%; P < .001). Patients undergoing tibial compared with popliteal bypass more often had impaired ambulation and prior ipsilateral bypasses and were less often taking antiplatelets and statins (all P < .05). In the perioperative period, tibial bypass patients had longer postoperative length of stay (4.5 ± 3.5 vs 3.5 ± 2.8 days), more pulmonary complications (1.3% vs 0.6%), and higher return to the operating room (7% vs 4%; all P < .05). Perioperative myocardial infarction (1.2% vs 0.8%; P = .19), stroke (0.4% vs 0.4%; P = .91), and mortality (0.3 vs 0.3%; P = .86) rates were similar between the cohorts. At 1 year, tibial compared with popliteal bypasses exhibited lower freedom from occlusion/death (81% vs 89%; P < .001), ipsilateral major amputation/death (90% vs 94%; P < .001), and reintervention/amputation/death (73% vs 80%; P < .001), but patient survival was similar (96% vs 97%; P = .07). On multivariable analysis, tibial compared with popliteal bypass was independently associated with increased occlusion/death (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.28-2.11; P < .001), major ipsilateral amputation/death (HR, 1.6; 95% CI, 1.12-2.19; P = .003), and ipsilateral reintervention/amputation/death (HR, 1.51; 95% CI, 1.28-1.79; P < .001), with similar patient survival. CONCLUSIONS In patients with IC, tibial bypass was associated with poor outcomes, including major amputation. Surgeons should exhaust nonoperative therapies and present realistic outcome expectations to their patients before offering such intervention.
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Affiliation(s)
- Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | | | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
| | - Graeme E McFarland
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
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Mathlouthi A, Yei KS, Naazie I, Bertges DJ, Malas MB. Increased mortality with paclitaxel-eluting stents is driven by lesion length. J Vasc Surg 2020; 73:548-553.e2. [PMID: 32615286 DOI: 10.1016/j.jvs.2020.05.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endovascular stenting has become the first-line treatment of symptomatic peripheral artery disease of the femoropopliteal axis (FPA). Several randomized clinical trials have reported that paclitaxel-eluting stents (PESs) significantly reduce the rates of restenosis. However, a meta-analysis investigating paclitaxel-coated devices in the FPA showed a significant increase in all-cause mortality after the use of PES. The aim of this study was to compare the long-term, real-world outcomes of bare-metal stents (BMSs) and PESs for treating FPA occlusive disease. METHODS A retrospective review of the medical records of 296 patients who underwent FPA stenting between January 2011 and December 2017 was performed. Patients were grouped into BMS and PES groups. The primary end point was all-cause mortality. Secondary end points included limb salvage, primary patency, primary assisted patency, and secondary patency. A comparison between the two groups within TransAtlantic Inter-Society Consensus (TASC) II subgroups was also performed. RESULTS Of the study cohort, 101 patients (34%) received PES, whereas 195 patients (66%) underwent BMS placement. Median follow-up time was 23 months (interquartile range, 7-40 months). The 2-year all-cause mortality estimates were 12% for the PES group compared with 11.4% for the BMS group (P = .26). There were no differences in the 2-year limb salvage (90.7% vs 92%; P = .4), primary patency (78.8% vs 81.1%; P = .62), primary assisted patency (100% vs 96.5%; P = .4), and secondary patency (100% vs 98.6%; P = .26) between the PES and the BMS groups, respectively (all P > .05). These findings persisted when patients were stratified by TASC II lesions. Among patients with TASC C and D lesions, the use of PES was associated with significantly higher 2-year all-cause mortality (23.9% vs 5.1%; P = .05). After adjustment for age and other potential confounders, PES use was associated with significant increase in all-cause mortality (adjusted hazard ratio, 2.3; 95% confidence interval, 1.31-27 P = .02) in TASC C and D patients. CONCLUSIONS Consistent with the meta-analysis of several randomized clinical trials, the use of PES in a real-world setting was associated with a twofold increase in the risk of death. However, these findings were seen only among patients with TASC C and D lesions, who required multiple longer stents and potentially larger paclitaxel dose. There was no advantage in terms of patency in PES vs BMS in this population with extensive disease. Further studies of larger populations are required.
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Affiliation(s)
| | - Kevin S Yei
- University of California San Diego, San Diego, Calif
| | - Isaac Naazie
- University of California San Diego, San Diego, Calif
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25
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Guo S, Zhang Z, Wang L, Yuan L, Bao J, Zhou J, Jing Z. Six-month results of stenting of the femoropopliteal artery and predictive value of interleukin-6: Comparison with high-sensitivity C-reactive protein. Vascular 2020; 28:715-721. [PMID: 32408853 DOI: 10.1177/1708538120921005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the association of pre- and postinterventional serum levels of interleukin-6 and high-sensitivity C-reactive protein at the six-month evaluation of restenosis after stenting of the femoropopliteal artery. METHODS Sixty-eight consecutive patients with steno-occlusive femoropopliteal artery disease of Rutherford category III or IV who underwent stent implantation were included. Six-month patency was evaluated with color-coded duplex ultrasound. The association of in-stent restenosis with interleukin-6 and high-sensitivity C-reactive protein levels at baseline, and 24-h postintervention was assessed with a multivariate logistic regression analysis. RESULTS In-stent restenosis was found in 15 patients (22.1%) within six months. Interleukin-6 and high-sensitivity C-reactive protein levels were significantly increased at 24-h postintervention compared to their preintervention values (p < 0.001 and p = 0.002, respectively). Interleukin-6 values at baseline (odds ratio, 1.11; 95% confidence interval: 1.00, 1.23; p = 0.044) and 24-h postintervention (odds ratio, 1.04; 95% confidence interval: 1.02, 1.06; p < 0.001) were independently associated with six-month in-stent restenosis. Twenty-four-hour postinterventional high-sensitivity C-reactive protein levels were also found to be related to restenosis (odds ratio, 1.15; 95% confidence interval: 1.04, 1.26; p = 0.006), but high-sensitivity C-reactive protein levels at baseline did not show an independent association with in-stent restenosis (odds ratio, 0.57; 95% confidence interval: 0.35, 1.80; p = 0.667). Smoking, diabetes mellitus, and cumulative stent length were other parameters associated with an increased risk for in-stent restenosis. CONCLUSIONS Femoropopliteal artery angioplasty with stent placement induces an inflammatory response. Interleukin-6 is a powerful independent predictor of intermediate-term outcomes for stenting of the femoropopliteal artery, suggesting that its predictive value may be superior to that of high-sensitivity C-reactive protein.
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Affiliation(s)
- Songlin Guo
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhang Zhang
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Wang
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Liangxi Yuan
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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Tepe G, Micari A, Keirse K, Zeller T, Scheinert D, Li P, Schmahl R, Jaff MR. Drug-Coated Balloon Treatment for Femoropopliteal Artery Disease: The Chronic Total Occlusion Cohort in the IN.PACT Global Study. JACC Cardiovasc Interv 2020; 12:484-493. [PMID: 30846089 DOI: 10.1016/j.jcin.2018.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/15/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study evaluated the 12-month safety and effectiveness of a paclitaxel drug-coated balloon for treatment of intermittent claudication or rest pain in subjects with femoropopliteal chronic total occlusions (CTO). BACKGROUND CTOs are difficult to treat, and the optimal intervention remains to be determined. METHODS The IN.PACT Global Study is an international single-arm study that enrolled 1,535 patients with symptomatic femoropopliteal artery disease. The study contains prospectively defined cohorts with prospectively planned imaging analyses, including a CTO (≥5 cm) cohort in which subjects underwent duplex ultrasonography analyzed by an independent core laboratory. The primary safety endpoint was a composite of freedom from device- and procedure-related mortality through 30 days, and freedom from major target limb amputation and target vessel revascularization through 12 months. An independent Clinical Events Committee adjudicated all adverse events. The primary effectiveness endpoint was primary patency at 12 months, defined as freedom from clinically driven target lesion revascularization and freedom from restenosis. RESULTS The CTO imaging cohort had 126 subjects with 127 lesions (mean lesion length 22.83 ± 9.76 cm). Primary patency by Kaplan-Meier estimate was 85.3% through 12 months. Provisional stenting was performed in 46.8% of lesions. The primary safety composite endpoint was achieved by 88.7% of subjects. There were no device- or procedure-related deaths through 30 days or major target limb amputations through 12 months. CONCLUSIONS The paclitaxel drug-coated balloon was safe and highly effective at 12 months after treatment of subjects with CTO ≥5 cm in the femoropopliteal arteries. (IN.PACT Global Clinical Study; NCT01609296).
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Affiliation(s)
- Gunnar Tepe
- Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany.
| | - Antonio Micari
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
| | - Koen Keirse
- Department of Vascular Surgery, Regional Hospital Heilig Hart Tienen, Tienen, Belgium
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Dierk Scheinert
- Division of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Pei Li
- Medtronic, Minneapolis, Minnesota
| | - Randy Schmahl
- Bakken Research Center, Medtronic, Maastricht, the Netherlands
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Liao MT, Chen MK, Hsieh MY, Yeh NL, Chien KL, Lin CC, Wu CC, Chie WC. Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0231463. [PMID: 32287283 PMCID: PMC7156061 DOI: 10.1371/journal.pone.0231463] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Restenosis remains a significant problem in endovascular therapy for hemodialysis vascular access. Drug-coated balloon (DCB) angioplasty decreases restenosis in peripheral and coronary artery diseases. The aim of this systematic review and meta-analysis is to assess the patency outcomes following DCB angioplasty, as compared to conventional balloon (CB) angioplasty for the stenosis of hemodialysis vascular access. Methods A comprehensive search in the MEDLINE, EMBASE, and CENTRAL databases was conducted in order to identify eligible randomized controlled trials evaluating DCB angioplasty for hemodialysis vascular access dysfunction. The primary endpoint was the 6-month target lesion primary patency and the secondary endpoints were 12-month target lesion primary patency and procedure-related complications. Risk ratios (RR) were pooled and relevant subgroups were analyzed separately. Results Eleven randomized controlled trials comprised of 487 patients treated with DCB angioplasty and 489 patients treated with CB angioplasty were included. There were no significant differences in the target lesion primary patency at 6 months [RR, 0.75; 95% confidence interval (CI), 0.56, 1.01; p = 0.06] and at 12 months (RR 0.89; 95% CI, 0.79, 1.00; p = 0.06). The absence of benefit for the DCB group remained, even in the arteriovenous fistula subgroup or the subgroup of studies excluding central vein stenosis. The risk of procedure-related complication did not differ between the two groups (RR 1.00; 95% CI 0.98, 1.02; p = 0.95). Conclusion DCB angioplasty did not demonstrate significant patency benefit for the treatment of hemodialysis vascular access dysfunction. Wide variations in patency outcomes across studies were noted. Further studies focusing on specific types of access or lesions are warranted to clarify the value of DCB for hemodialysis vascular access. (PROSPERO Number CRD42019119938)
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Affiliation(s)
- Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Meng-Kan Chen
- Department of Family Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Yang Hsieh
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Lun Yeh
- Department of Family Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Kuo-Liong Chien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan
- Cardiovascular Center, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan, Taiwan
- * E-mail: (CCW); (WCC)
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (CCW); (WCC)
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Giusca S, Lichtenberg M, Hagstotz S, Eisenbach C, Katus HA, Erbel C, Korosoglou G. Comparison of ante-versus retrograde access for the endovascular treatment of long and calcified, de novo femoropopliteal occlusive lesions. Heart Vessels 2020; 35:346-359. [PMID: 31531718 DOI: 10.1007/s00380-019-01498-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/06/2019] [Indexed: 01/22/2023]
Abstract
To compare antegrade versus retrograde recanalization, in terms of procedural time, radiation and contrast agent exposure, number and total length of implanted stents and procedural complications, in long and calcified, de novo femoropopliteal occlusions. We performed retrospective matching of prospectively acquired data by lesion length, occlusion length and lesion calcification by the peripheral arterial calcium scoring system (PACSS) score in patients who were referred for endovascular treatment due to symptomatic peripheral artery disease (PAD). Forty-two consecutive patients with antegrade and 23 patients with retrograde after failed antegrade recanalization were identified (mean lesion length = 32.1 ± 6.9 cm; mean occlusion length = 24.6 ± 7.7 cm; PACSS score = 3.25 ± 0.91). 23% of the patients had intermittent claudication, whereas 77% exhibited critical limb ischemia (CLI). Patients who underwent retrograde versus antegrade recanalization required a significantly lower number of stents (0.9 ± 1.0 versus 1.8 ± 1.4, p = 0.01) and a lower total stent length (6.8 ± 8.5 cm versus 11.7 ± 9.9 cm, p < 0.05) in the interest of more extensive coverage of the lesions using drug coated balloons (DCB) (28.5 ± 12.0 cm versus 18.2 ± 16.0 cm, p = 0.01). No re-entry device was required with the retrograde versus 9 of 42 (21%) with the antegrade recanalization group (p = 0.02). The rate of complications due to retrograde puncture was low (one patient with hematoma and one with distal pseudoaneurysm, both managed conservatively). In long and calcified femoropopliteal occlusions, the retrograde approach is associated with a lower number of re-entry devices and stents and with more extensive lesion coverage with DCB, in the interest of costs and possibly long-term patency.German Clinical Trials Register: DRKS00015277.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | | | - Saskia Hagstotz
- Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | - Christoph Eisenbach
- Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Erbel
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
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Imaeda S, Kuno T, Hirano K, Kodaira M, Anzai H, Numasawa Y. Risk of undiagnosed coronary artery disease associated with infrapopliteal artery occlusion from a multicenter study. Heart Vessels 2020; 35:307-311. [PMID: 31473802 DOI: 10.1007/s00380-019-01495-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022]
Abstract
Peripheral artery disease (PAD) is associated with high cardiovascular mortality. Which part of PAD with lower extremities is related to coronary artery disease (CAD) remains unknown. We hypothesized that PAD including infrapopliteal artery (IPA) occlusion was associated with CAD. A total of 260 patients who have no history of CAD or the anginal symptom, complain of the claudication or critical limb ischemia and underwent peripheral angiography were retrospectively analyzed. IPA occlusion was diagnosed with peripheral angiography, and CAD was diagnosed with the coronary angiography. A multivariate logistic regression analysis was performed to determine the predictors of silent CAD. Among them, a total of 146 patients (56.2%) had IPA occlusion. Baseline characteristics were significantly different between two groups as to the proportions of age, male, dyslipidemia (with vs. without IPA occlusion; 72.4 ± 10.8 vs. 69.1 ± 10.2; 62.3% vs. 75.4%; 38.6% vs. 52.6%, respectively, all comparisons P < 0.05). Notably, the prevalence of CAD was significantly higher in patients with IPA occlusion (50.7% vs. 34.2%, P = 0.008). On a multivariate analysis, IPA occlusion was an independent predictor for the presence of silent CAD (OR, 1.94; CI, 1.09-3.44, P = 0.024), but aortoiliac artery occlusion (OR, 1.16; CI, 0.53-2.56, P = 0.71) and femoropopliteal artery occlusion (OR, 1.02; CI, 0.57-1.83, P = 0.96) were not. IPA occlusion was associated with silent CAD. Vascular surgeons, interventional radiologists, as well as interventional cardiologists should recognize IPA occlusion as a risk factor of silent CAD.
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Affiliation(s)
- Shohei Imaeda
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan.
- Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
| | - Keita Hirano
- Department of Nephrology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Hitoshi Anzai
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
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Di Primio M, Angelopoulos G, Lazareth I, Priollet P, Zins M, Emmerich J, Yannoutsos A. Innovative endovascular approach for limb salvage in critical limb ischemia. J Med Vasc 2020; 45:23-27. [PMID: 32057322 DOI: 10.1016/j.jdmv.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
Abstract
In the absence of feasible revascularization, nearly one third of patients with critical limb ischemia experienced major amputation at 6 months. In patients with an independent living status, this decision is difficult to support without exhausting all chances to attain limb salvage and preserve functional autonomy. The present report describes a new procedure of revascularization by performing a full endovascular extra-anatomic femoropopliteal bypass for the treatment of limb-threatening ischemia. The patient presented with extensive tissue loss and a short-term risk of major amputation. She had experienced previous failure of conventional surgical and endovascular revascularization procedures and ligation of proximal femoral artery precluded any further revascularization attempt. Limb salvage was achieved with this endovascular revascularization procedure with complete wound closure. The patient still presents an independent living status and preserved functional autonomy without wound recurrence after a follow-up of more than 5 years.
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Affiliation(s)
- M Di Primio
- Interventional radiology department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - G Angelopoulos
- Interventional radiology department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - I Lazareth
- Vascular medicine department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université de Paris (Paris Descartes), Paris, France
| | - P Priollet
- Vascular medicine department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université de Paris (Paris Descartes), Paris, France
| | - M Zins
- Interventional radiology department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - J Emmerich
- Vascular medicine department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université de Paris (Paris Descartes), Paris, France; INSERM UMR 1153-CRESS, Paris, France
| | - A Yannoutsos
- Vascular medicine department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université de Paris (Paris Descartes), Paris, France; INSERM UMR 1153-CRESS, Paris, France
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Katsanos K, Spiliopoulos S, Kitrou P, Krokidis M, Paraskevopoulos I, Karnabatidis D. Risk of Death and Amputation with Use of Paclitaxel-Coated Balloons in the Infrapopliteal Arteries for Treatment of Critical Limb Ischemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Vasc Interv Radiol 2020; 31:202-212. [PMID: 31954604 DOI: 10.1016/j.jvir.2019.11.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023] Open
Abstract
A formal systematic review and study-level meta-analysis of randomized controlled trials investigating treatment of the infrapopliteal arteries with paclitaxel-coated balloons compared with conventional balloon angioplasty for critical limb ischemia (CLI) was conducted. Medical databases and online content were last screened in September 2019. The primary safety and efficacy endpoint was amputation-free survival defined as freedom from all-cause death and major amputation. Target lesion revascularization (TLR) constituted a secondary efficacy endpoint. Summary effects were synthesized with a random-effects model. Some 8 randomized controlled trials with 1,420 patients (97% CLI) were analyzed up to 1 year follow-up. Amputation-free survival was significantly worse in case of paclitaxel (13.7% crude risk of death or limb loss compared to 9.4% in case of uncoated balloon angioplasty; hazard ratio 1.52; 95% confidence interval: 1.12-2.07, p = .008). TLR was significantly reduced in case of paclitaxel (11.8% crude risk of TLR versus 25.6% in control; risk ratio 0.53; 95% confidence interval: 0.35-0.81, p = .004). The harm signal was evident when examining the high-dose (3.0-3.5 μg/mm2) devices, but attenuated below significance in case of a low-dose (2.0 μg/mm2) device. Actual causes remain largely unknown, but non-target paclitaxel embolization is a plausible mechanism.
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Affiliation(s)
- Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, Panepistimiou Street, Rion, Patras 26504, Greece.
| | - Stavros Spiliopoulos
- Department of Interventional Radiology, Attikon University Hospital, Athens, Greece
| | - Panagiotis Kitrou
- Department of Interventional Radiology, Patras University Hospital, Panepistimiou Street, Rion, Patras 26504, Greece
| | - Miltiadis Krokidis
- Department of Interventional Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Dimitrios Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, Panepistimiou Street, Rion, Patras 26504, Greece
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Kumins NH, King AH, Ambani RN, Thomas JP, Bose S, Shishehbor MH, Li J, Wong VL, Harth KC, Cho JS, Kashyap VS. Paclitaxel-coated peripheral artery devices are not associated with increased mortality. J Vasc Surg 2020; 72:968-976. [PMID: 31917036 DOI: 10.1016/j.jvs.2019.10.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Long-term safety concerns have been raised that the use of paclitaxel-coated balloons and stents is linked to excess mortality. Our objective was to compare outcomes in patients treated with paclitaxel vs uncoated devices and to analyze long-term mortality. METHODS We conducted a retrospective single-institution review of 1170 consecutive patients who underwent femoropopliteal percutaneous revascularization by angioplasty, atherectomy, stent placement, or combination between 2011 and 2018. The primary outcome measure was all-cause mortality. Groups were divided into patients who received paclitaxel (n = 652) and those who did not (n = 518). Categorical variables were assessed using χ2 analysis and continuous variables with the Wilcoxon signed rank test. A multivariable analysis was performed using multivariable logistic regression models. Mortality was compared using Kaplan-Meier survival analysis. RESULTS Demographics, risk factors, and Rutherford class were similar between the groups, except that the paclitaxel group was more likely to have diabetes (60.9% vs 55.0%; P = .04), was less likely to be on dialysis (10.7% vs 14.9%; P = .04), and had lower average creatinine concentration (1.6 ± 1.8 mg/dL vs 2.0 ± 2.3 mg/dL; P = .003). There were no differences in all-cause mortality through 2 years between paclitaxel and no-paclitaxel cohorts (25.5% vs 30.3%; log-rank, P = .098). At 3 years and 3.5 years, mortality was significantly lower in the paclitaxel group: year 3, 32.1% vs 39.4% (log-rank, P = .041); year 3.5, 35.2% vs 43.9% (log-rank, P = .027). Survival rates were not significantly different in examining subgroups by diabetes, chronic kidney disease, presence of chronic limb-threatening ischemia, or paclitaxel-coated balloon manufacturer. Multivariable analysis demonstrated that age, dialysis, chronic limb-threatening ischemia, chronic kidney disease, and congestive heart failure were independent risk factors for mortality, whereas paclitaxel use was associated with lower mortality. CONCLUSIONS The use of paclitaxel-coated balloons and stents does not increase mortality compared with uncoated devices out to 3.5 years. Paclitaxel-coated devices can be used with continued caution, especially in patients at increased risk of restenosis. Further long-term studies are needed to determine the risk of late mortality.
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Affiliation(s)
- Norman H Kumins
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio.
| | - Alexander H King
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Ravi N Ambani
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jones P Thomas
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Saideep Bose
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Mehdi H Shishehbor
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Virginia L Wong
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Karem C Harth
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jae S Cho
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Vikram S Kashyap
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
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33
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Ni Q, Yang S, Xue G, Zhou Z, Zhang L, Ye M. Viabahn Stent Graft for the Endovascular Treatment of Occlusive Lesions in the Femoropopliteal Artery: A Retrospective Cohort Study with 4-Year Follow-Up. Ann Vasc Surg 2019; 66:573-579. [PMID: 31743785 DOI: 10.1016/j.avsg.2019.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The polytetrafluoroethylene-covered Viabahn stent may be effective for the endovascular treatment of patients with femoropopliteal artery occlusive lesions. However, the long-term efficacy of Viabahn stent remains unclear. The aim of the study is to evaluate the long-term patency of Viabahn stent grafts in patients with occlusive lesions in the femoropopliteal artery. METHODS Consecutive patients with occlusive lesions in the femoropopliteal artery who had been treated with Viabahn stent grafts during the period from June 2013 to December 2016 at our center were retrospectively included. Accumulative incidences of primary patency and secondary patency were estimated by Kaplan-Meier survival analysis, and the predictors of primary patency were evaluated by Cox regression analysis. RESULTS A total of 66 patients underwent successful endovascular treatment and were included in the study. Endovascular treatment with a Viabahn stent was associated with a complication rate of 9.1% and a 30-day mortality rate of 1.5%. Sixty-one patients were followed for a mean duration of 29.5 months. The 1-year, 2-year, 3-year, and 4-year primary patency rates were 81.7%, 74.7%, 67.6%, and 58.9%, respectively. The secondary patency rates were 94.9%, 92.9%, 90.1%, and 90.1%, respectively. The overall major amputation rate was 5.0%. The results of multivariate Cox regression analyses showed that stent location was the only independent predictor of primary patency (P = 0.001). Implantation of a Viabahn stent above the knee, compared with implantation below the knee, was associated with a higher rate of primary patency. CONCLUSIONS The Viabahn stent graft is associated with a satisfactory rate of long-term patency for the endovascular treatment of occlusive lesions in the femoropopliteal artery, especially for those located above the knee.
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Affiliation(s)
- Qihong Ni
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Shuofei Yang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Guanhua Xue
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Zhaoxiong Zhou
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Lan Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Meng Ye
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China.
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Giannopoulos S, Kokkinidis DG, Jawaid O, Behan S, Hossain P, Alvandi B, Foley TR, Singh GD, Waldo SW, Armstrong EJ. Turbo-Power™ Laser Atherectomy Combined with Drug-coated Balloon Angioplasty is Associated with Improved One-Year Outcomes for the Treatment of Tosaka II and III Femoropopliteal In-stent Restenosis. Cardiovasc Revasc Med 2019; 21:771-778. [PMID: 31761634 DOI: 10.1016/j.carrev.2019.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Femoropopliteal (FP) artery in-stent restenosis (ISR) is associated with high rates of re-intervention and occlusion. The combined use of laser atherectomy (LA) with balloon angioplasty (BA) is superior to conventional balloon angioplasty (BA). Drug-coated balloons (DCBs) when combined with LA have provided additional efficacy for the treatment of FP-ISR. The aim of this study was to investigate the combination of DCB + LA with the recently approved Turbo-Power™ (Spectranetics Inc., Colorado Springs, CO, USA) LA device. METHODS This was a dual-center retrospective study enrolling 78 consecutive patients with Tosaka type II (n = 18) or III (n = 60) FP-ISR. The lesions were treated with either Turbo-Power™ LA followed by DCB (n = 27) or with other LA devices followed by plain BA (LA + BA; n = 51) from 2015 to 2017. A Cox regression analysis was performed to examine the association between the two groups in terms of target lesion revascularization (TLR) and occlusion rates over a follow up period of 12 months. Kaplan-Meier survival curves were estimated and compared with the log-rank test. RESULTS The overall procedural success was 90%. Eight periprocedural complications occurred without any difference between the two groups (Turbo-Power™ + DCB: 7.4% vs LA + BA: 11.8%, p = .7). The 12-month KM estimates for freedom from TLR were 90.9% in the Turbo-Power™ + DCB group vs 55.7% in the LA + BA group (p = .005). Among Toasaka III lesions, the 12 m-KM survival estimates for freedom from TLR were 88.9% in the Turbo-Power™ + DCB group vs 54.2% in the LA + BA group (p = .009). The 12 m-KM estimates for freedom from re-occlusion were 89.0% in the Turbo-Power™ + DCB group vs 58.9% in the LA + BA group (p = .070). CONCLUSIONS Turbo-Power™ laser atherectomy combined with DCB exerted synergistic mechanism of actions and improved 12-month TLR rates for the treatment of complex FP-ISR lesions.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Damianos G Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Omar Jawaid
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Sean Behan
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Prio Hossain
- Division of Cardiovascular Medicine, University of California, Davis, CA, USA
| | - Bejan Alvandi
- Division of Cardiovascular Medicine, University of California, Davis, CA, USA
| | - T Raymond Foley
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California, Davis, CA, USA
| | - Stephen W Waldo
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
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Khan SZ, Montross B, Rivero M, Cherr GS, Harris LM, Dryjski ML, Dosluoglu HH. Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers (ACEI/ARB) are Associated with Improved Limb Salvage after Infrapopliteal Interventions for Critical Limb Ischemia. Ann Vasc Surg 2019; 63:275-286. [PMID: 31626938 DOI: 10.1016/j.avsg.2019.08.093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme Inhibitors and Angiotensin II Receptor Blockers (ACEI/ARB) reduce the risk of cardiovascular events and mortality in patients with peripheral arterial disease (PAD). However, their effect on limb-specific outcomes is unclear. The objective of this study is to assess the effect of ACEI/ARB on patency and limb salvage in patients undergoing interventions for critical limb ischemia (CLI). METHODS Patients undergoing infrainguinal revascularization for CLI (Rutherford 4-6) between 06/2001 and 12/2014 were retrospectively identified. Primary Patency (PP), Secondary Patency (SP), Limb Salvage (LS), major adverse cardiac events (MACE), and survival rates were calculated using Kaplan-Meier. Multivariate analysis was performed using Cox regression. RESULTS A total of 755 limbs in 611 patients (311 ACEI/ARB, 300 No ACEI/ARB) were identified. Hypertension (86% vs. 70%, P < 0.001), diabetes (68% vs. 55%, P = 0.001) and statin use (61% vs. 45%, P < 0.001) were significantly greater in the ACEI/ARB group. Interventions were performed mostly for tissue loss (83% ACEI/ARB vs. 84% No ACEI/ARB, P = 0.73). Comparing ACEI/ARB versus No ACEI/ARB, in femoropopliteal interventions, 60-month PP (54% vs. 55%, P = 0.47), SP (76% vs. 75%, P = 0.83) and LS (84% vs. 87%, P = 0.36) were not significantly different. In infrapopliteal interventions, 60-month PP (45% vs. 46%, P = 0.66) and SP (62% vs. 75%, P = 0.96) were not significantly different. LS was significantly greater in ACEI/ARB (75%), as compared to No ACEI/ARB (61%) (P = 0.005). Cox regression identified diabetes (HR 2.4 (1.4-4.1), P = 0.002), ESRD (HR 3.5 (2.1-5.7), P < 0.001), hypertension (HR 0.4 (0.2-0.6), P < 0.001), and ACEI/ARB (HR 0.6 (0.4-0.9), P = 0.03), as factors independently associated with LS after infrapopliteal interventions. Freedom from MACE (ACEI/ARB 37% vs. 32%, P = 0.82) and overall survival (ACEI/ARB 42% vs. 35% No ACEI/ARB, P = 0.84) were not significantly different. CONCLUSIONS ACEI/ARB is associated with improved limb salvage in CLI patients undergoing infrapopliteal interventions, but not after femoropopliteal interventions. ACEI/ARB had no impact on patency rates. They were also associated with a trend toward improved survival and freedom from MACE. Our findings suggest that the use of ACEI/ARB may improve outcomes in the high-risk CLI patient population.
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Affiliation(s)
- Sikandar Z Khan
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY
| | - Brittany Montross
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY
| | - Mariel Rivero
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY; Department of Surgery, VA Western NY Healthcare System, Buffalo, NY
| | - Gregory S Cherr
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY
| | - Linda M Harris
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY
| | - Maciej L Dryjski
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY
| | - Hasan H Dosluoglu
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY; Department of Surgery, VA Western NY Healthcare System, Buffalo, NY.
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Riambau V, Acín F, de Blas MJ, Alonso M, Giménez-Gaibar A. Drug-Coated Balloon Angioplasty in Clinical Practice for Below-the-Knee, Popliteal, and Crural Artery Lesions Causing Critical Limb Ischemia: 1-Year Results from the Spanish Luminor Registry. Ann Vasc Surg 2019; 62:387-396. [PMID: 31449955 DOI: 10.1016/j.avsg.2019.06.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Luminor is a new drug-coated angioplasty balloon, which is approved by the European Conformity market. The aim of the present study is to analyze the 1-year results, in terms of effectiveness and safety, of the Luminor® 14/14M and 35 drug-coated balloons (iVascular, Sant Vicenç dels Horts, Barcelona, Spain) in a special cohort of critical limb ischemia (CLI) of the Luminor registry. METHODS Luminor is phase IV, nonrandomized, prospective, observational, and multicenter clinical study. The present study includes patients with CLI to analyze the effectiveness, in terms of primary patency, and the safety defined by the major adverse effects: any cause mortality, major amputation, and/or clinically driven target lesion revascularization (TLR). Both femoropopliteal and below-the-knee infrapopliteal lesions were treated. All the end points were assessed after the procedure, at 30 days, 6 and 12 months thereafter. RESULTS About 148 patients (101 males; mean age, 73.2 ± 11.4 years) with CLI were included. About 83.3% were classified as Rutherford's class 5. Diabetes mellitus was diagnosed in 71.6%; hypertension, hyperlipidemia, renal insufficiency, and coronary disease were present in 87.2%, 57.4%, 29.7%, and 39.2% of the sample, respectively. The average follow-up was 11.2 ± 3.27 months. The primary patency and the freedom of clinically driven TLR, at 1 year, were 87.7% and 92.1%, respectively. Survival and freedom from major amputations were 85.1% and 84.7%, respectively. CONCLUSIONS Even with a very sick population, the results at 12 months are highly satisfactory with reference to survival, freedom from amputation, patency, and the absence of reintervention.
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Affiliation(s)
- Vicente Riambau
- Vascular Surgery Division, Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Francisco Acín
- Angiology and Vascular Surgery Division, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Mariano Juan de Blas
- Angiology and Vascular Surgery Division, Hospital Universitario Donostia, San Sebastian, Spain
| | - Manuel Alonso
- Vascular Surgery Division, Hospital Universitario Central de Asturias, Oviedo, Spain
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Tacke J, Müller-Hülsbeck S, Schröder H, Lammer J, Schürmann K, Gross-Fengels W, Fischbach R, Textor J, Boguth L, Loewe C, Häuser H, Gschwendtner M, Tepe G, von Strandmann RP, Stahnke S, Dambach J, Hausegger K. The Randomized Freeway Stent Study: Drug-Eluting Balloons Outperform Standard Balloon Angioplasty for Postdilatation of Nitinol Stents in the SFA and PI Segment. Cardiovasc Intervent Radiol 2019; 42:1513-1521. [PMID: 31432220 PMCID: PMC6775030 DOI: 10.1007/s00270-019-02309-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/06/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The prospective randomized multicenter Freeway study evaluated the possible hemodynamic and clinical benefits of primary stent insertion followed by percutaneous transluminal angioplasty (PTA) with drug-eluting balloons (DEB) over post-stent insertion PTA with standard balloons in the treatment of symptomatic femoropopliteal arteriosclerotic lesions. METHODS In total, 204 patients in 13 centers in Germany and Austria were enrolled and randomized to primary stenting followed by either FREEWAY™ drug-eluting balloon or standard PTA balloon angioplasty. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) at 6 months; the secondary endpoints include TLR rate at 12 months and primary patency, shift in Rutherford classification, ankle-brachial index (ABI) and major adverse events (MAE) at 6 and 12 months. Lesion characteristics and vessel patency were analyzed by an independent and blinded corelab. RESULTS At 6-month and 12-month follow-up, TLR rate was lower in the DEB arm compared to standard PTA but did not reach statistical significance (4.1% vs. 9.0% p = 0.234 and 7.9% vs. 17.7% p = 0.064, respectively). Primary patency was significantly better for patients treated with the DEB at 6 months (90.3% vs. 69.8% p = 0.001) and 12 months (77.4% vs. 61.0% p = 0.027). Improvement in Rutherford classifications was likewise significantly better for patients in the DEB group at 6 (94.9% vs. 84.3% p = 0.027) and 12 months (95.5% vs. 79.9% p = 0.003). The percentage of patients with an improved ABI of 1.0-1.2 was significantly higher in the DEB group compared to the PTA group at 6 months (55.3% vs. 35.3%; p = 0.015) but without significant difference at 12 months (48.2% vs. 32.9%; p = 0.055). At 6 months, rate of major adverse events (MAE) was 1% in both arms, and at 12 months 2.2% for the DEB and 3.8% for the PTA group. CONCLUSION The Freeway Stent Study shows that the usage of DEB as a restenosis prophylaxis seems to be safe and feasible. The 12-month follow-up results give a clear sign in favor of the DEB group.
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Affiliation(s)
- Josef Tacke
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Passau, Innstraße 76, 94036, Passau, Germany
| | | | - Henrik Schröder
- Jüdisches Krankenhaus Berlin, Gemeinschaftspraxis für Radiologie, Neuroradiologie & Zentrum für Minimal Invasive Therapie am Jüdischen Krankenhaus Berlin, Heinz-Galinski-Str. 1, 13347, Berlin, Germany
| | - Johannes Lammer
- Kardiovaskuläre und Interventionelle Radiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Karl Schürmann
- Institut für Diagnostische und Interventionelle Radiologie St.-Johannes-Hospital Dortmund, Johannesstraße 9-17, 44137, Dortmund, Germany
| | - Walter Gross-Fengels
- Radiologie und Nuklearmedizin, Asklepios Klinik Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Roman Fischbach
- Radiologie, Neuroradiologie und Nuklearmedizin, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Jochen Textor
- Abteilung für Radiologie Gemeinschaftskrankenhaus Bonn, St. Elisabeth/St. Petrus/St. Johannes gGmbH, Bonner Talweg 4-6, 53113, Bonn, Germany
| | - Lothar Boguth
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Idar-Oberstein GmbH, Dr.-Ottmar-Kohler Str. 2, 55743, Idar-Oberstein, Germany
| | - Christian Loewe
- Kardiovaskuläre und Interventionelle Radiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hannes Häuser
- Klinik für Diagnostische und Interventionelle Radiologie, Klinikum St. Elisabeth Straubing GmbH, St.-Elisabeth-Str. 23, 94315, Straubing, Germany
| | - Manfred Gschwendtner
- Institut für Diagnostische und Interventionelle Radiologie, KH Elisabethinen Linz, Fadingerstrasse 1, 4010, Linz, Austria
| | - Gunnar Tepe
- Radiologie, Klinikum Rosenheim, Pettenkoferstr. 10, 83022, Rosenheim, Germany
| | | | | | | | - Klaus Hausegger
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Austria
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Anttila E, Balzani D, Desyatova A, Deegan P, MacTaggart J, Kamenskiy A. Mechanical damage characterization in human femoropopliteal arteries of different ages. Acta Biomater 2019; 90:225-240. [PMID: 30928732 PMCID: PMC6532398 DOI: 10.1016/j.actbio.2019.03.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 12/26/2022]
Abstract
Endovascular treatment of Peripheral Arterial Disease (PAD) is notorious for high failure rates, and interaction between the arterial wall and the repair devices plays a significant role. Computational modeling can help improve clinical outcomes of these interventions, but it requires accurate inputs of elastic and damage characteristics of the femoropopliteal artery (FPA) which are currently not available. Fresh human FPAs from n = 104 tissue donors 14-80 years old were tested using planar biaxial extension to capture elastic and damage characteristics. Damage initiation stretches and stresses were determined for both longitudinal and circumferential directions, and their correlations with age and risk factors were assessed. Two and four-fiber-family invariant-based constitutive models augmented with damage functions were used to describe stress softening with accumulating damage. In FPAs younger than 50 years, damage began accumulating after 1.51 ± 0.13 and 1.49 ± 0.11 stretch, or 196 ± 110 kPa and 239 ± 79 kPa Cauchy stress in the longitudinal and circumferential directions, respectively. In FPAs older than 50 years, damage initiation stretches and stresses decreased to 1.27 ± 0.09 (106 ± 52 kPa) and 1.26 ± 0.09 (104 ± 59 kPa), respectively. Damage manifested primarily as tears at the internal and external elastic laminae and within the tunica media layer. Higher body mass index and presence of diabetes were associated with lower damage initiation stretches and higher stresses. The selected constitutive models were able to accurately portray the FPA behavior in both elastic and inelastic domains, and properties were derived for six age groups. Presented data can help improve fidelity of computational models simulating endovascular PAD repairs that involve arterial damage. STATEMENT OF SIGNIFICANCE: This manuscript describes inelastic, i.e. damage, behavior of human femoropopliteal arteries, and provides values for three constitutive models simulating this behavior computationally. Using a set of 104 human FPAs 14-80 years old, we have investigated stress and stretch levels corresponding to damage initiation, and have studied how these damage characteristics change across different age groups. Presented inelastic arterial characteristics are important for computational simulations modeling balloon angioplasty and stenting of peripheral arterial disease lesions.
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Affiliation(s)
- Eric Anttila
- Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Daniel Balzani
- Continuum Mechanics, Ruhr-University Bochum, Bochum, Germany
| | - Anastasia Desyatova
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul Deegan
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alexey Kamenskiy
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
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Shahi N, Arosemena M, Kwon J, Abai B, Salvatore D, DiMuzio P. Functional Popliteal Artery Entrapment Syndrome: A Review of Diagnosis and Management. Ann Vasc Surg 2019; 59:259-267. [PMID: 31028851 DOI: 10.1016/j.avsg.2018.12.105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Functional popliteal artery entrapment syndrome (FPAES) results from hypertrophied gastrocnemius, soleus, and/or plantaris muscles, without an identifiable anatomic abnormality. Historically, FPAES has been managed with surgical myotomy or myomectomy. Herein, we review the literature to evaluate the results of surgery along with a newer treatment (botulinum toxin A injection) for this rare form of claudication. METHODS A literature search in PubMed, Cochrane, and Ovid for studies reporting incidence and management of FPAES yielded 3391 publications; 2804 articles were excluded based on initially established exclusion criteria. Ultimately, data were extracted from six articles, from which the number of patients, demographic information, preoperative workup, surgical treatment details, follow-up imaging, and results of treatment were obtained. RESULTS A total of 133 patients were studied. Mean age was 26 years; 57% were female, and noninvasive testing revealed bilateral findings in 39%. Treatment involved surgical myotomy/myomectomy (98; five studies) and botulinum toxin injection (35; two studies). Adjunctive vascular reconstruction was performed in eight of the surgical cases. Patients with FPAES who underwent surgical management were evaluated subjectively for symptomatic improvement, and some patients had duplex ultrasounds in follow-up averaging 25.6 months. Three of 98 patients (3%) had recurrent symptoms, and seven (7%) underwent revision surgical procedures. Complications in the surgical management group included seroma/hematoma (4%, 4/98) and infection (2%, 2/98). For the botulinum toxin treatment group, improvement of symptoms was achieved in 66% of patients at an average follow-up time of ten months. Most patients treated with botulinum toxin did not undergo imaging in follow-up. No complications were reported. CONCLUSIONS This review suggests FPAES may be treated successfully with surgical myotomy/myomectomy plus adjunctive vascular reconstruction if necessary. Botulinum toxin A injection may be useful as a diagnostic and therapeutic measure for FPAES.
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Affiliation(s)
- Niti Shahi
- Division of Vascular and Endovascular Surgery Department of Surgery Thomas Jefferson University Hospitals Philadelphia, PA.
| | - Mariano Arosemena
- Division of Vascular and Endovascular Surgery Department of Surgery Thomas Jefferson University Hospitals Philadelphia, PA
| | - Jeontaik Kwon
- Division of Vascular and Endovascular Surgery Department of Surgery Thomas Jefferson University Hospitals Philadelphia, PA
| | - Babak Abai
- Division of Vascular and Endovascular Surgery Department of Surgery Thomas Jefferson University Hospitals Philadelphia, PA
| | - Dawn Salvatore
- Division of Vascular and Endovascular Surgery Department of Surgery Thomas Jefferson University Hospitals Philadelphia, PA
| | - Paul DiMuzio
- Division of Vascular and Endovascular Surgery Department of Surgery Thomas Jefferson University Hospitals Philadelphia, PA
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Katsanos K, Spiliopoulos S, Kitrou P, Krokidis M, Karnabatidis D. Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2018; 7:e011245. [PMID: 30561254 PMCID: PMC6405619 DOI: 10.1161/jaha.118.011245] [Citation(s) in RCA: 580] [Impact Index Per Article: 96.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023]
Abstract
Background Several randomized controlled trials ( RCT s) have already shown that paclitaxel-coated balloons and stents significantly reduce the rates of vessel restenosis and target lesion revascularization after lower extremity interventions. Methods and Results A systematic review and meta-analysis of RCT s investigating paclitaxel-coated devices in the femoral and/or popliteal arteries was performed. The primary safety measure was all-cause patient death. Risk ratios and risk differences were pooled with a random effects model. In all, 28 RCT s with 4663 patients (89% intermittent claudication) were analyzed. All-cause patient death at 1 year (28 RCT s with 4432 cases) was similar between paclitaxel-coated devices and control arms (2.3% versus 2.3% crude risk of death; risk ratio, 1.08; 95% CI, 0.72-1.61). All-cause death at 2 years (12 RCT s with 2316 cases) was significantly increased in the case of paclitaxel versus control (7.2% versus 3.8% crude risk of death; risk ratio, 1.68; 95% CI, 1.15-2.47; -number-needed-to-harm, 29 patients [95% CI , 19-59]). All-cause death up to 5 years (3 RCT s with 863 cases) increased further in the case of paclitaxel (14.7% versus 8.1% crude risk of death; risk ratio, 1.93; 95% CI , 1.27-2.93; -number-needed-to-harm, 14 patients [95% CI , 9-32]). Meta-regression showed a significant relationship between exposure to paclitaxel (dose-time product) and absolute risk of death (0.4±0.1% excess risk of death per paclitaxel mg-year; P<0.001). Trial sequential analysis excluded false-positive findings with 99% certainty (2-sided α, 1.0%). Conclusions There is increased risk of death following application of paclitaxel-coated balloons and stents in the femoropopliteal artery of the lower limbs. Further investigations are urgently warranted. Clinical Trial Registration URL : www.crd.york.ac.uk/PROSPERO . Unique identifier: CRD 42018099447.
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Xu Y, Jia X, Zhang J, Zhuang B, Fu W, Wu D, Wang F, Zhao Y, Guo P, Bi W, Wang S, Guo W. Drug-Coated Balloon Angioplasty Compared With Uncoated Balloons in the Treatment of 200 Chinese Patients With Severe Femoropopliteal Lesions: 24-Month Results of AcoArt I. JACC Cardiovasc Interv 2018; 11:2347-2353. [PMID: 30448170 DOI: 10.1016/j.jcin.2018.07.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The authors sought to investigate the midterm efficacy and safety of drug-coated balloon (DCB) in the treatment of severe femoropopliteal artery disease (FPAD). BACKGROUND The midterm outcome of DCB versus uncoated balloon percutaneous transluminal angioplasty (PTA) for FPAD are still debated. METHODS A total of 200 Chinese patients with FPAD were prospectively randomized into treatment with DCB or with PTA. The primary efficacy endpoints were primary patency of the target lesion, freedom from clinically driven target lesion revascularization, improved ankle-brachial index, and improved Rutherford class at 24 months. The primary safety endpoint was the rate of major adverse events. RESULTS The DCB group and PTA group were comparable in demographic characteristics and clinical severity at baseline. At 24-month follow-up, primary patency was better in the DCB group versus PTA group (64.6% vs. 31.4%; p < 0.001). The DCB group had a higher rate of freedom from clinically driven target lesion revascularization than the PTA group (86.5% vs. 58.9%; p < 0.001). Rutherford class and ankle-brachial index also confirmed more improvements in the DCB group (p < 0.01 and p < 0.05, respectively). There was no significant difference in major adverse events. CONCLUSIONS The superiority of DCB versus PTA in the efficacy of FPAD treatment persists at 24-month follow-up and the safety of DCB is equivalent to that of PTA.
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Affiliation(s)
- Yongle Xu
- Chinese PLA General Hospital, Beijing, China
| | - Xin Jia
- Chinese PLA General Hospital, Beijing, China
| | - Jiwei Zhang
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Baixi Zhuang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiguo Fu
- Zhongshan Hospital Fudan University, Shanghai, China.
| | - Danming Wu
- The People's Hospital of Liaoning Province, Shenyang, China
| | - Feng Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Zhao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pingfan Guo
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wei Bi
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Shenming Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Guo
- Chinese PLA General Hospital, Beijing, China.
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Villaescusa Catalán JM, Martín IG, Cagigal Cobo ML. Popliteal Angiosarcoma after Bypass with Autologous Saphenous Vein. Ann Vasc Surg 2018; 55:308.e1-308.e4. [PMID: 30217704 DOI: 10.1016/j.avsg.2018.06.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/23/2018] [Accepted: 06/28/2018] [Indexed: 12/31/2022]
Abstract
Angiosarcoma (AS) is a type of malignancy within sarcomas affecting soft tissue and bone. It presents a very heterogeneous distribution in the human body, and it can appear in multiple locations, from breast to liver or skin. The incidence of this type of tumor is low; however, it is aggressive and requires an early diagnosis to initiate the treatment as soon as possible. In the present article, we report the case of a male patient who was diagnosed with epithelioid AS of popliteal artery after an aneurysm popliteal surgery, as well as its treatment and evolution. This kind of tumors has controversial treatment and poor survival rates in the early years.
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Affiliation(s)
| | - Iván García Martín
- Department of Cardiac Surgery Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Luisa Cagigal Cobo
- Department of Patologycal anatomy Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Björkman P, Auvinen T, Hakovirta H, Romsi P, Turtiainen J, Manninen H, Venermo M. Drug-Eluting Stent Shows Similar Patency Results as Prosthetic Bypass in Patients with Femoropopliteal Occlusion in a Randomized Trial. Ann Vasc Surg 2018; 53:165-170. [PMID: 29886215 DOI: 10.1016/j.avsg.2018.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Claudication and critical limb threatening ischemia are significant causes of mortality in the elderly. The gold standard of superficial femoral artery (SFA) revascularization is thus far considered to be the femoropopliteal bypass. The aim of this study was to compare mid-term patency between drug-eluting stents (DESs) and prosthetic bypass grafts (BSX). Studies have reported comparable results for both the methods. METHODS Forty-six patients with claudication or rest pain due to a 5-25 cm SFA occlusion were randomized between DES and BSX groups. The follow-up period was 24 months, and the primary outcome measure was overall patency. Secondary outcome measures were primary and primary assisted patency, change in ankle-brachial index (ABI), and amputation-free survival. RESULTS Forty-one patients were eventually analyzed. Six-month secondary patency was 91% (DES) versus 83% (BSX) (P = 0.450). The corresponding numbers at 12 months in the DES and BSX groups were 74% and 80% (P = 0.750), respectively. At 24 months, the respective numbers were 56% and 71% (P = 0.830). There were no statistically significant differences in primary or assisted primary patency at 1, 6, or 12 months. CONCLUSION There were no demonstrable differences in patency rates or clinical outcomes such as ABI or major amputations between DES and BSX. Although underpowered, the results suggest noninferiority of the DES compared with prosthetic bypass surgery. TRIAL REGISTRATION The trial was preregistered at ClinicalTrials.org (NCT01450722).
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Affiliation(s)
- Patrick Björkman
- Department of Vascular Surgery and University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Tommi Auvinen
- Department of Vascular Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Harri Hakovirta
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Pekka Romsi
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
| | | | - Hannu Manninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Maarit Venermo
- Department of Vascular Surgery and University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Nair PK, Carr JG, Bigelow B, Bhatt DL, Berwick ZC, Adams G. LumenRECON Guidewire: Pilot Study of a Novel, Nonimaging Technology for Accurate Vessel Sizing and Delivery of Therapy in Femoropopliteal Disease. Circ Cardiovasc Interv 2018; 11:e005333. [PMID: 29311285 DOI: 10.1161/circinterventions.117.005333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Proper vessel sizing during endovascular interventions is crucial to avoid adverse procedural and clinical outcomes. LumenRECON (LR) is a novel, nonimaging, 0.035-inch wire-based technology that uses the physics-based principle of Ohm's law to provide a simple, real-time luminal size while also providing a platform for therapy delivery. This study evaluated the accuracy, reliability, and safety of the LR system in patients presenting for a femoropopliteal artery intervention. METHODS AND RESULTS This multicenter, prospective pilot study of 24 patients presenting for peripheral intervention compared LR measurements of femoropopliteal artery size to angiographic visual estimation, duplex ultrasound, quantitative angiography, and intravascular ultrasound. The primary effectiveness and safety end point was comparison against core laboratory adjudicated intravascular ultrasound values and major adverse events, respectively. Additional preclinical studies were also performed in vitro and in vivo in swine to determine the accuracy of the LR guidewire system. No intra- or postprocedure device-related adverse events occurred. A balloon or stent was successfully delivered in 12 patients (50%) over the LR wire. Differences in repeatability between successive LR measurements was 2.5±0.40% (R2=0.96) with no significant bias. Differences in measurements of LR to other modalities were 0.5±1.7%, 5.0±1.8%, -1.5±2.0%, and 6.8±3.4% for intravascular ultrasound core laboratory, quantitative angiography, angiographic, and duplex ultrasound, respectively. CONCLUSIONS This study demonstrates that through a physics-based principle, LR provides a real-time, safe, reproducible, and accurate vessel size of the femoropopliteal artery during intervention and can additionally serve as a conduit for therapy delivery over its wire-based platform.
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Affiliation(s)
- Pradeep K Nair
- From the Cardiovascular Institute of the South, Houma, LA (P.K.N.); Cardiovascular Associates of East Texas, Tyler (J.G.C.); Heart Center of Indiana, Indianapolis (B.B.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.); 3DT Holdings, LLC, San Diego, CA (Z.C.B.); and North Carolina Heart and Vascular Research Center, Raleigh (G.A.).
| | - Jeffrey G Carr
- From the Cardiovascular Institute of the South, Houma, LA (P.K.N.); Cardiovascular Associates of East Texas, Tyler (J.G.C.); Heart Center of Indiana, Indianapolis (B.B.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.); 3DT Holdings, LLC, San Diego, CA (Z.C.B.); and North Carolina Heart and Vascular Research Center, Raleigh (G.A.)
| | - Brian Bigelow
- From the Cardiovascular Institute of the South, Houma, LA (P.K.N.); Cardiovascular Associates of East Texas, Tyler (J.G.C.); Heart Center of Indiana, Indianapolis (B.B.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.); 3DT Holdings, LLC, San Diego, CA (Z.C.B.); and North Carolina Heart and Vascular Research Center, Raleigh (G.A.)
| | - Deepak L Bhatt
- From the Cardiovascular Institute of the South, Houma, LA (P.K.N.); Cardiovascular Associates of East Texas, Tyler (J.G.C.); Heart Center of Indiana, Indianapolis (B.B.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.); 3DT Holdings, LLC, San Diego, CA (Z.C.B.); and North Carolina Heart and Vascular Research Center, Raleigh (G.A.)
| | - Zachary C Berwick
- From the Cardiovascular Institute of the South, Houma, LA (P.K.N.); Cardiovascular Associates of East Texas, Tyler (J.G.C.); Heart Center of Indiana, Indianapolis (B.B.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.); 3DT Holdings, LLC, San Diego, CA (Z.C.B.); and North Carolina Heart and Vascular Research Center, Raleigh (G.A.)
| | - George Adams
- From the Cardiovascular Institute of the South, Houma, LA (P.K.N.); Cardiovascular Associates of East Texas, Tyler (J.G.C.); Heart Center of Indiana, Indianapolis (B.B.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.); 3DT Holdings, LLC, San Diego, CA (Z.C.B.); and North Carolina Heart and Vascular Research Center, Raleigh (G.A.)
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Kuznetsov MR, Reshetov IV, Magnitskiĭ LA, V V, Marchenko IP, Matveev AD, Lugovoĭ AA, Tverskaia MS. [Embryology, anatomy and rare pathologies of the popliteal artery: Peculiarities of surgical treatment]. Angiol Sosud Khir 2018; 24:146-157. [PMID: 29924785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Knowledge of anatomical variations of the division of the popliteal artery and specific lesions of the arterial segment involved is necessary for the surgeon, traumatologist-orthopaedist, vascular surgeon. The article contains a review of recent literature data on the prevalence of different variants of branching patterns of the arteries of the crus, also providing a detailed discussion of embryological development of the arterial system of the lower extremities, in many ways explaining the appearance of rare pathologies of the popliteal artery, such as for example popliteal artery entrapment syndrome. Particular attention is paid to cystic damage of the popliteal artery, describing currently known theories of the development of this rare pathology, this is accompanied by sharing own experience in surgical treatment of the patients involved. Awareness of anatomical variants and peculiarities of embryonic development contributes to decreasing the possibility of iatrogenic damage of the popliteal artery during orthopaedic operations and to appropriate decision-making as to the method of revascularization.
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Affiliation(s)
- M R Kuznetsov
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia; Municipal Clinical Hospital #29 named after N.E. Bauman, Moscow, Russia
| | - I V Reshetov
- First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health (Sechenov University), Moscow, Russia
| | - L A Magnitskiĭ
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia; Municipal Clinical Hospital #1 named after N.I. Pirogov, Moscow, Russia
| | - Vasiliev V
- University Multimodality Hospital, Burgas, Bulgaria
| | - I P Marchenko
- Municipal Clinical Hospital #29 named after N.E. Bauman, Moscow
| | - A D Matveev
- Russian Medical Academy of Continuing Professional Education under the RF Ministry of Public Health, Moscow, Russia
| | - A A Lugovoĭ
- Municipal Clinical Hospital #29 named after N.E. Bauman, Moscow
| | - M S Tverskaia
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
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Elens M, Verhelst R, Possoz J, Mastrobuoni S, Lacroix V, Astarci P. Short-Term Results of Eluvia Paclitaxel-Eluting Stent in External Iliac and Femoropopliteal Lesions. Surg Technol Int 2017; 31:162-167. [PMID: 29121693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of this study was to independently evaluate the real-world performances of Eluvia paclitaxel drug-eluting stents (DES) (Boston Scientific, Marlborough, Massachusetts) for the treatment of external iliac and femoropopliteal artery lesions. MATERIALS AND METHODS We prospectively collected, and retrospectively reviewed, data for all patients who underwent an endovascular treatment with an Eluvia DES for the treatment of an external iliac or femoropopliteal lesion. Patient demographics, concomitant procedures, arterial lesions characteristics, procedural details, and follow-up were reviewed. RESULTS Between April and October 2016, 15 Eluvia DES were placed in 15 consecutive adult patients with a technical success of 100%. The treated lesions had a mean length of 93.9 ±58 mm. Sixty percent of the lesions were total occlusions and 13% were restenosis of previous stents. An additional inflow treatment was performed in 40% of the cases. At six months, two patients were lost at follow-up and one had an occluded stent. We had a primary patency rate and freedom from TLR of 92%. All remaining patients had an improved Rutherford class, improved quality of life and wound healing, and an increase in walking distance. Survival and limb salvage rates were 100%. CONCLUSIONS This study confirms the good result of DES, in general, and of the Eluvia stent, in particular, in the treatment of external iliac and femoropopliteal arterial lesions, with a primary patency rate and a freedom from TLR of 92% at six months. A larger number of patients and longer follow-up will be required to determine the true real-world efficacy of the Eluvia DES, but short-term experience is encouraging.
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Affiliation(s)
- Maxime Elens
- Cardiovascular and Thoracic Surgery Department, St Luc Hospital Catholic University of Louvain, Brussels, Belgium
| | - Robert Verhelst
- Cardiovascular and Thoracic Surgery Department, St Luc Hospital Catholic University of Louvain, Brussels, Belgium
| | - Julien Possoz
- Cardiovascular and Thoracic Surgery Department, St Luc Hospital Catholic University of Louvain, Brussels, Belgium
| | - Stefano Mastrobuoni
- Cardiovascular and Thoracic Surgery Department, St Luc Hospital Catholic University of Louvain, Brussels, Belgium
| | - Valerie Lacroix
- Cardiovascular and Thoracic Surgery Department, St Luc Hospital Catholic University of Louvain, Brussels, Belgium
| | - Parla Astarci
- Cardiovascular and Thoracic Surgery Department, St Luc Hospital Catholic University of Louvain, Brussels, Belgium
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Müller-Hülsbeck S, Keirse K, Zeller T, Schroë H, Diaz-Cartelle J. Long-Term Results from the MAJESTIC Trial of the Eluvia Paclitaxel-Eluting Stent for Femoropopliteal Treatment: 3-Year Follow-up. Cardiovasc Intervent Radiol 2017; 40:1832-1838. [PMID: 28948322 DOI: 10.1007/s00270-017-1771-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/09/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the 3-year results of the MAJESTIC first-in-human study of the Eluvia Drug-Eluting Vascular Stent System for treating femoropopliteal artery lesions. METHODS The prospective, single-arm, multicenter clinical trial enrolled 57 patients with symptomatic lower limb ischemia (Rutherford category 2, 3, or 4) and lesions in the superficial femoral artery or proximal popliteal artery. Mean lesion length was 70.8 ± 28.1 mm, and 46% of lesions were occluded. Efficacy measures at 2 years included primary patency, defined as duplex ultrasound peak systolic velocity ratio of ≤2.5 and the absence of target lesion revascularization (TLR) or bypass. Safety monitoring through 3 years included adverse events and TLR. RESULTS Primary patency was estimated as 83.5% (Kaplan-Meier analysis) at 24 months, and 90.6% (48/53) of patients maintained an improvement in Rutherford class. At 36 months, the Kaplan-Meier estimate of freedom from TLR was 85.3%. No stent fractures were identified, and no major target limb amputations occurred. CONCLUSION MAJESTIC results demonstrated long-term treatment durability among patients whose femoropopliteal arteries were treated with the paclitaxel-eluting Eluvia stent. LEVEL OF EVIDENCE Level 2b, cohort study.
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Affiliation(s)
- Stefan Müller-Hülsbeck
- Department of Diagnostic and Interventional Radiology/Neuroradiology, Ev. Luth. Diakonissenanstalt Flensburg, Knuthstr. 1, 24939, Flensburg, Germany.
| | - Koen Keirse
- Regional Hospital Heilig Hart Tienen, Tienen, Belgium
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
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48
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Morisaki K, Yamaoka T, Iwasa K, Ohmine T. Bypass Surgery after Endovascular Therapy for Infrapopliteal Lesion Is Not a Poor Outcome Compared with Initial Bypass Surgery by Vascular Surgeons. Ann Vasc Surg 2017. [PMID: 28647640 DOI: 10.1016/j.avsg.2017.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is unclear whether prior endovascular therapy (EVT) adversely affects bypass surgery. The aim of this study is to investigate treatment outcomes between initial bypass (bypass-first) and bypass surgery after EVT (EVT-first). METHODS We conducted a retrospective analysis of critical limb ischemia patients undergoing infrapopliteal bypass between November 2006 and December 2015. Graft patency, limb salvage (LS), amputation-free survival (AFS), and overall survival (OS) were examined between bypass-first and EVT-first groups. RESULTS The subjects in this study were 75 patients and 82 limbs in the bypass-first group and 24 patients and 24 limbs in the EVT-first group. The average age was higher in EVT-first group (P = 0.03). The percentage of inframalleolar bypass was higher in the EVT-first group (P = 0.002). Primary patency at 1 and 2 years was 72.0% and 67.5% for the bypass-first group and 53.1% and 47.2% for the EVT-first group, respectively (P = 0.04). Inframalleolar bypass was a risk factor for lower primary patency (hazard ratio 3.07, 95% confidence interval 1.18-8.51, P = 0.02) in multivariate analysis, while there were no differences in secondary patency, LS, AFS, and OS. CONCLUSIONS Bypass surgery after EVT has lower primary patency rates in comparison with primary bypass in patients submitted to infrapopliteal revascularization. Although very heterogeneous study population with a lot of bias in the indication of the revascularization, LS, OS and AFS are not affected by previous EVT.
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Affiliation(s)
- Koichi Morisaki
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Kazuomi Iwasa
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Takahiro Ohmine
- Department of Vascular Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
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49
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Popplewell MA, Davies HOB, Narayanswami J, Renton M, Sharp A, Bate G, Patel S, Deeks J, Bradbury AW. A Comparison of Outcomes in Patients with Infrapopliteal Disease Randomised to Vein Bypass or Plain Balloon Angioplasty in the Bypass vs. Angioplasty in Severe Ischaemia of the Leg (BASIL) Trial. Eur J Vasc Endovasc Surg 2017; 54:195-201. [PMID: 28602580 DOI: 10.1016/j.ejvs.2017.04.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/20/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim was to compare outcomes in a subgroup of patients with infrapopliteal (IP) disease randomised to infrapopliteal vein bypass (VB) or plain balloon angioplasty (PBA) in the original BASIL trial. METHODS A comparison of outcomes from patients randomised to VB or PBA undergoing revascularisation for severe limb ischaemia (SLI) because of IP disease with or without femoropopliteal disease. Data were extracted from case report forms from the BASIL trial. The primary outcome was amputation free survival (AFS); secondary outcomes included overall survival (OS), 30 day mortality and morbidity, freedom from arterial re-intervention, immediate technical success, repeat and crossover interventions, length of hospital stay, and quality of revascularisation. RESULTS A total of 104 patients were identified in the BASIL study with IP disease, 56 randomised to IP VB, and 48 to IP PBA. Groups were similar at baseline except for more chronic kidney disease and non-steroidal anti-inflammatory drug use in the VB group, and more previous surgical arterial intervention and antihypertensive use in the PBA group. There were no statistically significant differences in AFS or OS; however, clinically important trends were apparent in favour of a VB first strategy. Patients allocated to VB demonstrated significantly quicker relief of rest pain when compared with PBA (p = .005), but no significant differences in improved tissue healing. Median length of index hospital admission was significantly greater in the VB than in the PBA group (18 vs. 10 days, p < .0001) but there was no difference between the two groups in median total hospital stay between randomisation and the primary endpoint (VB 43.5 vs. PBA 42 days). CONCLUSIONS Further randomised trials, like BASIL-2 and BEST-CLI, are required to determine whether patients with severe limb ischaemia who require IP revascularisation and who are suitable for VB should have bypass or endovascular intervention as their primary revascularisation procedure.
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Affiliation(s)
- M A Popplewell
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK.
| | - H O B Davies
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
| | - J Narayanswami
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
| | - M Renton
- Heart of England Foundation Trust, Birmingham, UK
| | - A Sharp
- Heart of England Foundation Trust, Birmingham, UK
| | - G Bate
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
| | - S Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - J Deeks
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - A W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
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Ogawa Y, Yokoi H, Ohki T, Kichikawa K, Nakamura M, Komori K, Nanto S, O'Leary EE, Lottes AE, Saunders AT, Dake MD. Impact of Chronic Renal Failure on Safety and Effectiveness of Paclitaxel-Eluting Stents for Femoropopliteal Artery Disease: Subgroup Analysis from Zilver PTX Post-Market Surveillance Study in Japan. Cardiovasc Intervent Radiol 2017; 40:1669-1677. [PMID: 28488101 PMCID: PMC5651711 DOI: 10.1007/s00270-017-1673-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/24/2017] [Indexed: 01/30/2023]
Abstract
Purpose Favorable long-term outcomes of the Zilver PTX drug-eluting stent (DES) in femoropopliteal lesions have been demonstrated. Chronic renal failure (CRF) has been shown to be a risk factor for restenosis and decreased limb salvage. The results of the DES in patients with CRF have not previously been reported. This study compares the results with the DES in patients with CRF and those without CRF. Methods This retrospective analysis from the Zilver PTX Japan Post-Market Surveillance Study included 321 patients with CRF and 584 patients without CRF. Outcomes included freedom from target lesion revascularization (TLR) and patency. Results Of the patients included in this subgroup analysis, 2-year data were available for 209 patients in the CRF group and 453 patients in the non-CRF group. The two groups were similar in terms of lesion length and the frequency of in-stent restenosis. Critical limb ischemia, severe calcification, and diabetes were more common in patients with CRF, whereas total occlusion was more common in patients without CRF. Freedom from TLR rates were 81.4 versus 84.9% (p = 0.24), and patency rates were 70.7 versus 70.3% (p = 0.95) in patients with and without CRF at 2 years, respectively. Conclusion This is the first comparative study of the DES in femoropopliteal artery lesions in patients with and without CRF. These results indicate that the DES placed in femoropopliteal artery lesions of CRF patients is safe and effective with similar patency and TLR rates to patients without CRF. Level of Evidence Level 3, Post-Market Surveillance Study.
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Affiliation(s)
- Yukihisa Ogawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Takao Ohki
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | | | | | | | - Michael D Dake
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.
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