Key Points
Randomized clinical trials have previously demonstrated drug‐coated balloon (DCB) treatment of femoropopliteal disease reduces the odds of clinically driven target lesion revascularization ...(CD‐TLR) by 60%–70% at 2–3 years compared to balloon angioplasty alone.
The single‐arm IN.PACT Global Study demonstrates clinical outcomes observed at 2 years tend to remain durably stable through 5 years of follow‐up.
Approximately three‐quarters of patients undergoing DCB treatment of relatively complex femoropopliteal disease had freedom from CD‐TLR at 5 years.
Key Points
Critical limb ischemia (CLI) patients with end‐stage renal disease (ESRD) undergoing endovascular or open revascularization have 50%–70% lower odds of survival, freedom from amputation, ...and secondary patency than those without ESRD.
Increased arterial medial calcification, inflammation, comorbidities, and impaired wound healing are the likely causes of worse outcomes in ESRD CLI patients after revascularization compared to other CLI patients without ESRD.
Better risk prediction to inform revascularization decisions and enhanced local wound care are potential avenues for improving outcomes awaiting development of more effective systemic therapies and revascularization approaches for ESRD CLI patients.
Key Points
Steno‐occlusive disease of the common femoral artery (CFA) has been historically considered a "no go" and certainly "no stent" zone for endovascular therapy.
Largely a "leave nothing ...behind" strategy, Directional Atherectomy plus Anti‐Restenotic Theray (DAART) with drug coated balloon (DCB) appears to be a safe and durably effective treatment for CFA steno‐occlusive disease, as well as complex femoropopliteal disease.
Experienced operators safely achieved 84% primary patency and 87% freedom from target lesion revascularization in the CFA with DAART, sufficiently competitive with open endarterectomy to warrant larger randomized trials.
Covered stents favored in complex aortoiliac disease Winscott, John G.; Hillegass, William B.
Catheterization and cardiovascular interventions,
November 1, 2021, 2021-11-01, 2021-11-00, 20211101, Letnik:
98, Številka:
5
Journal Article
Recenzirano
Key Points
Covered balloon expandable stents have 2 year primary patency rates of approximately 85% compared to 75% for uncovered stents in complex aortoiliac disease.
A reduction in the area and ...thickness of neointimal hyperplasia may explain the superior maintenance of post‐procedural ankle‐brachial index improvements and patency of covered stents for complex aortoiliac disease.
Improved outcomes prediction based on anatomic disease (Trans‐Atlantic Inter‐Society Consensus disease classification) and clinical characteristics may inform patient‐specific device selection to improve long‐term outcomes and cost‐effectiveness in the endovascular treatment of aortoiliac disease.
Key Points
Consistent and durable patency and clinical benefit after initially successful infrapopliteal percutaneous balloon transluminal angioplasty (PTA) for critical limb ischemia remains an ...unmet need.
Permanently implanted metallic stents for suboptimal initial infrapopliteal PTA results also have limited patency and clinical results as well as other drawbacks.
In 48 critical limb ischemia patients with infrapopliteal lesions < 50 mm length, everolimus eluting bioresorbable vascular scaffolds (EEBVS) achieved 90% primary patency and freedom from clinically driven target lesion revascularization at 2 years follow‐up with no late scaffold thrombosis.
Key Points
Claudicants with femoropopliteal disease average 25% higher primary patency and reduced target lesion revascularization long term with crystalline paclitaxel eluting stent and balloon ...treatment compared to uncoated devices. In animal models, local and downstream tissues have detectable paclitaxel for greater than 180 days.
Aggregate data meta‐analyses of 28 randomized trials suggested 50–100% higher all‐cause mortality with paclitaxel device treatment.
In contrast, more complete ascertainment of follow‐up and pooled individual patient data analyses do not find significantly increased mortality, a dose‐mortality relationship, or an unexpected cause of death pattern with paclitaxel eluting device treatment in femoropopliteal claudicants.
Key Points
Spatial and quantitative measures of end‐tissue perfusion and oxygenation are an unmet need in the care of chronic limb‐threatening ischemia (CLTI) patients.
Pedal artery sheath ...measurements of pedal pressure are feasible, safe, and predictive of limb survival.
Extending this concept to other endovascular access sites and open surgery, multiple novel approaches may soon permit real‐time intraprocedural physiological measures to quantitatively inform revascularization and long‐term management of CLTI patients.
Sensors that implement laser speckle image streaming provide real-time, noninvasive assessment of peripheral blood flow during endovascular revascularization. This single-center feasibility study ...evaluated a laser speckle-based peripheral blood flow monitoring system in 24 patients with peripheral arterial disease. System-quantified blood flow values showed improvement at the conclusion of the procedure in 20 of 24 patients (83.3%). Of the four patients without improved flow values, waveform morphology improved in three. Waveforms graded as moderate to severe peripheral arterial disease decreased from 71% before the procedure to 25% after the procedure, with improvement in 19 of 24 patients. In this limited population, laser speckle imaging could offer a highly sensitive method of detecting intraprocedural pedal blood flow changes.
Outflow graft obstruction (OGO) is a potentially fatal complication of left ventricular assist device (LVAD) implantation. Common causes include graft kinking, luminal stenosis, and graft thrombosis. ...We describe a case of a 51-year-old female who presented with acute LVAD failure and cardiogenic shock. Initial imaging revealed OGO without luminal stenosis following which she was she was empirically treated for graft thrombosis with anticoagulation and catheter-based thrombolytic therapy with no success. Further imaging in the catheterization laboratory revealed a potential neointimal flap dissection acting as a one-way valve. A stent was successfully placed across the outflow graft with immediate resolution of cardiogenic shock. The case emphasizes the importance of including neointimal flap as a differential for OGO in acute LVAD failure, especially in cases where thrombolytic therapy fails to correct hemodynamic compromise.
