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Circulation. Cardiovascular... Nov 2020
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Aortic Coarctation; Humans; Infant
PubMed: 33167701
DOI: 10.1161/CIRCINTERVENTIONS.120.010139 -
Journal of Vascular Surgery May 2023No consensus has yet been reached regarding the optimal treatment of patients with thromboangiitis obliterans (TO) and chronic limb ischemia. In the present study, we... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
No consensus has yet been reached regarding the optimal treatment of patients with thromboangiitis obliterans (TO) and chronic limb ischemia. In the present study, we aimed to summarize the results on endovascular treatment of such patients.
METHODS
We performed a meta-analysis using the following databases: PubMed, Scopus, and the Cochrane Library. The eligible studies had been reported up to December 2021 and had evaluated endovascular angioplasty to treat patients with TO and chronic limb ischemia. The early (mortality and technical success) and late (primary/secondary patency and limb salvage) outcomes were evaluated. StatsDirect (StatsDirect Ltd, Merseyside, UK) was used for the statistical analysis.
RESULTS
Overall, 15 eligible studies were included (only endovascular in 11 studies and both endovascular and open repair in 4 studies). Among 601 patients, 402 endovascular procedures (416 limbs) were recorded (angioplasty plus stenting for 7.2% and angioplasty plus thrombolysis for 3.7%). The clinical presentation was intermittent claudication (stage II-III) for 7.9% of the patients and critical ischemia (stage IV-VI) for 92.1% of the patients. Most of the patients had had lesions below the knee, and five had had upper extremity lesions. The pooled technical success rate was 86% (range, 81.1%-90.3%), with no in-hospital mortality. The other complications included perforations (1.9%), wound complications (2.2%), and distal embolism (0.2%). Primary patency was 65.7% (range, 52.7%-77.6%) at 12 months and 50.7% (range, 23.3%-77.9%) at 36 months. Secondary patency was 76.2% (range, 57.5%-90.8%) at 12 months and 64.5% (range, 32.3%-90.6%) at 36 months. The limb salvage rate was 94.1% (range, 90.7%-96.7%) at 12 months and 89.1% (range, 80.6%-95.4%) at 36 months.
CONCLUSIONS
Endovascular angioplasty for patients with TO and chronic limb ischemia was associated with optimal safety and low complication rates. The technical success and late outcomes were acceptable.
Topics: Humans; Thromboangiitis Obliterans; Angioplasty, Balloon; Angioplasty; Peripheral Vascular Diseases; Arterial Occlusive Diseases; Ischemia; Limb Salvage; Vascular Patency; Retrospective Studies; Treatment Outcome
PubMed: 36174815
DOI: 10.1016/j.jvs.2022.09.017 -
Deutsche Medizinische Wochenschrift... Oct 2023In addition to conservative therapy with intensive walking training, endovascular revascularisation and open vascular surgical revascularisation are of high importance...
In addition to conservative therapy with intensive walking training, endovascular revascularisation and open vascular surgical revascularisation are of high importance in the treatment of peripheral arterial disease. Over the past decades, endovascular therapy has developed considerably and is now the treatment of choice for most vascular segments. The use of different devices has been shown to be beneficial for different vessel segments. Primary stent angioplasty has been shown to be superior to balloon angioplasty with secondary stent implantation for the treatment of iliac lesions. Femoropopliteal, the use of paclitaxel-eluting balloon angioplasty is recommended. A mortality signal shown in a meta-analysis was not confirmed. With directional atherectomy and intravascular lithotripsy, different options for plaque modification are available. The cytostatic drug sirolimus as another antirestenotic substance still has to be investigated in large, randomised trials. A final assessment of the effectiveness and safety is not yet possible. Infrapopliteal balloon angioplasty remains the standard treatment. After interventional therapy, regular follow-up is recommended.
Topics: Humans; Peripheral Arterial Disease; Angioplasty, Balloon; Femoral Artery; Atherectomy; Stents; Treatment Outcome; Popliteal Artery; Coated Materials, Biocompatible
PubMed: 37757890
DOI: 10.1055/a-2017-7786 -
JPMA. the Journal of the Pakistan... Mar 2023Peripheral arterial disease (PAD) in diabetic patients is often overlooked due to associated neuropathy. The very first presentation of these patients is with an... (Review)
Review
Peripheral arterial disease (PAD) in diabetic patients is often overlooked due to associated neuropathy. The very first presentation of these patients is with an Ischaemic ulcer or toe gangrene. Diabetics have a very high amputation rate compared to non-diabetic patients due to diffuse multi-segmental disease in the calcified tibial arteries. Early detection of the condition is a challenge in these patients. Even ankle-brachial pressure index may not be reliable. Both surgical and endovascular options are effective in wound healing. Endovascular techniques include percutaneous transluminal angioplasty with and without stenting, sub-intimal angioplasty, percutaneous transluminal angioplasty with drug-coated balloons, covered stents, and use of atherectomy devices. The current narrative review was planned to discuss the essentials of diagnosing PAD in diabetic patients and its various treatment options.
Topics: Humans; Peripheral Arterial Disease; Angioplasty; Diabetes Mellitus; Endovascular Procedures; Stents; Treatment Outcome; Angioplasty, Balloon
PubMed: 36932767
DOI: 10.47391/JPMA.4590 -
Translational Stroke Research Oct 2019The current literature indicates carotid endarterectomy (CEA) as the preferred treatment for symptomatic, moderate to severe carotid artery stenosis. However,... (Review)
Review
The current literature indicates carotid endarterectomy (CEA) as the preferred treatment for symptomatic, moderate to severe carotid artery stenosis. However, recommendations for the management of acute tandem stenosis and complete occlusion, as well as postintervention restenosis of the carotid artery, remain controversial. Here, we review the literature evaluating these conditions and provide suggestions for clinical decision-making. Acute tandem stenosis or occlusion of the common and internal carotid arteries may be treated with angioplasty alone, reserving carotid artery stenting (CAS) or CEA for severe and complex cases. Patients who underwent CEA and developed ipsilateral restenosis may be subjected to angioplasty followed by CAS, which carries a lower risk of cranial nerve injury and subsequent restenosis of the artery. For post-CAS restenosis, current evidence recommends angioplasty and CAS for the management of moderate stenosis and CEA for severe stenosis of the carotid artery. Given the lack of level 1 evidence for the management of these conditions, the abovementioned recommendations may assist clinical decision-making; however, each case and its unique risks and benefits need to be assessed individually. Future studies evaluating and defining the risks and benefits of specific treatment strategies, such as CEA and CAS, in patients with acute tandem stenosis, occlusion, and postintervention restenosis of the carotid artery need to be conducted.
Topics: Angioplasty; Carotid Stenosis; Endarterectomy, Carotid; Humans; Recurrence; Stents; Treatment Outcome
PubMed: 30793257
DOI: 10.1007/s12975-019-00693-z -
Cardiovascular Revascularization... Jan 2024
Topics: Humans; Angioplasty, Balloon; Cardiology
PubMed: 37993347
DOI: 10.1016/j.carrev.2023.11.004 -
PloS One 2023This prospective, multicenter, randomized study aimed to compare the 1-year clinical outcomes after primary stenting with self-expanding bare metal nitinol stent (SENS)... (Randomized Controlled Trial)
Randomized Controlled Trial
Randomized clinical trial to compare the efficacy of self-expanding bare metal nitinol stent and balloon angioplasty alone for below-the-knee lesions following successful balloon angioplasty: 1-year clinical outcomes.
This prospective, multicenter, randomized study aimed to compare the 1-year clinical outcomes after primary stenting with self-expanding bare metal nitinol stent (SENS) and plain old balloon angioplasty (POBA) in patients with critical limb ischemia (CLI) and below-the-knee (BTK) lesions. Overall, 119 patients with CLI and BTK lesions were randomized to POBA alone (POBA group, 61 patients) or primary stenting with SENS (stenting group, 58 patients) after achieving acceptable POBA results in target BTK lesions. Clinical outcomes including amputation and revascularization rates were prospectively compared for 1 year. After 1 year, similar incidence rates of individual clinical endpoints, including cardiac death (6.5% vs. 5.1%, p > 0.999), myocardial infarction (1.6% vs. 0.0%, p > 0.999), repeat revascularization (19.6% vs. 18.9%, p = 0.922), target lesion revascularization (13.1% vs. 17.2%, p = 0.530), and amputation (4.9% vs. 0.0%, p = 0.244), were observed. POBA appeared to have acceptable treatment outcomes compared with primary stenting with SENS after 1 year in CLI patients with BTK lesions undergoing percutaneous transluminal angioplasty (PTA).
Topics: Humans; Prospective Studies; Angioplasty, Balloon, Coronary; Angioplasty, Balloon; Stents; Treatment Outcome; Vascular Patency; Popliteal Artery; Peripheral Arterial Disease
PubMed: 37956128
DOI: 10.1371/journal.pone.0294132 -
Zentralblatt Fur Chirurgie Oct 2023Endovascular revascularisation with paclitaxel-coated balloons for the treatment of peripheral artery disease has been shown to be an effective therapeutic option in the... (Review)
Review
Endovascular revascularisation with paclitaxel-coated balloons for the treatment of peripheral artery disease has been shown to be an effective therapeutic option in the femoropopliteal segment. The antiproliferative effect of paclitaxel prevents restenosis. In contrast, in the infra-popliteal segment, the evidence is currently conflicting. However, there is evidence of an increased risk of amputation and mortality from the second year after angioplasty with paclitaxel-coated balloons. This may be due to a dose-dependent cytotoxic effect of paclitaxel. Sirolimus-coated balloons might therefore be an alternative because sirolimus is cytostatic rather than cytotoxic and thus has a wide therapeutic window.Three single-arm pilot studies (50, 25, and 50 patients, respectively) show that angioplasty with sirolimus-coated balloons leads to comparable results to those reported from paclitaxel-coated balloons (late lumen loss at 6 months: 0.29 mm; primary patency at 12 months: femoropopliteal 79%-82%, infra-popliteal 59%; freedom from target lesion revascularization at 12 months: femoropopliteal 83%-94%, infra-popliteal 86%). Randomised controlled trials comparing standard balloon angioplasty and paclitaxel-coated balloons for the treatment of intermittent claudication or chronic limb-threatening ischaemia are active and are expected to provide efficacy and safety results from mid 2024.This review presents the results of pilot studies on angioplasty with sirolimus-coated balloons for the treatment of peripheral artery disease and reviews currently ongoing randomised controlled trials.
Topics: Humans; Popliteal Artery; Sirolimus; Treatment Outcome; Angioplasty; Femoral Artery; Angioplasty, Balloon; Peripheral Arterial Disease; Paclitaxel; Coated Materials, Biocompatible
PubMed: 37846166
DOI: 10.1055/a-2174-7770 -
Lasers in Medical Science Dec 2023Vascular diseases, such as venous insufficiency and coronary artery diseases, have been threatening the health of people. Efficient treatment with proper postoperative... (Review)
Review
Vascular diseases, such as venous insufficiency and coronary artery diseases, have been threatening the health of people. Efficient treatment with proper postoperative care is required to relieve the pain of the patients. Traditionally, venous insufficiency is treated with ligation and stripping, an open surgery whose complication rate cannot be ignored. Coronary artery disease is often treated with balloon angioplasty during which undilatable lesions may be encountered, limiting the efficacy of this approach. With advances in laser photonics and percutaneous coronary intervention procedure, laser ablation is emerging as an alternative and adjunctive therapy for these diseases. Endovenous laser ablation has the advantages of high success rate, low complication risk, and fast postoperative recovery. Laser ablation in arteries can handle uncrossable or undilatable lesions with a low incidence of serious complications. In this review, previously published research concerning vascular diseases and their therapies are analyzed in order to provide a clear explanation of the mechanisms and merits of laser ablation. For endovenous laser ablation, the main mechanisms are steam bubbles, heat conduction, and heat pipe, and three main influencing factors are wavelength, fiber types, and laser energy density. For excimer laser coronary atherectomy, the main mechanisms are photochemical, photothermal, and photomechanical effects, and three main influencing factors are catheter, medium, and laser parameters.
Topics: Humans; Laser Therapy; Angioplasty, Balloon, Coronary; Lasers; Venous Insufficiency; Angioplasty, Balloon; Coronary Artery Disease; Treatment Outcome; Varicose Veins; Saphenous Vein; Catheter Ablation
PubMed: 38155274
DOI: 10.1007/s10103-023-03964-2 -
Journal of Vascular Surgery Dec 2019
Topics: Angioplasty, Balloon; Femoral Artery; Humans
PubMed: 31401114
DOI: 10.1016/j.jvs.2019.03.077