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Journal of Interventional Cardiology Dec 2007Atherectomy is experiencing increased interest from endovascular specialists as a therapeutic treatment in the peripheral arteries. Long studied in the coronary... (Review)
Review
Atherectomy is experiencing increased interest from endovascular specialists as a therapeutic treatment in the peripheral arteries. Long studied in the coronary vasculature, atherectomy has several theoretical advantages that make it uniquely suited for the peripheral circulation. In particular, infra-inguinal peripheral arterial disease experiences physiologic stresses and forces that have made traditional percutaneous coronary treatments such as angioplasty and stenting not as successful. Restenosis has been a major problem for angioplasty and stenting alone. The SilverHawk atherectomy device has favorable short-term data but important longer-term data are limited and need further study. Laser atherectomy also has favorable applications in niche patients but the number of studies is limited. Unfortunately, athero-ablative technologies for peripheral arterial disease require more definitive objective data regarding 12-month and longer-term outcomes in order to obtain widespread scientific acceptance.
Topics: Arteries; Atherectomy; Atherectomy, Coronary; Constriction, Pathologic; Equipment Design; Humans; Lasers, Excimer; Peripheral Vascular Diseases; Secondary Prevention; Treatment Outcome
PubMed: 18042047
DOI: 10.1111/j.1540-8183.2007.00280.x -
Journal of Vascular Surgery Jul 2014
Topics: Aneurysm; Angioplasty; Female; Humans; Male; Renal Artery
PubMed: 24594446
DOI: 10.1016/j.jvs.2014.01.074 -
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 -
The Journal of International Medical... 2012Intracranial artery stenosis can be fatal, requiring fast, safe and effective intervention. The introduction of the Wingspan™ stent system with Gateway™ percutaneous... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Intracranial artery stenosis can be fatal, requiring fast, safe and effective intervention. The introduction of the Wingspan™ stent system with Gateway™ percutaneous transluminal angioplasty balloon catheter has made intracranial intervention possible in a clinical trial setting. This systematic review planned to identify and review all randomized controlled trials comparing angioplasty and stenting of intracranial arteries with standard medical care.
METHODS
Electronic databases and relevant records were examined for possible trials using predefined inclusion and exclusion criteria.
RESULTS
A total of 3661 records were identified by searching several English language databases and other sources including Chinese academic journals. The recently discontinued Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was the single qualifying study and showed clear advantage of medical management over percutaneous transluminal angioplasty and stenting (PTAS).
CONCLUSIONS
The SAMPRASS trial indicated that PTAS is associated with high complication and morbidity rates. Definitive recommendations cannot be made until convincing results from additional robustly designed randomized trials become available.
Topics: Angioplasty; Clinical Trials as Topic; Humans; Intracranial Arteriosclerosis; Stents
PubMed: 22429342
DOI: 10.1177/147323001204000103 -
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 -
Journal of Vascular Surgery Apr 2010
Topics: Angioplasty; Aptitude Tests; Clinical Competence; Computer Simulation; Curriculum; Education, Medical; Humans; Learning; Mental Recall; Motor Skills; Patient Simulation; Psychomotor Performance; Renal Artery Obstruction; Space Perception; Stents; Students, Medical; Task Performance and Analysis; Visual Perception
PubMed: 20347703
DOI: 10.1016/j.jvs.2009.11.058 -
The Surgical Clinics of North America Aug 1998Endovascular interventions for the treatment of lower-extremity atherosclerotic disease have undergone a rapid course of development during the past 30 years. Balloon... (Review)
Review
Endovascular interventions for the treatment of lower-extremity atherosclerotic disease have undergone a rapid course of development during the past 30 years. Balloon angioplasty is the most widely applied of these techniques and has been shown to yield excellent results, at least in the short and intermediate terms, in appropriately selected patients. The ideal candidate is one with a focal stenotic lesion of the iliac artery; this is also the type of patient in whom placement of an endoluminal stent, whether primarily or as an adjunct to balloon angioplasty, has been shown to be most effective. The initial enthusiasm for transluminal atherectomy of lower-extremity atherosclerotic lesions has met with some disappointing long-term results. It is now used mainly in conjunction with either or both of the above modalities in a select group of patients. Clearly, more controlled studies of all these techniques are needed to better define their exact indications and limitations in treatment of lower-extremity arterial disease.
Topics: Angioplasty, Balloon; Arteriosclerosis; Atherectomy; Humans; Iliac Artery; Intermittent Claudication; Leg; Peripheral Vascular Diseases; Stents
PubMed: 9728203
DOI: 10.1016/s0039-6109(05)70336-4 -
Minerva Cardioangiologica Feb 2007The systemic nature of vascular atherosclerosis is beginning to involve not only the angiologists and the vascular surgeons, but also the clinical and the invasive... (Review)
Review
The systemic nature of vascular atherosclerosis is beginning to involve not only the angiologists and the vascular surgeons, but also the clinical and the invasive cardiologists. Femoral occlusive disease is one of the most challenging field due to the particular anatomical morphology of the femoral arterial wall that is prone to obstructive disease and high restenosis rate after percutaneous revascularization. Acute and chronic arterial diseases are the main clinical scenario involving femoral vessels. Percutaneous techniques include endoluminal recanalization, subintimal recanalization, stent implantation, mechanical and rheolytic thrombectomy, laser angioplasty, and cryoplasty. In this review the authors propose an overview and an update of the most recent advances in techniques and results in the field of endovascular treatment of femoral artery occlusive disease.
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Laser-Assisted; Arterial Occlusive Diseases; Atherectomy; Cryotherapy; Femoral Artery; Humans; Popliteal Artery; Stents; Thrombectomy; Treatment Outcome
PubMed: 17287687
DOI: No ID Found -
Journal of Vascular Surgery Nov 2013
Topics: Angioplasty; Atherosclerosis; Female; Humans; Ischemia; Male; Mesenteric Arteries; Mesenteric Ischemia; Metals; Stents; Vascular Diseases
PubMed: 23827337
DOI: 10.1016/j.jvs.2013.05.022 -
BMC Nephrology Oct 2023To access the efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula, compare the long-term...
BACKGROUND
To access the efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula, compare the long-term patency and post-operative complications between them.
MATERIALS AND METHODS
The medical records and Hemodialysis record sheets from 44 patients between May 2020 and January 2022 who underwent percutaneous transluminal angioplasty or arteriovenous fistula reconstruction treatment for immature autogenous arteriovenous fistula (AVF) were retrospectively reviewed. The patients were divided into two groups according to the type of surgery they received, including 25 patients in the PTA group and 19 patients in the AVF reconstruction group. Clinical outcomes were included, such as the primary and secondary patency rates following the procedure, maturation time, peak systolic velocity (PSV) of brachial artery, maximum pump-controlled blood flow at initial dialysis, and post-operative complications rates in the two groups.
RESULTS
Technical and clinical success was achieved in 100% of the 44 cases. For patients who underwent percutaneous transluminal angioplasty, the primary patency rate at 3, 6, and 9 months was 84.0%, 68.0%, 60.0%, and the secondary patency rate was 92.0%, 84.0%, 80.0%, respectively. And for patients who underwent arteriovenous fistula reconstruction, the primary patency rate at 3, 6, and 9 months was 89.5%, 73.7%, 68.4%, and the secondary patency rate was 100.0%, 94.7%, 94.7%, respectively. There were no significant differences between the two groups in terms of patency rates (p > .050). In patients whose maturation was successful, the average maturation time of fistula after the PTA procedure was 19.36 ± 13.94 days, and 58.63 ± 18.95 days for the reconstruction procedure (p < .010). The PSV of brachial artery before and after the procedure was 87.64 ± 23.87 cm/s and 153.20 ± 21.69 cm/s in PTA group, for reconstruction group, the number was 86.26 ± 20.59 cm/s and 151.26 ± 29.94 cm/s, respectively. No statistically significant differences (p > .050). The maximum pump-controlled blood flow at initial dialysis was 232.60 ± 16.72 ml/min in PTA group, which was significantly higher than 197.11 ± 10.45 ml/min in reconstruction group (p < .010). Subcutaneous hematoma, restenosis, thrombus formation, and pseudoaneurysm were major complications in PTA group. Restenosis, thrombus formation, and pseudoaneurysm were major complications in reconstruction group, with no statistically significant differences between the two groups (p > .050).
CONCLUSION
When immature AVFs require reconstruction surgery, the patency outcomes are comparable to AVFs that undergo successful management by PTA. While, when AVFs are successfully managed by PTA, they have significantly less maturation times and higher maximum pump-controlled blood flow rates at initial dialysis AVF use.
Topics: Humans; Graft Occlusion, Vascular; Vascular Patency; Retrospective Studies; Aneurysm, False; Renal Dialysis; Angioplasty; Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Constriction, Pathologic; Thrombosis; Treatment Outcome
PubMed: 37848833
DOI: 10.1186/s12882-023-03361-5