-
Journal of Vascular Surgery Apr 2004
Topics: Angioplasty; Carotid Artery Diseases; Consensus; Endarterectomy, Carotid; Humans; Practice Guidelines as Topic; Stents
PubMed: 15071467
DOI: 10.1016/j.jvs.2004.01.028 -
Renal Failure Dec 2023By analyzing the clinical history, laboratory test indexes, and intraoperative ultrasound imaging data of patients receiving ultrasound-guided percutaneous transluminal...
OBJECTIVE
By analyzing the clinical history, laboratory test indexes, and intraoperative ultrasound imaging data of patients receiving ultrasound-guided percutaneous transluminal angioplasty (UG-PTA) for the first time, the application value of UG-PTA in the treatment of peripheral stenosis of autogenous arteriovenous fistula (AVF) and the related factors affecting postoperative patency were investigated.
METHODS
A total of 381 patients with dysfunction of radio-cephalic AVF were treated with UG-PTA from June 2017 to September 2019. According to the inclusion and exclusion criteria, 199 patients were included in this study. Baseline characteristics of patients, including demographic, clinical, and laboratory data, were collected. Kaplan-Meier's survival curve was used to demonstrate the cumulative primary patency rate of UG-PTA. Univariate and multivariate Cox regression analysis was performed on clinical, anatomic, biochemical, and medication variables to identify the predictors of postintervention primary patency.
RESULTS
The early technical success rate of UG-PTA was 98.4% (375/381). One hundred and ninety-nine patients, with an average age of 52.9 years, were analyzed, 97 of whom were males (48.7%). The median follow-up duration was 21 months. No major complication was observed. Postintervention primary patency rates were 87.7%, 75.8%, and 60.0% at 6, 12, and 24 months, respectively. A previously failed AVF (HR, 1.935, 95% CI 1.071-3.494; = .029) and an increased level of parathyroid hormone (HR per 100 pg/mL increase, 1.105; 95% CI 1.014-1.203; = .004) were identified as independent negative predictors of primary patency of UG-PTA.
CONCLUSIONS
UG-PTA is a safe and effective method for the treatment of peripheral stenosis of AVF. Previously failed AVF and elevated parathyroid hormone levels are associated with lower primary patency rate.
Topics: Male; Humans; Middle Aged; Female; Vascular Patency; Constriction, Pathologic; Renal Dialysis; Retrospective Studies; Angioplasty; Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Ultrasonography; Parathyroid Hormone; Ultrasonography, Interventional; Angioplasty, Balloon; Treatment Outcome; Graft Occlusion, Vascular
PubMed: 37488970
DOI: 10.1080/0886022X.2023.2233623 -
Vascular Health and Risk Management 2014Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid... (Review)
Review
Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%-30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS) or carotid endarterectomy (CEA) is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment paradigms are based on identifying the magnitude of perioperative risk in patient subsets and on using predictive factors to stratify patients with high-risk asymptomatic stenosis.
Topics: Angioplasty; Asymptomatic Diseases; Carotid Stenosis; Diagnostic Imaging; Endarterectomy, Carotid; Humans; Predictive Value of Tests; Risk Assessment; Risk Factors; Stents; Treatment Outcome
PubMed: 25045271
DOI: 10.2147/VHRM.S48923 -
Annals of Surgery Jul 1992Endovascular surgery is a new multidisciplinary field that applies the recently innovated techniques of angioscopy, intraluminal ultrasound, balloon angioplasty, laser,... (Review)
Review
Endovascular surgery is a new multidisciplinary field that applies the recently innovated techniques of angioscopy, intraluminal ultrasound, balloon angioplasty, laser, mechanical atherectomy, and stents. This field can be defined as a diagnostic and therapeutic discipline that uses catheter-based systems to treat vascular disease. As such, it integrates the subspecialties of vascular surgery, interventional radiology, interventional cardiology, and biomedical engineering for the common purpose of improving arterial hemodynamics. Endovascular surgery offers many potential benefits: long incisions are replaced with a puncture wound, the need for postoperative intensive care is significantly reduced, major cardiac and pulmonary complications from general anesthesia are side stepped, and the dollar savings could be dramatic as the need for intensive care unit and in-hospital stay diminishes. Despite these technological advancements, endovascular surgery is still in its infancy and currently has limited applications. This review provides an updated summary of endovascular surgery today and addresses some of the obstacles still preventing its widespread use.
Topics: Angioplasty, Balloon; Angioplasty, Laser; Arterial Occlusive Diseases; Arteriosclerosis; Catheterization; Endoscopy; Humans; Stents; Ultrasonography
PubMed: 1385944
DOI: 10.1097/00000658-199207000-00002 -
Journal of Vascular Surgery Feb 2016
Topics: Adrenergic beta-Antagonists; Angioplasty; Carotid Artery Diseases; Female; Humans; Male; Stents; Stroke
PubMed: 26526053
DOI: 10.1016/j.jvs.2015.08.109 -
Journal of Vascular Surgery Apr 2016
Topics: Angioplasty; Carotid Arteries; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Radiography; Stents; Stroke
PubMed: 26610642
DOI: 10.1016/j.jvs.2015.08.120 -
Nanomedicine (London, England) May 2020To develop poly(lactide-co-glycolide)-graft-polyethylenimine (PgP) as a dual drug-delivery carrier for sirolimus (SR) and heparin (Hep) to inhibit restenosis after...
To develop poly(lactide-co-glycolide)-graft-polyethylenimine (PgP) as a dual drug-delivery carrier for sirolimus (SR) and heparin (Hep) to inhibit restenosis after balloon angioplasty. SR was loaded in the hydrophobic core and negatively charged Hep complexed with the positively charged hydrophilic shell of PgP. SR- and Hep-loaded PgP was tested on rat aortic smooth muscle cells and injured porcine coronary arteries after balloon angioplasty . SR and Hep loading efficiency in PgP were approximately 37 and 82%, respectively. SR- and Hep-loaded PgP treatment decreased smooth muscle cell proliferation up to 14 days post-treatment and decreased proliferation, collagen deposition and neointimal thickness and increased patency in porcine coronary arteries after balloon angioplasty .
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Animals; Coronary Restenosis; Heparin; Neointima; Rats; Sirolimus; Stents; Swine
PubMed: 32340540
DOI: 10.2217/nnm-2020-0028 -
Journal of Vascular Surgery Jun 2019
Topics: Angioplasty; Endarterectomy, Carotid
PubMed: 31159990
DOI: 10.1016/j.jvs.2018.11.008 -
European Journal of Vascular and... Sep 2010To explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument. (Review)
Review
OBJECTIVES
To explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument.
DESIGN
Literature review and an experimental study.
MATERIALS AND METHODS
The literature was searched for information regarding available global rating scales (GRSs); scientific societies' official statements on endovascular competence; and task analyses of endovascular procedures. In the experimental study, clinicians performed a video-recorded simulated iliac-artery stenting procedure. Subsequently, by using the method of retrospective verbalisation, the clinicians were interviewed while watching their performance on video commenting on key issues of the construct. Data from all sources were analysed, categorised and synthesised into a novel rating scale.
RESULTS
Available GRSs primarily included technical aspects of performance, whereas the competence statements, task analyses and clinicians' perceptions added a range of non-technical aspects. The novel rating scale SAVE (Structured Assessment of endoVascular Expertise) differs from prior scales by including issues of pre-planning; prediction of challenges; preparation of tools; management of imaging presentation; distinction of technical skills into external and internal control according to operator focus of visual attention; adaptation of strategy; clinical decision making; use of assistant; complications; inter-personal skills; and post-procedural planning.
CONCLUSIONS
The essence of developing endovascular expertise goes far beyond mere technical aspects.
Topics: Angioplasty; Attitude of Health Personnel; Clinical Competence; Computer Simulation; Education, Medical; Educational Measurement; Health Knowledge, Attitudes, Practice; Humans; Motor Skills; Perception; Task Performance and Analysis; Vascular Surgical Procedures; Video Recording
PubMed: 20807686
DOI: 10.1016/j.ejvs.2010.04.022 -
Stroke Aug 2018Background and Purpose- The VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated posterior circulation distal... (Clinical Trial)
Clinical Trial
Background and Purpose- The VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated posterior circulation distal flow status, determined by quantitative magnetic resonance angiography, is a robust predictor of vertebrobasilar stroke risk in patients with symptomatic atherosclerotic vertebrobasilar disease. Flow-compromised high-risk patients may benefit from flow-restoring endovascular procedures, such as submaximal angioplasty. In this study, we examine the cost-effectiveness of quantitative magnetic resonance angiography screening to identify patients who may benefit from submaximal angioplasty to restore vertebrobasilar flow. Methods- A Markov model was created comparing a no screening strategy with standard medical management alone and a screening strategy involving quantitative magnetic resonance angiography imaging and submaximal angioplasty for treatable patients with low vertebrobasilar flow for a 30-year time horizon. Outcomes included quality-adjusted life years (QALY) and lifetime costs. Rates of stroke and death were obtained from VERiTAS data, and disability rates and costs were derived from VERiTAS and the literature. A sensitivity analysis was performed with periprocedural stroke rate from angioplasty the primary variable of interest. Results- At a 6% periprocedural stroke risk, the screening strategy saved an average of 0.364 QALYs per patient and a lifetime cost savings of $7312 versus the no screening strategy. Among patients with low flow suitable for intervention, the benefit was substantially higher, averaging 1.485 QALYs saved and lifetime cost savings of $21 294. Across the entire cohort, QALY savings were observed at the end of the first year and economic savings at year 6. The benefit of screening declined at higher periprocedural risk. Conclusions- Quantitative magnetic resonance angiography screening and submaximal angioplasty with 6% periprocedural risk in suitable patients are cost effective both in terms of QALY and lifetime costs for patients with symptomatic vertebrobasilar occlusive disease. With potential health and economic savings, a clinical trial examining the periprocedural risk of submaximal angioplasty is warranted. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00590980.
Topics: Aged; Angioplasty; Blood Flow Velocity; Cohort Studies; Cost-Benefit Analysis; Female; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Vertebrobasilar Insufficiency
PubMed: 30012817
DOI: 10.1161/STROKEAHA.118.022339