Embolotherapy is a major part of today’s interventional medicine. Interventional radiologists started implementing different forms of embolotherapy in the 1970s. Since that time, newer methods and devices have been added to our armamentarium for a variety of indications. Some of these products provide temporary occlusion, whereas others have been designed for permanent occlusion.
I have been practicing interventional oncology (IO) for almost 25 years (most interventional radiologists probably have to a greater or lesser extent). The treatment of cancer by interventional radiologists dates back to the 1950s, even before interventional radiology (IR) was recognized as a discipline.1 Our “founding fathers” published extensively on minimally invasive, image-guided cancer therapy through the 1960s and ‘70s.2-4 Tumor embolization has been a standard of care for 3 decades, and tumor ablation has been common practice for the past 15 years. Palliative procedures for management of cancer-related obstruction, pain management, and provision of enteral and venous access are routine IR practice.
CVOs have historically been diagnosed using ultrasound while evaluating occlusions in the infrainguinal area. However, a large segment of patients with chronic venous disease has been overlooked and neglected for many years because practitioners—primarily primary care doctors and at times, even vascular specialists—are not looking above the inguinal ligament. For the past 15 years, it has been my practice to use cross-sectional imaging (either CT venography or MR venography) to understand the status of iliac veins and inferior vena cava (IVC). It has been shocking how much disease has been uncovered there, which explains the symptoms the patients have had for many years that have gone undiagnosed or untreated.
Since the introduction of retrievable filters, our division has kept a database of every patient in whom a retrievable filter was placed by the interventional radiology department. Over the years as we started to learn more about the complications of retrievable filters, we became more aggressive in reaching out to patients for filter retrieval. Today, our database has matured to include more detailed information such as the reason for filter placement, type of retrievable filter, and the referring physician to further improve patient follow-up.
Peripheral artery disease (PAD) is a chronic disorder that affects more than 8 million Americans and is defined by atherosclerotic stenosis and arterial occlusions in the extremities (typically the legs).1 Despite current therapies, PAD often leads to disability and, in some cases, amputation and death. This disease worsens over time due to the cumulative effects of cardiovascular risk factors that intensify with age (eg, hypertension, diabetes, and dyslipidemia), and thus the burden of PAD is projected to grow along with the aging population.2,3
There are multiple endovascular options for treatment of infrainguinal disease, but treatment of severe calcific disease of the superficial femoral artery (SFA), popliteal artery, and tibial vessels remains a challenge. Peripheral atherectomy is a unique treatment modality because it allows debulking of plaque with luminal gain and minimal barotrauma. This results in less injury to the vessel during initial treatment and theoretically reduces hyperplastic reaction to the initial treatment. In severely calcific vessels, calcium debulking changes the vessel wall compliance with the removal of calcium. It can then be treated with low-pressure balloon inflation with minimal injury to the vessel wall. This is now a particularly attractive concept with the availability of drug-coated balloons and drug-eluting stents, as the vessel can be prepared with atherectomy before delivery of these devices. This may ensure adequate drug delivery to the tissue, thereby reducing intimal hyperplastic reaction and increasing durability of the procedures. Prevailing concerns with atherectomy (ie, dissection, perforation, clinically significant embolization, and durability) have prevented the widespread use of atherectomy.1
The recently published JETSTREAM Calcium Study was a prospective, single-arm, multicenter study to evaluate the effect of the JETSTREAM™ Atherectomy System (Boston Scientific Corporation) when treating severely calcified peripheral arterial lesions in the common femoral, superficial femoral, or popliteal arteries causing claudication.
Peripheral artery disease (PAD) is a major cause of morbidity and mortality in the United States, affecting 8 to 12 million people. The incidence of PAD increases in the presence of well-defined atherosclerotic risk factors, including cigarette smoking, diabetes mellitus, hypertension, hyperlipidemia, and advanced age, and is estimated to affect > 20% of adults aged 55 years and older. When symptomatic, PAD may adversely have an impact on functional capacity, ability to work, and quality of life. Furthermore, PAD is associated with significant social and economic costs1 and increases the risk of future cardiovascular events.
With a 5-year head start using DCBs before US physicians, Prof. Jos van den Berg shares his take on best practices with this tool, as well as the available data.
Endovascular Today sat down with a multidisciplinary panel of esteemed interventionists to discuss their current practice paradigms for atherectomy, including the hot topic of Vessel Prep prior to drug-coated balloons and other adjunctive therapies.
Prof. Giovanni Pratesi outlines the effectiveness of a new-generation device in expanding EVAR applicability using clinical evidence from trials and real-world experience.
Corey L. Teigen, MD, summarizes his firsthand experience with the new ultra-low-profile INCRAFT® AAA Stent Graft System during his participation in the premarket INSPIRATION clinical trial.
Stephen Goode, MBChB, MRCS, FRCR, PhD, explains how ease of use and ultra-low profile benefit his patients and his practice.
Prof. Do and Dr. Makaloski discuss how a device with an ultra-low profile offers advantages to patients and the practice.
Prof. Jose M. Abadal, MD, PhD; Prof. Miguel Araujo, MD; and Prof. Esther Vazquez, MD, discuss their clinical experience using this innovative stent graft system.
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