Critical limb ischemia is a major cause of morbidity and mortality worldwide and is characterized by multilevel disease, often involving the tibiopedal vessels. There are some reports that the atherosclerotic pattern in diabetic patients affects the tibial vessels yet tends to spare the pedal vasculature.1,2 Although this may be true in many cases, our experience has demonstrated frequent involvement of the pedal vessels, including the pedal arch. In a subset of patients with critical limb ischemia, particularly in longstanding type 1 diabetic patients and patients on dialysis, a predominance of disease involving the pedal vessels can exist with relative sparing of the tibial vessels.3
Today, critical limb ischemia (CLI) due to diabetic arterial disease is a major worldwide cause of morbidity and mortality,1,2 affecting a large number of patients and can lead to severe disabilities. In fact, major amputations are usually associated with significant increases in mortality risk, and every effort should be pursued to minimize amputations and ensure limb salvage.3
Critical limb ischemia (CLI) occurs as an arterial stenosis approaches a critical point, compromising blood flow to the distal extremity and thus falling short of the basal tissue oxygen demand.1,2 As a result, patients present with rest pain and/or nonhealing ulceration and comprise approximately 1% to 2% of the peripheral arterial disease (PAD) population.3 Nearly 40% of patients with CLI require amputation, and roughly 150,000 amputations occur annually.4,5
Lower extremity peripheral artery disease (PAD) affects more than 8 million people in the United States and in excess of 202 million people globally. PAD is associated with a high prevalence of coincident coronary artery disease and cerebrovascular disease, which serves to increase morbidity and mortality in this population.1-5 For patients with symptomatic lower extremity PAD, assuagement of pain, prevention of amputation, preservation of ambulatory/functional status, cardiovascular protection, and containment of health care cost are important.6 The safety, efficacy, and lower cost of endovascular interventions compared to surgical revascularization for the treatment of PAD have been previously demonstrated.7,8
Existing endovascular options for lower extremity and visceral arterial thromboembolism face the challenges of limited trackability, vessel injury, and incomplete revascularization. At the forefront of advances in catheter materials and technology, Penumbra, Inc. recently introduced the Indigo™ System for mechanical thrombectomy in the periphery. The Indigo System is designed to address the limitations of conventional technology, bringing greater trackability and the power of large-bore catheters and the Indigo pump to the peripheral vasculature.
Background Current guidelines recommend that patients with peripheral arterial disease (PAD) cease smoking and be treated with aspirin, statin medications, and angiotensin‐converting enzyme (ACE) inhibitors. The combined effects of multiple guideline‐recommended therapies in patients with symptomatic PAD have not been well characterized.
Background: Vorapaxar is a novel antagonist of protease-activated receptor-1, the primary receptor for thrombin on human platelets that is also present on vascular endothelium and smooth muscle. Patients with peripheral artery disease are at risk of systemic atherothrombotic events, as well as acute and chronic limb ischemia and the need for peripheral revascularization.
Abstract: Vascular calcification (VC), particularly medial (Mönckeberg´s medial sclerosis) arterial calcification, is common in patients with diabetes mellitus and chronic kidney disease and is associated with increased cardiovascular morbidity and mortality. Although, the underlying pathophysiological mechanisms and genetic pathways of VC are not fully known, hypocalcemia, hyperphosphatemia, and the suppression of parathyroid hormone activity are central to the development of vessel mineralization and, consequently, bone demineralization. In addition to preventive measures, such as the modification of atherosclerotic cardiovascular risk factors, current treatment strategies include the use of calcium-free phosphate binders, vitamin D analogs, and calcium mimetics that have shown promising results, albeit in small patient cohorts. The impact of intimal and medial VC on the safety and effectiveness of endovascular devices to treat symptomatic peripheral arterial disease (PAD) remains poorly defined. The absence of a generally accepted, validated vascular calcium grading scale hampers clinical progress in assessing the safety and utility of various endovascular devices (e.g., atherectomy) in treating calcified vessels. Accordingly, we propose the peripheral arterial calcium scoring system (PACSS) and a method for its clinical validation. A better understanding of the pathogenesis of vascular calcification and the development of optimal medical and endovascular treatment strategies are crucial as the population ages and presents with more chronic comorbidities. © 2014 Wiley Periodicals, Inc.
Background: The efficacy and safety of primary stenting for superficial femoral artery (SFA) disease have been benchmarked against historically derived performance goals. However, contemporary evidence evaluating SFA stenting is accumulating. The objective of this systematic review and meta-analysis was to quantitatively assess outcomes after primary SFA stenting with nitinol stents in contemporary practice, to compare these rates with commonly used efficacy and safety goals, and to discuss the clinical and regulatory implications of these findings.
Background: For patients with critical limb ischemia (CLI), the optimal treatment to enhance limb preservation, prevent death, and improve functional status is unknown. We performed a systematic review and meta-analysis to assess the comparative effectiveness of endovascular revascularization and surgical revascularization in patients with CLI.
Background Current guidelines recommend that patients with peripheral arterial disease (PAD) cease smoking and be treated with aspirin, statin medications, and angiotensin‐converting enzyme (ACE) inhibitors. The combined effects of multiple guideline‐recommended therapies in patients with symptomatic PAD have not been well characterized.
Endovascular repair of thoracic (TEVAR) or abdominal aortic aneurysms (EVAR) has proven to be a safe, popular, and effective treatment option for managing aortic aneurysms. However, a major ongoing challenge to the near-universal use of endografts has been to create an endograft that ensures the same reliable aneurysm seal afforded by open surgical resection and suturing of a prosthetic graft directly to the aortic wall.
PURPOSE: We aimed to present our preliminary single-center experience of the endovascular management of thoracic and abdominal aortic ruptures.
Objectives: The aim of this study was to assess the results of hybrid techniques for the treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms based on multicenter results and the various series regarding hybrid procedures reported in the literature.
Purpose: To compare the durability of thoracic endovascular aortic repair (TEVAR) in two similar clinical trials that used early- and later-generation stent grafts.
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