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.
Purpose: To investigate the effect of renal denervation (RDN) on blood pressure and renal function in refractory hypertension after renal artery recanalization and optimal medical therapy.
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: he outcome of patients with ruptured abdominal aortic aneurysm (rAAA) varies by country. Study of practice differences might allow the formulation of pathways to improve care.
Femoral artery caliber or disease precludes vascular access in a significant minority of candidates for transcatheter aortic valve replacement or aortic endograft therapy. We propose an alternative access route to the abdominal aorta for large-vessel introducer sheaths by direct puncture from the adjoining inferior vena cava (IVC). We reason that the veins are larger and more compliant than corresponding arteries, that venous decompression may avert hemorrhage in confined-space arterial perforation, and that acquired aortocaval fistulas are not immediately life-threatening. We close the caval-aortic access tract using nitinol occluders. We also test intentional failure to close the caval-aortic access tract.
Objectives This study determined whether greater 2-year declines in Walking Impairment Questionnaire (WIQ) stair climbing, distance, or speed scores were associated with higher all-cause and cardiovascular disease (CVD) mortality among men and women with lower extremity peripheral artery disease (PAD).
Peripheral artery disease (PAD), which affects the large and medium arteries of the lower extremities, is a substantial cause of morbidity and health costs.1–5 Clinical studies assessing treatments for PAD guide clinical management but require standard definitions of disease and outcomes to ensure validity and consistency within and between studies.
Background—Evidence about the effect of smoking on venous thromboembolism risk, generally and in the postoperative period, is limited and inconsistent. We examined the incidence of venous thromboembolism in relation to smoking habits, both in the absence of surgery and in the first 12 postoperative weeks, in a large prospective study of women in the United Kingdom.
Background—The direct thrombin inhibitor, bivalirudin, is associated with similar efficacy and superior safety in patients undergoing percutaneous coronary intervention. However, the role of direct thrombin inhibitors in carotid artery stenting is not well defined. The objective of this study was to compare the safety and effectiveness of bivalirudin and unfractionated heparin (UFH) for carotid artery stenting. We hypothesized that bivalirudin would be associated with less in-hospital postprocedure bleeding than UFH but similar rates of in-hospital and 30-day ischemic outcomes.
Objective: Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensive patients because of a reduction in vascular resistance.
Utilizing the tibiopedal (TP) area for alternative access during endovascular procedures has recently become more common. Achieving hemostasis at the TP junction is usually straightforward, but difficult situations may arise, depending on the exact location of the access. Our approach to access and close the TP area that has proven to be the most successful is an algorithmic method: always attempt access first with the easiest and safest vessel to enter and exit; only use the most complex and least safe access site as a last resort.
Beginning with the first radial artery (RA) access I performed in 2000, I realized that the transradial approach is the true minimally invasive, safer, patient-friendly approach for coronary and endovascular intervention. This belief eventually evolved into a “radial always, unless contraindicated” approach. Because of the safety associated with radial access, the European Society of Cardiology consensus statement has recommended that radial access should be the default approach for cardiac catheterization.1
Since the early 2000s, percutaneous transcatheter aortic valve replacement (TAVR) has rapidly developed. Currently, there is sufficient evidence that it can be considered as a valid alternative to conventional cardiac surgery for patients with severe aortic stenosis who are at high surgical risk. The patients we currently treat are generally frail and elderly and are more likely to have vascular access issues.
Aortic dissections are classified by site (Stanford type A, ascending aorta; type B, descending aorta) and chronicity (acute if onset of symptoms < 2 weeks, chronic if > 2 weeks). The acute group can further be subdivided into complicated and noncomplicated subgroups. Complications, and therefore indications for intervention, include rupture, expanding aneurysms, visceral and lower limb malperfusion, refractory pain, hypertension, and false aneurysm formation.
Carotid artery stenting (CAS) has been shown to be an effective treatment modality in patients with carotid artery occlusive disease. However, patients with complex aortic arch anatomy and octogenarians may be considered high risk, with increased stroke risk during CAS. Schneider et al identified severe aortoiliac disease, unfavorable aortic arch configuration (type II or III), bovine arch anatomy, and supra-aortic vessel take-off as conditions rendering CAS more difficult.9
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