In terms of devices that treat chronic total occlusions (CTOs), the TruePath™ CTO Device (Boston Scientific Corporation, Natick, MA; see sidebar) offers the most versatility in managing a variety of lesion types and anatomical locations. For example, an intraluminal device such as the Frontrunner (Cordis Corporation, Bridgewater, NJ) serves its purpose, but when the interventionist is faced with a very hard, smooth proximal cap, it will not be easily traversed unless specific techniques are employed to make a “dent” in the cap. The TruePath device, however, is designed to “drill” through the proximal cap or occlusion regardless of composition, be it soft tissue, ulcerated plaque, mixed fibrocalcific, or extremely calcific. In addition, because of its 0.017-inch profile, it may traverse multiple levels over the length of a given CTO, including the distal cap.
Endovascular treatment of chronic total occlusions of the peripheral arteries was initially accomplished using subintimal angioplasty. After the seminal description of the technique by Bolia et al,1 the use of subintimal angioplasty was questioned as a useful technique for recanalization of totally occluded arteries. The patency of a subintimal tract was thought to be poor, and the technique raised the risk for propagation of the dissection into normal arteries beyond the occlusion. With improved wires and catheters, as well as the development of stents to address the acute technical and angiographic failure of subintimal angioplasty of total occlusions, the use of subintimal angioplasty increased.
The number of patients living with peripheral vascular disease (PVD) in the United States will continue to increase and will exceed 20 million by the year 2030. But this epidemic is not isolated to Western countries. A recent analysis evaluating the prevalence of PVD in third-world countries shows an increase of 27%. The overall incidence of critical limb ischemia (CLI) and lower extremity arterial ulcers has been estimated at 1% to 2%.
Objectives This study sought to evaluate whether a strategy with a 600-mg clopidogrel load and a short-term, high-dose atorvastatin reload would improve outcomes in clopidogrel-naïve, statin-treated patients undergoing protected carotid stenting.
Background: Dabigatran and warfarin have been compared for the treatment of acute venous thromboembolism (VTE) in a previous trial. We undertook this study to extend those findings.
Background: Factors explaining the association between impaired kidney function and venous thrombosis have not been identified so far. The aim of our study was to determine whether the association between impaired kidney function and venous thrombosis can be explained by the concurrent presence of genetic or acquired venous thrombosis risk factors.
Objectives: Because of the increasing number of interventional endovascular procedures with fluoroscopy and the corresponding high annual dose for interventionalists, additional dose-protecting measures are desirable. The purpose of this study was to evaluate the effect of disposable radiation-absorbing surgical drapes in reducing scatter radiation exposure for interventionalists and supporting staff during an endovascular aneurysm repair (EVAR) procedure.
It has been a singular honor and a privilege to serve as the 67th president of this distinguished society. A true American dream, when someone born behind the Iron Curtain, raised in communist Hungary, immigrates to this great nation, joins the staff of Mayo Clinic, and completes his term as president of the most prestigious vascular surgical society in the world. It is humbling to look around the room and see hundreds of colleagues I admire, including past presidents, giants of our profession who guided us during the past decades so that today we have a society that is stronger, larger, and more vibrant than any time before. I am thankful to them for their vision and hard work. I am equally thankful to the current leadership of the Society for Vascular Surgery (SVS), to a dedicated staff and hundreds of volunteers, many here today, who helped me build a better society and strengthen our profession during this past year.
Purpose: To test the ability of a drug-eluting balloon (DEB) to reduce recurrent in-stent restenosis (ISR) in diabetic patients with femoropopliteal stents.
Methods: We conducted a systematic review and meta-analysis of studies reporting circulating IL-6 in AAA, and new investigations of the association between a common non-synonymous functional variant (Asp358Ala) in the IL-6R gene (IL6R) and AAA, followed the analysis of the variant both in vitro and in vivo.
Objectives: The purpose of CONFIRM registry series was to evaluate the use of orbital atherectomy (OA) in peripheral lesions of the lower extremities, as well as optimize the technique of OA.
Objectives: To appraise clinical results of foot arteries recanalization using percutaneous retrograde transmetatarsal arteries access followed by retrograde recanalization of foot and tibial vessels.
Objectives: This study was designed to evaluate the safety of a novel drug-coated balloon (DCB) with 2 µg/mm2 paclitaxel and a carrier comprised of polysorbate and sorbitol in a swine femoral artery model.
Acute limb ischemia (ALI) is caused by embolisms or progressive atherosclerosis. We report the case of a 68-year-old female who presented with acute total occlusion of left iliac artery due to remarkably massive ascites from pancreatic cancer. To our knowledge, no other case reports of ALI caused by acute compartment syndrome have been published. We treated our case successfully by draining the ascites fluid without any balloon angioplasty or stent implantation. The removal of extrinsic compression may be the best treatment for cases of this type. © 2013 Wiley Periodicals, Inc.
Long saphenous femoral artery (SFA) chronic total occlusions (CTOs) are considered the “Achilles heel” of the lower extremity percutaneous interventions. Antegrade, retrograde, or transcollateral approaches, intraluminal or subintimal techniques with re-entry and specialized CTO devices using microdissection, vibrational energy, and laser have all been tried for the management of such challenging lesions with various success rates. Ocelot is the first CTO crossing device using real-time OCT technology. Its crossing catheter utilizes spiral wedges to corkscrew the CTO cap, while real-time OCT offers direct visualization to facilitate intravascular true-lumen orientation. The recently presented results of the CONNECT-II study demonstrated crossing success of 97% and freedom from major adverse events of 98%. We present one of the most challenging SFA CTOs with ambiguous proximal cap in the ostium of the SFA, heavy calcification and involving almost the entire length of the SFA. The Ocelot catheter assisted to the successful true-lumen recanalization of that complex lesion. © 2013 Wiley Periodicals, Inc.
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