Background: Vascular complications after transfemoral transcatheter aortic valve replacement are common and associated with significant morbidity and mortality. Little is known about the effect of access approach on vascular complications.
Purpose: To compare the safety and efficacy of ultrasound-accelerated thrombolysis (UAT) and standard catheter-directed thrombolysis (CDT) in patients with acute and subacute limb ischemia.
An 83-year-old female was found to have an fusiform aneurysm in the aortic arch. She was deemed to be a high surgical risk; therefore, endovascular stent–graft placement followed by revascularization of the brachiocephalic trunk using in situ stent–graft fenestration was considered. However, the safe application of fenestration was deemed difficult due to the tortuosity of the brachiocephalic artery. The patient was successfully treated with the aid of the “squid-capture” technique, which consists of deployment of the stent–graft in a snare wire loop that was advanced from the brachiocephalic artery and fenestration of the stent–graft with the support of the loop. A follow-up exam revealed complete sealing of the aneurysm without any complications. The squid-capture technique allows for the safe and secure puncture of the graft.
Background: It remains unclear whether cilostazol, which has been shown to improve the clinical outcomes of endovascular therapy for femoropopliteal lesions, also reduces angiographic restenosis.
Objectives: A prospective, multinational randomized controlled trial (RCT) and a complementary single-arm study evaluated the 2-year safety and effectiveness of a paclitaxel-coated drug-eluting stent (DES) in patients with superficial femoral artery lesions. The RCT compared the DES with percutaneous transluminal angioplasty (PTA) and provisional bare-metal stent (BMS) placement.
Objectives: This study aimed to assess the clinical implications and optimal cutoff value of high platelet reactivity (HPR) in patients receiving clopidogrel for peripheral endovascular procedures.
Background: We studied whether a 6‐month group‐mediated cognitive behavioral (GMCB) intervention for peripheral artery disease (PAD) participants, which promoted home‐based walking exercise, improved 6‐minute walk and other outcomes at 12‐month follow‐up, 6 months after completing the intervention, compared to a control group.
Purpose: To describe the use of transvascular autonomic modulation (TVAM) to improve cardiovascular autonomic nervous system (ANS) dysfunction in multiple sclerosis (MS) patients, comparing the safety and efficacy of this modified technique with traditional balloon angioplasty.
Purpose: To compare the performance of drug-coated balloons (DCB) and drug-eluting stents (DES) in long femoropopliteal lesions.
Although it is a relatively rare complication of endovascular therapy for patients with critical limb ischemia (CLI),1-3 distal embolization from atherothrombotic debris still remains a concern due to the major adverse events that may follow. These complications can in turn lead to additional procedures, increased limb amputation and mortality rates, as well as extended hospital stays and escalating hospitalization costs. The amount of dislodged thromboembolic material relies on many factors, ranging from lesion characteristics to revascularization techniques and the devices used.3,4 It has been documented that atherectomy and stent deployment induce dislodgement of more atherothrombotic material compared to percutaneous transluminal angioplasty (PTA) alone, and as expected, Transatlantic Inter-Society Consensus (TASC) C and D lesions tend to embolize more debris than lower-grade lesions.5
During the past 15 years, the number of major dysvascular amputations (defined as amputations above the ankle) performed annually has decreased. However, major amputation (MA) continues to be a primary therapy and is frequently the only treatment offered for critical limb ischemia (CLI).1,2
Critical limb ischemia (CLI) (characterized by rest pain and/or nonhealing ulcers) is a worldwide emergency because it frequently results in major limb amputation, which is a devastating event with profound physical, psychological, and work-related implications.1 Often, CLI appears along with “diabetic foot,” a chronic affliction of the lower extremities, with a lifetime risk that is estimated at approximately 15% for diabetics.2,3 It is caused by micro- and/or macrovascular complications of diabetes (sensory neuropathy, atherosclerosis, and motor, autonomic, or proprioceptive alterations) and by the altered response and resistance to infection.4 The macroangiopathy can also affect the coronary and cerebral anatomy.5
Multiple authors have published data on outcomes after endovascular therapy for complex tibioperoneal disease, demonstrating a staggering 20% to 40% technical failure rate with the antegrade approach.1,2 Unfortunately, due to the high morbidity in the population with critical limb ischemia, it is not rare that they are deemed unfit for open surgery. However, advancements in device technology and technical skills have resulted in higher technical success rates. This article describes the steps of and technical tips for one such technique: retrograde access.
Historically, the initial treatment of choice for revascularization of patients with critical limb ischemia (CLI) was lower extremity bypass grafting with autologous vein.1 With the publication of the randomized PREVENT III trial, it became apparent that real-world open revascularization for CLI patients carried 30-day rates of graft failure, perioperative mortality, and myocardial infarction of 5.2%, 2.7%, and 4.7%, respectively, as well as an overall primary graft patency rate of 61% at 1 year.2 As endovascular techniques and technologies have evolved, the paradigm of lower extremity revascularization has shifted. The BASIL (Bypass Versus Angioplasty in Severe Ischemia of the Leg) trial was the first randomized study of patients with CLI and infrainguinal disease; however, it failed to show a significant difference in amputation-free survival (AFS) between revascularization modalities.3 With the advent of newer approaches, it has been found that octogenarian CLI patients and those with high operative risk, such as patients with advanced kidney failure or end-stage renal disease, benefit from revascularization and should therefore be considered for an endovascular-first approach.4,5
By definition, critical limb ischemia (CLI) is the presence of ischemic rest pain or nonhealing wounds for > 2 weeks in the presence of reduced perfusion to the affected limb.1 The thresholds to define reduced perfusion commonly include an ankle pressure < 50 to 70 mm Hg or a first toe pressure < 30 to 50 mm Hg.2 Clinically, it can at times be difficult to attribute ischemia as the sole cause of a wound; however, ischemia may still contribute to poor healing. There is a strong association between CLI and amputation and death.3 Revascularization is often pursued to avoid amputation or to limit the extent of amputation with the goal of improving quality of life.
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