Distal embolization (DE) occurs frequently during femoropopliteal (FP) interventions. Treatment of FP atherosclerotic lesions with balloon angioplasty, stenting, atherectomy, embolectomy, or catheter-directed lysis is likely to yield significant debris.1-11 Despite a high rate of DE reaching 100% in some reports,3,10 data suggest that only 2% to 3% of patients will eventually require additional pharmacological and/or mechanical treatment.12
Despite advances in endovascular therapy, femoropopliteal in-stent restenosis (FP-ISR) remains a frequent clinical challenge. It is estimated that approximately 115,000 cases of FP-ISR occur each year in the United States.1 Therefore, identifying optimal treatments for FP-ISR is critical for improving the outcomes of endovascular therapy. This article reviews the safety and efficacy of current treatment options for FP-ISR, including balloon angioplasty, laser atherectomy with adjunctive balloon angioplasty, drug-eluting stents, and emerging uses of drug-coated balloons (DCBs).
Although the drug-coated balloon (DCB) was initially thought to be an alternative to stenting in superficial femoral artery (SFA) interventions, it is our opinion that the DCB will never walk alone, as the limitations of this technology (in particular, the lack of mechanical scaffolding and uncertainties regarding adequate drug delivery to complex, calcified lesions) prevent its solo use in several cases.
The superficial femoral artery (SFA) is highly exposed to biomechanical forces occurring during leg movement. The superficial course of the artery, with crossing of flexion points as well as interaction with the surrounding musculature, exposes the artery to external forces, including compression, torsion, and elongation.1 The implantation of metallic stents is standard for the treatment of SFA atherosclerotic disease; however, concerns exist about the potential for nitinol stents to fracture and the clinical implications of these stent fractures.1 Some reports suggest that stent fractures are associated with a higher incidence of in-stent restenosis, thrombosis, or embolism.2-4 Others do not report a significant association between stent fracture and clinical deterioration.5,6-8
More than 19 million Americans now suffer from peripheral artery disease (PAD),1,2 and, correspondingly, the economic cost of this disease is becoming increasingly overwhelming. It is now estimated that the annual economic burden from PAD is between $160 and $290 billion.3,4
To investigate factors in patients with critical limb ischemia (CLI) and isolated infrapopliteal lesions that adversely affect outcomes of endovascular therapy (EVT) with or without angiosome-oriented revascularization.
Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance.
We performed indocyanine green angiography (ICGA) in patients with peripheral arterial disease (PAD), and established a method for the quantitative measurement of appropriate parameters to assess peripheral perfusion and the applicability of ICGA tests.
To evaluate the feasibility, efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the delayed treatment of lower extremity deep venous thrombosis (DVT).
This study was designed to evaluate the effectiveness of endovascular treatment (EVAR) for ruptured abdominal aortic aneurysms (rAAAs).
The need for specialty devices to improve the technical outcome of endovascular interventions is dependent on the rate of early failure in such procedures. This meta-analysis assessed procedural outcomes of such interventions to elucidate the rate of early procedural failures and the need for such specialty devices.
Background: Atherosclerotic renal artery stenosis (ARAS) is known to reduce renal blood flow, glomerular filtration rate (GFR) and amplify kidney hypoxia, but the relationships between these factors and tubulointerstitial injury in the poststenotic kidney are poorly understood. The purpose of this study was to examine the effect of renal revascularization in ARAS on renal tissue hypoxia and renal injury.
Background: Amputation rates and mortality in patients with severe acute limb ischemia remain high. The protective effect of controlled reperfusion (CR) on tissue damage because of local and systemic reperfusion injury is unclear.
Background: Among patients identified prehospital with ST-segment–elevation myocardial infarction, emergency medical service transport from the field directly to the catheterization laboratory, thereby bypassing the emergency department (ED), may shorten time to reperfusion.
The association of a family history of peripheral arterial disease (PAD) with the presence of PAD is largely unknown. We conducted a case-control study of 2,296 patients with PAD (69 ± 10 years, 64% men) and 4,390 controls (66 ± 11 years, 62% men) identified from noninvasive vascular and stress testing laboratories at Mayo Clinic, Rochester, Minnesota, from October 2006 through June 2012. PAD was defined as an ankle brachial index of ≤0.9 at rest and/or after exercise, a history of lower extremity revascularization, or having poorly compressible leg arteries. Controls were patients with normal ankle brachial index or without a history of PAD. Family history of PAD was defined as having at least 1 first-degree relative who had undergone revascularization or stent placement for PAD before the age of 65 years. Logistic regression analyses were used to evaluate whether a family history of PAD was associated with the presence of PAD, independent of conventional risk factors. A family history of PAD was present more often in patients with PAD than in controls, with a resulting odds ratio (OR) of 2.20 (95% confidence interval [CI] 1.82 to 2.67). The association remained significant after adjustment for conventional risk factors (OR 1.97, 95% CI 1.60 to 2.42). The association was stronger in younger subjects (age <68 years; adjusted OR 2.46, 95% CI 1.79 to 3.38) than in older subjects (adjusted OR 1.61, 95% CI 1.22 to 2.12). A greater number of affected relatives with PAD was also associated with greater odds of presence of PAD (adjusted OR 1.86, 95% CI 1.48 to 2.33 and adjusted OR 2.56, 95% CI 1.60 to 4.11 for patients with 1 and ≥2 affected relatives with PAD, respectively). In conclusion, individuals with a family history of PAD have nearly double the odds of having PAD relative to those without such a history.
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