17 julio 2013

EUROPEAN HEART JOURNAL. Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis

Nasser Malyar*, Torsten Fürstenberg, Jürgen Wellmann, Matthias Meyborg, Florian Lüders, Katrin Gebauer, Holger Bunzemeier, Norbert Roeder and Holger Reinecke

Aims: The prevalence of peripheral arterial disease (PAD) and especially of critical limb ischaemia (CLI) is announced to rise dramatically worldwide, with a considerable impact on the health care and socio-economic systems. We aimed to characterize the recent trends in morbidity and in-hospital outcome of PAD among all hospitalized patients in the entire German population between 2005 and 2009.

01 agosto 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Drug Delivering Technology for Endovascular Management of Infrainguinal Peripheral Artery Disease

Karan Sarode, MA∗; David A. Spelber, BA‡; Deepak L. Bhatt, MD, MPH§; Atif Mohammad, MD∗; Anand Prasad, MD‡; Emmanouil S. Brilakis, MD, PhD∗; Subhash Banerjee, MD∗

Endovascular intervention has become a well-recognized treatment modality for peripheral artery disease; however, mid- and long-term outcomes have been plagued by limited durability. Plain balloon angioplasty and bare-metal stents have historically suffered from high restenosis rates leading to the need for frequent repeat revascularization procedures. The innovation of locally administered, drug-delivering balloons and stents has been a direct result of technological innovations directed toward prevention and treatment of this limitation. Over the last 5 years, numerous clinical trials investigating the use of drug-coated stents and drug-coated balloons indicate a significant improvement in endovascular treatment durability and outcomes. This review provides an up-to-date assessment of the current evidence for the use of drug-coated stents and drug-coated balloons in the treatment of femoropopliteal and infrapopliteal peripheral artery disease. Additionally, it provides an overview of the development of this technology, highlights landmark ongoing and completed clinical trials, examines evidence to support the use of drug-coated technologies in combination with other modalities, and examines promising new technological developments. Last, it summarizes the challenges and safety concerns that have delayed U.S. Food and Drug Administration approval of these devices.

11 julio 2014

CIRCULATION. Vascular Medicine. Vitamin D Promotes Vascular Regeneration

Michael Sze Ka Wong, PhD; Matthias S. Leisegang, PhD; Christoph Kruse, MSc; Juri Vogel, MSc; Christoph Schürmann, PhD; Nathalie Dehne, PhD; Andreas Weigert, PhD; Eva Herrmann, PhD; Bernhard Brüne, PhD; Ajay M. Shah, MD, PhD; Dieter Steinhilber, PhD; Stefan Offermanns, MD; Geert Carmeliet, MD, PhD; Klaus Badenhoop, MD; Katrin Schröder, PhD*; Ralf P. Brandes, MD*

Background: Vitamin D deficiency in humans is frequent and has been associated with inflammation. The role of the active hormone 1,25-dihydroxycholecalciferol (1,25-dihydroxy-vitamin D3; 1,25-VitD3) in the cardiovascular system is controversial. High doses induce vascular calcification; vitamin D3 deficiency, however, has been linked to cardiovascular disease because the hormone has anti-inflammatory properties. We therefore hypothesized that 1,25-VitD3 promotes regeneration after vascular injury.

30 septiembre 2014

CIRCULATION. Surgery for Aortic Disease. Outcomes of Patients Presenting With Acute Type A Aortic Dissection in the Setting of Prior Cardiac Surgery

Nicholas R. Teman, MD; Mark D. Peterson, MD; Mark J. Russo, MD; Marek P. Ehrlich, MD; Truls Myrmel, MD; Gilbert R. Upchurch Jr, MD; Kevin Greason, MD; Mark Fillinger, MD; Alberto Forteza, MD; George Michael Deeb, MD; Daniel G. Montgomery, MS; Kim A. Eagle, MD; Eric M. Isselbacher, MD; Christoph A. Nienaber, MD; Himanshu J. Patel, MD

Background: Prior cardiac surgery (PCS) can complicate the presentation and management of patients with type A acute aortic dissection (TAAAD). This report from the International Registry of Acute Aortic Dissection examines this hypothesis.

12 julio 2013

CIRCULATION. Vascular Medicine. Stratified Meta-Analysis of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Hospitalized Patients

Kwok M. Ho, MPH, PhD, FRCP; Jen Aik Tan, MBBS

Background: Optimal thromboprophylaxis for patients at risk of bleeding remains uncertain. This meta-analysis assessed whether intermittent pneumatic compression (IPC) of the lower limbs was effective in reducing venous thromboembolism and whether combining pharmacological thromboprophylaxis with IPC would enhance its effectiveness.

30 septiembre 2014

CIRCULATION. Epidemiology and Prevention. Fruit and Vegetable Consumption With Risk of Abdominal Aortic Aneurysm

Otto Stackelberg, MD; Martin Björck, MD, PhD; Susanna C. Larsson, PhD; Nicola Orsini, PhD; Alicja Wolk, DMSc

Background: Dietary factors affecting the risk of developing abdominal aortic aneurysm (AAA) are scarcely investigated. The aim of this study was to investigate the associations of fruit and vegetable consumption with the risk to develop AAA.

01 julio 2013

CIRCULATION. Interventional Cardiology. Direct Quantitative Assessment of the Peripheral Artery Collateral Circulation in Patients Undergoing Angiography

Tobias Traupe, MD; Jana Ortmann, MD; Michael Stoller, MD; Iris Baumgartner, MD; Stefano F. de Marchi, MD; Christian Seiler, MD

Background: Despite the fact that numerous studies have pursued the strategy of improving collateral function in patients with peripheral artery disease, there is currently no method available to quantify collateral arterial function of the lower limb.

30 septiembre 2014

CIRCULATION. Peripheral Artery Disease. Management of Patients After Endovascular Interventions for Peripheral Artery Disease

Piotr Sobieszczyk, MD; Andrew Eisenhauer, MD

Introduction: Endovascular therapy to relieve intermittent claudication or critical limb ischemia in patients with lower-extremity peripheral artery disease is now firmly established as an alternative to surgical revascularization.1 The advent of novel technologies allows percutaneous interventions of increasingly complex arterial disease previously reserved for surgical interventions.2 Although the durability of aortoiliac interventions rivals that of surgical bypass, restenosis after femoropopliteal interventions remains the Achilles’ heel of endovascular therapies.

24 junio 2013

CIRCULATION. Interventional Cardiology. Drug-Eluting Balloon in Peripheral Intervention for Below the Knee Angioplasty Evaluation (DEBATE-BTK)

Francesco Liistro, MD; Italo Porto, MD PhD; Paolo Angioli, MD; Simone Grotti, MD; Lucia Ricci, MD; Kenneth Ducci, MD; Giovanni Falsini, MD; Giorgio Ventoruzzo, MD; Filippo Turini, MD; Guido Bellandi, MD; Leonardo Bolognese, MD

Background: The 1-year restenosis rate after balloon angioplasty of long lesions in below-the-knee arteries may be as high as 70%. Our aim was to investigate the efficacy of a paclitaxel drug-eluting balloons versus conventional percutaneous transluminal angioplasty (PTA) for the reduction of restenosis in diabetic patients with critical limb ischemia undergoing endovascular intervention of below-the-knee arteries.

15 julio 2014

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Peripheral Vascular Disease. Factors Associated With Vascular Complications in Patients Undergoing Balloon-Expandable Transfemoral Transcatheter Aortic Valve Replacement via Open Versus Percutaneous Approaches

Mitul B. Kadakia, MD, Howard C. Herrmann, MD, Nimesh D. Desai, MD, Zachary Fox, BS, Jeffrey Ogbara, MD, Saif Anwaruddin, MD, Dinesh Jagasia, MD, Joseph E. Bavaria, MD, Wilson Y. Szeto, MD, Prashanth Vallabhajosyula, MD, Robert Li, MD, Rohan Menon, BS, Dale M. Kobrin, BA and Jay Giri, MD, MPH

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.

01 agosto 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Ultrasound-Accelerated versus Standard Catheter-Directed Thrombolysis in 102 Patients with Acute and Subacute Limb Ischemia

Melanie B. Schernthaner, MD , Shaun Samuels, MD , Peter Biegler, MD , James F. Benenati, MD , Heiko Uthoff, MD

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.

01 agosto 2014

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. “Squid-Capture” Modified In Situ Stent–Graft Fenestration Technique for Aortic Arch Aneurysm Repair

Norio Hongo, Shinji Miyamoto, Rieko Shuto, Tomoyuki Wada, Noritaka Kamei, Aiko Sato, Shunro Matsumoto, Hiro Kiyosue, Hiromu Mori

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.

01 mayo 2013

CIRCULATION. Interventional Cardiology. Cilostazol Reduces Angiographic Restenosis After Endovascular Therapy for Femoropopliteal Lesions in the Sufficient Treatment of Peripheral Intervention by Cilostazol Study

Osamu Iida, MD; Hiroyoshi Yokoi, MD; Yoshimitsu Soga, MD; Naoto Inoue, MD; Kenji Suzuki, MD; Yoshiaki Yokoi, MD, PhD; Daizo Kawasaki, MD, PhD; Kan Zen, MD, PhD; Kazushi Urasawa, MD, PhD; Yoshiaki Shintani, MD; Akira Miyamoto, MD; Keisuke Hirano, MD; Yusuke Miyashita, MD, PhD; Taketsugu Tsuchiya, MD, PhD; Norihiko Shinozaki, MD; Masato Nakamura, MD, PhD; Takaaki Isshiki, MD, PhD; Toshimitsu Hamasaki, MSc, PhD; Shinsuke Nanto, MD, PhD; on behalf of the STOP-IC investigators

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.

01 junio 2013

JACC. Sustained Safety and Effectiveness of Paclitaxel-Eluting Stents for Femoropopliteal Lesions. 2-Year Follow-Up From the Zilver PTX Randomized and Single-Arm Clinical Studies

Michael D. Dake, MD∗; Gary M. Ansel, MD†; Michael R. Jaff, DO‡; Takao Ohki, MD§; Richard R. Saxon, MD⋮; H. Bob Smouse, MD¶; Scott A. Snyder, PhD#; Erin E. O´Leary, PhD#; Gunnar Tepe, MD∗∗; Dierk Scheinert, MD††; Thomas Zeller, MD‡‡

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.

01 junio 2013

JACC. Platelet Responsiveness to Clopidogrel Treatment After Peripheral Endovascular Procedures. The PRECLOP Study: Clinical Impact and Optimal Cutoff Value of On-Treatment High Platelet Reactivity

Stavros Spiliopoulos, MD, PhD; Georgios Pastromas, MD; Konstantinos Katsanos, MD, MSc, PhD; Panagiotis Kitrou, MD; Dimitrios Karnabatidis, MD, PhD; Dimitrios Siablis, MD, PhD

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.