Infrainguinal Arterial Intervention: Is There a Role for an Atherectomy Device?

Vascular ◽  
2006 ◽  
Vol 14 (5) ◽  
pp. 313-318 ◽  
Author(s):  
Leila Mureebe ◽  
James F. McKinsey
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Intervention ◽  
Arterial Disease ◽  
Atheromatous Plaque ◽  
Peripheral Arteries ◽  
Invasive Treatment ◽  
Attractive Option ◽  
Percutaneous Removal ◽  
Peripheral Arterial ◽  
Redwood City

Excision of atheromatous plaque is an attractive option for the minimally invasive treatment of peripheral arterial disease. Approved for use in 2003, the SilverHawk Plaque Exicison System (FoxHollow Technologies, Redwood City, CA) is a catheter-based plaque excision device allowing percutaneous removal of atheromatous material. This device represents the most recent generation of atherectomy tools. Overall experience with plaque debulking in the peripheral arteries spans almost two decades, and understanding of the technique continues to evolve. This article reviews the technology, current practices, and data on plaque excision.

scholarly journals P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
MI Qureshi ◽  
HL Li ◽  
GK Ambler ◽  
KHF Wong ◽  
S Dawson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Intervention ◽  
Arterial Disease ◽  
Endovascular Intervention ◽  
Randomised Trials ◽  
Peripheral Arterial ◽  
High Level

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

scholarly journals Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e025419 ◽  
Author(s):  
Marijn ML van den Houten ◽  
Sandra CP Jansen ◽  
Anneroos Sinnige ◽  
Lijckle van der Laan ◽  
Patrick WHE Vriens ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peripheral Arterial Disease ◽  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Imaging Modality ◽  
Arterial Disease ◽  
Invasive Treatment ◽  
Supervised Exercise ◽  
Peripheral Arterial ◽  
Prospective Longitudinal

IntroductionDespite guideline recommendations advocating conservative management before invasive treatment in intermittent claudication, early revascularisation remains widespread in patients with favourable anatomy. The aim of the Effect of Disease Level on Outcomes of Supervised Exercise in Intermittent Claudication Registry is to determine the effect of the location of stenosis on the outcomes of supervised exercise in patients with intermittent claudication due to peripheral arterial disease.Methods and analysisThis multicentre prospective cohort study aims to enrol 320 patients in 10 vascular centres across the Netherlands. All patients diagnosed with intermittent claudication (peripheral arterial disease: Fontaine II/Rutherford 1–3), who are considered candidates for supervised exercise therapy by their own physicians are appropriate to participate. Participants will receive standard care, meaning supervised exercise therapy first, with endovascular or open revascularisation in case of insufficient effect (at the discretion of patient and vascular surgeon). For the primary objectives, patients are grouped according to anatomical characteristics of disease (aortoiliac, femoropopliteal or multilevel disease) as apparent on the preferred imaging modality in the participating centre (either duplex, CT angiography or magnetic resonance angiography). Changes in walking performance (treadmill tests, 6 min walk test) and quality of life (QoL; Vascular QoL Questionnaire-6, WHO QoL Questionnaire-Bref) will be compared between groups, after multivariate adjustment for possible confounders. Freedom from revascularisation and major adverse cardiovascular disease events, and attainment of the treatment goal between anatomical groups will be compared using Kaplan-Meier survival curves.Ethics and disseminationThis study has been exempted from formal medical ethical approval by the Medical Research Ethics Committees United ‘MEC-U’ (W17.071). Results are intended for publication in peer-reviewed journals and for presentation to stakeholders nationally and internationally.Trial registration numberNTR7332; Pre-results.

Abstract 105: Racial Differences in Health Status, Clinical Characteristics and Treatment Patterns Among Patients With Peripheral Artery Disease: Insights From the PORTRAIT Registry

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Qurat-ul-ain Jelani ◽  
Kim Smolderen ◽  
John A Spertus ◽  
Wang Jingyan ◽  
Edward R Tuohy ◽  
...  
Keyword(s):  
Health Status ◽  
Peripheral Arterial Disease ◽  
Racial Differences ◽  
Clinical Characteristics ◽  
Artery Bypass ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Peripheral Artery ◽  
Invasive Treatment ◽  
Peripheral Arterial

Background: Despite the higher prevalence and excess morbidity associated with peripheral arterial disease (PAD) in blacks, as compared with whites, little is known about racial differences in clinical characteristics, treatment referral and health status outcomes (symptoms, functioning, quality of life) at the time of PAD presentation. Methods: We used data from the Patient-centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease Investigating Trajectories (PORTRAIT) registry, a multicenter, international prospective study of patients with new or worsening PAD symptoms consulting specialty care (2011-2015). Clinical and treatment characteristics were abstracted from medical records and health status was collected via patient interviews at presentation using the Peripheral Artery Questionnaire (PAQ). We calculated summary statistics using t-test/chi-square analyses and examined mean differences in the PAQ summary score at baseline between blacks and whites. Results: The final cohort consisted of 760 patients (N=183 blacks; 24%). Compared with whites, blacks were younger (66±9.8 vs 70±9.2; P=< 0.001), more likely to be female (58% vs. 37%, P= <0.001), non-married (40% vs. 59% P=<0.001), and had a higher prevalence of hypertension (94.5% vs. 86.3%, P=0.002), diabetes (47.5% vs. 34.8%, P= 0.002), chronic kidney disease (23.5% vs. 12.7%, P=<0.001), current smoking (38.8% vs. 25.5%, P=0.002) and lower ankle brachial index values (0.6 vs. 0.7, P=0.034). Blacks were also less likely to have had prior percutaneous coronary intervention (22.4% vs. 29.3%, P= 0.07) or coronary artery bypass grafting (13.7% vs. 28.4%, P=< 0.001), but had similar rates of non-healing ulcers (2.2% vs. 1.4%, P=0.50) or amputation (2.7% vs. 1.0%, P=0.146). Black and white patients had similar mean PAQ summary scores at presentation (46.8±22.4 vs. 47.6±21.8; P=0.669) and were equally likely to be referred for revascularization (30.1% vs. 36.9 %, P=0.09) Conclusion: Despite excess prevalence of adverse risk factors including diabetes, hypertension, and smoking, black patients presenting with PAD have similar health status outcomes and invasive treatment strategies when compared with whites. Follow-up studies are needed to determine if these observations persist after adjustment for covariates and if there are differences in health status recovery over time.

scholarly journals Is There a Real Correlation Between Red Cell Distribution Width and Peripheral Arterial Disease?

2017 ◽  
Vol 36 (4) ◽  
pp. 309-313 ◽  
Author(s):  
Enes Duman ◽  
Sevsen Kulaksızoglu ◽  
Egemen Çifçi ◽  
Mehmet Ozulku
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Peripheral Arteries ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Cholesterol Levels ◽  
Hs Crp ◽  
Peripheral Arterial ◽  
The Relationship

SummaryBackground: Few data is available concerning the association between peripheral arterial disease (PAD) and red cell distribution width (RDW). In this study, we analyzed the relationship between RDW and atherosclerosis of the vessels other than coronary arteries in patients who had undergone digital substraction angiography (DSA). Methods: This study included 730 patients who had undergone DSA. Patients were divided into two groups according to their angiographic images. The association between RDW and atherosclerosis of peripheral arteries was analyzed. The relationship between atherosclerosis and smoking, hypertension (HT), diabetes mellitus (DM), hs-CRP, hemoglobin, white blood cell (WBC), triglyceride, total cholesterol, HDL and LDL cholesterol levels was assessed. Results: Atherosclerosis was observed more common in male and patients with older age, HT, DM and smoking (p<0.001). hs-CRP and WBC levels were both in significantly positive association with atherosclerosis (p<0.05). However, there were no significant differences in the RDW levels, hemoglobin, triglyceride, total cholesterol, LDL and HDL cholesterol levels in the groups (p>0.05). Conclusion: Our results seem to demonstrate that older age, male gender, HT, DM and smoking are powerful risk factors for PAD. In contrast to the previous reports, RDW levels are found not to be associated with atherosclerosis of peripheral arteries.

scholarly journals Determinants of invasive treatment in lower extremity peripheral arterial disease

2014 ◽  
Vol 59 (2) ◽  
pp. 400-408.e2 ◽  
Author(s):  
Moniek van Zitteren ◽  
Patrick W. Vriens ◽  
Desiree H. Burger ◽  
W. Marnix de Fijter ◽  
G. Pieter Gerritsen ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Arterial Disease ◽  
Invasive Treatment ◽  
Peripheral Arterial

scholarly journals Review: Quality of life in lower limb peripheral vascular surgery

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 88-95 ◽  
Author(s):  
JMW Donker ◽  
J de Vries ◽  
GH Ho ◽  
F Bastos Gonçalves ◽  
SE Hoeks ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peripheral Arterial Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Invasive Treatment ◽  
Vascular Intervention ◽  
Peripheral Arterial

Purpose Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffering from either claudication or critical limb ischemia. Basic methods A review of the literature was undertaken in the Medline library. A search was performed on quality of life in peripheral arterial disease. Results were stratified according to treatment groups. Principal findings Twenty-one articles described quality of life in approximately 4600 patients suffering from peripheral arterial disease. Invasive treatment generally results in better quality of life scores (at a maximum of 2 years of follow-up), compared with non-invasive treatment. In patients with critical limb ischemia, successful revascularization improves quality of life scores. Only one study reported long-term results. Conclusions Increase in quality of life scores can be found for any intervention performed for peripheral arterial disease. However, there is scarce information on long-term quality of life after vascular intervention.

scholarly journals Pathophysiology of chronic peripheral ischemia: new perspectives

2020 ◽  
Vol 11 ◽  
pp. 204062231989446
Author(s):  
Salvatore Santo Signorelli ◽  
Luca Vanella ◽  
Nader G. Abraham ◽  
Salvatore Scuto ◽  
Elisa Marino ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
New Drugs ◽  
Peripheral Arteries ◽  
Chronic Ischemia ◽  
Peripheral Ischemia ◽  
Oxidative Markers ◽  
Peripheral Arterial ◽  
And Oxidative Stress

Peripheral arterial disease (PAD) affects individuals particularly over 65 years old in the more advanced countries. Hemodynamic, inflammatory, and oxidative mechanisms interact in the pathophysiological scenario of this chronic arterial disease. We discuss the hemodynamic, muscle tissue, and oxidative stress (OxS) conditions related to chronic ischemia of the peripheral arteries. This review summarizes the results of evaluating both metabolic and oxidative markers, and also therapy to counteract OxS. In conclusion, we believe different pathways should be highlighted to discover new drugs to treat patients suffering from PAD.

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