scholarly journals Mechanical rotational thrombectomy in long femoropopliteal artery and bypass occlusions: risk factors for periprocedural peripheral embolization

2021 ◽  
Author(s):  
Erik Stahlberg ◽  
◽  
Susanne Anton ◽  
Malte Sieren ◽  
Franz Wegner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoropopliteal Artery ◽  
Rotational Thrombectomy ◽  
Peripheral Embolization

scholarly journals Embolic Protection in Complex Femoropopliteal Interventions: Safety, Efficacy and Predictors of Filter Macroembolization

2020 ◽  
Author(s):  
Michael Czihal ◽  
Zeynep Findik ◽  
Christoph Bernau ◽  
Max Seidensticker ◽  
Jens Ricke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Balloon Angioplasty ◽  
Critical Limb Ischaemia ◽  
Lesion Length ◽  
Limb Ischaemia ◽  
Distal Embolization ◽  
Embolic Protection ◽  
Endovascular Interventions ◽  
Directional Atherectomy ◽  
Peripheral Embolization

Abstract Objectives To evaluate the safety and efficacy of a filter embolic protection device (FEPD) in endovascular interventions of the femoropopliteal arteries. Methods Patients who underwent endovascular interventions of the femoropopliteal arteries between 2008 and 2016 and in whom the SpiderFXTM FEPD was applied were included in this retrospective study. Clinical and angiographic characteristics, filter macroembolization (FME), device-related complications, distal embolization, as well as the early clinical and hemodynamic outcome, were assessed. Potential risk factors for FME were evaluated by multivariate analysis. Results A total of 244 cases were identified (203 patients, claudication 60.4%, critical limb ischaemia 39.6%, mean lesion length 13.2 ± 12.9 cm, complete occlusions in 72.7%). Balloon angioplasty ± stenting (BAP), directional atherectomy ± balloon angioplasty ± stenting (DA) and rotational thrombectomy ± balloon angioplasty ± stenting (RT) were performed in 141, 61 and 42 cases, respectively. FEPD placement and retrieval were successful in all but one case each. Permanent filter-related vessel damage was not observed. The rate of FME was 37.3% (BAP 36.2%, DA 32.8%, RT 47.7%). Risk factors for FME in the BAP- and DA-group were total occlusion, lesion length > 19 cm, visible thrombus and diabetes mellitus. The distal embolization rate despite filter protection was 4.1 % (BAP 4.9%, DA 1.6%, RT 4.8%) and was higher in cases with FME compared with those without FME (8.7% vs. 1.5%, p = 0.02). Conclusion The Spider FXTM device is safe and effective in capturing embolic debris during femoropopliteal interventions. A residual risk of peripheral embolization remains. Level of Evidence III, Cohort study

scholarly journals Efficacy and safety of paclitaxel drug-eluting balloons in femoropopliteal artery disease: a prospective observational study

2021 ◽  
Vol 9 (10) ◽  
pp. 3051
Author(s):  
Mohammed Hidayathulla ◽  
Nagesh .
Keyword(s):  
Risk Factors ◽  
Clinical Symptoms ◽  
Efficacy And Safety ◽  
Femoropopliteal Artery ◽  
Peripheral Angioplasty ◽  
Significant Difference ◽  
Drug Eluting ◽  
Unhealthy Diet ◽  
Artery Disease ◽  
Drug Eluting Balloon

Background: The femoropopliteal artery is most frequently involved artery in peripheral artery disease. To treat femoropopliteal artery disease (FPAD), various revascularization approaches have been available such as simple balloon angioplasty, debulking techniques, stent implantation, and recently the drug-eluting balloon (DEBs). Nowadays, the paclitaxel DEBs have been emerged to treat FPAD with promising outcomes. We therefore evaluate the efficacy and safety of paclitaxel DEBs in patients with lower limb FPAD.Methods: In total, 25 patients with FPAD were enrolled in the study. All patients underwent peripheral angioplasty using paclitaxel DEBs via antegrade femoral approach or contralateral femoral artery using crossover sheath. Demographics, risk factors, clinical characteristics, and pre- and post-procedure VascuQol-6 score were noted.Results: Out of 25 patients, the majority of patients (52%) were in the 6th decades of life. The incidence of FPAD was most common in patients with an O +ve blood group. The common risk factors of FPAD, include smoking (88%), diabetes (68%), dyslipidemia (68%), and hypertension (64%). Rest pain (64%) and ulcer (32%) were the most frequent clinical symptoms of FPAD. The percent stenosis was 100% in 17 patients, and 70-99% in 32 patients. A statistically significant difference was found in VascuQol-6 score between pre and post peripheral angioplasty (p<0.001).Conclusions: We have concluded that the paclitaxel DEBs are safe and efficacious in treating FPAD. Authors recommend that clinician should educate FPAD patients pertaining to modification of controllable risk factors such as cessation of smoking, unhealthy diet, sedentary lifestyle, high blood pressure, and high blood sugar. 

Abstract 713: Effects of Demographics and Clinical Risk Factors on Human Femoropopliteal Artery Histopathology

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Alexey Kamenskiy ◽  
Sheridan Nusz ◽  
William Hunter ◽  
Anastasia Desyatova ◽  
Melissa Ruhlman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arterial Wall ◽  
Pearson Correlation ◽  
Circumferential Stress ◽  
Patient Characteristics ◽  
Clinical Risk Factors ◽  
Smoking History ◽  
Femoropopliteal Artery ◽  
Clinical Risk ◽  
Medial Calcification

Introduction: Disease of the femoropopliteal artery (FPA) is associated with significant morbidity and quality of life impairment. End-stage lesions may be too advanced to determine how demographics and clinical risk factors impact arterial wall damage and lesion development; therefore we investigated the influence of these patient characteristics on various stages of human FPA histopathology. Methods: FPAs were obtained from 14-80 year-old human tissue donors ( n =120). Proximal segments of the arteries were mechanically tested and labeled with Verhoeff-Van Gieson stains. FPA intimal-medial damage severity was assessed and correlated with histology, mechanical properties, subject demographics, risk factors, and physiological stresses and stretches using Pearson correlation r with two-tailed significance levels. Results: Age correlated strongest ( r =0.664, p<0.01) with the degree of FPA intimal-medial damage, explaining 50% of the variation alone. Primarily due to medial calcification, more damaged FPAs were stiffer and demonstrated lower physiological circumferential stretch ( r =-0.510, p<0.01), circumferential stress and longitudinal stress ( r =-0.355, r =-0.379, p<0.01). More damage was associated with larger arterial radii ( r =0.470, p<0.01), thickened arterial walls ( r =0.238, p<0.01), decreased in situ longitudinal pre-stretch ( r =-0.537, p<0.01), less elastin in the arterial wall ( r =-0.432, p<0.01), thinner individual elastin fibers ( r =-0.571, p<0.01), and thinner, less dense, and more discontinuous external elastic laminae ( r =-0.252, r =-0.456, r =0.588, p<0.01). Damage was positively associated with male gender ( r =0.265, p<0.01), higher BMI ( r =0.224, p=0.01), hypertension ( r =0.266, p<0.01), diabetes ( r =0.265, p<0.01) and coronary artery disease ( r =0.375, p<0.01), but not with dyslipidemia ( r =0.117, p=0.161) or smoking history ( r =0.041, p=0.626). Conclusions: More severely damaged FPAs demonstrate elastin loss, medial calcification and increased stiffness compared to less damaged arteries. FPA damage correlates with most classical cardiovascular risk factors, but not with dyslipidemia or tobacco history, suggesting possible unique pathophysiological mechanisms that require further investigation.

Early Experience with a Rotational Thrombectomy Device for Treatment of Acute and Subacute Infra-Aortic Arterial Occlusions

2003 ◽  
Vol 10 (2) ◽  
pp. 322-331 ◽  
Author(s):  
Thomas Zeller ◽  
Ulrich Frank ◽  
Karlheinz Bürgelin ◽  
Christian Müller ◽  
Peter Flügel ◽  
...  
Keyword(s):  
Bypass Graft ◽  
Limited Capacity ◽  
Group Iii ◽  
Native Artery ◽  
Rotational Thrombectomy ◽  
Peripheral Embolization ◽  
Group I ◽  
Primary Success ◽  
Thrombectomy Device ◽  
Group Ii

Purpose: To evaluate a rotational thrombectomy device in the treatment of acute and subacute/chronic thrombotic infra-aortic occlusions of native vessels and bypass grafts. Methods: From July 2000 to February 2002, 98 patients (65 men; mean age 66±9 years, range 47–90) with 100 thrombotic occlusions (mean age of occlusion 31±33 days, range 0–140) measuring an average of 21±11 cm long (range 2–40) were treated with rotational thrombectomy (Rotarex). There were 33 acute (≤14 days) thrombotic/embolic native artery occlusions (group I), 58 subacute/chronic (>14 days) native artery occlusions (group II), and 9 acute bypass graft occlusions (group III). Results: The device activation time was 4.9±1.4 minutes, during which 4.0±1.4 passes of the device were performed. The amount of aspirated fluid was 240±119 mL. Slightly less than half the arteries (48%) were stented. Primary success (residual stenosis <30%) was achieved in 92% (94% for group I, 93% for group II, and 78% for group III; 100% for the ipsilateral approach, 56% for the crossover approach). Among the 18 complications, 3 were serious (2 amputations after unsuccessful intervention and 1 death); there were 8 vessel perforations and 7 cases of peripheral embolization. Thirty-day survival and limb salvage was 88% for group I, 100% for group II, and 66% for group III. Conclusions: The device is an easy-to-handle, useful tool for ipsilateral treatment of acute and subacute thrombotic arterial and bypass graft occlusions. The use of this device is limited by the 8-F diameter of the catheter and the limited capacity for crossover interventions.

Endovascular Therapy for Femoropopliteal Artery Disease and Association of Risk Factors With Primary Patency

2015 ◽  
Vol 49 (8) ◽  
pp. 236-241 ◽  
Author(s):  
Toshiya Nishibe ◽  
Kiyohito Yamamoto ◽  
Yoshimasa Seike ◽  
Hitoshi Ogino ◽  
Masayasu Nishibe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endovascular Therapy ◽  
Primary Patency ◽  
Femoropopliteal Artery ◽  
Artery Disease

scholarly journals Increased Plasma Cathepsin S at the Time of Percutaneous Transluminal Angioplasty is Associated with 6-Months’ Restenosis of the Femoropopliteal Artery

2018 ◽  
Vol 37 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Mojca Bozic Mijovski ◽  
Vinko Boc ◽  
Ursa Pecar Fonovic ◽  
Janja Marc ◽  
Ales Blinc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasma Concentration ◽  
Cystatin C ◽  
Percutaneous Transluminal Angioplasty ◽  
Plasma Concentrations ◽  
Transluminal Angioplasty ◽  
Cathepsin S ◽  
Angiotensin Ii Receptor ◽  
Femoropopliteal Artery ◽  
Percutaneous Transluminal

SummaryBackground: We tested the hypothesis that increased levels of cathepsin S and decreased levels of cystatin C in plasma at the time of percutaneous transluminal angioplasty (PTA) are associated with the occurrence of 6-months’ restenosis of the femoropopliteal artery (FPA). Methods: 20 patients with restenosis and 24 matched patients with patent FPA after a 6-months follow-up were in - cluded in this study. They all exhibited disabling claudication or critical limb ischemia and had undergone technically successful PTA. They were all receiving statins and ACE in hi - bitors (or angiotensin II receptor antagonist) before the PTA and the therapy did not change throughout the observational period. Plasma concentrations of C-reactive protein were < 10 mg/L and of creatinine within the reference range at the time of the PTA. Plasma concentration and activity of cathepsin S, together with its potent inhibitor cystatin C, were measured the day before and the day after the PTA. Results: The increased plasma concentration and activity of cathepsin S at the time of PTA was associated with the occurrence of 6-months’ restenosis of FPA, independently of established risk factors (lesion complexity, infrapopliteal run-off vessels, type of PTA, age, gender, smoking, diabetes, lipids) and of cystatin C. Plasma cystatin C concentration was not associated with restenosis and did not correlate with cathepsin S activity and concentration in the plasma. Conclusion: Increased level of plasma cathepsin S at the time of PTA is associated with 6-months’ restenosis of PTA, independently of established risk factors.

Three-Year Clinical Outcomes Following Implantation of LifeStent Self-Expanding Nitinol Stents in Patients With Femoropopliteal Artery Lesions

Angiology ◽  
2021 ◽  
pp. 000331972110426
Author(s):  
Michinao Tan ◽  
Mitsuyoshi Takahara ◽  
Yoshimitsu Soga ◽  
Shinsuke Mori ◽  
Taketsugu Tsuchiya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Randomized Study ◽  
Vessel Diameter ◽  
Lesion Length ◽  
Total Occlusion ◽  
Femoropopliteal Artery ◽  
Nitinol Stents ◽  
Independent Risk Factors ◽  
Artery Disease

The aim of this study was to evaluate midterm clinical outcomes after implantation of LifeStent self-expanding nitinol stents for the treatment of femoropopliteal lesions. This retrospective, multicenter, non-randomized study examined 260 femoropopliteal lesions in 250 consecutive patients with peripheral artery disease implanted with LifeStents from April 2016 to April 2017. The prevalence of chronic total occlusion (CTO), lesion length ≥25 cm, and distal reference vessel diameter (RVD) <5 mm was 58%, 35%, and 50%, respectively. The 3-year restenosis rate in the overall population was estimated to be 72.9% and a major adverse limb event was observed in 36.9%. Multivariate analysis revealed that chronic limb-threatening ischemia (CLTI) (odds ratio [OR]: 8.04; 95% confidence interval [CI]: 1.86–34.7), CTO (OR: 4.87; 95% CI: 1.43–16.6), lesion length ≥25 cm (OR: 5.95; 95% CI: 1.11–32.0), and distal RVD <5 mm (OR: 4.43; 95% CI: 1.34–14.6) were independent risk factors for 3-year restenosis. The present study demonstrated the midterm clinical outcomes and risk factors for restenosis after implantation of the LifeStent in femoropopliteal artery lesions. CLTI, CTO, lesion length ≥25 cm, and distal RVD <5 mm predicted decreased patency after a 3-year follow-up.

Sign in / Sign up

Export Citation Format

Share Document