Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

Trocciola, Susan M.; Chaer, Rabih A.; Dayal, Rajeev; Lin, Stephanie; Kumar, Naveen; Rhee, Jason; Pierce, Matthew; Ryer, Evan J.; McKinsey, James F.; Morrissey, Nicholas J.; Bush, Harry L.; Kent, K. Craig; Faries, Peter L.

doi:10.1177/000313480507100605

Cited by 43 publications

(13 citation statements)

References 14 publications

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“…Run-off was also significantly worse. Similar observations were also made by other authors [ 7 , 8 ]. In the NIS (USA) database the proportion of diabetic patients with CLI was almost twice as high as those with IC, while the proportion of patients with reduced renal function was almost three times higher [ 9 ].…”

Section: Discussionsupporting

confidence: 92%

Percutaneous endovascular treatment of infrainguinal PAOD

et al. 2016

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BackgroundThe percutaneous infrainguinal stent (PSI) register study aimed to collate all percutaneous endovascular procedures for infrainguinal peripheral arterial occlusive disease (PAOD) conducted in 74 German vascular centers between September and November 2015 (3 months). In order to obtain representative results all consecutive treatment procedures had to be submitted by the participating trial centers.Material and methodsThis was a prospective, nonrandomized multicenter study design. All patients suffering from intermittent claudication (IC, Fontaine stage II) or critical limb ischemia (CLI, Fontaine stages III and IV) were included. Trial centers with less than 5 cases reported within the 3‑month trial period or centers that could not ensure the submission of all treated patients were excluded.ResultsIn the final assessment 2798 treated cases from 74 trial centers were reported of which 65 (87.8 %) centers were under the leadership of a vascular surgeon. Approximately 33 % of the interventions in centers under the leadership of vascular surgeons were conducted by radiologists. Risk factors, especially chronic renal disease, diabetes and cardiac risk factors were significantly different between patients with IC and CLI. Of the patients with Fontaine stage II PAOD 41.3 % had 3 patent crural vessels compared to only 10.8 % of patients with Fontaine stage IV. With respect to peri-interventional complications, percutaneous endovascular treatment of IC was a safe procedure with severe complications in less than 1 % and no fatalities. Only 4.5 % of the procedures were conducted under ambulatory conditions. In the supragenual region self-expanding bare metal stents, standard percutaneous transluminal angioplasty (PTA) and drug-coated balloons were the most frequently used procedures. For interventions below the knee, standard PTA was the most commonly employed treatment.ConclusionThe main aim of the PSI study was to obtain a realistic picture of percutaneous endovascular techniques used to treat suprapopliteal and infrapopliteal PAOD lesions and to describe the treatment procedures used by vascular specialists in Germany. To investigate the change in trends for treatment over time, this study has to be repeated in the future in order to test how quickly the results of randomized studies can be implemented in practice.Electronic supplementary materialA complete list of the PSI study collaborators is available under doi: 10.1007/s00772-016-0202-2.

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Section: Discussionsupporting

confidence: 92%

Percutaneous endovascular treatment of infrainguinal PAOD

et al. 2016

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“…1,22,23 Therefore, tibial vessel restenosis traditionally has been dismissed as clinically benign, especially because reinterventions may not be required after resolution of critical limb ischemia. Although the literature is replete with studies comparing infrapopliteal angioplasty and open bypass showing acceptable limb salvage rates after intervention in patients with CLI, 1,4,13,16,[24][25][26] no studies have focused on the repercussions of tibial restenosis, particularly in patients with extensive tissue loss or gangrene. The current study demonstrates that TAEIs have a high rate of restenosis, which is in line with the published literature.…”

Section: Discussionmentioning

confidence: 99%

Predictors and outcomes of restenosis following tibial artery endovascular interventions for critical limb ischemia

Saqib

Domenick

Cho

et al. 2013

Journal of Vascular Surgery

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TAEIs can be used successfully to treat patients with critical limb ischemia with acceptable limb salvage rates. Special attention should be given to patients with extensive tissue loss or gangrene because they are at risk for early restenosis and subsequent limb loss. Strict wound and hemodynamic surveillance, wound care, and timely reinterventions are crucial to achieve successful outcomes in this patient population. Amputation or alternative revascularization options, when feasible, should be considered in patients with restenosis and tissue loss given the high rate of limb loss with tibial reinterventions.

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“…Todoran et al [27] have found a higher mortality rate in CLI patients with femoropopliteal lesions compared to claudicants, although patency rates were similar between the two groups during follow-up. Conversely, Trocciola et al [28] have found significantly lower patency rates in CLI patients compared to claudicants within one year of follow-up. However, most of comparative studies refer to patients treated with plain angioplasty, and comparative data on patients treated with DCBs are limited.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Patients Treated with Drug-Coated Balloon Angioplasty for Symptomatic Peripheral Artery Disease

Sigala

Galyfos

Stavridis

et al. 2018

VSI

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PurposeAim of this study is to report real-life experience on the treatment of peripheral artery disease (PAD) with a specific drug-coated balloon (DCB), and to evaluate potential prognostic factors for outcomes.Materials and MethodsThis is a retrospective study reporting outcomes in patients with PAD who were treated with the Lutonix DCB during a four-year period. Major outcomes included: all-cause mortality, amputation, clinical improvement, wound healing and target lesion revascularization (TLR). Mean follow-up was 24.2±2.3 months.ResultsOverall, 149 patients (mean age: 68.6±8.3 years; 113 males) were treated, either for intermittent claudication (IC) (n=86) or critical limb ischemia (CLI) (n=63). More than half the target lesions (n=206 in total) were located in the superficial femoral artery and 18.0% were below-the-knee lesions. CLI patients presented more frequently with infrapopliteal (P=0.002) or multilevel disease (P=0.0004). Overall, all-cause mortality during follow-up was 10.7%, amputation-free survival was 81.2% and TLR-free survival was 96.6%. CLI patients showed higher all-cause mortality (P=0.007) and total amputation (P=0.0001) rates as well as lower clinical improvement (P=0.0002), compared to IC patients. Coronary artery disease (CAD), gangrene and infrapopliteal disease were found to be predictors for death whereas CLI and gangrene were found to be predictors for amputation, during follow-up.ConclusionPAD treatment with Lutonix DCBs seems to be an efficient and safe endovascular strategy yielding promising results. However, CAD, gangrene, CLI and infrapopliteal lesions were found to be independent predictors for adverse outcomes. Larger series are needed to identify additional prognostic factors.

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Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

Cited by 43 publications

References 14 publications

Percutaneous endovascular treatment of infrainguinal PAOD

Percutaneous endovascular treatment of infrainguinal PAOD

Predictors and outcomes of restenosis following tibial artery endovascular interventions for critical limb ischemia

Prognostic Factors in Patients Treated with Drug-Coated Balloon Angioplasty for Symptomatic Peripheral Artery Disease

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