Drug-Eluting Balloon Versus Standard Balloon Angioplasty for Infrapopliteal Arterial Revascularization in Critical Limb Ischemia

Zeller, Thomas; Baumgartner, Iris; Scheinert, Dierk; Brodmann, Marianne; Bosiers, Marc; Micari, Antonio; Peeters, Patrick; Vermassen, Frank; Landini, Mario; Snead, D.; Kent, K. Craig; Rocha‐Singh, Krishna; Investigators, In.Pact Deep Trial

doi:10.1016/j.jacc.2014.06.1198

Cited by 334 publications

(121 citation statements)

References 29 publications

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“…Son dönemlerde aterektomi, kriyoplasti, kesici balonlar ve lazer anjiyoplastinin diz altı arterlerde güvenle uygulanabileceği gösterilmesine rağmen bu uygulamaların konvansiyonel yöntemlere üstünlüğü olmadığı ve konvansiyonel yöntemlerden daha maliyetli yöntemler olduğu saptanmıştır (25)(26)(27)(28). Yine son yıllarda perkütan işlemlerde ilaç salınımlı balonların etkili olabileceği düşünülmüş ancak bunların konvansiyonel balonlara belirgin üstünlüğü olmadığı çeşitli çalışmalarla gösterilmiştir (29,30). Bizim çalışmamızda sekiz (%25) hastada ilaç salınımlı balon kullanılmış olup, işlem başarısı ve uzuv koruma oranı, konvansiyonel balon kullanılmış olan hastalarla karşılaştırıldığında anlamlı farklılık izlenmedi.…”

Section: Discussionunclassified

Infrapopliteal Percutan Transluminal Angioplasty of Patients with TASC D Group Diabetic Foot Lesions According to the Transatlantic Inter-Society Consensus II

Çildağ¹,

Köseoğlu²,

Ertuğrul³

2017

Haseki

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Section: Discussionunclassified

Infrapopliteal Percutan Transluminal Angioplasty of Patients with TASC D Group Diabetic Foot Lesions According to the Transatlantic Inter-Society Consensus II

Çildağ¹,

Köseoğlu²,

Ertuğrul³

2017

Haseki

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“…So far the outcomes of DCB in the femoropopliteal region are promising, 25,26 but in the BTK region the results are still suboptimal. 27, 28 Nevertheless, early reports on the combination of plaque modification with AT and subsequent DCB look promising. 29, 30 Novel technologies, including local drug delivery nano-technology, may soon be able to be utilized after plaque modification by AT.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes After Percutaneous Lower Extremity Arterial Interventions With Atherectomy vs. Balloon Angioplasty　― Propensity Score-Matched Registry ―

Janas

Buszman

Milewski

et al. 2017

Circ J

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reassuring early outcome. In contrast, in the femoropopliteal artery mechanical stress is high, thus implanted stents are exposed to the risk of stent fracture and malformation, increasing the rate of restenosis. 8, 9 In the below-the-knee (BTK) region, use of metal, balloon-expandable drugeluting stents is more common than the self-expandable nitinol ones, because those stents are even more susceptible to fracture. Moreover, due to the characteristics of BTK lesions, in most cases multiple stents are needed. 10 Therefore, atherectomy (AT), which removes the atherosclerotic plaque from the arterial wall, appears to be promising. This expectancy is linked to the fact that these devices cut out the plaque from the artery wall, thus significantly increasing lumen diameter and removing potential sources of inflammation, thus facilitating satisfactory outcome. 11Thus far, the long-term outcomes after endovascular A ccording to recent clinical practice and evidence, endovascular revascularization of the lower limb arteries has superseded surgical procedures. 1,2 Regardless of advancement in endovascular technology, restenosis and the need for repeat revascularization are still challenging. Moreover, the mortality in peripheral artery disease (PAD), especially in critical limb ischemia (CLI), is high, fluctuating at around 20% at 6-month follow-up, and exceeding 50% within 5 years from diagnosis. 3,4 These numbers increase in patients with coexisting symptomatic coronary artery disease (CAD). Additionally, CLI is associated with poor quality of life 5 and high treatment costs. Background: The impact of endovascular revascularization of the lower extremity arteries with atherectomy (AT) compared with percutaneous transluminal angioplasty (PTA) is still unclear. Therefore, the aim of the study was to compare long-term outcomes after percutaneous PTA and AT in patients requiring endovascular revascularization.

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“…Outcome occurrence rates were adjusted to 1 year if different follow-up timeframes were available as long as they were for a reasonable time period (≥6 months). A total of 13 studies were identified [22][23][24][25][26][27][28][29][30][31][32][33][34]. Patient demographic, PAD-CLI disease and comorbid risk profiles were extracted from each study to evaluate their clinical compatibility to the CALCIUM 360…”

Section: Scenario Analysismentioning

confidence: 99%

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

et al. 2018

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Aim:The incremental cost of peripheral orbital atherectomy system (OAS) plus balloon angioplasty (BA) versus BA-only for critical limb ischemia was estimated. Materials & methods: A deterministic simulation model used clinical and healthcare utilization data from the CALCIUM 360• trial and current cost data. Incremental cost of OAS + BA versus BA-only included differential utilization during the procedure and adverse-event costs at 3, 6 and 12-months. Results: For every 100 procedures, incremental annual costs to the hospital were US$350,930 lower with OAS + BA compared with BA-only. Despite higher upfront costs, savings were realized due to reduced need for revascularization, amputation and end-of-life care over 6-12-month postoperative period. Conclusion: Atherectomy with OAS prior to BA was associated with cost savings to the hospital. Critical limb ischemia (CLI) is the most serious manifestation of peripheral artery disease (PAD). Considered as the 'end stage' of PAD, it involves a chronic lack of blood supply leading to persistent ischemic rest pain in the feet or toes, nonhealing wounds and ulcers, and gangrene [1]. CLI often results in amputation of the affected limb(s) with roughly 25% of CLI patients receiving at least one lower extremity amputation [2]. The economic burden of CLI-diagnosed Medicare patients exceeds US$3.1 billion annually, with most of this cost reflecting the high incidence of hospitalizations related to limb loss and the need for major amputation [3].Treating CLI patients has remained quite challenging, since the associated calcification requires a unique mechanism of action to treat the lesion without damaging the vessel [4]. Balloon angioplasty (BA) continues to be the first-line of revascularization strategy in patients where procedural success via less invasive, nonsurgical approach is favored despite consistently poor intermediate and long-term patency outcomes [5,6]. The latter has been attributed to the presence of calcified plaque in femoropopliteal lesions, with arterial wall calcium associated with higher rates of procedural complications, and flow-limiting dissections that frequently require stent deployment in order to maintain vessel patency [4][5][6]. Furthermore, restenosis rates as high as 40-60% within 1 year of postprocedure and poor correlation between primary patency and limb preservation have been reported. But the American College of Cardiology/American Heart Association guidelines currently recommend against primary stenting of femoropopliteal lesions with atherectomy and stent devices indicated for 'bailout' purposes following suboptimal BA results [5]. Stenting in calcified segments after a prior failed BA often results in stent under expansion and malapposition [6,7]. These are recognized predictors of long-term stent patency and indicate an increased risk of

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Drug-Eluting Balloon Versus Standard Balloon Angioplasty for Infrapopliteal Arterial Revascularization in Critical Limb Ischemia

Cited by 334 publications

References 29 publications

Infrapopliteal Percutan Transluminal Angioplasty of Patients with TASC D Group Diabetic Foot Lesions According to the Transatlantic Inter-Society Consensus II

Infrapopliteal Percutan Transluminal Angioplasty of Patients with TASC D Group Diabetic Foot Lesions According to the Transatlantic Inter-Society Consensus II

Long-Term Outcomes After Percutaneous Lower Extremity Arterial Interventions With Atherectomy vs. Balloon Angioplasty　― Propensity Score-Matched Registry ―

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

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Drug-Eluting Balloon Versus Standard Balloon Angioplasty for Infrapopliteal Arterial Revascularization in Critical Limb Ischemia

Cited by 334 publications

References 29 publications

Infrapopliteal Percutan Transluminal Angioplasty of Patients with TASC D Group Diabetic Foot Lesions According to the Transatlantic Inter-Society Consensus II

Infrapopliteal Percutan Transluminal Angioplasty of Patients with TASC D Group Diabetic Foot Lesions According to the Transatlantic Inter-Society Consensus II

Long-Term Outcomes After Percutaneous Lower Extremity Arterial Interventions With Atherectomy vs. Balloon Angioplasty ― Propensity Score-Matched Registry ―

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

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Long-Term Outcomes After Percutaneous Lower Extremity Arterial Interventions With Atherectomy vs. Balloon Angioplasty　― Propensity Score-Matched Registry ―