Efficacy of balloon angioplasty of the superficial femoral artery and popliteal artery in the relief of leg ischemia

Stanley, Brendan M.; Teague, B. D.; Raptis, S.; Taylor, David J.; Berce, Michael

doi:10.1016/s0741-5214(96)80049-8

Cited by 56 publications

(23 citation statements)

References 17 publications

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“…Percutaneous angioplasty, because of the progress of the intraluminal and the extraluminal techniques and the availability of new materials, has demonstrated great efficacy in the treatment of CLI in terms of success rate, clinical outcome, and procedure-related complications [4,5,16].…”

Section: Discussionmentioning

confidence: 99%

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The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Gandini

Pipitone

Stefanini

et al. 2007

Cardiovasc Intervent Radiol

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The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.

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Section: Discussionmentioning

confidence: 99%

“…The percutaneous endovascular recanalization approach, consisting of the intraluminal or the subintimal technique, represents a valid alternative to the surgical bypass in patients at risk of limb loss and not suitable for surgery [3][4][5].…”

mentioning

confidence: 99%

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Gandini

Pipitone

Stefanini

et al. 2007

Cardiovasc Intervent Radiol

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“…Matsi et al (2) obtained a 3-year secondary patency rate of 55% after superficial femoral artery angioplasty in patients with leg claudication; Alback et al (3) noted a hemodynamic 2-year patency rate of 55% after angioplasty; Unni et al (4) achieved a primary patency rate of 40% at 3 years; Stanley et al (5) recorded a 2-year primary patency rate of 46% after angioplasty of superficial femoral and popliteal arteries. Stanley et al (5) did not recommend balloon angioplasty to treat claudication because of the low patency rate (5); Marzelle et al (6) observed a primary patency rate of 52% at 4 years after angioplasty in a series of stenosed or occluded superficial femoral, popliteal, or tibial arteries. Clinical trials were undertaken at our medical center to assess laser-assisted balloon angioplasty (7) and transcutaneous extraction catheter atherectomy-assisted angioplasty (8,9) to reopen chronic occlusions in superficial femoral arteries.…”

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confidence: 99%

Angioplasty and Stent Placement in Chronic Occlusion of the Superficial Femoral Artery: Technique and Results

Conroy

Gordon

Tobis

et al. 2000

Journal of Vascular and Interventional Radiology

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Abbreviations: ABI ϭ ankle/brachial index, OR ϭ odds ratio, UK ϭ urokinase PURPOSE: To improve the patency rate for angioplasty in chronic occlusion of the superficial femoral artery by deploying stents after angioplasty. MATERIALS AND METHODS:Angioplasty and stent placement were performed in 61 arteries in 48 male patients. The mean occlusion length was 13.5 cm and the mean stent length was 30 cm. Patency rates were analyzed at 6 months and at 1, 2, 3, and 4 years. The predictors of restenosis were analyzed by univariate and multiple logistic regression.RESULTS: Patency rates were 87% at 6 months, consisting of 74% primary, 6% primary assisted, and 7% secondary; 79% at 1 year, consisting of 47% primary, 19% primary assisted, and 13% secondary; 72% at 2 years, consisting of 36% primary, 26% primary assisted, and 10% secondary; 70% at 3 years, consisting of 26% primary, 22% primary assisted, and 22% secondary; and 63% at 4 years, consisting of 25% primary, 0% primary assisted, and 38% secondary. There was a 15% morbidity rate and one mortality as a result of retroperitoneal bleeding. Better patency rates were noted at all time intervals in diabetic limbs, 7-mm-diameter versus 10-mmdiameter stents, shorter obstructions and shorter stents, nonsmokers, in limbs in which urokinase was not necessary after stent deployment, and in limbs with an International Society of Cardiovascular Surgery (ISCVS) classification under 3. Patency rates were not affected by age, race, number of trifurcation vessels patent, experience in performing the procedures, and procedures requiring less time. By multivariate logistic analysis, the independent predictors of patency at 6 months were postprocedure ankle/brachial index (ABI) and shorter stent length; at 1 year, preprocedure ABI, shorter stent length, and the presence of diabetes; at 2 years, preprocedure ABI and the presence of diabetes; and at 3 years, the preprocedure ABI. CONCLUSIONS:The techniques used to reestablish antegrade flow in these superficial femoral arteries yielded a high success rate. In addition, the use of angioplasty with stents may improve patency rates over angioplasty without stents.A common cause of lower extremity claudication is arteriosclerotic occlusion of the superficial femoral artery. A recent analysis of leg arteriograms on 1,000 consecutive patients with lower extremity claudication from our medical center revealed that in patients with no previous surgical or radiologic intervention in the arteries of the

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“…Percutaneous transluminal balloon angioplasty is a low-risk and low-cost procedure, but it is associated with a fairly high restenosis rate (2)(3)(4)(5). Primary stent placement does not improve the patency rate of PTA performed for femoropopliteal arterial disease and is thus currently used only to salvage a failed balloon angioplasty procedure (6,7).…”

Section: Discussionmentioning

confidence: 99%

Cost and Patency Rate Targets for the Development of Endovascular Devices to Treat Femoropopliteal Arterial Disease

Muradin¹,

Hunink²

2001

Radiology

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Radiology 2001; 218:464 -469Abbreviations: NHB ϭ net health benefit PTA ϭ percutaneous transluminal angioplasty QALY ϭ quality-adjusted life-year To determine the criteria that would make use of an endovascular device cost-effective compared with bypass surgery and percutaneous transluminal angioplasty in the treatment of femoropopliteal arterial disease. MATERIALS AND METHODS:A decision model was developed to compare treatment with the use of a hypothetical endovascular device with established therapies. Cost-effectiveness from the perspective of the health care system was considered. Outcome measures were lifetime costs and quality-adjusted life-years. With the use of net health benefit calculations and threshold analysis, combinations of costs and patency rates were determined that would make the device cost-effective compared with established therapies. In subgroup and sensitivity analyses, the effect on decision-making of sex, age, indication, lesion type, procedural risk, and society's willingness to pay for incremental gain in health were explored. RESULTS:Use of a device that costs $3,000 would be cost-effective compared with bypass surgery for critical ischemia if the 5-year patency rate is 29%-46%. Use of the same device would be cost-effective compared with angioplasty for disabling claudication and stenosis if the 5-year patency rate is 69%-86%. CONCLUSION:The target combinations of costs and patency rates found in this study are probably attainable, and further development of such endovascular devices seems warranted.Although bypass surgery and percutaneous transluminal angioplasty (PTA) are commonly used revascularization procedures in the treatment of femoropopliteal arterial occlusive disease, both procedures have disadvantages (1). Percutaneous transluminal balloon angioplasty is a low-risk and low-cost procedure, but it is associated with a fairly high restenosis rate (2-5). Primary stent placement does not improve the patency rate of PTA performed for femoropopliteal arterial disease and is thus currently used only to salvage a failed balloon angioplasty procedure (6,7). Bypass surgery, on the other hand, has higher long-term patency rates but is also associated with a higher procedural risk, higher cost, and longer convalescence period (4,5). In general, PTA is performed as primary treatment of short focal lesions of the femoropopliteal artery, whereas bypass surgery is the primary treatment in diffuse disease.Endovascular devices are currently being developed as alternative interventions to overcome the problems of established procedures. Important considerations in choosing the optimal treatment strategy are the effectiveness of the device, the risks of the procedures, and the costs. These parameters are generally unknown during the development of a new technology. In particular, the patency and cost estimates associated with endovascular devices are uncertain and may even change with time. It is difficult, if not impossible, to predict what the precise values for the parameters of a new te...

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Efficacy of balloon angioplasty of the superficial femoral artery and popliteal artery in the relief of leg ischemia

Abstract: Percutaneous transluminal angioplasty of the SFA and popliteal arteries is commonly used to treat claudication and critical ischemia but is associated with a high initial failure rate and poor patency at 24 months. Balloon angioplasty is not recommended to treat claudication.

Cited by 56 publications

References 17 publications

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Angioplasty and Stent Placement in Chronic Occlusion of the Superficial Femoral Artery: Technique and Results

Cost and Patency Rate Targets for the Development of Endovascular Devices to Treat Femoropopliteal Arterial Disease

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