Endovascular Brachytherapy after Percutaneous Transluminal Angioplasty of Recurrent Femoropopliteal Obstructions

Zehnder, Thomas; Briel, C. von; Baumgartner, Iris; Triller, Jürgen; Greiner, Richard; Mahler, F; Do, Dai-Do

doi:10.1177/152660280301000221

Cited by 32 publications

(13 citation statements)

References 29 publications

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“…In a randomized study on restenotic SFA lesions, the patients were either randomized to either angioplasty with high-dose gamma BT using a non-centred 192 Ir source (12 Gy) or repeat angioplasty alone. 81 At 1 year, the restenosis rates were 23% in the BT group versus 42% in the control group ( p ϭ 0.028) by duplex ultrasound, confirming that BT exerts a beneficial effect in patients with recurrent lesions after prior balloon angioplasty.…”

Section: Brachytherapymentioning

confidence: 71%

Current state of endovascular treatment of femoro-popliteal artery disease

Zeller

2007

Vasc Med

113

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Considerable advances have been made over the last decade in percutaneous technology for the treatment of atherosclerotic diseases in the femoro-popliteal arteries. While treatment strategies are well defined in the iliac segment, where angioplasty and stenting perform well in appropriately selected lesions, the search for a durable transcatheter therapy for femoro-popliteal lesions continues. Whereas balloon angioplasty (PTA) is the accepted therapy for short lesions, long diffuse lesions are still recommended for surgical treatment. However, attractive new technologies ranging from transcatheter plaque excision to laser ablation, rotational atherectomy, cryoplasty, brachytherapy, and placement of drug-eluting stents to simple angioplasty with drug-coated balloons may have the potential to replace femoro-popliteal bypass surgery as a treatment of choice for complex lesions. This article reviews the status of percutaneous endovascular techniques for the treatment of femoro-popliteal artery occlusive disease.Key words: angioplasty; percutaneous intervention; peripheral occlusive disease; popliteal artery; stent; superficial femoral artery Albert-Ludwigs-University Freiburg, Freiburg, Germany and Department of Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany Address for correspondence: Thomas Zeller, Abteilung Angiologie, Herz-Zentrum Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Germany. Tel: ϩ49 7633/4020; Fax: ϩ49 7633/402-8208; E-mail: thomas.zeller@herzzentrum.de defined as target lesion revascularization (TLR). If another lesion at the target vessel site but not the index lesion itself needs to be treated during follow-up this intervention is defined as target vessel revascularization (TVR). Superficial femoral artery and popliteal artery diseaseThe superficial femoral artery (SFA) extending to the proximal popliteal artery segment is the most commonly diseased vasculature. More than 50% of all PAD cases involve the SFA and popliteal artery. Femoro-popliteal disease is often characterized by long, diffuse lesions, long occlusions (as opposed to mild focal stenoses). The unique slow-flow and highresistance environment in the femoro-popliteal region creates a milieu that seems to increase the prevalence of de novo disease. The same issues that lead to accumulation of plaque within the femoro-popliteal region likely amplify the response to injury and may explain the high incidence of restenosis following traditional angioplasty. 9 Femoro-popliteal occlusive disease is still the Achilles heel of the vascular specialist.The durability of femoro-popliteal intervention can be predicted by the pre-procedural angiographic characteristics of the target lesion. The TASC I and the updated TASC II document 6 divided the femoropopliteal lesions into four categories (Table 1). TASC A lesions are more suitable for endovascular procedures, whereas surgery is recommended for TASC D lesions. The TASC document clearly states that it takes more evidence to make firm recommendations about the role of an...

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Section: Brachytherapymentioning

confidence: 71%

Current state of endovascular treatment of femoro-popliteal artery disease

Zeller

2007

Vasc Med

113

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“…Similarly, multiple randomized trials of laser angioplasty versus PTA have shown no advantage of laser therapy (465)(466)(467)(468). Investigational randomized trials suggest that endovascular brachytherapy may reduce restenosis rates of PTA and stenting in the femoral-popliteal arteries (469)(470)(471)(472)(473). Techniques to be investigated in randomized trials in the peripheral circulation include fabric-covered stents (474,475) and drug-coated stents (476,477).…”

Section: Table 19 Indications For Revascularization In Intermittent mentioning

confidence: 99%

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Hirsch

Haskal²,

Hertzer³

et al. 2006

Circulation

2,973

1,111

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“…[1][2][3][4][5][6] Few controlled trials have been performed with brachytherapy in peripheral arterial obstructive disease. 9,[11][12][13][14] Although most of these studies reported a reduction of restenosis, a multicenter trial 14 did not demonstrate significant benefit, whereas another found no difference in restenosis with the intention-to-treat analysis approach. 13 The limitations of endovascular brachytherapy include the fact that it is sometimes technically impossible to deliver the radiation, 13 that the required vascular manipulations are cumbersome, and that they may also be associated with thromboembolic events.…”

Section: Discussionmentioning

confidence: 99%

External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

et al. 2005

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Background— Femoropopliteal percutaneous transluminal angioplasty (PTA) remains limited by restenosis. Although vascular brachytherapy may be effective in reducing restenosis, external beam radiation would be more practical to administer after PTA. Methods and Results— After femoropopliteal PTA without stent placement, 99 patients were randomly assigned to 0 Gy (placebo; n=24), 7 Gy (n=24), 10.5 Gy (n=26), or 14 Gy (n=25) of external beam radiation of the PTA site (with a 3-cm margin at both extremities) in 1 session 24 hours after PTA. The primary end point was minimum lumen diameter on quantitative angiography 1 year after PTA. One year after PTA, the mean minimum lumen diameter was 1.92, 1.64, 1.92, and 2.91 mm, respectively, for the 0-, 7-, 10.5-, and 14-Gy groups ( P =0.0072 for 0 versus 14 Gy). Mean luminal loss was 1.14, 1.27, 1.08, and 0.14 mm, respectively, for the 4 groups ( P =0.0072 for 0 versus 14 Gy). Restenosis >50% was present in 50%, 65%, 48%, and 25% of patients, respectively, for the 0-, 7-, 10.5-, and 14-Gy groups ( P =0.072). At 18 months, repeated revascularizations were required in 25% of patients in the 0-Gy group versus 12% of patients in the 14-Gy group ( P =0.24). Conclusions— A single session of external beam radiation of 14 Gy of the femoropopliteal angioplasty site significantly reduces restenosis at 1 year.

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Endovascular Brachytherapy after Percutaneous Transluminal Angioplasty of Recurrent Femoropopliteal Obstructions

Abstract: EVBT without a centering device reduced restenosis significantly in patients with recurrent stenosis after angioplasty, which confirms previous results in primary long-segment femoropopliteal obstructions.

Cited by 32 publications

References 29 publications

Current state of endovascular treatment of femoro-popliteal artery disease

Current state of endovascular treatment of femoro-popliteal artery disease

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

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