Outflow protection filters during percutaneous recanalization of lower extremities’ arterial occlusions: a pilot study

Siablis, Dimitrios; Karnabatidis, Dimitrios; Κατσάνος, Κωνσταντίνος; Ravazoula, Panagiota; Kraniotis, Pantelis; Kagadis, George C.

doi:10.1016/j.ejrad.2004.07.010

Cited by 52 publications

(60 citation statements)

References 14 publications

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“…Numerous studies have performed lower extremity intervention with distal protection and demonstrated that debris is collected. [11][12][13][14][15] These studies have been cited as evidence to support the use of distal protection during lower extremity intervention. The critical shortcoming of these studies is that they are small series without controls and therefore only demonstrate that debris is collected in filters.…”

Section: Discussionmentioning

confidence: 92%

“…[6][7][8] Numerous studies have confirmed the presence of particulate matter in filters after intervention; however, they do not provide a measure of clinically significant embolization. [12][13][14][15] Our previous work suggested a 1% rate for significant embolization after femoral and popliteal intervention. 6 Studies on the rate of embolization after carotid intervention are often based on duplex detection of particles or analysis of collected debris.…”

Section: Discussionmentioning

confidence: 98%

“…Published reports have involved the use of protection devices and confirmation of the presence of debris without a control group to confirm clinical efficacy. [12][13][14][15] The rates of embolization with newer atherectomy devices such as the Jetstream (Pathway Medical Technologies, Kirkland, Wash) and DiamondBack 360 (Cardiovascular Systems Inc [CSI], Minneapolis, Minn) atherectomy devices are not clearly understood.…”

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confidence: 99%

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Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions

Shrikhande

Khan

Hussain

et al. 2011

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions

Shrikhande

Khan

Hussain

et al. 2011

Journal of Vascular Surgery

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“…Micro-and macrodebris are frequently captured with various embolic protection devices. [62][63][64][65][66] DE requiring further treatment occurs in 2 to 3% of unselected infrainguinal interventions. 67 Its predictors are long occlusions, thrombotic lesions, 67 mechanical thrombectomy, 26 directional atherectomy, 6,65 and laser atherectomy.…”

Section: Procedural Factorsmentioning

confidence: 99%

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Shammas¹

2013

Int J Angiol

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ReviewPeripheral arterial disease is highly prevalent in the general population affecting 12 to 14% of people and leading to claudication or threatened limb ischemia. 1 Endovascular lower extremity arterial interventions have increased exponentially over the past decade. 2 The femoropopliteal (FP) segment represents 40% of vessels treated and its treatment continues to be a challenge to the endovascular specialist. Despite a high rate of acute procedural success, target lesion revascularization (TLR) and target vessel revascularization remain elevated. 3,4 We have previously proposed a triad of optimal peripheral vascular revascularization strategy (►Fig. 1) 5 with an emphasis on three key principles: (1) Mechanical, improve vessel compliance to allow dilatation of a stenotic segment at low balloon inflation pressure and reduce dissection and recoil. Low balloon inflation pressure would theoretically preserve vessel integrity by minimizing barotrauma and bailout stenting. (2) Biological, inhibit smooth muscle cell (SMC) proliferation to improve patency rates and reduce repeat revascularization. (3) Procedural, preserve the outflow vessels by minimizing distal embolization (DE) and reduce procedural time and radiation exposure to both operator and patient.In this overview, we examine these principles to determine whether current data support their validity. We recognize the lack of uniform performance criteria and reporting standards in clinical trials in peripheral arterial disease. This unfortunately makes comparisons across studies difficult. Mechanical FactorsThe concept of improving vessel compliance as a prerequisite to a more definitive treatment of the FP artery has gained more attention over the past few years. Measurement of vessel compliance in vivo is difficult to obtain. One surrogate endpoint is the minimum balloon pressure (MBP) needed to fully stretch the artery to a lumen diameter equal to a normal reference segment with the use of a noncompliant balloon sized 1:1 to the reference vessel. The balloon is typically inflated to two atmospheres then the inflation pressure is increased by increment of one atmosphere at a time until full balloon expansion is achieved. 6,7 According to Laplace's law, tension (T) in the vessel wall is equal to (pressure (P) gradient across the arterial wall * radius (R) of artery)/wall thickening (M), or (T¼ [P * R]/M). In order for MBP change to reflect on compliance, the segments under comparison need to have similar radius and lesion Keywords AbstractTreatment of the femoropopliteal (FP) artery remains a challenge to the endovascular specialist. Long-term patency is low with a high rate of target lesion revascularization. The true patency rate varies considerably between studies partly because there is a lack of uniform performance criteria and reporting standards in peripheral arterial interventions. Literature review supports three principles that emerge as important components of an optimal strategy in treating the FP artery: (1) improving vessel compliance and sub...

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“…Distal embolization is also a well documented phenomenon in the setting of infrainguinal percutaneous balloon angioplasty, stent placement, thrombolysis, and endovascular atherectomy (3)(4)(5)(6). However, the occurrence of this event has been viewed as largely insignificant (7).…”

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confidence: 98%

Revascularization for Critical Limb Ischemia Using the SpiderFX Embolic Protection Device in the Below-the-Knee Circulation: Initial Results

Ward

Piechowiak

Patel

et al. 2014

Journal of Vascular and Interventional Radiology

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Outflow protection filters during percutaneous recanalization of lower extremities’ arterial occlusions: a pilot study

Cited by 52 publications

References 14 publications

Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions

Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Revascularization for Critical Limb Ischemia Using the SpiderFX Embolic Protection Device in the Below-the-Knee Circulation: Initial Results

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