Percutaneous endovascular treatment of infrainguinal PAOD

Abstract

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.

Population Based Analysis of Gender Disparities in 23,715 Percutaneous Endovascular Revascularisations in the Metropolitan Area of Hamburg

“…Regarding differences in clinical presentation, it was found that female patients more often suffer from ischaemic rest pain when compared with males. This finding confirms prior results from disease registries 8,22,28 and cross sectional studies where women with PAD were more likely than men to have exertional leg pain that sometimes begins at rest. 23 Others have found women to be more prone to present with no symptoms when compared with their male counterparts.…”

“…This finding confirms results from three studies where females had a higher incidence of femoropopliteal disease when compared with males. 22,33,34 A higher rate of diabetes with corresponding non-valid ABI values in males seems to support the conclusion that male patients more often suffer from atherosclerotic diseases BTK while females primarily suffer from lesions ATK.…”

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

“…Numerous guidelines on this topic have already been published. The PSI-study aimed to investigate the most common percutaneous endovascular practices and interventions of both suprapopliteal and infrapopliteal lesions in patients with symptomatic PAD [4]. As there is evidence for signifi cant gender diff erences in clinical manifestations [5,6] and risk factors [7], this paper covers aspects of gender-specifi c dif-departments were contacted.…”

Radiation Dosage for Percutaneous PAD Treatment is Different in Cardiovascular Disciplines: Results From an Eleven Year Population Based Registry in the Metropolitan Area of Hamburg

“…In contrast, about 85% of lesions causing IC are located above the knee. 11 While current guidelines and systematic reviews favour stenting and drug-coated devices to treat lesions above the knee, PTA alone remains the gold standard for treatment below the knee. 12 Furthermore, the significantly lower DAP values in surgical units might be explained by non-surgical units being more prone to solve even complex lesions in advanced diseases by endovascular means as their sole option of treatment.…”