RESUMO
OBJECTIVE: We evaluated the midterm results of atherectomy-assisted angioplasty for the treatment of femoropopliteal lesions and the identification of possible subgroups of patients with superior outcomes. METHODS: We conducted a single-center, physician-initiated, nonindustry-sponsored retrospective analysis of patients with Rutherford category ranging from II to V and de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries treated with atherectomy-assisted angioplasty (Jetstream rotational atherectomy + drug-eluting ballooning). In cases of subintimal recanalization or patients without an SFA stamp, with previous ipsilateral bypass surgery, systemic coagulopathy, end-stage renal disease requiring hemodialysis, life expectancy of <12 months, and intolerance to aspirin, clopidogrel, and/or heparin were excluded. RESULTS: In a total of 103 enrolled patients, the median SFA and/or popliteal lesion length was 80 mm (interquartile range, 61.2 mm) with 73 lesions being occlusive (70.9%) and 84 (81.5%) classified as Fanelli calcification score 3 and 4. Technical success was met in 96.1% of cases (n = 99) at a median operative time of 108 minutes. Adjunctive stenting was needed in 10 patients (9.8%). At a median follow-up of 18.0 ± 10.8 months, Rutherford class clinical improvement was present in 77 patients (74.8%), and 7 patients (6.79%) presented target lesion occlusion needing reintervention in 6 cases (5.82%). The primary patency rates were 97% at 12 months and 83% at 24 months with secondary patency rates of 99% at 12 months and 91% at 24 months of follow-up. There were no significant differences when treating differently located lesions, diabetic vs nondiabetic patients, or comparing experienced vs nonexperienced operators. CONCLUSIONS: The use of rotational atherectomy and drug-eluting balloons for the treatment of severe femoropopliteal disease showed relatively low need for bailout stenting and good midterm primary patency rates. The influence of lesion location, diabetes mellitus, or operator experience did not show statistically different results in terms of patency. Longer term outcomes and comparative analysis are needed to consolidate further clinical evidence.
Assuntos
Angioplastia com Balão , Aterectomia Coronária , Doença Arterial Periférica , Humanos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Angioplastia com Balão/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Aterectomia/efeitos adversos , Aterectomia/métodos , Grau de Desobstrução VascularAssuntos
Angioplastia com Balão , Aterectomia , Artéria Femoral , Doença Arterial Periférica , Artéria Poplítea , Humanos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Angioplastia com Balão/instrumentação , Aterectomia/métodos , Resultado do Tratamento , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Doença Arterial Periférica/cirurgia , Recidiva , Masculino , Lasers de Excimer/uso terapêutico , Stents , Idoso , Feminino , Materiais Revestidos Biocompatíveis , Grau de Desobstrução Vascular , Dispositivos de Acesso Vascular , Pessoa de Meia-IdadeRESUMO
Radial artery (RA) access has been increasingly utilized for coronary procedures because of lower rates of access-site complications and improved patient satisfaction. However, limited data are available for RA access for peripheral vascular intervention (PVI). We performed a retrospective review of 143 patients who underwent PVI through RA access from February 2020 to September 2022 at a single institution. Baseline characteristics and follow-up data were ascertained from a prospectively maintained institutional database. Of 491 PVI, 156 (31.8%) were performed through the RA. Anatomical locations for intervention were the femoral (44.8%), iliac (31.1%), popliteal (9.6%) peroneal (2.7%), tibial (9.9%), and subclavian (1.9%) arteries. Procedural access was obtained through the right RA (92.9%), left RA (4.5%), or right ulnar artery (2.6%) using the 6 French R2P Destination Slender sheath in 85, 105, and 119 cm lengths. Atherectomy was used in 34.7%. Mean contrast volume was 105.5 ml and the average fluoroscopy time was 18.5 minutes. Conversion to femoral access occurred in 3 cases (1.9%) because of arterial spasm and noncrossable lesions. Concomitant pedal access occurred in 2 cases (1.3%). Periprocedural complication rate was 3.84%, of which access-site hematoma was most common (3.2%); none required blood transfusion, surgical intervention, or additional hospital stay. There was 1 case (0.64%) of in-hospital stroke. The mortality rate at 30-day, 6-month, and 1-year was 1.4%, 2.8%, and 4.2%, respectively. In conclusion, RA access is feasible for diverse PVI, and future studies are needed to assess safety and benefit compared with femoral artery access.
Assuntos
Artéria Radial , Humanos , Masculino , Feminino , Estudos Retrospectivos , Idoso , Pessoa de Meia-Idade , Cateterismo Periférico/métodos , Artéria Femoral , Procedimentos Endovasculares/métodos , Aterectomia/métodos , Resultado do Tratamento , Doença Arterial Periférica/cirurgiaRESUMO
This study evaluated the outcomes of a bare metal stent (BMS), DCB alone, atherectomy plus a drug-coated balloon (AT + DCB) and AT alone for the treatment of femoropopliteal artery occlusion. Four groups were included in this retrospective cohort study: 119 patients underwent the BMS procedure, 89 patients underwent DCB alone, 52 patients underwent AT + DCB, and 61 patients underwent AT alone. Patients were followed-up at 1, 6, 12 and 24 months after the procedure, the clinical outcomes and complications were assessed, and the primary outcomes were primary patency and restenosis. AT + DCB showed a lower bailout stent, and BMS displayed a higher retrograde puncture, flow-limiting dissection and postdilation (p < 0.05). For all procedures, the walking distance, ABI and pain score post-procedure were significantly improved compared with the pre-procedure values (p < 0.001). The restenosis rate was higher in BMS (21.0%) and AT alone (24.6%) than in DCB (10.1%) alone and AT + DCB (11.5%) (p = 0.04); there was no difference in amputation or clinically driven target lesion revascularization among procedures. The primary patency rates were 77.7%, 89.4%, 88.0% and 73.7% in the BMS, DCB alone, AT + DCB and AT alone groups at 24 months, respectively (p = 0.03), while the secondary patency and main adverse events (stroke, MI and death) were similar. Proximal concavity, proximal target vessel diameter ≥ 5 mm, runoff number ≥ 2 and DCB use were protective factors for primary patency. Our results suggested that AT + DCB and DCB alone were associated with higher primary patency, and DCB devices (combined with/without AT) should be the preferred choice for FP lesions.
Assuntos
Angioplastia com Balão , Doença Arterial Periférica , Humanos , Artéria Femoral/cirurgia , Artéria Poplítea/cirurgia , Doença Arterial Periférica/cirurgia , Doença Arterial Periférica/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Fatores de Risco , Materiais Revestidos Biocompatíveis , Grau de Desobstrução Vascular , Angioplastia com Balão/efeitos adversos , Stents/efeitos adversos , Aterectomia/efeitos adversos , Aterectomia/métodosRESUMO
BACKGROUND: Endovascular therapy has become established as a first-line therapy in most arterial regions. However, open vascular surgery (endarterectomy) remains the treatment of choice for common femoral artery (CFA) lesions. The aim of this study is to investigate the acute and mid-term results of directional atherectomy plus drug-coated balloon (DCB) in comparison to endarterectomy in treatment of de novo arteriosclerotic CFA lesions. METHODS: This prospective, randomized, multicenter non-inferiority study will enroll 306 participants with symptomatic (Rutherford category 1 to 5) de novo stenosis of the CFA including the bifurcation. Patients eligible for both treatment groups could be included in this 1:1 randomized trial. Primary efficacy endpoint is patency of the target lesion at 12 months defined as restenosis < 50% without the need of clinically driven target lesion revascularization (cdTLR). Primary safety endpoint is a combined endpoint including death, myocardial infarction, major or minor amputation of the target limb, and peri-procedural complications at 30 days. Secondary endpoints include primary patency of the target lesion at 6 and 24 months, secondary patency, cdTLR 6, 12, and 24 months, change in ankle-brachial index, and Rutherford-Becker class at 6, 12, and 24 months. Limb salvage, change in quality of life measured by Walking Impairment Questionnaire, and major adverse events including death, myocardial infarction, and minor or major amputation of the target limb will be determined at 6, 12, 24, and 36 months. DISCUSSION: Endovascular treatment of CFA lesions is still a matter of debate. Few studies compared modern endovascular therapy methods against the so-called gold standard surgical endarterectomy so far. Based on recent positive results, this study aims to confirm non-inferiority of a "leaving nothing behind" endovascular approach combining directional atherectomy and DCB compared to surgical therapy. TRIAL REGISTRATION: ClinicalTrials.gov NCT02517827.
Assuntos
Endarterectomia , Artéria Femoral , Doença Arterial Periférica , Grau de Desobstrução Vascular , Humanos , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/métodos , Angioplastia com Balão/instrumentação , Aterectomia/efeitos adversos , Aterectomia/métodos , Materiais Revestidos Biocompatíveis , Endarterectomia/efeitos adversos , Endarterectomia/métodos , Estudos de Equivalência como Asunto , Artéria Femoral/cirurgia , Salvamento de Membro , Estudos Multicêntricos como Assunto , Doença Arterial Periférica/terapia , Doença Arterial Periférica/cirurgia , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Dispositivos de Acesso VascularAssuntos
Aterectomia , Artéria Femoral , Artéria Poplítea , Calcificação Vascular , Humanos , Artéria Femoral/diagnóstico por imagem , Artéria Poplítea/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia , Aterectomia/métodos , Masculino , Idoso , Tomografia de Coerência Óptica/métodos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Doença Arterial Periférica/cirurgia , FemininoRESUMO
No disponible
No disponible
Assuntos
Humanos , Masculino , Idoso , Tomografia de Coerência Óptica/métodos , Aterectomia/métodos , Stents Farmacológicos , Tomografia de Coerência Óptica/tendências , EcocardiografiaRESUMO
No disponible
Assuntos
Humanos , Artéria Femoral/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Angioplastia/métodos , Criocirurgia , Aterectomia/métodos , Túnica Íntima/cirurgiaRESUMO
As lesões em bifurcação representam um grande desafio no tratamento percutâneo da insuficiência coronária. Os resultados imediatos e a médio prazo obtidos com a angioplastia convencional por balão mostraram-se desapontadores. O desenvolvimento de novos dispositivos, como aterectomia e stents, cateteres-guia, balões de baixo perfil e cordas-guia, e a associação de tienopiridínicos-aspirina trouxeram gradativa e substancial melhora nos resultados clínicos e angiográficos desses procedimentos. O implante de stents em bifurcação tornou-se o procedimento de escolha, com resultados seguros e previsíveis na maioria dos casos, embora a taxa de reestenose persistisse elevada. os stents eluidores de medicamentos proporcionaram à cardiologia intervencionista a possibilidade de oferecer, em todos os subgrupos de pacientes com lesões obstrutivas coronarias, substancial melhora do seguimento clínico, por redução de necessidade de nova revascularização da lesão tratada. Essa evolução propiciou o desenvolvimento de novas técnicas para tratamento das lesões que envolvem bifurcação, assim como abriu perspectiva de utilização de próteses estritamente dedicadas a esse segmento, que, em última análise, podem significar a resposta final a esse problema.
Assuntos
Masculino , Feminino , Humanos , Angioplastia com Balão/métodos , Angioplastia com Balão , Angioplastia/métodos , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico , Reestenose Coronária/complicações , Reestenose Coronária/diagnóstico , Aterectomia/métodos , Aterectomia , StentsAssuntos
Humanos , Masculino , Feminino , Idoso , Angioplastia com Balão , Endarterectomia , Extremidade Inferior , Aterectomia/métodos , Força de Mordida , ChileRESUMO
No disponible