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Below the knee angioplasty

Costantino Del Giudice, Roberto Gandini
PURPOSE: To evaluate the safety and efficacy of low-frequency, high-intensity ultrasound energy delivered via a new dedicated ultrasound catheter followed by conventional balloon angioplasty to treat calcified infrapopliteal lesions. MATERIALS AND METHODS: A prospective, nonrandomized, single-center pilot study enrolled 12 patients (mean age 72.2±5.3 years; 8 men) with critical limb ischemia (9 Rutherford category 5 and 3 category 6) between January and November 2017...
February 11, 2019: Journal of Endovascular Therapy
Stavros Spiliopoulos, Nikiforos Vasiniotis Kamarinos, Elias Brountzos
New and sophisticated endovascular devices, such as drug-eluting stents (DES) and drug-coated balloons (DCB), provide targeted drug delivery to affected vessels. The invention of these devices has made it possible to address the reparative cascade of arterial wall injury following balloon angioplasty that results in restenosis. DESs were first used for the treatment of infrapopliteal lesions almost 20 years ago. More recently, however, DCB technology is being investigated to improve outcomes of endovascular below-the-knee arterial procedures, avoiding the need for a metallic scaffold...
January 26, 2019: World Journal of Cardiology
Fragiska Sigala, George Galyfos, Kyriakos Stavridis, Konstantinos Tigkiropoulos, Ioannis Lazaridis, Dimitrios Karamanos, Vangelis Mpontinis, Nikolaos Melas, Ioulia Zournatzi, Konstantinos Filis, Nikolaos Saratzis
Purpose: Aim of this study is to report real-life experience on the treatment of peripheral artery disease (PAD) with a specific drug-coated balloon (DCB), and to evaluate potential prognostic factors for outcomes. Materials and Methods: This is a retrospective study reporting outcomes in patients with PAD who were treated with the Lutonix DCB during a four-year period. Major outcomes included: all-cause mortality, amputation, clinical improvement, wound healing and target lesion revascularization (TLR)...
December 2018: Vascular Specialist International
Carolina Dutra Queiroz Flumignan, Fábio Cabral Freitas Amaral, Ronald Luiz Gomes Flumignan, Vladimir Tonello Vasconcelos, Gabriela Araújo Attie, Raul Muffato Daolio, Henrique Jorge Guedes-Neto, Jorge Eduardo de Amorim, José Carlos Costa Baptista-Silva, Luis Carlos Uta Nakano
BACKGROUND: The worldwide incidence and prevalence of diabetes mellitus (DM) are increasing. DM has a high social and economic burden due to its complications and associated disorders. Peripheral arterial disease (PAD) is closely related to DM. More than 85% of patients with DM will develop PAD in their lifetime, and between 10 and 25% of patients with DM will have a foot ulcer. In such cases, it is important to determine for each patient whether it is necessary and feasible to revascularise the affected limb as well as the optimal technique...
December 11, 2018: Systematic Reviews
Charlie C-T Hsu, Gigi Nc Kwan, Dalveer Singh, John A Rophael, Chris Anthony, Mieke L van Driel
BACKGROUND: Chronic limb-threatening ischaemia (CLTI) is a manifestation of peripheral arterial disease (PAD) that includes chronic ischaemic rest pain or ischaemic skin lesions, ulcers, or gangrene for longer than two weeks. The severity of the disease depends on the extent of arterial stenosis and the availability of collateral circulation. Treatment for CLTI aims to relieve ischaemic pain, heal ischaemic ulcers, prevent limb loss, improve quality of life, and prolong survival. CLTI due to occlusive disease in the infrapopliteal arterial circulation (below-knee circulation) can be treated via an endovascular technique by a balloon opening the narrowed vessel, so called angioplasty, with or without the additional deployment of a scaffold made of metal alloy or other material, so called stenting...
December 8, 2018: Cochrane Database of Systematic Reviews
Stavros Spiliopoulos, Panagiotis M Kitrou, Elias N Brountzos
Patients with below-the-knee arterial disease are primarily individuals suffering from critical limb ischemia (CLI), while a large percentage of these patients are also suffering from diabetes or chronic renal failure or both. Available data from randomized controlled trials and their meta-analysis demonstrated that the use of infrapopliteal drug-eluting stents (DES), in short- to medium- length lesions, obtains significantly better results compared to plain balloon angioplasty and bare metal stenting with regards to vascular restenosis, target lesion revascularization, wound healing and amputations...
November 26, 2018: World Journal of Cardiology
Houman Khalili, Haekyung Jeon-Slaughter, Ehrin J Armstrong, Amutharani Baskar, Ishita Tejani, Nicolas W Shammas, Anand Prasad, Mazen Abu-Fadel, Emmanouil S Brilakis, Subhash Banerjee
BACKGROUND: Use of atherectomy for the treatment of peripheral arterial disease (PAD) is increasing as an adjunctive treatment to either conventional or drug-coated balloon angioplasty. There is limited data on atherectomy outcomes in below-the-knee (BTK) endovascular interventions. METHODS: Data from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were analyzed to examine predictors of atherectomy use and its associated 1-year patency rate...
November 30, 2018: Catheterization and Cardiovascular Interventions
Paweł Kaczmarczyk, Marek Krzanowski, Ewelina Szybiak, Mikołaj Maga, Agnieszka Wachsmann, Katarzyna Tyrak, Rafał Januszek, Andrzej Belowski, Łukasz Partyka, Paweł Maga
BACKGROUND: Patients with advanced lower limb ischemia are at present, mainly treated using revascularization. AIM: The aim of the study was to investigate whether the dynamics of blood flow in below-the-knee (BTK) arteries assessed at angiogram completion correlate with clinical outcomes after a 12-month follow-up period among patients with severe leg ischemia treated percutaneously. METHODS: The current study enrolled 287 consecutive patients who underwent 302 endovascular procedures on the infra-inguinal arteries...
October 19, 2018: Kardiologia Polska
Vinko Boc, Anja Boc, Urban Zdešar, Aleš Blinc
BACKGROUND: Percutaneous endovascular revascularisation interventions are increasingly used in treatment of lower extremity artery disease and may expose patients to substantial radiation. PATIENTS AND METHODS: Dose-area product (DAP) was retrospectively analysed in 1063 consecutive interventions performed in adult patients with lower extremity artery disease in a single tertiary medical centre. Differences between procedure types, stratified according to anatomical region and arterial lesion complexity were evaluated...
October 16, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Akihiro Higashimori, Mitsuyoshi Takahara, Makoto Utsunomiya, Masashi Fukunaga, Daizo Kawasaki, Shinsuke Mori, Hideyuki Takimura, Keisuke Hirano, Yoshinori Tsubakimoto, Tatsuya Nakama, Yoshiaki Yokoi
OBJECTIVES: To assess the efficacy of indigo carmine angiography for wound healing after successful below-the-knee intervention in patients with critical limb ischemia (CLI). METHODS: A multi-center prospective intervention study was conducted. Fifty-four limbs of 53 patients in Rutherford categories 5 and 6 underwent endovascular therapy (EVT). After successful EVT, 5 mL of indigo carmine was injected through a catheter at the distal popliteal artery and color changes in the foot were evaluated...
August 25, 2018: Catheterization and Cardiovascular Interventions
Ming Ngan Aloysius Tan, Zhiwen Joseph Lo, Soon Hong Lee, Rui Ming Teo, Wei Leong Glenn Tan, Sadhana Chandrasekar
Objective : To evaluate outcomes after transmetatarsal amputation (TMA) in peripheral arterial disease (PAD) limb salvage in an Asian population and identify risk factors associated with TMA failure. Methodology : A retrospective review of 147 patients with PAD, who had undergone TMA between 2008 and 2014, was carried out. Univariate and multivariate analysis were used to identify predictors of TMA failure. Kaplan-Meier survival analysis was used to calculate major amputation and all-cause mortality rates. Results : The mean age was 66 years...
June 25, 2018: Annals of Vascular Diseases
C Del Giudice, D Van Den Heuvel, J Wille, T Mirault, E Messas, R Ferraresi, S Kum, M Sapoval
PURPOSE: To report our initial experience of fully percutaneous deep venous arterialization (pDVA) for the treatment of chronic critical limb ischemia (cCLI) after failed distal angioplasty. MATERIALS AND METHODS: pDVA was performed in five consecutive patients by creating an arteriovenous fistula (AVF) between a below the knee artery and its satellite deep vein. In this early experience, only patients with failed prior interventional attempts at establishing flow with no distal targets for an arterial bypass were selected...
October 2018: Cardiovascular and Interventional Radiology
Jehad Almasri, Jayanth Adusumalli, Noor Asi, Sumaya Lakis, Mouaz Alsawas, Larry J Prokop, Andrew Bradbury, Philippe Kolh, Michael S Conte, M Hassan Murad
BACKGROUND: The optimal strategy for revascularization in infrainguinal chronic limb-threatening ischemia (CLTI) remains debatable. Comparative trials are scarce, and daily decisions are often made using anecdotal or low-quality evidence. METHODS: We searched multiple databases through May 7, 2017, for prospective studies with at least 1-year follow-up that evaluated patient-relevant outcomes of infrainguinal revascularization procedures in adults with CLTI. Independent pairs of reviewers selected articles and extracted data...
August 2018: Journal of Vascular Surgery
Michele Carrabba, Paolo Madeddu
Occlusive arterial disease, including coronary heart disease (CHD) and peripheral arterial disease (PAD), is the main cause of death, with an annual mortality incidence predicted to rise to 23.3 million worldwide by 2030. Current revascularization techniques consist of angioplasty, placement of a stent, or surgical bypass grafting. Autologous vessels, such as the saphenous vein and internal thoracic artery, represent the gold standard grafts for small-diameter vessels. However, they require invasive harvesting and are often unavailable...
2018: Frontiers in Bioengineering and Biotechnology
Pasternak J Janko, Budakov B Nebojsa, Petres V Andrej
BACKGROUND: Peripheral arterial occlusive disease (PAD) includes acute and chronic disorders of the blood supply as a result of obstruction of blood flow in the arteries of the limb. Treatment of PAD can be conservative, surgical and endovascular. Percutaneous transluminal angioplasty with or without stenting has become a recognized method, which is increasingly used in treatment of arterial occlusive disease. This study aimed to determine early results of endovascular treatment of critical limb ischemia (CLI) patients with infrapopliteal lesions...
March 1, 2018: Archives of Iranian Medicine
Takenobu Shimada, Tsuyoshi Goto, Shunsuke Kubo, Seiji Habara, Hiroyuki Tanaka, Kazushige Kadota
A 69-year-old man on maintenance dialysis underwent endovascular therapy for a refractory wound due to critical limb ischemia in the popliteal and below-knee arteries. Because of bulky calcified nodules projecting into the popliteal artery, conventional balloon angioplasty alone did not seem to provide a sufficient lumen area, and we ablated the calcified nodules by using myocardial biopsy forceps for lesion preparation. Under roadmap guidance, we repeated ablation 39 times to carefully tear off the bulky calcified nodules, and subsequently performed balloon angioplasty in the popliteal artery...
May 30, 2018: International Heart Journal
Marianne Brodmann, Christian Wissgott, Andrew Holden, Robert Staffa, Thomas Zeller, Thodur Vasudevan, Peter Schneider
OBJECTIVES: The Tack implant is designed for focal, minimal metal management of dissections. This study evaluated Tacks for treating postpercutaneous transluminal angioplasty (PTA) dissection in patients with below-the-knee (BTK) arterial occlusive disease. BACKGROUND: PTA is the most commonly used endovascular treatment for patients with occlusive disease of the BTK vessels. Post-PTA dissection is a significant clinical problem that results in poor outcomes, but currently there are limited treatment options for managing dissections...
March 24, 2018: Catheterization and Cardiovascular Interventions
Berkan Ozpak, Sahin Bozok, Mustafa Cagdas Cayir
Objectives To evaluate 36-month outcomes of drug-eluting balloons in infrapopliteal (=below-the-knee) arterial segments, we made a prospective registry enrolling patients (Rutherford class 2 to 5, ankle-brachial index 0.4-0.7) who were revascularized with drug-eluting balloon from August 2011 to December 2014. Methods Three hundred and seven infrapopliteal arteries were revascularized only with drug-eluting balloon. Endpoints included target lesion revascularization, primary patency rate, and changes in ankle-brachial index and Rutherford class...
October 2018: Vascular
Graeme K Ambler, Christopher P Twine
BACKGROUND: Femoro-popliteal bypass is implemented to save limbs that might otherwise require amputation, in patients with ischaemic rest pain or tissue loss; and to improve walking distance in patients with severe life-limiting claudication. Contemporary practice involves grafts using autologous vein, polytetrafluoroethylene (PTFE) or Dacron as a bypass conduit. This is the second update of a Cochrane review first published in 1999 and last updated in 2010. OBJECTIVES: To assess the effects of bypass graft type in the treatment of stenosis or occlusion of the femoro-popliteal arterial segment, for above- and below-knee femoro-popliteal bypass grafts...
February 11, 2018: Cochrane Database of Systematic Reviews
Burak Teymen, Süleyman Aktürk
BACKGROUND: The purpose of this study is to investigate the feasibility and outcome of balloon angioplasty for the treatment of below the ankle (BTA) lesions in addition to below the knee (BTK) lesions in diabetic patients with critical limb ischemia (CLI). METHODS: Inclusion criteria are diabetes mellitus (DM), CLI (Rutherford class 4 or higher) and revascularized significant stenosis or occlusion of at least 1 below-the-knee vessel with incomplete or no pedal loop...
June 2018: Journal of Interventional Cardiology
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