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      Technical Success, Midterm Primary Patency, and Factors Affecting Primary Patency of Subintimal Angioplasty Followed by Vasculomimetic Stenting for Trans-Atlantic Intersociety Consensus II C and D Femoropopliteal Arterial Disease—A Prospective Study

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          Abstract

          Background  The best option among the endovascular options in long, complex femoropopliteal (FP) lesions, and factors affecting the patency have yet to be well described. There are few studies describing the mid- and long-term patency of endovascular stents in long-segment FP occlusions.

          Aim  This study aimed to determine the technical success and mid-term patency of subintimal angioplasty with vasculomimetic stenting in Trans-Atlantic Inter-Society Consensus II (TASC) C and D FP disease. The patient and imaging factors that affect primary patency were also analyzed.

          Methods and Materials  A single-center prospective study was performed on 52 consecutive patients undergoing endovascular treatment for TASC C and D FP disease from 2017 to 2021. Angioplasty with stenting was performed in all patients and followed up for 36 months. Endpoints were primary patency rates and amputation-free survival of the limb. Kaplan–Meier curves were used to see patency rates and amputation-free survival rates.

          Results  A total of 52 patients underwent stenting with a technical success rate of 100% if the sub-intimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique was used. Primary stent patency at 6, 12, 18, 24, and 36 months was 89.8, 81.4, 76.2, 71.4, and 62.5%, respectively. Amputation-free survival was 98, 95.6, 91.8, and 85.7% at 12, 24, 30, and 36 months, respectively. Cox proportional regression analysis showed smoking and vessel wall calcium score more than 270 degrees as independent predictors of loss of primary patency (hazard ratio 0.35 confidence interval [CI]: 0.003–0.448) and 0.102 (CI: 0.022–0.47), respectively.

          Conclusion  Subintimal angioplasty with vasculomimetic stent has good midterm patency in and amputation-free survival in long-segment FP occlusions. Smoking and severe vessel wall calcification adversely affect patency.

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          Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).

          L Norgren, W.R. Hiatt, J.A. Dormandy … (2007)
          Article 0 comments Cited 490 times – based on 0 reviews     Review now
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            Global vascular guidelines on the management of chronic limb-threatening ischemia

            Michael S. Conte, Andrew W Bradbury, Philippe Kolh … (2019)
            Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.
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              Calcium burden assessment and impact on drug-eluting balloons in peripheral arterial disease.

              F Fanelli, A Cannavale, M Gazzetti … (2014)
              This study was designed to assess the effect of calcium on the efficacy of DEB during revascularization of steno-obstructive SFA lesions.
              Article 0 comments Cited 75 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Radiol Imaging
                Journal ID (iso-abbrev): Indian J Radiol Imaging
                Journal ID (doi): 10.1055/s-00050590
                Title: The Indian Journal of Radiology & Imaging
                Publisher: Thieme Medical and Scientific Publishers Pvt. Ltd. (A-12, 2nd Floor, Sector 2, Noida-201301 UP, India )
                ISSN (Print): 0971-3026
                ISSN (Electronic): 1998-3808
                Publication date (Electronic): 04 December 2023
                Publication date Collection: April 2024
                Publication date PMC-release: 1 December 2023
                Volume: 34
                Issue: 2
                Pages: 254-261
                Affiliations
                [1 ]Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
                [2 ]Department of Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
                Author notes
                Address for correspondence Jineesh Valakkada, MD Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College Trivandrum 695011, KeralaIndia jineesh174@ 123456sctimst.ac.in
                Author information
                http://orcid.org/0000-0002-0419-774X
                http://orcid.org/0000-0003-3382-6063
                http://orcid.org/0000-0001-5552-810X
                Article
                Publisher ID: IJRI-23-8-2904
                DOI: 10.1055/s-0043-1777015
                PMC ID: 10972645
                SO-VID: 47173c3b-fd15-467a-9cf0-9d4a298dc8c2
                Copyright © Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ )
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                Funding
                Funding None.
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: peripheral arterial disease,tasc c and d fp disease,subintimal angioplasty,vasculomimetic stent
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: peripheral arterial disease, tasc c and d fp disease, subintimal angioplasty, vasculomimetic stent

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