Gender differences in endovascular treatment of infrainguinal peripheral artery disease

VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 296-303 ◽  
Author(s):  
Henrik Christian Rieß ◽  
Eike Sebastian Debus ◽  
Franziska Heidemann ◽  
Konstanze Stoberock ◽  
Reinhart T. Grundmann ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Bleeding Complications ◽  
Limb Ischaemia ◽  
Ongoing Research ◽  
Below The Knee ◽  
Gender Specific Differences ◽  
Artery Disease ◽  
Peripheral Arterial

Abstract. Background: Despite ongoing research concerning comorbidities and clinical presentation of peripheral arterial disease (PAD), the issue of gender associated differences in treatment is far from being settled. Patients and methods: This was a prospective, non-randomized multicentre study design. All patients suffering from intermittent claudication (IC) or critical limb ischaemia (CLI) were included. Results: A total of 2,798 procedures for symptomatic PAD in the infrainguinal region were recorded, with 1,696 (61.4 %) males. Distribution of comorbidities for patients with IC were gender-specifically different. Smoking was more common in men (41.9 vs. 31.9 %, p < .001), men had more often previous coronary heart disease (35.2 vs. 27.7 %, p = .007), and suffered more often from diabetes (33.9 vs. 28.2 %, p = .037). Women were generally older (71 vs. 77 years). Men were more prone to present with IC (46.9 vs. 43.6 %, p < .001) and ulcer/gangrene (43.6 vs. 41.2 %, p < .001). Women were more likely to present with rest pain (9.5 vs. 15.1 %, p < .001). Men were more often treated for a lesion below the knee (BTK) (21.1 vs. 14.9 %, p < .001), and females above the knee (ATK) (58.1 vs. 61.5 %, p < .001). Logistic regression analysis revealed a significant association of male gender and treatment for lesions BTK (OR 1.565, 95 % CI 1.281-1.913, p < .001). Dissections and bleeding complications were more often observed in females with IC (3.3 vs. 7.2 %, p = 0.003; 0.4 vs. 1.5 %, p = 0.044). Women were rather discharged to rehabilitation and had a longer hospital stay compared to men (3.4 vs. 8.9 %, p < .001; three vs. four days, p = .023). Conclusions: The present study provides an overview on gender-specific differences in endovascular treatment of PAD. To date, available evidence on this topic is limited, emphasising the importance of further vascular research targeting this topic.

Epidemiology and global burden of peripheral arterial disease and aortic aneurysms

ESC CardioMed ◽  
2018 ◽  
pp. 328-334
Author(s):  
Holger Reinecke ◽  
Nasser Malyar
Keyword(s):  
General Population ◽  
Large Scale ◽  
Arterial Disease ◽  
Aortic Aneurysms ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Thoracic Aortic Aneurysms ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Older Populations

Peripheral artery disease (PAD) and aortic aneurysms are common diseases in older populations, sharing common aetiological risk factors. From community-based trials assessing ankle–brachial indices, 2–4% of the general population have been shown to be affected by PAD, which increases up to 15% in those above 70 years of age. About 30–40% of the in-hospital cases with PAD have critical limb ischaemia and suffer from a 1-year mortality of 20–40%. Abdominal aortic aneurysms (AAAs) also show a relatively high prevalence of about 1–2% in the general population as found by large-scale, systematic duplex screening. Of these, about 5% come to hospital admittance with a ruptured AAA which is still associated with an in-hospital mortality of up to 50%. The prevalence of thoracic aortic aneurysms (TAAs) was reported to be at about 0.16–0.34% in selected subgroups of the general population. The incident cases of TAAs have risen from 10/100,000 cases in the late 1980s up to about 17/100,000 cases in the first decade of this millennium. It is noteworthy that PAD and aortic aneurysms as well as their associated co-morbidities remain in many cases underdiagnosed and undertreated. This leads to a high cardiovascular morbidity and mortality which could not be obviously markedly reduced in the recent decades. Since nearly all vascular disorders are systemic diseases, not only the specific vessel bed which leads to a presentation should be assessed but also all other possible vascular manifestations should be thoroughly examined to reduce the high rates of adverse events and the persistent poor outcome.

scholarly journals Below-the-ankle Angioplasty: Current Evidence and Future Perspectives

2019 ◽  
Vol 2 (1) ◽  
pp. 6-8
Author(s):  
Stavros Spiliopoulos ◽  
Lazaros Reppas ◽  
Konstantinos Palialexis ◽  
Elias Brountzos
Keyword(s):  
Endovascular Treatment ◽  
Bypass Surgery ◽  
Arterial Disease ◽  
Annual Incidence ◽  
Critical Limb Ischaemia ◽  
Current Evidence ◽  
Limb Ischaemia ◽  
Future Perspectives ◽  
Severe Stage ◽  
Peripheral Arterial

Over 20 million adults in Europe suffer from peripheral arterial disease (PAD). The annual incidence of PAD is approximately 2.4%, while the annual incidence of critical limb ischaemia (CLI), the last and most severe stage of PAD, has been reported to be 0.4%. Endovascular angioplasty and/or stenting of infrapopliteal disease is, today, an established treatment for critical limb ischaemia. The main technical advantages of endovascular treatment over open bypass surgery include the possibility to revascularise more than one infrapopliteal vessels and, most importantly, to treat outflow pedal vessel disease or even reconstitute the pedal arch. Data of below-the-ankle angioplasty are beginning to sum up and the contribution of pedal arch angioplasty in limb salvage and wound healing are currently under investigation. In this review, currently available data and the future perspectives on below-the-ankle and pedal arch endovascular treatment will be presented.

scholarly journals Short-Term Clinical Outcomes of Single Versus Dual Antiplatelet Therapy after Infrainguinal Endovascular Treatment for Peripheral Arterial Disease

2020 ◽  
Vol 9 (11) ◽  
pp. 3515
Author(s):  
Jetty Ipema ◽  
Rutger H. A. Welling ◽  
Olaf J. Bakker ◽  
Reinoud P. H. Bokkers ◽  
Jean-Paul P. M. de Vries ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Disease ◽  
Bleeding Complications ◽  
Major Adverse Cardiovascular Events ◽  
Below The Knee ◽  
Peripheral Arterial ◽  
Male Rate

After infrainguinal endovascular treatment for peripheral arterial disease (PAD), it is uncertain whether single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) should be preferred. This study investigated major adverse limb events (MALE) and major adverse cardiovascular events (MACE) between patients receiving SAPT and DAPT. Patient data from three centers in the Netherlands were retrospectively collected and analyzed. All patients treated for PAD by endovascular revascularization of the superficial femoral, popliteal, or below-the-knee (BTK) arteries and who were prescribed acetylsalicylic acid or clopidogrel, were included. End points were 1-, 3-, and 12-month MALE and MACE, and bleeding complications. In total, 237 patients (258 limbs treated) were included, with 149 patients receiving SAPT (63%) and 88 DAPT (37%). No significant differences were found after univariate and multivariate analyses between SAPT and DAPT on 1-, 3-, and 12-month MALE and MACE, or bleeding outcomes. Subgroup analyses of patients with BTK treatment showed a significantly lower 12-month MALE rate when treated with DAPT (hazard ratio 0.33; 95% confidence interval 0.12–0.95; p = 0.04). In conclusion, although patient numbers were small, no differences were found between SAPT and DAPT regarding MALE, MACE, or bleeding complications. DAPT should, however, be considered over SAPT for the subgroup of patients with below-the-knee endovascular treatment.

scholarly journals A Case Report of Angioplasty and Stenting Experience for Peripheral Arte-rial Disease of the Lower Limbs at Annapurna Neurological Institute

2021 ◽  
Vol 1 (1) ◽  
pp. 38-41
Author(s):  
Sandeep Raj Pandey ◽  
Anik Jha ◽  
Sudikchya Acharya ◽  
Sudan Dhakal
Keyword(s):  
Case Report ◽  
Early Stage ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Primary Stenting ◽  
Artery Disease ◽  
Peripheral Arterial

Atherosclerosis leading to stenosis or blockage in the major vessels of lower extremities causes peripheral arterial disease(PAD). PAD may be asymptomatic in early stage. But in late stage PAD present in the form of intermittent claudication (IC) or critical limb ischaemia (CLI) . The Fontaine classification is commonly used to measure the severity of disease which is staged from l-asymtomatic to lV-gangrene. PAD can be treated by medical , endovascular and surgical management The purpose of this case report is to consider the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities.  

Epidemiology and global burden of peripheral arterial disease and aortic aneurysms

2018 ◽  
Author(s):  
Holger Reinecke
Keyword(s):  
General Population ◽  
Large Scale ◽  
Arterial Disease ◽  
Aortic Aneurysms ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Cardiovascular Morbidity And Mortality ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Incident Cases

Peripheral artery disease (PAD) and aortic aneurysms are common diseases which show an increasing prevalence and incidence. From community-based trials assessing ankle–brachial indices, 2–4% of the general population have been shown to be affected by PAD, which increases up to 15% in those above 70 years of age. About 30–40% of the in-hospital cases with PAD have critical limb ischaemia and suffer from a 1-year mortality of 20–40%. Abdominal aortic aneurysms (AAAs) also show a relatively high prevalence of about 1–2% in the general population as found by large-scale, systematic duplex screening. Of these, about 5% come to hospital admittance with a ruptured AAA which is still associated with an in-hospital mortality of up to 50%. The prevalence of thoracic aortic aneurysms (TAAs) was reported to be at about 0.16–0.34% in selected subgroups of the general population. The incident cases of TAAs have risen from 10/100,000 cases in the late 1980s up to about 17/100,000 cases in the first decade of this millennium. It is noteworthy that PAD and aortic aneurysms as well as their associated co-morbidities remain in many cases underdiagnosed and undertreated. This leads to a high cardiovascular morbidity and mortality which could not be obviously markedly reduced in the recent decades. Since nearly all vascular disorders are systemic diseases, not only the specific vessel bed which leads to a presentation should be assessed but also all other possible vascular manifestations should be thoroughly examined to reduce adverse events.

scholarly journals Predictors of post-operative outcomes in patients with peripheral arterial disease and critical limb ischaemia: a systematic review and meta-analysis

2021 ◽  
Vol 55 (1) ◽  
pp. 69-76
Author(s):  
Lily P. Wu ◽  
Nadraj G. Naidoo ◽  
Olatunji O. Adetokunboh
Keyword(s):  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Graft Patency ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Wound Complications ◽  
Limb Ischaemia ◽  
Operative Outcomes ◽  
One Year ◽  
Peripheral Arterial

Background: A very small proportion (1%) of patients with peripheral artery disease (PAD) present with critical limb threatening ischaemia (CLTI) with poor prognosis. The present review showcased several pre-operative predictors and key post-operative outcomes. Identification of any modifiable predictors may impact positively on surgical outcomes.Design: PubMed/Medline, Google scholar and Cochrane databases were searched using terms such as “peripheral arterial disease” AND “critical limb ischemia,” “post-operative outcome,” AND “predictors of post-operative outcomes”. Search was for relevant English-language articles published between January 1997 and December 2007 Selected articles were screened first by title and abstract, and selection of full articles was based on relevance using our inclusion and exclusion criteria and quality ratings performed with the MINORS score.Results: The included studies were published between 1997 and 2007. Only six (6) articles out of a total of 2,114 were deemed suitable for analysis. Ambulatory recovery was >70% at six months, 86.7% and 70.0% at one year and five years respectively. Rate of local wound complications was between 12% and 24%. Reported limb salvage rates were >90% at six months, >70% at one year and 70.0-90.0% at five years. Primary graft patency rate at one year ranged from 63% and 76.6%. Gangrene, diabetes and impaired pre-operative ambulatory function are associated with more wound complications, low limb salvage, reduced graft patency and poor functional outcome.Conclusion: Pre-operative ambulatory status was the most important predictor of post-operative ambulatory recovery. Diabetes mellitus was an important risk factor for prolonged wound healing, local wound complications and major amputation.

scholarly journals Endovascular Treatment of Common Femoral Artery Atherosclerotic Disease

2018 ◽  
Vol 1 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Omar Jawaid ◽  
Ehrin Armstrong
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Long Term Outcomes ◽  
Patch Angioplasty ◽  
The Common ◽  
Artery Disease

Common femoral artery atherosclerosis is a common cause of claudication and critical limb ischaemia. Surgical endarterectomy with or without patch angioplasty has been considered the gold standard for the treatment of common femoral peripheral artery disease. Endovascular intervention to the common femoral artery has gained popularity in recent years as devices and technical skills have advanced. A systematic review of the literature from 1987 to 2018 for endovascular treatment of common femoral artery disease was conducted. This article summarises the data on acute and long-term outcomes for endovascular treatment of common femoral artery disease.

Thrombophilic risk factors and peripheral arterial disease severity

2010 ◽  
Vol 104 (07) ◽  
pp. 71-77 ◽  
Author(s):  
Elisabetta Favaretto ◽  
Cristina Legnani ◽  
Michela Cini ◽  
Eleonora Conti ◽  
Alfio Amato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Cross Sectional Study ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Cross Sectional ◽  
G20210a Mutation ◽  
Peripheral Arterial ◽  
Few Data

SummaryFew data are available on thrombophilic risk factors and progression of atherosclerotic peripheral arterial disease (PAD). Thrombophilic alterations can be an aggravating factor when arterial stenoses are present. In a cross-sectional study, we evaluated the presence of the thrombophilic factors fibrinogen, homocysteine, factor (F)VIII, lupus anticoagulant (LAC), FII G20210A, and FV R506Q mutations in 181 patients with PAD at Fontaine’s stage II (claudication), in 110 patients with critical limb ischaemia (CLI), and in 210 controls. Fibrinogen was higher in patients with CLI vs. those with claudication and controls (427.9 ± 10.5 vs. 373.1 ± 5.2 vs. 348.9 ± 7.0 p=0.001, respectively). Homocysteine and FVIII were higher in patients with PAD than in controls, but were similar in patients with CLI and claudication. The prevalence of LAC increased in patients with CLI vs. those with claudication and controls (21.4% vs. 7.8% vs. 5.2% p<0.001, respectively). The prevalence of FII 20210A allele was higher in patients with CLI vs. those with claudication and controls. Using a logistic model, FII G20210A mutation (odds ratio [OR] 19.8, confidence interval [CI] 4.5–87.1, p=0.001), LAC (OR 2.7, CI1.1–6.5, p=0.032), and fibrinogen (OR 1.01, CI 1.00–1.01, p=0.001) were associated with CLI, whereas homocysteine, FVIII, and FV R506Q mutation were not. CLI risk increased according to the number of thrombophilic alterations. In conclusion, altered levels of some important thrombophilic risk factors are independently associated with PAD severity. These data suggest that the presence of two or more thrombophilic risk factors raise the likelihood of PAD being more severe, justifying the need for larger longitudinal studies.

Are there predictors for the outcome of a PGE1 treatment in peripheral arterial disease with critical limb ischaemia?

VASA ◽  
2005 ◽  
Vol 34 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Heidrich ◽  
Schmidt ◽  
Fahrig
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Vascular Reconstruction ◽  
Clinical Analysis ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Prior Therapy ◽  
Predictors Of Response ◽  
Peripheral Arterial ◽  
Vascular Occlusions

Background: In a multivariate retrospective analysis was conducted to examine whether and to what extent PGE1 is therapeutically effective and whether there are predictors of response. Patients and methods: The examination included 767 patients (448 women, 319 men) of a mean age of 71.2 years and with peripheral arterial disease (PAD) having existed for 44.7 months on the average. They suffered from critical limb ischaemia (Fontaine’s stages III/IV) and showed average tcpO2 values at the instep of 2 mmHg (0 to 15) and average systolic malleolar artery pressures of 18 mmHg (0 to 35 mmHg). Between 1989 and 2001, the patients had received treatments in hospital with i.v. PGE1 doses (2 x 20 mug or 1 x 60 mug/day) for an average of 34.2 days (mean of responder- and non-responder group). Patients were called responders when pain had markedly decreased or disappeared, necroses had been reduced or healed completely, and vascular reconstruction, PTA or amputations were not necessary. Results: The clinical analysis showed 82.4% of the patients to be responders and 17.6% to be non-responders. It was demonstrated that the outcome of the therapy was not dependent on the supine or sitting tcpO2, the malleolar artery pressure, the patient’s age or sex, the duration of PAD, the number or kind of concomitant diseases, the patient’s general condition, the localization and number of vascular occlusions, the kind of prior therapy, or the number of previous amputations, although differences in some of the parameters, while clinically irrelevant, were found to be statistically significant. They are not predictors of the outcome of a PGE1 therapy. Conclusions: Even in extremely bad haemodynamic situations at the beginning of a therapy (malleolar artery pressures from 0 to 35 mmHg, tcpO2 0 to 15 mmHg, multilevel occlusive disease, multiple previous operations and concomitant diseases), PGE1 therapies of more than 20 days – on the average 35.6 days (mean of responder group) – duration allow clinically relevant positive results to be achieved.

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