One-Year Outcomes of Heparin-Bonded Stent-Graft Therapy for Real-World Femoropopliteal Lesions and the Association of Patency With the Prothrombotic State Based on the Prospective, Observational, Multicenter Viabahn Stent-Graft Placement for Femoropopliteal Diseases Requiring Endovascular Therapy (VANQUISH) Study

Purpose: To evaluate the real-world primary patency of heparin-bonded stent-graft therapy for femoropopliteal (FP) occlusive disease and identify any clinical factors, including the prothrombotic state, associated with the loss of patency. Materials and Methods: This multicenter study prospectively enrolled 424 limbs of 371 patients (mean age 75±8 years; 247 men) scheduled for Viabahn stent-graft placement in the FP segment. A full-coverage strategy using only a Viabahn stent-graft was preferred, but “spot stenting” with the Viabahn was also allowed. The prothrombotic state was assessed by measuring platelet reactivity. Vascular morphology was evaluated using intravascular ultrasound (IVUS). Primary patency was estimated using the Kaplan-Meier method in the subgroup of patients having full lesion stent-graft coverage (n=343 limbs, 81.1%). The secondary outcomes were major amputation, surgical reconstruction, target lesion revascularization (TLR), and thrombotic occlusion. Regression analyses were used to explore associations of baseline and clinical variables with loss of patency; the results are given as the odds ratio (OR) and 95% confidence interval (CI). Results: The 1-year primary patency estimate was 80.3% (95% CI 75.5% to 85.1%) in the full-coverage group. There were 7 surgical reconstructions, 46 TLRs, 21 acute thrombotic occlusions, and 1 major amputation during the 1-year follow-up in the full-coverage group. Only angiography- and IVUS-determined vessel diameters were significantly associated with loss of patency, with crude ORs of 0.64 (95% CI 0.45 to 0.89, p=0.009) and 0.67 (95% CI 0.51 to 0.90, p=0.009), respectively, per 1-mm increase, whereas other variables, including the prothrombotic state (p=0.74), were not. Multivariable analysis demonstrated that only IVUS-determined vessel diameter was independently associated with loss of patency (adjusted OR per 1-mm increase 0.72, 95% CI 0.52 to 1.00, p=0.049). Conclusion: FP stent-graft placement achieved acceptable patency at 1 year in a real-world setting. A smaller vessel size was significantly associated with loss of patency, whereas the prothrombotic state was not.

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Trends in Utilization and Outcomes of Orbital, Laser, and Excisional Atherectomy for Lower Extremity Revascularization

Journal of Endovascular Therapy ◽

10.1177/15266028211050329 ◽

2021 ◽

pp. 152660282110503

Author(s):

Halbert Bai ◽

Arash Fereydooni ◽

Yawei Zhang ◽

Britt H. Tonnessen ◽

Raul J. Guzman ◽

...

Keyword(s):

Multivariable Analysis ◽

Major Amputation ◽

Primary Patency ◽

Perioperative Outcomes ◽

Technical Success ◽

Disease Treatment ◽

Orbital Atherectomy ◽

Vascular Beds ◽

Lower Extremity Revascularization ◽

Laser Atherectomy

Purpose: The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes. Materials and Methods: All patients undergoing atherectomy in the 2010–2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared. Results: Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18–5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09–0.95]). Conclusion: Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds.

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Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

Vascular Medicine ◽

10.1177/1358863x16676901 ◽

2016 ◽

Vol 22 (1) ◽

pp. 28-34 ◽

Cited By ~ 10

Author(s):

Caitlin W Hicks ◽

Alireza Najafian ◽

Alik Farber ◽

Matthew T Menard ◽

Mahmoud B Malas ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Multivariable Analysis ◽

Limb Ischemia ◽

Major Amputation ◽

Primary Patency ◽

Tissue Loss ◽

Vascular Intervention ◽

Below The Knee ◽

Endovascular Interventions ◽

One Year

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

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Promising results of stent graft placement for cephalic arch stenosis after repeated failure of angioplasty in patients on hemodialysis

Journal of International Medical Research ◽

10.1177/0300060520920419 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092041

Author(s):

Pin-Chao Feng ◽

Chun-Hui Lee ◽

Hung-Chang Hsieh ◽

Po-Jen Ko ◽

Sheng-Yueh Yu ◽

...

Keyword(s):

Stent Graft ◽

Clinical Success ◽

Medical Center ◽

Retrospective Chart Review ◽

Target Lesion ◽

Primary Patency ◽

Secondary Patency ◽

Success Rates ◽

Graft Placement ◽

Significant Difference

Objective Cephalic arch stenosis (CAS) causes repeated dysfunction and failure of arteriovenous access. Percutaneous transluminal angioplasty is the standard initial treatment for CAS, but its outcome is unsatisfactory. This study aimed to evaluate the outcome of stent graft placement for CAS in patients on hemodialysis. Methods A retrospective chart review from a tertiary medical center was performed in patients receiving stent graft placement for CAS between January 2012 and 2016. Patency was analyzed using the Kaplan–Meier method. Results Twenty-one patients received stent graft placement for CAS. Technical and clinical success rates were 100%. Primary target lesion patency was 95% (95% confidence interval [CI], 86%–100%), 76% (95% CI, 58%–94%), and 43% (95% CI, 22%–64%) at 3, 6, and 12 months, respectively. No significant difference in patency was observed between the arteriovenous fistula and arteriovenous graft groups. Assisted primary patency was 95% (95% CI, 86%–100%), 71% (95% CI, 52%–91%), and 57% (95% CI, 36%–78%) at 3, 6, and 12 months, respectively. Secondary patency was 100% at 3, 6, and 12 months. Conclusions After repeated failed angioplasty for cephalic arch stenosis, patients on hemodialysis who receive stent graft placement have effective and durable outcomes.

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Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts

VASA ◽

10.1024/0301-1526/a000470 ◽

2015 ◽

Vol 44 (6) ◽

pp. 466-472 ◽

Cited By ~ 1

Author(s):

Chia-Hsun Lin ◽

Yen-Yang Chen ◽

Chai-Hock Chua ◽

Ming-Jen Lu

Keyword(s):

Risk Factors ◽

Stent Graft ◽

Target Lesion ◽

Primary Patency ◽

Anastomotic Stenosis ◽

Secondary Patency ◽

Endovascular Stent ◽

Stent Grafts ◽

Venous Anastomosis ◽

Arteriovenous Grafts

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

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Partial Blockage of the Renal Artery Ostium After Stent-Graft Placement: Detection and Treatment

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2003)010<0684:pbotra>2.0.co;2 ◽

2003 ◽

Vol 10 (3) ◽

pp. 684-684 ◽

Cited By ~ 3

Author(s):

Lukas C. van Dijk ◽

Marc R. H. M. van Sambeek ◽

Filippo Cademartiri ◽

Peter M. T. Pattynama

Keyword(s):

Renal Artery ◽

Stent Graft ◽

Graft Placement

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DISSECT-N is an Observational Registry to Assess Real-world Safety and Effectiveness of the Valiant Navion Thoracic Stent Graft in Routine Clinical Practice in Subjects Diagnosed With a Dissection of the Thoracic Aorta.

Case Medical Research ◽

10.31525/ct1-nct04267055 ◽

2020 ◽

Author(s):

Keyword(s):

Clinical Practice ◽

Thoracic Aorta ◽

Stent Graft ◽

Real World ◽

Routine Clinical Practice ◽

Thoracic Stent Graft

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Faculty Opinions recommendation of Total arch repair for acute type A aortic dissection with 2 modified techniques: open single-branched stent graft placement and reinforcement of the dissected arch vessel stump with stent graft.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.12215956.13383054 ◽

2011 ◽

Author(s):

John Augoustides ◽

Michael Andritsos

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Graft Placement

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One-year outcomes of drug-coated balloon treatment for long femoropopliteal lesions: a multicentre cohort and real-world study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02127-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoxi Yu ◽

Xin Zhang ◽

Zhichao Lai ◽

Jiang Shao ◽

Rong Zeng ◽

...

Keyword(s):

Real World ◽

Cox Regression ◽

Ankle Brachial Index ◽

Primary Patency ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Cox Regression Analysis ◽

Femoropopliteal Artery ◽

Kaplan Meier ◽

Multicentre Cohort

Abstract Background Drug-coated balloons (DCBs) have shown superiority in the endovascular treatment of short femoropopliteal artery disease. Few studies have focused on outcomes in long lesions. This study aimed to evaluate the safety and effectiveness of Orchid® DCBs in long lesions over 1 year of follow-up. Methods This study is a multicentre cohort and real-world study. The patients had lesions longer than or equal to 150 mm of the femoropopliteal artery and were revascularized with DCBs. The primary endpoints were primary patency, freedom from clinically driven target lesion revascularization (TLR) at 12 months and major adverse events (all-cause death and major target limb amputation). The secondary endpoints were the changes in Rutherford classification and the ankle brachial index (ABI). Results One hundred fifteen lesions in 109 patients (mean age 67 ± 11 years, male proportion 71.6%) were included in this study. The mean lesion length was 252.3 ± 55.4 mm, and 78.3% of the lesions were chronic total occlusion (CTO). Primary patency by Kaplan–Meier estimation was 98.1% at 6 months and 82.1% at 12 months. The rate of freedom from TLR by Kaplan–Meier estimation was 88.4% through 12 months. There were no procedure- or device-related deaths through 12 months. The rate of all-cause death was 2.8%. Cox regression analysis suggested that renal failure and critical limb ischaemia (CLI) were statistically significant predictors of the primary patency endpoint. Conclusion In our real-world study, DCBs were safe and effective when used in long femoropopliteal lesions, and the primary patency rate at 12 months by Kaplan–Meier estimation was 82.1%.

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