The Role of Drug-coated Balloons in Infrapopliteal Intervention

2012 ◽  
Vol 7 (1) ◽  
pp. 63 ◽  
Author(s):  
Gary M Ansel ◽  
Peter A Schneider ◽  
◽  
Keyword(s):  
Endovascular Therapy ◽  
Metal Stents ◽  
Below The Knee ◽  
Straight Line ◽  
Improved Outcomes ◽  
Line Flow ◽  
Drug Eluting ◽  
One Year

The goal of infrapopliteal endovascular therapy is the re-establishment of straight-line flow to the foot with adequate perfusion of tissue. This treatment should be the first method in properly selected patients to relieve ischaemic rest pain, heal ulcers and prevent limb loss, improving quality of life. Percutaneous angioplasty (PTA) continues to be the cornerstone of infrapopliteal therapy. Metal stents are reserved for suboptimal PTA. Although data are accumulating that may eventually guide the use of alternative devices such as lasers, excisional and rotational atherectomy, drug-eluting stents or drug-coated balloons, we currently lack adequate evidence demonstrating improved outcomes. Endovascular therapy has expanded to include patients with severe co-morbidities such as renal failure and complex occlusive disease. Despite advances in below-the-knee (BTK) angioplasty balloons and a focus on angioplasty technique, current PTA results demonstrate one-year restenosis rates up to 80 %, depending on lesion complexity. Drug-coated balloons have demonstrated superior patency in the superficial femoral artery and it is yet to be determined if this technology can achieve improved patency and the clinical outcomes in the infrapopliteal region.

The Role of Drug-coated Balloons in Infrapopliteal Intervention

2012 ◽  
Vol 9 (2) ◽  
pp. 112-114
Author(s):  
Gary M Ansel ◽  
Peter A Schneider
Keyword(s):  
Endovascular Therapy ◽  
Metal Stents ◽  
Below The Knee ◽  
Straight Line ◽  
Improved Outcomes ◽  
Line Flow ◽  
Drug Eluting ◽  
One Year

The goal of infrapopliteal endovascular therapy is the re-establishment of straight-line flow to the foot with adequate perfusion of tissue. This treatment should be the first method in properly selected patients to relieve ischemic rest pain, heal ulcers and prevent limb loss, improving quality of life. Percutaneous angioplasty (PTA) continues to be the cornerstone of infrapopliteal therapy. Metal stents are reserved for suboptimal PTA. Although data are accumulating that may eventually guide the use of alternative devices such as lasers, excisional, and rotational atherectomy, drug-eluting stents or drug-coated balloons, we currently lack adequate evidence demonstrating improved outcomes. Endovascular therapy has expanded to include patients with severe co-morbidities such as renal failure and complex occlusive disease. Despite advances in below-the-knee (BTK) angioplasty balloons and a focus on angioplasty technique, current PTA results demonstrate one-year restenosis rates up to 80 %, depending on lesion complexity. Drug-coated balloons have demonstrated superior patency in the superficial femoral artery and it is yet to be determined if this technology can achieve improved patency and the clinical outcomes in the infrapopliteal region.

scholarly journals Hope, Hype, Hurdles & Future Perspective for PRP, PRP versus Hyaluronic Acid Injection in Osteoarthritis of Knee: A Review Article.

2020 ◽  
Vol 2 (1) ◽  
pp. e1-e12
Author(s):  
Ashok Kumar ◽  
Anikait Ghosh Kadamb ◽  
Krish Ghosh Kadamb
Keyword(s):  
Hyaluronic Acid ◽  
Knee Joint ◽  
Platelet Rich Plasma ◽  
Future Perspective ◽  
Osteoarthritis Of The Knee ◽  
Stiff Knee ◽  
Injection Interval ◽  
One Year

BackgroundComparative studies of platelet-rich plasma (PRP) and hyaluronic acid show variable results. PurposeA review was conducted to understand the current role of PRP and its efficacy versus hyaluronic acid in osteoarthritis (OA) of the knee joint. MethodsOut of 170 identified studies, 14 studies involving 1575 patients with 637 males and 938 females were selected based on PRISMA flow chart guidelines and were analyzed for the study. ResultsA standard PRP regimen consisting of 2–3 intra-articular injections (IA) of 4–6 mL of leucocyte poor PRP at 1–2 weekly intervals provides a better result than HA during the first 3–6 months, and which may continue up to one year. PRP and HA may have synergistic effect; pain and swelling are the two most com-mon complications with PRP, the incidence is more with leucocyte rich PRP (LP-PRP) and intra-osseous PRP treatment.ConclusionPRP provides hope and is more effective than hyaluronic acid in pain relief and improving the quality of life in mild to moderate osteoarthritis of the knee joint. However, hype, that is effective in all, irrespective of grades of OA, mal-aligned or stiff knee, ligamentous laxity, and can avoid joint replacement is a big hindrance in establishing it as a preferred treatment in OA knee. The author follows the above-mentioned PRP regimen; and recommends to combine leucocyte poor PRP with HA for IA injections & with LP-PRP injections along with the two most common painful points (medial collateral ligament, pesanisernius) in a highly painful OA knee. PRP may not address extra-articular causes of knee pain (mal-alignment, muscle wasting, tendinosis), should be corrected for optimum outcome. Contact sports, running, exercises putting pressure on knee and NSAID should be avoided during PRP treatment. Also, more randomized controlled trials are required to further standardize the PRP preparation, administration, injection interval & proper documentation of efficacy and complications in the regenerative registry.

scholarly journals 10-Year Paclitaxel Dose-Related Outcomes of Drug-Eluting Stents Treated Below the Knee in Patients with Chronic Limb-Threatening Ischemia (The PADI Trial)

2020 ◽  
Vol 43 (12) ◽  
pp. 1881-1888 ◽  
Author(s):  
Louise C. D. Konijn ◽  
Thijs Wakkie ◽  
Marlon I. Spreen ◽  
Pim A. de Jong ◽  
Lukas C. van Dijk ◽  
...  
Keyword(s):  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Survival Analyses ◽  
Below The Knee ◽  
Increased Risk ◽  
Significant Difference ◽  
Drug Eluting ◽  
Related Mortality

Abstract Purpose Recently, two meta-analyses concluded that there appears to be an increased risk of long-term mortality of paclitaxel-coated balloons and stents in the superficial femoral and popliteal artery, and paclitaxel-coated balloons below the knee. In this post hoc study of the PADI Trial, we investigated the long-term safety of first-generation paclitaxel-coated drug-eluting stents (DES) below the knee and the dose–mortality relationships of paclitaxel in patients with chronic limb-threatening ischemia (CLI). Materials and Methods The PADI Trial compared paclitaxel-coated DES with percutaneous transluminal angioplasty with bail-out bare-metal stents (PTA ± BMS) in patients with CLI treated below the knee. Follow-up was extended to 10 years after the first inclusion, and survival analyses were performed. In addition, dose-related mortality and dose per patient weight-related mortality relations were examined. Results A total of 140 limbs in 137 patients were included in the PADI Trial. Ten years after the first inclusion, 109/137 (79.6%) patients had died. There was no significant difference between mortality in the DES group compared with the PTA ± BMS group (Log-rank p value = 0.12). No specific dose-related mortality (HR 1.00, 95% CI 0.99–1.00, p = 0.99) or dose per weight mortality (HR 1.05, 95% CI 0.93–1.18, p = 0.46) relationships were identified in the Cox-proportional Hazard models or by Kaplan–Meier survival analyses. Conclusions There is a poor 10-year survival in both paclitaxel-coated DES and PTA ± BMS in patients with CLI treated below the knee. No dose-related adverse effects of paclitaxel-coated DES were observed in our study of patients with CLI treated below the knee. Level of Evidence The PADI Trial: level 1, randomized clinical trial

scholarly journals A viewpoint on material and design considerations for oesophageal stents with extended lifetime

2022 ◽  
Author(s):  
Caitlin E. Jackson ◽  
Liam S. J. Johnson ◽  
Dominic A. Williams ◽  
Hans-Ulrich Laasch ◽  
Derek W. Edwards ◽  
...  
Keyword(s):  
Patient Survival ◽  
Drug Eluting Stent ◽  
Material Surface ◽  
Device Performance ◽  
Stent Design ◽  
Novel Treatments ◽  
Construction Methods ◽  
Drug Eluting

AbstractOesophageal stents are meshed tubular implants designed to maintain patency of the oesophageal lumen and attenuate the symptoms of oesophageal cancer. Oesophageal cancers account for one in twenty cancer diagnoses and can lead to dysphasia, malnutrition and the diminishment of patient quality of life (QOL). Self-expanding oesophageal stents are the most common approach to attenuate these symptoms. Recent advances in oncological therapy have enabled patient survival beyond the lifetime of current devices. This introduces new complications for palliation, driving the need for innovation in stent design. This review identifies the factors responsible for stent failure. It explores the challenges of enhancing the longevity of stent therapies and outlines solutions to improving clinical outcomes. Discussions focus on the role of stent materials, construction methods, and coatings upon device performance. We found three key stent enhancement strategies currently used; material surface treatments, anti-migratory modifications, and biodegradable skeletons. Furthermore, radioactive and drug eluting stent designs were identified as emerging novel treatments. In conclusion, the review offers an overview of remaining key challenges in oesophageal stent design and potential solutions. It is clear that further research is needed to improve the clinical outcome of stents and patient QOL.

The role of the practice nurse in cancer care reviews

2021 ◽  
Vol 32 (6) ◽  
pp. 238-240
Author(s):  
Sandra Dyer
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Models Of Care ◽  
Practice Nurses ◽  
Improved Outcomes ◽  
Quality And Outcomes ◽  
Quality And Outcomes Framework

Recent changes to the Quality and Outcomes Framework provide an ideal opportunity to improve the quality of cancer care reviews and cancer patients' experiences. Sandra Dyer explains the important role practice nurses can play in improving care Improved outcomes for people diagnosed with cancer have led to increasing numbers of people living with and beyond the disease, and for many, cancer has transitioned to a long-term condition. There is a greater need for models of care that best meet these patients' needs, with the role of primary care becoming increasingly important. Recent changes to the Quality and Outcomes Framework (QOF) provide an ideal opportunity to improve the quality of cancer care reviews and improve cancer patients' experiences. More education and training for general practice nurses on cancer is urgently required to allow them to lead on quality improvement in this important area of care.

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