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 P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
MI Qureshi ◽  
HL Li ◽  
GK Ambler ◽  
KHF Wong ◽  
S Dawson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Intervention ◽  
Arterial Disease ◽  
Endovascular Intervention ◽  
Randomised Trials ◽  
Peripheral Arterial ◽  
High Level

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

scholarly journals Extended Duration Dual Antiplatelet Therapy After Coronary Stenting Among Patients With Peripheral Arterial Disease

2017 ◽  
Vol 10 (9) ◽  
pp. 942-954 ◽  
Author(s):  
Eric A. Secemsky ◽  
Robert W. Yeh ◽  
Dean J. Kereiakes ◽  
Donald E. Cutlip ◽  
P. Gabriel Steg ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Disease ◽  
Coronary Stenting ◽  
Extended Duration ◽  
Peripheral Arterial

scholarly journals Características Clínicas E Imagenológicas De Los Pacientes Con Úlcera Por Pie Diabético Con Tratamiento Endovascular De La Enfermedad Periférica Arterial. Marzo 2015 a Junio 2017.

2019 ◽  
Vol 38 (3) ◽  
Author(s):  
Jossuett Barrios ◽  
Bernardino Denis ◽  
Gilberto Chanis
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Foot Ulcer ◽  
Arterial Disease ◽  
Primary Patency ◽  
Diabetic Patients ◽  
Anterior Tibial Artery ◽  
Below The Knee ◽  
Imaging Characteristics ◽  
Peripheral Arterial

<p>[Clinical and radiological Characteristics of patients with diabetic foot ulcer with endovascular treatment of peripheral arterial disease. March 2015 to June 2017.]</p><p><br /><strong>Resumen</strong><br />Introducción: La Diabetes mellitus es un problema global, y junto a sus complicaciones representa la causa líder de muerte por enfermedades no transmisibles. El 50% de los pacientes con Diabetes presentan signos de compromiso vascular que al complicarse ameritan tratamiento con bypass quirúrgico que es el método convencional, pero se ha visto que la técnica endovascular ha ayudado a disminuir la morbilidad y la mortalidad de estos pacientes, reduciendo además, el número de amputaciones mayores en los pacientes con pie diabético y enfermedad arterial periférica Objetivo: Describir características clínicas e imagenológicas de pacientes diabéticos con tratamiento endovascular de la enfermedad periférica arterial. Metodología: Estudio descriptivo retrospectivo mediante revisión de expedientes clínicos y radiológicos. Utilizando un formulario para la recolección de datos y EpiInfo v7.2 para la creación y análisis la base de datos. Resultados: Participaron 50 pacientes, el 52% pertenecían al sexo femenino, la mayoría de los pacientes pertenecían al grupo de los 61-70 años. La hipertensión arterial fue la comorbilidad más frecuente (78%). La enfermedad arterial por debajo de la rodilla fue la más observada, con afectación de la arteria tibial anterior principalmente (84%). La angioplastia con balón se realizó en el 100% de los casos, con falló en el 8% de los casos. Conclusión: La enfermedad arterial periférica afecta en mayor medida a los vasos de la pierna por debajo de la rodilla. El tratamiento endovascular de las lesiones arteriales periféricas constituye un método con una gran tasa de éxito en el procedimiento inicial.<br /><br /><strong>Abstract</strong><br />Objective: Describe the clinical and imaging characteristics of diabetic patients who underwent endovascular treatment for peripheral arterial disease. Method: A retrospective descriptive study was carried out. We reviewed the data in the clinical and radiological file of the patients included in the study; they were collected in a survey sheet previously authorized by the Bioethics Committee of the Institution. The data obtained were tabulated in the EpiInfo v7.2 program and graphed using the Office Excel 2016 program. Results: Fifty patients who met the inclusion criteria were included in the study, 52% of them were women, mainly in the age group between 61-70 years. Arterial hypertension was the most frequent comorbidity in the study population with 78% of the total patients. Arterial disease below the knee was more frequent, with involvement of the anterior tibial artery in 84% of the patients evaluated. Balloon angioplasty was performed in 100% of the cases, while stent placement was necessary in 10% of the procedures performed. The result of the procedure was not successful only in 4/50 patients performed. 84% of the patients presented primary patency at 6 months of evaluation. Conclusion: Peripheral arterial disease mainly the vessels of the leg below the knee. Endovascular treatment of peripheral arterial injuries is a safe method with a high success rate in the initial procedure, as well as a low recurrence of intervention at least 6 months after the procedure.<br /><br /></p>

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.

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