The role of atherectomy in the treatment of lower extremity peripheral artery disease (original) (raw)
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Role of Atherectomy Devices in the Treatment of Lower Extremity Peripheral Arterial Disease
Atherosclerosis is a systemic disease affecting all major vascular beds. Risk factors for atherosclerosis, and therefore, for PAD, include active smoking, advance age, dyslipidemia, diabetes mellitus, and hypertension. Due to continuous increase in aging population and diabetes, incidence of peripheral arterial disease will continue to increase. While atherosclerotic coronary disease usually have focal lesions and can successfully be treated with balloon angioplasty or stent. Lower extremity peripheral arterial occlusive disease however, poses a unique challenge to traditional angioplasty-based endovascular therapies. The diffuse nature of lower extremity atherosclerotic disease, the presence of chronic total occlusions, poor distal runoff, and the presence of critical limb ischemia all have contributed to the disappointing results of balloon angioplasty for complex infrainguinal arterial disease. This results in development of a host of new technologies such drug eluting balloon and atherectomy in an attempt to improve the safety and effectiveness of percutaneous revascularization for lower extremity peripheral arterial occlusive disease. This review summarizes the available atherectomy devices their mechanism of action and literature supporting their use.
The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives
Vascular and Endovascular Review
An ageing population and the increasing prevalence of cardiovascular risk factors have aggravated the burden of peripheral artery disease (PAD). Despite advances in the pharmacological treatment of atherosclerosis, many patients with symptomatic PAD require invasive procedures to reduce the symptoms of claudication, salvage tissue and prevent amputation and subsequent disability in those with critical limb ischaemia. After significant advances in endovascular treatment over the past two decades, these techniques are widely accepted as first-choice treatment in the majority of patients with PAD. However, in patients with severely calcified lesions, standard endovascular treatment such as plain or drug-coated balloon (DCB) angioplasty may fail due to vessel recoil or severe dissection in the acute setting, and intimal hyperplasia in the long term. With the use of percutaneous plaque modification and debulking techniques based on atherectomy, such calcified lesions can be tackled more ...
Update on the Management of Peripheral Arterial Disease (PAD)
Med J Malaysia, 2011
There has been much progress made in the management of peripheral arterial disease (PAD) in the past two decades. Progress in the understanding of the endothelial-platelet interaction during health and disease state have resulted in better antiplatelet drugs that can prevent platelet aggregation, activation and thrombosis during angioplasty and stenting. Collaborative effort by different international societies has resulted in a consensus guideline that recommends the modality of intervention in certain disease states. Progress in perioperative care has reduced the morbidity and mortality associated with peripheral vascular reconstruction surgery. Nevertheless, the advances in percutaneous peripheral intervention (PPI) have made a paradigm shift in the current management of patients. The procedure is safe and effective and is emerging as the first choice revascularization procedure.
Contemporary management of peripheral arterial disease: III. Endovascular and surgical management
Cleveland Clinic Journal of Medicine, 2006
Traditional indications for invasive treatment in patients with peripheral arterial disease (PAD) have been salvage of a threatened limb or improvement of functional capacity in cases of disabling intermittent claudication, but advances in interventional therapy may be lowering the threshold for these therapies. Percutaneous transluminal angioplasty (PTA), with or without stent placement, is the most common endovascular intervention in patients with occlusive lower extremity PAD. In general, PTA is best suited to cases of short-segment stenosis or large-bore vessels, whereas surgery is best applied to multilevel occlusions involving smaller and more distant vessels. This article reviews endovascular therapy, catheter-based thrombolysis, and surgical revascularization procedures in patients with PAD, with special attention to recommendations from new American College of Cardiology/American Heart Association guidelines.
Seminars in interventional radiology, 2008
Atherectomy, the removal of plaque from diseased vessels, is theoretically appealing with respect to various procedures used for revascularization of lower extremity vessels. Instead of damaging the native vessel by pushing aside plaque with a balloon or stent, the plaque is removed. Many atherectomy devices have been designed in attempts to achieve this goal. The SilverHawk device is the latest percutaneous device employing this treatment strategy. We discuss patient selection, technical considerations, and strategies for both above and below the knee revascularization, as well as pitfalls in each location based on our experience with over 200 patients.
Endovascular Treatment of Peripheral Vascular Disease
Current Problems in Cardiology, 2009
Peripheral arterial disease (PAD) affects about 27 million people in North America and Europe, accounting for up to 413,000 hospitalizations per year with 88,000 hospitalizations involving the lower extremities and 28,000 involving embolectomy or thrombectomy of lower limb arteries. Many patients are asymptomatic and, among symptomatic patients, atypical symptoms are more common than classic claudication. Peripheral arterial disease also correlates strongly with risk of major cardiovascular events, and patients with PAD have a high prevalence of coexistent coronary and cerebrovascular disease. Because the prevalence of PAD increases progressively with age, PAD is a growing clinical problem due to the increasingly aged population in the United States and other developed countries. Until recently, vascular surgical procedures were the only alternative to medical therapy in such patients. Today, endovascular practice, percutaneous transluminal angioplasty with or without stenting, is used far more frequently for all types of lower extremity occlusive lesions, reflecting the continuing advances in imaging techniques, angioplasty equipment, and endovascular expertise. The role of endovascular intervention in the treatment of limb-threatening ischemia is also expanding, and its promise of limb salvage and symptom relief with reduced morbidity and mortality makes percutaneous transluminal angioplasty/stenting an attractive alternative to sur-
Transactions of The ... Meeting of The American Surgical Association, 2008
Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease are typified with diminished patency. A novel alternative to standard angioplasty and stent is the excision of the obstructing arterial plaque using a minimally invasive technique, the Silverhawk Atherectomy device. Methods: A prospective database was maintained of SilverHawk procedures from 2004 to 2007. A total of 579 lesions were treated in 275 patients (claudication 101 patients (36.7%) and critical limb ischemia (CLI) in 174 patients (63.3%). Noninvasive laboratory evaluation was performed at 1, 3, and 6 months, and yearly. Stand-alone atherectomy was attempted, and adjunct therapy was used for residual stenosis. Results: Mean age was 70.0 years (range, 37-102) (62.5% male, 46.2% smokers, 67.6% diabetes mellitus). Lesion characteristics were 199 superficial femoral arteries, 110 popliteal, 218 tibials, and 52 multilevel. Thirty-day perioperative mortality was 1.8%. Mean follow-up was 12.5 months (range, 0.5-48.2). 18-month primary and secondary patency for all lesions was 52.7% Ϯ 2.8 and 75.0% Ϯ 2.4 (P Ͻ 0.0001). Eighteen-month primary and secondary patency for claudicants was 58.0% Ϯ 4.3 and 82.5% Ϯ 3.5 (P Ͻ 0.0001) and for CLI was 49.4% Ϯ 3.7 and 69.9% Ϯ 3.2 (P Ͻ 0.0001), respectively. The reintervention rate was 25.3% in claudicants and 30.1% for CLI. Limb salvage was 100% in claudicants and overall limb salvage was 92.4% per patient at 18 months and only 4.4% required bypass. Conclusion: This is the largest reported series with the longest follow-up showing the SilverHawk device as an effective endovascular therapy for patients with claudication and CLI with a low mortality, low complications rate, low amputation rate, and rare need for conversion to surgical bypass. The majority of reintervention was performed with endovascular techniques.
Vasa
Summary: With an increasing global burden of patients with chronic peripheral artery disease (PAD) the safe and effective provision of lower limb revascularisation is a growing medical need. Endovascular procedures for the treatment of PAD have become a crucial cornerstone of modern vascular medicine, and the first line revascularisation approach if technically feasible and taking patient choice into consideration. With the increasing age of patients with PAD and the increasing number of comorbidities open vascular surgery is also often not feasible. We outline a framework of key messages, endorsed by the board of the European Society of Vascular Medicine for pre-, peri- and post procedural management of patients requiring endovascular arterial procedures of the lower limbs. These key messages emphasize the important and increasing role of interventional vascular physicians.