Below knee bare nitinol stent placement in high-risk patients with critical limb ischemia is still durable after 24 months of follow-up

Donas, Konstantinos P.; Torsello, Giovanni; Schwindt, Arne; Schönefeld, Eva; Boldt, Olga; Pitoulias, Georgios A.

doi:10.1016/j.jvs.2010.02.281

Cited by 45 publications

(22 citation statements)

References 14 publications

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“…Bare nitinol self-expanding stents are currently used to treat suboptimal angioplasty results in infrapopliteal disease. A nonrandomized retrospective study of 53 patients with CLI and infrapopliteal disease (Rutherford ‡4) undergoing infrapopliteal stent placement with self-expanding nitinol stents for suboptimal angioplasty reported a high technical success (98%) and primary patency rate of 75.5% with a freedom from amputation rate of 88.7% at 2 years [50]. This study supports the feasibility and efficacy of infrapopliteal stenting, specifically in the CLI patient population.…”

Section: Covered Stentssupporting

confidence: 59%

Endovascular therapy for critical limb ischemia

Domínguez

Bahadorani

Reeves

et al. 2015

Expert Review of Cardiovascular Therapy

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Critical limb ischemia (CLI) represents an advanced disease state of peripheral arterial disease. It manifests as lower extremity ischemic rest pain or ischemic skin lesions leading to ulceration or gangrene. Patients with CLI often have multiple medical comorbidities and a 1-year mortality rate of 25% and a 1-year amputation rate of 25%. Historically, bypass surgery with autogenous veins for flow restoration has been the first-line therapy for CLI. However, advances in endovascular techniques and device technology have changed the treatment paradigm. Catheter-based technologies are rapidly evolving at a rate that is outpacing large-scale studies evaluating relevant clinical outcomes. Patients with CLI require a multidisciplinary management approach centered on aggressive medical therapies, wound care and prompt revascularization, with an emphasis on limb salvage. This review summarizes the contemporary endovascular therapies including balloon angioplasty, atherectomy and bare-metal stenting. In addition, we review emerging technologies, such as drug-eluting stents, drug-coated balloons and chronic total occlusion recanalization devices.

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Section: Covered Stentssupporting

confidence: 59%

Endovascular therapy for critical limb ischemia

Domínguez

Bahadorani

Reeves

et al. 2015

Expert Review of Cardiovascular Therapy

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“…Although the difference was not significant, the rate was higher in the bypass group. Pomposelli, et al 5) reported that the limb salvage rate at 5 years after bypass was 78%, and those reported by Shah, et al 6) and Higashi 7) were 94%, whereas Iida, et al 8) reported that the rate at 3 years after endovascular treatment was 80%, Donas, et al 9) reported it to be 88.7% after 2 years, and Ferraresi, et al 10) reported it to be 93% after 3 years.…”

Section: Discussionmentioning

confidence: 93%

Bypass vs. Endovascular Therapy of Infrapopliteal Lesions for Critical Limb Ischemia

Hara

Tabuchi

Yunoki

et al. 2014

Annals of Vascular Diseases

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IntroductionWe have increasingly encountered patients with arteriosclerosis obliterans-associated critical limb ischemia in association with increases in diabetic patients and those with subsequent dialysis. The first-line treatment of critical limb ischemia is endovascular treatment or bypass. The TASC II 1) indicates one of these depending on the location and range of lesions. Objective: This study was conducted to determine whether to perform endovascular intervention or bypass surgery as a treatment option for critical limb ischemia (CLI) with lesions in the popliteal artery or below. Subjects and Methods: A total of 150 patients (164 limbs) with CLI underwent endovascular intervention or bypass surgery for lesions in the popliteal artery or below at our department between May 1995 and June 2011. Therapeutic outcomes were examined by surgical technique. An indication for endovascular intervention was established with the combination of (1) poor general condition, and (2) a stenotic or occlusive lesion ≤5 cm. Results: The bypass group (group B) comprised 119 patients (99 males, 20 females) with 131 affected limbs at 46 to 89 years of age (mean: 70 years). The endovascular intervention group (group E) comprised 31 patients (25 males, 6 females) with 33 affected limbs at 47 to 89 years of age (mean: 72 years). There was no significant difference in patient demography between the two groups. Regarding preoperative complications, hypertension was observed in 54% and 61% of the subjects in groups B and E, respectively, diabetes in 36% and 55%, renal dysfunction in 29% and 58%, ischemic heart disease in 27% and 32%, and cerebrovascular disorder in 18% and 23%; renal dysfunction accounted for a significantly higher percentage in group E. As for early postoperative complications, subjects in group B experienced wound infections (6 patients), hemorrhage (2), thrombosis (2), pneumonia (1), and another complication (1), and those in group E experienced wound infections (1) and another complication (1). The hospital mortality rate was 0.8% (1 patient) for group B and 0% for group E. The 3-year cumulative primary patency rate was 72% for group B and 54% for group E; the rate was significantly higher for group B. The 3-year secondary patency rate was 82% for group B and 60% for group E. The 3-year limb salvage rate was 86% for group B and 82% for group E; there was no significant difference between the two groups. The 5-year survival rate was 57% for group B and 42% for group E; the survival rate was significantly lower for group E. Conclusion: For the study population of CLI patients with lesions in the popliteal artery or below, the patency rate was higher for the bypass group than for the endovascular intervention group, whereas there was no difference in the limb salvage rate. Based on the findings in prognosis for survival, the indication for endovascular intervention at our department is believed to be appropriate. (*English translation of Jpn J Vasc Surg 2013; 22: 715-718) Bypass vs. Endovascular Therapy of Infr...

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“…14 The durability of suboptimal infragenicular PTA through stent placement has been reviewed in recent studies. 4,15 In this case, we decided to use a balloon-expandable stent, aiming to its more precise deployment. 16 In the infragenicular region, to avoid restenoses, we considered use of double antiplatelet therapy with clopidogrel and aspirin during the first 4 weeks to be convenient 4 ; some authors go even further and use cilostazol or even anticoagulation if an infrapopliteal stent has been placed.…”

Section: Discussionmentioning

confidence: 99%