Cost-Effectiveness of Drug-Eluting Stents for Infrapopliteal Lesions in Patients with Critical Limb Ischemia: The PADI Trial

Wakkie, Thijs; Konijn, Louise C.D.; Herpen, Nils P C van; Maessen, Martijn F.H.; Spreen, Marlon I.; Wever, Jan J.; Eps, Randolph G. Statius van; Veger, Hugo T.C.; Dijk, Lukas C. van; Mali, Willem P.Th.M.; Overhagen, Hans van

doi:10.1007/s00270-019-02385-5

Cited by 11 publications

(4 citation statements)

References 27 publications

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“…Data from the PADI trial which included patients with CLI, were used. Detailed study design and results of this study have been published elsewhere [32][33][34][35]. In short, the PADI trial is a randomized controlled trial to investigate drug eluting stents (DES) for the treatment of infrapopliteal lesions in patients with CLI in comparison with the current reference treatment.…”

Section: Patientsmentioning

confidence: 99%

Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients

Konijn

Takx

Jong

et al. 2020

European Journal of Radiology

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Within five years after presentation 50-60% of patients with chronic limb-threatening ischemia (CLI) have died or had an amputation. We assessed the predictive value of lower extremity arterial calcification on computed tomography (CT) characteristics on both 7-years amputation-free survival and 10-years all-cause mortality in patients with CLI. Method: Included were 89 CLI patients (mean age 73.1 ± 11.6 years) who underwent a CT angiography of the lower extremities. In the femoropopliteal and crural arteries based on a CT score the following calcification characteristics were assessed: severity, annularity, thickness and continuity. The predictive value of different arterial calcification characteristics was analysed by age-and sex-adjusted multivariate Cox regression analysis. Results: Complete annular calcifications were common (femoropopliteal 43.7%, n = 38; crural, 63.2%, n = 55). Mean survival was 278.4 weeks (95% CI 238.77-318.0 weeks). Patients with complete annular calcifications had a higher all-cause 10-year mortality (femoropopliteal unadjusted HR 1.64, p = 0.04 and adjusted for age and sex HR 1.68, p = 0.04; crural unadjusted HR 1.92, p = 0.02, adjusted for age and sex HR 2.29, p = 0.006) than patients with other calcification characteristics. Conclusions: Annularity of calcification of both femoropopliteal and crural arteries is a predictor for 10-year allcause survival, its hazard being even higher than the traditional prognostic risk factors for CLI and therefore could be involved in the poor survival of these patients.

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Section: Patientsmentioning

confidence: 99%

Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients

Konijn

Takx

Jong

et al. 2020

European Journal of Radiology

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“…22 Despite the poor long-term survival of this very high-risk cohort of patients, regardless of treatment option for critical limb ischaemia, treatment with PES is theorised to offer additional economic benefits, at least through 5 years, due to the increased incidence-and event-free survival associated with the PES. 23 The SAVAL trial is a recently completed multicentre trial studying a DES designed specifically for use in infrapopliteal critical limb ischaemia (NCT03551496). The SAVAL DES (Boston Scientific, Boston, MA, US) is a paclitaxel-coated self-expanding stent measuring 3.5 mm x 80 mm, longer than coronary artery stents, specifically engineered to be durable in infrapopliteal arteries.…”

Section: Drug-eluting Stentsmentioning

confidence: 99%

Novel Scaffolds for the Treatment of Below-the-Knee Peripheral Arterial Disease With Chronic Limb Threatening Ischemia: A Review

Zilinyi

Alsaloum

Raja

et al. 2023

VER

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Below-the-knee (BTK) peripheral arterial disease (PAD) is a significant source of cardiovascular morbidity and mortality. Patients with chronic limb-threatening ischaemia in BTK PAD represent one of the highest-risk cohorts of PAD patients, with little progress having been made regarding long-term patency and mortality over the past four decades. Although conventional balloon angioplasty has long been the standard of care, several novel scaffolds have been introduced over the past decade with promising 1-year patency rates and freedom from clinically driven target limb revascularisation, which may herald a new age of endovascular intervention for BTK PAD. In this review, we present a critical appraisal of the literature surrounding novel scaffolds and drug-eluting technology in the treatment of BTK PAD.

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“…elsewhere [14][15][16][17]. Briefly, the PADI Trial was an investigator-initiated prospective, multicenter RCT in CLI patients due to infrapopliteal pathology to assess the value of drug eluting stents (DES) compared to the current reference treatment with bare-metal stents (BMS).…”

Section: Patientsmentioning

confidence: 99%

Different Lower Extremity Arterial Calcification Patterns in Patients with Chronic Limb-Threatening Ischemia Compared with Asymptomatic Controls

Konijn

Takx

Mali

et al. 2021

Preprint

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Objectives The most severe type of peripheral arterial disease (PAD) is critical limb ischaemia (CLI). In CLI, calcification of the vessel wall plays an important role in symptoms, amputation rate and mortality. However, calcified arteries are also found in asymptomatic persons (non-PAD patients). We investigated whether the calcification pattern in CLI patients and non- PAD patients are different and could possibly explain the symptoms in CLI patients. Materials and Methods 130 CLI and 204 non-PAD patients underwent a CT of the lower extremities. This resulted in 118 CLI patients (mean age 72±12, 70.3% male) that were age-matched with 118 non-PAD patients (mean age 71±11, 51.7% male). The characteristics severity, annularity, thickness and continuity were assessed in the femoral and crural arteries and analysed by binary multiple logistic regression. Results Nearly all CLI patients have calcifications and these are equally frequent in the femoropopliteal (98.3%) and crural arteries (97.5%), while the non-PAD patients had in just 67% any calcifications with more calcifications in the femoropopliteal (70.3%) than in the crural arteries (55.9%, p<0.005). The crural arteries of the CLI patients had significantly more complete annular calcifications (OR 2.92, p=0.001.) while in the non-PAD patients dot-like calcifications dominated. In CLI patients, the femoropopliteal arteries had more severe, irregular / patchy and thick calcifications (OR 2.40, 3.27, 1.81, p≤0.05, respectively) while in non-PAD patients, thin continuous calcifications prevailed. Conclusions Compared with non-PAD patients CLI patients are more frequently and extensively calcified. Annular calcifications were found in the crural arteries of CLI patients while dot-like calcifications were mostly present in the non-PAD patients. These different patterns of calcifications in CLI point at different etiology and can have prognostic and eventually therapeutic consequences.

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Cost-Effectiveness of Drug-Eluting Stents for Infrapopliteal Lesions in Patients with Critical Limb Ischemia: The PADI Trial

Cited by 11 publications

References 27 publications

Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients

Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients

Novel Scaffolds for the Treatment of Below-the-Knee Peripheral Arterial Disease With Chronic Limb Threatening Ischemia: A Review

Different Lower Extremity Arterial Calcification Patterns in Patients with Chronic Limb-Threatening Ischemia Compared with Asymptomatic Controls

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