Current Treatment of Peripheral Arterial Disease

Mahmud, Ehtisham; Cavendish, Jeffrey J.; Salami, Ali

doi:10.1016/j.jacc.2007.03.056

Cited by 32 publications

(6 citation statements)

References 137 publications

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“…Higher FDG uptake in the carotid and iliac arteries of patients with a prior history of CAD reinforces the global nature of atherosclerotic disease, whereas in patients with a history of cigarette smoking, FDG uptake was only increased in the iliac arteries. It is well known that iliac artery disease is common amongst smokers 31 , and this result suggests a site-specific nature of the response to certain risk factors.…”

Section: Discussionmentioning

confidence: 95%

Relationships Among Regional Arterial Inflammation, Calcification, Risk Factors, and Biomarkers

Rudd

Myers

Bansilal

et al. 2009

Circ: Cardiovascular Imaging

231

118

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Background Fluorodeoxyglucose positron emission tomography (FDG PET) imaging of atherosclerosis has been used to quantify plaque inflammation and to measure the effect of plaque stabilizing drugs. Here we explore how atherosclerotic plaque inflammation varies across arterial territories and how it relates to arterial calcification. We also test the hypotheses that the degree of local arterial inflammation measured by PET is correlated with the extent of systemic inflammation and presence of risk factors for vascular disease. Methods and Results Forty-one subjects underwent vascular PET/CT imaging with FDG. All had either vascular disease or multiple risk factors for it. Forty subjects underwent carotid imaging, twenty-seven underwent aortic, twenty-four iliac and thirteen femoral imaging. Thirty-three subjects had a panel of biomarkers analyzed. We found strong associations between FDG uptake in neighboring arteries (left vs. right carotid r=0.91, p<0.001, ascending aorta vs. aortic arch r=0.88, p<0.001). Calcification and inflammation rarely overlapped within arteries – carotid artery FDG uptake vs. calcium score r=−0.42, p=0.03). Carotid artery FDG uptake was greater in those with a history of coronary artery disease (target to background ratio (TBR) 1.83 vs. 1.61, p<0.01), and in males vs. females (TBR 1.83 vs. 1.63, p<0.05). Similar findings were also noted in the aorta and iliac arteries. Subjects with the highest levels of FDG uptake also had the greatest concentrations of inflammatory biomarkers: descending aorta TBR vs. matrix metalloproteinase 3 (MMP 3): r=0.53, p=0.01 and carotid TBR vs. MMP 9: r=0.50, p=0.01. Non-significant positive trends were seen between FDG uptake and levels of interleukin 18, fibrinogen and C-reactive protein. Finally, we found that the atheroprotective biomarker adiponectin was negatively correlated with the degree of arterial inflammation in the descending aorta: r=−0.49, p=0.03). Conclusions This study shows that FDG PET imaging can increase our knowledge of how atherosclerotic plaque inflammation relates to calcification, serum biomarkers and vascular risk factors. Plaque inflammation and calcification rarely overlap, supporting the theory that calcification represents a late, burnt-out stage of atherosclerosis. Inflammation in one arterial territory is associated with inflammation elsewhere, and the degree of local arterial inflammation is reflected in the blood levels of several circulating biomarkers. We suggest that FDG PET imaging could be used as a surrogate marker of both atherosclerotic disease activity and drug effectiveness. Prospective, event driven studies are now underway to determine the role of this technique in clinical risk prediction.

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Section: Discussionmentioning

confidence: 95%

Relationships Among Regional Arterial Inflammation, Calcification, Risk Factors, and Biomarkers

Rudd

Myers

Bansilal

et al. 2009

Circ: Cardiovascular Imaging

231

118

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“…Recently, technological advances favoured a significant evolution of percutaneous revascularization therapies that now can be offered as treatment options less invasive than traditional surgery. The optimal endovascular therapy is not well established: there are several options including percutaneous transluminal angioplasty (PTA), stents, drug-coated balloons, crioplasty, percutaneous thrombectomy (rheolytic [9] and aspiration thrombectomy) and atherectomy [10,11]. In particular, the promise of atherectomy is to overcome the limitations and complications of traditional angioplasty such as dissection, elastic recoil, and disruption of the internal elastic lamina, resulting in overwhelming neo-intima and smooth muscle cell proliferation [12].…”

Section: Introductionmentioning

confidence: 99%

The role of atherectomy in the treatment of lower extremity peripheral artery disease

et al. 2012

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BackgroundThe incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of percutaneous revascularization strategies, over the past decade, LE-PAD still represents a unique challenge for interventional cardiologists and vascular surgeons.MethodTypical features of atherosclerosis that affects peripheral vascular bed (diffuse nature, poor distal runoff, critical limb ischemia, chronic total occlusion) contribute to the disappointing results of traditional percutaneous transluminal angioplasty (PTA). New technologies have been developed in attempt to improve the safety and effectiveness of percutaneous revascularization. Among these, atherectomy, debulking and removing atherosclerotic plaque, offers the potential advantage of eliminating stretch on arterial walls and reducing rates of restenosis.ConclusionsThis review summarizes the features and the current applications of new debulking devices.

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“…The advancement of endovascular treatment method for peripheral arterial disease has continuously been improved toward substituting existing surgical methods [11]. Such advancement of endovascular treatment methods seems to have increased the applicable range of invasive treatment in peripheral arterial disease in general.…”

Section: Discussionmentioning

confidence: 99%

Role of surgical treatment for peripheral arterial disease in endovascular era

et al. 2013

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PurposeThe purpose of this study is to review the roll changes of surgical treatment for peripheral artery disease in endovascular era.MethodsOne hundred and twelve surgically treated cases of peripheral artery disease at a single institution during the period from 2006 to 2011 were studied retrospectively. The cases were divided into two groups of different time periods, one before 2009 (surgical period group) and the other from 2009 onward (endovascular period group). We analyzed the type and location of surgery as well as clinical characteristics of patients and treatment results.ResultsFifty-three cases were for the surgical period group and 59 cases for the endovascular group. No difference in the demographic characteristics and the distribution of major atherosclerosis risk factors was found between the two groups. Additionally, the technical and functional success rate was similar in both groups. However, it is found that there were more acute cases in the endovascular period group than in the surgical period group. The number of cases in need of suprainguinal or below knee exposure was similar in both groups. In hybrid cases, suprainguinal or below knee exposures were more frequently needed during the former period than the latter period.ConclusionThe role of surgical treatment is currently in the process of changing. Surgical treatment seems to be a complementary alternative to endovascular treatment for chronic limb ischemia. However, it still seems to play a major role for acute limb ischemia.

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Current Treatment of Peripheral Arterial Disease

Cited by 32 publications

References 137 publications

Relationships Among Regional Arterial Inflammation, Calcification, Risk Factors, and Biomarkers

Relationships Among Regional Arterial Inflammation, Calcification, Risk Factors, and Biomarkers

The role of atherectomy in the treatment of lower extremity peripheral artery disease

Role of surgical treatment for peripheral arterial disease in endovascular era

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