Dethrombosis of the Lower Extremity Arteries Using the Power-Pulse Spray Technique in Patients with Recent Onset Thrombotic Occlusions:<b>Results of the DETHROMBOSIS Registry</b>

Shammas, Nicolas W.; Dippel, Eric J.; Shammas, Gail A.; Gayton, Laura; Coiner, Denise; Jerin, Mike

doi:10.1583/08-2453.1

Cited by 34 publications

(25 citation statements)

References 26 publications

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“…Although we have not analyzed the duration of symptoms for all interventions in our series, the low number of patients with subacute presentation (9%) suggests that this accounts for a minority of all embolic events. 21 …”

Section: Discussionmentioning

confidence: 99%

Clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices

Mendes

Oderich

Fleming

et al. 2014

Journal of Vascular Surgery

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Objective The purpose of this study was to evaluate the incidence and clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices (EPDs). Methods We reviewed the clinical data of 566 patients treated by 836 endovascular femoropopliteal interventions for lower extremity claudication (46%) or critical limb ischemia (54%) from 2002 to 2012. Outcomes were analyzed in 74 patients/ 87 interventions performed with EPDs (Spider Rx, Covidien, Plymouth, MN) and 513 patients/ 749 interventions performed without EPDs. TASC classification, run-off scores and embolic events were analyzed. End-points were morbidity, mortality, re-intervention, patency and major amputation rates. Results Both groups had similar demographics, indications, cardiovascular risk factors and run-off scores, but patients treated with EPDs had significantly (P<0.05) longer lesions (109±94 vs 85±76mm) and more often had occlusions (64% vs 30%) and TASC C/D lesions (56% vs 30%). Embolic events occurred in 35 of 836 interventions (4%), including 2 (2%) performed with EPD and 33 (4%) without EPD (P=0.35). Macroscopic debris was noted in 59 (68%) filter baskets. Embolic events were not associated with lesion length, TASC classification, run-off scores, treatment type or indication, but were independently associated with occlusion. Patients who had embolization required more re-interventions (20% vs 3%, P<.001) and major amputations at 30-days (11% vs 3%, P=0.02). There was no difference in hospital stay (2.4±4 vs 1.6±2 days, P=0.08), re-intervention (2% vs 4%) and major amputation (1% vs 4%) among patients treated with or without EPD, respectively. The two patients who developed embolization with EPDs had no clinical sequela and required no re-intervention. Most emboli were successfully treated by catheter aspiration or thrombolysis, but 8 patients (24%) treated without EPD required prolonged hospital stay, 7 (21%) had multiple re-interventions, 1 (3%) had unanticipated major amputation, and 1 (3%) died from hemorrhagic complications of thrombolysis. Median follow up was 20 months. At 2-years, primary patency and freedom for re-intervention was similar for TASC A/B and TASC C/D lesions treated with or without EPDs. Conclusions Rates of embolization are low in patients undergoing endovascular femoropopliteal interventions with (4%) or without (2%) EPD. Embolization is more frequent in patients with occlusions. While emboli in patients with EPD had no clinical sequel, those treated without EPD require multiple re-interventions in 21% or resulted in major amputation or death in 3%. Late outcomes were similar in patients treated with or without EPDs.

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Section: Discussionmentioning

confidence: 99%

Clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices

Mendes

Oderich

Fleming

et al. 2014

Journal of Vascular Surgery

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“…Quite often ISR is associated with total thrombotic-restenotic occlusions with high embolic potential during endovascular treatment and likely to require additional stenting. 26,27 Furthermore, it is unknown how the presence of one or several layers of stents in the FP segment alters the effectiveness of current and future antirestenotic treatment. Finally, stents involving the popliteal and common femoral arteries can hinder future targets for surgery, and stents are generally best avoided as primary treatment in these locations.…”

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confidence: 99%

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Shammas¹

2013

Int J Angiol

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ReviewPeripheral arterial disease is highly prevalent in the general population affecting 12 to 14% of people and leading to claudication or threatened limb ischemia. 1 Endovascular lower extremity arterial interventions have increased exponentially over the past decade. 2 The femoropopliteal (FP) segment represents 40% of vessels treated and its treatment continues to be a challenge to the endovascular specialist. Despite a high rate of acute procedural success, target lesion revascularization (TLR) and target vessel revascularization remain elevated. 3,4 We have previously proposed a triad of optimal peripheral vascular revascularization strategy (►Fig. 1) 5 with an emphasis on three key principles: (1) Mechanical, improve vessel compliance to allow dilatation of a stenotic segment at low balloon inflation pressure and reduce dissection and recoil. Low balloon inflation pressure would theoretically preserve vessel integrity by minimizing barotrauma and bailout stenting. (2) Biological, inhibit smooth muscle cell (SMC) proliferation to improve patency rates and reduce repeat revascularization. (3) Procedural, preserve the outflow vessels by minimizing distal embolization (DE) and reduce procedural time and radiation exposure to both operator and patient.In this overview, we examine these principles to determine whether current data support their validity. We recognize the lack of uniform performance criteria and reporting standards in clinical trials in peripheral arterial disease. This unfortunately makes comparisons across studies difficult. Mechanical FactorsThe concept of improving vessel compliance as a prerequisite to a more definitive treatment of the FP artery has gained more attention over the past few years. Measurement of vessel compliance in vivo is difficult to obtain. One surrogate endpoint is the minimum balloon pressure (MBP) needed to fully stretch the artery to a lumen diameter equal to a normal reference segment with the use of a noncompliant balloon sized 1:1 to the reference vessel. The balloon is typically inflated to two atmospheres then the inflation pressure is increased by increment of one atmosphere at a time until full balloon expansion is achieved. 6,7 According to Laplace's law, tension (T) in the vessel wall is equal to (pressure (P) gradient across the arterial wall * radius (R) of artery)/wall thickening (M), or (T¼ [P * R]/M). In order for MBP change to reflect on compliance, the segments under comparison need to have similar radius and lesion Keywords AbstractTreatment of the femoropopliteal (FP) artery remains a challenge to the endovascular specialist. Long-term patency is low with a high rate of target lesion revascularization. The true patency rate varies considerably between studies partly because there is a lack of uniform performance criteria and reporting standards in peripheral arterial interventions. Literature review supports three principles that emerge as important components of an optimal strategy in treating the FP artery: (1) improving vessel compliance and sub...

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“…However, either the study group has a small subset of patients with popliteal and infrapopliteal lesions or the study did not report the efficacy for infrapopliteal lesions. 3,4,14,15 Exact status of the CDT procedure specifically for popliteal and infrapopliteal thromboocclusive lesions has not been documented. [16][17][18][19][20] Rheolytic thrombectomy (AngioJet) has been reported to be successful in approximately half of cases as a stand-alone technique.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of intra-arterial catheter-directed thrombolysis for popliteal and infrapopliteal acute limb ischemia

Lian

Das

et al. 2020

Journal of Vascular Surgery

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Objective: The purpose of this study was to examine the efficacy and safety of catheter-directed thrombolysis (CDT) for first-line treatment of popliteal and infrapopliteal acute limb ischemia. Methods: A total of 28 consecutive patients (30 limbs) who underwent CDT for treatment of popliteal and infrapopliteal acute limb ischemia of thromboembolic origin between March 2012 and December 2017 were enrolled in this study. Per the Society for Vascular Surgery, limbs were classified into three runoff score groups: <5, good; 5 to 10, compromised; and >10, poor. The primary end points were primary patency and limb salvage assessed by Kaplan-Meier survival analysis. Secondary end points were technical success and clinical success. The Society for Vascular Surgery-recommended scale for gauging changes in clinical status was used to assess clinical success. Safety of the procedure was evaluated on the basis of periprocedural complications according to the Society of Interventional Radiology classification system. Results: Technical success was achieved in 25 (83.33%) treated limbs. Improved clinical status (grade þ3/þ2) was achieved in 93.33% of limbs. Primary patency and limb salvage for the entire cohort were 76.67% and 90% at 6 months and 60.0% and 76.67% at 12 months, respectively. The patency rate at 6 months and 12 months was 91.67% and 83.33% for the good runoff group, 80% and 60% for the compromised runoff group, and 50% and 25% for the poor runoff group, respectively. The patency rate of the good runoff group was significantly higher compared with that of the poor runoff group (P ¼ .004). Major amputation rate and mortality rate were 16.67% and 7.14%, respectively, at 12 months. The reintervention rate was 3.57% at 6 months and 21.42% at 12 months. Conclusions: CDT is safe and effective for revascularization of smaller vessel acute arterial thromboembolism as a primary therapy. However, more studies with a larger sample are warranted.

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Dethrombosis of the Lower Extremity Arteries Using the Power-Pulse Spray Technique in Patients with Recent Onset Thrombotic Occlusions:Results of the DETHROMBOSIS Registry

Cited by 34 publications

References 26 publications

Clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices

Clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Efficacy of intra-arterial catheter-directed thrombolysis for popliteal and infrapopliteal acute limb ischemia

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