Differential efficacy between stenting and plain balloon angioplasty for femoropopliteal disease with or without total occlusion

Chae, In‐Ho; Yoon, Chang-Hwan; Ko, Young–Guk; Min, Pil‐Ki; Lee, Jae‐Hwan; Yu, Cheol Woong; Lee, Seung Whan; Lee, Sang-Rok; Choi, Seung Hyuk; Koh, Yoon Seok; Choi, Donghoon; Investigators, K-Vis

doi:10.3904/kjim.2019.039

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…38 Total occlusion in femoropopliteal lesions has been reported to be associated with worse outcomes. 39 In our study, we separated organizing thrombus and organized thrombus. An interventional approach at the stage of organized thrombus may require a more complex procedure in comparison with the stage of organizing thrombus, as the stage is likely to be more advanced.…”

Section: Discussionmentioning

confidence: 99%

Angioscopic Findings of Stenosis Versus Occlusion in Femoropopliteal Artery Disease

et al. 2022

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Background: Despite the increase in the number of patients with peripheral artery disease (PAD), the pathophysiology is not fully elucidated. Recently, angioscopy with a 0.48-megapixel equivalent resolution camera became available for patients with PAD. We aimed to compare the plaque component between native stenosis and occlusion in the femoropopliteal artery using this modality. Materials and Methods: Thirty-two consecutive patients who underwent endovascular treatment for native femoropopliteal artery disease with angioscopy were studied. The major angioscopic classifications of each lesion were defined as follows: atheromatous plaque (AP) was defined as luminal narrowing without any protrusion, calcified nodule (CN) was defined as a protruding bump with surface irregularity, a mainly reddish thrombus was defined as organizing thrombus (OG), and organized thrombus (OD) was defined by more than half of the thrombus showing a whitish intima-like appearance. Results: A total of 34 lesions (stenosis, n=18; occlusion, n=16) from 32 patients were included. All stenotic lesions showed AP or CN (n=8 [44%], n=10 [56%], respectively), whereas all occluded lesions showed OG or OD (n=5 [31%], n=11 [69%], respectively), which amounted to a statistically significant difference (p<0.001). In occluded lesions, stiff wires (>3 g) were required to cross all lesions classified as OD, whereas this was not always necessary for lesions classified as OG (11 [100%] of 11, 1 [25%] of 5, respectively; p=0.04). Yellow color plaques were observed to a similar degree in all angioscopic classifications. Major adverse limb events, defined as amputation and any reintervention at 12 months, were highly variable, depending on the angioscopic findings, and tended to be more frequently observed in CN and OD (13% in AP, 40% in CN, 0% in OT, and 36% in OD, p=0.25). Conclusion: Angioscopy revealed varying components in stenosis and occlusion with different degrees of clinical impact. This may provide new information on the pathophysiology of PAD.

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Section: Discussionmentioning

confidence: 99%

Angioscopic Findings of Stenosis Versus Occlusion in Femoropopliteal Artery Disease

et al. 2022

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“…Loss of primary patency was defined as the occurrence of any of the following conditions: 1) any occlusion during follow-up; 2) peak systolic velocity ratio >2.4 on duplex ultrasonography; 3) ABI decreased by more than 20% or by more than 0.15 and CT-or digital subtraction angiography-confirmed stenosis >50%; and 4) any CD-TLR. CD-TLR was defined as any revascularization procedure of previously placed FFB performed when the physician considered retreatment for the target lesion necessary or when the patient complained of exertional limb discomfort or claudication within the follow-up period [2]. Postoperative wound complications were classified and graded according to the recommended standards for reports dealing with lower-extremity ischemia [3].…”

Section: Methodsmentioning

confidence: 99%

The Results of Femorofemoral Bypass Using a Saphenous Vein Graft as an Alternative to PTFE Grafts

Kwon

Park

Kwak

et al. 2023

Vasc Specialist Int

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Purpose: This study aimed to report the results of femorofemoral bypass (FFB) using a great saphenous vein (GSV) graft as an alternative to polytetrafluoroethylene (PTFE) grafts. Materials and Methods: From January 2012 to December 2021, 168 patients who underwent FFB (PTFE, 143; GSV, 25) were included. The patients' demographic features and surgical intervention results were retrospectively reviewed. Results: There were no intergroup differences in patients' demographic features. In GSV vs. PTFE grafts, the superficial femoral artery provided statistically significant inflow and outflow (P<0.001 for both), and redo bypass was more common (P=0.021). The mean follow-up duration was 24.7±2.3 months. The primary patency rates at 3 and 5 years were 84% and 74% for PTFE grafts and 82% and 70% for GSV grafts, respectively. There was no significant intergroup difference in primary patency (P=0.661) or clinically driven target lesion revascularization (CD-TLR)-free survival (P=0.758). Clinical characteristics, disease details, and procedures were analyzed as risk factors for graft occlusion. Multivariate analysis revealed that none of the factors was associated with an increased risk of FFB graft occlusion. Conclusion: FFB using PTFE or GSV grafts is a useful method with an approximately 70% 5-year primary patency rate. The GSV and PTFE grafts showed no difference in primary patency or CD-TLR-free survival during follow-up; however, FFB using GSV may be an option in selective situations.

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International Cross-Sectional Survey ON TReatment Of Occluded Femoro-Popliteal Stents (SUNROOF)

Bertagna,

Troisi,

Lepidi

et al. 2024

J Endovasc Ther

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Purpose: The aim of this project is to explore practice patterns of experienced vascular specialists involved in the treatment of patients with arterial femoro-popliteal in-stent occlusion (ISO) and to understand key concepts and shared thoughts, throughout an international cross-sectional survey. Materials and Methods: The web-based survey was in English and included 31 questions. One-hundred experts were invited by email to fill in the survey anonymously on Google Forms using a dedicated link. Reminders were sent after the first 2 weeks. In addition to reporting of pooled responses, subanalyses of answers were also performed, according to country of origin (European vs non-European), years of experience (≤20 years vs >20 years), and type of institution (Academic/University vs Non-academic/Private). Results: A total of 77 physicians from 22 countries completed the survey. Most responders were males (70/77, 91%). Most of the participants were vascular surgeons (58/77, 75%). Endovascular therapy was the preferred option in patients presenting with either acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Atherectomy/thrombectomy+Drug-Coated Balloon (DCB) was the preferred endovascular modality (32/77, 42%). No differences between country of origin, years of experience, and type of institution of the participants were found. Conclusions: The international SUrvey oN TReatment Of Occluded Femoro-Popliteal Stent (SUNROOF) survey has suggested that endovascular therapy is the preferred method for the treatment of femoro-popliteal ISO. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks good-level scientific evidence and appropriate guidelines. Clinical Impact The international SUNROOF survey included 31 questions. It was performed by 77 vascular physicians from 22 countries. More than a half of respondents considered an endovascular approach as the preferred treatment modality in acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Most responders agreed they would intensify the follow-up protocol and anti-thrombotic medications regimen after a first in-stent occlusion episode. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks of good level scientific evidence and appropriate guidelines.

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Differential efficacy between stenting and plain balloon angioplasty for femoropopliteal disease with or without total occlusion

Cited by 3 publications

References 24 publications

Angioscopic Findings of Stenosis Versus Occlusion in Femoropopliteal Artery Disease

Angioscopic Findings of Stenosis Versus Occlusion in Femoropopliteal Artery Disease

The Results of Femorofemoral Bypass Using a Saphenous Vein Graft as an Alternative to PTFE Grafts

International Cross-Sectional Survey ON TReatment Of Occluded Femoro-Popliteal Stents (SUNROOF)

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