Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

Patel, Manesh R.; Conte, Michael S.; Cutlip, Donald E.; Dib, Nabil; Geraghty, Patrick J.; Gray, William A.; Hiatt, William R.; Ho, Mami; Ikeda, Koji; Ikeno, Fumiaki; Jaff, Michael R.; Jones, W. Schuyler; Kawahara, Makoto; Lookstein, R.; Mehran, Roxana; Misra, Sanjay; Norgren, Lars; Olin, Jeffrey W.; Povsic, Thomas J.; Rosenfield, Kenneth; Rundback, John H.; Shamoun, Fadi; Tcheng, James E.; Tsai, Thomas T.; Suzuki, Yuka; Vranckx, Pascal; Wiechmann, Bret N.; White, Christopher J.; Yokoi, Hiroyoshi; Krucoff, Mitchell W.

doi:10.1016/j.jacc.2014.12.036

Cited by 302 publications

(115 citation statements)

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“…The high mortality of HD may be due to the plenty of vascular complications, such as vascular calcification [4] and atherosclerosis [5]. Peripheral arterial disease (PAD) is a systemic vascular disorder involving the aorta, iliac, and lower extremity arteries usually secondary to atherosclerosis [6, 7]. It is diagnosed by ankle-brachial/arm blood pressure index (ABI, or AAI, or ABPI) measurement and clinical assessment.…”

Section: Introductionmentioning

confidence: 99%

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

et al. 2016

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BackgroundRecent studies have shown an association between peripheral arterial disease (PAD) and increased risk of mortality in hemodialysis (HD) patients; however, the estimates vary widely and are inconsistent. It is necessary to elucidate the degree of mortality risk for PAD patients in HD population.MethodsPubMed, EMBASE, Web of Science and Cochrane Library (from inception to September 4th, 2016) were systematically searched for cohort studies assessing the association between PAD and mortality in HD patients. We calculated the pooled risk ratios (RRs) with 95% confidence intervals (CI) of all-cause and cardiovascular (CV) mortality using random effects models. Subgroup analyses were conducted to explore the source of heterogeneity.ResultsThe search identified 2,973 potentially eligible records and 10 studies (n = 32,864) were included. Our meta-analysis revealed that PAD significantly increased the risk of all-cause mortality (RR 2.15, 95 % CI 1.67–2.77, n = 32,864) and CV mortality (RR 2.99, 95 % CI 1.66-5.38, n = 31,794) in HD patients after multivariate adjustment. Subgroup analyses showed the study design and follow-up time might be two sources of heterogeneity.ConclusionPAD may be a prognostic marker of all-cause and CV mortality in HD patients. More attention should be paid to diagnosis and management of PAD in HD patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0397-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

et al. 2016

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“…Two or three runoff tibial trunks were evinced in 84% cases, while one or none permeable vessel were found in 23 (16%) of limbs. Moderate-to-severe arterial calcifications [12] were present in 55 (38%) cases ( Table 3).…”

Section: Study Design and Cohortmentioning

confidence: 99%

“…The additional hemodynamic involvement of the common femoral artery (CFA) in more complex infrainguinal occlusive presentations [2] [3] [12] was however less studied in the contemporary literature [3]. While most of these patients are either treated by femoro-popliteal bypass [2] [3] [12]- [14], or by way of CFA endarterectomy [15] [16], new reports analyzing specific endovascular recanalization techniques indicate comparable patency rates at one year [17].…”

Section: Introductionmentioning

confidence: 99%

Hybrid Common Femoral Artery Surgical Revascularization Associated to Endovascular Femoropopliteal Recanalization in High-Risk (ASA 3 - 4) Patients: A Seven-Year Period Institutional Experience

Alexandrescu¹,

Jacquemin²,

Wuidar³

et al. 2016

WJCD

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Objective: The present study was conceived to analyze the clinical benefit of hybrid interventions with surgical common femoral artery (CFA) reconstruction coupled to superficial femoral/popliteal endovascular recanalization for severe infrainguinal multilevel occlusive disease in high-risk ASA Class 3-4 patients. Material and Methods: From August 2008 until May 2015, a series of 143 hybrid infrainguinal interventions in 124 ASA Class 3-4 patients were performed in our department for Rutherford category 2-6 ischemic presentations. Patient demographics, specific risk factors, technical characteristics and patency results were retrospectively examined during a mean 36.8 months of follow-up. In a majority of 94 limbs (65%), the endovascular stage of interventions focused on long (>15 cm) femoropopliteal occlusions in parallel to regular CFA surgical revascularization. Two or three runoff tibial trunks were evinced in 84% cases, while one or none permeable vessel was found in 23 (16%) limbs. Results: Inasmuch surgical approach was successful in all cases, the endovascular stage was technically profitable in 134 (93%) cases. The ABI posto-peratively improved (>1.5) in 73% of cases, while clinical presentation gained at least one Rutherford category in 89% limbs. The mean hospital stay was 6.1 days (3-12 days) whereas the 30-day * Corresponding author. V.-A. Alexandrescu et al. 32 mortality rate in this homogeneous "high-risk" group of patients was 3.2%. Global risk factors alike age (>70 years/p = 0.0005), smoking (p = 0.0170) and female gender (p = 0.0111), together with CTOs length (>15 cm/p = 0.0470), severe calcifications (p = 0.0001), poor tibial runoff (p = 0.0001), TASC "C" and "D" lesions (p = 0.360 and p = 0.0394), the stent number (n = 3) and length (>6 cm) (p = 0.0039 and p = 0.0003) and the initial ABI scoring (p = 0.0051) showed statistical negative influence on primary patency. Conclusion: Hybrid infrainguinal revascularization may afford useful results in selected ASA "high risk" patients, owning low invasiveness, reproducibility and acceptable patency in return to punctual postoperative surveillance.

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“…Ankle pressure criteria range from less than 40–70mmHg, toe pressures less than 30–50mmHg, TcO2 less than 20–40mmHg. Higher cutpoints are often used for tissue loss on the assumption that greater perfusion is required for wound healing, but expert consensus on these hemodynamic criteria differs between guidelines 2, 4–7 . The original definitions were designed to standardize entry criteria for clinical trials of CLI in patients without diabetes to permit comparisons across studies 4, 6 , or to assess the likelihood of wound healing 8 .…”

Section: Definitionsmentioning

confidence: 99%

“…More recently, several proposals for endpoints important in CLI have converged on limb salvage (avoiding a major amputation), and the need for major re-intervention (a new bypass graft, or thrombolysis of graft or treated segment) 4, 7, 51 . As a result of these developments, the NIH sponsored the BEST-CLI study - a new randomized trial of open surgery versus endovascular revascularization in CLI 52 .…”

Section: Open Surgical Revascularizationmentioning

confidence: 99%

Management of Critical Limb Ischemia

Kinlay

2016

Circ: Cardiovascular Interventions

135

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Critical limb ischemia (CLI) is a clinical syndrome of ischemic pain at rest or tissue loss, such as non-healing ulcers or gangrene, related to peripheral artery disease. CLI has a high short-term risk of limb loss and cardiovascular events. Non-invasive or invasive angiography help determine the feasibility and approach to arterial revascularization. An “endovascular-first” approach is often advocated based on a lower procedural risk, however, specific patterns of disease may be best treated by open surgical revascularization. Balloon angioplasty and stenting form the backbone of endovascular techniques, with drug-eluting stents and drug-coated balloons offering low rates of repeat revascularization. Combined antegrade and retrograde approaches can increase success in long total occlusions. Below the knee, angiosome-directed angioplasty may lead to greater wound healing, but failing this, any straight line flow into the foot is pursued. Hybrid surgical techniques such as iliac stenting and common femoral endarterectomy are commonly used to reduce operative risk. Lower extremity bypass grafting is most successful with a good quality, long, single-segment autogenous vein of at least 3.5mm diameter. Minor amputations are often required for tissue loss as part of the treatment strategy. Major amputations (at or above the ankle) limit functional independence and their prevention is a key goal of CLI therapy. Medical therapy after revascularization targets risk factors for atherosclerosis and assesses wound healing and new or recurrent flow limiting disease. The ongoing NIH sponsored BEST-CLI study is a randomized trial of the contemporary endovascular versus open surgical techniques in patients with CLI.

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Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

Cited by 302 publications

References 36 publications

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

Hybrid Common Femoral Artery Surgical Revascularization Associated to Endovascular Femoropopliteal Recanalization in High-Risk (ASA 3 - 4) Patients: A Seven-Year Period Institutional Experience

Management of Critical Limb Ischemia

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