How to deal with calcium in the superficial femoral artery

Stavroulakis, Konstantinos; Argyriou, Angeliki; Watts, Mike; Varghese, Joji J.; Estes, Bailey; Torsello, Giovanni; Bisdas, Theodosios; Huasen, Bella

doi:10.23736/s0021-9509.19.11038-5

Cited by 5 publications

(9 citation statements)

References 42 publications

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“…The use of interwoven stents, stent grafts, and different “leave-nothing-behind” approaches has been recently described for the treatment of calcified femoropopliteal disease. 3 In a small cohort of 34 patients,the use of the Supera platform (Abbott Vascular, Santa Clara, CA, USA) in long (mean lesion length 27.9 cm), moderate- and severely calcified lesions led to a primary patency of 94.1%. 17 Moreover, in a retrospective analysis of 67 patients with long, heavily calcified disease (mean lesion length 26.9 cm, 62% PACSS 4), the “pave-and-crack” technique with the Supera scaffold and the Viabahn stent-graft (W.L.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 On the contrary, the presence of challenging lesions like chronic total occlusions (CTOs), calcified disease, and long lesions still limit the durability of minimally invasive procedures. [3][4][5][6] Vascular calcification is associated with an increased risk for crossing failure and the stiffness of the arterial wall portends to dissections, recoil, and excessive injury after plain old balloon angioplasty (POBA). 3,7 An additional challenge is the higher prevalence of calcified disease among high-risk subjects for cardiovascular morbidity and mortality, namely in patients with chronic kidney disease (CKD) or diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Vascular calcification is associated with an increased risk for crossing failure and the stiffness of the arterial wall portends to dissections, recoil, and excessive injury after plain old balloon angioplasty (POBA). 3,7 An additional challenge is the higher prevalence of calcified disease among high-risk subjects for cardiovascular morbidity and mortality, namely in patients with chronic kidney disease (CKD) or diabetes. 3,8 Thus, both the effectiveness and the safety profile of a calcium-dedicated therapy are important parameters for the treatment of these frail patients.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…3,7 An additional challenge is the higher prevalence of calcified disease among high-risk subjects for cardiovascular morbidity and mortality, namely in patients with chronic kidney disease (CKD) or diabetes. 3,8 Thus, both the effectiveness and the safety profile of a calcium-dedicated therapy are important parameters for the treatment of these frail patients.…”

Section: Introductionmentioning

confidence: 99%

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Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Femoropopliteal Arterial Disease

et al. 2022

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Introduction: The combination of intravascular lithotripsy (IVL) and drug-coated balloon (DCB) angioplasty for calcified peripheral lesions is associated with promising short-term results. However, data regarding the 12 months performance of this treatment option is missing. This study reports on the outcomes of IVL and DCB angioplasty for calcified femoropopliteal disease. Methods: Patients treated with IVL and DCB for calcified femoropopliteal lesions between February 2017 and September 2020 were included into this study. The primary outcome measure of this analysis was primary patency. Secondary patency, freedom from target lesion revascularization (TLR) and overall mortality were additionally analyzed. Results: Fifty-five ( n = 55) patients and 71 lesions were analyzed. Most patients presented with long-term limb-threatening ischemia ( n = 31, 56%), 47% ( n = 26) were diabetics, and 66% ( n = 36) had long-term kidney disease. The median lesion length was 77 mm (interquartile range: 45-136), and 20% ( n = 14) of the lesions were chronic total occlusions (CTOs). Eccentric calcification was found in 23% of the vessels ( n = 16), and circumferential calcium (peripheral arterial calcium scoring system [PACSS] Class 3 and 4) was present in 78% ( n = 55) of the treated lesions. The technical success after IVL amounted to 87% ( n = 62) and the procedural success to 97% ( n = 69). A flow-limiting dissection was observed in 2 cases (3%). Both the rates of target lesion perforation and distal embolization were 1% ( n = 1). A bail-out scaffold was deployed in 5 lesions (7%). At 12 months the Kaplan-Meier estimate of primary patency was 81%, the freedom from TLR was 92% and the secondary patency 98%. The overall survival amounted to 89%, while the freedom from major amputation to 98%. The presence of eccentric disease, CTOs, or PACSS Class 4 did not increase the risk for loss of patency or TLR. Conclusions: In this challenging cohort of patients, the use of IVL and DCB for calcified femoropopliteal lesions was associated with promising 12 months outcomes and an excellent safety profile.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Femoropopliteal Arterial Disease

et al. 2022

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Arterial Revascularization

Ali,

Arslan,

Beasley

et al. 2023

Limb Preservation for the Vascular Specialist

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Risk Factor Analysis for Crossing Failure in Primary Antegrade Wire-Catheter Approach for Femoropopliteal Chronic Total Occlusions

et al. 2022

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Introduction: Antegrade wire-catheter crossing remains the primary approach for femoropopliteal interventions. Nonetheless, data reporting on crossing failure are limited. Aim of this study is to identify risk factors for antegrade crossing failure in patients with femoropopliteal chronic total occlusions (CTOs). Methods: This is a single-center, retrospective analysis. Patients with femoropopliteal CTOs treated between May 2018 and February 2020 were included into this study. Primary endpoint of this analysis was primary crossing success defined as successful antegrade crossing without the use of retrograde access, crossing or re-entry devices. The assisted crossing success was additionally analyzed. A logistic regression analysis identified risk factors for failed primary antegrade crossing. Results: Data from 300 patients were analyzed. The majority (n=183, 61%) presented with lifestyle limiting claudication. The mean lesion length was 180 mm [interquartile range (IQR) 100–260 mm], whereas the median CTO length was 100 mm (IQR=50–210 mm). A chronic total occlusion crossing approach based on plaque morphology (CTOP) type I configuration was observed in 9% (n=26) of the lesions, type II in 61% (n=183), type III in 8% (n=25), and type IV in 66 CTOs (n= 66, 22%). Severe calcification based on the Peripheral Arterial Calcium Scoring Scale (PACSS), Peripheral Academic Research Consortium (PARC), and 360° grading systems was identified in 17%, 24%, and 28% of the lesions, respectively. A contralateral femoral access was used in 278 cases (93%). The primary crossing success amounted to 70% (n=210). The use of a re-entry device in 28 patients (9%) or of a combined antegrade–retrograde approach in 11% (n=34) of the cases increased the assisted crossing success to 89% (n=267). The presence of calcification (odds ratio [OR]=4.2, 95% CI=1.7–10.2) or of circumferential calcium (OR=2.5, 95% CI=1.3–4.9), a CTOP class ΙΙΙ or ΙV (OR=1.9, 95% CI=1.4–2.6), a proximal superficial femoral artery (SFA) occlusion (OR=3.5, 95% CI=1.7–7.4) and a CTO at P3 (OR=4.1, 95% CI=1.5–10.8) were associated with an increased risk for antegrade crossing failure. Conclusions: In this study, chronic total occlusions (CTO) morphology, calcification burden, and lesion’s location were identified as independent risk factors for failed antegrade crossing. Nonetheless, the use of alternative crossing strategies significantly increased the overall crossing success.

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How to deal with calcium in the superficial femoral artery

Cited by 5 publications

References 42 publications

Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Femoropopliteal Arterial Disease

Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Femoropopliteal Arterial Disease

Arterial Revascularization

Risk Factor Analysis for Crossing Failure in Primary Antegrade Wire-Catheter Approach for Femoropopliteal Chronic Total Occlusions

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