Infrapopliteal run-off and the outcome of femoropopliteal percutaneous transluminal angioplasty

Salapura, Vladka; Blinc, Aleš; Kozak, Matija; Ježovnik, Mateja K; Perme, Maja Pohar; Berden, Pavel; Kuhelj, Dimitrij; Ključevšek, Tomaž; Popović, Petar; Stanković, Milenko; Vrtovec, Matjaž; Šurlan, Miloš

doi:10.1024/0301-1526/a000022

Cited by 25 publications

(29 citation statements)

References 15 publications

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“…Abbreviations as in Figure 1. (13)(14)(15). In this context, results of the present study support findings that the degree of IC is positively affected by successful and long-lasting interventions of IPA lesions (4,5,16).…”

Section: Figure 3 Event-free Survivals In Patients With Critical Limbsupporting

confidence: 92%

Sirolimus-Eluting Stents for Treatment of Infrapopliteal Arteries Reduce Clinical Event Rate Compared to Bare-Metal Stents

Rastan

Brechtel

Krankenberg

et al. 2012

Journal of the American College of Cardiology

165

143

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Section: Figure 3 Event-free Survivals In Patients With Critical Limbsupporting

confidence: 92%

Sirolimus-Eluting Stents for Treatment of Infrapopliteal Arteries Reduce Clinical Event Rate Compared to Bare-Metal Stents

Rastan

Brechtel

Krankenberg

et al. 2012

Journal of the American College of Cardiology

165

143

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“…The number of patent tibial vessels at the time of index procedure did not impact limb salvage (p ¼ 0.063). 60 Interestingly, Salapura et al 61 reported early restenosis and reocclusion in patients' limbs with good periprocedural runoff that worsened in the year after PTA. This suggests that loss of tibial runoffs post procedure may have an adverse impact on the long-term outcome of FP treatment.…”

Section: Procedural Factorsmentioning

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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“…In our study on the effect of tibial runoff on femoropopliteal patency after PTA [22], consecutive consenting patients with claudication or critical limb ischemia admitted for femoropopliteal PTA to the Department of Vascular Diseases of the University Medical Centre Ljubljana have been enrolled and prospectively followed up. In addition to femoropopliteal PTA, infrapopliteal PTA has been performed in all cases when lesions of the calf arteries have been judged suitable for intervention.…”

Section: Methodsmentioning

confidence: 99%

Is Restenosis/Reocclusion after Femoropopliteal Percutaneous Transluminal Angioplasty (PTA) the Consequence of Reduced Blood Flow, Inflammation, and/or Hemostasis Disturbances?

Mijovski¹,

Boc²,

Salapura³

et al. 2015

Thrombosis, Atherosclerosis and Atherothrombosis - New Insights and Experimental Protocols

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Percutaneous transluminal angioplasty PTA is an established method for treatment of peripheral artery disease PAD of the femoropopliteal artery. However, in up to % of patients restenosis and/or reocclusion remain a frequent complication occurring in the first year after the procedure. In this study, we focused on the influence of compromised postprocedural infrapopliteal runoff of the affected limb, on the hypercoagulability as detected by a global hemostasis assay and on genetic predisposition to hypercoagulability and on the regulation of the inflammation through the nuclear receptor related protein NuRR . Consecutive PAD patients treated by femoropopliteal PTA because of disabling claudication or critical limb ischemia were followed up by vascular ultrasound imaging at , , and months after the procedure. Venous blood samples for hemostasis, inflammation, and gene analysis were obtained before and h after PTA. One month after femoropopliteal PTA, % of patients with compromised runoff developed the combined end point restenosis/reocclusion in comparison to % with good runoff p = . . After months, the differences were no longer significant. It was concluded that compromised postprocedural infrapopliteal runoff predisposes to early restenosis/reocclusion after femoropopliteal PTA and that the deterioration of infrapopliteal runoff in the year after femoropopliteal PTA is accompanied by worsening of long-term femoropopliteal patency. Patients were genotyped for the prothrombotic gene polymorphisms platelet receptor glycoprotein IIIa T C, coagulation factor V G A, coagulation factor II G A, coagulation factor XII C -T, and plasminogen activator inhibitor-G G. We were not able to show any association between these polymorphisms and the restenosis/reocclusion rate in patients treated with femoropopliteal PTA. Furthermore, no association between thrombin generation and reste-

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Infrapopliteal run-off and the outcome of femoropopliteal percutaneous transluminal angioplasty

Abstract: Compromised postprocedural infrapopliteal run-off predisposes to early restenosis/reocclusion after femoropopliteal PTA. Deterioration of infrapopliteal run-off in the year after femoropopliteal PTA is accompanied by worsening of long-term femoropopliteal patency.

Cited by 25 publications

References 15 publications

Sirolimus-Eluting Stents for Treatment of Infrapopliteal Arteries Reduce Clinical Event Rate Compared to Bare-Metal Stents

Sirolimus-Eluting Stents for Treatment of Infrapopliteal Arteries Reduce Clinical Event Rate Compared to Bare-Metal Stents

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

Is Restenosis/Reocclusion after Femoropopliteal Percutaneous Transluminal Angioplasty (PTA) the Consequence of Reduced Blood Flow, Inflammation, and/or Hemostasis Disturbances?

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