Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease

Janas, Adam; Milewski, Krzysztof; Buszman, Piotr P.; Trendel, Wojciech; Kolarczyk-Haczyk, Aleksandra; Hochuł, Mariusz; Pruski, Maciej; Wojakowski, Wojciech; Kiesz, R. Stefan

doi:10.5603/cj.a2018.0122

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…Studies that investigated atherectomy devices report also high technical success rates (99%), but with complication rates ranging from 3.4% to 27.5%. [21][22][23] Complications included perforation, distal embolization and dissections among others. Therefore, treatment with these devices should be performed with caution in infrapopliteal arteries.…”

Section: Discussionmentioning

confidence: 99%

High-pressure, non compliant balloon angioplasty for long and calcified infrapopliteal and inframalleolar lesions is feasible

et al. 2020

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Background: To evaluate the safety, feasibility and effectiveness of high-pressure, noncompliant balloon angioplasty in the management of long infrapopliteal calcified lesions. Methods: Consecutive patients, presenting with chronic limb-threatening ischemia (CLTI) and long (>100 mm) calcified infrapopliteal lesions who were treated with a high pressure, noncompliant balloon (JADE, OrbusNeich, Hong Kong) between January 2016 and July 2016 were retrospectively analyzed. Angioplasty was performed by inflating the balloon to a pressure of 22 to 24 atm for 90 seconds. Primary outcome was technical success. Secondary outcomes were procedure-related complications, limb salvage, amputation-free survival (AFS), wound healing, overall survival, freedom from clinically driven target lesion reintervention (CD-TLR), and resolution of CLTI at 2 and 3 years. Results: Overall, 23 lesions in 21 limbs of 20 patients were treated. All patients had tissue loss (Rutherford 5 or 6). The mean lesion length was 374.8 mm. Of all lesions, 56.5% were occlusions, 91.3% were classified as TransAtlantic Inter-Society Consensus (TASC) C and D lesions, and 78.3% had severe calcification classification. Of all lesions, 52.2% extended into the below-the-ankle arteries. Technical success was achieved in 22 lesions (95.7%). There were no procedure-related complications. No bailout stenting was required. At 2 and 3 years, limb salvage was 84.7% and 78.7%, AFS was 71.4% and 56.1%, wound healing was 81.0% and 85.7%, overall survival was 75.0% and 64.3% and freedom from CD-TLR was 77.6% and 63.5%, respectively. Resolution of CLTI without TLR was 81.0% at 2 and 3 years. Conclusions: This study is the first to analyze safety and feasibility of a high-pressure, noncompliant balloon for long, calcified infrapopliteal and inframalleolar lesions.

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Section: Discussionmentioning

confidence: 99%

High-pressure, non compliant balloon angioplasty for long and calcified infrapopliteal and inframalleolar lesions is feasible

et al. 2020

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“…Secondary patency rates were similar (96% vs. 96%) between two groups at 12 months. Bailout stenting was more often following DCB angioplasty (p = 0.13) and aneurysmal degeneration was more common after DAART (p = 0.25) 26 .…”

Section: Discussionmentioning

confidence: 99%

Atherectomy followed by drug-coated balloon angioplasty for below knee lesions in diabetic patients

Rodoplu¹,

Er²,

Erdinç³

et al. 2022

CIRU

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Objective:The aim of this study was to compare the long-term outcomes of below the knee revascularization with percutaneous atherectomy followed by drug-coated balloon and revascularization with drug-coated balloon alone for symptomatic diabetic patients with peripheral arterial disease. Patients and methods: Between April 2015 and January 2020, total of 128 patients and 228 below the knee procedures were enrolled into this retrospective study. Sixty-five patients were treated with atherectomy followed by drug-coated balloon and 63 patients were treated solely with drug-coated balloon. Results: Technical success rates were similar in the AT+DCB group and DCB group. Target lesion revascularization (TLR) was found similar in both groups at 6-month follow-up. Clinically, driven repeat endovascular and surgical limb revascularization rates were also significantly lower at 12 and 24 months. Conclusion: Combined usage of rotational atherectomy and drug-coated balloons for the treatment of diabetic patients with below-the knee arterial lesions and critical limb ischemia is associated with reduced long-term TLR rates and improved the long-term outcomes.

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“…Despite controversial study results, diabetes mellitus is accepted as a predictive factor in the development of restenosis [29,30]. The long-term results in diabetic patients after a sole PTCA with 63% compared to non-diabetics with 36% on the one hand, and after a PTCA and stent implantation in non-diabetics with 27% compared to diabetics with 25% on the other, speak for a protective effect of stent implantation in diabetic patients [31].…”

Section: Discussionmentioning

confidence: 99%

“…Differentiated studies clearly relativises the role of hypercholesterolemia as a risk factor for instentstenosis [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Long-term results for post-interventional systemic heparinization following angioplasty of peripheral vessels

Mirzaie¹,

Guliyev²,

Dakna³

2020

J Cardiol Cardiovasc Med

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Objective: The long-term outcome of percutaneous transluminal angioplasties is mainly determined by restenoses, either by progression of the underlying disease or by intimal hyperplasia. Pharmacological substances on the one hand and the implantation of stents on the other have been developed with the intention of preventing precisely this complication. While patients are treated after PTA of peripheral vessels with diff erent low-molecular-weight heparins, the indication for stent implantation is determined individually rather by experience. The aim of this study was to determine gender-specifi c risk factors of long-term outcome after percutaneous transluminal angioplasty (PTA) of peripheral vessels with or without stentimplantation. Methods: In the present study, we examined the long-term results of percutaneous transluminal angioplasty (PTA) of peripheral vessels. Between 2007 and 2017, in total, 3,276 patients underwent PTA with or without stent implantation in our clinic. All patients were treated postinterventionally for 48 hours with 25,000 IU heparin (Unfractionated Heparin (UFH), heparinsodium-Braun, 25,000 I.E./5 ml, 2 ml/h) monitored by the partial thromboplastin time and subsequently underwent a control investigation every 6 months. The endpoint of the study was determination of symptomatic stenosis larger than 50% that required reintervention. Results: 239 (68.2% with mean age 68.02 years) male patients and 111 female patients (31.71% with mean age 62.92 years) were evaluated with complete follow-up. A total of 470 PTAs were performed on male patients and 213 on female patients in multiple interventions. The majority of patients at the time of treatment were in stage IIb according to the classifi cation of Fontaine (81.6% of male patients and 68% of females). In our sample, peripheral arterial disease stage III and IV according to Fontaine classifi cation occurred twice as frequently in female patients as in male patients (stage III in 12.6% in female versus 6.1% in male, and stage IV in 18% in female versus 8.9% in males). In both groups, the femoral superfi cialis artery was most frequently dilated (64 cases, 30% in female and 155 cases, 32.9% in male), followed by the iliacal communis artery (46 cases in female and 99 cases in male, both with 21.5%). A balloon angioplasty of the tibialis anterior and posterior arteries was performed twice as frequently in female patients as in male patients (28 cases with 13.1% of tibialis ant. artery in female versus 32 cases with 6.8% in male patients, and in 17 cases with 7.9% of tibialis post. artery in female versus 16 cases with 3.4% in male patients). In this study, without consideration of gender, patency rates of 79% after 2.5 years, 67% after 5 years, 49% after 7.5 years and 37% after 10 years were determined for PTA without stent implantation. Between the 7th and 10th year in follow-up, the cumulative patency rates for stent implantation was 49%, whereas it was 31% for PTA alone. The results of this study show that the stent assisted PTA`s of comm. art...

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Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease

Cited by 5 publications

References 14 publications

High-pressure, non compliant balloon angioplasty for long and calcified infrapopliteal and inframalleolar lesions is feasible

High-pressure, non compliant balloon angioplasty for long and calcified infrapopliteal and inframalleolar lesions is feasible

Atherectomy followed by drug-coated balloon angioplasty for below knee lesions in diabetic patients

Long-term results for post-interventional systemic heparinization following angioplasty of peripheral vessels

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