Specialty Balloons for Vessel Preparation During Infrainguinal Endovascular Revascularization Procedures: A Review of Literature

Giannopoulos, Stefanos; Volteas, Panagiotis; Virvilis, Dimitrios

doi:10.1177/15385744231156077

Cited by 3 publications

(1 citation statement)

References 84 publications

(141 reference statements)

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“…The UK Prospective Diabetes Study (UKPDS) reported that for every 1% reduction in HbA1c, there was a 43% reduction in the risk of lower extremity amputation and lower extremity arterial disease-related mortality (10). However, studies investigating restenosis after endovascular intervention in complicated patients have primarily concentrated on drug-eluting and bare balloons and stents (11)(12)(13). Despite the relatively limited literature on glycemic control in PAD, there is a significant lack of consensus regarding the optimal approach to achieving this control.…”

Section: Independent Predictors Of Target Vessel Restenosismentioning

confidence: 99%

Endovascular Revascularization Outcomes in Peripheral Arterial Disease Patients With Type-Ii Diabetes Mellitus

Kaya

2023

esmj

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Introduction: Type 2 diabetes mellitus is a strong predisposing factor for peripheral arterial disease, it is also a significant risk factor for endovascular revascularization treatment success. Patient selection is critical in endovascular revascularization for patients with type 2 diabetes mellitus. Methods: Fifty-seven patients with type 2 diabetes mellitus underwent endovascular lower limb revascularization. The follow-up time was 6 months and the outcomes were recorded two times in one and six months after the procedure. Multivariate analysis was run to determine independent factors that related to target vessel restenosis. Results: Mean age of the study cohort was 66.5 years and 21.2% of patients were female. The smoking rate was 59.6%. Sixteen patients underwent stent angioplasty and forty-one patients underwent balloon angioplasty. 1-month and 6-month patent target vessel rates were found 93% and 64.9% respectively. Multivariate analysis showed that smoking is a negative indicator, and balloon angioplasty and insulin-based therapy are positive indicators for endovascular revascularization outcomes in patients with type 2 diabetes mellitus. Conclusion: Endovascular revascularization is a promising option for peripheral arterial disease patients with type 2 diabetes. However, actively smoking and stenting may be risk factors for endovascular treatment success and insulin-based therapy and balloon angioplasty related to improved outcomes.

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Section: Independent Predictors Of Target Vessel Restenosismentioning

confidence: 99%

Endovascular Revascularization Outcomes in Peripheral Arterial Disease Patients With Type-Ii Diabetes Mellitus

Kaya

2023

esmj

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Safety and Effectiveness of Debulking for the Treatment of Infrainguinal Peripheral Artery Disease. Data From the Recording Courses of vascular Diseases Registry in 2910 Patients

Korosoglou,

Feld,

Langhoff

et al. 2024

Angiology

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We investigated the safety and efficacy of debulking infrainguinal lesions in patients with peripheral artery disease (PAD) undergoing endovascular revascularization (EVR) as part of the RECording Courses of vascular Diseases (RECCORD) registry. Patient and lesion specific characteristics, including the lesion complexity score (LCS) were analyzed. The primary endpoint encompassed: (i) clinical improvement in Rutherford categories, (ii) index limb re-interventions, and (iii) major amputations during follow-up. The secondary endpoint included the need for bail-out stenting. Overall, 2910 patients were analyzed; 2552 without and 358 with debulking-assisted EVR. Patients were 72 (interquartile range (IQR) = 15) years old and 1027 (35.3%) had diabetes. Overall complication rates were similarly low in the debulking vs the non-debulking group (4.7 vs 3.2%, P = .18). However, peripheral embolizations rates were low but more frequent with debulking vs. non-debulking procedures (3.9 vs 1.1%, P < .001). After adjustment for clinical and lesion-specific parameters, including LCS, no differences were noted for the primary endpoint (odds ration (OR) = 0.99, 95%CI = 0.69–1.41, P = .94). Bail-out stenting was less frequently performed in patients with debulking-assisted EVR (OR = 0.5, 95%CI = 0.38–0.65, P < .0001). Debulking-assisted EVR is currently used in ∼12% of EVR with infrainguinal lesions and is associated with lower bail-out stent rates but higher peripheral embolization rates; no differences were found regarding index limb re-intervention and amputation rates.

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Collateral vessel size and number could predict severe dissection after balloon angioplasty in patients with femoropopliteal artery chronic total occlusion

Acar,

Donmez,

Güneş

et al. 2024

Vascular

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Objective Collateral vessels develop from pre-existing arterioles in response to shear stress from arterial stenosis and mechanosensor activation. Animal studies suggest that these vessels increase in number and size after arterial occlusion, potentially offering a natural bypass and protection against critical limb ischemia. Efforts to enhance collateral vessel growth aim to improve walking performance in peripheral arterial disease (PAD). Factors influencing collateral vessel formation include plaque accumulation, tissue components, and comorbid conditions. Balloon angioplasty is a primary treatment for PAD but often leads to vessel dissection, with severe dissections linked to reduced long-term patency and requiring additional treatments. The relationship between collateral vessel characteristics and dissection severity remains unexplored. Materials and Methods This retrospective study analyzed endovascular treatments for femoropopliteal chronic total occlusion (FP-CTO) in 824 limbs of 706 PAD patients from January 2018 to May 2023. Exclusion criteria included prior treatments, severe aortoiliac and common femoral artery disease, and deep femoral artery disease. The final cohort comprised 410 limbs from 387 patients. Data on risk factors, lesion characteristics, and procedural details were collected. Collateral vessels were assessed by grade and number, and vessel dissection was categorized from Type A to Type F. Multivariate logistic regression identified predictors of severe dissection. Results Severe dissection was more frequent in TASC II C/D lesions and in patients with longer FP-CTO lengths, CTOP class-4 plaque morphology, flush ostial CTO, severe calcification, and large or numerous collateral vessels. Significant predictors of severe dissection included end-stage renal disease, FP-CTO length, CTOP class-4, flush ostial CTO, severe calcification, and large collateral vessels. Conclusion Longer CTO lengths and complex plaque characteristics increase the risk of severe dissection during balloon angioplasty. Large and numerous collateral vessels are associated with severe dissection. Severe dissection is more common in complex lesions and those with end-stage renal disease. The findings suggest that plaque compliance and collateral vessel characteristics are crucial in assessing dissection risk, highlighting the need for further research with larger cohorts and advanced imaging techniques.

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Specialty Balloons for Vessel Preparation During Infrainguinal Endovascular Revascularization Procedures: A Review of Literature

Cited by 3 publications

References 84 publications

Endovascular Revascularization Outcomes in Peripheral Arterial Disease Patients With Type-Ii Diabetes Mellitus

Endovascular Revascularization Outcomes in Peripheral Arterial Disease Patients With Type-Ii Diabetes Mellitus

Safety and Effectiveness of Debulking for the Treatment of Infrainguinal Peripheral Artery Disease. Data From the Recording Courses of vascular Diseases Registry in 2910 Patients

Collateral vessel size and number could predict severe dissection after balloon angioplasty in patients with femoropopliteal artery chronic total occlusion

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