Drug-eluting stents for revascularization of infrapopliteal arteries: updated meta-analysis of randomized trials.
Massimiliano Fusaro,Salvatore Cassese,Gjin Ndrepepa,Gunnar Tepe,Lamin King,Ilka Ott,Mateja Nerad,Heribert Schunkert,Adnan Kastrati +8 more
TLDR
In focal disease of infrapopliteal arteries, DES therapy reduces the risk of reintervention and amputation compared with plain balloon angioplasty or BMS implantation without any impact on mortality and Rutherford class at 1-year follow-up.Abstract:
Objectives This study sought to undertake an updated meta-analysis of randomized trials investigating the outcomes of percutaneous revascularization with primary drug-eluting stenting in patients with atherosclerotic disease of infrapopliteal arteries. Background In atherosclerotic disease of infrapopliteal arteries, drug-eluting stents (DESs) improve patency rates compared with plain balloon angioplasty or bare-metal stents (BMSs). However, the clinical impact of DES placement in this vascular territory still remains uncertain. Methods We searched MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), scientific session abstracts, and relevant Websites. The keywords used were “below the knee,” “infrapopliteal artery,” “angioplasty,” “drug-eluting stent(s),” “bare metal stent(s),” “trial,” and “randomized trial.” Inclusion criteria were randomized design, intention-to-treat analysis, and a minimum of 6-month follow-up. Exclusion criteria were vessels treated other than infrapopliteal arteries; devices used other than DESs, plain balloons, or BMSs; and duplicated data. The primary endpoint was target lesion revascularization; secondary endpoints were restenosis, amputation, death, and improvement in Rutherford class. Results A total of 611 patients from 5 trials were randomly assigned to DESs (n = 294) versus control therapy (plain balloon angioplasty/BMS implantation, n = 307). Overall, the median lesion length was 26.8 mm (interquartile range [IQR]: 18.2 to 30.0 mm) with a reference vessel diameter of 2.86 mm (IQR: 2.68 to 3.00 mm). At a median follow-up of 12 months (IQR: 12 to 36 months), DESs reduced the risk of target lesion revascularization (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.18 to 0.54; p Conclusions In focal disease of infrapopliteal arteries, DES therapy reduces the risk of reintervention and amputation compared with plain balloon angioplasty or BMS implantation without any impact on mortality and Rutherford class at 1-year follow-up.read more
Citations
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Global vascular guidelines on the management of chronic limb-threatening ischemia
Michael S. Conte,Andrew W. Bradbury,Philippe Kolh,John V. White,Florian Dick,Robert Fitridge,Joseph L. Mills,Jean-Baptiste Ricco,Kalkunte R Suresh,M. Hassan Murad,Victor Aboyans,Murat Aksoy,Vlad-Adrian Alexandrescu,David G. Armstrong,Nobuyoshi Azuma,Jill J. F. Belch,Michel Bergoeing,Martin Björck,Nabil Chakfe,Stephen W.K. Cheng,Joseph Dawson,Eike Sebastian Debus,Andrew Dueck,Sue Duval,Hans-Henning Eckstein,Roberto Ferraresi,Raghvinder Gambhir,Mauro Gargiulo,Patrick J. Geraghty,Steve Goode,Bruce H. Gray,Wei Guo,Prem C. Gupta,Robert J. Hinchliffe,Prasad Jetty,Kimihiro Komori,Lawrence A. Lavery,Wei Liang,Robert A. Lookstein,Matthew T. Menard,Sanjay Misra,Tetsuro Miyata,Greg Moneta,Jose A. Munoa Prado,Alberto Munoz,Juan E. Paolini,Manesh R. Patel,Frank B. Pomposelli,Richard J. Powell,Peter A Robless,Lee C. Rogers,Andres Schanzer,Peter Schneider,Spence M. Taylor,Melina Vega de Ceniga,Martin Veller,Frank Vermassen,Jinsong Wang,Shenming Wang +58 more
TL;DR: The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP) resulting in three stages of complexity for intervention.
Journal ArticleDOI
An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)
Michael R. Jaff,Christopher J. White,William R. Hiatt,Gerry Fowkes,John A. Dormandy,Mahmood K. Razavi,Jim A. Reekers,Lars Norgren +7 more
TL;DR: The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
Journal ArticleDOI
An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).
Michael R. Jaff,Christopher J. White,William R. Hiatt,Gerry Fowkes,John A. Dormandy,Mahmood K. Razavi,Jim A. Reekers,Lars Norgren +7 more
TL;DR: The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
Journal ArticleDOI
An update on methods for revascularization and expansion of the TASC lesion classification to include below‐the‐knee arteries: A supplement to the inter‐society consensus for the management of peripheral arterial disease (TASC II): The TASC steering committee*
Michael R. Jaff,Christopher J. White,William R. Hiatt,Gerry Fowkes,John A. Dormandy,Mahmood K. Razavi,Jim A. Reekers,Lars Norgren +7 more
TL;DR: The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
Journal ArticleDOI
Critical Limb Ischemia : An Expert Statement
Mehdi H. Shishehbor,Christopher J. White,Bruce H. Gray,Matthew T. Menard,Robert A. Lookstein,Kenneth Rosenfield,Michael R. Jaff +6 more
TL;DR: A comprehensive summary that includes diagnostic assessment and analysis, endovascular versus open surgical treatment, regenerative and adjunctive therapies, and other important aspects of CLI is provided.
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