JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS

Data supporting the use of intravascular ultrasound (IVUS) in aortoiliac and femoropopliteal endovascular intervention are becoming increasingly robust, but data in the infrapopliteal circulation remain limited. The aim of this study was to evaluate the association between IVUS use and 1-year outcomes after infrapopliteal intervention.

AMERICAN HEART ASSOCIATION NEWS

Early diagnosis and treatment of peripheral artery disease (PAD) are essential to prevent amputations and cardiovascular issues. New guidelines emphasize the need to address disparities in amputation and revascularization procedures to help improve outcomes for all PAD patients. Early diagnosis, a multispecialty approach, and targeted treatments are crucial. Special focus on at-risk groups is essential for better management and outcomes.

CIRCULATION

In the BEST-CLI trial (Best Endovascular Versus Best Surgical Therapy for Patients With Chronic Limb-Threatening Ischemia), a prespecified secondary objective was to assess the effects of revascularization strategy on health-related quality of life (HRQoL).

AMERICAN COLLEGE OF CARDIOLOGY

3D imaging approach improves outcomes with procedure to open clogged arteries in the leg.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

Patients with chronic limb-threatening ischemia, the terminal stage of peripheral artery disease, are frequently afflicted by below-the-knee disease. Although all patients should receive guideline-directed medical therapy, restoration of inline flow is oftentimes necessary to avoid limb loss. Proper patient selection and proficiency in endovascular techniques for below-the-knee revascularization are intended to prevent major amputation and promote wound healing. This review, a consensus among an international panel of experienced operators, provides guidance on these challenges from an endovascular perspective and offers techniques to navigate this complex disease process.

JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS

Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable’s aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.

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CUREUS

Phlegmasia cerulea dolens is a rare and severe form of deep venous thrombosis (DVT), characterized by an extensive thrombus burden and compromised venous outflow. We present the case of a 28-year-old male with a history of bilateral lower extremity DVTs and multiple venous stents who presented with acute-onset pain and swelling in the left lower extremity. Diagnostic imaging confirmed an acute DVT extending throughout the left lower extremity, including the external iliac vein. Given the diagnosis of phlegmasia cerulea dolens, a multidisciplinary approach involving interventional cardiology, orthopedic surgery, and vascular surgery was adopted. Intravascular ultrasound (IVUS)-guided thrombus removal and angioplasty were performed to restore venous outflow and improve limb perfusion. The procedure successfully removed a significant amount of thrombus and improved flow throughout the venous system. The patient exhibited an excellent clinical response, with pain resolution and improved perfusion. This case highlights the challenges and effectiveness of a combined intervention in managing complex phlegmasia cerulea dolens cases with previous venous stents.

THE LANCET

Chronic limb-threatening ischaemia is the severest manifestation of peripheral arterial disease and presents with ischaemic pain at rest or tissue loss (ulceration, gangrene, or both), or both. We compared the effectiveness of a vein bypass first with a best endovascular treatment first revascularisation strategy in terms of preventing major amputation and death in patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion.

THE NEW ENGLAND JOURNAL OF MEDICINE

BACKGROUND Approximately 20% of patients with chronic limb-threatening ischemia have no revascularization options, leading to above-ankle amputation. Transcatheter arterialization of the deep veins is a percutaneous approach that creates an artery-to-vein connection for delivery of oxygenated blood by means of the venous system to the ischemic foot to prevent amputation.

EUROPEAN HEART JOOURNAL OPEN

Sleep duration has been associated with cardiovascular disease, however the effect of sleep on peripheral artery disease (PAD) specifically remains unestablished. We conducted observational and Mendelian randomization (MR) analyses to assess the associations of sleep duration and daytime napping with PAD risk.

CARDIOVASCULAR BUSINESS

We spoke with BEST-CLI trial principal investigators Alik Farber, MD, from Boston Medical Center; Matthew Menard, MD, from Brigham and Women's Hospital; and Ken Rosenfield, MD, from Mass General Hospital during the American Heart Association’s Scientific Sessions 2022 conference in Chicago The trial looked at endovascular versus bypass surgery in patients with critical limb ischemia (CLI) to see which treatment option is better.

CISION PRNEWSWIRE

The VIVA Foundation, a not-for-profit organization dedicated to advancing the field of vascular medicine and intervention through education and research, announces the results for the first of three Late-Breaking Clinical Trials session at the VIVA22 conference, hosted at Wynn Las Vegas.

AMERICAN DIABETES ASSOCIATION

Diabetes is the single greatest factor in amputations—more than 60 percent of non-traumatic lower limb amputations happen in the diabetes population. An individual who has had an amputation has a worse chance of five-year survival than someone with coronary artery disease, breast cancer, and colorectal cancer. Amputations in the United States are also substantially more prevalent among people of color.

DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY

Details on late-breaking clinical trials to be presented during The VEINS (Venous Endovascular INterventional Strategies) and VIVA (Vascular InterVentional Advances) Annual Conference have been announced. Leading physicians and researchers will present results from 21 clinical trials, from Monday, October 31, to Wednesday, November 2, at Wynn Las Vegas.

CARDIOVASCULAR COALITION

September is Peripheral Artery Disease (PAD) Awareness Month! PAD is a chronic circulatory condition, which if left untreated can result in unnecessary limb amputations. PAD affects nearly 20 million Americans, and an estimated 200,000 of them – disproportionately from minorities communities – suffer avoidable amputations every year.

CUREUS

Abstract: Peripheral vascular disease (PVD) is chronic limb ischemia caused by atherosclerosis of the peripheral arteries. Diabetes mellitus (DM) is a risk factor for this disease. The probability of a diabetic foot ulcer (DFU) is higher in a patient with DM and PVD than in a patient without DM. Ankle-brachial-pressure index (ABPI) allows the measurement of blood flow towards the distal extremities, which could help timely diagnosis, initiate brief therapy, and minimize the risk of critical limb ischemia and loss. This study aims to determine the prevalence of peripheral vascular disease and assess its association with intima-media thickness (IMT) in diabetic patients with and without foot ulcers in India. In the present study, we included all type 2 DM patients. The assessment was...

THE CLINICAL ADVISOR

Walking at high intensity improved leg function among people with peripheral artery disease (PAD), according to research published in the Journal of the American Heart Association. “We were surprised by the results because walking for exercise at a pace that induces pain in the legs among people with PAD has been thought to be damaging to leg muscles,” said senior study author...

APPLIEDRADIOLOGY

Royal Philips announced the latest results from the Tack Optimized Balloon Angioplasty (TOBA) II below-the-knee (BTK) clinical trial, demonstrating that the Philips endovascular system – Tack (4F) – provides a sustained treatment effect and positive impact on quality of life for patients with critical limb ischemia (CLI), a severe stage of peripheral arterial disease (PAD), out to three years of clinical follow-up.

TCTMD

Compared with angiography alone, adding IVUS imaging to femoropopliteal artery interventions with drug-coated balloons (DCBs) results in less binary restenosis at 1 year, according to results from a single-center RCT. Yet the benefit wasn’t seen for procedures involving plain old balloon angioplasty (POBA) or stenting.

EURASIA REVIEW

Researchers at the University and the University Hospital of Bonn have developed a method that could be used to diagnose atherosclerosis. Using self-learning software, they were able to identify vascular changes in patients with peripheral arterial disease (PAD), often at an early stage. Although these early stages do not yet cause symptoms, they are nevertheless already associated with increased mortality. The algorithm used photos from an organ not normally associated with PAD: the eye. The results have now been published in the journal Scientific Reports.

GLOBE NEWSWIRE

TheWaytoMyHeart.org, a national non-profit Peripheral Artery Disease (PAD) patient advocacy group out of California, announced today that February 19, 2022 will be the first annual national “Red Sock Day” building awareness for Peripheral Artery Disease (PAD), its patients and treatment. The official proclamation will take place Wednesday February 16 at 10 am CST.

PAD is a disease that affects over 12 million Americans. Left untreated, PAD can lead to resting leg pain, foot wounds that won’t heal, gangrene and even amputation. Yet the majority of cases go undiagnosed, in part due to low awareness and testing.

VASCULAR NEWS

At this year’s International Symposium on Endovascular Therapy (ISET 2022; 16–19 January, Hollywood, USA), experts presented an array of late-breaking trial results on topics ranging from venous stenting to abdominal aortic aneurysm (AAA) sac sealing. Waseem Wahood (Dr Kiran C Patel College of Allopathic Medicine, Davie, USA) gave a US national perspective on disparities in the treatment of peripheral arterial disease (PAD) and chronic limb-threatening ischaemia (CLTI).

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MEDICAL XPRESS

There is an increased risk for venous thromboembolism (VTE) and peripheral vascular disease (PVD) among patients with psoriatic disease, according to a review published online Dec. 1 in JAMA Dermatology.

DOCWIRE NEWS

Peripheral arterial disease (PAD) patients face a high risk of limb amputation, according to the European Journal of Vascular and Endovascular Surgery.

The ultimate aim of this study was to assess the link between long term risk of hospitalization for heart failure (HHF) and lower extremity minor and major amputation (LEA) in patients initiating sodium glucose cotransporter 2 inhibitors (SGLT2i) suffering from type 2 diabetes and PAD.

CATHETERIZATION & CARDIOVASCULAR INTERVENTIONS

Abstract

Background: Endarterectomy is considered the gold standard therapy for common femoral artery (CFA) steno-occlusive lesions, but a significant risk of perioperative mortality and complications has been reported.

Objective: Aim of this study is to evaluate the efficacy at a long-term follow-up of patients with CFA steno-occlusive lesions treated with directional atherectomy and drug coated balloon (DCB).

VASCULAR NEWS

Royal Philips today announced the results of a new large-scale real-world analysis of Centers for Medicare & Medicaid Services (CMS) data on the health outcomes of peripheral vascular interventions guided by intravascular ultrasound (IVUS).

VASA

Summary: Patients with peripheral arterial disease (PAD) are at very high risk of cardiovascular events, but risk factor management is usually suboptimal. This Joint Task Force from the European Atherosclerosis Society and the European Society of Vascular Medicine has updated evidence on the management on dyslipidaemia and thrombotic factors in patients with PAD. Guidelines recommend a low-density lipoprotein cholesterol (LDLC) goal of more than 50% reduction from baseline and <1.4 mmol/L (<55 mg/dL) in PAD patients. As demonstrated by randomized controlled trials, lowering LDL-C not only reduces cardiovascular events but also major adverse limb events (MALE), including amputations, of the order of 25%...

JOURNAL OF THE AMERICAN HEART ASSOCIATION

Background: Ankle‐brachial index (ABI) is used to identify lower‐extremity peripheral artery disease (PAD). However, its association with severe ischemic leg outcomes (eg, amputation) has not been investigated in the general population.

MEDICAL DIALOGUES

Patients with peripheral artery disease (PAD) undergoing lower extremity revascularization (LER) benefit from low-dose rivaroxaban and aspirin therapy, suggests a study published in the Circulation. Patients with peripheral artery disease (PAD) are at heightened risk of acute limb ischemia (ALI), a thrombotic event associated with amputation, disability, and mortality. Prior lower extremity revascularization (LER) is associated with increased ALI risk in chronic peripheral artery disease (PAD).

BIZ NEW ORLEANS

Cardiovascular Institute of the South founder Craig Walker said he is the first physician in the U.S. to use the Philips Laser System Nexcimer to reopen blockages in arteries. The first case took place on Oct. 28 at the CIS Ambulatory Surgery Center in Gray, Louisiana to treat peripheral artery disease in the legs.

DOCWIRE NEWS

Introduction: Guideline-directed medical therapy (GDMT) is imperative to improve cardiovascular and limb outcomes for patients with critical limb ischemia (CLI), especially amongst those at highest risk for poor outcomes, including those with comorbid chronic kidney disease (CKD). Our objective was to examine GDMT prescription rates and their variation across individual sites for patients with CLI undergoing peripheral vascular interventions (PVIs), by their comorbid CKD status.

CIRCULATION: CARDIOVASCULAR INTERVENTIONS

Background: There are limited data on differences in angiographic distribution of peripheral artery disease and endovascular revascularization strategies in patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). We aimed to compare anatomic features, treatment strategies, and clinical outcomes between patients with IC and CLI undergoing endovascular revascularization.