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1.
J Endovasc Ther ; 27(1): 34-41, 2020 02.
Article in English | MEDLINE | ID: mdl-31637956

ABSTRACT

Purpose: To explore the provisional use of a drug-eluting stent (DES) after suboptimal drug-coated balloon (DCB) angioplasty in complex, calcified femoropopliteal lesions. Materials and Methods: A prospective, single-center, investigator-initiated pilot study enrolled 15 patients (mean age 71.3 years; 9 men) with symptomatic stenosis (n=6) or occlusion (n=9) of the native superficial femoral and/or proximal popliteal arteries who experienced suboptimal DCB dilation despite postdilation. Lesion characteristics were evaluated with computed tomography angiography and duplex ultrasound confirmed by intravascular ultrasound. Follow-up included clinical and imaging evaluations as well as blood tests to monitor inflammatory markers. Endpoints included systemic inflammation, acute/chronic thrombosis, aneurysm formation, and mortality. Results: Provisional stenting was required for residual stenosis >50% in 4 cases and flow-limiting dissection in 11. Provisional spot stenting was done using the Zilver PTX DES. Clinical improvement was observed in all cases. After 24-month follow-up all patients were alive and in good clinical condition. One- and 2-year primary patency rates were 93.3% and 92.9%, respectively; secondary patency was 100%. Restenosis required reintervention in 2 cases. No local or systemic complications or toxicity were observed due to the use of a double dose of paclitaxel. No significant increase in any inflammation marker was observed in the perioperative period, and no aneurysm formation was seen over 24 months of follow-up. Conclusion: Combined DCB plus DES therapy seems to be safe and correlated with high primary patency following suboptimal angioplasty. Larger studies are required to confirm the safety and efficacy of this approach.


Subject(s)
Angioplasty, Balloon/instrumentation , Cardiovascular Agents/administration & dosage , Coated Materials, Biocompatible , Drug-Eluting Stents , Femoral Artery , Paclitaxel/administration & dosage , Peripheral Arterial Disease/therapy , Popliteal Artery , Vascular Access Devices , Vascular Calcification/therapy , Aged , Angioplasty, Balloon/adverse effects , Cardiovascular Agents/adverse effects , Constriction, Pathologic , Female , Femoral Artery/diagnostic imaging , Femoral Artery/physiopathology , Humans , Male , Paclitaxel/adverse effects , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Pilot Projects , Popliteal Artery/diagnostic imaging , Popliteal Artery/physiopathology , Prospective Studies , Prosthesis Design , Time Factors , Treatment Outcome , Vascular Calcification/diagnostic imaging , Vascular Calcification/physiopathology , Vascular Patency
2.
Ann Vasc Surg ; 55: 272-284, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30114503

ABSTRACT

Lower limb atherosclerotic disease has classically been classified as acute or chronic; however, this is an evolving process that has a wide spectrum of clinical and imaging aspects. Owing to the evolvement of endovascular and imaging techniques, we have now garnered new information regarding the pathophysiology and behavior of atherosclerotic disease, also in response to endovascular and surgical techniques. Clinical presentation can actually be classified according to the time of presentation, ranging from acute (<2 weeks) and subacute (from 2 weeks to 3 months) to chronic (over 3 months) and acute/subacute on underlying chronic disease. Imaging characteristics such as the presence of thrombus, number of collaterals, and target vessel wall features may help in defining the correct type of atherosclerotic lesion, triggering the appropriate treatment strategy. Clinical and imaging characteristics of those different stages are complex and not systematically addressed by current guidelines, that do not show any specific recommendations for imaging pathways/characteristics or treatment. This review illustrates the clinical and imaging characteristics of the different stages of lower limb atherosclerotic disease and related treatment options.


Subject(s)
Lower Extremity/blood supply , Peripheral Arterial Disease/diagnostic imaging , Acute Disease , Aged , Aged, 80 and over , Chronic Disease , Clinical Decision-Making , Female , Humans , Male , Middle Aged , Patient Selection , Peripheral Arterial Disease/classification , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/therapy , Prognosis , Regional Blood Flow , Risk Factors , Severity of Illness Index
3.
Vasc Endovascular Surg ; 52(6): 440-447, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29669475

ABSTRACT

The application of advanced endovascular techniques in very complex femoropopliteal atherosclerotic lesions has shown to expose patients to a higher risk of distal embolization (DE). This complication can affect both the short- and long-term outcomes, leading to worsening ischemia, early minor/major amputation, and longer hospital stay. Recently, there has been an increasing body of evidence on pathophysiology and clinical-radiological management of DE that however has not been systematically addressed by guidelines. The aim of this review was to analyze the current evidence outlining definition and classification, risk assessment, prevention, and management strategies of DE in femoropopliteal endovascular interventions.


Subject(s)
Embolism/etiology , Endovascular Procedures/adverse effects , Femoral Artery , Peripheral Arterial Disease/therapy , Popliteal Artery , Aged , Computed Tomography Angiography , Embolism/diagnostic imaging , Embolism/therapy , Female , Femoral Artery/diagnostic imaging , Humans , Male , Middle Aged , Peripheral Arterial Disease/diagnostic imaging , Popliteal Artery/diagnostic imaging , Risk Factors , Treatment Outcome
4.
J Vasc Interv Radiol ; 27(7): 1056-69, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27107982

ABSTRACT

The management of malignant biliary tumors (MBTs) is complex and requires a multidisciplinary approach. Guidelines and methods of staging for biliary tumors have recently been released by main international societies, altering the clinical and radiologic approach to this pathologic condition. The aim of the present review is to detail the updated role of imaging in preoperative staging and follow-up and to illustrate clinical/therapeutic pathways. In addition, future perspectives on imaging and targeted/embolization therapies are outlined.


Subject(s)
Biliary Tract Neoplasms/diagnostic imaging , Biliary Tract Neoplasms/therapy , Diagnostic Imaging/methods , Aged , Biliary Tract Neoplasms/complications , Biliary Tract Neoplasms/pathology , Female , Humans , Male , Middle Aged , Neoplasm Staging , Patient Selection , Practice Guidelines as Topic , Predictive Value of Tests , Treatment Outcome
5.
JACC Cardiovasc Interv ; 9(2): 183-91, 2016 Jan 25.
Article in English | MEDLINE | ID: mdl-26793960

ABSTRACT

OBJECTIVES: The aim of this study was to assess factors influencing the clinical outcome and morphological changes of acute and chronic type B aortic dissection after thoracic endovascular aortic repair (TEVAR). BACKGROUND: Aortic remodeling after TEVAR may be associated with clinical outcome, complications, and endoleak development. METHODS: Sixty cases of TEVAR for complicated type B acute aortic dissection (AAD) (n = 29) and chronic aortic dissection (CAD) (n = 31) with a minimum follow-up of 3 years were retrospectively reviewed. Using computed tomography images, we assessed true lumen, false lumen, and total aortic short-axis diameters. Six procedural factors were analyzed in relation to aortic remodeling and other outcomes. Analysis of variance was used to compare short-axis, false lumen, and true lumen diameters during the follow-up period. Univariate and multivariate analyses were used to assess the relationship between procedural factors and multiple outcomes. RESULTS: A total of 100 stent grafts were implanted in 60 consecutive patients with acute aortic dissection (AAD) and CAD. Aortic remodeling consisting of false lumen thrombosis and shrinkage was more prominent in AAD than in CAD, especially within the first 18 months. Of note, the entire aortic diameter increased significantly cephalad to the stent graft in AAD. Only in the AAD group there was increased aortic remodeling related to post-dilation of the stent graft. Type I and II endoleaks occurred in 17 patients (28%); in AAD, embolization of the left subclavian artery after stent graft deployment was significantly associated with a lower risk of endoleak development, but this was not evident in CAD. CONCLUSIONS: Aortic remodeling and clinical outcome after TEVAR can be influenced by procedural techniques (post-dilation and embolization of the left subclavian artery in patients with acute but not chronic aortic dissection).


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Vascular Remodeling , Acute Disease , Aged , Aortic Dissection/diagnosis , Aortic Dissection/physiopathology , Aorta, Thoracic/pathology , Aorta, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/physiopathology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Chronic Disease , Endoleak/etiology , Endoleak/physiopathology , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Female , Humans , Male , Multivariate Analysis , Retrospective Studies , Risk Factors , Stents , Time Factors , Treatment Outcome
7.
Atherosclerosis ; 231(2): 205-10, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24267227

ABSTRACT

INTRODUCTION: Altered carotid blood flow velocities (CFV) have a complex background but the underlying genetic contribution is still unclear. We sought to evaluate the influence of genetics, shared and unshared environmental components on individual differences of CFV. METHODS: 193 healthy twin pairs, 126 monozygotic (MZ) and 67 dizygotic (DZ) (mean age 53 ± 14 years) recruited in Italy, in the United States and in Hungary underwent bilateral color-coded Doppler flow assessment of the common carotid artery (CCA) and of the internal carotid artery (ICA) in order to assess the peak systolic (PSV) and end diastolic (EDV) velocities. Means of bilateral CFV values were used in the analysis. RESULTS: Age- and country-adjusted intra-class correlations were higher in monozygotic than in dizygotic pairs for mean PSV of the ICA indicating a heritability of 63%. Unique environmental factors contributed to 37% of ICA PSV. With regards to the mean PSV and EDV of the CCA, and EDV of the ICA, heritability analysis indicated no discernible role for genetic components, while the contributions of shared and unshared environmental factors ranged between 56% and 63%, and between 37% and 44% adjusted for age and country, respectively. Mean ICA/CCA ratio was driven by unique environmental factors (82%) with modest heritability (18%). CONCLUSIONS: Our study showed that the heritability of ICA PSV and ICA/CCA ratio is moderate, while the findings do not support heritability of other investigated CFV values. Environmental effects account for a moderate to major portion of the variance. These findings support the value of early ultrasound screening as well as the prevention of modifiable environmental factors in case of altered carotid flow velocities.


Subject(s)
Blood Flow Velocity/physiology , Carotid Artery, Common/pathology , Carotid Artery, Internal/pathology , Stroke/genetics , Adult , Aged , Carotid Artery, Common/diagnostic imaging , Carotid Artery, Internal/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/pathology , Cohort Studies , Female , Gene-Environment Interaction , Genetic Predisposition to Disease , Humans , Hungary , Ischemia/pathology , Italy , Male , Middle Aged , Regression Analysis , Risk Factors , Stroke/pathology , Ultrasonography, Doppler , United States , Young Adult
8.
Cardiovasc Intervent Radiol ; 36(1): 264-8, 2013 Feb.
Article in English | MEDLINE | ID: mdl-22526105

ABSTRACT

This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.


Subject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Femoral Artery/surgery , Ischemia/surgery , Leg/blood supply , Prosthesis-Related Infections/surgery , Stents , Aged , Angiography/methods , Blood Vessel Prosthesis Implantation/methods , Device Removal , Femoral Artery/diagnostic imaging , Follow-Up Studies , Humans , Ischemia/diagnosis , Male , Multidetector Computed Tomography/methods , Prosthesis-Related Infections/diagnosis , Reoperation/methods , Risk Assessment , Rupture, Spontaneous/diagnostic imaging , Rupture, Spontaneous/surgery , Treatment Outcome , Ultrasonography, Doppler, Color/methods
9.
J Vasc Surg ; 51(3): 584-91, 591.e1-3; discussion 592, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20045614

ABSTRACT

OBJECTIVE: Subclinical alterations of cerebral function can occur during or after carotid revascularization and can be detected by a variety of standard tests. This comparative study assessed the relationship among serum levels for two biochemical markers of cerebral injury, postoperative diffusion-weighted magnetic resonance imaging (DW-MRI), and neuropsychometric testing in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) for high-grade asymptomatic carotid stenosis. METHODS: Forty-three consecutive asymptomatic patients underwent carotid revascularization by endarterectomy (CEA, 20) or stenting (CAS, 23). They were evaluated with DW-MRI and the Mini-Mental State Examination (MMSE) test preoperatively and 5 points (P = .001). Analysis of S100beta and NSE levels showed a significant increase at 24 hours in CAS patients compared with CEA patients (P = .02). The MMSE score at 6 months showed a nonsignificant increase vs the postoperative score in both groups. CONCLUSIONS: Biochemical markers measurements of brain damage combined with neuropsychometric tests and DW-MRI can be used to evaluate silent injuries after CAS. The mechanisms of rise in S100beta and NSE levels at 24 hours after CAS may be due to increased perioperative microembolization rather than to hypoperfusion. Further studies are required to assess the clinical significance of those tests in carotid revascularization.


Subject(s)
Angioplasty, Balloon/instrumentation , Carotid Stenosis/therapy , Cerebrovascular Disorders/diagnosis , Diffusion Magnetic Resonance Imaging , Endarterectomy, Carotid , Nerve Growth Factors/blood , Neuropsychological Tests , Phosphopyruvate Hydratase/blood , S100 Proteins/blood , Stents , Aged , Aged, 80 and over , Angioplasty, Balloon/adverse effects , Biomarkers/blood , Brain/metabolism , Brain/pathology , Carotid Stenosis/surgery , Cerebrovascular Disorders/blood , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/pathology , Endarterectomy, Carotid/adverse effects , Female , Humans , Male , Pilot Projects , Predictive Value of Tests , Prospective Studies , Psychiatric Status Rating Scales , Psychometrics , S100 Calcium Binding Protein beta Subunit , Time Factors , Treatment Outcome
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