ABSTRACT
OBJECTIVES: We compared the angiographic outcomes of patients treated with orbital atherectomy for profunda femoris artery (PFA) and superficial femoral artery (SFA) disease from the CONFIRM I-III registries. BACKGROUND: Endovascular revascularization of the PFA is considered a high-risk procedure given that it is an important collateral vessel when the SFA becomes occluded. Data on outcomes of endovascular revascularization of calcified PFA disease are limited. METHODS: The treatment of PFA disease with orbital atherectomy has not been previously reported. Patient demographics, lesion characteristics, and procedure data for all CONFIRM patients with at least one PFA lesion location (n = 33 patients; n = 33 lesions) were compared to patients with at least one SFA lesion location (n = 1574 patients; n = 1811 lesions). The primary endpoint was angiographic complication, defined as the composite of flow-limiting dissection, perforation, slow flow, vessel closure, spasm, embolism, or thrombosis. RESULTS: The PFA group had a shorter lesion length, larger residual stenosis, shorter total run time, and shorter inflation time. Adjunctive stenting was only performed in the SFA group (10%); no patient in the PFA group underwent stenting. The primary endpoint was low in the PFA group and compared favorably with the SFA group (3% vs 11%; P=.15). One patient in the PFA group had vessel spasm, while no patients had flow-limiting dissection, perforation, slow flow, vessel closure, embolism, or thrombus. CONCLUSIONS: Orbital atherectomy of the PFA was feasible and safe. A randomized trial is needed to determine the ideal treatment strategy for calcified PFA disease.
Subject(s)
Atherectomy/adverse effects , Endovascular Procedures/adverse effects , Femoral Artery , Peripheral Arterial Disease/surgery , Postoperative Complications/epidemiology , Registries , Vascular Calcification/surgery , Acute Disease , Aged , Female , Follow-Up Studies , Humans , Incidence , Male , Peripheral Arterial Disease/diagnosis , Retrospective Studies , Risk Factors , Severity of Illness Index , Treatment Outcome , United States/epidemiology , Vascular Calcification/diagnosisABSTRACT
Endovascular intervention is an appealing revascularization strategy for iliac artery disease. Atherectomy of the iliac artery is uncommon due to the risk of life-threatening perforation but may be necessary if the iliac lesion is heavily calcified, preventing stent delivery or optimal expansion. We assessed the feasibility and safety of orbital atherectomy for the treatment of iliac artery disease. Demographic data, lesion characteristics, and procedure outcomes for the CONFIRM patients with at least one iliac artery lesion treated with orbital atherectomy (n=62 patients; n=68 lesions) were compared to patients with at least one superficial femoral artery (SFA) lesion treated with orbital atherectomy (n=1570 patients; n=1809 lesions). The procedural complication rate, defined as the composite of flow limiting dissection, perforation, slow flow, vessel closure, spasm, embolism, or thrombosis, was compared in iliac lesions versus SFA lesions. The iliac artery group had more patients with diabetes, shorter lesions, and more severely calcified lesions. The orbital atherectomy run time was significantly shorter in the iliac artery group. Additionally, in the iliac group there was one reported perforation and one reported vessel closure; the rates of slow flow, spasm, embolism, thrombus, and flow limiting dissection were 0%. The overall procedural complication rate was significantly lower in the iliac group (2.9% vs. 11.2%, p=0.03). Orbital atherectomy of the iliac artery is feasible with few reported angiographic complications and compared favorably with the SFA group. Orbital atherectomy may be considered to facilitate the delivery and expansion of a balloon or stent if the iliac artery is calcified.
Subject(s)
Atherectomy/methods , Iliac Artery/surgery , Peripheral Arterial Disease/surgery , Aged , Aged, 80 and over , Atherectomy/adverse effects , Feasibility Studies , Female , Humans , Iliac Artery/diagnostic imaging , Male , Middle Aged , Operative Time , Peripheral Arterial Disease/diagnostic imaging , Postoperative Complications/etiology , Registries , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , United StatesABSTRACT
In patients with carcinoid syndrome, the development of carcinoid valve disease typically carries an unfavorable prognosis. We present the case of a patient with significant valvular dysfunction secondary to carcinoid valve disease. Valve replacement surgery was complicated by the development of prosthetic valve degeneration, ultimately requiring percutaneous valve implantation in a valve-in-valve fashion. The technical details of the case, as well as a review of carcinoid valve disease, including its pathophysiology, clinical manifestations, diagnostic features and management considerations, are presented.
Subject(s)
Carcinoid Heart Disease , Pulmonary Valve Insufficiency , Pulmonary Valve , Tricuspid Valve Insufficiency , Tricuspid Valve , Bioprosthesis , Carcinoid Heart Disease/complications , Carcinoid Heart Disease/diagnostic imaging , Carcinoid Heart Disease/pathology , Carcinoid Heart Disease/surgery , Cardiac Catheterization/instrumentation , Female , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Humans , Middle Aged , Prosthesis Failure , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/pathology , Pulmonary Valve/surgery , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/etiology , Pulmonary Valve Insufficiency/pathology , Pulmonary Valve Insufficiency/surgery , Treatment Outcome , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/pathology , Tricuspid Valve/surgery , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/pathology , Tricuspid Valve Insufficiency/surgeryABSTRACT
This analysis compared the angiographic outcomes of patients treated with orbital atherectomy for calcified common femoral artery (CFA) and superficial femoral artery (SFA) disease. The ideal revascularization strategy for CFA disease is unknown. Endarterectomy has been considered the standard of care for CFA disease for over 50 years. Endovascular intervention is becoming more commonly used to revascularize the CFA given the advances in technology and the less invasive nature of the procedure. Patient demographics, lesion characteristics, and procedure data for all CONFIRM patients with at least one CFA lesion location ( n=147 patients; n=200 lesions) were compared to patients with at least one SFA lesion location ( n=1508 patients; n=2367 lesions). The primary endpoint was angiographic complication, defined as the composite of dissection, perforation, slow flow, closure, spasm, embolism, or thrombosis. The CFA group had more patients with Rutherford class 4 and shorter lesion length. The CFA group had a higher final residual stenosis, shorter total run time, and shorter total inflation time. The primary endpoint was lower in the CFA group compared with the SFA group (17% vs 24%, p=0.02), driven by a lower dissection rate (10% vs 15%, p=0.04). Plaque modification of the CFA with orbital atherectomy was safe and compared favorably with SFA disease. The need for bail-out stenting was low. A randomized trial is needed to determine the ideal treatment strategy for calcified CFA disease.
