RESUMO
Peripheral arterial disease (PAD) involving the lower extremity is a major source of morbidity and mortality. Clinical manifestations of PAD span the spectrum from lifestyle limiting claudication to ulceration and gangrene leading to amputation. Advancements including balloon angioplasty, self-expanding stents, drug-eluting stents, and atherectomy have resulted in high technical success rates for endovascular therapy in patients with PAD. However, these advances have been limited by somewhat high rates of clinical restenosis and clinically driven target lesion revascularization. The recent introduction of drug-coated balloon technology shows promise in limiting neointimal hyperplasia induced by vascular injury after endovascular therapies. This review summarizes the contemporary clinical data in the emerging area of drug-coated balloons.
RESUMO
Off-label "double-wire" technique for closure of large-bore vascular access has been reported in the setting of percutaneous aortic valvuloplasty. We present 5 cases of high-risk percutaneous coronary intervention (HRPCI) supported by a 2.5 LP Impella assist device with 13 and 14 Fr size femoral access. Following successful HRPCI, vessel closure was complicated by unsuccessful deployment of a suture-mediated closure device. Subsequently, deployment of two successive collagen-based closure devices with a "double-wire" technique was performed. Our cases warrant further studies to test the feasibility of using double-closure device as an alternative for vessel closure when left ventricular assist devices are needed to support HRPCI.
