Peripheral Arterial Lesions Research Articles

Feasibility of Ambulatory Percutaneous Femoral Access without the Use of Arterial Closure Systems

To evaluate the feasibility of early ambulation in patients treated for peripheral occlusive lesions by femoral percutaneous access, without the use of closure systems and the application to ambulatory practice. This single-center observational exploratory study was undertaken among 99 consecutive patients between August 1-December 31, 2011 (mean age: 72years; 72 men) who were treated by percutaneous femoral route for peripheral arterial lesions. All the patients had a manual compression then pressure bandage. A clinical evaluation was carried out after 4hours, seeking a local or a general complication and checking the procedure. Rising and walking in the unit of hospitalization were authorized in the absence of complication as of 4 hours postoperatively. All patients remained in hospital for at least 1 night, with a clinical revaluation before discharge. All patients were contacted by telephone at postoperative day 7 in order to verify the absence of local complications. All the individual factors and those related to the procedure were analyzed. With criteria of complications related to the gesture, 72 patients (72.7%) were considered ready to be discharged as of postoperative hour 4. Among the 27 patients who were not able to leave, 7 presented with an early local complication without reoperation, and 20 could not walk because of a necrotic lesion (n=8), their advanced age (n=4), morbid obesity (n=2), or a choice of the surgeon in charge (n=6). Twenty-five patients could, however, stroll after 12 hours. The mean duration of hospitalization was 1.3days (range: 0-10days). Two patients required distal amputation during the same hospitalization, and 1underwent a femoropopliteal bypass after failure of a femoropopliteal recanalization. With univariate analysis, the treatment by anticoagulants and the duration of the hospitalization were the only factors significantly related to the impossibility of early ambulation. The occurrence of complications was linked with the experience of the surgeon, the age of the patient, and the female sex. Three patients, including 2 regarded as ready to walk by postoperative hour 4, were rehospitalized after 1 week for reoperation because of 1 major hematoma and 2 femoral false aneurysms. Percutaneous endovascular surgery by the femoral route without using an arterial closure system is feasible in an ambulatory practice in nearly 75% of cases. Particular monitoring must be done in the oldest patients, women, and those treated with anticoagulants.

Directional atherectomy of a heavy calcified axillary artery stenosis inducing critical hand ischemia

The presence of a severe calcified peripheral artery lesion is responsible for a poor response to balloon dilation, due to significant acute vessel recoil and frequent flow-limiting dissections requiring stent implantation. This possibility could be associated with very high compression and/or fracture rates particularly in cases of lesion located at the mobile joints. In this setting directional atherectomy offers the theoretical advantages of eliminating stretch injury on arterial walls and reducing the restenosis rate by direct plaque excision. In this report, we present a case of critical hand ischemia due to a heavily calcified axillary artery lesion managed by directional atherectomy and balloon angioplasty followed by immediate angiographic success and sustained clinical benefit up to 3years of follow-up.

超音波による大動脈・末梢動脈病変の標準的評価法

「脈管」とは動脈・静脈およびリンパ管の総称であり，動脈と静脈を「血管」と称している．血管疾患には動脈疾患（脳・頸動脈，大動脈，冠・腹部・腎・末梢などの疾患）と静脈疾患（深部静脈血栓症など）がある．近年では動脈硬化性疾患の増加に伴い，無（低）侵襲的に動脈疾患を診断する方法などが注目され関心も高まってきた．動脈は全身に分布するため，全身の臓器とともに，動脈疾患の診断では動脈の特性やその特異性に注目する必要がある．本稿の目的は，高齢化や生活習慣病（糖尿病，脂質異常症，高血圧症，喫煙，肥満など）と関連し増加傾向にある動脈硬化疾患である「大動脈・末梢動脈病変」の超音波検査による標準的な評価方法を提示することである．それぞれの疾患を周知し，その診断基準に応じて確定診断をすることが必要である．

Organ-protective effect of fixed-dose combination antihypertensive therapy with eprosartan and hydrochlorothiazide for subclinical and clinical target organ damage in hypertensive patients

Aim: to evaluate the efficiency of starting fixed-dose combination therapy with eprosartan and hydrochlorothiazide on the clinical and subclinical parameters of target organ damage in patients with hypertensive disease (HD) irrespective of baseline blood pressure (BP) and cardiovascular risk. Subjects and methods. The study consisted of two parallel substudies. Substudy 1 that screened 3536 workers from industrial enterprises identified 395 (13%) hypertensive patients. Among them, there were 50 (12,7%) untreated patients with HD who had three-component target organ damages: left ventricular hypertrophy, hypertensive nephropathy, peripheral artery lesion. Sixty (15,2%) untreated patients with Stage 1 HD without clinical signs of organ changes were recorded among the same cohort in Substudy 2. In both substudies, Group 1 received a fixed-dose combination of eprosartan mesylate 600 mg once daily and hydrochlorothiazide 12,5 once daily regardless of baseline BP at the onset of the study. Group 2 had monotherapy with enalapril and/or its combination with hydrochlorothiazide depending on the degree of BP elevation and the group of a cardiovascular risk. Results. Starting fixed-dose combination antihypertensive therapy (eprosartan + hydrochlorothiazide) irrespective of baseline BP and cardiovascular risk versus monotherapy with enalapril and/or its free combination with hydrochlorothiazide, which was used in terms of BP level and cardiovascular risk ensured a more significant regression of both clinical and subclinical target organ damages during 6-month therapy according to the changes in left ventricular mass (LVM), LVM index, and tissue inhibitor of type 1 matrix metalloproteinases, microalbuminuria and glomerular filtration rate, intima-media complex thickness during carotid Doppler ultrasound study, and pulse wave velocity in different segments, as evidenced by volumetric sphygmoplethysmography. Conclusions. The use of a fixed-dose combination of eprosartan and hydrochlorothiazide in untreated patients of able-bodied age regardless of baseline BP and cardiovascular risk ensures the regression of target organ damages and the prevention of their development in the absence of organ changes.

A clinicopathologic study of immunoglobulin G4-related disease of the femoral and popliteal arteries in the spectrum of immunoglobulin G4-related periarteritis

Immunoglobulin (Ig) G4-related disease has recently been recognized to occur in the cardiovascular system in the aorta and main branching arteries, often manifesting as aneurysms and arteritis/periarteritis. Peripheral arteries (the femoral and popliteal arteries) are frequent sites of arteriosclerosis obliterans (ASO) and occasionally show aneurysms or arteritis. This study re-examined peripheral arterial lesions from the standpoint of IgG4-related disease. The study comprised 104 patients who underwent surgical treatment of peripheral arterial lesions, including 30 patients with peripheral arterial aneurysms (PAAs) and 74 with ASO. IgG4-related disease was identified on the basis of diffuse infiltration of numerous IgG4-positive plasmacytes as revealed by immunohistochemical examination. Clinicopathologic features were compared between IgG4-related and IgG4-unrelated lesions. IgG4-related disease was found in four of the 30 patients with PAAs (13.3%; two in the deep femoral artery, two in the popliteal artery) but not in any patients with ASO. IgG4-related PAA displayed clinicopathologic features resembling those of other IgG4-related diseases and a characteristic saccular appearance (P = .002). IgG4-related disease was detected in PAA patients but not in ASO patients. IgG4-related disease thus represents one potential etiology of aneurysm in the peripheral arteries.

Twisting of peripheral balloon appearing as a non-dilating peroneal artery lesion

Peripheral arterial lesions are usually longer than coronary artery lesions and require longer balloons and stents. Theoretically while advancing a long balloon in a long, high grade lesion with aggressive manipulation, the balloon can twist inside the lesion, but this has not been described before in the literature. Herein we are reporting a case where peripheral balloon (PB) twisted and appeared as a non-dilating lesion.

Use of Endovascular Therapy for Peripheral Arterial Lesions: An Analysis of the National Trauma Data Bank From 2007 to 2009

An endovascular approach is increasingly used for the treatment of peripheral arterial trauma (PAT), but evidence supporting this approach is lacking. The objective of our study was to assess outcomes for endovascular repair (ER) versus operative repair (OR) in PAT. We used the National Trauma Data Bank from 2007 to 2009 for our analysis, comparing in-hospital morbidity and mortality for all adult patients undergoing ER versus OR for PAT of the upper and lower extremities. Unadjusted and risk-adjusted generalized linear models were performed, with multiple imputation techniques being used to replace missing values. Of 8,977 patients, 531 (5.9%) underwent ER. Most patients were male (77.1%) and Caucasian (42.6%), with a mean age of 34.7 years (standard deviation: 14.8). ER was performed more commonly for lower- (n = 370, 10.4%) than upper-extremity lesions (n = 161, 3.0%, P < 0.001). Risk-adjusted analysis showed that ER patients had significantly greater injury severity scores (P < 0.001), were more likely to suffer a blunt (vs. penetrating) mechanism of injury (P < 0.001), and were more likely to have multiple comorbid illnesses (P < 0.001) than OR patients. Overall, risk-adjusted complications were less frequent after ER than OR (risk-adjusted OR: 0.79, P = 0.05), whereas in-hospital mortality between the two groups did not differ (risk-adjusted OR: 1.10, P = 0.59). Length of hospital stay was shorter among ER patients (adjusted mean difference: 0.78 days, P < 0.001), whereas length of intensive care unit stay did not differ between the two groups (P = 0.44). ER appears to be a viable option for patients with PAT. Further research is needed to identify potential subgroups of PAT patients in whom ER may be superior to OR.

Plaque characteristics and arterial remodeling in coronary and peripheral arterial systems

BackgroundFew studies have examined plaque characteristics among multiple arterial beds in vivo. The purpose of this study was to compare the plaque morphology and arterial remodeling between coronary and peripheral arteries using gray-scale and radiofrequency intravascular ultrasound (IVUS) at clinical presentation. Methods and resultsIVUS imaging was performed in 68 patients with coronary and 93 with peripheral artery lesions (29 carotid, 50 renal, and 14 iliac arteries). Plaques were classified as fibroatheroma (VH-FA) (further subclassified as thin-capped [VH-TCFA] and thick-capped [VH-ThCFA]), fibrocalcific plaque (VH-FC) and pathological intimal thickening (VH-PIT). Plaque rupture (13% of coronary, 7% of carotid, 6% of renal, and 7% of iliac arteries; P = NS) and VH-TCFA (37% of coronary, 24% of carotid, 16% of renal, and 7% of iliac arteries; P = 0.02) were observed in all arteries. Compared with coronary arteries, VH-FA was less frequently observed in renal (P < 0.001) and iliac arteries (P < 0.006). Lesions with positive remodeling demonstrated more characteristics of VH-FA in coronary (84% vs. 25%, P < 0.001), carotid (72% vs. 20%, P = 0.001), and renal arteries (42% vs. 4%, P = 0.001) compared with those with intermediate/negative remodeling. There was positive relationship between remodeling index and percent necrotic area in all four arteries. ConclusionsAtherosclerotic plaque phenotypes were heterogeneous among four different arteries; renal and iliac arteries had more stable phenotypes compared with coronary artery. In contrast, the associations of remodeling pattern with plaque phenotype and composition were similar among the various arterial beds.

Prevalence of combined atherosclerotic vascular lesions in patients with diabetes mellitus

During latest decade, as threat of acute complications of diabetes mellitus was surmounted, cardiovascular complications became leadingcause of death. Clinical manifestation of coronary, brachiocephalic and renal atherosclerosis is quite dramatic in diabetes mellitus,which determines extent of dissemination and intensity of lesions. Combination of these mutually confounding conditions is a characteristicproblem of patients with diabetes mellitus. Presence of 2+ risk factors (one of which is diabetes mellitus in itself) requiresactive examination in order to rule out coronary, brachiocephalic, peripheral and renal artery lesions. Aggressive care is necessaryin order to control progression of disease and administer adequate conservative and endovascular treatment with account of high riskof combination of lesions.

Historical Aspects of Transcatheter Treatment of Heart Disease in Children

The very first transcatheter intervention to treat congenital cardiac defects was reported by Rubio-Alvarez et al. [1] in 1953, when they performed pulmonary valvotomy using a modified ureteral catheter. A decade later Dotter, Rashkind, Porstmann and their associates described progressive dilatation of peripheral arterial stenotic lesions, balloon atrial septostomy and transcatheter occlusion of patent ductus arteriosus, respectively. The purpose of this review is to present these and other historical developments of catheter-based interventions in the treatment of heart disease in children. Historical aspects of 1. balloon angioplasty/valvuloplasty of valvar pulmonary stenosis, valvar aortic stenosis, fixed subaortic stenosis, native aortic coarctation, postsurgical aortic recoarctation, branch pulmonary artery stenosis, mitral stenosis, cyanotic heart defects with pulmonary oligemia, stenotic bioprosthetic valves, congenital tricuspid and mitral stenosis, truncal valve stenosis, subvalvar pulmonary stenosis, supravalvar pulmonary stenosis (congenital membranous or postoperative), stenosis of the aorta (Leriche syndrome, atherosclerotic and Takayasu’s arteritis), baffle obstruction following Mustard or Senning procedure (both systemic and pulmonary venous obstructions), superior and inferior vena caval obstructions, pulmonary vein stenosis, pulmonary veno‑occlusive disease, vertical vein stenosis in total anomalous pulmonary venous connection, pulmonary venous obstruction following repair of total anomalous pulmonary venous obstruction, specially designed pulmonary artery bands, cor triatriatum, cor triatriatum dexter, and coronary artery stenotic lesions that develop after Kawasaki disease; 2. stents to enlarge stenotic lesions of branch pulmonary arteries, systemic veins, systemic and pulmonary venous pathways after Mustard procedure, aorta, right ventricular outflow conduits, pulmonary veins and native right ventricular outflow tract or to keep the ductus arteriosus open in patients with pulmonary atresia and hypoplastic left heart syndrome and maintaining patency of stenosed aorto-pulmonary collateral vessels, surgically created but obstructed shunts or acutely thrombosed shunts as well as covered stents; 3. transcatheter occlusion of cardiac defects comprising of atrial septal defect, patent foramen ovale, patent ductus arteriosus, ventricular septal defect and aortopulmonary window and 4. catheter-based atrial septostomy such as Rashkind balloon atrial septostomy, Park’s blade atrial septostomy, balloon angioplasty of the atrial septum, trans-septal puncture and atrial septal stents were presented.

A imagem da hipertensão pulmonar

For instance, although the current guidelines strongly recommend the use of ventilation/perfusion imaging to exclude chronic thromboembolic pulmonary hypertension, this technique is not always available. At facilities staffed with well-trained radiologists who are familiar with the diagnosis of chronic thromboembolism, CT and magnetic resonance (MR) angiography present potential alternatives to ventilation/perfusion imaging. The ideal situation is that in which the various techniques are available and are used in a complementary manner, experienced hands making optimal use of the strengths of each imaging modality. For instance, when pulmonary hypertension is suspected, ventilation/perfusion imaging is considered the most sensitive tool for the diagnosis of chronic thromboembolic pulmonary hypertension. However, this technique provides no information on the pulmonary vasculature. Therefore, if ventilation/perfusion imaging indicates chronic thromboembolic pulmonary hypertension, additional investigation is required. Although CT angiography provides excellent data on the central pulmonary arteries, it is limited in the detection of small peripheral artery lesions.

Clinical success of hybrid surgical and endovascular therapy in multi-focal peripheral arterial lesions – Two year outcome study

Clinical success of hybrid surgical and endovascular therapy in multi-focal peripheral arterial lesions – Two year outcome study

Mechanism of lumen gain with a novel rotational aspiration atherectomy system for peripheral arterial disease: examination by intravascular ultrasound

The purpose of this study was to evaluate the mechanism of luminal gain with a novel atheroablation system (Pathway PV) for the treatment of peripheral artery disease using intravascular ultrasound (IVUS). The atherectomy system is a rotational atherectomy device, which employs expandable rotating blades with ports that allow flushing and aspiration of the plaque material or thrombus. In this first-in-man clinical study, IVUS analysis was available in 6 patients with lower limb ischemia treated with this device. The treatment results were assessed using IVUS at pre and post atherectomy. Lumen beyond burr size (LBB) was defined as lumen gain divided by the estimated burr area determined by the burr-size. IVUS analysis was available in six patients (superficial femoral artery n=3, popliteal artery n=2, posterior tibial artery n=1). Atheroablation achieved a significant increase in lumen area (LA) (preintervention 3.9+/-0.4, postatheroablation 8.0+/-1.7 mm(2), P<.05), and significant reduction in plaque area (27.5+/-4.0, 23.7+/-3.1 mm(2), P=.001), while there was no change in the vessel area (31.3+/-4.2, 32.1+/-2.8 mm(2), P=.4). LBB was 57.4+/-51.3%. This novel rotational aspiration atherectomy device achieved significant luminal gain by debulking in the absence of vessel stretching. The LA was greater than burr-sized lumen expectancy at cross-sections along the treated segments, suggesting a complimentary role of aspiration in luminal gain in atherosclerotic peripheral artery lesions.

Infrapopliteal run-off and the outcome of femoropopliteal percutaneous transluminal angioplasty

The outcome of percutaneous transluminal angioplasty (PTA) of peripheral arterial lesions is influenced by several factors, including the haemodynamic conditions. Our study tested: (a) whether infrapopliteal run-off after completed PTA influenced the time course of restenosis/reocclusion of the femoropopliteal arterial segment, and (b) whether worsening of infrapopliteal run-off influenced the long-term femoropopliteal patency after PTA. Among 245 patients treated by femoropopliteal PTA we enrolled 176 patients who consented to regular follow-up. Concomitant infrapopliteal PTA was performed whenever feasible. The technical success of PTA and the patency of calf arteries were assessed by angiography. Infrapopliteal run-off was scored by a modification of the Society for Vascular Surgery criteria. The treated patients' limbs were divided into a group with good infrapopliteal run-off and a group with compromised run-off. Follow-up examination of the femoropopliteal arterial segment was performed by vascular ultrasonography (US) 1, 6 and 12 months after PTA, and an adverse outcome was defined by a > or = 50 % stenosis, i.e., at least doubling of the maximal systolic velocity, or occlusion - evidenced by the absence of flow. The patency of calf arteries was re-assessed by US 12 months after PTA. One month after femoropopliteal PTA 19 / 83 (23 %) of patients with compromised run-off developed the combined end-point of restenosis or reocclusion in comparison to 10 / 93 (11 %) with good run-off (p = 0.03). After 6 months the incidence of restenosis/reocclusion had increased in both groups at an approximately equal rate, but the differences were no longer significant: 39 / 80 (49 %) in the compromised run-off group vs. 36 / 83 (43 %) in the good run-off group after 6 months, p = 0.49, and 42 / 73 (57 %) vs. 38 / 73 (52 %) after 12 months, p = 0.51. However, in patients' limbs with good periprocedural run-off that deteriorated into compromised run-off in the year after PTA, femoropopliteal restenosis/reocclusion occurred more often than in limbs which retained good run-off: 10 / 14 (71 %) vs. 18 / 51 (35 %), p = 0.02. Compromised postprocedural infrapopliteal run-off predisposes to early restenosis/reocclusion after femoropopliteal PTA. Deterioration of infrapopliteal run-off in the year after femoropopliteal PTA is accompanied by worsening of long-term femoropopliteal patency.

Comparison of 3D-diffusion-prepared segmented steady-state free precession and 2D fast spin echo imaging of femoral artery atherosclerosis

Magnetic resonance (MR) imaging is a promising modality for the in vivo detection and characterization of atherosclerotic lesions in peripheral arteries. 2D imaging techniques for evaluation of peripheral artery disease (PAD) suffer from poor spatial coverage and have long scan times. The purpose of this study was to compare a diffusion prepared dark blood 3D steady state free precession (3D-DP-SSFP) sequence for evaluating atherosclerotic plaque burden in inguinal and thigh segments of the femoral artery and comparing the results obtained with 2D turbo spin echo (2D-TSE) techniques. A further goal of the study was to examine the inter observer reproducibility of MR plaque burden measures using the 3D DP-SSFP technique. Results of the study indicated higher signal to noise ratios for the 3D-DP-SSFP technique and higher CNR (better vessel-wall delineation) compared to the 2D-TSE technique. Furthermore, a good correlation between 3D-DP-SSFP and 2D-TSE techniques for the inguinal segment but poorer correlation for the thigh segment was observed. Inter-observer reproducibility for the 3D plaque burden measures was excellent. 3D-DP-SSFP may be a useful and reproducible technique for evaluating atherosclerosis in peripheral arteries.

Mesenchymal stem cells-derived vascular smooth muscle cells release abundant levels of osteoprotegerin.

Although several studies have shown that the serum levels of osteoprotegerin (OPG) are significantly elevated in patients affected with atherosclerotic lesions in coronary and peripheral arteries, the cellular source and the role of OPG in the physiopathology of atherosclerosis are not completely defined. Therefore, we aimed to investigate the potential contribution of mesenchymal stem cells in the production/release of OPG. OPG was detectable by immunohistochemistry in aortic and coronary atherosclerotic plaques, within or in proximity of intimal vascular smooth muscle cells (SMC). In addition, bone marrow mesenchymal stem cell (MSC)-derived vascular SMC as well as primary aortic SMC released in the culture supernatant significantly higher levels of OPG with respect to MSC-derived endothelial cells (EC) or primary aortic EC. On the other hand, in vitro exposure to full-length human recombinant OPG significantly increased the proliferation rate of aortic SMC cultures, as monitored by bromodeoxyuridine incorporation. Taken together, these data suggest that OPG acts as an autocrine/paracrine growth factor for vascular SMC, which might contribute to the progression of atherosclerotic lesions.

Mesenchymal stem cells-derived vascular smooth muscle cells release abundant levels of osteoprotegerin

Although several studies have shown that the serum levels of osteoprotegerin (OPG) are significantly elevated in patients affected with atherosclerotic lesions in coronary and peripheral arteries, the cellular source and the role of OPG in the physiopathology of atherosclerosis are not completely defined. Therefore, we aimed to investigate the potential contribution of mesenchymal stem cells in the production/release of OPG. OPG was detectable by immunohistochemistry in aortic and coronary atherosclerotic plaques, within or in proximity of intimal vascular smooth muscle cells (SMC). In addition, bone marrow mesenchymal stem cell (MSC)-derived vascular SMC as well as primary aortic SMC released in the culture supernatant significantly higher levels of OPG with respect to MSC-derived endothelial cells (EC) or primary aortic EC. On the other hand, in vitro exposure to full-length human recombinant OPG significantly increased the proliferation rate of aortic SMC cultures, as monitored by bromodeoxyuridine incorporation. Taken together, these data suggest that OPG acts as an autocrine/paracrine growth factor for vascular SMC, which might contribute to the progression of atherosclerotic lesions.

Polymorphic Variants of Extracellular Superoxide Dismutase Gene in a Romanian Population with Atheroma

Extracellular superoxide dismutase (EC-SOD) is the main SOD isoform in the arterial wall contributing to cardiovascular defense against oxidative stress by removing the superoxide anion. In our study, the Thr40Ala and Arg213Gly polymorphic variants of the EC-SOD gene (SOD ( 3 )) were investigated for associations with atherosclerosis and other related factors in 144 subjects with significant atheroma (having one, two, or three major coronary arteries with >50% obstruction, and/or peripheral artery lesions, and/or carotid artery stenosis demonstrated by angiography and echography) and in 150 subjects with no significant atheroma. For the Arg213Gly polymorphism, only five heterozygous subjects were found. Although the difference in the genotype distribution for the Thr40Ala polymorphism was not statistically significant between patients with atheroma (AA 49.3%, AG 34.7%, GG 16.0%) and those without significant atheroma (AA 41.3%, AG 43.3%, GG 15.3%), there was an association of the Thr40 allele with diabetes (P = 0.03) and hypertension (P = 0.04).

Oral sirolimus for prevention of recurrent infrainguinal arterial obstructions after surgical and endovascular revascularizations

No data are currently available on the role of oral sirolimus in the prevention of recurrent stenosis in the periphery. We report the effects of oral sirolimus in the prevention of recurrent infrainguinal obstructions in patients with complex peripheral arterial disease. Three patients with ischemic rest pain of the lower limbs and repeated short-term need for surgical and/or endovascular revascularization: 9 times within 12 months, 7 times within 15 months, 11 times within 26 months, respectively. Oral sirolimus on a case by case basis, resulted in less frequent restenosis and longer intervention-free intervals: three re-interventions within 37 months in the first patient, one balloon angioplasty within 17 months in the second, and three re-interventions within 21 months in the third patient, respectively. Side effects, in particular dyspepsia and diarrhoea, were mild and tolerable. To our knowledge, this is the first report to show that oral sirolimus was successfully administered in patients with recurrent excessive neointimal proliferation after revascularization of peripheral arterial lesions lowering the necessity of re-intervention and hence prolonging intervention-free intervals.

QS372. The Use of a Re-Entry Device to Facilitate Revascularization of Complex Aortoiliac and Femoropopliteal Arterial Occlusive Lesions

Background: Minimally invasive treatment of advanced vascular disease using endoluminal therapy affords the patient a lower morbidity and mortality than open reconstruction. The Trans-Atlantic Inter-Society Consensus (TASC) developed a set of guidelines used to determine the ease and appropriateness with which peripheral arterial lesions can be treated by endovascular therapy. The commonly employed technique of subintimal angioplasty is challenging in complex cases (TASC class C and D lesions). Recently, re-entry devices have been developed to overcome this technical limitation.