Peripheral Endovascular Procedures Research Articles

Abstract 18548: Racial Disparities in the In-Hospital Outcomes of Patients Undergoing Percutaneous Peripheral Endovascular Procedures

Introduction: Endovascular revascularization is becoming the mainstay management of peripheral vascular disease (PVD). Our study seeks to find out the impact of racial disparity on the outcome of this procedure. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest all-payer inpatient healthcare database in the United States. The NIS was searched for hospitalization of adult patients with PVD who had endovascular revascularization, using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Following Propensity score matching, we assessed for a primary outcome of inpatient mortality. The secondary results were acute kidney injury (AKI), amputation, cardiac arrest, cardiogenic shock, total hospital charge (THC), and length of stay (LOS). Results: About 395,510 patients with PVD had endovascular revascularization; 322,015 patients who had the procedure were either White (n=254,840, 79.1%) or Black (n=67,175, 20.9%). White patients had a mean age of 69.2±0.1 years compared to 64.9±0.1 years in Black patients (males: 61.1% versus 53.4%; females: 38.9% versus 46.6%). Compared to White patients, Blacks had significantly lower in-hospital mortality (2.2% versus 2.6%; p=0.005) and cardiogenic shock (0.9% vs 1.2%; p=0.004); however, they had significantly higher AKI (21.6% vs 19.0% p-value 0.015), amputations (7.6% vs 4.4% p-value <0.001), and LOS (10.1 vs 7.5; p-value <0.001) compared to Whites. Conclusions: This study showed that compared to Whites, Black patients were more predisposed to amputations, AKI, and higher LOS despite having a lower mortality rate after endovascular revascularization.

The CathPilot: Performance Validation and Preclinical Safety and Feasibility Assessment.

Peripheral endovascular revascularization procedures often fail due to technical limitations of guidewire support, steering, and visualization. The novel CathPilot catheter aims to address these challenges. This study assesses the safety and feasibility of the CathPilot and compares its performance to conventional catheters for peripheral vascular interventions. The study compared the CathPilot to non-steerable and steerable catheters. The success rates and access times for a relevant target inside a tortuous vessel phantom model were assessed. The reachable workspace within the vessel and the guidewire's force delivery capabilities were also evaluated. To validate the technology, chronic total occlusion tissue samples were used ex vivo to compare crossing success rates with conventional catheters. Finally, in vivo experiments in a porcine aorta were conducted to evaluate safety and feasibility. The success rates for reaching the set targets were 31%, 69%, and 100% with the non-steerable catheter, the steerable catheter, and the CathPilot, respectively. CathPilot had a significantly larger reachable workspace, and allowed for up to four times higher force delivery and pushability. In crossing of chronic total occlusion samples, the CathPilot achieved a success rate of 83% and 100%, for fresh and fixed lesions respectively, which was also significantly higher than conventional catheters. The device was fully functional in the in vivo study, and there were no signs of coagulation or damage to the vessel wall. This study shows the safety and feasibility of the CathPilot system and its potential to reduce failure and complication rates in peripheral vascular interventions. The novel catheter outperformed conventional catheters in all defined metrics. This technology can potentially improve the success rate and outcome of peripheral endovascular revascularization procedures.

Alt Ekstremite Periferik Arter Hastalığında Endovasküler Girişimlerden Kaynaklanan Akut Komplikasyonların Cerrahi Yönetimi: Eskimeyen Yeni

Aim: The importance of endovascular procedures in the diagnosis and treatment of peripheral vascular diseases has seen a notable rise in recent years. Nevertheless, this surge has resulted in a corresponding rise in iatrogenic vascular complications and subsequent interventions associated with peripheral endovascular procedures. This study involved a retrospective evaluation of acute complications associated with endovascular treatments performed for lower limb peripheral artery diseases, as well as a closer look of the related therapeutic strategies for these challenges.
 Materials and Methods: A retrospective evaluation was conducted on a cohort of 400 patients who received endovascular intervention for lower extremity peripheral artery disease at our clinic. The study included 27 patients (6.7%) from this cohort who received surgical or endovascular treatment for acute complications following endovascular intervention. Our preference for endovascular or surgical treatments was chosen based on the type and localization of the complications.
 Results: The mean age of patients who experienced complications was 63.7±6 years. The complications were as follows in order of frequency: dissection 14 (51.9%) patients, arterial perforation 5 (18.5%) patients, major hematoma 3 (11.1%) patients, pseudoaneurysm 2 (7.4%) patients, distal embolism 2 (7.4%) patients and arterio-venous fistula 1 (3.7%) patient. In the treatment of complications, endovascular methods were preferred in 19 (4.7%) patients and surgical approaches were used in 8 (2%) patients. Following endovascular intervention, minor amputation was performed in one patient.
 Conclusion: The rapid and effective management of complications related to peripheral endovascular procedures in the lower extremities is of utmost importance. Despite the notable advancements in endovascular procedures in recent years, there are scenarios where these interventions may be insufficient for dealing with complications. The management of such problems may necessitate surgical intervention. Hence, the integration of well-established and validated vascular surgical techniques with endovascular interventions is believed to yield optimal outcomes.

Feasibility and Clinical Value of Intraprocedural Doppler Ultrasonography Blood Flow Parameters During Peripheral Endovascular Procedures for Limb Salvage: A Pilot Study.

To investigate whether Doppler ultrasound (DUS) blood flow parameters could serve as quantifiable functional endpoints of peripheral endovascular arterial procedures for chronic limb-threatening ischemia (CLTI), influencing wound healing. This is a prospective single-center study investigating intraprocedural DUS parameters (pulsatility index [PI] and pedal acceleration time [PAT]) in quantifying immediate hemodynamic alterations in consecutive CLTI patients with wound, ischemia, and foot infection wound class ≥1 undergoing endovascular interventions. Primary endpoints were feasibility of preendovascular and postendovascular treatment measurements of PI/PAT, quantification of immediate PI/PAT modifications of the posterior and anterior foot circulation following revascularization, the correlation between PI and PAT, and 6-month complete wound healing. Secondary endpoints included the 6-month limb salvage (no major amputation) and complete and partial wound healing rates. A total of 28 patients (75.0% male) were enrolled, and 68 vessels were treated. The overall mean PAT values significantly decreased from 154.15±70.35 ms preprocedural to 107.21±49.6 ms postprocedural (p<0.01), and the mean PI values significantly increased from 0.93±0.99 to 1.92±1.96 (p<0.01). Postprocedural PAT at the anterior tibial (r2=0.804; p=0.346) and the posterior tibial arteries (r2=0.784; p=0.322) had a strong correlation and postprocedural PI at the anterior tibial (r2=0.704; p=0.301) and the posterior tibial arteries (r2=0.707; p=0.369) had a good correlation with 6-month complete wound healing. The 6-month complete and partial wound healing rates were 38.1% and 47.6%, respectively. Limb salvage was 96.4% and 92.4% at 6 and 12 months of follow-up, respectively. Pedal acceleration time and PI accurately detected immediate hemodynamic changes of foot perfusion following revascularization and could serve as prognostic factors of wound healing in patients with CLTI. Intraprocedural measurement of simple Doppler ultrasound blood flow parameters, Pulsatility Index (PI) and Pedal Acceleration Time (PAT), accurately detected immediate hemodynamic changes of foot perfusion following endovascular revascularization and could therefore serve as intraprocedural prognostic factors of wound healing in patients with chronic limb-threatening ischemia. This is the first time that PI has been proposed as a hemodynamic index of successful angioplasty outcome. The optimization of intraprocedural PAT and PI could be used to guide angioplasty and predict clinical success.

Extravascular Ultrasound (EVUS) to Assess the Results of Peripheral Endovascular Procedures

Contrast arteriography (CA) is considered the gold standard to evaluate any phase in peripheral arterial disease (PAD) interventions, from diagnostics to final results. Nevertheless, duplex ultrasonography (DUS) mostly used for the pre/postoperative phase and follow-up control, could be a potential intraoperative adjunctive imaging tool to assess the effects of endovascular revascularization in patients with iliac and femoropopliteal lesions. The PAD "duplex-assisted" protocol includes a preoperative DUS control followed by an intraoperative and a postoperative control. The most important parameters are pulsed doppler spectral analysis and waveform changes, which are impossible to detect with intravascular ultrasound (IVUS). By using a similar acronym, the intraoperative DUS has been previously described as extravascular ultrasound (EVUS). B-mode imaging, color flow, and peak systolic velocity (PSV) are considered. EVUS could be very useful to evaluate the effects of endovascular treatment, mainly in cases of unclear CAs, severe calcifications and/or dissections. In the context of the "leaving nothing behind" strategy, EVUS can drive the physician to evaluate the absence of flow-limiting dissections and decide which target lesion should be treated with antirestenotic therapy, further vessel preparation, or stenting. The EVUS protocol could be a safe and feasible option to improve the completion assessment of endovascular PAD treatment. A better ultrasound waveform is a sign of improved luminal gain and compliance, which is extremely important to finalize the results of new peripheral device technology, such as intravascular lithotripsy.

Costs and Budget Impact of Collagen-Based Vascular Closure Device Versus Manual Compression Following Peripheral Endovascular Procedures

To evaluate the annual costs and budget impact of using a vascular closure device to achieve haemostasis following femoral access endovascular procedures in England, compared with manual compression. A budget impact model was developed in Microsoft® Excel, based on the estimated number of peripheral endovascular procedures eligible for day-case management performed annually by the National Health Service in England. The clinical effectiveness of vascular closure devices was captured based on the requirement for inpatient stays and the incidence of complications. Data for endovascular procedures, time to haemostasis, length of hospital stay, and complications were collected from public sources and the published literature. There were no patients involved in this study. Model outcomes are reported as estimated number of bed days and annual costs to the National Health Service for all peripheral endovascular procedures in England, and the average cost per procedure. The robustness of the model was tested in a sensitivity analysis. The model estimated savings for the National Health Service of up to £4.5 million annually if vascular closure devices were used in every procedure instead of manual compression. The model estimated an average cost saving of £176 per procedure for vascular closure devices over manual compression, primarily due to fewer inpatient stays. The sensitivity analysis demonstrated that the proportion of day-case procedures for vascular closure devices and manual compression was a key driver of costs and savings. The use of vascular closure devices for achieving haemostasis after peripheral endovascular procedures may be associated with lower resource use and cost burden, compared with manual compression, based on shorter time to haemostasis and ambulation and an increased likelihood of a day-case procedure.

3D-printed model of simulation for acute thrombus removal in peripheral arteries.

Surgical training and evaluation of medical devices require simulation models. The aim of this study was to assess a 3D-printed model as a training model for peripheral endovascular procedures, including thromboaspiration in acute limb ischemia (ALI). The 3D-simulation model was modeled from an aorta and lower limbs CT scan by segmentation of the arterial light. The 3D simulator was printed in multimaterial with photo-polymerizable resins (Polyjet). The simulator consisted of interchangeable cartridges intended to reproduce the lower limb vasculature. The simulator was connected to a pump to obtain a pulsative flow. A gelled product was positioned in a cartridge just above a stenosis in order to simulate an ALI by in-situ thrombosis. Vascular interventionalists should perform a thrombo-aspiration (Indigo®, Penumbra Inc., Alameda, CA, USA) by crossover in an experimental hybrid room (Discovery®, General Electric, Boston, MA, USA). The analysis of the results was based on the feedback of vascular interventionalists using a Likert Psychometric Scale. A total of 6 vascular surgeons performed two training sessions in real-life conditions. Access to the target lesion was achieved by cross-over or antegrade approach with an 8 F - 45 cm introducer. An angiogram was used to localize the thrombus. Due to the flow, a part of the thrombus was migrating from femoropopliteal segment to below the knee level. Thromboaspiration was realized by Indigo (Penumbra Inc.) CAT-8 and -6 with separators. The average score out of 5 was 4.5 (±0.55) regarding anatomical reproducibility, 4.3 (±0.82) for navigation, and 4.5 (±0.84) for aspiration. The didactical evaluation showed a score of 4.3 (±0.52) for improving technical skills. The improvement of the confidence score in the simulator was +1.2 (±1.72). The 3D-simulation model for peripheral endovascular procedures provides a realistic training for thromboaspiration. This model could mimic different types of peripheral arterial pathologies and participate to the vascular interventionalists training.

“Insuring” appropriate tibial endovascular procedures

The authors of the article that accompanies this commentary1 provide a startling statistic. More than one-quarter of all peripheral endovascular procedures used to treat Medicare patients with claudication between 2017 and 2019 may have been unnecessary. They surveyed 59,930 Medicare patients who underwent peripheral vascular interventions for claudication and found that 16,594 (27.7%) underwent a tibial angioplasty, atherectomy, or stent. Even more unsettling is that 38.5% of these tibial procedures were performed in isolation without a concomitant proximal intervention.

Popliteal access for endovascular procedures in femoropopliteal artery occlusive disease.

Even though it has been reported that femoropopliteal artery endovascular revascularization is often performed with antegrade femoral artery interventions, which are technically relatively challenging, having the advantage of better control, it has also been reported that recanalization failure may occur in approximately 20% of patients and some materials have been developed for this reason. To evaluate the safety of retrograde popliteal artery intervention and our procedural success rate for symptomatic femoropopliteal artery occlusive disease. A total of 95 endovascular revascularization procedures were performed for treating symptomatic occlusive peripheral artery disease in the study period. Inclusion criteria were defined as patients who underwent endovascular revascularization procedures for symptomatic femoropopliteal artery occlusive disease. Patients who underwent a percutaneous endovascular procedure for iliac artery or below-knee arterial occlusive disease in the same session and patients who had previously undergone peripheral arterial bypass grafting or endovascular treatment for existing femoropopliteal artery disease were excluded. We evaluated 45 peripheral endovascular procedures performed on 39 patients with a mean age of 62.49 ±11.38 years in our hospital for chronic femoropopliteal artery occlusive disease. Twelve (26.7%) of the endovascular treatment procedures were performed with retrograde access through the popliteal artery (Group 2). In neither group were any complications of arterial rupture, distal embolism, early thrombosis, or pseudoaneurysms observed. We are of the opinion that the retrograde popliteal artery technique is an effective and safe intervention option in endovascular revascularization, particularly in the revascularization of the long segment and complex femoropopliteal artery occlusions.

Robotic Control of a 0.035-Inch Guidewire: Initial Feasibility and First-in-Human Experience.

Robotic procedures represent a new frontier for interventional cardiology. 1 Beyar R. Davies J.E. Cook C. Dudek D. Cummins P.A. Bruining N. Robotics, imaging, and artificial intelligence in the catheterisation laboratory. EuroIntervention. 2021; 17: 537-549 Crossref PubMed Scopus (3) Google Scholar The latest generation robotic platform is the CorPath GRX System (Corindus Inc, Waltham, MA), which is composed of an interventional cockpit and a single-use cassette incorporated within a robotic arm. The cassette has a dedicated “wire track” to control 0.014-inch or 0.018-inch wires and a dedicated “device track” to advance and retrieve balloons and stents (Fig. 1A). One limitation of the current cassette is the absence of a specific “track” designed for the commonly used 0.035-inch wire. 2 Chakravartti J. Rao S.V. Robotic-assisted percutaneous coronary intervention: hype or hope?. J Am Heart Assoc. 2019; 8: 1-4 Crossref Scopus (14) Google Scholar The possibility of controlling this wire is important, particularly for peripheral endovascular procedures, in which the 0.035-inch wire is commonly used to advance catheters, balloons, and stents.

Cost and budgetary impact of the vascular systems of closure versus manual compression for peripheral endovascular procedures

To evaluate the annual costs and the budgetary impact of the use of a vascular closure device (VCD) compared to manual compression to obtain hemostasis after ambulatory percutaneous peripheral endovascular interventions.

3D printed simulation model for peripheral endovascular procedures

Surgical training and the evaluation of medical devices require simulation models. Ethical reasons oblige to limit the use of animal models. The objective was to develop a three-dimensional (3D) model of vascular simulation intended for peripheral endovascular procedures, in particular thromboaspiration for acute ischemia.

EE272 Economic Burden Associated with ISO-Osmolar Versus Low Osmolar Iodinated Contrast Media during Peripheral Endovascular Procedures: Evidence from Premier Database

Iodinated contrast media are used in most interventional revascularization procedures. Several prior studies have demonstrated lower incidence of adverse clinical outcomes associated with iso-osmolar iodinated contrast media (IOCM) compared with low-osmolar contrast media (LOCM), including a recent analysis in comorbid patients with peripheral arterial disease (PAD). The objective of this study was to evaluate association of IOCM and LOCM use with direct costs and length of hospital stay in PAD patients undergoing endovascular interventions.

Reduction of Occupational Radiation Exposure During Endovascular Treatment of Peripheral Artery Disease Using Radiation Absorbing Drapes

A chronic exposure to low dose radiation, as encountered in endovascular procedures, may impact the health of surgeons and radiologists over a timespan of several months to a lifetime. This study evaluates the feasibility and efficacy of a radiation absorbing sterile drape (RADPAD) to reduce operator exposure during the endovascular treatment of obstructive peripheral artery disease (PAD). Between February 2016 and September 2017, patients with PAD who received percutaneous transluminal angioplasty, stent placement, remote endarterectomy, or a combination thereof were included in this nonrandomized study. Patients were equally divided over a study cohort (with RADPAD) and a control cohort (without RADPAD). The unshielded body dose (E) of the staff was measured via electronic dosimeters placed at a chest height of the first operator (FO), second operator (SO), and sterile nurse (SN). A virtual maximum operator (MO) dose was constructed, yielding the highest dose per fluoroscopy run for either of the operators. Simultaneously, the dose area product (DAP) and C-arm settings for each fluoroscopy run were extracted. Staff exposures of the study cohort and control cohort were compared in terms of relative exposure (E/DAP). A secondary analysis involved an analysis of the individual fluoroscopy runs using a multivariate generalized linear mixed effect model. In total, 49 patients were included in this study. The use of RADPAD was technically feasible. Significant reductions of relative exposure were observed when comparing the study cohort with the control cohort. The relative exposure of the FO was reduced with 66.5% (1.82 vs. 0.61μSv/Gycm2, P<0.001), the relative exposure of the SO with 68.3% (0.55 vs. 0.17μSv/Gycm2, P=0.02), and the relative exposure of the MO with 65.8% (2.06 vs. 0.71μSv/Gycm2, P<0.001). Dose levels of SN were too low to draw conclusions under the current sample size. The multivariate generalized linear mixed effect model showed a significant correlation between absolute exposure of the MO and the use of the RADPAD (odds: 0.51, P<0.001). Usage of a radiation absorbing drape (RADPAD) during endovascular treatment of PAD results in statistically significant reduction in a relative operator dose while presenting no drawbacks. The use of these drapes is advised in future peripheral endovascular procedures.

Radial artery access for peripheral endovascular procedures

Radial artery access for peripheral endovascular procedures

Percutaneous Axillary Artery Access for Peripheral and Complex Endovascular Interventions: Clinical Outcomes and Cost Benefits

The aim of this study was to determine the safety, efficacy, and applicability of percutaneous axillary artery (pAxA) access in patients requiring upper extremity large sheath access during complex aortic, cardiac, and peripheral endovascular procedures. We also take this opportunity to address the potential cost-benefits offered by pAxA access compared to open upper extremity access. A total of 26 consecutive patients, between June 2018 and October 2020, underwent endovascular intervention, requiring upper extremity access (UEA). Ultrasound-guided, percutaneous access of the axillary artery was used in all 26 patients with off-label use of pre-close technique with Perclose ProGlide closure devices. Access sites accommodated sheath sizes that ranged from 6 to 14 French (F). End points were technical success and access site-related complications including isolated neuropathies, hematoma, distal embolization, access-site thrombosis, and post-operative bleeding requiring secondary interventions. Technical success was defined as successful arterial closure intraoperatively with no evidence of stenosis, occlusion, or persistent bleeding, requiring additional intervention. Of the 26 patients requiring pAxA access, 15 underwent complex endovascular aortic aneurysm repairs (EVAR) with branched, fenestrated, snorkel, or parallel endografts, 6 underwent peripheral vascular interventions, and 5 underwent cardiac interventions. Fifty-three percent accommodated sheath sizes of 12F or higher. Technical success was achieved in 100% of cases with no major perioperative access complications requiring additional open or endovascular procedures. In our series, we had one post-operative mortality secondary to myocardial infarction in a patient with significant coronary artery disease. Our data again demonstrated the proposed safety and efficacy attributable to pAxA access, while extending its application to wide spectrum of endovascular interventions which included peripheral or coronary vascular in addition to complex EVAR.

Abstract 14150: Evaluation of Real-World Long-Term Mortality Following Paclitaxel-Eluting Devices Use in Femoropopliteal Disease Among Veterans

Introduction: Use of paclitaxel eluting devices have been shown to improve endpoints following femoropopliteal interventions, driven by decreased need for repeat procedures. Post hoc analysis of clinical trials suggest that use of these devices may be associated with increased mortality, without evidence of causation. To assess if relevance of this in usual clinical use, analysis of real-world data is necessary. Methods: The Long-term Excess All-Cause Death with Paclitaxel-eluting device in Infrainguinal Peripheral Endovascular procedures - Veterans’ Administration (LEADPIPE-VA) study is a single-center retrospective evaluation of 134 consecutive patients undergoing infrainguinal femoropopliteal interventions from 2010 to 2019 at the Cardiology Division in the St. Louis VA Medical Center. Baseline Data Age Total DCB Non-DCB p-value&lt;60 11 2 (18.2%) 9 (81.8%) 0.034860-75 92 51(55.4%) 41(44.6%) 0.2971&gt;75 31 17 (54.8%) 14(45.2%) 0.59Mean 71.2 ± 6.6 71.2 ± 6.6 71.2 ± 6.8 0.9527Gender Male 129 67 (51.9%) 62 (48.1%) 0.6598Female 5 3(60%) 2 (40%) Comorbidities HTN 134 (100%) 70 (52.2%) 64 (47.8%) 0.2687DM 82 (61.2%) 41 (30.6%) 41 (30.6%) 0.5147HLD 134 (100%) 70 (52.2%) 64 (47.8% 0.2687Ever smoker 132 (93.9%) 68 (51.5%) 56 (42.4%) 0.1012Current smoker 55 (41.7%) 27 (20.5%) 28 (21.2%) 0.4434CAD 118 (88.1%) 65 (48.5%) 53 (39.6%) 0.0733Carotid disease 45 (33.6%) 28 (20.9%) 17 (12.7%) 0.0999History of MI 95 (70.9%) 56 (41.8%) 39 (29.1%) 0.0404Mean BMI 26.8 ± 5.4 26.7 ± 5.3 26.9 ± 5.7 0.8335Rutherford cl. 3.1 ± 0.6 3.2 ± 0.5 3.1 ± 0. Results: Mortality Total Population DCB Non-DCB p-value30-day 4 (3.0%) 0 (0%) 4 (6.3%) 0.04761-year 6 (4.9%) 3 (4.4%) 3 (5.5%) 0.30752-year 16 (16.0%) 10 (10.0%) 6 (6.0%) 0.31543-year 7 (9.9%) 6 (8.5%) 1 (1.4%) 0.01224-year 7 (15.2%) 2 (4.4%) 5 (10.9%) 0.22595-year 2 (6.3%) NA 2 (6.3%) No significant differences were noted between groups with regards to clinical improvement, repeat interventions, or need for amputation. Conclusions: Given the limitation of a small single center retrospective analysis in a real-world population with higher overall complexity, morbidity and mortality, differences between the two groups are small and unlikely to represent a clinical hazard.

Use of iso-osmolar contrast media during endovascular revascularization is associated with a lower incidence of major adverse renal, cardiac, or limb events.

We examined the association of iso-osmolar contrast media (IOCM) versus low-osmolar contrast media (LOCM) with major adverse renal, cardiovascular, or limb events in patients at high-risk of acute kidney injury (AKI) undergoing peripheral endovascular procedures. Procedural characteristics including iodinated contrast type and volume have been associated with adverse renal and cardiovascular outcomes in patients undergoing angiographic interventions. Patients at high-risk of AKI, undergoing peripheral endovascular procedures were identified using the Premier Healthcare Database and separated into claudication and critical limb ischemia (CLI) cohorts. For each cohort, we compared IOCM versus LOCM for the primary endpoint of MARCE (major adverse renal or cardiovascular events) and secondary endpoints of major adverse renal events (MARE) and major adverse renal and limb events (MARLE). These outcomes were captured within the indexed hospitalization via adjusted multivariable regression analyses. Two procedure-based cohorts of high-risk patients were formed: claudication (N= 11,976) and CLI (N= 8713). Use of IOCM was associated with a significant absolute risk reduction (ARR) of 2.2% (p< 0.0001) for MARCE overall and in each cohort (claudication, 1.8%, p= 0.0070; CLI, 2.7%, p= 0.0054). The incidence of MARE and MARLE in the overall cohort was also lower with the use of IOCM: MARE (ARR=1.4%, p= 0.0072) and MARLE (ARR=2.0%, p= 0.0043). Using IOCM versus LOCM in patients at high-risk of adverse renal events undergoing peripheral endovascular procedures was independently associated with lower risk of MARCE, MARE, and MARLE.

High Platelet Reactivity Despite Taking Adenosine Diphosphate Receptor Inhibitors: Do We Need to Care?

Platelet activation and aggregation play a key role in the development of adverse cardiovascular events after endovascular treatment of peripheral arterial disease (PAD). Adenosine diphosphate (ADP) receptor (P2Y12) inhibitors such as clopidogrel, prasugrel, and ticagrelor are used increasingly as single treatment or in conjunction with aspirin (dual antiplatelet therapy [DAPT]). However, the antiplatelet activity varies significantly among individuals, and firm evidence for use after peripheral endovascular procedures is lacking.

Quantifying tissue perfusion after peripheral endovascular procedures: Novel tissue perfusion endpoints to improve outcomes.

Peripheral artery disease (PAD) is a flow-limiting condition caused by narrowing of the peripheral arteries typically due to atherosclerosis. It affects almost 200 million people globally with patients either being asymptomatic or presenting with claudication or critical or acute limb ischemia. PAD-affected patients display increased mortality rates, rendering their management critical. Endovascular interventions have proven crucial in PAD treatment and decreasing mortality and have significantly increased over the past years. However, for the functional assessment of the outcomes of revascularization procedures for the treatment of PAD, the same tests that have been used over the past decades are still being employed. Those only allow an indirect evaluation, while an objective quantification of limb perfusion is not feasible. Standard intraarterial angiography only demonstrates post-intervention vessel patency, hence is unable to accurately estimate actual limb perfusion and is incapable of quantifying treatment outcome. Therefore, there is a significant necessity for real-time objectively measurable procedural outcomes of limb perfusion that will allow vascular experts to intraoperatively quantify and assess outcomes, thus optimizing treatment, obviating misinterpretation, and providing significantly improved clinical results. The purpose of this review is to familiarize readers with the currently available perfusion-assessment methods and to evaluate possible prospects.