Treatment Of Peripheral Vascular Disease Research Articles

Overexpression of Thioredoxin1 enhances functional recovery in a mouse model of hind limb ischemia

BackgroundThere is keen interest in finding nonsurgical treatments for peripheral vascular disease (PVD). Previously, we demonstrated that selective activation of Thioredoxin1 (Trx1), a 12-kDa cytosolic protein, initiates redox-dependent signaling and promotes neovascularization after ischemic heart disease. Therefore, Trx1 might possess immense potential to not only treat murine hind limb ischemia (HLI) through effective angiogenesis but also provide PVD patients with nonsurgical therapy to enhance neovascularization and improve blood perfusion. MethodsTo determine whether activation of Trx1 increases blood perfusion in HLI, two different strategies were used—gene therapy and transgenic model system. In adenoviral-mediated gene therapy, 8- to 12-wk-old mice were divided into two groups: (1) control Adeno-LacZ (Ad-LacZ) and (2) Adeno-Thiroedoxin1 (Ad-Trx1). The mice underwent surgical intervention to induce right HLI followed by injection with Ad-LacZ or Ad-Trx1, respectively. In the second strategy, we used wild-type and transgenic mice overexpressing Trx1 (Trx1Tg/+). All the animals underwent Doppler imaging for the assessment of limb perfusion followed by immunohistochemistry and Western blot analysis. ResultsSignificant increases in perfusion ratio were observed in all the Trx1 overexpressed groups compared with their corresponding controls. Expressions of heme oxygenase-1, vascular endothelial growth factor, and the vascular endothelial growth factor receptors Flk-1 and Flt-1 were increased in Trx1 overexpressed mice compared with their respective controls. Blood perfusion in the ischemic limb gradually improved and significantly recovered in Trx1Tg/+ and Ad-Trx1 groups compared with their corresponding controls. The capillary and arteriolar density in the ischemic zone were found to be higher in Trx1Tg/+ group compared with wild type. ConclusionsThe overall outcomes of our study demonstrate that Trx1 enhances blood perfusion and increases angiogenic protein expression in a rodent HLI model. These results suggest that Trx1 is a potential target for clinical trials and drug therapy for the treatment of PVD.

Treatment of peripheral arterial disease via percutaneous brachial artery access

ObjectiveThis review was conducted to evaluate the types of endovascular procedures that can be performed via brachial artery access, evaluate the access success rate, and determine the incidence of technical complications. MethodsA retrospective 10-year record review at a tertiary facility from January 1, 2005, through June 30, 2015, was completed. Patients who underwent attempted brachial artery access were eligible for review. Outcomes intended to be evaluated included ability to access the vessel, reach an identified lesion, and perform an indicated procedure, while describing the incidence and type of complications that occurred to clarify the utility and safety of brachial artery access. ResultsThe review included 265 access cases in 179 patients. The access success rate was 98.9%. Intervention was performed in 223 cases (84.2%). Angioplasty was the most common intervention (59%, [154 cases]), with stents, atherectomy, coiling, and percutaneous thrombectomy having also been performed. Complications included hematoma (2.3%) and pseudoaneurysm (1.5%). Complications requiring intervention occurred in 1.9% of procedures. Interventions were performed on all major vessels as distal as the dorsalis pedis. Sheath sizes ranged from 4F to 7F. Intervention was performed on bilateral lower extremities in 38 cases (14.5%). A femoral bypass graft was present in 141 patients (53%) as the main indication for brachial artery access. ConclusionsBrachial access is a reliable and effective option for treatment of peripheral vascular disease and should be considered when femoral access is difficult or contraindicated and when a bypass graft is present in the femoral region. In addition, bilateral lesions may be approached easily through one brachial artery access site, making this approach advantageous when bilateral lesions are expected. The complication rate is similar to femoral access and can be minimized with ultrasound-guided access distally over the humerus, micropuncture access, and a dedicated postprocedure “hold team.”

CRT-300.19 Evaluation of Safety and Efficacy of Ranger Paclitaxel-Coated Balloon in a Swine Femoral Artery Model

Drug-coated balloon (DCB) have emerged as a therapeutic alternative in the treatment of peripheral vascular disease. The aim of this study was designed to evaluate the safety and efficacy of a Ranger DCB in a swine femoral artery model. The femoral arteries of 42 swine were treated with low

Abstract No. 90 - 2D-perfusion angiography technique independent of pump injections for assessment of interventional treatment of peripheral vascular disease

Abstract No. 90 - 2D-perfusion angiography technique independent of pump injections for assessment of interventional treatment of peripheral vascular disease

Structure and properties of self-expanding intravascular NiTi stents doped with Si ions

Here we present research results on the structure, functional properties, and mechanical characteristics of self-expanding nickel-titanium (NiTi) stents the surface of which is doped with silicon (Si) by plasma immersion ion implantation. The stents are of two dimension types used to recover the lumen of peripheral vessels (carotid artery and abdominal aorta). When implanted, Si ions penetrate into the stents, forming a Si-doped layer of thickness up to 80 nm at their inner and outer surfaces. After deformation at room and lower temperature, the surface-modified stents fully recover their shape under unloading at body temperature. The surface modification by plasma immersion ion implantation decreases the stress for the formation of stress-induced martensite under loading and increases the hysteresis under unloading. The research results allow the conclusion that Si-doped stents are promising for treatment of peripheral vascular disease. However, related studies on laboratory animals are required.

Acute Limb Ischemia due to a Fractured Superficial Femoral Artery Stent

Peripheral Vascular Disease (PVD) is a rapidly growing and recognized disease of the peripheral circulation. Its presentation can vary between asymptomatic state, exercise limiting limb pain, limb loss and even death. Advances have been achieved in the treatment of PVD especially in the field of interventional cardiovascular medicine. Different devices and techniques are used in the treatment of peripheral atherosclerotic disease, which have lowered the need for bypass surgery. Although invasive peripheral intervention has a low rate of complications, there are still well recognized acute and chronic complications that an operator should be aware of. We present an interesting case of acute limb ischemia due to Superficial Femoral Artery (SFA) stent fracture.

Treatment of Peripheral Vascular Disease Through Percutaneous Brachial Artery Access

Treatment of Peripheral Vascular Disease Through Percutaneous Brachial Artery Access

SS04. Variation in Peripheral Vascular Disease Treatment Between Salaried and Fee-For-Service Providers

SS04. Variation in Peripheral Vascular Disease Treatment Between Salaried and Fee-For-Service Providers

Role of Stent Grafts and Helical-Woven Bare-Metal Stents in the Superficial Femoral and Popliteal Arteries

Peripheral vascular disease (PVD) is a devastating medical problem that may lead to significant life alterations for patients, from simply limiting their daily activities to potential loss of limbs and eventual demise. Superficial femoral and popliteal arteries are significantly common locations for PVD sequelae to present itself, and owing to their length and mobile nature, treatment of these segments are quite challenging. Indications for PVD treatment include lifestyle-limiting claudication that is not responding to medical management, ischemic rest pain, nonhealing ulcers, and lower extremity gangrene. There is a wide variety of treatment options that include medical management, interventional, and surgical techniques. Interventional techniques include plain old balloon angioplasty, cryoplasty, drug-coated balloon angioplasty, self-expanding bare-nitinol stents, self-expanding covered stents, self-expanding drug-eluding stents, and a number of atherectomy devices (ie, laser, rotational, orbital, and excisional). The scope of this article is to review indications, patient selection, and deployment techniques of Viabahn and Supera self-expanding stents.

Using the diamond intermediate anastomosis in composite sequential bypass grafting for critical limb ischemia

Composite sequential bypass grafting is an effective alternative in the treatment of peripheral vascular disease when autologous vein is limited. We describe a modified technique for composite sequential bypass grafting anastomosis using a combination of synthetic graft with native vein connected via a common intermediate anastomotic junction, which also benefits from having additional outflow at the native, noncontiguous arteriotomy in a diamond configuration. This technique was piloted on six patients to treat critical limb ischemia when no other revascularization options were deemed suitable. Limb salvage with resolution of symptoms was achieved in all six patients at the 6-month follow-up. The diamond anastomosis is a promising method to maximize limb salvage using a unique composite sequential bypass configuration when native vein is limited.

Cilostazol suppresses angiotensin II-induced apoptosis in endothelial cells.

Patients with essential hypertension undergo endothelial dysfunction, particularly in the conduit arteries. Cilostazol, a type III phosphodiesterase inhibitor, serves a role in the inhibition of platelet aggregation and it is widely used in the treatment of peripheral vascular diseases. Previous studies have suggested that cilostazol suppresses endothelial dysfunction; however, it remains unknown whether cilostazol protects the endothelial function in essential hypertension. The aim of the present study was to investigate whether, and how, cilostazol suppresses angiotensin II (angII)-induced endothelial dysfunction. Human umbilical vein endothelial cells (HUVECs) and Sprague Dawley rats were exposed to angII and treated with cilostazol. Endothelial cell apoptosis and function, nitric oxide and superoxide production, phosphorylation (p) of Akt, and caspase-3 protein expression levels were investigated. AngII exposure resulted in the apoptosis of endothelial cells in vitro and in vivo. In vitro, cilostazol significantly suppressed the angII-induced apoptosis of HUVECs; however, this effect was reduced in the presence of LY294002, a phosphoinositide 3 kinase (PI3K) inhibitor. Furthermore, cilostazol suppressed the angII-induced p-Akt downregulation and cleaved caspase-3 upregulation. These effects were also alleviated by LY294002. In vivo, cilostazol suppressed the angII-induced endothelial cell apoptosis and dysfunction. Cilostazol was also demonstrated to partially reduced the angII-induced increase in superoxide production. The results of the present study suggested that cilostazol suppresses endothelial apoptosis and dysfunction by modulating the PI3K/Akt pathway.

Feraheme-Enhanced Magnetic Resonance Angiography (FEMRA) vs. Digital Subtraction Angiography in the Diagnosis and Treatment of Peripheral Vascular Disease in Patients with Renal Insufficiency

Background: Ferumoxytol is an Ultrasmall Superparamagnetic Iron Oxide (USPIO) which has demonstrated promise as a novel contrast agent with an excellent safety profile in patients with CKD. Our aim was to evaluate the safety and utility of this agent for diagnosis and operative planning in the setting of PAD and CKD. A comparison with digital subtraction angiography is also provided. Methods: Between April, 2013 and September, 2014 seven patients with renal insufficiency (CKD ≥ Stage 3) and symptomatic PAD underwent Fe-MRA. This was followed by DSA limited to the vascular bed with significant stenosis as detected by Fe-MRA. Renal function was assessed before and after each procedure. Images were qualitatively scored at the iliac, femoral, popliteal and tibial levels by two interventional radiologists. Degree of stenosis was also scored for comparison. Results: Seven male patients were studied with a mean age of 75 years (64-92). 5 therapeutic procedures (4 endovascular and 1 open) were performed. There were no statistically significant differences in creatinine or GFR after Fe-MRA or DSA. Iodinated contrast load (mg I) for DSA was reduced in comparison with age and disease matched controls (8240 ± 5206 vs. 29320 ± 15605, p=0.001). No statistically significant differences were found for degree of stenosis or mean image quality score below the iliac level. There were no adverse events in response to Ferumoxytol administration. Conclusion: Fe-MRA provides image quality and estimation of degree of stenosis comparable to DSA. Fe-MRA may serve as an alternative to CTA or gadoliniumbased MRA for patients with end-stage renal disease.

Technique of computed tomography guided chemical lumbar sympathectomy for peripheral vascular disease-a study of its efficacy in the Indian population

Background: Surgical lumbar sympathectomy is an established procedure in the treatment of peripheral vascular disease for patients with severe rest pain and where revascularization is not possible. The aim of the present study is to evaluate the efficacy of chemical lumbar sympathectomy using computed tomography (CT) guidance in the Indian population. Methods: A prospective study was done on 22 patients with inoperable peripheral vascular disease in Coimbatore medical college hospital, Coimbatore between June 2013 and May 2015. Using Toshiba 4-slice helical CT guidance and absolute alcohol as neurolytic solution, chemical lumbar sympathectomy was performed at single level. Rest pain was assessed by visual analogue scale. Size of the ischemic ulcers were measured before and 2 months after the procedure. Results: At 2 months post procedure, 77 % of patients reported substantial relief of rest pain. In 57% of patients, there was significant reduction in size of the ulcers. Conclusions: Lumbar sympathectomy has still got a specific role in modern vascular surgery practice. The precision of computed tomography guidance in chemical neurolysis is unparalleled. It is safe, as effective as surgical sympathectomy and can be quickly performed as an out-patient procedure with local anaesthesia. It is a valuable technique that can be easily mastered by the radiologist doing interventional procedures using computed tomography.

Kinetic Modelling of Drug Release from Pentoxifylline Matrix Tablets based on Hydrophilic, Lipophilic and Inert Polymers

Abstract Pentoxifylline is a xanthine derivative used in the treatment of peripheral vascular disease, which because of its pharmacokinetic and pharmacologic profile is an ideal candidate for the development of extended release formulations. The aim of this study is to present a kinetic analysis of the pentoxifylline release from different extended release tablets formulations, using mechanistic and empirical kinetic models. A number of 28 formulations were prepared and analysed; the analysed formulations differed in the nature of the matrix forming polymers (hydrophilic, lipophilic, inert) and in their concentrations. Measurements were conducted in comparison with the reference product Trental 400 mg (Aventis Pharma). The conditions for the dissolution study were according to official regulations of USP 36: apparatus no. 2, dissolution medium water, volume of dissolution medium is 1,000 mL, rotation speed is 50 rpm, spectrophotometric assay at 274 nm. Six mathematical models, five mechanistic (0 orders, 1st-order release, Higuchi, Hopfenberg, Hixson-Crowell) and one empirical (Peppas), were fitted to pentoxifylline dissolution profile from each pharmaceutical formulation. The representative model describing the kinetics of pentoxifylline release was the 1st-order release, and its characteristic parameters were calculated and analysed.

Microsecond-pulsed dielectric barrier discharge plasma stimulation of tissue macrophages for treatment of peripheral vascular disease.

Angiogenesis is the formation of new blood vessels from pre-existing vessels and normally occurs during the process of inflammatory reactions, wound healing, tissue repair, and restoration of blood flow after injury or insult. Stimulation of angiogenesis is a promising and an important step in the treatment of peripheral artery disease. Reactive oxygen species have been shown to be involved in stimulation of this process. For this reason, we have developed and validated a non-equilibrium atmospheric temperature and pressure short-pulsed dielectric barrier discharge plasma system, which can non-destructively generate reactive oxygen species and other active species at the surface of the tissue being treated. We show that this plasma treatment stimulates the production of vascular endothelial growth factor, matrix metalloproteinase-9, and CXCL 1 that in turn induces angiogenesis in mouse aortic rings in vitro. This effect may be mediated by the direct effect of plasma generated reactive oxygen species on tissue.

Oito semanas de treinamento intervalado na doença vascular periférica: um estudo de caso

Introduction: The interval exercise is characterized by periods of high intensity, followed by periods of moderate intensity to recover, leading to benefits in muscle and endothelial functions, therefore, being an alternative treatment for peripheral vascular disease.Objective: This study aimed to observe the effects of eight weeks of interval exercise in the sub maximum physical capacity on a patient with peripheral vascular disease.Case Description: A case study was performed with a male patient, seventy years old, with normal body mass index (24.7 kg/m²), smoker, sedentary and diabetic (insulin dependent), being diagnosed with peripheral vascular disease for a year. This study was performed for eight weeks with the application of a high-intensity walking interval training and strength exercises. After eight weeksof treatment the patient decreased his resting heart rate and subjective sensation of tiredness, increased the distance in the 6-minutewalking test in 24%, endured greater training intensity and increased the “sit down and get up” test score.Conclusion: The interval training associated to strength training improved the aerobic and anaerobic capacities of the patient, and may be a good alternative in the treatment of peripheral vascular disease.

Feraheme-Enhanced Magnetic Resonance Angiography (FEMRA) vs Conventional Angiography (CA) in the Diagnosis and Treatment of Peripheral Vascular Disease in Patients With Renal Insufficiency

Feraheme-Enhanced Magnetic Resonance Angiography (FEMRA) vs Conventional Angiography (CA) in the Diagnosis and Treatment of Peripheral Vascular Disease in Patients With Renal Insufficiency

FT19. Antibiotic Treatment as a Marker for Health Care-Associated Infections After Lower Extremity Revascularization

Objectives: Composite sequential arterial bypass is a useful option for treatment of peripheral vascular disease when autologous vein is limited. We have described a modified technique for composite sequential bypass using an extended polytetrafluoroethylene (ePTFE) synthetic graft and the long saphenous vein. These are linked via a common intermediate section anastomosed to the native vessel arteriotomy in a diamond configuration (diamond anastomosis). Methods: The diamond composite sequential bypass procedure was performed on six patients to treat critical limb ischemia (gangrene, ischemic ulceration, severe rest pain). The proximal bypass grafts consist of ePTFE, to

Nanoscale strategies: treatment for peripheral vascular disease and critical limb ischemia.

Peripheral vascular disease (PVD) is one of the most prevalent vascular diseases in the U.S. afflicting an estimated 8 million people. Obstruction of peripheral arteries leads to insufficient nutrients and oxygen supply to extremities, which, if not treated properly, can potentially give rise to a severe condition called critical limb ischemia (CLI). CLI is associated with extremely high morbidities and mortalities. Conventional treatments such as angioplasty, atherectomy, stent implantation and bypass surgery have achieved some success in treating localized macrovascular disease but are limited by their invasiveness. An emerging alternative is the use of growth factor (delivered as genes or proteins) and cell therapy for PVD treatment. By delivering growth factors or cells to the ischemic tissue, one can stimulate the regeneration of functional vasculature network locally, re-perfuse the ischemic tissue, and thus salvage the limb. Here we review recent advance in nanomaterials, and discuss how their application can improve and facilitate growth factor or cell therapies. Specifically, nanoparticles (NPs) can serve as drug carrier and target to ischemic tissues and achieve localized and sustained release of pro-angiogenic proteins. As nonviral vectors, NPs can greatly enhance the transfection of target cells with pro-angiogenic genes with relatively fewer safety concern. Further, NPs may also be used in combination with cell therapy to enhance cell retention, cell survival and secretion of angiogenic factors. Lastly, nano/micro fibrous vascular grafts can be engineered to better mimic the structure and composition of native vessels, and hopefully overcome many complications/limitations associated with conventional synthetic grafts.

Transradial peripheral vascular intervention: challenges and opportunities

Endovascular therapy for the interventional treatment of peripheral vascular disease is becoming increasingly prevalent. Radial access is replacing femoral access for coronary intervention owing to its superior safety profile. These parallel advances forecast a future paradigm shift to routine transradial peripheral vascular intervention. This review highlights the technical challenges preventing immediate adoption of transradial peripheral vascular intervention, describes the technical aspects of the procedure in different anatomic beds utilizing currently available equipment, details the procedural, morbidity, and possible mortality benefits inherent to transradial access, reviews the available scientific evidence, and recommends a framework for successful transition to a radial strategy for peripheral vascular intervention.