Management and Challenges in Peripheral Arterial Disease

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiovascular Clinical Research".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 7349

Special Issue Editors


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Guest Editor
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, University Clinic of Essen, Hufelandstr. 55, 45147 Essen, Germany
Interests: peripheral interventions; vascular function; peripheral artery disease; prevention; risk stratification

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Guest Editor
Department of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, 69469 Weinheim, Germany
Interests: peripheral artery disease; peripheral interventions; cardiovascular imaging
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Special Issue Information

Dear Colleagues,

Atherosclerotic peripheral artery disease (PAD) is a major manifestation of cardiovascular disease. More than 200 million individuals worldwide suffer from PAD and such patients have amongst the highest morbidity and mortality rates. In addition, the associated costs are even higher than after stroke, as shown in recent population-based studies.

Recent advances, including antiplatelet and lipid-lowering therapies, along with innovations in endovascular treatment, such as thrombectomy, atherectomy, and lithotripsy, have created great opportunities to improve treatment algorithms in PAD and, possibly, patient related outcomes. Nonetheless, there is a clear need for novel evidence-based treatment strategies to effectively treat PAD patients and reduce the burden of the disease. These encompass pharmacologic as well as endovascular and surgical strategies. PAD treatment has been the focus of major global efforts to improve diagnostic, therapeutic, and preventive strategies.

The aim of our Special Issue is, thus, to collect original articles and reviews investigating pathophysiologic, diagnostic, and therapeutic aspects related to the management of PAD.

Prof. Dr. Christos Rammos
Prof. Dr. Grigorios Korosoglou
Guest Editors

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Keywords

  • peripheral vascular interventions
  • endovascular/hybrid/surgical therapy
  • peripheral perfusion
  • primary prevention
  • secondary prevention
  • peripheral artery disease

Published Papers (4 papers)

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Research

10 pages, 1201 KiB  
Article
BioMimics 3D Stent in Femoropopliteal Lesions: 3-Year Outcomes with Propensity Matching for Drug-Coated Balloons
by Michael Piorkowski, Thomas Zeller, Christos Rammos, Koen Deloose, Klaus Hertting, Volker Sesselmann, Gunnar Tepe, Peter Gaines and Michael Lichtenberg
J. Cardiovasc. Dev. Dis. 2023, 10(3), 126; https://doi.org/10.3390/jcdd10030126 - 16 Mar 2023
Cited by 2 | Viewed by 1490
Abstract
Background: Through its helical centreline geometry, the BioMimics 3D vascular stent system is designed for the mobile femoropopliteal region, aiming to improve long-term patency and the risk of stent fractures. Methods: MIMICS 3D is a prospective, European, multi-centre, observational registry to evaluate the [...] Read more.
Background: Through its helical centreline geometry, the BioMimics 3D vascular stent system is designed for the mobile femoropopliteal region, aiming to improve long-term patency and the risk of stent fractures. Methods: MIMICS 3D is a prospective, European, multi-centre, observational registry to evaluate the BioMimics 3D stent in a real-world population through 3 years. A propensity-matched comparison was performed to investigate the effect of the additional use of drug-coated balloons (DCB). Results: The MIMICS 3D registry enrolled 507 patients (518 lesion, length 125.9 ± 91.0 mm). At 3 years, the overall survival was 85.2%, freedom from major amputation 98.5%, freedom from clinically driven target lesion revascularisation 78.0%, and primary patency 70.2%. The propensity-matched cohort included 195 patients in each cohort. At 3-year follow-up, there was no statistically significant difference in clinical outcomes, such as overall survival (87.9% in the DCB vs. 85.1% in the no DCB group), freedom from major amputation (99.4% vs. 97.2%), clinically driven TLR (76.4% vs. 80.3%), and primary patency (68.5% vs. 74.4%). Conclusion: The MIMICS 3D registry showed good 3-year outcomes of the BioMimics 3D stent in femoropopliteal lesions, demonstrating the safety and performance of this device under real-world conditions, whether used alone or in combination with a DCB. Full article
(This article belongs to the Special Issue Management and Challenges in Peripheral Arterial Disease)
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8 pages, 256 KiB  
Article
Patient Characteristics in the Recording Courses of Vascular Diseases (Reccord) Registry: Comparison with the Voyager Pad Endovascular Cohort
by Michael Czihal, Nasser Malyar, Jürgen Stausberg and Ulrich Hoffmann
J. Cardiovasc. Dev. Dis. 2023, 10(3), 115; https://doi.org/10.3390/jcdd10030115 - 10 Mar 2023
Cited by 1 | Viewed by 1482
Abstract
Background: To compare the characteristics of a “real world” population included in a prospective registry to patients enrolled in a randomized, controlled trial (RCT) after endovascular revascularization (EVR) for symptomatic peripheral artery disease (PAD). Methods: The RECcording COurses of vasculaR Diseases (RECCORD) registry [...] Read more.
Background: To compare the characteristics of a “real world” population included in a prospective registry to patients enrolled in a randomized, controlled trial (RCT) after endovascular revascularization (EVR) for symptomatic peripheral artery disease (PAD). Methods: The RECcording COurses of vasculaR Diseases (RECCORD) registry is an observational registry prospectively recruiting patients undergoing EVR for symptomatic PAD in Germany. VOYAGER PAD was an RCT which demonstrated the superiority of rivaroxaban and aspirin versus aspirin to reduce major cardiac and ischemic limb events following infrainguinal revascularization for symptomatic PAD. For this exploratory analysis, the clinical characteristics of 2.498 patients enrolled in RECCORD and of 4.293 patients from VOYAGER PAD who underwent EVR were compared. Results: The rate of patients aged ≥ 75 years was considerably higher in the registry (37.7 vs. 22.5%). More patients in the registry had undergone previous EVR (50.7 vs. 38.7%) or suffered from critical limb threatening ischemia (24.3 vs. 19.5%). Registry patients were more commonly active smokers (51.8 vs. 33.6%), but less frequently suffered from diabetes mellitus (36.4 vs. 44.7%). While statins (70.5 vs. 81.7%) were less frequently used, antiproliferative catheter technologies (45.6 vs. 31.4%) and postinterventional dual antiplatelet therapy (64.5 vs. 53.6%) were more commonly applied in the registry. Conclusions: There were many similarities but some clinically meaningful differences in clinical characteristics between PAD patients who underwent EVR and were included in a nationwide registry and PAD patients from the VOYAGER PAD trial. Full article
(This article belongs to the Special Issue Management and Challenges in Peripheral Arterial Disease)
11 pages, 1077 KiB  
Article
Target Balloon-Assisted Antegrade and Retrograde Use of Re-Entry Catheters in Complex Chronic Total Occlusions
by Lorenzo Patrone, Nada Selva Theivacumar, Brahman Dharmarajah, Narayanan Thulasidasan, Athanasios Diamantopoulos, Luis Mariano Palena, Muliadi Antaredja, Lisa Tilemann and Erwin Blessing
J. Cardiovasc. Dev. Dis. 2023, 10(2), 53; https://doi.org/10.3390/jcdd10020053 - 29 Jan 2023
Cited by 2 | Viewed by 2310
Abstract
Purpose, Retrograde recanalizations have gained increasing recognition in complex arterial occlusive disease. Re-entry devices are a well described adjunct for antegrade recanalizations. We present our experience with target balloon-assisted antegrade and retrograde recanalizations using re-entry devices in challenging chronic total occlusions. Materials and [...] Read more.
Purpose, Retrograde recanalizations have gained increasing recognition in complex arterial occlusive disease. Re-entry devices are a well described adjunct for antegrade recanalizations. We present our experience with target balloon-assisted antegrade and retrograde recanalizations using re-entry devices in challenging chronic total occlusions. Materials and Methods: We report data from a retrospective multicenter registry. Eligibility criteria included either antegrade or retrograde use of the OutbackTM or GoBackTM re-entry catheter in combination with a balloon as a target to accomplish wire passage, when conventional antegrade and retrograde recanalization attempts had been unsuccessful. Procedural outcomes included technical success (defined as wire passage though the occlusion and delivery of adjunctive therapy with <30% residual stenosis at final angiogram), safety (periprocedural complications, e.g., bleeding, vessel injury, or occlusion of the artery at the re-entry site, and distal embolizations), and clinical outcome (amputation-free survival and freedom from target lesion revascularization after 12-months follow-up). Results: Thirty-six consecutive patients underwent target balloon-assisted recanalization attempts. Fourteen (39 %) patients had a history of open vascular surgery in the index limb. Fifteen patients were claudications (Rutherford Class 2 or 3, 21 presented with chronic limb threatening limb ischemia (Rutherford Class 4 to 6). The locations of the occlusive lesions were as follows: iliac arteries in 3 cases, femoropopliteal artery in 39 cases, and in below-the-knee arteries in 12 cases. In 15 cases, recanalization was attempted in multilevel occlusions. Retrograde access was attempted in 1 case in the common femoral artery, in the femoropopliteal segment in 10 cases, in below-the-knee arteries in 23 cases, and finally in 2 patients via the brachial artery. In 10 cases, the re-entry devices were inserted via the retrograde access site. Technical success was achieved in 34 (94 %) patients. There were 3 periprocedural complications, none directly related to the target balloon-assisted re-entry maneuver. Amputation-free survival was 87.8 % and freedom from clinically driven target lesion revascularization was 86.6 % after 12-months follow-up. Conclusion: Target balloon-assisted use of re-entry devices in chronic total occlusions provides an effective and safe endovascular adjunct, when conventional antegrade and retrograde recanalization attempts have failed. Full article
(This article belongs to the Special Issue Management and Challenges in Peripheral Arterial Disease)
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10 pages, 2269 KiB  
Article
Income-Related Peripheral Artery Disease Treatment: A Nation-Wide Analysis from 2009–2018
by Daniel Messiha, Olga Petrikhovich, Julia Lortz, Amir Abbas Mahabadi, Ramona Hering, Mandy Schulz, Tienush Rassaf and Christos Rammos
J. Cardiovasc. Dev. Dis. 2022, 9(11), 392; https://doi.org/10.3390/jcdd9110392 - 14 Nov 2022
Cited by 4 | Viewed by 1539
Abstract
Economic status has a measurable and significant effect on cardiovascular health. Socioeconomic- and income-related disparities worsen cardiovascular risk factors. Peripheral artery disease (PAD) remains a major risk factor for morbidity and mortality. Not all patients benefit equally from recent advances in outpatient healthcare. [...] Read more.
Economic status has a measurable and significant effect on cardiovascular health. Socioeconomic- and income-related disparities worsen cardiovascular risk factors. Peripheral artery disease (PAD) remains a major risk factor for morbidity and mortality. Not all patients benefit equally from recent advances in outpatient healthcare. The implementation of guideline recommendations regarding treatment is inadequate. Income-related disparities for PAD treatment are unknown. We aimed to analyse income-stratified PAD prevalence, outpatient treatment and pharmacotherapy. Associations of statutory health insurance physicians at the regional level, income-stratified PAD prevalence and differences in outpatient care and pharmacotherapy were analysed in 70.1 million statutorily insured patients/year between 2009 and 2018. Analysis was based on claims data (§295 of the social code (SGB V)) and drug-prescription data (§300 SGB V). The diagnosis of PAD was defined by ICD I70.2-9. Regional income data were derived from the German Census Bureau. PAD prevalence was higher in low-income than in high-income areas. Low-income patients more often presented to angiology outpatient care and more frequently received guideline recommended pharmacotherapy. High-income patients more often presented to outpatient vascular surgery. This was true for statins, antiplatelets, intermittent claudication and critical limb ischemia alike. These data indicate that PAD and income are associated. Regional income is related to insufficiencies in guideline-recommended treatment and contact to vascular specialists. Our results aim to encourage medical professionals to implement PAD guideline recommendations, especially in high-income areas. Further studies on associations between spatial-level income and healthcare in PAD are needed. Full article
(This article belongs to the Special Issue Management and Challenges in Peripheral Arterial Disease)
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