Article

Endovascular Management of the Popliteal Artery: Comparison of Atherectomy and Angioplasty

Section of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA 02118, USA.
Vascular and Endovascular Surgery (Impact Factor: 0.77). 11/2009; 44(1):25-31. DOI: 10.1177/1538574409345028
Source: PubMed

ABSTRACT Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications, and midterm outcomes of atherectomy and angioplasty involving the popliteal segment.
We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008.
A total of 56 patients (36% women, age 72.8 +/- 12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n = 18) or angioplasty (n = 38). These patients had similar clinical characteristics, TransAtlantic Intersociety Consensus (TASC)/ TASC II classification, mean lesion length, and runoff scores. We observed a trend toward higher rates of technical success defined as <30% residual stenosis after atherectomy compared to angioplasty (94% vs 71%, P = .08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs 0%, P = .003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, P = 0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs 6%, P = .005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index (ABI) was similar between the 2 treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (P = not significant [NS]). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups.
Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage, and freedom from intervention.

1 Follower
 · 
154 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The blue light emission from yttrium niobiumtantalate Y(Ta, Nb)O4 phosphors under X-ray excitation, is associated with TaO43- and NbO43- groups from the host crystalline lattice. Such luminescent emission could be shifted toward longer wavelengths when activators: rare earth ions such Eu3+ or Tb3+ replace partially the yttrium ions in the host crystalline lattice. The paper presents the analogical modelling and numerical simulation for fitting the equation to experimental data by a regression analysis. The program determines the theoretical parameters for incorporation degree of activators: KAc and Emax and they are compared with the values of the same parameters experimentally determined.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The popliteal artery may well be the most challenging of all infra-inguinal vessels to treat. Not only is it anatomically unique but it's also exposed to some of the most brutal forces seen in the lower limb, during normal knee flexion. Management may be challenging and with few randomized trials dedicated to answering questions of technical success and durability the correct approach remains contentious. Herein we seek to describe and evaluate the growing number of options for treatment in this vascular territory.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Women have high rates of peripheral artery disease (PAD) despite fewer cardiovascular disease (CVD) risk factors, compared to men. We sought to determine the gender-specific prevalence of low ankle brachial index (ABI) and the relationship to C-reactive protein (CRP) levels and CVD risk factors in the Life Line Screening population. Between April 2005 and August 2011, 133 750 women and 71 996 men had ABI and CRP measured at a Life Line Screening Center. Women were slightly older than men, whereas men were more likely to be current smokers, have diabetes mellitus (DM), and coronary artery disease (CAD) (P<0.001 for each). Women were more likely to have ABI≤1.0, compared to men (26.6% versus 14.4%, respectively; P<0.001), as well as ABI≤0.9 (4.1% women versus 2.6% men; P<0.001). Women had higher median CRP levels (1.94 mg/L; interquartile range [IQR], 0.89, 4.44 mg/L), compared to men (1.35 mg/L; IQR, 0.73, 2.80 mg/L; P<0.001). Men and women shared similar risk factors for ABI≤0.9, including older age, black race, smoking, DM, hypertension, hypercholesterolemia, CAD, and elevated CRP levels. In an adjusted model, there were significant interactions between gender and age (P<0.001), CRP (P<0.001), CAD (P=0.03), and DM (P=0.06) with ABI as the outcome. The associations between age, CRP, CAD, and DM with ABI≤0.9 were stronger in men than in women. Women participating in the Life Line Screening had higher CRP levels and a higher prevalence of PAD, compared to men. Neither higher CRP levels nor conventional CVD risk factors explained the excess prevalence of PAD in women.
    Journal of the American Heart Association 03/2014; 3(2):e000651. DOI:10.1161/JAHA.113.000651 · 2.88 Impact Factor