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Peripheral Angioplasty
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Peripheral Angioplasty is performed to open narrowed or blocked arteries which improves the blood flow to the affected area. This treatment helps preserve kidney function or control high blood pressure, in the case of renal artery stenosis. It also relieves the symptoms of claudication for those with PVD, and can help to avoid the need for amputation of a limb due to loss of arterial blood flow.
Bivalirudin in Peripheral Vascular Interventions: A Single Center Experience
Unfractionated heparin is a widely utilized anticoagulant during peripheral angioplasty procedures (PTA). In contrast to heparin, bivalirudin is a direct thrombin inhibitor with predictable anticoagulation, does not activate platelets, and inhibits both soluble and bound thrombin. The experience with bivalirudin during PTA remains limited. In this single-center prospective study, 48 consecutive patients (60.4% males, mean age 70.0 ± 12.1) received bivalirudin as the primary anticoagulant during PTA (0.75 mg/kg bolus, 1.75 mg/kg/h during the procedure). Thirty-four (70.8%) had claudication and 6 (12.5%) had ulceration. Thrombus was angiographically seen in 3 (6.3%) patients. In-hospital serious procedural complications were limited to 2 (4.2%) (exact 95% confidence interval: (0.5%,14.3%]) patients with major bleeding; none (0.0%) of the other following endpoints occurred: death, limb loss, emergent need for revascularization of the same vessel, embolic strokes, and vascular complications (exact 95% confidence intervals: [0.0%,6.1%]). This compared favorably to previously reported data using unfractionated heparin and the same serious procedural complications endpoints from our group at the same institution (9.2%). We conclude that the use of bivalirudin during PTA appears feasible and safe. Large prospective registries are needed to confirm these findings.
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Dethrombosis of the Lower Extremities: Pharmacologic and Mechanical Techniques
Thrombus is widely present in the peripheral vasculature and its frequency depends on the patient?s clinical presentation. Thrombus is almost always present in acute critical limb ischemia (ALI) and is commonly found in patients with subacute presentations, chronic critical limb ischemia (CLI) and chronic occlusions. The approach to dethrombosing a vessel depends on multiple factors, including the age of the thrombus, but generally requires a combination therapy with chemical lysis and rheolytic thrombectomy, such as the use of Power-Pulse Spray (P-PS) technique, or atherectomy with dethrombosing capability such as the excimer laser. Surgery or chemical lysis as stand alone therapies carry very high rates of amputation and mortality. The role of embolic protection devices is still unclear but is promising, as embolization of atherothrombus continues to be a frequent occurrence during peripheral angioplasty. In this review, algorithms to treat thrombus in peripheral arterial disease are suggested.
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Critical Limb Ischemia ? A Contemporary Review of Reperfusion Techniques
A Contemporary Review of Reperfusion Techniques Original Contribution: Critical Limb Ischemia ? Endoscopic vein harvest for infrainguinal vascular reconstruction and limb salvage in chronic critical limb ischemia. Limb salvage following laser-assisted angioplasty for critical limb ischemia: Results of the LACI multicenter trial.
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