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SFA Stenting
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The process of placing a stent in the superficial femoral artery
?Magic? Bioabsorbable Metal Stents: The Role of the ?Houdini stent? in the disappearance of CLI
are being creatively treated, but certainly a safe and effective short-term nonpermanent BMS solution ( Stent fractures have been reported in almost every vascular territory, including coronary artery stents.6-7 Several recent reports have identified nitinol stent fractures in infrainguinal arteries to be common and associated with adverse clinical outcomes.8-9 Scheinert et al analyzed 261 SFA stents in 121 legs and reported a 37.2% incidence of stent fractures in the treated legs and 64 of ...
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Combined Glycoprotein IIb/IIIa and Direct Thrombin Inhibition with Eptifibatide and Bivalirudin in the Interventional Treatment of Critical Limb Ischemia: A Safety and Feasibility Report
Objective: To evaluate the safety and feasibility of optimizing platelet inhibition and thrombin inhibition anticoagulation during peripheral vascular interventions (PVI) for patients with critical limb ischemia (CLI). Background: Glycoprotein (GP) IIb/IIIa inhibition combined with direct thrombin inhibition (DTI) with bivalirudin (Angiomax, The Medicines Company, Cambridge, Massachusetts) has shown decreased bleeding and ischemic complications in percutaneous coronary interventions (PCI). PCI benefits potentially applicable to CLI treatment include improved efficacy in diabetes, small complex vessels, microembolism reduction, and clinical outcomes. PVI cases have higher complications, more frequent reinterventions, and poorer outcomes than PCI. In CLI, a high incidence of diabetes, renal insufficiency, platelet dysfunction, hypercoagulability, inflammation, diffuse disease, and thrombus make DTI and eptifibatide (Integrilin, Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts) an attractive combination treatment. Methods: Between July 1, 2001 and August 1, 2004, 162 CLI patients underwent PVI utilizing bivalirudin (0.75mg/kg bolus with 1.75mg/kg/hr infusion) and eptifibatide (180 mcq/kg IV bolus and 2 mcq/kg/min for 12 hours) (group A) and were compared to a contemporary clinically matched heparin (UFH) control group without IIb/IIIa?s (group B). Results: The bivalirudin/eptifibatide group exhibited a statistically significant improvement (p = < 0.0001) in the variables of sheath removal time < 2 hours and length of stay < 72 hours vs. the UFH group. Trends towards significance were also exhibited in less major (3.7% vs. 5.5%) access site complications, 30-day thrombosis (1.8% vs. 4.3%), 6-month duplex ultrasound > 50% restenosis (17.3% vs. 24.7%), secondary reinterventions (11.7% vs. 16.0%), and 6-month limb salvage (92.6% vs. 87.6%, p = 0.1363). Conclusion: Combined eptifibatide and bivalirudin is a safe, feasible, and theoretically advantageous antiplate
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