Editor's Update


Editor’s Update*

September 2015, Vol. 12, No. 9


New Technique

A Novel Simple Technique Using Hyperemia to Enhance Pressure Gradient Measurement of the Lower Extremity During Peripheral Intervention

Issam Koleilat, MD; Bruce Gray, MD

From Greenville Health System, Greenville, South Carolina.

Abstract: Purpose: To describe a novel technique coupling the use of a pressure-wire gradient measurement with and without hyperemia (induced with an external blood pressure cuff inflated to 20 mmHg above the systolic blood pressure for 1 minute on the affected calf). Case: A 70-year-old patient presented with lifestyle-limiting lower-extremity calf claudication. He underwent angiography, which revealed left superficial femoral artery stenosis. Angioplasty of the lesion improved the angiographic appearance, but a residual pressure gradient could be elicited with provocative hyperemia testing. This prompted stenting, which resolved the differential. Conclusions: Pressure-wire gradient detection with and without provocative hyperemia testing using our novel approach may prove to be a useful adjunct in the diagnosis and treatment of lower extremity occlusive disease.


Clinical Review

Current Status and Limitations in the Treatment of Femoropopliteal In-Stent Restenosis

Osamu Iida, MD; Masaaki Uematsu, MD

From the Kansai Rosai Hospital Cardiovascular Center, Amagasaki City, Japan.

ABSTRACT: Approximately 60% to 70% of symptomatic peripheral artery disease (PAD) is secondary to femoropopliteal (FP) lesions.1,2 Although endovascular therapy (EVT) of FP lesions with nitinol bare metal stents (BMS) improved the relatively low 6- to 12-month primary patency rates achieved with balloon angioplasty (BA),3 19% to 37% of BMS-treated FP lesions develop in-stent restenosis (ISR) within 1 year,4 with risk increasing with lesion length. Because traditional BA and cutting balloon have failed to provide acceptable durability,5 FP ISR treatment remains a major challenge calling for alternative EVT approaches to avoid surgical bypass therapy while achieving acceptable long-term patency.



A Study of CO2 Angiography in Critical Limb Ischemia Patients With Kidney Disease: Interview With Larry J. Diaz-Sandoval, MD

Interview by Jennifer Ford



The PRIME Registry: An Interview With Jihad A. Mustapha, MD

Interview by Jennifer Ford



An Aspirational Atherectomy Case Presented by Fadi Saab, MD

Interview by Jennifer Ford


* Articles are subject to change at the editor’s discretion. 

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