VASCULAR DISEASE MANAGEMENT
October 2015, Vol. 12, No. 10
Use of Covered Stents to Treat Occlusive Mesenteric Artery Disease
Ying Huang, MD; Gustavo S. Oderich, MD; Peter Banga, MD; Leonardo Reis de Souza, MD
From the Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Abstract: The number of mesenteric revascularizations has increased tenfold in the United States in the last decade. In most centers, angioplasty with stenting surpassed open bypass as the first treatment option for patients with chronic mesenteric ischemia (CMI); however, endovascular therapy using bare metal stents (BMS) has been plagued by high rates of restenosis and reinterventions affecting as much as 20% to 66% of patients treated for CMI. Studies have shown that covered stent (CS) can effectively decrease rates of restenosis and reintervention when applied to treat iliac occlusive disease and chronic mesenteric lesions, yielding results comparable to open surgical bypasses. This review describes the use of CS in endovascular treatment of chronic mesenteric ischemia, including indications, techniques, and results.
The Current State of Endovascular Intervention for Peripheral Arterial Disease
Rigved V. Tadwalkar, MD, MS; Michael S. Lee, MD
From the UCLA Medical Center, Los Angeles, California.
ABSTRACT: The rising incidence of peripheral arterial disease (PAD) has resulted in a concomitant increase in complications such as critical limb ischemia and lower-extremity amputation. Although a full spectrum of treatments exists for femoropopliteal PAD, there is not yet a well-defined consensus on the role of a specific type of endovascular modality that is best suited for treatment. Although percutaneous transluminal angioplasty (PTA) is commonly used for revascularization in PAD due to high initial success rates of around 90%, long-term patency is a concern. Studies comparing drug-eluting balloons to PTA have demonstrated encouraging results with respect to primary patency but inconsistent results from the perspective of freedom from target lesion revascularization and adverse events. While stent placement has primarily been utilized as “bail-out” therapy for PTA with complications, newer generation drug-eluting stents including sirolimus-eluting and everolimus-eluting stents have shown favorable outcomes, suggesting an increasing role for this form of percutaneous revascularization. Although a diverse array of atherectomy devices is available, these devices’ role has yet to be clearly defined due to lack of high-quality studies that are appropriately powered to evaluate for long-term clinical outcomes. Despite this, the continued study of these modalities complemented by refinements in technique for new devices foreshadows a bright future for new endovascular approaches in the treatment of PAD.
Antiplatelet Therapy for Peripheral Artery Disease: An Interview With Craig Walker, MD
Vascular Disease Management speaks with Craig Walker, MD, clinical professor of medicine at Tulane University School of Medicine and Louisiana State University School of Medicine in New Orleans, and founder, president, and medical director of the Cardiovascular Institute of the South in Houma, Louisiana.
Data From the EASE Atherectomy Trial: An Interview With Tom Davis, MD
Interview by Jennifer Ford
Understanding the Science of Atherectomy: Lawrence A. Garcia, MD, Discusses DEFINITIVE LE
Interview by Jennifer Ford
* Articles are subject to change at the editor’s discretion.