Cath Lab Digest

Continuing on the theme of evidence-based medicine and an open dialogue, I want to further discuss the current state of lower extremity revascularization for patients with claudication and critical limb ischemia and focus on the treatment of the superficial femoral artery (SFA) for claudicative diseases.

The discussion was not very robust last month despite what I thought would be provocative statements. For this month, I want to ask a simple question: Where are the SFA data? Do we really think that any trial using a lesion length of 6–10 cm is one that would translate to the general population we treat every day in the cath lab or operative suites? The one “real-world” trial of recent memory was the VIBRANT trial. The data presented thus far and not published showed that a stent graft using the Gore ViaBhan technology had a primary patency of 53% compared to 58% with non-stent graft endoprotheses in lesions that averaged 19 cm. RESILIENT and ABSOLUTE were 6.4 and 10.3 cm, respectively. Thus, with a longer lesion, the primary patency declines dramatically. The 2-year data from ABSOLUTE confirmed the decline of primary patency in the 54% range.

Should we accept the meager data from the SFA trials and infer the data to the real world with reckless abandon? Where are the scientists and the science?

Let’s see where this discussion leads and reconvene next month.

Lawrence A. Garcia, MD

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Dr. Garcia received his B.A. and M.D. degrees from the University of Arizona. He was an Intern and Resident at Parkland Memorial Hospital, University of Texas at Southwestern in Dallas, Texas. He received his training in Cardiology at the University of Iowa Hospitals and Clinics in Iowa City, Iowa, and as an interventional cardiologist at the Beth Israel Deaconess Medical Center, Harvard Medical School. Further, he received his peripheral vascular training at St. Elizabeth’s Medical Center, Tuft’s University, Boston, Massachusetts. He then served as the Chief of Vascular Medicine and Peripheral Vascular Interventions for the Florida Heart Group in Orlando, Florida. Dr. Garcia returned to Harvard’s Beth Israel Hospital as a full-time interventional cardiologist and Director of the Peripheral Cardiovascular Program and Peripheral Interventions at the Beth Israel Deaconess Medical Center as well as the Director of the Interventional Fellowship Program. This program developed into one of the busiest in the city of Boston, performing over 600 peripheral procedures per year.

Dr. Garcia has now returned to St. Elizabeth’s Medical Center as Chief of the Section of Interventional Cardiology and as Associate Director of the Vascular Medicine Program. Dr. Garcia’s work has largely focused on arterial occlusion-reperfusion models and the efficacy of therapeutic modalities or interventions with regard to free radical generation or endovascular stenting outcomes. Dr. Garcia continues his research interests in a wide variety of studies including acute MI studies, unstable angina studies, interventional trials, peripheral interventional trials, angiogenesis trials, imaging modality studies, and numerous device trials for both the coronary and peripheral circulations. His work has been presented in numerous manuscripts, abstracts, textbooks and textbook chapters.