Volume 1 - Issue 2 - Nov/Dec 2004
Original Contribution »
Endovascular-First Strategy in Patients with Critical Limb Ischemia
Introduction
Surgical bypass is considered the gold standard for the treatment of patients with chronic severe lower extremity ischemia.1,2 However, the 5-year limb salvage rates reported as high as 80% in single center/surgeon series have not been reproduced in multicenter studies or national registries.1,3,4 Often, these are extensive surgeries being performed in a mostly elderly patient population with multiple comorbidities. This has an impact on functional outcome. Only 45% of patients under going infrainguinal bypass reported feeling “back to normal” at
Feature »
Initial Experience in the Treatment of Chronic Superficial Femoral Artery Occlusion with Fiberoptic Guidance Technology
SUMMARY
Percutaneous treatment of chronic total occlusions may result in dissection or perforation. A fiberoptic guidance system that visualizes lesion characteristics and incorporates a radiofrequency energy source to aid in crossing total occlusions was used to cross five superficial femoral artery lesions, and there were no observed complications.
INTRODUCTION
Recent study of percutaneous intervention in chronic superficial femoral artery (SFA) occlusions indicates crossing the lesion is feasible in 68-100% of cases1-12 but that flow-limiting dissections and
Feature »
Ipsilateral Lumbar Artery Coil Embolization Made Possible by the Technology of a Novel Guide Catheter: A Case Report
The patient is a 83-year old male with an infrarenal abdominal aortic aneurysm (AAA) and right iliac aneurysm. Previously the patient underwent coil embolization of the proximal right hypogastric artery followed by stent grafting of the abdominal aortic aneurysm. The right limb of the stent graft ended in the proximal external iliac artery. At 1-month follow-up, a large type II endoleak via the inferior mesenteric artery was present. Repeat CT-scan completed at 3 months showed enlargement of the endoleak and a small amount of enlargement of the AAA. The patient underwent coil embolization of t
Feature »
The CIS "Power-Pulse Spray" Technique
Introduction
Thrombus is now accepted as playing a key role in patients with acute myocardial infarction (AMI), unstable angina, acute coronary syndromes (ACS), deep venous thrombosis (DVT), pulmonary embolus (PE), and acute limb ischemia (ALI). Angioscopic evidence of thrombus was noted in a significant percentage of patients presenting with ACS and AMI by White et al.1 and large acute and subacute thrombus burdens are often associated with ALI, DVT, and PE. Thrombus formation is a complex process. It culminates in a final common pathway, with the thrombin cleavage of fibri
Feature »
Commentary: Ipsilateral Lumbar Artery Coil Embolization Made Possible by the Technology of a New Novel Guide Catheter
The advent of endoluminal graft repair for abdominal aortic aneurysms has dramatically changed the therapeutic option for many patients. It is now well established that the devices can be safely inserted and short-term results have been excellent. Long-term outcome for many of these patients remains uncertain. The authors present a case report in which incomplete exclusion of the aneurysm with continued endoleak has resulted in aneurysm enlargement. As a result, the patient is not protected from continued expansion and the potential for eventual rupture. It is established in the literature tha
Feature »
Ask the Expert: A Responsible Approach to Carotid Artery Stent (CAS) Training
A national and international thought leader in the field of vascular medicine, Dr. Jaff recently served as the Medical Director of the Vascular Ultrasound Core Laboratory at the Cardiovascular Research Foundation in Morristown, New Jersey. He has lectured extensively throughout the world, and has authored numerous publications in the field. Dr. Jaff currently serves on the Editorial Board for Catheterization and Cardiovascular Intervention, Journal of Endovascular Therapy, Journal of Invasive Cardiology, and Angiology. He is currently President of the Society for Vascular Medic
Interview »
Cyroplasty in the Treatment of Infrainguinal Arterial Disease: An Interview with James Joye, DO
Many physicians are exploring device use in the lower extremities, while techniques for successful and appropriate stenting are also being intensely discussed. Where does cryoplasty fit into the current picture?
Peripheral vascular disease, in general, is a relentless and proliferative process. With cryoplasty, whether it be in the fem-pop segment or below the knee, we are trying to achieve both better acute outcomes and long-term outcomes. What we're trying to accomplish is a minimization of the need for stent implants in the legs because they have their own set of problems and simu
Interview »
Recognizing Expertise: Obtaining Certification by the American Board of Vascular Medicine
Why do you think this board is of value to the field of endovascular medicine?
Right now, there aren’t enough experts in vascular medicine to care for the masses of patients who have systemic atherosclerosis. So many different specialists are involved in the care of these patients that it’s hard to know who really has expertise in the overall management of patients with vascular disease. The concept behind the creation of the American Board of Vascular Medicine is to set a standard level so that people who have really dedicated themselves to the management of these patients and to
Discussion Forum »
Discussion question: Will drug-eluting stens have a major impact in prevention of restenosis after non-coronary interventions? F
Drug-eluting stents (DES) have revolutionized the treatment of obstructive coronary disease and expanding their applications to the periphery is inevitable. However, a better understanding of stent-associated restenosis in the periphery is needed.
1) The restenosis rate is very different in various vascular beds and clearly very high in infrainguinal vessels. The superficial femoral artery is probably the vascular bed that will be most in need of DES technology, given its long lesions and high restenosis rate.
2) The restenosis process in the periphery appears to continue beyond t
Feature »
Combined Approach to Limb Salvage with Cryoplasty Therapy and Transmetatarsal Amputation in a Patient with Chronic Critical Limb
The patient is a 72-year-old woman who was transferred from a local area hospital for continued work up of PVD with ischemia of the third digit on the left foot. The patient had undergone attempted left lower extremity bypass. However, autogenous veins were found unsuitable to serve as conduit and the procedure was aborted. She was admitted to Yale-New Haven Hospital under the podiatric surgical service for a final attempt at limb salvage.
The patient has a significant past medical history: PVD, diabetes, coronary artery disease, hypertension, hypercholesterolemia, myocardial infarction, c
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