Abstract:
OBJECTIVE:Several trials have reported early superior patency of stenting over isolated angioplasty (plain old balloon angioplasty [POBA]) for infra-inguinal occlusive disease, yet long-term data are sparse. The purpose of this study was to contrast long-term clinical outcomes and costs of angioplasty alone vs angioplasty with selective stenting in the treatment of femoropopliteal occlusive disease. METHODS:Patients undergoing primary endovascular treatments of the native femoropopliteal arteries from 2002 to 2009 were divided into two groups, POBA alone or stenting based on final treatment received at their index procedure. Study end points included actuarial 5-year primary patency (using strict criteria of any hemodynamic deterioration or return of symptoms), 5-year limb salvage, and 5-year survival and hospital costs. RESULTS:Eight hundred twenty-four primary procedures were performed during the study interval; 517 (63%) were POBA and 307 (37%) were stenting. The mean follow-up duration was 33 months (range, 0-98 months). The indication for intervention in the stenting group was claudication in 71% of the patients, whereas the remaining 29% had critical limb ischemia (CLI). In the POBA cohort, the indication for treatment was claudication in 59% of the patients and CLI in the remaining 41%. A higher percentage of POBA lesions were TransAtlantic Inter-Society Consensus (TASC) II A & B when compared to stenting (91% POBA vs 73% stenting; P < .001). There was no difference in overall 5-year primary patency (POBA 36% ± 3%; stenting 41% ± 4%; P = .31), nor was there a difference in patients with claudication (POBA 42% ± 4%; stenting 45% ± 4%; P = .8). In patients with CLI, the 4-year primary patency was 27% ± 5% (POBA) vs 36% ± 8% (stenting), P = .22; the 4-year limb salvage was 80% ± 4% (POBA) vs 90% ± 5% (stenting), P = .18. There was no difference in survival between the two groups (claudication: 83% ± 3% POBA vs 84% ± 4% stenting at 5 years (P = .65), CLI: 44% ± 4% POBA vs 49% ± 6% stenting at 4 years (P = .40). Subgroup analysis by lesion anatomy showed similar primary patency between POBA and stenting for TASC II A & B lesions, while the primary patency was significantly higher at 5 years after stenting of TASC II C & D lesions (34% ± 6% vs 12% ± 9%; P < .05). Stenting increased the procedural cost by 57% when compared to POBA (P < .001) regardless of treatment indication. In addition, stenting added 45% (P < .001) to the overall hospital cost of patients treated for claudication. CONCLUSION:Stenting resulted in equivalent long-term outcomes compared to POBA when stratified by indications. However, stenting yielded statistically better primary patency in patients with TASC II C & D lesions. The lack of improved clinical outcomes and significantly higher cost of stenting supports a posture of selective use of stents (especially in TASC II A & B) in the endovascular treatment of femoropopliteal occlusive disease.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Nguyen BN,Conrad MF,Guest JM,Hackney L,Patel VI,Kwolek CJ,Cambria RPdoi
10.1016/j.jvs.2011.03.283subject
Has Abstractpub_date
2011-10-01 00:00:00pages
1051-1057.e1issue
4eissn
0741-5214issn
1097-6809pii
S0741-5214(11)00834-2journal_volume
54pub_type
杂志文章abstract:PURPOSE:Percutaneous angioplasty and stenting (PTAS) is emerging as a therapeutic option for patients with chronic mesenteric ischemia. This study evaluated patency and mortality, and their relationship between degree of vessel occlusion (stenotic or totally occluded), stent characteristics, and comorbidities in patien...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.11.046
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:Many patients with peripheral arterial occlusive disease who require a lower-limb bypass have no available autologous saphenous vein (ASV) for the procedure and thus require a prosthetic graft. Expanded polytetrafluoroethylene (ePTFE) grafts are commonly used, but results with these prostheses have varied, es...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.12.009
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:To describe our experience with endoluminal stent graft repair of aortobronchial fistulas. METHODS:We reviewed the records of patients treated with endoluminal stent grafting of aortobronchial fistulas at a private teaching hospital. All patients underwent the following diagnostic studies: computed tomograph...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.118583
更新日期:2002-02-01 00:00:00
abstract::Fistulous communication between the aorta and esophagus is a rare but usually fatal disorder. Esophageal foreign bodies have been reported to cause aortoesophageal fistula rarely. Spontaneous aortoesophageal fistula as a result of atherosclerotic disease of the aorta has not been reported. This article describes a cas...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1067/mva.1987.avs0060379
更新日期:1987-10-01 00:00:00
abstract::Patency of vein grafts may be influenced by the medium in which they are stored temporarily. We compared saline solution vs blood on prostanoid production and maintenance of endothelium in canine veins after 1 hour of storage at 23 degrees C with 0.2 mg/ml of papaverine. Spontaneous and arachidonate-stimulated prostag...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1988-04-01 00:00:00
abstract:OBJECTIVE:Abdominal aortic aneurysm (AAA) rupture is associated with a systemic inflammatory response syndrome, characterized by increased microvascular permeability and neutrophil sequestration, leading to multiorgan dysfunction. We examined the role of a novel complement factor 5a (C5aR) receptor antagonist, the cycl...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2003.07.001
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Plasma 25 hydroxycholecalciferol (vitamin D) deficiency has been associated with adverse cardiovascular outcomes in epidemiologic studies. Chronic kidney disease is associated with loss of 1α-hydroxylase and consequently vitamin D deficiency. We hypothesized that vitamin D deficiency was associated with incr...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.01.037
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:The sandwich technique is an endovascular off-the-shelf solution for patients with thoracoabdominal aortic aneurysms (TAAAs). In a sandwich configuration, the chimney stent runs in the middle of a space created by two or three aortic endografts. METHODS:All patients with TAAAs who were treated with the sand...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.12.044
更新日期:2014-06-01 00:00:00
abstract::Previous reports have demonstrated that endothelial cell seeding of polytetrafluoroethylene (PTFE) grafts enhances short-term patency. This experiment was undertaken to study its impact on the long-term patency of a highly porous, experimental PTFE graft and to determine whether increasing the internodal distance of t...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1987-04-01 00:00:00
abstract:BACKGROUND:The study was conducted to demonstrate improved survival (30-day mortality) after the introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms (rAAA). Numerous authors have successfully demonstrated reduced mortality in patients with rAAA using endovascular technique...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.11.047
更新日期:2007-03-01 00:00:00
abstract:OBJECTIVE:Wound healing in venous leg ulcer (VLU) is a multi-step process involving complex pathways. Scanty knowledge at molecular level hinders clinical assessment and treatment. Anomalous handling of local iron overload, as well as unbalancing in matrix metalloproteinases (MMPs) and transglutaminase, has a recognize...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.07.103
更新日期:2009-12-01 00:00:00
abstract:PURPOSE:This study evaluated perioperative variables to predict death in nonruptured and ruptured abdominal aortic aneurysm (AAA) surgery. METHODS:A consecutive review of all patients who underwent AAA surgery from January 1984 to December 1993 was carried out. Perioperative variables were analyzed with univariate and...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(96)70077-0
更新日期:1996-10-01 00:00:00
abstract:OBJECTIVE:This study reviews the results of en bloc resection of the inferior vena cava (IVC) for malignant tumor excision and reconstruction. METHODS:A prospective database was reviewed. IVC resection was categorized as suprarenal, perirenal, infrarenal, or extensive (>one segment resected). Repairs were divided into...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.11.054
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVE:Multiple vascular inflow reconstruction options exist for claudication, including aortofemoral bypass (AFB) and alternative inflow procedures (AIPs) such as femoral reconstruction with iliac stents, and femoral-femoral, iliofemoral, and axillofemoral bypass. Contemporary multi-institution comparison of these ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.05.081
更新日期:2016-12-01 00:00:00
abstract:PURPOSE:This retrospective review describes surgical management of atherosclerotic renovascular disease (RVD) in hypertensive adults with diabetes mellitus. METHODS:From July 1987 through July 1995, 54 consecutive hypertensive diabetics (mean 213/103 mm Hg; mean medications three drugs) requiring either insulin (16 pa...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(96)70194-5
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVE:Aortic reconstruction for complex thoracoabdominal aortic aneurysms (TAAAs) can be challenging, especially in patients with connective tissue disorders (CTDs) in whom tissue fragility is a major concern. Branched graft reconstruction is a more complex operation compared with inclusion patch repair of the aort...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2017.03.451
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVES:Complications after abdominal aortic aneurysm (AAA) repair resulting in reintervention increase mortality risk, but have not been well studied. Mortality after reintervention is termed failure to rescue and may reflect differences related to quality management of the complication. This study describes the re...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.01.030
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:Induction of collateral development to improve tissue perfusion is a promising approach for the treatment of arterial occlusive diseases. Several growth factors and cells have been reported to increase collateral circulation; however, the appropriate site for the delivery of these factors and cells is unclea...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.02.004
更新日期:2015-07-01 00:00:00
abstract::Embolization of discs from various prosthetic mitral valves produces fulminant cardiac failure with possible survival after emergent mitral valve prosthetic replacement. The embolized discs lodge in the aorta at various levels parallel to the blood stream and have not occluded distal flow. Some embolized discs have be...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1985-09-01 00:00:00
abstract::A 64-year-old man was admitted with abdominal pain 6 weeks after treatment with intravenous flucloxacillin for cellulitis of his right leg. Urgent operation was necessary for a mycotic aneurysm of the abdominal aorta due to infection with Pasteurella multocida, a microorganism residing in the oral cavity of domestic a...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.06.052
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVE:Our study aimed to perform a meta-analysis based on current evidence to investigate the efficacy of different debulking devices in the treatment of femoropopliteal in-stent restenosis (FP-ISR). METHODS:We systematically searched for articles reporting treatment of FP-ISR patients in the MEDLINE, Embase, and ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.jvs.2019.11.058
更新日期:2020-07-01 00:00:00
abstract::The pedigrees were constructed of 43 patients (probands) who underwent resection of an abdominal aortic aneurysm. Seven probands (16.2%) had a first-degree relative (parent, sibling, child) known to have had an abdominal aortic aneurysm (multiplex family). To determine the prevalence of undiagnosed abdominal aortic an...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1991.25382
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Acute aortic syndromes remain life-threatening. Time is of the essence, as mortality rises with increasing time after the acute episode. The aim of this report is to show changes in practice and outcomes after the establishment of an acute aortic treatment center (AATC) to expedite the care of acute aortic s...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.06.157
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVE:The optimal role for bare metal stents (BMS) or stent grafts (SG) in femoropopliteal occlusive disease (FPOD) is as of yet undefined. Understanding the clinical consequences of failure can help guide initial treatment decisions. The goal of this study was to define the nature, frequency, and risk factors for ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.05.094
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:We investigated the outcomes of hybrid repair of thoracoabdominal aortic aneurysms and performed meta-analyses and meta-regressions to assess whether the number of stages during hybrid repair is associated with mortality. METHODS:Review methods were according to the Preferred Reporting Items for Systematic R...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jvs.2013.04.061
更新日期:2013-11-01 00:00:00
abstract:PURPOSE:We set out to assess the new Aberdeen Varicose Veins Questionnaire (Aberdeen Questionnaire) for the properties necessary for a valid measure of health outcome, to determine quality of life of patients with varicose veins, and to determine the effect of surgery on quality of life. METHODS:A prospective consecut...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70110-2
更新日期:1999-10-01 00:00:00
abstract::During a 28-year period from 1955 to 1983, two cases of massive repetitive arterial thromboembolism from nonaneurysmal aortic mural thrombus were diagnosed antemortem and successfully corrected at the University of California, Los Angeles Medical Center. Within the same time period, 48 cases of nonaneurysmal aortic mu...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1986-11-01 00:00:00
abstract:OBJECTIVE:Surgical treatment of arterial lesions associated with Behçet disease (BD) is often complicated by graft occlusion and recurrence of aneurysms. The purpose of this study was to clarify the long-term outcome of surgical intervention for arterial involvement in BD. METHODS:Ten patients with BD (9 men, 1 woman)...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.03.019
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVES:To evaluate the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin A5 on treatment of venous malformation (VM) in cervical-facial region. METHODS:Seventy-five patients (32 male, 43 female), ranging in age from 13 to 60 years old, suffering from VM in cervical-facial region were ad...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.11.038
更新日期:2010-04-01 00:00:00
abstract:PURPOSE:Dissatisfaction with conventional methods of treatment of infected infrarenal aortic prosthetic grafts and excellent long-term results reported by heart surgeons after allograft replacement for management of infections involving the ascending aorta have prompted us to investigate allograft replacement in the ma...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1993-02-01 00:00:00