Τίτλος:
Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Femoropopliteal Chronic Total Occlusions: A Systematic Review of 87 Studies and 4,665 Patients
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Subintimal angioplasty (SIA) is often utilized to cross femoropopliteal (FP) artery chronic total occlusions (CTOs). Re-entry devices (RED) can further assist with true lumen re-entry. Objective: To systematically review the literature for studies reporting on the use of SIA, with or without RED. Methods: A systematic review according to the PRISMA guidelines was performed. Quantitative synthesis was applied when possible. Results: 87 studies and 4665 patients (5161 lesions) were included (63.9% male). 46.7% of patients had critical limb ischemia at the time of the intervention. Two RED types were used (Pioneer and Outback). Sixty-eight studies included lesions treated with SIA without RED, 17 studies included lesions treated with RED only, and two studies included a comparison between the two treatment methods. In total, 3898 (83.6%) patients were treated with SIA without RED and 754 (12.2%) with RED. Procedural success rate ranged from 64.5%–100% (92.5% for SIA without RED, 88.3% for RED cases). The complication rate ranged from 1.6% - 28% among different studies (cumulative rates: SIA: 9.1%, RED 9.3%). Perforations occurred in 1.6% of the total population (n = 46). Primary patency at one year ranged from 22% to 94.1%. Newer studies had a higher patency rate, ranging from 70% to 94.1%. Conclusion: SIA with or without RED is a valuable alternative to intraluminal crossing for endovascular treatment of FP CTOs. Procedural success was excellent for both techniques, while the cumulative complication rate was numerically lower in the RED group. Short- and long-term outcomes were acceptable for both techniques. © 2019
Συγγραφείς:
Kokkinidis, D.G.
Katsaros, I.
Jonnalagadda, A.K.
Avner, S.J.
Chaitidis, N.
Bakoyiannis, C.
Kakkar, A.
Secemsky, E.A.
Giri, J.S.
Armstrong, E.J.
Περιοδικό:
Cardiovascular Revascularization Medicine
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Λέξεις-κλειδιά:
angioplasty; artery; Article; chronic total occlusion; critical limb ischemia; femoropopliteal artery; human; meta analysis; priority journal; quantitative analysis; subintimal angioplasty; systematic review; treatment outcome; adverse event; aged; angioplasty; blood vessel injury; chronic disease; devices; diagnostic imaging; equipment design; female; femoral artery; injury; male; middle aged; pathophysiology; peripheral occlusive artery disease; popliteal artery; risk factor; stenosis, occlusion and obstruction; time factor; vascular access device; vascular patency; very elderly, Aged; Aged, 80 and over; Angioplasty; Chronic Disease; Constriction, Pathologic; Equipment Design; Female; Femoral Artery; Humans; Male; Middle Aged; Peripheral Arterial Disease; Popliteal Artery; Risk Factors; Time Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency; Vascular System Injuries
DOI:
10.1016/j.carrev.2019.03.016
