Peripheral Arterial Interventions: Evolving Therapeutic Strategies

Description

This book examines new technologies (device and pharmacologic) that have evolved over the past few years in treating peripheral arterial disease. Chapters offer optimal strategies to treat PAD, supported by peer-reviewed data. The pillars of this strategy will focus on (a) changing vessel compliance to allow better lumen expansion, (b) less recoil and dissections, and (c) less bailout stenting. Chapters also review embolic protection devices and apply the adjunctive use of anti-proliferative therapy to maintain good long term outcomes. In addition, the book reviews drug coated balloons and drug eluting stent technologies and other means of drug delivery into the vessel wall. The goal of this book is to discuss all these emerging technologies under the strategy of treating patients with the focus on both acute and long term outcomes. Featuring world renown experts, this book offers a critical and comprehensive overview of the current data and future directions that would pave the way for optimal PAD management. Peripheral Arterial Interventions is an essential resource for physicians, residents, fellows, and medical students in cardiology, radiology, vascular surgery, primary care, and health promotion and disease prevention as well as internal and vascular medicine specialists. Preface Contents About the Editor Chapter 1: Peripheral Arterial Atherogenesis Peripheral Artery Disease Epidemiology and Risk Factors Detection of PAD Clinical Findings and Imaging Biomarkers Vascular Anatomy and Rheology Arterial Structure Normal Function of the Endothelium Development of Atherosclerosis Pathogenesis of Atherosclerosis Entry of LDL into the Subendothelial Space Clearance of LDL into the Subendothelial Space Propagation of Atherosclerosis Atherosclerosis in Peripheral Artery Disease Ischemia-Induced Changes Conclusion References Chapter 2: Risk Factors of Patients with Peripheral Arterial Disease Non-modifiable Risk Factors of PAD Age Family History Renal Dysfunction Ethnicity Modifiable Risk Factors for PAD Tobacco Use Hypertension Hyperlipidemia Diabetes Obesity Inflammation Summary References Chapter 3: The Role of Exercise in Treating Symptomatic Claudication in Patients with Peripheral Arterial Disease Definitions Vascular Effects of Exercise Exercise and/or Revascularization Versus Control Exercise Programs for PAD Patients Cost-Effectiveness of Exercise for PAD Summary References Chapter 4: Pharmacologic Interventions in Patients with Peripheral Arterial Disease Oral Antiplatelet Therapies Aspirin Clopidogrel Ticagrelor Vorapaxar Oral Anticoagulants Rivaroxaban Warfarin Edoxaban Cilostazol (Pletal) Lipid-Lowering Drugs Statins PCSK9 Inhibitors Oral Antidiabetic Drugs GLP-1 Agonists SGLT2 Inhibitors in Diabetics Summary References Chapter 5: Blood Vessel Compliance, Barotrauma and Angioplasty-Induced Dissection Following Treatment of the Patient with Peripheral Artery Disease Blood Vessel Wall Structure and Compliance Pathophysiology of Intimal and Medial Calcification Barotrauma and the Immediate Cellular Response to Angioplasty Mid-Term Cellular Response and Remodeling The Concept of Controlled Versus Uncontrolled Dissection Stents for Mechanical Support Modes of Failure Following Balloon Angioplasty Acute Occlusion Restenosis The Classification of Dissection Classification Systems: Angiography Classification Systems: Intravascular Ultrasound (IVUS) The DiSForM Classification System Summary References Chapter 6: Controlling Dissections in Peripheral Arterial Interventions Precise Imaging The Relationship Between Deep Injury, Plaque Excision, Dissection Repair, and Antiproliferative Therapy Aggressive Debulking, High Rate of Deeper Dissections, and Antiproliferative Treatment No Debulking, Deeper Dissections, Dissection Repair, and/or Antiproliferative Treatment Low-Level Debulking, Minimal Rate of Deep Dissections, and Antiproliferative Therapy Other Technologies to Reduce Dissections Dissection Repair References Chapter 7: The Role of Atherectomy in Vessel Prepping During Infrainguinal Arterial Interventions Laser Atherectomy Orbital Atherectomy Rotational Atherectomy Directional Atherectomy Atherectomy and Drug-Coated Balloons Conclusion References Chapter 8: Vessel Preparation with Longitudinal and Controlled-Depth Micro-Incisions The Clinical Benefit of Reducing Dissections Current Methods for Vessel Preparation Specialty Angioplasty Balloons Atherectomy Intravascular Lithotripsy (IVL) Creating Longitudinal Micro-Incisions to Modify Plaque with Fewer Complications Clinical Data in Peripheral Arterial Disease Mechanism of Action FLEX VP Micro-Incisions May Facilitate Drug Delivery Future Directions References Chapter 9: Intravascular Lithotripsy for Calcified Peripheral Arterial Disease Introduction IVL: Device Specifics IVL in Peripheral Artery Disease Effect of Calcium on Drug Elution IVL-Facilitated Large-Bore Vascular Access Indications for IVL in Specific Vascular Beds with Case Examples Brachiocephalic Lesions in Patient with Symptomatic Arm Claudication or TIA Carotid In-Stent Restenosis (ISR) Due to Stent Underexpansion Mesenteric Ischemia Due to Calcific Stenosis of the Superior Mesenteric Artery (SMA) Treatment of Aorto-Iliac Calcific Disease Treatment of Calcific Common Femoral Artery (CFA) Stenosis Calcified Femoropopliteal Lesions in Patients with Symptomatic Claudication or Critical Limb Ischemia Calcified Below-the-Knee (BTK) Lesions in Patients with Symptomatic Claudication or Critical Limb Ischemia (CLI) Future Applications References Chapter 10: Preserving Vessel Integrity and Reducing Vascular Recoil with Focal Force Balloons Introduction Functionalities of Balloon Angioplasty and Focal Force Balloons Peripheral Cutting Balloon (Boston Scientific) (Fig. 10.1) Device Mechanism Specifications Evidence and Use Chocolate PTA Balloon (Medtronic) (Fig. 10.2) Device Mechanism Device Specifications Evidence and Use AngioSculpt Balloon (Philips) (Fig. 10.3) Device Mechanism Device Specifications Evidence and Use VascuTrak (Bard) (Fig. 10.4) Device Mechanism Specifications Evidence and Use Shockwave Intravascular Lithotripsy (IVL) (Shockwave) (Fig. 10.5) Device Mechanism Specifications Evidence and Use FLEX Scoring Catheter (VentureMed) (Fig. 10.6) Device Mechanism Specifications Evidence and Use Conclusions References Chapter 11: Reducing the Metal Burden in the Infrainguinal Arteries: Tack Endovascular System References Chapter 12: Drug-Coated Balloons in Infrainguinal Arteries Background Technical and Pharmacologic Considerations of DCBs Clinical Applications of DCBs in PAD Drug-Coated Balloons in Native Femoropopliteal Lesions Drug-Coated Balloons in Below-the-Knee Interventions DCB Use in Other Lesion Subsets: In-Stent Restenosis, Long Lesions, and Combination Therapy In-Stent Restenosis (ISR) Long Lesions Combination Therapies Future Innovations in DCB Technology Mortality and Paclitaxel Cost-Effectiveness of Drug-Coated Balloons Conclusion References Chapter 13: Stenting in Infrainguinal Interventions A Brief History of Femoropopliteal Stenting Challenge of the SFA Initial Treatment Approaches Nitinol-Based Self-expanding Stents First-Generation Stents Newer-Generation Stents Stent-Grafting in the SFA Drug-Eluting SFA Stents Conclusion References Chapter 14: Femoropopliteal Chronic Total Occlusions: Approach and Considerations for Crossing and Intervention Introduction General Principles Procedure Planning Imaging Vascular Access Treatment Intraluminal and Subintimal Retrograde Hybrid Approaches Below-the-Knee Chronic Total Occlusions References Chapter 15: Approach to Treatment of Iliac Artery Disease Introduction Clinical Presentation and Evaluation Treatment Options for Revascularization Considerations for Endovascular Therapy Complications of Endovascular Revascularization Conclusion References Chapter 16: Chronic Limb-Threatening Ischemia: Evaluation and Management Introduction Definition and Diagnosis Treatment Modalities Medical Management Revascularization Endovascular Approach Technical Aspects of Endovascular Intervention Access Site Guidewire Balloon/Support Catheter The Concept of Angiosome in Treating CLTI Different Endovascular Modalities Surgical Approach Endovascular Versus Surgical First Novel Treatment Modalities Deep Venous Arterialization (DVA) Endovascular Bypass Technology Postrevascularization CLTI Management Wound Care Future Perspectives Conclusion References Chapter 17: Distal Embolization in the Treatment of Peripheral Arterial Disease Historical Background The Problem: Distal Embolization from Endovascular Procedures What are the Rates of Distal Embolization? Incidence of Distal Emboli The Clinical Relevance of Distal Emboli Indications for the Use of Distal Embolic Filters Current Status of Distal Protection Technique of Distal Protection Conclusion and Future of Distal Protection References Chapter 18: Management of Aortic Aneurysms Introduction Indications for EVAR Preoperative Assessment and Planning Operative Technique Postoperative Surveillance and Complications Conclusion References Chapter 19: Putting It All Together: An Algorithmic Approach to Treat Patients with Peripheral Arterial Disease References Index