The International Symposium on Endovascular Therapy, or ISET, held its 2010 annual meeting from January 17-21in Hollywood, Florida. The features below highlight some of the news emerging from the meeting. For more information on these items and other research that was presented, go to www.iset.org.
Can A Blood Test Identify Endoleaks?
The Particulars: Ruptured abdominal aortic aneurysms (AAAs) kill more than 13,000 Americans every year. Endovascular aneurysm repair (EVAR) is less invasive than open surgical repair of AAAs, but a downside is that about 10% of such repairs result in endoleaks. To monitor for endoleaks, patients undergo CT scans at 3, 6, and 12 months after EVAR and yearly thereafter.
Data Breakdown: A study of AAA patients who had an endoleak and a simple blood test found elevated concentrations of a blood protein called matrix metalloproteinase-9 (MMP-9). Researchers determined that MMP-9 concentrations of 55.18 or greater helped to identify endoleaks with both high sensitivity and specificity. Results must be confirmed by a prospective clinical validation trial.
Take Home Pearls: A blood test appears to be capable of detecting endoleaks after EVAR for AAAs. Use of this test may help prevent up to 90% of follow-up CT scans.
Gender Differences in Treatment of Blocked Leg Arteries
The Particulars: Narrowed and blocked leg arteries are a common symptom of peripheral arterial disease (PAD). About 8 million Americans have PAD, which can cause pain while walking. In extreme cases, these blocked leg arteries can lead to gangrene, lower-extremity amputations, or death.
Data Breakdown: A retrospective study reviewed the use of endovascular therapy for blocked leg arteries. After 2 years, 46% of treated leg arteries in women remained open, compared with 30% in men. However, women experienced higher rates of blood clotting; 9.0% of women experienced clotting compared with just a 0.6% rate for men. At 2 years after receiving endovascular treatment (eg, angioplasty, stenting, and atherectomy), 88% of women in the study had avoided amputation, compared with an 83% rate for men. There was no difference in results between the various forms of endovascular therapy.
Take Home Pearl: Endovascular therapy should be strongly considered in women with blocked arteries below the knee.
Analyzing Use of Stents to Treat Stroke
The Particulars: About 750,000 people suffer from stroke every year, and more than 20% die. The use of stents to treat stroke has been explored because they may be able to reopen arteries more quickly than other therapies in some cases.
Data Breakdown: In a study using stents to treat stroke, the devices opened blocked arteries for all 20 participants. Three in five (60%) patients receiving the treatment had significant improvement in brain function. On a brain function scale of 0 to 5 (0=no brain impairment; 5=extreme brain impairment), 45% of patients scored a 0 or 1 after treatment.
Take Home Pearls: Although no device or treatment will be beneficial for every stroke, stents appear to open blocked arteries and improve brain function. This strategy may be helpful in cases where other treatments fail to be effective.
A Promising Strategy for Uncontrolled Hypertension
The Particulars: The kidneys play a central role in the long-term control of blood pressure. More than a third of the 75 million Americans with hypertension are unable to control the condition despite taking medication. Uncontrolled hypertension can lead to stroke, heart disease, vascular disease, heart failure, and kidney failure.
Data Breakdown: Sympathetic renal denervation (RDN) is a minimally invasive therapy, which uses radiofrequency ablation. A study assessed 70 patients, each of whom had uncontrolled hypertension despite taking three or more blood pressure medications, who underwent RDN. At 1 month after treatment, the average decrease in systolic blood pressure was 18 mm Hg; for diastolic blood pressure, the average decrease was 11 mm Hg. For patients who reached the 12-month follow-up, systolic and diastolic blood pressures decreased on average to 27 mm Hg and 11 mm Hg, respectively.
Take Home Pearl: RDN appears to be a promising treatment for uncontrolled hypertension as it short circuits nerves in the kidney arteries.
Family Doctors Lack Info on UFE
The Particulars: About 40% of women over the age of 35 have fibroids, which can cause excess bleeding and pain. Treatments for fibroids include hormone therapy, myomectomy, and hysterectomy, as well as minimally invasive procedures. Uterine fibroid embolization (UFE) is an interventional radiology procedure, which has been shown to be effective; some investigations have found that 85% of women who undergo UFE experience significant relief from their fibroid symptoms.
Data Breakdown: A survey of 108 family physicians, who saw an average of 19 fibroid patients per month, was conducted to assess knowledge of UFE. According to survey data, 90% of family physicians stated they had little knowledge about UFE. Of those who had heard of UFE, 42% were unaware that the procedure is performed by interventional radiologists. About 80% of respondents familiar with UFE said they would be likely to refer women who have fibroids to interventional radiologists for treatment.
Take Home Pearls: Many family physicians treat women with uterine fibroids, but the vast majority feel that they are relatively uninformed or only somewhat informed on UFE. Family physicians should be educated by interventional radiologists about the benefits of UFE as a fibroid treatment option.