These features highlight some of the studies that emerged from the International Symposium of Endovascular Therapy 2011 meeting, including carotid angioplasty in high- and low-risk patients, safety and efficacy of cryoballoon angioplasty, drug-eluting stents for renal artery stenosis, and the management of critical limb ischemia.
The Particulars: Carotid angioplasty and stenting (CAS) is an alternative treatment for carotid artery stenosis. Recent studies have shown that CAS appears to have superior short-term outcomes when compared to carotid endarterectomy (CEA) in high-risk surgical patients. However, there are little data on whether low-risk surgical patients have fewer risks with CAS.
Data Breakdown: Researchers analyzed results of CAS in patients at high and low surgical risks. High-risk patients included those who were older than 80 and those with postoperative restenosis, prior neck surgery or radiation, contralateral occlusion, low or high anatomic lesions, unstable or severe coronary or heart diseases, and severe comorbidities. CAS appeared to be safe overall, with favorable low event rates in high-risk and low-risk patients. Low-risk patients had a trend toward lower death and stroke rates after CAS when compared with CEA, but this risk was not statistically significant.
Take Home Pearls: CAS appears to be safe for both high- and low-risk patients with carotid artery stenosis. Its use should be expanded to low-risk patients as CAS is becoming the gold standard treatment for a carotid stenosis.
Costs in the Management of Critical Limb Ischemia [back to top]
The Particulars: Cost analyses in hospitalized patients have become increasingly important in the healthcare system. Endovascular and open surgical interventions are available for the treatment of critical limb ischemia (CLI), but long-term results of these interventions have been subject to debate and scientific investigation. A study was performed to determine if open or endovascular procedures had a significant impact on cost.
Data Breakdown: In an analysis of 137 patients presenting with CLI, patients were analyzed for cost of the admission. The mean length of stay was 9.3 ± 8.66 days for patients receiving endovascular treatment, 10.4 ± 7.89 days for those receiving open procedures, and 9.8 ± 6.45 days for patients receiving a hybrid of these interventions. The mean cost of an open procedure hospitalization was $45,832 ± $23,053, compared with $49,802 ± $27,657 for those receiving endovascular procedures, and $27,922 ± $10,053 for patients receiving hybrid procedures.
Take Home Pearls: Patients presenting with CLI appear to have shorter lengths of stay if they undergo an endovascular-only procedure, but they may be prone to longer admissions. Hospitalization costs of patients undergoing open- or endovascular-only procedures are similar and have similar rates of readmission. Overall, endovascular treatment does not appear to offer a cost-saving advantage over open surgical reconstruction.
Safety & Efficacy of Cryoballoon Angioplasty [back to top]
The Particulars: Previous investigations have suggested that using cryoballoon angioplasty in conjunction with thrombolysis and laser atherectomy is a safe and effective treatment for critical limb ischemia in patients with peripheral vascular disease. A 5-year analysis retrospectively analyzed primary interventions using cryoballoon angioplasty.
Data Breakdown: The technical success rate associated with cryoballoon angioplasty was 97%. The clinical success rate within 30 days was 87.9%. Within the 30-day postoperative period, 4.8% of patients receiving cryoballoon angioplasty had repeat interventions. Balloon cryoplasty appeared to have impressive primary and secondary patency as well as limb salvage rates for below-the-knee interventions for up to 2 years.
Take Home Pearls: Cryoplasty appears to be a safe and effective alternative to bypass or amputation in patients with advanced peripheral vascular disease. The procedure is associated with a high clinical success rate and few postoperative complications.
Guideline Adherence for IVC Filter Placements [back to top]
The Particulars: Inferior vena cava (IVC) filter placement has increased significantly over the past few decades as indications for it have expanded. However, the indications for IVC filter placement vary widely depending on which professional society’s recommendations are followed. A study assessed the effect of placement on medical specialty and evaluated compliance with accepted standards from the American College of Chest Physicians (ACCP) and Society of Interventional Radiology (SIR).
Data Breakdown: In a single-center, retrospective medical record review of all patients who received an IVC filter over 26 months, researchers found that 87.2% of IVC filter placements were recommended by medicine and its subspecialties, and 12.8% were recommended by non-medical specialties. SIR guidelines were met by 79.1% of filters placed, whereas ACCP guidelines were met by only 43.3%. Of the total number of filters placed in the investigation, 35.8% met SIR criteria but did not meet ACCP guidelines.
Take Home Pearls: Less than half of IVC filters that are placed appear to meet ACCP guidelines, but more than three-fourths meet criteria set by the SIR. Most IVC filters are placed for patients classified as “fall risks,” failures of anticoagulation, limited cardiopulmonary reserve, and medication noncompliance. There is a need for harmonization of current guidelines.
For more information on these items and other research that was presented at ISET 2011, go to: www.iset.org.