New research was presented at ISET 2015, the annual International Symposium on Endovascular Therapy, from January 31 to February 4 in Hollywood, FL. The features below highlight some of the studies that emerged from the conference.
Comparing Treatments for Femoro-Popliteal PAD
The Particulars: Previous studies have shown that drug-coated balloons (DCBs) may be promising for improving outcomes among patients with peripheral artery disease (PAD). However, comparisons of DCBs to percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic femoro-popliteal disease are lacking.
Data Breakdown: For a study, patients with intermittent claudication or ischemic rest pain due to femoro- popliteal PAD were randomized to DCB or PTA. Primary patency rates were higher for DCB than PTA (82.2% vs 52.4%), but PTA was better for clinically driven target lesion revascularization (20.6% vs 2.4%). Vessel thrombosis occurred in 3.7% of PTA cases, compared with 1.4% for DCB. There were no device- or procedure-related mortalities or major amputations in the study.
Take Home Pearl: Among patients with symptomatic femoro-popliteal PAD, DCB appears to be superior to PTA as a treatment option.
Covered Stents for Visceral Aneurysms
The Particulars: Few studies have evaluated the mid- and long-term safety and effectiveness of covered stents for the endovascular exclusion of visceral aneurysms.
Data Breakdown: Study investigators implanted 25 covered stents in 24 patients affected by aneurysms of the splenic, hepatic, gastroduodenal, and renal arteries. Immediate aneurysm exclusion was obtained in 21 of 24 aneurysms. Ischemic injuries to distal organs were observed postoperatively in six patients. Among 21 successfully treated aneurysms, 18 stents remained patent from 24 to 72 months, and three were occluded at 6 and 12 months.
Take Home Pearls: Covered stents appear to be safe and effective but not always technically feasible in the endovascular treatment of visceral aneurysms. Such treatment appears to have a low complication rate as well as a high long-term patency rate.
Treating TRAS With Drug-Eluting Stents
The Particulars: Research has shown that transplant renal artery stenosis (TRAS) is a key cause of allograft dysfunction, refractory hypertension, and inferior allografts. The short- and long-term outcomes of drug-eluting stent (DES) use in the endovascular treatment of TRAS have not been well defined.
Data Breakdown: For a study, 53 patients with TRAS underwent 64 endovascular interventions, among which 18 patients underwent a total of 19 interventions with 23 DES. The overall technical success rate was 95%, with no adverse events reported at 30 days after the intervention. All patients experienced net improvements in allograft function and blood pressure control. No significant differences in short-term outcomes were found between primary and secondary interventions. Patients remained free from re-intervention for an average of 21.4 months and had an average allograft survival time of 22.2 months.
Take Home Pearl: In both primary and secondary TRAS, DES appears to be safe and effective, with a low re-intervention rate.