Peripheral Arterial Interventions: Evolving Therapeutic Strategies

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