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91.
《Journal of vascular and interventional radiology : JVIR》2022,33(10):1153-1158.e2
PurposeTo describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of femoropopliteal peripheral arterial disease (PAD).Materials and MethodsThe Medicare Physician/Supplier Procedure Summary dataset containing 100% of Part B claims was interrogated for years 2011–2019. The Current Procedural Terminology codes specific for femoropopliteal angioplasty, stent placement, and atherectomy were used to create summary statistics for utilization by year, place of service (hospital inpatient, hospital outpatient, and office-based laboratory), and provider specialty (cardiology, radiology, and surgery).ResultsThe use of atherectomy increased from 34,732 (33%) procedures in 2011 to 75,435 (53%) procedures in 2019, and atherectomy became the dominant treatment strategy for femoropopliteal PAD. The relative utilization of stent placement (36,793 [35%] to 28,899 [20%]) and angioplasty only (34,398 [32%] to 38,228 [27%]) decreased concomitantly from 2011 to 2019. By 2019, the use of atherectomy was twofold higher in office-based laboratories than in the outpatient hospital setting (44,767 and 20,901, respectively). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925 [43%]), whereas radiologists used angioplasty alone (5,928 [6%]) and surgeons stented (18,009 [37%]) most frequently. By 2019, all specialties utilized atherectomy most frequently (29,564 [59%] for cardiology, 10,912 [58%] radiology, and 33,649 [47%] surgery).ConclusionsThe national approach to endovascular management of femoropopliteal PAD has changed since 2011 toward an implant-free strategy, including a multifold increase in the use of atherectomy. Discordant rates of atherectomy use between the ambulatory hospital and office-based settings highlight the need for comparative effectiveness studies to guide management. 相似文献
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Purpose
To evaluate the safety and effectiveness of combined scoring balloon (SB) and paclitaxel-coated balloon (PCB) angioplasty for stenosis in the dysfunctional hemodialysis access circuit.Material and methods
Patients were referred from outpatient dialysis centers by their nephrologists because of dysfunctional dialysis access circuit. Fistulogram/graftogram was performed by experienced interventional radiologists. Those with in-stent stenosis, stent edge stenosis or vessel diameter at the culprit segment larger than 6 mm were excluded. Angioplasty of the stenotic segment was performed with SB and followed by PCB. All study outcomes were defined according to the Society of Interventional Radiology technology assessment committee reporting standards for percutaneous interventional procedures in dialysis access circuit.Results
A total of 23 patients received combined SB/PCB angioplasty for stenosis of hemodialysis access circuit which included 15 fistulas and 8 grafts. There were 10 men and 13 women with a mean age of 63.3 ± 2.7 (SD) years (range: 37–85 years). The technical success and clinical success rates were both 100%. There were no complications during or after the procedures. The target lesion primary patency rates at 3, 6 and 12 months were 91.3%, 69.6%, and 45.2%, respectively and the estimated median target lesion restenosis (TLR) free duration was 11.0 months (95% confidence interval [CI]: 5.1–16.9 months). In patients with a recurrent stenosis, the median TLR-free duration of combined angioplasty was significantly higher than that of prior angioplasty with plain balloon (10.2 months [95% CI: 6.4–14.0 months] vs. 4.2 months [95%CI: 2.1–6.4 months]) (P = 0.047). The mean TLR-free duration was significantly higher in patients with a juxta-anastomotic stenosis than those with non-juxta-anastomotic lesion (21.3 months [95% CI: 14.7–28.0 months] vs. 8.2 months [95% CI: 5.1–11.4 months]) (P = 0.004).Conclusion
Combined SB/PCB angioplasty is safe and effective for the hemodialysis access stenosis. 相似文献95.
O. Yazar A. Provoost A. Broughton L. Ghijselings Y. Leclef K. Van Calster 《Acta chirurgica Belgica》2020,120(2):85-91
AbstractObjectives: To report our experience of angioplasty with Lutonix (Bard Peripheral Vascular, Inc., Tempe, AZ) drug-coated balloon (DCB) for the treatment of failing arteriovenous fistulas (AVF).Materials and methods: Retrospective, single-center analysis consisting of 14 patients treated with Lutonix paclitaxel DCBs in the period from July 2015 through April 2017. We analyzed technical success, clinical success, primary patency of the target lesion, primary patency of the dialysis circuit, and the rate of complications. Regular follow-up of AVF patency was realized by clinical examination and duplex ultrasonography. The Kaplan–Meier survival method was applied to determine the cumulative primary patency of the target lesion and the dialysis circuit.Results: Technical success was 100% and clinical success 92.9%. There were no major or minor complications. Cumulative target lesion primary patency after DCB was 69.2% at 6 months and 31.6% at 12 months. Cumulative vascular circuit primary patency was 61.5% at 6 months and 31.6% at 12 months.Conclusion: Compared to results reported in literature with plain old balloon angioplasty (POBA), Lutonix paclitaxel DCB angioplasty proved a short-term patency benefit in treatment of dialysis AVF stenosis. 相似文献
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韦海珠 《哈尔滨医科大学学报》2013,47(3):269-271
目的 探讨颅内动脉瘤的两种辅助栓塞技术与围手术期预后之间的关系.方法 回顾2006年5月至2010年12月栓塞治疗颅内动脉瘤患者围手术期预后情况,将结果转换为GOS评分,并分组统计;统计学分析两种栓塞技术与围手术期预后之间的相关性.结果 共辅助栓塞治疗动脉瘤患者148例,球囊辅助弹簧圈栓塞技术治疗55例,围手术期预后良好率74.5%,重残率20.0%,死亡率5.5%;支架辅助弹簧圈栓塞技术治疗93例,围手术期预后良好率84.9%,重残率9.7%,死亡率5.4%;两组之间存在统计学差异(P<0.001).结论 围手术期预后支架辅助栓塞优于球囊辅助栓塞. 相似文献
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目的探讨经皮球囊导管阻断在合并Ⅱ、Ⅲ型下腔静脉瘤栓的肾癌患者的手术疗效。方法回顾性分析河南省肿瘤医院普外科自2006年7月至2011年3月治疗的11例合并Ⅱ、Ⅲ型下腔静脉瘤栓的肾癌患者的临床病理资料、手术方法及疗效。结果 11例患者的平均年龄为48.4岁(36~66岁),所有患者均经术前CT、MRI或彩超明确肿瘤及瘤栓情况。所有患者术前在DSA下经颈内静脉预置球囊导管在瘤栓附近,术中充盈球囊阻断下腔静脉后再切除肾脏及瘤栓。手术时间为(67.3±12.3)min,手术出血量为(762.3±125.5)ml,术后住院时间为(12.6±1.8)d,无手术或围手术期死亡。术后1年生存率为81%,3年生存率为54%。结论经皮球囊导管阻断法在肾癌合并Ⅱ、Ⅲ型下腔静脉瘤栓手术中是安全有效的预防瘤栓脱落方法,具有一定的临床推广价值。 相似文献
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《Techniques in Gastrointestinal Endoscopy》2017,19(1):41-45
Bariatric surgery remains the gold standard for therapy of the morbidly obese patient. However, these procedures are not without risk. Risk factors for adverse events and readmission after bariatric surgery are well studied. Included in these risk factors are preoperative weight, liver size, and medical comorbidities that can be improved with modest weight loss before bariatric surgery and other major abdominal procedures. This article reviews intragastric space-occupying devices, endoluminal gastric volume reduction procedures, gastric content aspiration therapy, and endoluminal duodenal exclusion as possible choices to “bridge” the high-risk patient to bariatric surgery and as a possible alternative to bariatric surgery. The current state of the literature is robust for the intragastric balloon, supporting both primary and preoperative indications. The limited literature support for gastric volume reduction, gastric content aspiration, and endoluminal barrier therapy is reviewed. 相似文献
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