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To evaluate the effectiveness and safety of atherectomy versus plain balloon angioplasty (POBA) for treatment of critical limb ischemia (CLI) due to tibioperoneal arterial disease (TPAD).Patients enrolled in the Vascular Quality Initiative registry who had CLI (Rutherford Class 4-6) and underwent atherectomy versus POBA alone for isolated TPAD were retrospectively identified. Of eligible patients, a cohort of 2,908 patients was propensity matched 1:1 by clinical and angiographic characteristics. The atherectomy group comprised 1,454 patients with 2,183 arteries treated, and the POBA group comprised 1,454 patients with 2,141 arteries treated. The primary study endpoint was major ipsilateral limb amputation. Secondary endpoints were minor ipsilateral amputations, any ipsilateral amputation, primary patency, target vessel reintervention (TVR), and wound healing at 12 months.The median follow-up period was 507 days, the mean patient age was 69 years ± 11.7, and the mean occluded length was 6.9 cm ± 6.5. There was a trend toward higher technical success rates with atherectomy than with POBA (92.9% vs 91.0%, respectively; P = .06). The rates of major complications during the procedure were not significantly different. The 12-month major amputation rate was similar in the atherectomy and POBA groups (4.5% vs 4.6%, respectively; P = .92; odds ratio, 0.97; 95% CI, 0.68-1.37). There was no difference in 12-month TVR (17.9% vs 17.8%; P = .97) or primary patency (56.4% vs 54.5%; P = .64) between the atherectomy and POBA groups.In a large national registry, treatment of CLI from TPAD using atherectomy versus POBA showed no significant differences in procedural complications, major amputations, TVR, or vessel patency at 12 months.

Despite the widespread use of inferior vena cava filters (IVCFs), no large controlled trials have examined the IVCF retrieval rates and clinical events for patients without retrieved IVCFs. We hypothesized that IVCF retrieval success would decrease as the time from placement increased and that the clinical event rates would be more prevalent for those without a retrieved IVCF. We evaluated retrieval success as a function of time and compared the rates of venous thromboembolism and mortality between patients who had undergone IVCF retrieval within 12 months vs patients with unsuccessful IVCF retrieval.All patients who had undergone IVCF placement between 2011 and 2017 with available follow-up data at eight community hospitals were enrolled in our retrospective cohort study. The procedure dates, incidence of subsequent deep vein thrombosis (DVT) and pulmonary embolism, and mortality dates were collected. Patients were classified as having a nonretrieved IVCF if their IVCF had not been retrieved after ≥12 months of follow-up.Of 1709 patients who had undergone IVCF placement, IVCF retrieval was successful for 770. We found a significant (P = .018) decrease in retrieval success as the time from IVCF insertion increased. After a mean of 36 ± 16 months, the incidence of subsequent DVT was lower in the retrieved group than in the nonretrieved group (8.1% vs 11.9%; P = .05; hazard ratio, 0.65; 95% confidence interval, 0.42-1.00). Mortality was lower for those with retrieved than for those without retrieved IVCFs (8.8% vs 28.8%; P .001; hazard ratio, 0.5; 95% confidence interval, 0.35-0.7). No significant difference was found in the rate of pulmonary embolism.IVCF nonretrieval was more likely for older patients with a greater prevalence of comorbid conditions. Increased rates of subsequent DVT and mortality were observed for patients without IVCF retrieval. Finally, the likelihood of successful IVCF retrieval decreased with increased time from IVCF placement.

Heart failure (HF) constitutes a major public health problem in the USA with self-management playing a key role in treatment. Depressed patients often have poor insights which correlates with increased rates of adverse events such as emergency room visits, admissions and readmissions, length of hospital stay and mortality.To determine the prevalence, trends, and predictors of depression among community-based patients with HF in the USA, and its association with self-perceived health status.Using the 2007 through 2016 NHANES data, we identified patients with HF aged 20-80 years with completed PHQ-9 depression screening questionnaire. PHQ-9 scores ≥10 were considered diagnostic for depression. The Chi square test was used for comparison of prevalence of depression between subgroups with p 0.05 considered statistically significant.The prevalence of depression among community-based patients with HF was 17.3% and remained stable from 2007 through 2016. Female participants, persons60years, individuals with low socioeconomic status, and never married individuals were more likely to be depressed, comparatively. After controlling for confounders, living in poverty was the lone predictor of depression with OR 5.1 (95% CI 1.4-17.9), compared to those with incomes ≥3 times the poverty threshold. Depressed individuals were more likely to report a poor health status (76.4%) compared to non-depressed individuals (45.9%), p 0.001.Over 1 in 6 community-based patients with HF suffers from depression with women, individuals60years, never married, and persons with low socioeconomic status shouldering a disproportionately higher burden.

Small, older studies have suggested that the use of atherectomy devices has become common in peripheral vascular interventions (PVIs) despite the paucity of strong clinical guidelines. We analyzed the 10-year trends in the use of atherectomy for PVIs across the United States and identified the main predictors of atherectomy use.Using the Vascular Quality Initiative registry, we identified all patients who had undergone endovascular PVIs for occlusive lower extremity arterial disease from 2010 to 2019. Procedures in which an atherectomy device had been used as the primary or secondary device were classified as the atherectomy group. We calculated the frequency of atherectomy use over time and across geographic regions. Using regression modeling, we identified the factors that were independently associated with atherectomy use.A total of 205,377 PVIs had been performed for 152,693 unique patients. During the 10-year period, 16.6% of the PVI procedures had used atherectomy, increasing from 8.5% in 2010 to 19.7% in 2019 (PAtherectomy use in PVI significantly increased from 2010 to 2019. We found wide regional variability in the use of atherectomy that seemed to be driven more strongly by nonclinical factors.

Background: Recent review of hypertension guidelines requires fresh updates of prevalence and control rates. Though retrospective analysis provided burden estimates, control rates were grossly misleading. We set out to update the prevalence and control rates of hypertension in the USA using contemporary NHANES data. Methods: Persons with mean systolic blood pressure (mSBP) ≥130 mmHg or mean diastolic blood pressure (mDBP) ≥80 mmHg or self-reported current use of antihypertensive medications were classified as hypertensives. Hypertensives on medications with mSBP

Hypertension (HTN), a common adult condition, confers significant risk in the development of cardiovascular (CV) disease. Ambulatory blood pressure monitoring (ABPM) is superior to office measurements alone in the management of HTN. Despite advances in technology making ABPMs easier and more cost

Many patients with inferior vena cava filters (IVCF) never have them retrieved and there are no well validated studies examining IVCF retrieval rates and clinical events in patients with abandoned IVCF. In this retrospective cohort study, we evaluate differences in the rates of venous

With an ageing population, the burden of peripheral artery diseases (PADs) is increasing. The treatment of these diseases has largely been performed by interventional radiologists, vascular surgeons and interventional cardiologists. Due to the strong relationship between PAD and overall cardiovascular morbidity and mortality, cardiologists need to play a greater role in the management of PAD. The physician who cares for the patient with peripheral vascular disease should have a broad understanding of atherosclerotic disease involving all vascular beds. Endovascular interventions play a major role in relieving symptoms and reducing morbidity related to PAD, but long-term optimal medical treatment is an essential determinant of prognosis. This paper reviews current endovascular/percutaneous interventions for PAD.

Purpose: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83) vs. 13.6 ± 7.1% for CABG (n=187) (P=0.31). After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke) was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8). There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001). Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23). Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P 5%.

Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is an acquired immune-mediated disease of adults and children characterized by a transient or persistent decrease of platelets and, depending upon the degree of thrombocytopenia, an increased risk of bleeding. The use of standard treatments for acute myocardial infarction (AMI), such as antiplatelet agents and anticoagulants, pose serious problems in patients with ITP due to the potential higher risk of bleeding complications. There are no current guidelines available for management of ITP patients with AMI. In this brief review of the limited available literature, we discuss the proposed pathophysiological link between ITP and arterial thrombosis and the challenging medical and interventional treatment of these patients. (J Patient-Centered Res Rev.

Transcatheter aortic valve replacement (TAVR) has emerged as a safe alternative for treating severe aortic stenosis (AS) in patients at moderate to high risk for surgery. However, the use of contrast and radiation during TAVR is not without adverse effects. We evaluated if Valve ASSIST2 (GE

The trends of use and efficacy of drug-coated balloons (DCB) and drug-eluting stents (DES) for femoropopliteal lesions in real-world population remain unclear. A retrospective single center study included 301 consecutive lesions successful treated with either DES (51.1%) or DCB (48.9%) between 10/

The use of atherectomy devices for the treatment of lower extremity arterial disease has been increasing despite sparse evidence of clinical benefit. The primary goal of intervention on occlusive arterial disease of tibial and peroneal arteries (TPA) is to prevent limb loss. We sought to compare

The use of atherectomy devices to assist endovascular treatment of occlusive lower extremity peripheral artery disease (OLEPAD) is rapidly growing. There are no good data to compare the performance of these treatment systems. In this study we compared procedural and longterm outcomes between

Although uncomplicated type B aortic dissection (uTBAD) is traditionally treated medically as per American Heart Association guidelines, recent studies, performed primarily in interventional radiology or surgical operating rooms, suggest feasibility and superiority of TEVAR due to recent

Atrial septal defects (ASDs) are commonly encountered and can be associated with extra-cardiac conditions. Holt-Oram, although rare, is such an example. A 35-year-old healthy man was admitted with 1 month of progressive dyspnea, chest tightness and palpitations. He was tachycardic (128bpm), blood

Severe aortic stenosis causes recurrent mucosal bleeds, mainly from angiodysplasias and acquired von Willebrand deficiency (vWD) which is corrected after aortic valve replacement, either transcatheter (TAVR) or surgical (SAVR). Studies have shown major GI bleeding post-TAVR as an independent

Background: Access site complications after angiography and percutaneous coronary intervention (PCI) affect mortality, morbidity, length of stay and overall cost. The SoftSeal-STF Hemostatic Pad (SS) is a novel product to achieve hemostasis. We hypothesized SS with a short hold time was equivalent

Background: Popliteal artery aneurysm (PAA) is the most common peripheral aneurysm. When left untreated, it is associated with significant morbidity and limb loss. Here, we present our experience and outcome of endovascular repair of popliteal artery aneurysm with Gore Viabhan stent. Methods: This

Background: The efficacy of common femoral artery (CFA) access in preventing access site complications (ASC) in patients undergoing peripheral vascular intervention (PVI) by palpation alone, with fluoroscopy guidance (FG) or with ultrasound guidance (UG) remains unclear. We aimed to elucidate trends

Background: We aimed to elucidate the post-hospitalization outcomes in patients undergoing therapeutic hypothermia and cardiac catheterization after sudden cardiac arrest (SCA). Methods: A retrospective, tertiary-center study consisted of 173 consecutive patients who met inclusion criteria between

Improvements in the design of endovascular devices and technical skills of interventionalists have opened new possibilities for patients with a wide range of peripheral vascular diseases. In lower extremity peripheral artery disease, percutaneous treatments have become the predominant revascularization strategy for simple and complex lesions. Newer generations of stents and drug-coated balloons have demonstrated strong potential in the treatment of femoropopliteal and infrainguinal diseases. One of the most dramatic advances in the recent past has been endovascular repair of thoracic and abdominal aortic aneurysms, which has become the preferred approach in lieu of open surgical repair. Contemporary trials have established the safety and effectiveness of carotid stenting in selected patients with severe stenosis. Endovascular treatments for venous occlusive disease have long been underutilized, but their effectiveness is being increasingly recognized. This review covers new endovascular procedures performed by interventional cardiologists for peripheral vascular diseases.

Severe aortic stenosis is associated with acquired Von Willebrand deficiency (vWD) manifesting with recurrent gastrointestinal bleed (GIB) if left untreated. Few small studies have shown decreased incidence of GIB after surgical aortic valve replacement (SAVR) but limited data are available with

Background In a push to treat ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) within 90 min of door-to-balloon time, emergency cardiac catheterization laboratory activation protocols bypass routine clinical assessments, raising the possibility of more frequent catheterizations in patients with no culprit coronary lesion. Objective To determine the incidence, predictors, and prognosis of false-positive STEMI. Methods We followed a prospective cohort of patients diagnosed with STEMI by usual criteria receiving emergency cardiac catheterization with intention of primary PCI between January 2005 and December 2007 at a tertiary care center. False-positive STEMI was defined as absence of a clear culprit lesion on coronary angiography. Results Of 489 patients who received emergency cardiac catheterization indicated for STEMI, 54 (11.0%, 95% confidence interval [CI] 8.3–13.8) had no culprit lesion on coronary angiography. Independent predictors of false-positive STEMI were absence of chest pain (odds ratio [OR] 18.2, 95% CI 3.7–90.1), no reciprocal ST-segment changes (OR 11.8, 95% CI 5.14–27.3), fewer than three cardiovascular risk factors (OR 9.79, 95% CI 4.0–23.8), and symptom duration longer than 6 h (OR 9.2, 95% CI 3.6–23.7); all p

Cardiac allograft vasculopathy (CAV) is the leading cause of death after the first year following heart transplantation. We compared restenosis rates, mortality, and other major adverse cardiac events (MACE) between transplant recipients treated with DES and BMS for CAV.All patients from our heart transplant registry undergoing PCI with stenting for CAV were identified. Procedural data, baseline clinical characteristics, yearly coronary angiography, cardiac events and death were prospectively collected. Primary outcome was in-stent restenosis (ISR). Secondary outcomes were in-segment restenosis, target vessel revascularization (TVR), all-cause mortality and combined MACE.36 lesions in 25 patients treated with DES were compared with 31 BMS-treated lesions in 19 patients. There were no significant differences in baseline characteristics. 12-month incidence of ISR was 0% with DES vs. 12.9% with BMS, P = 0.03. Over mean (+/-standard error) follow-up of 51.1 +/- 7.5 months this difference was significant for vesselsor =3 mm in diameter, hazard ratio (HR) DES vs. BMS 0.37 (95% CI 0.11 to 0.95) P = 0.037; but not for vessels3 mm P = 0.45. However, there was no difference in overall longterm patency because of similar rates of in-segment restenosis between DES and BMS, HR 1.13 (95% CI 0.43 to 2.97) P = 0.81. Also, the rates of TVR, death from any cause and combined MACE were similar; log rank P 0.88, 0.67, and 0.85, respectively.This study suggests that after PCI for cardiac allograft vasculopathy, despite a lower in-stent restenosis rate in DES compared with BMS, in-segment restenosis and clinical cardiac endpoints are similar.

A 43-year-old man with repaired tetralogy of Fallot presented with chest pain. His electrocardiogram revealed sinus rhythm with non-specific ST-T wave changes, and a nuclear stress test was negative for ischaemia. Transthoracic echocardiography in the parasternal short-axis view at the level of the aortic cusp (AC) …

Previous studies comparing percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in patients with left main or three–vessel coronary artery disease (LM–3VD) have excluded patients at high surgical risk. Our nonrandomized prospective study included patients with