Adding rivaroxaban to the standard treatment might reduce events incidence in lower limbs, heart, and brain, in patients with peripheral vascular disease undergoing revascularization. These new data resulted from the analysis of the VOYAGER PAD subgroups and were presented at the virtual ESC 2020. The COMPASS study had reached similar conclusions using 2.5 mg rivaroxaban…
Common Femoral Artery Endarterectomy Plus Angioplasty in Critical Ischemia
This prospective study analyzed patients with critical lower limb ischemia (due to complex, multiple lesions in several places) who were treated uniformly with common femoral artery endarterectomy combined with angioplasty to improve inflow and/or outflow. This hybrid treatment, which must be carried out by a team, can be greatly beneficial for this high-risk patient group…
Virtual ACC 2020 | VOYAGER PAD: Rivaroxaban Superior to Aspirin in Preventing Events
In patients with peripheral artery disease undergoing revascularization, the combination of rivaroxaban (Xarelto) and low doses of aspirin are superior to aspirin alone in the prevention of acute low limb ischemic events, amputation, cardiovascular events and strokes. The outcomes of VOYAGER PAD add to the COMPASS outcomes, showing the combination of therapies can benefit risk…
Virtual ACC 2020 | COMPASS Sub-Analysis: Diabetes Increases the Benefit of Rivaroxaban Combined with AAS
In patients with stable coronary or peripheral artery disease, diabetes increases the benefit of combining low doses of rivaroxaban and aspirin vs. aspirin alone. This analysis was pre-specified in the COMPASS protocol and was presented virtually for the ACC 2020 and simultaneously published in Circulation. Patients with diabetes, showed numerically greater reduction in terms of…
New European Guidelines on the Management of Lower Limb Acute Ischemia
Clinical practice guidelines are usually tedious and, frankly, while a lot of people make an enormous effort to write them, they are ultimately read in full by just a few. These new European Guidelines on the Management of Lower Limb Acute Ischemia represent a special team effort, since they include physicians, cardiologists, surgeons, and interventionists,…
Felling Reassured with Paclitaxel Coated Devices in Peripheral Artery Disease
This big analysis shows rapid absorption of paclitaxel coated devices for PCI in femoropopliteal territory, which reassures us about its alleged association to increased mortality. In fact, survival, amputation-free survival and cardiovascular events rate resulted better with paclitaxel coated devices in the treatment of chronic limb ischemia. This study emphasizes the difference that might exist…
Angioplasty in Long Femoropopliteal Lesions Offers Reasonable Results
Courtesy of Dr. Carlos Fava. Around half the treated lesions in peripheral disease are femoropopliteal lesions. Long lesions are among the challenges faced: they are associated with higher mortality and morbidity, and revascularization in that setting always entails some degree of difficulty. Nowadays, with the development of nitinol stents and more operator experience, angioplasty is becoming…
Safety of Paclitaxel-Coated Balloons in Peripheral Vascular Disease
Everybody keeps wondering whether drug-coated balloons can actually increase mortality. If that is the case, there is an even harder question in need of an answer: what would be the physiopathology for such increase in mortality? As a lukewarm message, the US Food and Drug Administration recommended a special informed consent form when these devices…
Angioplasty vs. Surgery in Lower Limb Ischemia
This analysis of data from an already published study, “Bypass Versus Angioplasty in Severe Ischemia of the Limb (BASIL-1),” confirms the superiority of bypass over balloon angioplasty, with or without stenting, in patients with chronic lower limb ischemia who require a femoropopliteal intervention. While analyzed interventions took place between 1999 and 2003 (a fact subject…
New FDA Updates on Paclitaxel Device Outcomes
A new FDA letter confirms late mortality signal with paclitaxel eluting stents and paclitaxel coated balloons in peripheral territory. Even though this recently published letter confirms data, there are no new recommendations on the use of these devices. After careful consideration of their own analyzis outcomes and a 2-day discussion of an advisory panel especially…
Supervised Exercise and Revascularization for Intermittent Claudication
The combination of optimal medical treatment plus angioplasty plus supervised exercise seems to be the first line of treatment for patients with intermittent claudication, in terms of maximum walking distance and best quality of life. This combination requires a multidisciplinary team for the best possible results. The aim of this study was to conduct a…