Even after the US Food and Drug Administration (FDA) issued an alert on paclitaxel devices in patients with femoropopliteal artery disease, which caused the interruption of a few ongoing studies, reality indicates that the efficacy of these devices has been proven and that they are still used. The increased mortality observed in the meta-analysis that…
Surveillance after EVAR: When and How Long
It has been suggested that surveillance after endovascular abdominal aorta aneurysm repair (EVAR) should be for life, seeing as on one hand we are not sure how long these devices last (and they keep coming out), and on the other hand, there could be late complications, such as type 2 leaks. This is why the…
Safety in Abdominal Aortic Aneurysm Surveillance Programs
Abdominal Aortic Aneurysm (AAA) rupture rate in the UK justifies the current surveillance programs and bring ease to some physicians that at some point have cast a shadow on their efficacy. This study also endorses reference thresholds to intervene patients. In 2009, the UK National Health Service (NHS) implemented a AAA national surveillance scheme where…
The Most Relevant Articles of 2018 in Peripheral Vascular Disease
1- What’s New in the European Guidelines on Peripheral Arterial Disease Since the last version of the European guidelines on the diagnosis and treatment of peripheral arterial disease in 2011, there have been many trials and registries that warrant guideline adjustments in many aspects. The first novelty is the teamwork that gave way to these…
Long Term Effect of Low Dose Paclitaxel Coated Balloon
The beneficial effect of low dose drug coated balloons with paclitaxel is sustained in time according to this randomized study. In a nutshell, this study has shown a significant statistical difference in favor of paclitaxel coated balloons vs. conventional PCI at 2 years. The safety and efficacy of new generation low dose drug coated balloons…
Exercise Programs in Peripheral Artery Disease
Programmed exercises are recommended as initial management strategy for patients with peripheral artery disease (PAD). Most exercise programs include supervised treadmill walking twice or three times a week in a strategic facility (such as a gym). PAD patients often give up on these programs seeing as they might find it difficult to keep to a…
Frailty: What Happens When We Are Too Late in Critical Lower Limb Ischemia
This condition, now “trending” among patients undergoing transcatheter aortic valve replacement (TAVR), has expanded to almost all patients we treat, always with the same outcome: the prognosis is bad, so bad that it might warrant making the difficult decision of not going forward. The association between frailty and bad prognosis is easy to see and…
HIV and Peripheral Artery Disease: Acknowledging the Association
The role of human immunodeficiency virus (HIV) in the development of vascular disease (specifically peripheral artery disease) remains unclear. Is the virus per se the direct cause of this disease or is it a consequence of dyslipidemia, one of the adverse effects of antiretrovirals? This study looked into the effect of HIV infection on peripheral…
Frailty and Critical Limb ischemia: Facing a New Challenge
Courtesy of Dr. Carlos Fava. Critical limb ischemia is the final stage of peripheral vascular disease and is associated to pain at rest, trophic lesions, and gangrene. It is also associated to amputation and reduced mobility. When it happens in frail patients, it presents a challenge. This population is on the rise and there is…
Mortality in Peripheral Vascular Disease Drops Due to Revascularization
This cohort study shows that, from 2006 to 2015, the overall survival rate increased and the risk of major amputation decreased following lower limb revascularization. These population observations indicate that outcomes after lower limb revascularization have improved during the assessed period, and so have the centralization and specialization of interventional services. The availability and diversity…