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…
Should We Start Using the Retrograte Access in Critical Limb Ischemia?
Courtesy of Dr. Carlos Fava. Peripheral vascular disease in lower limbs is on the rise. Antegrade recanalization is associated with amputation and death, and therefore contraindicated. For a while we have been using the retrograde access when classic revascularization is not possible. Even though there is evidence in favor of this access, it is just…
The Real Impact of Peripheral Artery Disease in TAVR
Courtesy of Dr. Carlos Fava. The real incidence of peripheral artery (PAD) disease in TAVR remains unclear. Different reports still estimate it is between 10 and 46%, but they have shown it has a negative impact in evolution. 51,685 TAVR patients were analyzed. 12,740 of these patients presented PAD (24.6%). PAD patients tended to be…
Drug-Eluting Stents vs. Balloons While Paclitaxel Is in the Eye of the Storm
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…