1. Basic Technical Tips of Endovascular Treatment for Aorto-iliac Arterial Diseases
Department of Radiology and IVR center, Nara Medical University
Shigeo Ichihashi, Shinichi Iwakoshi, Wataru Kitatsuji, Natsuhiko Saito
Yutaka Yoshiyama, Takeshi Matsumoto, Hidehiko Taguchi, Kimihiko Kichikawa
With an advent of aging society, endovascular treatment has been chosen as the first treatment option for a large number of peripheral arterial disease (PAD) patients complaining intermittent claudication or critical limb ischemia. Endovascular treatment can offer high initial treatment success and durable long term result with significant symptom relief especially in the aorto-iliac segment. This chapter focuses on literature review, basic procedure step, and bail-out method after complication.
2. The Latest Evidence of Endovascular Therapy for Femoropopliteal Lesions
Kansai Rosai Hospital Cardiovascular Center
Yosuke Hata, Osamu Iida, Masaaki Uematsu
Over 20 million people are estimated to suffer from peripheral artery disease (PAD) and its morbidity will grow rapidly in the world. 50-70% of patients with symptomatic PAD have femoropopliteal (FP) disease. In FP region, the recommendations for EVT are different in several guidelines, because of remarkable progress in new techniques and devices of endovascular therapy (EVT). Therefore, the standardization for FP-EVT has not yet been established. We introduce the current indications and EVT procedures, and review the latest evidence of new devices.
- Endovascular therapy
- Femoropopliteal region
- New devices
3. Important Role of Endovascular Therapy and Wound Healing for Critical Limb Ischemia
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
Norihiro Kobayashi, Keisuke Hirano
Critical limb ischemia (CLI) is the most advanced stage of peripheral vascular disease, and endovascular therapy (EVT) for CLI is challenging. However, numerous CLI patients have a severe background and no distal artery to connect the bypass, and so EVT is an important strategy of revascularization for CLI. The final goal of the treatment of CLI is not obtaining long-term treated vessel patency but achieving wound healing and improvement of quality of life. Although wound healing is an essential endpoint, it has not been so stressed as other endpoints such as amputation free survival, limb salvage, and major adverse limb events. In this article, we discuss actual EVT treatment for CLI in daily practice and the important role of wound healing to improve patients’ clinical outcomes.
- Critical limb ischemia
- Endovascular therapy
- Wound healing
4. IVR for Subclavian Artery Disease
Department of Cardiology, Kokura Memorial Hospital
Endovascular therapy (EVT) for subclavian artery disease (SCAD) has been shown to be effective and is widely used as first-line treatment. Additionally, endovascular techniques and devices have been advancing. Some studies have already shown that primary EVT for SCAD is safe with long-term durability. However, these are small samples. Here, a largescale,
multicenter retrospective study was performed to evaluate the safety and efficacy in 556 patients. From this database, procedure success was achieved in 96.8%. The perioperative complication rate was 9.2%. Stroke was found in 1.8%. Primar y, assisted-primar y and secondary patencies at 3 years were 83.2±1.8%, 91.5±1.3% and 98.2±0.6%, respectively. There was no significant difference in primary patency between stenosis and occlusive lesions. On
multivariate analysis, critical hand ischemia, cerebrovascular disease, current smoker, lesion length, and, the use of intravascular ultrasound were independent predictors of primary patency. The 3-year overall survival was 86.7%. There were 89 deaths during follow-up. Of them, cardiovascular death accounted for 49%. Finally, primary EVT for SCAD seemed to achieve acceptable outcomes regarding perioperative complication and long-term patency.
- Subclavian artery disease
5. IVR of Atherosclerosis of Renal Arteries
Department of Cardiology, Nagano Red Cross Hospital
Department of Cardiovascular Medicine, Shinshu University Hospital
Renal artery interventional treatment is very important for the patients who have real indication of treatment. Two major studies indicated that renal artery interventional treatment is not effective. But many enrolled patients of these studies did not have real indication. Renal artery intervention has some risks of injury to the aorta and renal artery. And renal artery intervention also has much risk of distal embolization. Some techniques, novel renal artery stent, and adequate devices reduce such risks of renal artery intervention.
- Renal artery