How dissections impact PAD and CLI

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Percutaneous transluminal angioplasty (PTA) is a commonly used endovascular intervention for peripheral artery disease (PAD) and critical limb ischemia (CLI) and can be followed by stents within the same procedure, especially if a dissection occurs. Stents may introduce new complications and limit options for retreatment. To prevent some of these complications, drug-coated balloons (DCBs) have been introduced. POBA (plain old balloon angioplasty) and DCB therapies are effective, but dissections are a frequent and known problem associated with both.

Why? Because untreated dissections may cause acute occlusion and/or thrombus and can negatively affect long-term outcomes.

For informational purposes only. You should always consult with your doctor when seeking medical advice or considering treatment.

References

  1. Werk M, Albrecht T, Meyer DR et al. Paclitaxel-coated balloons reduce restenosis after femoro-popliteal angioplasty: evidence from the randomized PACIFIER trial. Circ Cardiovasc Interv. 2012;5(6):831-840.
  2. Tepe G, Laird J, Schneider P et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and/or popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2014;114.011004
  3. Tepe G, Zeller T, Schnorr B et al. High-grade, non-flow-limiting dissections do not negatively impact long-term outcome after paclitaxel-coated balloon angioplasty: an additional analysis from the THUNDER study. J Endovasc Ther 2013;20:792-800.
  4. Rosenfield K, et al. N Engl J Med. 2015;373:145-153 [Suppl].
  5. Fujihara M, Takahara M, Sasaki S et al. Angiographic dissection patterns and patency outcomes after balloon angioplasty for superficial femoral artery disease. J Endovasc Ther 2017;1-9.
  6. Fanelli F, Cannavale A, Corona M, Lucatelli P, Wlderk A, Salvatori FM. The “DEBELLUM”- -lower limb multilevel treatment with drug eluting balloon—randomized trial: 1-year results. J Cardiovasc Surg. 2014 Apr;55(2):207-16.
  7. Razavi MK, Mustapha JA, Miller LE. Contemporary systematic review and meta-analysis of early outcomes with percutaneous treatment for infrapopliteal atherosclerotic disease. J Vasc Interv Radiol. 2014 Oct;25(10):1489-96.