- Email: [email protected]
AS-042 Twelve-Month Prognosis of Infrapopliteal Endovascular Therapy for Patients with Critical Limb Ischemia Classified as Rutherford Category 6
Thursday, April 28, 2011
O R A L
Peripheral Vascular Intervention (non carotid, non neurovascular) Endovascular Intervention Thursday, April 28, 2011 2:00 PM ⬃ 3:00 PM (Abstracts nos. AS-041, AS-042, AS-045, AS-125)
AS-041 Endovascular Aneurysm Repair of AAA with Chimney Technique : Case Report. Jang Yong Kim1, Yong Sun Jeon1, Soon Gu Cho1, Kee Chun Hong1, W. Anthony Lee2. 1Inha University Hospital, Incheon, Korea (Republic of); 2Christine E. Lynn Heart and Vascular Institute, Boca Raton, Florida, USA. Background: Abdominal Aortic aneurysm (AAA) with severe aortic neck angulation is not indicated for routine endovascular aneurysm repair (EVAR) still in most countries. That case can be treated by open repair of AAA, fenestrated EVAR, branched EVAR, Debranching of visceral artery with EVAR and EVAR with chimney technique. Authors experienced successful treatment of AAA with Chimney technique : chimney stents for both renal artery and EVAR with covering ostium of both renal arteries. Methods:
Eighty two year old man presented with gastric ulcer with bleeding. During ulcer treatment, AAA was found. AAA had 1,3cm length and severely angulated aortic neck, 7.5cm in largest portion, without iliac aneurysm. Under the general anesthesia, the patient was positioned in supine position with arm elevated. Both proximal arteries were approached for renal stent by cutdown method and both femoral arteries was approached for aortic endograft by perclose technique. After 7F shuttle sheath insertion into both renal arteries were done, endograft was deployed with covering opening of both renal arteries. 36cm*149cm Zenith, Cook medical was used for endograft. After confirming of endograft, deployment, balloon expandable covered stent (V12, atrium) was deployed. kissing ballooning for endograft and renal stent was done for keep renal stent open. Completion angiogram showed patent superior mesenteric artery and both renal arteries and showed no type 1 endoleak. Results: The patient was awaken after procedure and there was transient hematuria for 1 day. There was no renal insufficiency postoperatively. The patient went home in 1 week without significant complications. Conclusion: EVAR with Chimney technique can be one of reasonable alternative options for AAA with severe aortic neck angulation with high risk patient.
AS-042 Twelve-Month Prognosis of Infrapopliteal Endovascular Therapy for Patients with Critical Limb Ischemia Classified as Rutherford Category 6. Masatsugu Nakano, Toshiya Muramatsu, Keisuke Hirano, Reiko Tsukahara, Yoshiaki Itou, Masahiro Yamawaki, Motoharu Araki, Shinya Sasaki, Yasunari Sakamoto, Hideyuki Takimura, Ikki Komatsu, Takurou Takama. Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. Background: Clinical outcomes after infrapopliteal endovascular therapy (EVT) for patients with critical limb ischemia (CLI) classified as Rutherford category 6 were not clear. Methods: Subjects were serial 91 patients (107 limbs, 154 vessels) who underwent infrapopliteal EVT for CLI in the period up to April 2009. Subjects were classified into two groups for comparative study of clinical outcomes: the patients with CLI classified as Rutherford cate-
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
31A
A B S T R A C T S
Thursday, April 28, 2011
O R A L A B S T R A C T S
gory 6: R6 group (30 patients, 34 limbs, 66⫾12 years) and classified as category 4 or 5: Non-R6 group (61 patients, 73 limbs, 70⫾9 years). Results: For patient and lesion characteristics, The R6 group had a higher percentage of diabetic (83.3 vs. 60.6%, P⫽0.06) or hemodialysis patients (80.0 vs. 26.2 %, P⬍0.05). For the target vessel, there was no significant difference in the ratio of target vessels with total occlusion (76.5 vs. 65.1 %). The R6 group had a significantly lower percentage keeping pedal loop flow after EVT (6.5 vs. 38.1%, P⬍0.05). At the 12 months clinical follow-up, The R6 group had high rates of major amputation (38.2 vs. 2.7% P⬍0.01) and death (50.0 vs. 13.1% P⬍0.05), and CLI classified as Rutherford category 6 was an independent predictor of major amputation (P⫽0.021). Conclusion: Twelve months prognosis after infrapopliteal EVT for patients with critical limb ischemia classified as the Rutherford category 6 was poor. It cannot be said that EVT for such serious CLI patients is effective.
AS-045 Retrospective Analysis of the Renal Artery Stenting for the Salvage of the Renal Function (REAL RAS study). Yusuke Miyashita1, Yoshimitsu Soga2, Kenji Suzuki3, Junya Matsumi4. 1Shinshu University Hospital, Matsumoto, Japan; 2 KokuraMemorial Hospital, Kokura, Japan; 3Sendai Kousei Hospital, Sendai, Japan; 4Shonankamakura General Hospital, Kamakura, Japan. Background: It is expected that renal artery stenting improve or stabilize the renal function. But previous studies failed to prove the efficacy of the renal artery stenting in the patient whose renal dysfunction is moderate degree. And the efficacy of the renal artery stenting in the patient whose renal dysfunction is severe degree is not clear. Methods: This study was multi-center registry trial. Four institutions were chosen for this study. We retrospectively analyzed the long term outcomes of the renal artery stenting to the patients whose renal function severely reduced. We defined S-Creatinine 2.5mg/dl or more as the severe renal dysfunction. We analyzed the interaction between renal function and distal protection. And we also analyzed the interaction between renal function and dosage of the contrast medium. Results: We retrospectively analyzed twenty-three patients. Average S-Creatinine was 3.1mg/dl, and average peak systolic velocity (PSV) of narrowing site was 267cm/sec. In seven (31%) patients, the improvement of the renal function was found. In twelve (52%) patients, the stabilization of the renal function was found. In four (17%) patients,
32A
renal deterioration was found. The distal protection device was used in all patients of improved group, and used in only one patient of deteriorated group. Renal deterioration was found in only one (6%) patient of distal protection group, but was found in three (50%) patients of non-distal protection group. The dosage of the contrast medium was not significantly changed between improved group and deteriorated group. Conclusion: Our data suggest that distal protection device may play an important role of prevention of the renal deterioration after the renal artery stenting in patient with severe renal dysfunction. In the treatment of the renal narrowing in patient with severe renal dysfunction, distal protection should be needed to prevent the renal deterioration.
AS-125 Polymer-Free Sirolimus and Probucol-Eluting Stent for Renal Artery: An Initial Experience in Swine. Hongbing Yan1, Zhengcai Zhang2, Yuxin Zhang2, Bin Zheng3, Zheng Wu3, Hongyu Peng3, Rencao Chang3, Hongjian Wang3. 1Cardiovascular Institute & Fuwai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; 2Lepu Medical Technology (Beijing) Co., Ltd, Beijing, China; 3Beijing Anzhen Hospital, Beijing, China. Background: Bare metal stent (BMS) implantation can resolve renal artery stenosis successfully, but in-stent restenosis does occur, especially in small diameter renal arteries (⬍5.0mm). The aim of this study is to test whether a newly designed polymer-free sirolimus and probucol-eluting stent (SPES) can inhibit neointimal hyperplasia of renal artery in swine. Methods: Thirty-six stents (18 SPES and 18 BMS) were implanted in 36 renal arteries of 18 animals. During every procedure, a SPES and a BMS were randomized to the right or left renal artery. Seven animals were sacrificed after 90 days, and 11 after 180 days. Results: Histomorphometric analysis was performed. After 90 days, minimal lumen area, neointimal area, score of inflammation and score of endothelialization were not significantly different between BMS and SPES. After 180 days, minimal lumen area was not significantly different between BMS and SPES (6.55⫾2.91mm2 vs 7.32⫾1.99 mm2, P⫽0.477), but neointimal area was significantly less in SPES vessles than in BMS vessels (3.07⫾0.83 mm2 vs 4.47⫾1.23 mm2, P⫽0.005). Score of inflammation and score of endothelialization were not significantly different between BMS and SPES after 180 days. Conclusion: SPES can successfully inhibit neointimal hyperplasia of renal artery in swine. At the same time, inflammation and endothelialization in SPES vessels were similar to BMS vessels.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
O R A L
Peripheral Vascular Intervention (non carotid, non neurovascular) Endovascular Intervention Thursday, April 28, 2011 2:00 PM ⬃ 3:00 PM (Abstracts nos. AS-041, AS-042, AS-045, AS-125)
AS-041 Endovascular Aneurysm Repair of AAA with Chimney Technique : Case Report. Jang Yong Kim1, Yong Sun Jeon1, Soon Gu Cho1, Kee Chun Hong1, W. Anthony Lee2. 1Inha University Hospital, Incheon, Korea (Republic of); 2Christine E. Lynn Heart and Vascular Institute, Boca Raton, Florida, USA. Background: Abdominal Aortic aneurysm (AAA) with severe aortic neck angulation is not indicated for routine endovascular aneurysm repair (EVAR) still in most countries. That case can be treated by open repair of AAA, fenestrated EVAR, branched EVAR, Debranching of visceral artery with EVAR and EVAR with chimney technique. Authors experienced successful treatment of AAA with Chimney technique : chimney stents for both renal artery and EVAR with covering ostium of both renal arteries. Methods:
Eighty two year old man presented with gastric ulcer with bleeding. During ulcer treatment, AAA was found. AAA had 1,3cm length and severely angulated aortic neck, 7.5cm in largest portion, without iliac aneurysm. Under the general anesthesia, the patient was positioned in supine position with arm elevated. Both proximal arteries were approached for renal stent by cutdown method and both femoral arteries was approached for aortic endograft by perclose technique. After 7F shuttle sheath insertion into both renal arteries were done, endograft was deployed with covering opening of both renal arteries. 36cm*149cm Zenith, Cook medical was used for endograft. After confirming of endograft, deployment, balloon expandable covered stent (V12, atrium) was deployed. kissing ballooning for endograft and renal stent was done for keep renal stent open. Completion angiogram showed patent superior mesenteric artery and both renal arteries and showed no type 1 endoleak. Results: The patient was awaken after procedure and there was transient hematuria for 1 day. There was no renal insufficiency postoperatively. The patient went home in 1 week without significant complications. Conclusion: EVAR with Chimney technique can be one of reasonable alternative options for AAA with severe aortic neck angulation with high risk patient.
AS-042 Twelve-Month Prognosis of Infrapopliteal Endovascular Therapy for Patients with Critical Limb Ischemia Classified as Rutherford Category 6. Masatsugu Nakano, Toshiya Muramatsu, Keisuke Hirano, Reiko Tsukahara, Yoshiaki Itou, Masahiro Yamawaki, Motoharu Araki, Shinya Sasaki, Yasunari Sakamoto, Hideyuki Takimura, Ikki Komatsu, Takurou Takama. Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. Background: Clinical outcomes after infrapopliteal endovascular therapy (EVT) for patients with critical limb ischemia (CLI) classified as Rutherford category 6 were not clear. Methods: Subjects were serial 91 patients (107 limbs, 154 vessels) who underwent infrapopliteal EVT for CLI in the period up to April 2009. Subjects were classified into two groups for comparative study of clinical outcomes: the patients with CLI classified as Rutherford cate-
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
31A
A B S T R A C T S
Thursday, April 28, 2011
O R A L A B S T R A C T S
gory 6: R6 group (30 patients, 34 limbs, 66⫾12 years) and classified as category 4 or 5: Non-R6 group (61 patients, 73 limbs, 70⫾9 years). Results: For patient and lesion characteristics, The R6 group had a higher percentage of diabetic (83.3 vs. 60.6%, P⫽0.06) or hemodialysis patients (80.0 vs. 26.2 %, P⬍0.05). For the target vessel, there was no significant difference in the ratio of target vessels with total occlusion (76.5 vs. 65.1 %). The R6 group had a significantly lower percentage keeping pedal loop flow after EVT (6.5 vs. 38.1%, P⬍0.05). At the 12 months clinical follow-up, The R6 group had high rates of major amputation (38.2 vs. 2.7% P⬍0.01) and death (50.0 vs. 13.1% P⬍0.05), and CLI classified as Rutherford category 6 was an independent predictor of major amputation (P⫽0.021). Conclusion: Twelve months prognosis after infrapopliteal EVT for patients with critical limb ischemia classified as the Rutherford category 6 was poor. It cannot be said that EVT for such serious CLI patients is effective.
AS-045 Retrospective Analysis of the Renal Artery Stenting for the Salvage of the Renal Function (REAL RAS study). Yusuke Miyashita1, Yoshimitsu Soga2, Kenji Suzuki3, Junya Matsumi4. 1Shinshu University Hospital, Matsumoto, Japan; 2 KokuraMemorial Hospital, Kokura, Japan; 3Sendai Kousei Hospital, Sendai, Japan; 4Shonankamakura General Hospital, Kamakura, Japan. Background: It is expected that renal artery stenting improve or stabilize the renal function. But previous studies failed to prove the efficacy of the renal artery stenting in the patient whose renal dysfunction is moderate degree. And the efficacy of the renal artery stenting in the patient whose renal dysfunction is severe degree is not clear. Methods: This study was multi-center registry trial. Four institutions were chosen for this study. We retrospectively analyzed the long term outcomes of the renal artery stenting to the patients whose renal function severely reduced. We defined S-Creatinine 2.5mg/dl or more as the severe renal dysfunction. We analyzed the interaction between renal function and distal protection. And we also analyzed the interaction between renal function and dosage of the contrast medium. Results: We retrospectively analyzed twenty-three patients. Average S-Creatinine was 3.1mg/dl, and average peak systolic velocity (PSV) of narrowing site was 267cm/sec. In seven (31%) patients, the improvement of the renal function was found. In twelve (52%) patients, the stabilization of the renal function was found. In four (17%) patients,
32A
renal deterioration was found. The distal protection device was used in all patients of improved group, and used in only one patient of deteriorated group. Renal deterioration was found in only one (6%) patient of distal protection group, but was found in three (50%) patients of non-distal protection group. The dosage of the contrast medium was not significantly changed between improved group and deteriorated group. Conclusion: Our data suggest that distal protection device may play an important role of prevention of the renal deterioration after the renal artery stenting in patient with severe renal dysfunction. In the treatment of the renal narrowing in patient with severe renal dysfunction, distal protection should be needed to prevent the renal deterioration.
AS-125 Polymer-Free Sirolimus and Probucol-Eluting Stent for Renal Artery: An Initial Experience in Swine. Hongbing Yan1, Zhengcai Zhang2, Yuxin Zhang2, Bin Zheng3, Zheng Wu3, Hongyu Peng3, Rencao Chang3, Hongjian Wang3. 1Cardiovascular Institute & Fuwai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; 2Lepu Medical Technology (Beijing) Co., Ltd, Beijing, China; 3Beijing Anzhen Hospital, Beijing, China. Background: Bare metal stent (BMS) implantation can resolve renal artery stenosis successfully, but in-stent restenosis does occur, especially in small diameter renal arteries (⬍5.0mm). The aim of this study is to test whether a newly designed polymer-free sirolimus and probucol-eluting stent (SPES) can inhibit neointimal hyperplasia of renal artery in swine. Methods: Thirty-six stents (18 SPES and 18 BMS) were implanted in 36 renal arteries of 18 animals. During every procedure, a SPES and a BMS were randomized to the right or left renal artery. Seven animals were sacrificed after 90 days, and 11 after 180 days. Results: Histomorphometric analysis was performed. After 90 days, minimal lumen area, neointimal area, score of inflammation and score of endothelialization were not significantly different between BMS and SPES. After 180 days, minimal lumen area was not significantly different between BMS and SPES (6.55⫾2.91mm2 vs 7.32⫾1.99 mm2, P⫽0.477), but neointimal area was significantly less in SPES vessles than in BMS vessels (3.07⫾0.83 mm2 vs 4.47⫾1.23 mm2, P⫽0.005). Score of inflammation and score of endothelialization were not significantly different between BMS and SPES after 180 days. Conclusion: SPES can successfully inhibit neointimal hyperplasia of renal artery in swine. At the same time, inflammation and endothelialization in SPES vessels were similar to BMS vessels.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral