State-of-the-art lesion preparation in femoropopliteal lesions - a case-based systematic approach.

IF 2.4 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Grigorios Korosoglou, Andrej Schmidt, Michael Lichtenberg, Nasser Malyar, Konstantinos Stavroulakis, Holger Reinecke, Gerd Grözinger, Dittmar Böckler, Christian A Behrendt, Erwin Blessing, Ralf Langhoff, Thomas Zeller, Christos Rammos
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Abstract

Vessel preparation has emerged as a key feature in endovascular treatment strategies as treated lesions are increasingly complex. While treatment algorithms have been presented, a practical systematic case-based approach, entailing contemporary vessel preparation tools, would provide assistance for vascular specialists in the daily routine. Based on patient characteristics, including clinical presentation, age and comorbidities and lesion specific parameters, team-based and patient-centered decisions are necessary for successful treatment. In addition, pre- and procedural imaging, lesion specific characteristics, such as the presence of chronic total occlusions, lesion length and calcification or the presence of thrombus are evaluated. Furthermore, run-off vessels serving as potential conduits for retrograde puncture in case of failed antegrade crossing need to be considered. Based on lesion-specific variables and the type of crossing (intraluminal versus subintimal), options for lesion preparation techniques, including plain-old-balloon angioplasty (POBA), specialty balloons, atherectomy, intravascular lithotripsy and/or thrombectomy are selected prior to the definitive treatment of the lesion. The selection of such vessel preparation strategies depends on the current scientific evidence, guidelines and expert opinion statements. Treatment of patients with intermittent claudication or chronic limb threatening ischemia (CLTI) are now discussed, where a recently published lesion preparation algorithm is applied. By the establishment of this algorithm in daily practice, harmonization of endovascular practice and further improvements in vessel and patient specific outcomes are anticipated.

最先进的股腘动脉病变准备-以病例为基础的系统方法。
随着治疗的病变越来越复杂,血管准备已成为血管内治疗策略的一个关键特征。虽然已经提出了治疗算法,但一种实用的系统的基于病例的方法,包括现代血管准备工具,将为血管专家的日常工作提供帮助。基于患者特征,包括临床表现、年龄、合并症和病变特定参数,团队为基础和以患者为中心的决策是成功治疗的必要条件。此外,术前和手术成像,病变特异性特征,如慢性全闭塞的存在,病变长度和钙化或血栓的存在进行评估。此外,在逆行穿越失败的情况下,需要考虑径流血管作为逆行穿刺的潜在导管。根据病变特异性变量和交叉类型(腔内或内膜下),选择病变准备技术,包括普通旧球囊血管成形术(POBA),专业球囊,动脉粥样硬化切除术,血管内碎石和/或血栓切除术,然后对病变进行最终治疗。这种血管准备策略的选择取决于当前的科学证据、指南和专家意见陈述。现在讨论间歇性跛行或慢性肢体威胁缺血(CLTI)患者的治疗,其中应用了最近发表的病变准备算法。通过在日常实践中建立该算法,可以协调血管内实践并进一步改善血管和患者的具体结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.90
自引率
11.10%
发文量
61
审稿时长
1 months
期刊介绍: Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology. The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation. Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.
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