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Successful Peripheral Vascular Intervention in Patients with High-risk Comorbidities or Lesion Characteristics

  • Peripheral Vascular Disease (WS Jones, Section Editor)
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Abstract

Purpose of Review

Certain comorbidities and lesion characteristics are associated with increased risk for procedural complications, limb events, and cardiovascular events following peripheral vascular intervention (PVI) in patients with peripheral arterial disease (PAD). The purpose of this review is to provide an overview of high-risk modifiable and unmodifiable patient characteristics and its relative impact on clinical outcomes such as amputation risk and mortality. Furthermore, general approaches to potentially mitigating these risks through pre-intervention planning and use of modern devices and techniques are discussed.

Recent Findings

Diabetes, tobacco use, and older age remain strong risk factors for the development of peripheral arterial disease. Recent data highlight the significant risk of polyvascular disease on major limb and cardiac events in advanced PAD, and ongoing studies are assessing this risk specifically after PVI. Challenging lesion characteristics such as calcified disease and chronic total occlusions can be successfully treated with PVI by utilizing novel devices (e.g., intravascular lithotripsy, re-entry devices) and techniques (e.g., subintimal arterial “flossing” with antegrade-retrograde intervention).

Summary

Understanding high-risk patient comorbidities and lesion characteristics will improve our ability to counsel and manage patients with advanced PAD. Continued device innovation and novel techniques will aid in procedural planning for successful interventions to improve clinical outcomes.

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Authors and Affiliations

  1. Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA

    E. Hope Weissler

  2. Division of Cardiology, Duke University School of Medicine, Durham, NC, USA

    J. Antonio Gutierrez, Manesh R. Patel & Rajesh V. Swaminathan

  3. Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA

    J. Antonio Gutierrez, Manesh R. Patel & Rajesh V. Swaminathan

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E. Hope Weissler reports no conflict of interest.

Antonio Gutierrez reports personal fees from Janssen Pharmaceuticals and Amgen.

Manesh R. Patel reports grants from NHLBI and AstraZeneca; and grants and personal fees from Heartflow, Bayer, and Janssen.

Rajesh V. Swaminathan reports grants and non-financial support from ACIST Medical, personal fees and non-financial support from Medtronic, and grants from Cardiovascular Systems, Inc.

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Weissler, E.H., Gutierrez, J.A., Patel, M.R. et al. Successful Peripheral Vascular Intervention in Patients with High-risk Comorbidities or Lesion Characteristics. Curr Cardiol Rep 23, 32 (2021). https://doi.org/10.1007/s11886-021-01465-8

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