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Long term results of plaque excision combined with aggressive pharmacotherapy in high risk patients with advanced peripheral artery disease (save a leg registry).
MedLine Citation:
PMID:  23172729     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: In United States alone there are over 12 million people with peripheral artery disease (PAD). Long term outcomes of plaque excision in high risk population (diabetics and dialysis patients) are scarce. METHODS: Since November 2003 we treated 225 consecutive patients (138 male, mean age 66.3 ± 12.4, range 29-93) with SilverHawk(TM) plaque excision for critical limb ischemia or disabling claudication. A total of 367 procedures were performed treating 832 lesions (157 restenotic, 675 de novo). One hundred fifty five patients (68.9%) were diabetics, 74 (32.9%) were on dialysis. All patients were treated with statins, clopidogrel, aspirin and aggressive glycemic control. The primary endpoint for our study was target lesion revascularization (TLR), secondary endpoint was an assessment of major adverse events (all cause death, amputation, TLR). RESULTS: The average time of observation was 2.2 ± 1.2 years. Procedural success rate was 99.4% with <30% residual stenosis achieved in 818 (98.9%) lesions. SilverHawk(TM) was used alone in 86.7%. No acute limb loss or major perforation occurred. Sixty (26.6%) patients had TLR. Long term mortality was 16.4%. Seven (3.1%) patients had to undergo major amputations and 7 (3.1%) minor amputations. Seventy (31.1%) patients had a major adverse event. Atorvastatin 80mg was found to be independent predictor of survival and major amputation was found to be independent predictor of mortality. CONCLUSIONS: SilverHawk(TM) Plaque Excision combined with aggressive pharmacotherapy in this presented high risk population is associated with promising long term outcomes which compare favorably with accepted standards of care. © 2012 Wiley Periodicals, Inc.
Authors:
R Stefan Kiesz; Szymon L Wiernek; Barbara K Wiernek; Martin G Radvany; Piotr P Buszman; Radosław Szymański; Magda D Konkolewska; Jack L Martin; Paweł E Buszman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-21
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Affiliation:
San Antonio Endovascular & Heart Institute, San Antonio, TX, USA; University of Texas, Health Science Center, San Antonio, TX, USA. rs.kiesz@sbcglobal.net.
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