To Save Limbs, A Multi-Disciplinary Approach is Vital

The loss of a limb has a devastating impact on individuals and can be a death sentence in some parts of the world. Treating patients with complex medical needs is challenging though, and clinicians are most likely to successfully prevent amputation and its repercussions by working as part of a multidisciplinary team. In this Q&A,… Read More »

Shockwave Medical reports positive results for Lithoplasty in calcified lesions below the knee

 Shockwave Medical has reported positive results from the DISRUPT BTK Study, which were presented at the annual Cardiovascular and Interventional Radiological Society of Europe congress (CIRSE; 16-20 September, Copenhagen, Denmark). “The results of this study are consistent with findings from previous studies of Lithoplasty, showing a low rate of residual stenosis with minimal complications in… Read More »

The Roundabout Way to Save a Foot: Utilization of Pedal Access for Limb Salvage

Anwar Zaitoun, MD; Andrew Boshara, MD;  Antonious Attallah, MD St John Hospital, Detroit, Michigan Issue Volume 14 – Issue 10 – October 2017 Citation Vascular Disease Management. 2017;14(10):e225-e228. Abstract In patients with peripheral arterial disease (PAD) refractory to conservative therapy or in those who develop critical limb ischemia, percutaneous vascular interventions (PVIs) can potentially be… Read More »

AAA Repair: England vs US

  Abdominal Aortic Aneurysm Repair in England and the United States To the Editor: Karthikesalingam et al. (Nov. 24 issue)1 found a larger diameter of abdominal aortic aneurysm at the time of repair in England than in the United States (mean diameter, 63.8 vs. 58.2 mm), as well as higher rates of hospitalization due to… Read More »

Ringing in the radial revolution

There is an explosion of interest in transradial access within interventional radiology. With the twitterverse abuzz with hashtags such as #radialfirst and #transradial and physicians stating that the best way to a person’s heart is through their radial artery, Interventional News spoke to two proponents of the radial revolution, Darren Klass and Aaron Fischman, about… Read More »

Medtronic Endurant II/IIs granted CE mark for ChEVAR parallel graft technique

Medtronic has received CE mark for its Endurant II/IIs stent graft system to treat abdominal aortic aneurysm patients using a ChEVAR procedure—a parallel graft chimney technique that uses commercially available balloon expandable covered stents combined with a standard aortic stent graft. This expanded indication in the EU enables the Endurant II/IIs stent graft system to… Read More »

Study shows fewer aortic aneurysm repairs and higher death rate in England versus the USA 23rd November 2016 89 Alan Karthikesalingam at the 2016 Charing Cross Symposium Alan Karthikesalingam at the 2016 Charing Cross Symposium A new study published in the New England Journal of Medicine has shown that surgeons in England operate significantly less often on aortic aneurysms in the population than US surgeons, and that the English death rate for the condition is over twice that in the USA. Although there are international guidelines suggesting thresholds at which surgery to repair abdominal aortic aneurysms should be considered, clinical practice varies considerably in different countries. The impact of this variation on a country’s rate of death due to aortic aneurysms has never previously been investigated. Researchers in Harvard and London, led by Alan Karthikesalingam at St George’s, University of London, looked at several national datasets for abdominal aortic aneurysm repair, comparing the rate of aneurysm repair and the diameter at the time of repair between England and the USA. They found that for the condition of aortic aneurysm, the rates of repair in England were half that of the USA, with repair being done at a higher average diameter. The weighted mean diameter for aneurysm undergoing repair in England was 6.37cm, compared to the weighted mean diameter at repair in the USA of 5.83cm. International guidelines currently suggest aneurysm repair should be considered at 5.5cm in men and 5cm in women. The rate of death in England from ruptured aneurysm was found to be double that of the USA, while deaths from aneurysm-related causes were over three times more common than in the USA. Karthikesalingam explained, “Aneurysm diameter is the best predictor of whether an aneurysm will rupture, and the risk increases as the diameter increases. Although guidelines specify that 5.5cm is a reasonable threshold to consider surgery for infrarenal aneurysms, the risk of rupture must be balanced against personalised procedural risks, life expectancy and preference. We know there is considerable variation in international practice, with large numbers of patients undergoing repair below guideline thresholds. Deciding whether to repair an aneurysm, and selecting the best technique, involves carefully balancing the risks and is for the patient and clinician to discuss.” The data raises the question of whether English outcomes would be improved if the repair thresholds used in the USA were adopted. Karthikesalingam added, “It has been suggested that the size threshold for aneurysm repair should be revisited, which might require new clinical trials.

Study shows fewer aortic aneurysm repairs and higher death rate in England versus the USA 23rd November 2016 89 Alan Karthikesalingam at the 2016 Charing Cross Symposium Alan Karthikesalingam at the 2016 Charing Cross Symposium A new study published in the New England Journal of Medicine has shown that surgeons in England operate significantly less… Read More »

First patients treated with Endologix’s Ovation Alto abdominal stent graft system

First patients treated with Endologix’s Ovation Alto abdominal stent graft system 19th August 2016 27 Endologix’s Ovation Alto Endologix’s Ovation Alto The first use of Endologix’s Ovation Alto abdominal stent graft system has been reported in two patients with abdominal aortic aneurysms (AAA). The patients were treated by Andrew Holden and Andrew Hill of Auckland… Read More »