New angioplasty procedure improves blood flow in blocked arteries to extremities
Patients with blocked arteries to their extremities, known as peripheral artery disease (PAD) or critical limb ischemia (CLI), may now find relief from lower leg pain and wounds caused by impaired leg artery circulation with the previously unproven therapy, percutaneous transluminal angioplasty (PTA). The XCELL trial results now available in Catheterization and Cardiovascular Interventions, a journal published by Wiley on behalf of the Society for Cardiovascular Angiography and Interventions (SCAI), reports that infrapopliteal nitinol stenting to treat CLI is safe and effective in improving wound healing, providing pain relief, and promoting amputation-free survival.
PAD is a disorder in which narrowed blood vessels restrict blood flow in the limbs. CLI affects close to 30 million people in Europe and North America, with most experiencing pain and ulcers with or without gangrene in the legs. Experts agree that current treatment options should aim to relieve pain, heal ulcers, prevent limb loss, improve quality of life and prolong survival. Previous research, however, show amputation rates are as high 40% in CLI patients in the first year following their diagnosis, with mortality rates approaching 20%. Moreover, prior studies estimate that 160,000 amputations due to PAD are performed each year in the U.S., of which a 25% reduction could save $29 billion in health care costs according to the Sage Group.
"With the obesity epidemic, we expect the incidence of diabetes to rise as well, and as these patients age this could sharply increase rates of CLI," explains Dr. Krishna J. Rocha-Singh, MD, FSCAI with Prairie Education & Research Cooperative in Springfield, Ill. "It is essential that we identify less invasive treatment strategies that are safe and effective in improving vascular disease."
One promising procedure for improving CLI outcomes is PTA with stenting of the infrapopliteal arteries. The multi-center trial of the "XpertTM Nitinol Stenting For Critically IschEmic Lower Limbs" (XCELL) evaluates the safety and effectiveness of this device in patients with CLI. The Xpert stent is manufactured by Abbott, a global health care company. The device was evaluated in 120 CLI patients with infrapopliteal lesions of 4-15 cm in length. A total of 140 limbs and 212 implanted devices were included in the study, with 12-month amputation-free survival (AFS), limb salvage, wound healing and pain relief determining the success of the procedure.
Results reveal that 12-month AFS was 78%. Further analysis confirmed that according to baseline Rutherford classes 4, 5, and 6, the 12-month AFS rates were 100%, 77%, 55%, respectively; freedom from major amputation were 100%, 91% and 70%, respectively. The investigators also determined that the 12-month freedom from major amputation rate and clinically driven target lesion revascularization were 90% and 70%, respectively. Six-month and 12-month wound-healing rates were 49% and 54%, respectively. Moreover, Rutherford class 4 patients had significant pain relief through 12 months.
"Our XCELL trial findings confirm that infrapopliteal nitinol stenting is safe and effective in treating CLI patients," concludes Dr. Rocha-Singh. "While there were a few major adverse events, such as death, heart attack, or major amputation that occurred in the first 30 days, at the first year post-procedure, limb preservation, wound healing and pain relief rates were excellent." The authors also point out that the 12-month wound healing with nitinol stenting was similar to the more invasive open surgery.
More information: "Major Adverse Limb Events and Wound Healing Following Infrapopliteal Artery Stent Implantation in Patients with Critical Limb Ischemia: The XCELL Trial." Krishna J. Rocha-Singh, Michael Jaff, James Joye, John Laird, Gary Ansel, Peter Schneider on behalf of the VIVA Physicians. Catheterization and Cardiovascular Interventions; Published Online: July 24, 2012. DOI: 10.1002/ccd.24485
Journal reference: Catheterization and Cardiovascular Interventions
Provided by Wiley
- Emerging interventional radiology treatment with drug-eluting stents saves limbs Mar 15, 2010 | not rated yet | 0
- Researcher transplants stem cells to try to save patients' legs Jan 22, 2008 | not rated yet | 0
- Regenerative stem cell therapy offers new hope for treating cardiovascular disease Nov 17, 2010 | not rated yet | 0
- Research offers new hope for peripheral artery disease sufferers May 02, 2012 | not rated yet | 0
- Promising 3-year data: Saving limbs with drug-eluting stents Mar 10, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Calculating on-axis elements of a solenoid
9 hours ago I wanted to mention that this solenoid has many winds over many layers. The thickness of the windings is 2.4 inches coming off of the engineering...
latitude & longitude & air pressure
11 hours ago Hi there, I have a peculiar question. Imagine that you are in a earth position, obtained by google, that gives you the latitude and longitude....
Differences of Classical Mechanics when learned with Calc vs algebra?
14 hours ago what are the differences? Every example I find usually has a derivative or integral or some kind of calculus defined concept that seems to make it...
what is the distance traveled
18 hours ago A rough sketch of experiment. Image: http://i43.tinypic.com/14t4sk5.png the red dots represent a side view of path traveled, F is downward force...
Image of a Convex Lens Cut in Half Horizontally
22 hours ago Hello everyone, A friend of mine came up with this question in class and I really do not have a good answer. Suppose you have a convex lens...
Ray tracing through optical system of thick lenses
22 hours ago Can you advise me a free software that allow to draw rays passed throught system of thick lenses (preferable in 3D)?
- More from Physics Forums - Classical Physics
More news stories
Costs to treat stroke are projected to more than double and the number of people having strokes may increase 20 percent by 2030, according to the American Heart Association/American Stroke Association.
Cardiology 19 hours ago | not rated yet | 0
Blood thinners are the preferred treatment option to prevent heart attacks, blood clots and stroke, but they are not without risk, and not just because of their side effects. These high-risk drugs, known as anticoagulants, ...
Cardiology 21 hours ago | not rated yet | 0
Results from a large observational study reported at EuroPCR 2013 today question whether bivalirudin is superior to heparin in the absence of GPIIb/IIIa blockade, showing similar 30-day mortality in patients with non-ST segment ...
Cardiology 21 hours ago | not rated yet | 0
The DESolve bioresorbable coronary scaffold system achieves good efficacy and safety with low rates of late lumen loss and major coronary adverse events at six months, show first results from the pivotal DESolve Nx trial ...
Cardiology 21 hours ago | not rated yet | 0
The Orsiro stent, which is a novel stent platform eluting sirolimus from a biodegradable polymer, demonstrated non-inferiority to the Xience Prime everolimus-eluting stent for the primary angiographic endpoint of in-stent ...
Cardiology May 21, 2013 | 5 / 5 (1) | 0
US teen births have dropped to a record low, but the country still has one of the highest rates among developed nations, the US Centers for Disease Control and Prevention said Thursday.
39 minutes ago | not rated yet | 0
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
18 hours ago | 4.9 / 5 (9) | 1 |
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
18 hours ago | 4.7 / 5 (3) | 0 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
15 hours ago | 5 / 5 (2) | 2 |
Existing research shows that bicyclists who wear helmets have an 88 percent lower risk of brain injury, but researchers at Boston Children's Hospital found that simply having bicycle helmet laws in place showed a 20 percent ...
7 hours ago | not rated yet | 0
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
14 hours ago | 4 / 5 (2) | 0 |