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Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD)

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 22723

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Prof. Dr. Jean-Paul P. M. De Vries

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Chair Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands
Interests: vascular surgery; aneurysm; carotid; peripheral arterial disease; peri-operative [tele]monitoring; critical limb ischemia; vascular graft infection
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Dear Colleagues,

Peripheral arterial occlusive disease (PAOD) is a common disease whose incidence has increased by 24% during the past 10 years. In multimorbid patients, this condition may lead to chronic limb-threatening ischemia (CLTI), with high risk of major amputation and mortality. In recent years, endovascular techniques have become the preferred treatment modality for patients with femoro-crural arterial obstructions.

Although major improvements have been made in the last decade, the outcomes of endovascular and surgical revascularization of the lower extremity require improvement. It is of utmost importance to further improve the diagnostics in PAOD and CLTI patients and focus more on tissue perfusion instead of only imaging patency of the main arteries. Periprocedural tissue perfusion monitoring may be of help in defining the technical and clinical success of revascularization procedures and post-procedural monitoring with continuation in a home setting, which may predict early failure.

I encourage (endo)vascular specialists dedicated to peripheral arterial interventions to submit their manuscripts addressing innovative diagnostics, treatment, and follow-up modalities in PAOD and CLTI patients toward overcoming this devastating disease.

Prof. Dr. Jean-Paul P.M. De Vries
Guest Editor

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Keywords

endovascular chronic limb-threatening ischemia
peripheral arterial occlusive disease
femoropopliteal bypass
tissue perfusion
ischemia
ischemic ulcers
stents
percutaneous transluminal angioplasty
home-monitoring

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Published Papers (7 papers)

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Research

13 pages, 1214 KiB

Open AccessArticle

The Impact of Lower Extremity Skeletal Muscle Atrophy and Myosteatosis on Revascularization Outcomes in Patients with Peripheral Arterial Disease

by Kirsten F. Ma, Stef Levolger, Issi R. Vedder, Mostafa El Moumni, Jean-Paul P. M. de Vries, Reinoud P. H. Bokkers and Alain R. Viddeleer

J. Clin. Med. 2021, 10(17), 3963; https://doi.org/10.3390/jcm10173963 - 31 Aug 2021

Cited by 4 | Viewed by 2743

Abstract

Background: This study investigated whether lower extremity muscle atrophy and myosteatosis in patients with peripheral arterial disease (PAD) are correlated to postoperative outcomes, such as reintervention or amputation-free survival. Methods: In this single-center retrospective cohort study of 462 patients treated for peripheral arterial disease scheduled for intervention, muscle mass and the presence of fattening of the lower extremity muscles were measured semiautomatically in a single computed tomography slice of the treated leg. Binary logistic regression models and Cox proportional hazards models were used to determine the effect of muscle atrophy and myosteatosis on reintervention and amputation. Results: Muscle atrophy and myosteatosis increased in PAD patients with Fontaine class IV compared with Fontaine class IIa. In PAD patients with muscle atrophy or myosteatosis, no association was found with the reintervention rate or reintervention-free survival, but an association was found with amputation-free survival, even after adjustment for patient-related, disease-severity, and comorbidities-related factors. Conclusion: Muscle atrophy and mysosteatosis increased in PAD patients with increasing disease severity. Lower extremity muscle atrophy and myosteatosis are associated with amputation rate and amputation-free survival in PAD patients. No association with reintervention rate or reintervention-free survival was found. Muscle atrophy and myosteatosis may serve as additional risk factors in decision making in the often frail vascular patient. Full article

(This article belongs to the Special Issue Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD))

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11 pages, 1229 KiB

Open AccessArticle

A Reperfusion BOLD-MRI Tissue Perfusion Protocol Reliably Differentiate Patients with Peripheral Arterial Occlusive Disease from Healthy Controls

by Kristina Törngren, Stefanie Eriksson, Jonathan Arvidsson, Mårten Falkenberg, Åse A. Johnsson, Carl Sjöberg, Kerstin Lagerstrand and Joakim Nordanstig

J. Clin. Med. 2021, 10(16), 3643; https://doi.org/10.3390/jcm10163643 - 18 Aug 2021

Cited by 11 | Viewed by 2829

Abstract

There is no established technique that directly quantifies lower limb tissue perfusion. Blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) is an MRI technique that can determine skeletal muscle perfusion. BOLD-MRI relies on magnetic differences of oxygenated and deoxygenated hemoglobin, and regional changes in oxy/deoxyhemoglobin ratio can be recorded by T2* weighted MRI sequences. We aimed to test whether BOLD-MRI can differentiate lower limb tissue perfusion in peripheral arterial occlusive disease (PAOD) patients and healthy controls. Twenty-two PAOD patients and ten healthy elderly volunteers underwent lower limb BOLD-MRI. Reactive hyperemia was provoked by transient cuff compression and images of the gastrocnemius and soleus muscles were continuously acquired at rest, during ischemia and reperfusion. Key BOLD parameters were baseline T2* absolute value and time to T2* peak value after cuff deflation (TTP). Correlations between imaging parameters and ankle-brachial index (ABI) was investigated. The mean TTP was considerably prolonged in PAOD patients compared to healthy controls (m. gastrocnemius: 111 ± 46 versus 48 ± 22 s, p = 0.000253; m. soleus: 100 ± 42 versus 41 ± 30 s, p = 0.000216). Both gastrocnemius and soleus TTP values correlated strongly with ABI (−0.82 and −0.78, p < 0.01). BOLD-MRI during reactive hyperemia differentiated most PAOD patients from healthy controls. TTP was the most decisive parameter and strongly correlated with the ABI. Full article

(This article belongs to the Special Issue Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD))

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12 pages, 2427 KiB

Open AccessArticle

Technical Success and Mid-Term Outcomes of Endovascular Revascularization of Tibio-Peroneal Trunk Lesions

by Sanne W. de Boer, Patricia A. H. van Mierlo-van den Broek, Jean-Paul P. M. de Vries, Simone F. Kleiss, Gijs C. Bloemsma, Debbie A. B. de Vries-Werson, Bram Fioole and Reinoud P. H. Bokkers

J. Clin. Med. 2021, 10(16), 3610; https://doi.org/10.3390/jcm10163610 - 16 Aug 2021

Cited by 1 | Viewed by 1985

Abstract

Tibio-peroneal trunk (TPT) lesions are usually categorized as ‘complex’ in anatomical classifications, which leads to the perception that endovascular therapy (EVT) will be challenging and the outcome most likely poor. This multicenter, retrospective cohort study investigates the efficacy of the EVT of TPT lesions in patients with chronic limb threatening ischemia (CLTI) or an infrapopliteal bypass at risk. The primary endpoint was limb-salvage. The secondary outcomes were technical success, freedom from clinically driven target lesion revascularization (CD-TLR), overall survival, and amputation-free survival. A total of 107 TPT lesions were treated in 101 patients. At 3 years, the limb-salvage rate was 76.4% (95% CI 66.0–86.8%). Technical success was achieved in 96.3% of cases. The freedom from CD-TLR, amputation-free survival, and overall survival at 3 years were 53.0% (95% CI 38.1–67.9%), 33.6% (95% CI 23.0–44.2%), and 47.7% (95% CI 36.1–59.3%), respectively. Reintervention significantly increased the hazard ratio for amputation by 7.65 (95% CI 2.50–23.44, p < 0.001). Our results show that the EVT of both isolated and complex TPT lesions is associated with high technical success and acceptable limb-salvage rates, with reintervention being a major risk factor for amputation. Moreover, mid-term mortality rate was relatively high. In future revisions of the anatomical grading scales, the classification of TPT lesions as highly complex should be reconsidered. Full article

(This article belongs to the Special Issue Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD))

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25 pages, 1802 KiB

Open AccessArticle

Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite

by Kor H. Hutting, Wouter B. aan de Stegge, Jaap J. van Netten, Wouter A. ten Cate, Luuk Smeets, Gijs M. J. M. Welten, Dick M. Scharn, Jean-Paul P. M. de Vries and Jeff G. van Baal

J. Clin. Med. 2021, 10(2), 371; https://doi.org/10.3390/jcm10020371 - 19 Jan 2021

Cited by 18 | Viewed by 5039

Abstract

Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187–11.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608–9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required. Full article

(This article belongs to the Special Issue Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD))

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11 pages, 613 KiB

Open AccessArticle

Short-Term Clinical Outcomes of Single Versus Dual Antiplatelet Therapy after Infrainguinal Endovascular Treatment for Peripheral Arterial Disease

by Jetty Ipema, Rutger H. A. Welling, Olaf J. Bakker, Reinoud P. H. Bokkers, Jean-Paul P. M. de Vries and Çagdas Ünlü

J. Clin. Med. 2020, 9(11), 3515; https://doi.org/10.3390/jcm9113515 - 30 Oct 2020

Cited by 7 | Viewed by 2820

Abstract

After infrainguinal endovascular treatment for peripheral arterial disease (PAD), it is uncertain whether single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) should be preferred. This study investigated major adverse limb events (MALE) and major adverse cardiovascular events (MACE) between patients receiving SAPT and DAPT. Patient data from three centers in the Netherlands were retrospectively collected and analyzed. All patients treated for PAD by endovascular revascularization of the superficial femoral, popliteal, or below-the-knee (BTK) arteries and who were prescribed acetylsalicylic acid or clopidogrel, were included. End points were 1-, 3-, and 12-month MALE and MACE, and bleeding complications. In total, 237 patients (258 limbs treated) were included, with 149 patients receiving SAPT (63%) and 88 DAPT (37%). No significant differences were found after univariate and multivariate analyses between SAPT and DAPT on 1-, 3-, and 12-month MALE and MACE, or bleeding outcomes. Subgroup analyses of patients with BTK treatment showed a significantly lower 12-month MALE rate when treated with DAPT (hazard ratio 0.33; 95% confidence interval 0.12–0.95; p = 0.04). In conclusion, although patient numbers were small, no differences were found between SAPT and DAPT regarding MALE, MACE, or bleeding complications. DAPT should, however, be considered over SAPT for the subgroup of patients with below-the-knee endovascular treatment. Full article

(This article belongs to the Special Issue Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD))

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9 pages, 603 KiB

Open AccessArticle

Photo-Optical Transcutaneous Oxygen Tension Measurement Is of Added Value to Predict Diabetic Foot Ulcer Healing: An Observational Study

by Bernard Leenstra, Robert de Kleijn, Geoffrey Kuppens, Bart Arnoldus Nicolaas Verhoeven, Jan Willem Hinnen and Gert J. de Borst

J. Clin. Med. 2020, 9(10), 3291; https://doi.org/10.3390/jcm9103291 - 14 Oct 2020

Cited by 9 | Viewed by 2836

Abstract

Currently, transcutaneous oxygen tension measurement (TCpO2) is the most favorable non-invasive test for diabetic foot ulcer (DFU) healing prognosis. Photo-optical TCpO2 is novel, less time-consuming and more practical in use compared to regular electro-chemical TCpO2. We prospectively investigated the clinical value of photo-optical TCpO2 to predict DFU healing. Patients with suspected DFU undergoing conservative treatment underwent an ankle pressure, toe-pressure and photo-optical TCpO2 test. The primary endpoint was DFU wound healing at 12 months. Based on their clinical outcome, patients were divided into a DFU healing and DFU non-healing group. Healing was defined as fully healed ulcers and non-healing as ulcers that deteriorated under conservative treatment or that required surgical amputation. Differences between groups were analyzed and an optimal TCpO2 cut-off value was determined. In total, 103 patients were included, of which 68 patients (66%) were classified as DFU healing. The remaining 35 patients (34%) had deteriorated ulcers, of which 29 (83%) eventually required surgical amputation. An optimal TCpO2 cut-off value of 43 mmHg provided a sensitivity, specificity and odds ratio of 0.78, 0.56 and 4.4, respectively. Photo-optical TCpO2 is an adequate alternative tool to validate the vascular status of the lower extremity indicating healing prognosis in patients with DFU. Therefore, we recommend that photo-optical TCpO2 can be safely coapplied in clinical practice to assist in DFU treatment strategy. Full article

(This article belongs to the Special Issue Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD))

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15 pages, 1007 KiB

Open AccessArticle

The Imbalance among Oxidative Biomarkers and Antioxidant Defense Systems in Thromboangiitis Obliterans (Winiwarter-Buerger Disease)

by Hiva Sharebiani, Bahare Fazeli, Rosanna Maniscalco, Daniela Ligi and Ferdinando Mannello

J. Clin. Med. 2020, 9(4), 1036; https://doi.org/10.3390/jcm9041036 - 7 Apr 2020

Cited by 21 | Viewed by 3317

Abstract

(1) Background: Thromboangiitis obliterans or Winiwarter-Buerger disease (WBD), is an inflammatory, thrombotic occlusive, peripheral vascular disease, usually occurring in young smokers. The pathophysiological mechanisms underlying the disease are not clearly understood. The aim of this study is to investigate the imbalance between oxidants and antioxidants occurring in these patients. (2) Patients and Methods: In this cross-sectional study, 22 male patients with WBD and 20 healthy male smoking habit matched control group were included. To evaluate the possible sources of oxidative stress, the antioxidant biomarkers, and the markers of lipid peroxidation and protein oxidation, serum samples were analyzed for total oxidative status (TOS), total antioxidant capacity (TAC), myeloperoxidase (MPO), coenzyme Q10 (CoQ10), superoxide dismutase (SOD), glutathione reductase (GR), malondialdehyde (MDA), and protein carbonyl (PC) activity and/or content. (3) Results: The circulating levels of TOS, TAC, and CoQ10 were significantly higher in WBD patients, with respect to healthy smokers as controls. No significant difference was found among the serum level of PC, total cholesterol, MPO, and GR activity in WBD patients and healthy smoker controls. The activity of SOD and the mean serum level of MDA were significantly lower in WBD patients, with respect to healthy smoker controls. (4) Conclusion: Considerably high levels of oxidative stress were detected in WBD patients, which were greater than the antioxidant capacity. The low level of MDA may be associated with the enzymatic degradation of lipid peroxidation products. High levels of CoQ10 and low levels of SOD may be related to a harmful oxidative cooperation, leading to the vasoconstriction of WBD, representing a promising tool to discern possible different clinical risks of this poorly understood peripheral occlusive disease. Full article

(This article belongs to the Special Issue Latest Advances in Diagnostics and Treatment Modalities for Peripheral Arterial Occlusive Disease (PAOD))

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