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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPercutaneous stenting can be an effective approach for the treatment of various types of occlusive arterial disease; however, appropriate patient selection is critical.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EPercutaneous stenting can be an effective approach for the treatment of various types of occlusive arterial disease; however, appropriate patient selection is critical.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EKenneth Rosenfield, MD, Massachusetts General Hospital, Boston, Massachusetts, USA, discussed the role of renal intervention. Renal artery stenting (RAS) can be considered for appropriately selected patients. The CORAL trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00081731\u0026amp;atom=%2Fspmdc%2F14%2F13%2F32.atom\u0022\u003ENCT00081731\u003C\/a\u003E; Cooper CJ et al. AHA 2013 (abstr 19524)], STAR trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00150943\u0026amp;atom=%2Fspmdc%2F14%2F13%2F32.atom\u0022\u003ENCT00150943\u003C\/a\u003E], and ASTRAL trial [\u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN59586944\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN59586944\u003C\/a\u003E] all had negative results with RAS; however, Dr. Rosenfield pointed out that these trials did not preselect the correct patient population. A pooled analysis of 5 prospective single-arm trials showed that both systolic and diastolic blood pressure significantly decreased following RAS (both p \u0026lt; .0001) [Weinberg I et al. \u003Cem\u003ECatheter Cardiovasc Interv\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EPatient selection for RAS involves a thorough evaluation of clinical indications, patient substrate, degree of stenosis, anatomic factors, available alternative therapies, and the expected benefits and risks of stenting. Dr. Rosenfield called angiographic RAS assessment the \u201cweakest link\u201d in renal stenting, as there is a lack of correlation with hemodynamic parameters [Subramanian R et al. \u003Cem\u003ECatheter Cardiovasc Interv\u003C\/em\u003E 2005]. The use of fractional flow reserve in the renal arteries can accurately predict blood pressure improvement after RAS in patients with hypertension (p = .0017) [Mitchell JA et al. \u003Cem\u003ECatheter Cardiovasc Interv\u003C\/em\u003E 2007; De Bruyne B et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2006]. Dr. Rosenfield suggested that RAS may be appropriate in patients with resistant hypertension or ischemic neuropathy with chronic kidney disease, whereas patients with controlled blood pressure and normal renal function, end-stage renal disease, or renal artery with a chronic total occlusion are likely not appropriate candidates for RAS.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EA presentation from James P. Zidar, MD, Rex Healthcare, Raleigh, North Carolina, USA, discussed when to intervene in celiac artery and superior mesenteric artery (SMA) disease. Disease of the celiac artery and SMA is rare, but mesenteric ischemia can be life threatening and can lead to cachexia. Acute mesenteric ischemia is typically the result of obstructive thrombosis, frank embolism, or preexisting disease and causes symptoms such as leukocytosis and lactic acidosis. An abdominal dual-phase contrast computed tomography scan can identify a clot or a bowel ischemia or infarction, whereas angiography can be used for diagnostic and therapeutic purposes. Patients with SMA embolism often experience rapid clinical decline. Chronic mesenteric ischemia is frequently a result of arterial atherosclerosis and, in some cases, mesenteric venous obstruction, and it often causes symptoms such as food avoidance, weight loss, and ischemic gastropathy and colitis. A study of endovascular therapy of the SMA and celiac trunk with percutaneous transluminal angioplasty and stenting had a technical success rate of 95% and a clinical success rate of 61%; 67% of patients were without recurrent symptoms at 4 years [AbuRahma AF et al. \u003Cem\u003EJ Endovasc Ther\u003C\/em\u003E 2003]. In addition, survival rates were 93%, 80%, and 53% at 1, 3, and 4 years, respectively. Therefore, endovascular therapy of celiac artery and SMA disease can be offered as first-line therapy, and although recurrent stenosis occurs, it responds well to repeat dilation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EMichael S. Lee, MD, University of California at Los Angeles Medical Center, Los Angeles, California, USA, presented on the role of endovascular intervention in Leriche syndrome. Leriche syndrome is characterized by the atheromatous occlusion of the distal portion of the abdominal aorta at the bifurcation of the common iliac arteries. This syndrome typically affects male patients aged 30 to 40 years and causes symptoms such as leg weakness or numbness, claudication, erectile dysfunction, and a weak pulse in the femoral arteries. Known risk factors for the development of Leriche syndrome are cigarette smoking and hypercholesterolemia. As a result, chronic atherosclerosis, vasculitis, and thrombosis can occur. Surgical treatment of Leriche syndrome includes aortoiliac bypass graft or axillofemoral and femoral\u2013femoral bypass. In a study of \u0026gt; 2000 patients with aortoiliac disease who received successful aortoiliac stenting, the primary patency rate was 73% at 6 years, and assisted-primary patency and secondary primacy rates were 91% and 99% [Soga Y et al. \u003Cem\u003ECirc J\u003C\/em\u003E 2012]. In addition, 77% of patients were alive at 6 years, and 72% had not experienced major adverse cardiovascular events. Researchers who compared bypass surgery to aortic stenting found that patients who underwent stenting experienced significantly less emergency surgery (p = .029) and infection or sepsis (p \u0026lt; .001; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Burke CR et al. \u003Cem\u003EAnn Vasc Surg\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16419\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16419\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16419\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EBypass Surgery Compared With Aortic Stenting in Aortoiliac Occlusive Disease\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EUsing a case study, Paul A. Jones, MD, Mercy Hospital and Medical Center, Chicago, Illinois, USA, discussed potential complications that can occur during aortoiliac intervention. The case involved a 74-year-old man with a history of tobacco abuse, chronic obstructive pulmonary disease, and systemic hypertension who had presented 19 months prior with left thigh and calf claudication. At the time, the patient refused conventional surgery. The patient presented again 18 months later with progressive, debilitating claudication, and after refusing conventional surgery again, he underwent percutaneous endovascular revascularization. Initially, brachial and common femoral access attempts were unsuccessful, and entry was gained with an ultrasound-guided reentry device. Predilation with a balloon (6 mm \u00d7 10 cm) was used to place 14- and 12-mm self-expanding stents in the left common and external iliac arteries, respectively. Yet, reflow was not achieved in the aortoiliac artery. Bolus eptifibatide was administered, and left brachial artery access was used to performed a percutaneous thrombectomy. However, the right iliac artery ruptured, and the patient was hemodynamically stabilized with a balloon occlusion and intravenous vasopressors. Aortic occlusion balloon was placed on standby, as were the surgeon and operating room. The rupture was successfully sealed with deployment of a self-expanding stent graft (13 mm \u00d7 5 cm). However, the patient experienced numerous severe complications 24 to 72 hours after the procedure, including bilateral blue toe syndrome, acute rhabdomyolysis, acute visceral ischemia, lactic acidemia, and thrombocytopenia, as well as a loss of distal pulses that prompted a left below-the-knee amputation. After a conservative approach of supportive care\u2014including administration of acetylsalicylic acid, clopidogrel, and cilostazol with high-dose statins and aggressive local wound care\u2014the patient was discharged after 3 weeks.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EWhen considering percutaneous revascularization of aortic, renal, or mesenteric occlusive arterial disease, providers should carefully select patients and be prepared for potential serious complications during and after endovascular procedures.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/13\/32.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzozgd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzozgd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}