Peripheral Arterial Interventions: Evolving Therapeutic Strategies

Preface
Contents
About the Editor
Chapter 1: Peripheral Arterial Atherogenesis
	Peripheral Artery Disease
	Epidemiology and Risk Factors
	Detection of PAD
		Clinical Findings and Imaging
		Biomarkers
	Vascular Anatomy and Rheology
	Arterial Structure
	Normal Function of the Endothelium
	Development of Atherosclerosis
		Pathogenesis of Atherosclerosis
	Entry of LDL into the Subendothelial Space
	Clearance of LDL into the Subendothelial Space
	Propagation of Atherosclerosis
	Atherosclerosis in Peripheral Artery Disease
	Ischemia-Induced Changes
	Conclusion
	References
Chapter 2: Risk Factors of Patients with Peripheral Arterial Disease
	Non-modifiable Risk Factors of PAD
		Age
		Family History
		Renal Dysfunction
		Ethnicity
		Modifiable Risk Factors for PAD
		Tobacco Use
		Hypertension
		Hyperlipidemia
		Diabetes
		Obesity
		Inflammation
	Summary
	References
Chapter 3: The Role of Exercise in Treating Symptomatic Claudication in Patients with Peripheral Arterial Disease
	Definitions
	Vascular Effects of Exercise
	Exercise and/or Revascularization Versus Control
	Exercise Programs for PAD Patients
	Cost-Effectiveness of Exercise for PAD
	Summary
	References
Chapter 4: Pharmacologic Interventions in Patients with Peripheral Arterial Disease
	Oral Antiplatelet Therapies
		Aspirin
		Clopidogrel
		Ticagrelor
		Vorapaxar
	Oral Anticoagulants
		Rivaroxaban
		Warfarin
		Edoxaban
	Cilostazol (Pletal)
	Lipid-Lowering Drugs
		Statins
		PCSK9 Inhibitors
	Oral Antidiabetic Drugs
		GLP-1 Agonists
		SGLT2 Inhibitors in Diabetics
	Summary
	References
Chapter 5: Blood Vessel Compliance, Barotrauma and Angioplasty-Induced Dissection Following Treatment of the Patient with Peripheral Artery Disease
	Blood Vessel Wall Structure and Compliance
		Pathophysiology of Intimal and Medial Calcification
	Barotrauma and the Immediate Cellular Response to Angioplasty
	Mid-Term Cellular Response and Remodeling
	The Concept of Controlled Versus Uncontrolled Dissection
		Stents for Mechanical Support
	Modes of Failure Following Balloon Angioplasty
		Acute Occlusion
		Restenosis
	The Classification of Dissection
		Classification Systems: Angiography
		Classification Systems: Intravascular Ultrasound (IVUS)
		The DiSForM Classification System
	Summary
	References
Chapter 6: Controlling Dissections in Peripheral Arterial Interventions
	Precise Imaging
	The Relationship Between Deep Injury, Plaque Excision, Dissection Repair, and Antiproliferative Therapy
		Aggressive Debulking, High Rate of Deeper Dissections, and Antiproliferative Treatment
		No Debulking, Deeper Dissections, Dissection Repair, and/or Antiproliferative Treatment
		Low-Level Debulking, Minimal Rate of Deep Dissections, and Antiproliferative Therapy
	Other Technologies to Reduce Dissections
	Dissection Repair
	References
Chapter 7: The Role of Atherectomy in Vessel Prepping During Infrainguinal Arterial Interventions
	Laser Atherectomy
	Orbital Atherectomy
	Rotational Atherectomy
	Directional Atherectomy
	Atherectomy and Drug-Coated Balloons
	Conclusion
	References
Chapter 8: Vessel Preparation with Longitudinal and Controlled-Depth Micro-Incisions
	The Clinical Benefit of Reducing Dissections
	Current Methods for Vessel Preparation
		Specialty Angioplasty Balloons
		Atherectomy
		Intravascular Lithotripsy (IVL)
	Creating Longitudinal Micro-Incisions to Modify Plaque with Fewer Complications
	Clinical Data in Peripheral Arterial Disease
	Mechanism of Action
	FLEX VP Micro-Incisions May Facilitate Drug Delivery
	Future Directions
	References
Chapter 9: Intravascular Lithotripsy for Calcified Peripheral Arterial Disease
	Introduction
	IVL: Device Specifics
	IVL in Peripheral Artery Disease
	Effect of Calcium on Drug Elution
	IVL-Facilitated Large-Bore Vascular Access
	Indications for IVL in Specific Vascular Beds with Case Examples
		Brachiocephalic Lesions in Patient with Symptomatic Arm Claudication or TIA
		Carotid In-Stent Restenosis (ISR) Due to Stent Underexpansion
		Mesenteric Ischemia Due to Calcific Stenosis of the Superior Mesenteric Artery (SMA)
		Treatment of Aorto-Iliac Calcific Disease
		Treatment of Calcific Common Femoral Artery (CFA) Stenosis
		Calcified Femoropopliteal Lesions in Patients with Symptomatic Claudication or Critical Limb Ischemia
		Calcified Below-the-Knee (BTK) Lesions in Patients with Symptomatic Claudication or Critical Limb Ischemia (CLI)
	Future Applications
	References
Chapter 10: Preserving Vessel Integrity and Reducing Vascular Recoil with Focal Force Balloons
	Introduction
	Functionalities of Balloon Angioplasty and Focal Force Balloons
	Peripheral Cutting Balloon (Boston Scientific) (Fig. 10.1)
		Device Mechanism
		Specifications
		Evidence and Use
	Chocolate PTA Balloon (Medtronic) (Fig. 10.2)
		Device Mechanism
		Device Specifications
		Evidence and Use
	AngioSculpt Balloon (Philips) (Fig. 10.3)
		Device Mechanism
		Device Specifications
		Evidence and Use
	VascuTrak (Bard) (Fig. 10.4)
		Device Mechanism
		Specifications
		Evidence and Use
	Shockwave Intravascular Lithotripsy (IVL) (Shockwave) (Fig. 10.5)
		Device Mechanism
		Specifications
		Evidence and Use
	FLEX Scoring Catheter (VentureMed) (Fig. 10.6)
		Device Mechanism
		Specifications
		Evidence and Use
	Conclusions
	References
Chapter 11: Reducing the Metal Burden in the Infrainguinal Arteries: Tack Endovascular System
	References
Chapter 12: Drug-Coated Balloons in Infrainguinal Arteries
	Background
	Technical and Pharmacologic Considerations of DCBs
	Clinical Applications of DCBs in PAD
		Drug-Coated Balloons in Native Femoropopliteal Lesions
		Drug-Coated Balloons in Below-the-Knee Interventions
	DCB Use in Other Lesion Subsets: In-Stent Restenosis, Long Lesions, and Combination Therapy
		In-Stent Restenosis (ISR)
		Long Lesions
		Combination Therapies
	Future Innovations in DCB Technology
	Mortality and Paclitaxel
	Cost-Effectiveness of Drug-Coated Balloons
	Conclusion
	References
Chapter 13: Stenting in Infrainguinal Interventions
	A Brief History of Femoropopliteal Stenting
	Challenge of the SFA
	Initial Treatment Approaches
	Nitinol-Based Self-expanding Stents
	First-Generation Stents
	Newer-Generation Stents
	Stent-Grafting in the SFA
	Drug-Eluting SFA Stents
	Conclusion
	References
Chapter 14: Femoropopliteal Chronic Total Occlusions: Approach and Considerations for Crossing and Intervention
	Introduction
	General Principles
	Procedure Planning
	Imaging
	Vascular Access
	Treatment
	Intraluminal and Subintimal
	Retrograde
	Hybrid Approaches
	Below-the-Knee Chronic Total Occlusions
	References
Chapter 15: Approach to Treatment of Iliac Artery Disease
	Introduction
	Clinical Presentation and Evaluation
	Treatment
	Options for Revascularization
	Considerations for Endovascular Therapy
	Complications of Endovascular Revascularization
	Conclusion
	References
Chapter 16: Chronic Limb-Threatening Ischemia: Evaluation and Management
	Introduction
	Definition and Diagnosis
	Treatment Modalities
		Medical Management
		Revascularization
			Endovascular Approach
				Technical Aspects of Endovascular Intervention
				Access Site
				Guidewire
				Balloon/Support Catheter
				The Concept of Angiosome in Treating CLTI
				Different Endovascular Modalities
			Surgical Approach
			Endovascular Versus Surgical First
	Novel Treatment Modalities
		Deep Venous Arterialization (DVA)
		Endovascular Bypass Technology
	Postrevascularization CLTI Management
		Wound Care
	Future Perspectives
	Conclusion
	References
Chapter 17: Distal Embolization in the Treatment of Peripheral Arterial Disease
	Historical Background
	The Problem: Distal Embolization from Endovascular Procedures
	What are the Rates of Distal Embolization?
	Incidence of Distal Emboli
	The Clinical Relevance of Distal Emboli
	Indications for the Use of Distal Embolic Filters
	Current Status of Distal Protection
	Technique of Distal Protection
	Conclusion and Future of Distal Protection
	References
Chapter 18: Management of Aortic Aneurysms
	Introduction
	Indications for EVAR
	Preoperative Assessment and Planning
	Operative Technique
	Postoperative Surveillance and Complications
	Conclusion
	References
Chapter 19: Putting It All Together: An Algorithmic Approach to Treat Patients with Peripheral Arterial Disease
	References
Index