In the August 2020 issue of the JEVT, Shammas et al1 highlighted a crucial point regarding the value of imaging in the treatment of infrapopliteal arterial occlusive disease. The authors compared angiography to intravascular ultrasound (IVUS) imaging in the evaluation of infrapopliteal vessel diameter and the presence and severity of dissections after balloon dilation alone or atherectomy followed by balloon dilation. The findings of their study are of outmost importance since technical details are crucial to success in a challenging vascular district. It is clear that angiography, as a diagnostic tool, is largely inadequate to provide all the necessary information for evaluating both preoperative conditions and treatment outcome. Too many aspects cannot be evaluated by simple contrast imaging, that is, hemodynamic pattern, 3-dimensional distribution of the lesion, and the condition of the arterial wall. Moreover, to characterize any lesion, angiography should be performed in a variety of projections, which has a series of drawbacks. First of all, the amount of contrast medium would increase significantly, with consequences on renal function, which is typically already impaired in atherosclerotic patients. Also, in some projections the target arterial segment may be hidden by bone margin or other arteries. Finally, the hemodynamic aspect cannot be evaluated.2 Up to now, no clear benefit of endovascular techniques has been demonstrated over surgical revascularization in infrainguinal disease.3,4 Plain balloon angioplasty, primary stenting, subintimal angioplasty, atherectomy, bailout stenting, drug-coated balloon (DCB) angioplasty, and so on, have been advocated as the method of choice in treating lower limb occlusive disease without reaching a consensus.5,6 The Shammas study1 focused on infrapopliteal treatment, which is still a particularly challenging field in peripheral revascularization and is associated with poor results.

Commentary: Investigating and Predicting the Fate of Infrapopliteal Arterial Disease After Endovascular Treatment / Faggioli G.; Abualhin M.; Vacirca A.; Gargiulo M.. - In: JOURNAL OF ENDOVASCULAR THERAPY. - ISSN 1526-6028. - STAMPA. - 27:4(2020), pp. 581-583. [10.1177/1526602820928087]

Commentary: Investigating and Predicting the Fate of Infrapopliteal Arterial Disease After Endovascular Treatment

Faggioli G.;Abualhin M.;Vacirca A.;Gargiulo M.
2020

Abstract

In the August 2020 issue of the JEVT, Shammas et al1 highlighted a crucial point regarding the value of imaging in the treatment of infrapopliteal arterial occlusive disease. The authors compared angiography to intravascular ultrasound (IVUS) imaging in the evaluation of infrapopliteal vessel diameter and the presence and severity of dissections after balloon dilation alone or atherectomy followed by balloon dilation. The findings of their study are of outmost importance since technical details are crucial to success in a challenging vascular district. It is clear that angiography, as a diagnostic tool, is largely inadequate to provide all the necessary information for evaluating both preoperative conditions and treatment outcome. Too many aspects cannot be evaluated by simple contrast imaging, that is, hemodynamic pattern, 3-dimensional distribution of the lesion, and the condition of the arterial wall. Moreover, to characterize any lesion, angiography should be performed in a variety of projections, which has a series of drawbacks. First of all, the amount of contrast medium would increase significantly, with consequences on renal function, which is typically already impaired in atherosclerotic patients. Also, in some projections the target arterial segment may be hidden by bone margin or other arteries. Finally, the hemodynamic aspect cannot be evaluated.2 Up to now, no clear benefit of endovascular techniques has been demonstrated over surgical revascularization in infrainguinal disease.3,4 Plain balloon angioplasty, primary stenting, subintimal angioplasty, atherectomy, bailout stenting, drug-coated balloon (DCB) angioplasty, and so on, have been advocated as the method of choice in treating lower limb occlusive disease without reaching a consensus.5,6 The Shammas study1 focused on infrapopliteal treatment, which is still a particularly challenging field in peripheral revascularization and is associated with poor results.
2020
Commentary: Investigating and Predicting the Fate of Infrapopliteal Arterial Disease After Endovascular Treatment / Faggioli G.; Abualhin M.; Vacirca A.; Gargiulo M.. - In: JOURNAL OF ENDOVASCULAR THERAPY. - ISSN 1526-6028. - STAMPA. - 27:4(2020), pp. 581-583. [10.1177/1526602820928087]
Faggioli G.; Abualhin M.; Vacirca A.; Gargiulo M.
File in questo prodotto:
Eventuali allegati, non sono esposti

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/804518
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 0
  • ???jsp.display-item.citation.isi??? 0
social impact