Purpose: To evaluate the effectiveness and safety of atherectomy versus plain balloon angioplasty (POBA) for treatment of critical limb ischemia (CLI) due to tibioperoneal arterial disease (TPAD).Materials and Methods: Patients enrolled in the Vascular Quality Initiative registry who had CLI (Rutherford Class 4-6) and underwent atherectomy versus POBA alone for isolated TPAD were retrospectively identified. Of eligible patients, a cohort of 2,908 patients was propensity matched 1:1 by clinical and angiographic characteristics. The atherectomy group comprised 1,454 patients with 2,183 arteries treated, and the POBA group comprised 1,454 patients with 2,141 arteries treated. The primary study endpoint was major ipsilateral limb amputation. Secondary endpoints were minor ipsilateral amputations, any ipsilateral amputation, primary patency, target vessel reintervention (TVR), and wound healing at 12 months.Results: The median follow-up period was 507 days, the mean patient age was 69 years +/- 11.7, and the mean occluded length was 6.9 cm +/- 6.5. There was a trend toward higher technical success rates with atherectomy than with POBA (92.9% vs 91.0%, respectively; P = .06). The rates of major adverse events during the procedure were not significantly different. The 12-month major amputation rate was similar in the atherectomy and POBA groups (4.5% vs 4.6%, respectively; P = .92; odds ratio, 0.97; 95% CI, 0.68-1.37). There was no difference in 12-month TVR (17.9% vs 17.8%; P = .97) or primary patency (56.4% vs 54.5%; P = .64) between the atherectomy and POBA groups.Conclusions: In a large national registry, treatment of CLI from TPAD using atherectomy versus POBA showed no sig-nificant differences in procedural adverse events, major amputations, TVR, or vessel patency at 12 months.

The use of atherectomy devices to assist endovascular treatment of occlusive lower extremity peripheral artery disease (OLEPAD) is rapidly growing. There are no good data to compare the performance of these treatment systems. In this study we compared procedural and longterm outcomes between

Access site complications (ASC) after peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Arteriotomy closure devices (ACD) have been shown to reduce ASC, however, their routine use for the specific purpose of reducing ASC is not recommended

The use of atherectomy devices for the treatment of lower extremity arterial disease has been increasing despite sparse evidence of clinical benefit. The primary goal of intervention on occlusive arterial disease of tibial and peroneal arteries (TPA) is to prevent limb loss. We sought to compare

Background: The efficacy of common femoral artery (CFA) access in preventing access site complications (ASC) in patients undergoing peripheral vascular intervention (PVI) by palpation alone, with fluoroscopy guidance (FG) or with ultrasound guidance (UG) remains unclear. We aimed to elucidate trends

Background: We aimed to elucidate the post-hospitalization outcomes in patients undergoing therapeutic hypothermia and cardiac catheterization after sudden cardiac arrest (SCA). Methods: A retrospective, tertiary-center study consisted of 173 consecutive patients who met inclusion criteria between

Access site complications (ASC) after peripheral vascular interventions (PVI) are associated with prolonged hospitalization and increased mortality. The association between the use of vascular closure devices (VCDs) and ASC as a function of a patient’s preprocedural risk of complication is unknown

Purpose: Access site complications following peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI. Methods: The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression model, with access site complications as the outcome variable. A predictive model was developed with a random sample of 19,683 (70%) PVI procedures and validated in 8,314 (30%). Results: Access site complications occurred in 939 (3.4%) patients. The risk tool predictors are female gender, age > 70 years, white race, bedridden ambulatory status, insulin-treated diabetes mellitus, prior minor amputation, procedural indication of claudication, and nonfemoral arterial access site (model c-statistic = 0.638). Of these predictors, insulin-treated diabetes mellitus and prior minor amputation were protective of access site complications. The discriminatory power of the risk model was confirmed by the validation dataset (c-statistic = 0.6139). Higher risk scores correlated with increased frequency of access site complications: 1.9% for low risk, 3.4% for moderate risk and 5.1% for high risk. Conclusions: The proposed clinical risk score based on eight preprocedural characteristics is a tool to stratify patients at risk for post-PVI access site complications. The risk score may assist physicians in identifying patients at risk for access site complications and selection of patients who may benefit from bleeding avoidance strategies.

ObjectivesThis study aimed to compare the association of access site complications and the use of unfractionated heparin versus bivalirudin during subinguinal peripheral vascular intervention.BackgroundCompared to unfractionated heparin, bivalirudin has been associated with fewer bleeding complications in patients undergoing percutaneous coronary intervention but more ischemic events. The safety and efficacy of direct thrombin inhibitors in peripheral vascular interventions is not well defined.MethodsWe compared the incidence of in‐hospital access site complications and discharge status among patients in the multicenter, prospective Vascular Quality Initiative registry who underwent peripheral vascular intervention between August 2007 and January 2014 using bivalirudin or unfractionated heparin. Propensity score matching was used to obtain a balanced cohort of 1,524 patients in each treatment group.ResultsPatients treated with bivalirudin had a significantly lower incidence of access site hematomas (2.4% vs. 3.9%, P = 0.018), shorter post‐procedural hospitalization (1.0 vs. 1.2 days, P < 0.001) and lower rates of discharge to a nursing home or rehabilitation center rather than home (7.61% vs. 9.73%, P = 0.034) when compared with unfractionated heparin‐treated patients. The incidence of in‐hospital access site occlusion, distal embolization, and mortality did not differ significantly between groups.ConclusionsPatients who received bivalirudin had lower rates of access site hematoma, shorter length of stay, and improved discharge status compared with unfractionated heparin during hospitalization for peripheral vascular intervention. Randomized comparisons of these agents are needed to confirm these findings. © 2016 Wiley Periodicals, Inc.

The comparative effectiveness of external physical compression and different vascular closure devices (VCD) in reducing access site complications (ASC) after peripheral vascular interventions (PVI) remains unclear. We compared short-term outcomes among 57,166 patients in the multicenter,

The trends of use and efficacy of drug-coated balloons (DCB) and drug-eluting stents (DES) for femoropopliteal lesions in real-world population remain unclear. A retrospective single center study included 301 consecutive lesions successful treated with either DES (51.1%) or DCB (48.9%) between 10/

Compared to unfractionated heparin (UFH), bivalirudin is associated with similar efficacy and improved safety in patients undergoing percutaneous coronary intervention. However, the role of direct thrombin inhibitors in peripheral vascular interventions is not well defined. We compared the

A pproximately 8.5-million Americans aged >40 years have peripheral artery disease, a disease that increases morbidity and mortality. 1 Recent advances in peripheral vas-cular intervention (PVI) have improved safety and vessel patency, increasing the popularity of percutaneous endovas-cular treatment modalities for peripheral artery disease over traditional open surgical approaches associated with higher morbidity. 2 Since 1995 there has been a 10-fold growth in the rate of PVI and a simultaneous decrease in surgical vascular interventions. 3 Access site complications (ASCs), including hematoma associated with and without pseudoaneurysm, is the most frequent PVI complication, occurring in 1.0% to 11% of procedures. 4–8 Proposed risk factors of this complication include female sex, advanced age, prior anemia, prior heart failure, low creatinine clearance, rest pain, heparin use, and nonuse of a closure device. 9 Because of incomplete analysis, inconsistent bleeding definitions and small study populations of patients undergoing PVI, ASC predictors, and outcomes are not fully elucidated in the literature. Accordingly, this study evaluated the incidence, predictors, and outcomes of peripro-cedural ASCs in an unselected real-world patient population who underwent PVI. This retrospective study analyzed data on 22 226 patients who underwent 27 048 PVI procedures from August 2007 to May 2013 in >130 centers participating in the Society for Vascular Surgery's Vascular Quality Initiative (VQI). A description of the VQI has been published previously. 10 Complications are site determined and based on examination of the medical record documentation. Basic automated validation occurs when a data field is empty or when data are outside preset parameters. Further validation occurs by comparing data entered into Background—Access site hematomas and pseudoaneurysms are the most frequent complications of peripheral vascular intervention (PVI); however, their incidence and risk factors remain unclear. Methods and Results—We retrospectively analyzed data from the multicenter Vascular Quality Initiative on 22 226 patients who underwent 27 048 PVI from August 2007 to May 2013. Primary end points included incidence and predictors of access site complications (ASCs), length of postprocedural hospitalization, discharge status, and 30-day and 1-year mortality. ASC complicated 936 procedures (3.5%). Of these, 74.4% were minor complications, 9.7% were moderate requiring transfusion, 5.4% were moderate requiring thrombin injection, and 10.5% were severe requiring surgery. Predictors of ASC were age >75 years, female sex, white race, no prior PVI, nonfemoral arterial access site, >6-Fr sheath size, thrombolytics, arterial dissection, fluoroscopy time >30 minutes, nonuse of vascular closure device, bedridden preoperative ambulatory status, and …

Background—Access site hematomas and pseudoaneurysms are the most frequent complications of peripheral vascular intervention (PVI); however, their incidence and risk factors remain unclear. Methods and Results—We retrospectively analyzed data from the multicenter Vascular Quality Initiative on 22 226 patients who underwent 27 048 PVI from August 2007 to May 2013. Primary end points included incidence and predictors of access site complications (ASCs), length of postprocedural hospitalization, discharge status, and 30-day and 1-year mortality. ASC complicated 936 procedures (3.5%). Of these, 74.4% were minor complications, 9.7% were moderate requiring transfusion, 5.4% were moderate requiring thrombin injection, and 10.5% were severe requiring surgery. Predictors of ASC were age >75 years, female sex, white race, no prior PVI, nonfemoral arterial access site, >6-Fr sheath size, thrombolytics, arterial dissection, fluoroscopy time >30 minutes, nonuse of vascular closure device, bedridden preoperative ambulatory status, and urgent indication. Mean hospitalization was longer after procedures complicated by ASC (1.2±1.6 versus 1.9±1.9 days; range, 0–7 days; P=0.002). Severity of ASC correlated with higher rates of discharge to rehabilitation/nursing facilities compared with home discharge. Patients with severe ASC had higher 30-day mortality (6.1% versus 1.4%; P<0.001), and those with moderate ASC requiring transfusion had elevated 1-year mortality (12.1% versus 5.7%; P<0.001). Conclusions—Several factors independently predict ASC after PVI. Appropriate use of antithrombotic therapies and vascular closure device in patients at increased risk of ASC may improve post-PVI outcomes.

Nontyphoidal Salmonella, especially Salmonella enterica, is a rare cause of endocarditis and pericarditis that carries a high mortality rate. Proposed predisposing conditions include immunodeficiency states, congenital heart defects, and cardiac valve diseases. We present 2 cases of cardiovascular salmonellosis. The first case is that of a 73-year-old woman with mechanical mitral and bioprosthetic aortic valves who died from sequelae of nontyphoidal Salmonella mitral valve vegetation, aortic valve abscess, and sepsis. The second case is that of a 62-year-old man with a recent systemic lupus erythematosus exacerbation treated with oral steroids, who presented with obstructive features of tamponade and sepsis secondary to a large S. enteritidis purulent pericardial cyst. He recovered after emergent pericardial drainage and antibiotic therapy. Identifying patients at risk of cardiovascular salmonellosis is important for early diagnosis and treatment to minimize sequelae and death. We reviewed the literature to identify the predisposing risk factors of nontyphoidal Salmonella cardiac infection.