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6 recent updates on PAD management, treatment
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September is Peripheral Artery Disease Awareness Month, with the goal of increasing awareness and understanding of vascular disease.
Approximately 8.5 million people in the United States have PAD, including 12% to 20% of individuals aged older than 60 years, according to statistics from the CDC.
Risk factors for PAD include smoking, diabetes, hypertension, high cholesterol, obesity and physical inactivity. The theme for this year’s PAD Awareness Month — Saving Limbs, Saving Lives — aims to increase awareness of these risk factors and to increase patient access to PAD screening and treatment options.
Cardiology Today and Cardiology Today’s Intervention compiled a list of recent articles highlighting updates in PAD management and treatment.
HDL levels may predict risk for CV events, mortality in PAD
Patients with PAD and low HDL levels may have a greater risk for MACE and all-cause mortality, compared with patients with normal levels, new data suggest.
“This study confirms that [HDL cholesterol] may represent an important independent prognostic biomarker of [CVD] in patients with symptomatic PAD. These findings highlight the usefulness of this simple test for early identification of PAD patients at high risk of mortality and MACE,” researchers wrote in the study.
Serration balloon catheter achieves low residual stenosis in PAD
Results of the PRELUDE feasibility study 25 patients of a serration balloon catheter (Serranator Alto, Cagent Vascular) showed it greatly reduced stenosis with superficial femoral or popliteal artery disease with no serious adverse events
“The Serranator [Alto] is safe and effective in treating critical femoropopliteal lesions,” Marianne Brodmann, MD, interim head of the clinical division of angiology, department of internal medicine, Medical University Graz, Austria, said at VIVA 17. “We had 100% technical success and the confirmation of the serration effect by OCT and IVUS. The acute results show that these patients can achieve low residual stenosis, and the device was effective in moderate and severe calcification, which surprised us. The majority of subjects were successfully treated with low pressure inflation.”
DCB safe, effective at 2 years for PAD with femoropopliteal lesions
New 2-year data from the multicenter, prospective Global SFA Registry demonstrate long-term safety and efficacy of treatment with a drug-coated balloon in a real-world population of patients with PAD and femoropopliteal lesions.
Of the 691 patients (mean age, 68 years) with PAD and femoropopliteal lesions treated with the Lutonix 035 DCB (Bard Peripheral Vascular), 99.4% were free from the composite safety endpoint of target vessel restenosis, major limb index amputation and device- or procedure-related death at 30 days, according to data published in JACC: Cardiovascular Interventions.
DEFINITIVE AR: Atherectomy plus DCB may be beneficial in PAD
In patients with PAD, lumen gain achieved at 2 years after treatment with directional atherectomy with the SilverHawk or TurboHawk device (Medtronic Endovascular) followed by a DCB (Cotavance, Medrad) may result in better outcomes, according to data from the DEFINITIVE AR pilot study.
IN.PACT SFA: DCB for PAD confers less TLR vs. angioplasty at 4 years
At 4 years, the rate of target lesion revascularization was lower among patients with femoropopliteal lesions who received a DCB compared with those who received percutaneous transluminal angioplasty, according to new data from the IN.PACT SFA trial.
The superiority in safety is consistent with results from the first 3 years, Peter A. Schneider, MD, chief of vascular therapy at Kaiser Foundation Hospital, Honolulu, said during a press conference at VIVA 17.
High-intensity statin therapy associated with lower mortality in PAD
Patients with symptomatic PAD who received high-intensity statin therapy had improved survival compared with those who received low- or moderate-intensity therapy, according to a recently published study.
“Among patients with critical limb ischemia, the most severe manifestation of PAD, statin therapy has also been associated with reduced mortality and improved amputation-free survival,” T. Raymond Foley, MD, of the Denver VA Medical Center and University of Colorado School of Medicine, and colleagues wrote. “Despite compelling evidence and guideline recommendations, patients with PAD are undertreated medically and are significantly less likely than patients with CAD to receive statin therapy.”