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Vascular Disease Management Increasingly Important

July 20, 2011

Current issue of Progress in Cardiovascular Diseases explores recent evidence-based vascular medicine

As the population ages and obesity and diabetes increase, more people suffer from noncardiac vascular diseases. In the July/August issue of Progress in Cardiovascular Diseases, published by Elsevier, a series of articles from recognized experts on key topics in vascular disease and endovascular medicine provide an insightful compendium of the evidence available to help improve the care of this complex patient population.

“Over the past decade, interest in the management of patients with noncardiac vascular disease has exploded,” commented guest editors Christopher J. White, MD, The John Ochsner Heart & Vascular Institute, Ochsner Clinical Foundation, New Orleans, LA, and Michael R. Jaff, DO, Massachusetts General Hospital Vascular Center, Boston, MA. “There are several potential explanations for this, including the aging population, the increasing prevalence of diabetes mellitus and obesity, rapidly evolving endovascular technologies, and increasing interest among vascular specialists to perform cutting-edge, minimally invasive procedures. Despite this interest, the literature remains devoid of many high-level scientific studies aiding the clinician in the practice of evidence-based vascular medicine. This issue of Progress in Cardiovascular Diseases was developed to provide an up-to-date summary of the most recent evidence by expert clinicians in vascular and endovascular medicine.”

“This timely symposium offers the clinical cardiologist much needed access to the latest developments and capacities in an arena that is expanding rapidly and will continue to do so,” stated Editor-in-Chief Henry Greenberg, MD, Columbia University College of Physicians and Surgeons and St. Luke’s Roosevelt Hospital, New York, NY,

KEY POINTS:

Comprehensive Medical Management of Peripheral Artery Disease
Sanjay Gandhi, Ido Weinberg, Ronan Margey, and Michael R. Jaff
Peripheral arterial disease is the most underrecognized and undertreated atherosclerotic syndrome in the general population. Patients with PAD are at very high risk for future cardiovascular events and mortality. Once the diagnosis of PAD is established, all patients must receive comprehensive intervention, including aggressive atherosclerotic risk factor modification””namely tobacco cessation, weight loss, antiplatelet therapy, lipid-lowering therapy, control of diabetes mellitus, and high blood pressure.

Carotid Stenting or Carotid Surgery in Average Surgical-Risk Patients: Interpreting the Conflicting Clinical Trial Data
William A. Gray
The author describes the previous clinical data comparing carotid artery stenting (CAS), carotid angioplasty (CA) and carotid endarterectomy (CEA) and cautions that many studies have methodologic concerns. He concludes that the available evidence supports CAS as an equivalent, effective treatment for carotid artery disease.

Treatment Strategies for Carotid Stenosis in Patients at Increased Risk for Surgery
Robert D. Safian
Symptomatic patients with severe carotid stenosis (CS) who are at high risk for CEA should be considered for CAS. In asymptomatic patients with CS 80% or greater but who are at high risk for CEA should undergo careful risk benefit assessment. Patients who have normal cognitive function, favorable aortic arch and carotid artery anatomy, and a likelihood of survival 3 years or greater should be considered for CAS, whereas patients with multiple unfavorable features may be treated with optimal medical therapy, without surgical intervention.

Renal Artery Stenosis: Optimizing Diagnosis and Treatment
William R. Colyer, Ehab Eltahawy, and Christopher J. Cooper
Renal artery stenosis (RAS) is a common problem that affects young patients with fibromuscular dysplasia and old patients with atherosclerosis. Treatment of FMD with balloon angioplasty and antihypertensive medications is well accepted. Treatment of atherosclerotic RAS remains controversial, largely because of the disparity in results between observational studies suggesting a treatment advantage and randomized trials that have failed to detect such differences in treatment outcome.

Chronic Mesenteric Ischemia: Diagnosis and Management
Christopher J. White
Although chronic mesenteric ischemia (CMI) is the most common vascular disorder of the intestines, it occurs infrequently. Since randomized control trials are difficult to perform, case series can be used to evaluate treatment outcomes. The current treatment recommendation is that patients who are candidates for either surgery or percutaneous therapy should initially receive percutaneous therapy with stent placement.

Claudication: Treatment Options for Femoropopliteal Disease
Martin Schillinger and Erich Minar
Walking limitation due to arterial obstruction to the legs can be disabling, especially in older patients. This article outlines the recommended treatments depending on the patients’ symptoms and their reduction in quality of life.

Critical Limb Ischemia: Endovascular Strategies for Limb Salvage
Philip B. Dattiloa and Ivan P. Casserly
As the most severe manifestation of peripheral artery disease (PAD), critical limb ischemia (CLI) can result in the loss of a limb. The authors discuss how an endovascular-first approach to treatment of CLI can lead to positive outcomes. In addition, they note that optimizing overall clinical care after revascularization may hold the key to altering the poor long-term prognosis of patients with CLI.

Venous Ablation Therapy: Indications and Outcomes
Julianne Stoughton
Venous disease is a progressive, debilitating, and recurrent problem, which until recently was often undertreated. During the past decade, an explosion in the treatment options has occurred. Endovenous ablation therapy has nearly replaced the conventional surgical treatments for patients with superficial venous insufficiency. These newer techniques are much less invasive and consequently have reduced risks of wound complications or bleeding. With the lower procedural risks and the dramatically shortened recovery times, earlier intervention can be done.

Endovascular Therapies to Treat Iliofemoral Deep Venous Thrombosis
J. Stephen Jenkins
Although venous thromboembolism (VTE) is responsible for more than 250,000 hospital admissions per year in the United States, published guidelines do not adequately address invasive therapies for iliofemoral deep venous thrombosis (DVT). Ileofemoral DVT generally has a worse prognosis than other forms of lower-limb DVT. The authors review the anticoagulation management and catheter-based invasive therapies for the treatment of this condition.

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