Key result
Endovascular treatment for peripheral artery disease improved local endothelial function from 3.7% at baseline to 4.2% at 6 months (p=0.01), though higher paclitaxel doses attenuated this benefit.
Why the study?
Endovascular interventions for symptomatic PAD restore perfusion but may cause severe injury to the vascular endothelium, so the study aimed to determine the impact of percutaneous interventions on changes in endothelial function.
Does lower limb endovascular intervention improve endothelial function in patients with symptomatic peripheral artery disease?
Cohort (n=42)
Does lower limb endovascular intervention improve endothelial function in patients with symptomatic peripheral artery disease?
Absolute Event Rate: 4.2% vs 3.7%
p-value: p=0.01
Endovascular treatment for peripheral artery disease improves both local and systemic endothelial function, although higher doses of paclitaxel may attenuate the local benefits.
May support endothelial benefits of endovascular PAD therapy; hypothesis-generating and requires RCTs before practice change.
Summary: Background: Treatment of symptomatic peripheral artery disease (PAD) through endovascular interventions is the primary revascularization strategy. Interventions restore perfusion but may cause severe injury to the vascular endothelium, which regulates vascular tone. Endothelial dysfunction is involved in the progression of cardiovascular disease, with higher incidences of vascular events. We aimed to determine the impact of percutaneous interventions on change in endothelial function. Patients and methods: Endothelial function was determined using flow-mediated dilation (FMD) before, the day after lower limb intervention with paclitaxel-coated balloons or stent guided interventions and after a six-month follow-up in the target limb, control limb and the systemic circulation in 42 PAD patients aged 70.2±9 years and 66% men. Additionally, macro- and microvascular function were assessed. Results: In PAD patients aged 70.2±9 years and 66% men, we observed an immediate enhancement of macro-, microvascular and endothelial function after endovascular treatment (FMD of superficial femoral artery (SFA) 3.7±0.2% to 4.1±0.1%, n=42, p=0.02), a sustained long-term improvement after 6-months (FMD SFA 3.7±0.2% to 4.2±0.1%, n=42, p=0.01), and moreover an improved systemic endothelial function (FMD brachial artery 4.3±0.1% to 4.7±0.2, n=42, p=0.01) following peripheral interventions. Subgroup analysis however revealed that following paclitaxel-based percutaneous intervention, the paclitaxel dosage applied was inversely related to the chronic improvement in local endothelial function (r=−0.6, n=22, p=0.005) without evidence for systemic effects (r=−0.25, p=0.27). Conclusions: We demonstrate an improved local and systemic endothelial function after treatment of atherosclerotic peripheral disease with a distinguished response after endovascular intervention with higher dosage of applied paclitaxel restraining the benefits. Further studies have to determine the optimal interventional strategy with respect to different treatment modalities to maintain vessel functions.
No takes yet. Share an insight, caveat, or question.
Rammos et al. (2021) conducted a cohort in symptomatic peripheral artery disease (PAD) (n=42). Endovascular treatment (paclitaxel-coated balloons or stents) vs. Baseline was evaluated on Flow-mediated dilation (FMD) of superficial femoral artery at 6 months (p=0.01). Endovascular treatment for peripheral artery disease improved local endothelial function from 3.7% at baseline to 4.2% at 6 months (p=0.01), though higher paclitaxel doses attenuated this benefit.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: