Zeitplan Slot

To report the clinical outcomes of endovascular therapy in nonagenarians treated for symptomatic peripheral arterial disease (PAD).

This is a retrospective analysis of 81 nonagenarians (mean age 93 ± 2.4 years). treated by endovascular therapy for chronic limb threatening ischemia (CLTI) or claudication between December 2017 and August 2023. The composite of amputation and/or death (amputation-free survival; AFS) was the primary endpoint. Technical success, mortality, major limb amputation, risk for Major Adverse Cardio-Cerebro-vascular Events (MACCE) and re-intervention during follow-up were additionally analysed.

Most patients presented with CLTI (n=75, 93%). Popliteal artery interventions were most frequently performed (n=59, 73%), followed by superficial femoral artery (n=57, 70%), tibial (n=49, 61%), aortoiliac (n=11, 14%) and common femoral artery (n=7, 9%) procedures. The technical success rate was 100% and the in-hospital mortality was 1% (n=1). At 24 months the AFS was 23.5%, while the major amputation and mortality rates were 4.9% and 75.3% respectively. In the same period the rate of MACCE was 74.1% and the freedom from re-intervention rate amounted to 85.2% The cox regression analysis revealed a lower AFS among males (HR:1.8, 95% CI: 1.06-3.03, p=0.03) and a higher risk for MACCE in patients on warfarin (HR:3.1, 95% CI:1.26-7.59, p=0.01).

Despite the high technical success and the low amputation rates, a very high mortality rate at follow up was observed among nonagenarians undergoing endovascular procedures for PAD. Male gender and Warfarin administration increased the risk for adverse events.

Sirolimus-coated balloons (SCBs) have emerged as a promising alternative to paclitaxel-coated devices for the treatment of femoropopliteal lesions. However, real-world data on SCB performance in also complex peripheral arterial disease remains unknown. We sought to evaluate the safety and 12-month clinical outcomes of the Solution SLR™ balloon angioplasty in a challenging real-world patient cohort.

This single-center, retrospective observational study with prospective follow-up included 21 patients with symptomatic peripheral arterial disease treated with the Solution SLR™ SCB (Med. Alliance, SA, Mont-sur-Rolle, Switzerland) after vessel preparation with rotational atherectomy, between October 2023 and November 2024. The primary endpoints were technical success, 12-month primary patency, and target lesion revascularization (TLR). Secondary endpoints included major adverse cardiac events (MACE), major adverse limb events (MALE), and changes in Rutherford classification and ankle-brachial index (ABI).

The median age was 79 years, with 47.6% of patients over 80 years old. Most patients presented with advanced peripheral atherosclerotic disease (PAD) (Rutherford category V, 47.6%). Lesions were predominantly occlusive (76.2%), with a median length of 130 mm and severe/moderate calcification in 71.4% of cases. Technical success was achieved in 95.2% of procedures. The 12-month primary patency was 95%, with a TLR-Rate of 5%. No major amputations or cardiovascular deaths occurred. Significant improvements in Rutherford category and ABI were maintained at 12 months.

In this real-world cohort of patients with complex PAD, vessel preparation-assisted Solution SLR™ angioplasty demonstrated safety and promising 12-month outcomes. These findings support the use of SCBs in also challenging peripheral interventions, though larger-scale studies are warranted to establish SCBs’ role as crucial in the treatment algorithm of PAD.

Peripheral arterial disease (PAD) represents a significant global health burden, often requiring endovascular revascularisation for symptomatic relief and/or limb-salvage. However, procedural success is frequently compromised by complex lesion morphology, calcification, and thrombus. Vessel preparation technologies—including atherectomy, intravascular lithotripsy, and various angioplasty balloons—are increasingly used to address these challenges, but agreement on the definition, aims/purpose, and appropriate use of vessel-preparation remains lacking. This work aimed to (1) define vessel preparation in the context of endovascular PAD treatment, (2) establish its main clinical aims, and (3) identify key barriers and enablers to its adoption in routine practice.

A modified Delphi consensus approach was used, incorporating two rounds of international online surveys and structured interviews with 103 experienced clinicians across 18 countries. Participants were selected based on their expertise in PAD interventions via the Research Collaborative for PAD membership. Free-text responses and interviews were thematically analysed to identify recurring themes and areas of agreement.

There was 93% agreement that vessel preparation should be defined as “the initial step in an endovascular procedure to facilitate subsequent interventions by modifying lesion characteristics.” Six primary aims were identified: luminal gain, improved vessel compliance, reduction of plaque/calcification burden, enhanced drug delivery, reduction of procedural complications, and improved technical success. Despite widespread use, significant barriers to adoption included lack of reimbursement, high costs, and insufficient evidence. The most frequently reported contraindications were subintimal crossing and presence of circumferential thrombus, though none reached full consensus agreement.

This international position statement and consensus defines vessel preparation in PAD intervention and outlines its core aims. While vessel-preparation is increasingly integrated into clinical practice, clear barriers remain. Standardised definitions and aims will support improved clinical decision-making, research, and health policy related to these endovascular technologies.