Study Questions: Chapter 14 Chapter 14: Infrainguinal Intervention DARRAGH MORAN, MD; THOMAS J. KIERNAN, MD Study Questions: Chapter 14 * 1.) Which of the following most closely represents the rate of access site complications of endovascular therapy? 25%–35% 5%–18% 0.5%–1.0% >40% Show answerThe correct answer is 2, 5%–18%. Complications with endovascular intervention occur most frequently at the access site, affecting 5% to 18% of procedures. * 2.) Which of the following is the best definition of primary assisted patency? Revision of the revascularization method to prevent impending occlusion or progression of stenosis Patency of the initially treated vessel following a reintervention to restore patency after occlusion Uninterrupted patency following the revascularization procedure Greater than 50% restenosis of the target lesion Show answerThe correct answer is 1, Revision of the revascularization method to prevent impending occlusion or progression of stenosis. Secondary patency (choice B) refers to patency of the initially treated vessel following a reintervention to restore patency after occlusion. Primary patency (choice C) refers to uninterrupted patency following the revascularization procedure. Binary restenosis (choice D) means ≥50% restenosis of the target lesion. * 3.) Which of the following is true, regarding antegrade puncture of the ipsilateral CFA? It is the most commonly used approach for lower limb revascularization access. Access is generally easier to obtain when compared to a retrograde contralateral CFA approach. This approach may fail in up to 50% of cases. It may provide greater support in cases of significant tortuosity of the iliac vessels. Show answerThe correct answer is 4, It may provide greater support in cases of significant tortuosity of the iliac vessels. A retrograde, contralateral long sheath up-and-over the aortic bifurcation is the most commonly used approach. An antegrade approach may be challenging, particularly in obese patients; however, it does provide good support and has the advantage of a shorter distance to the popliteal and infrapopliteal vessels. It is an unsuccessful approach to obtaining access in 20% of cases. * 4.) Which of the following is most correct regarding subintimal angioplasty of the lower extremities? There is clear evidence for this technique in below-the-knee arterial disease. Standard catheter and wire techniques are successful in reentering the true lumen in approximately 85% of cases. Contrast injection is not required to confirm distal wire position when using true lumen reentry devices. May be considered a first-line endovascu- lar treatment of SFA lesions. Show answerThe correct answer is 2, Standard catheter and wire techniques are successful in reentering the true lumen in approximately 85% of cases. Standard catheter and wire techniques are successful in reentering the true lumen in approximately 85% of cases. In those cases that fail standard techniques, subintimal angioplasty may be considered. Although there are good data for its use in femoral occlusive disease, it has not been as well described for patients with BTK disease. Contrast injection to confirm reentry into the true lumen is of key importance in all subintimal angioplasties. * 5.) Which of the following statements is most accurate regarding infrapopliteal intervention? CryoPlasty provides superior patency, compared with PTA. Balloon-expandable stents are contraindicated. A catheter reentry device is required in 20% of cases. Drug-eluting stents may provide better patency than PTA. Show answerThe correct answer is 4, Drug-eluting stents may provide better patency than PTA. CryoPlasty has been utilized in the BTK Chill trial. However, the results appear no better than PTA alone. Balloon-expandable or self-expanding stents may be used in the infrapopliteal vessels. Catheter reentry devices are utilized for iliac and femoropopliteal procedures. However, the devices are not designed for infrapopliteal use. The use of drug-eluting stents in BTK disease may provide better patency rates than PTA alone. The industry-sponsored trials DESTINY32 and ACHILLES29 show significant improvement of 12-month angiographic patency rates with drug-eluting stents of BTK lesions, compared to balloon angioplasty alone. The ACHILLES data showed 21.3% in-stent binary restenosis in the DES group, versus 45.5% in the PTA group at 12-month follow-up.