Surgery News - September 2008 - (Page 12) VASCULAR SURGERY NEWS • S E P T E M B E R 2 0 0 8 Claudication Compromises Success of Cardiac Rehab BY DOUG BRUNK Else vier Global Medical Ne ws S A N D I E G O — The prevalence of peripheral arterial disease and intermittent claudication in a group of patients referred for cardiac rehabilitation ranged from 24% to 29%, results from a year-long study showed. “We are all familiar with the fact that patients with peripheral arterial disease and intermittent claudication are at high risk for cardiac death,” Dr. John V. White said at the Vascular Annual Meeting. “These patients would benefit from participation in a supervised cardiac rehabilitation program. Unfortunately, the exercise demands of cardiac rehabilitation may exceed the walking capabilities of the body. A policy of selective invasive treatment [of peripheral arterial disease] is warranted for those patients who cannot successfully complete cardiac rehabilitation.” Dr. White, an ACS Fellow with Advocate Lutheran General Hospital, Park Ridge, Ill., and his associates reviewed the records of 126 patients who were referred by their cardiologists to attend a cardiac rehabilitation program in 2004. Cardiac rehabilitation failure was defined as termination of participation prior to the completion of 32 sessions, or failure to reach a target heart rate within the last 3 sessions. Study participants completed a Walking Impairment Questionnaire (WIQ) after termination or completion of their cardiac rehabilitation program. A subset of 39 patients also presented for the recording of an ankle brachial index. Cardiac rehabilitation performance was then correlated with WIQ-reported symptoms, WIQ-reported walking distance, and the ankle-brachial index (ABI). Patients with significant walking impairment—such as that resulting from severe claudication, critical limb ischemia, severe arthritis, or stroke—were excluded from the study. The patients’ mean age was 65 years, and nearly threequarters (74%) were male. Dr. White reported that the prevalence of peripheral arterial disease was 29% based on WIQ claudication symptoms, 24% based on WIQ walking distance score, and 26% based on ABI. Intermittent claudication symptoms had a significantly negative effect on the successful completion of cardiac rehabilitation. Of 37 patients who reported claudication symptoms on the WIQ, 28 (76%) failed cardiac rehabilitation, whereas only 23 of the 89 patients (26%) who reported no symptoms of claudication failed the program. Of 23 patients who reported joint pain only on ambulation, 9 (39%) failed the cardiac rehabilitation program. “This was similar to the 41% failure rate noted in patients who reported no joint pain,” Dr. White said. “Therefore, joint pain did not interfere with the successful completion of the exercise program.” He also reported that 17 of the 30 patients (57%) with peripheral arterial disease based on their walking distance score failed cardiac rehabilitation, compared with 34 of the 96 patients (35%) who had no peripheral arterial disease based on their walking distance score. A higher percentage of patients with an ABI less than 0.90 failed cardiac rehabilitation than did those with an ABI of 0.90 or greater (70% vs. 38%, respectively). Dr. White had no relevant conflicts to disclose. ■ Drug-Eluting Stent Proves Durable at 6- and 12-Month Follow-Up BY DOUG BRUNK Else vier Global Medical Ne ws S A N D I E G O — The Zilver PTX DrugEluting Peripheral Stent appears to have excellent durability in the superficial femoral artery at 6- and 12-month followup, interim results from a large registry study showed. Manufactured by Cook Inc., the Zilver PTX is an investigational self-expanding nitinol stent coated with paclitaxel. “It does not use a polymer or binder,” Dr. Michael D. Dake said at the Vascular Annual Meeting. “This differentiates it from most of the drug-eluting stents in practice today.” He reported on interim results from the registry arm of the study, which included 790 patients treated at 30 sites in Europe, Russia, Canada, and Korea. A randomized study that intends to enroll 400 patients is currently underway in the United States, Japan, and Germany. The registry trial involved treatment of the above-the-knee femoropopliteal artery from a point 1 cm below the bifurcation to a point above the medial femoral epicondyle. The reference vessel diameters were 4-9 mm. “The trial included all comers,” Dr. Dake, chairman of the department of radiology at the University of Virginia Health System, Charlottesville, and the study’s principal investigator. “There was no lesion length limitation. Up to four stents per patient could be placed.” The mean age of patients was 67 years, and most (73%) were men. More than one-third (36%) had diabetes, 55% had high cholesterol, 80% had hypertension, and 79% were past or current smokers. The mean lesion length was 9.6 cm, the reference vessel diameter was 5.4 mm, and the mean diameter of stenosis was 85%. Prestenting (l) and poststenting of long lesions show effect of Zilver stent. Occluded lesions are shown before (l) and after Zilver stent placement. “Roughly one-third of the patients were total occlusions.” He reported 6-month follow-up data on 435 patients and 12-month follow-up data on 200 patients. In terms of stent in- Strive to be the best. Seek accreditation from the Commission on Cancer (CoC) of the American College of Surgeons. Has your facility’s cancer program reached its full potential? When your facility’s cancer program is accredited by the CoC, it demonstrates its commitment to offering cancer patients the highest standard in quality treatment and care. Plus, the Commission on Cancer helps you strengthen your cancer program through its standard-setting, educational, and research initiatives. Even more, CoC accreditation offers a model for managing your facility’s cancer program by: Setting Standards to promote high-quality, multidisciplinary patient care Facilitating ongoing assessment of your program’s activities Providing real-time access to National Cancer Data Base data to evaluate and improve your delivery of care Take the challenge, build a bet ter cancer program for your facilit y and for your patients, and become accredited by the Commission on Cancer. Visit the Commission’s Web site at: www.facs.org/cancerprograms/mh08 Or send an E-mail query to: CoC@facs.org tegrity, the fracture rate was 1% at 6 months (8 of 825 stents) and 2% at 12 months (11 of 547 stents). “Actually these are fractures pending confirmation, so the rate may actually be less than that, but at least it’s in the low single digits,” he said. Event-free survival was defined as freedom from death, amputation, revascularization, or worsening of Rutherford classification by two classes or to a class 5 or 6. The event-free survival was 94% at 6 months and 84% at 12 months. Stent effectiveness as measured by the clinical end point of freedom from target lesion revascularization, defined as clinically driven reintervention or greater than a 50% stenosis within the treated segment, was 96% at 6 months and 88% at 12 months. Clinical outcomes, as measured by ankle brachial index, Rutherford score, and walking distance and speed scores, improved significantly at 6 and 12 months, compared with preprocedure values. “There are no safety concerns apparent at this time with the Zilver PTX stent,” Dr. Dake concluded. “In terms of effectiveness, this appears favorable, with the initial results appearing better than expected for complex TASC C and D lesions, occlusions, in-stent restenosis, and lesions longer than 7 cm.” Dr. Dake disclosed that he receives research support from Cook Inc., which sponsored the trial. ■ THE ZILVER® PTX™ INVESTIGATORS The average number of stents placed per lesion was 1.9. “These were very complex cases, with almost 45% being TransAtlantic InterSociety Consensus [TASC] C and D lesions,” said Dr. Dake, who is also a professor of radiology at the . http://www.facs.org/cancerprograms/mh08 http://www.facs.org/cancerprograms/mh08
Table of Contents Feed for the Digital Edition of Surgery News - September 2008 Surgery News - September 2008 Contents Appreciation Low Scores News From the College: New Leader Practice Trends: High Price to Pay Surgery News - September 2008 Surgery News - September 2008 - Contents (Page 1) Surgery News - September 2008 - Contents (Page 2) Surgery News - September 2008 - Contents (Page 3) Surgery News - September 2008 - Appreciation (Page 4) Surgery News - September 2008 - Low Scores (Page 5) Surgery News - September 2008 - Low Scores (Page 6) Surgery News - September 2008 - Low Scores (Page 7) Surgery News - September 2008 - News From the College: New Leader (Page 8) Surgery News - September 2008 - News From the College: New Leader (Page 9) Surgery News - September 2008 - News From the College: New Leader (Page 10) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 11) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 12) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 13) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 14) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 15) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 16)
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