Navigation Links
Minimally invasive stents show some advantage over bypass in opening blocked leg arteries
Date:8/6/2013

New Johns Hopkins research suggests that people who undergo minimally invasive placement of stents to open clogged leg arteries are significantly less likely than those who have conventional bypass surgery to need a second treatment for the condition within two years.

For now, bypass surgery remains the gold standard for treating symptoms of peripheral artery disease (PAD), but the Johns Hopkins researchers are hopeful that further study will confirm the advantage their study shows for the stents.

The researchers, reporting online in the Journal of Vascular Surgery, also found that both treatments were equally successful in restoring healthy blood circulation to the legs. But threading a stent through an artery through access in the groin and into the blocked leg vessel to create a wider path for blood requires no general anesthesia and is typically associated with shorter hospital stays and recovery times than open bypass, they add.

"We are constantly looking for the best way to improve quality of life for the 10 percent of the population who suffer from peripheral artery disease," says study leader Mahmoud B. Malas, M.D., M.H.S., an associate professor of surgery at the Johns Hopkins University School of Medicine, director of endovascular surgery and director of The Vascular and Endovascular Clinical Research Center at Johns Hopkins Bayview Medical Center. "Our study suggests the minimally invasive approach shows real promise, and we are embarking on a large, randomized study of the two procedures to develop guidelines that can be used for determining when a stent is likely to be best and when a bypass cannot be avoided."

PAD is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs, a likely sign of a widespread accumulation of fatty deposits in the coronary and cerebral vessels, where blockages may lead to heart attacks and stroke, respectively. Without enough oxygen-rich blood flow to keep up with demand, people experience PAD's most notable symptom leg pain when walking. As the disease progresses, patients may develop gangrene or open sores that threaten the limb.

Once the pain is serious and chronic, even without walking, doctors consider manually bypassing the blockages. In contrast to minimally invasive stenting, a so-called femoral-popliteal bypass requires a large incision to open the leg, and the surgical attachment of a piece of vein or a synthetic tube above and below the blockage to reroute blood flow.

The small study, just published, was conducted by analyzing records from 104 patients with PAD who either got a stent or a bypass operation at Johns Hopkins Bayview Medical Center between September 2005 and September 2010. The average age of patients in the study was 68 years.

Patients who received stents had a 31 percent risk of needing another procedure to restore blood flow within 24 months, while those who received a bypass had a 54 percent chance of needing another intervention. The researchers found that women were twice as likely as men to need a second operation.

Malas cautions that patients in the stent group may have had better outcomes because 77 percent of them had what were considered smaller blockages, while 73 percent of those who had bypass surgery had larger ones. Physicians use a somewhat subjective measure to choice a treatment, confounding efforts to tease out clear guidelines about when to use stents or bypass.

It is most difficult to determine which course of action to take with medium-sized blockages, Malas says, noting that in his study, patients with longer blockages were more likely to have had a stent in the past that failed, so their diseases may have progressed further along.

Malas says he tells his patients how important it is to adopt healthy habits exercising, eating properly, taking aspirin and medications to control elevated cholesterol and not smoking to try to reduce the effects of PAD, which is a "cousin" of coronary artery disease. By the time they need surgical intervention, he says, their disease could not only be threatening their limbs, but their lives.

"We try to improve their quality of life, but stents and bypass won't cure the patient of PAD at this stage," he says. "We're improving circulation, but the disease is still there and it will continue to progress, so modifying other risk factors is a must."


'/>"/>

Contact: Stephanie Desmon
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medicine
Source:Eurekalert

Related medicine news :

1. Chuback Medical Group Launches New Public Health Campaign via Social Media to Promote Minimally Invasive Vein Treatment Options
2. The Society for Advanced Spinal Intervention Comments on Landmark Case, Calls for Standards in Minimally Invasive Spine Surgery
3. Minimally Invasive SpineCARE® Opens Three New Clinics in Texas Branches out into Burleson, Arlington and Joshua
4. Nemours Pediatric ENT Performs Minimally Invasive Procedure on South Florida Boy at Wolfson Children’s Hospital in Jacksonville, FL
5. SAGES Issues Guidelines on Hiatal Hernia - Laparoscopic, or Minimally Invasive, Hiatal Hernia Repair is the Preferred Approach
6. West Penn Allegheny Health System is First in Pennsylvania to Perform Groundbreaking Minimally-Invasive Procedure for Swallowing Disorder
7. Dr. Sam Speron Reveals New Minimally Invasive In-Office Options for Cellulite Removal
8. New minimally invasive, MRI-guided laser treatment for brain tumor found to be promising in study
9. Top Surgeons to Convene for SAGES 2013 Conference to Feature Breakthroughs in Gastrointestinal, Robotic and Minimally Invasive Surgery
10. Kidney stone surgery: More women, more complications with minimally invasive procedure
11. Minimally Invasive Surgery for Treatment of Colorectal Cancer Yields Optimal Outcomes for Patients
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... , ... February 12, 2016 , ... Fisher House Foundation ... Mayor John J. Lee, Nevada Military Support Alliance president Scott Bensing, and Peggy Kearns ... the VA Southern Nevada Healthcare System. This will be the first Fisher House ...
(Date:2/12/2016)... ... 2016 , ... Young Asset Protection, a full service insurance ... latest charity campaign in their community enrichment program. Art Expression utilizes after-school programs ... are currently being accepted at: http://artexpressioninc.org/ . , Art Expression is a ...
(Date:2/12/2016)... ... February 12, 2016 , ... ... , The print component of “Revolutionizing Cancer Care” is distributed within ... Washington DC/Baltimore, and Seattle, with a circulation of approximately 250,000 copies and an ...
(Date:2/12/2016)... ... 2016 , ... A lot has been reported about the fitness routines of ... health and wellness resources most Americans could ever dream of having at their disposal. ... as frenetic as the U.S. President. , In honor of President’s Day on ...
(Date:2/12/2016)... ... , ... Basketball is a game for everyone, not just those who can ... language translation is featured in the top right of the screen. Every technique that ... a sign language translator to teach kids the game and how to be as ...
Breaking Medicine News(10 mins):
(Date:2/12/2016)... DIEGO and SEOUL, South ... Silicon Biosys­tems Menarini and Macrogen, Inc. today announced ... assays and innovative procedures for precision medicine in ... combine Silicon Biosystems, DEPArray™ digital-sorting technology with Macrogen,s ... of tests certified under the Clinical Laboratory Improvement ...
(Date:2/12/2016)... LOUISVILLE, Ky. , Feb. 12, 2016 ... it has completed a $47.1 million Series ... investors Cormorant Asset Management, Hillhouse Capital Group ... investors Morningside Venture Investments, AJU IB Investment, ... will be used to further advance clinical ...
(Date:2/11/2016)... -- Stem cells are primitive cells found in all ... capacity to differentiate into mature cell types Stem cells ... mouse embryonic stem cells were derived from embryos in ... first culturing of embryonic stem cells from non-human primates ... 2006 As a result of these discoveries, stem cells ...
Breaking Medicine Technology: