Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Minimally invasive stents show some advantage over bypass in opening blocked leg arteries

07.08.2013
Compared to open bypass, stenting keeps circulation flowing longer in some patients, small study concludes

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."

Other Johns Hopkins researchers involved in the study include Ngozi Enwerem, M.B.B.S.; Umair Qazi, M.D., M.P.H.; Brendan Brown, M.P.H.; Eric B. Schneider, Ph.D.; Thomas Reifsnyder, M.D.; Julie A. Freischlag, M.D.; and Bruce A. Perler, M.D.

For more information: http://tinyurl.com/mgqsf4h

Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.5 billion integrated global health enterprise and one of the leading health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of the Johns Hopkins Hospital and Health System. JHM's mission is to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, JHM educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness. JHM operates six academic and community hospitals, four suburban health care and surgery centers, and more than 30 primary health care outpatient sites. The Johns Hopkins Hospital, opened in 1889, was ranked number one in the nation from 1990 to 2011 by U.S. News & World Report.

Media Contacts:
Stephanie Desmon
410-955-8665; sdesmon1@jhmi.edu
Helen Jones
410-502-9422; hjones49@jhmi.edu

Stephanie Desmon | EurekAlert!
Further information:
http://www.jhmi.edu

More articles from Medical Engineering:

nachricht Novel breast tomosynthesis technique reduces screening recall rate
21.02.2017 | Radiological Society of North America

nachricht Biocompatible 3-D tracking system has potential to improve robot-assisted surgery
17.02.2017 | Children's National Health System

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

From rocks in Colorado, evidence of a 'chaotic solar system'

23.02.2017 | Physics and Astronomy

'Quartz' crystals at the Earth's core power its magnetic field

23.02.2017 | Earth Sciences

Antimicrobial substances identified in Komodo dragon blood

23.02.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>