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 | EurekAlert!
New bioimaging technique is fast and economical
21.08.2017 | Rensselaer Polytechnic Institute
Noninvasive eye scan could detect key signs of Alzheimer's years before patients show symptoms
18.08.2017 | Cedars-Sinai Medical Center
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
21.08.2017 | Materials Sciences
21.08.2017 | Health and Medicine
21.08.2017 | Materials Sciences