The Council on Peripheral Vascular Disease (PVD) seeks to integrate the academic and clinical missions of all interdisciplinary vascular health professionals in order to expand professional and public vascular education; to advance the basic science and clinical research and evidence based practice; and to thereby improve clinical outcomes of individuals with PVD.
Annually AHA asks all of its Councils and science groups what in their estimation have been the most important advances in their respective fields within the past year. We have pulled out of all of those suggestions the ones that came from or are relevant to our community. Several studies this year brought the future of medicine closer to the present with new insight into emerging technologies. These advances and their potential to impact peripheral vascular disease and the patient are listed in the table below.
Mary M. McDermott MD, FAHA, is the Chair of the PVD Council. She is also Professor of Medicine Northwestern University Feinberg School of Medicine and Contributing Editor for JAMA.
Michael Conte, MD, FAHA, is Vice Chair of the PVD Council. He is also Professor and Chief, University of California, San Francisco, Division of Vascular Surgery.
Top Advances PVD for 2011
|1||Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis.|
This paper contributed to the recognition that 90% of patients with asymptomatic carotid stenosis would be better off with medical therapy, and the 10% who could benefit from endarterectomy or stenting can be identified by two or more microemboli on transcranial Doppler, or the presence of multiple ulcers on 3D ultrasound, or a combination of microemboli on TCD with echolucent plaques.
Topakian R, King A, Kwon SU, Schaafsma A, Shipley M, Markus HS; ACES Investigators. Neurology. 2011 Aug 23;77(8):751-8. Epub 2011 Aug 17. PubMed PMID: 21849657.
|2||High-risk asymptomatic carotid stenosis: ulceration on 3D ultrasound vs TCD microemboli.|
Patients undergoing CABG do not need their asymptomatic carotid stenosis dealt with preoperatively or intraoperatively.
Madani A, Beletsky V, Tamayo A, Munoz C, Spence JD. Neurology. 2011Aug 23;77(8):744-50. Epub 2011 Aug 17.
|3||Efficacy of quantified home-based exercise and supervised exercise in patients with intermittent claudication: A randomized controlled trial.|
A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving claudication measures similar to a standard supervised exercise program.
Gardner AW et al. Circulation 2011;123:491-498.
|4||Paclitaxel-Eluting Stents Show Superiority to Balloon Angioplasty and Bare Metal Stents in Femoropopliteal Disease.|
This represents the first positive trial of drug eluting stents in the peripheral vasculature.
Michael D. Dake, MD; Gary M. Ansel, MD; Michael R. Jaff, DO; et al. Circ Cardiovasc Interv published online September 27, 2011.
|5|| Effect of fibroblast growth factor NV1FGF on amputation and death: a randomised placebo-controlled trial of gene therapy in critical limb ischaemia.|
The negative results show the challenges faced by the development of single genes programs that could result in therapeutic angiogenesis leading to the prevention of limb amputations.
Jill Belch, William R Hiatt, Iris Baumgartner, I Vickie Driver, Sigrid Nikol, Lars Norgren, Eric Van Belle, on behalf of the TAMARIS Committees and Investigators Lancet 2011; 377: 1929–37.