Citations 2
Development of a standard definition of ‘no-option’ and ‘poor-option’ for revascularization in chronic limb-threatening ischemia
Fabiani, Mario Alejandro , Berg, Jos C van den, Torre, Oscar A De la, Verastegui, Alfredo , Dua, Anahita, Alexandrescu, Vlad Adrian, Baadh, Amanjit S. , Bahaa, Nasr, Carvajal, Juan Guillermo Barrera, Beasley, Robert , Bisdas, Theodosios, Blessing, Erwin , Bonvini, Stefano, Brodmann, Marianne, Cabral, Gonçalo, Cancellieri, Roberto, Casini, Andrea , Chandra, Venita , Chisci, Emiliano, Chohan, Omar, Choke, Edward, Chong, Patrick, Clerici, Giacomo , Coscas, Raphaël, Costantino, Del Giudice, D'Oria, Mario, Davies, Robert, Donato, Gianmarco de , Vries, Jean-Paul de , Río-Solá, M.L. del, Deloose, Koen , Dhand, Sabeen , Díaz-Sandoval, Larry J, Falcone, Gianmarco , Fanelli, Fabrizio , Cardona, Lucas Ferrer, Garg, Karan, Giuffrida, Stefania, Gouëffic, Yann, Goverde, Peter , Henao, Esteban, Vegas, Diego Jorge Herrera, Hinchliffe, Robert, Hoballah, Jamal J. , Howard, Dominic, Huasen, Bella , Iida, Osamu, Katsanos, Konstantinos, Kolh, Philippe, Korosoglou, Grigorios, Lecis, Alexandre, Leopoldo, Marine, Lessne, Mark L. , Lichtenberg, Michael, Lobato, Marta , Loreni, Giorgio, Madassery, Kumar, Manzi, Marco, Maene, Lieven, Maresch, Martin, Trabal, Jorge Martinez, Mathews, S Jay, Michael, Siah, J, Bosiers Michel, Migliara, Bruno , Mills, Joseph, Miserlis, Dimitrios , Montero-Baker, Miguel, Alvarez, Luis Morelli, Morgan, Robert Anthony, Mouawad, Nicolas, Moxey, Paul, Antonio, Jose, Nakama, Tatsuya , Neville, Richard, Noronen, Katariina , Palena, Mariano, Parikh, Sahil, Parlani, Gianbattista, Pasqui, Edoardo , Patel, Rafiuddin, Patel, Ashish, Perkov, Dražen , Portou, Mark James, Langhoff, Ralf , Reijnen, Michel Marinus Petrus Johannes, Roy, Trisha , Ruffino, Maria Antonella , Gúzman, Tania Sáez, Sakr, Ahmed, Santini-Domínguez, Rafael , Schmidt, Andrej, Schneider, Peter, Sheorain, Virendersingh K, Siracuse, Jeffrey, Sirvent, Marc , Sommerset, Jill , Spiliopoulos, Stavros, Spinelli, Alessio , Stavroulakis, Konstantinos, Taneva, Gergana T, Teso, Desarom , Thomas, Shannon, Torsello, Giovanni, Tummala, Venkat, Tummala, Srinivas, Twine, Christopher, Uberoi, Raman, Heuvel, Daniel Van den, Varcoe, Ramon Lee, Serrano, José Francisco Vargas, Céniga, Melina Vega de, Venermo, Maarit, Vijaynagar, Badri, Stempel, Conrad von , Voûte, Michiel Thomas, Watts, Mine, Zaefferer, Patricio, Zayed, Hany , Zeebregts, Clark J, Zola, N'Dandu, Mills, Joseph L. , Torre, O. , Verastegui, Alfredo , de la Torre, Oscar , Fabiani, Mario Alejandro , Berg, Jos C. van den , Dua, Anahita , Nasr, Bahaa , Biasi, Lukla , Bisdas, Theodosios , Brodmann, Marianne , Cabral, Gonçalo , Caradu, Caroline , Casini, Andrea , Chisci, Emiliano , Choke, E, Chong, Patrick L.E., Cioppa, Angelo , Coscas, Raphaël , Giudice, Costantino Del , D'Oria, Mario , Peruyera, Pablo Del Canto , Διαμαντόπουλος, Αθανάσιος , Díaz‐Sandoval, Larry J. , Dick, Florian , Fazzini, Stefano , Ferrer, Lucas M. , Fujihara, Masahiko , Garg, Karan , Garriboli, Luca , Genovese, Elizabeth A. , Gifford, Edward D. , Gouëffic, Yann , Gupta, Prem Chand , Vegas, Diego Herrera , Hinchliffe, Robert J. , Holden, Andrew Hugh , Isernia, Giacomo , Kolh, Philippe H. , Korosoglou, Grigorios , Krokidis, Miltiadis E. , Lichtenberg, Michael, Loureiro, Luís , Mathews, S. Jay , Bosiers, Michel Joseph , Morosetti, Daniele , Mouawad, Nicolas J. , Moxey, Paul, Neville, Richard, Palena, Luis Mariano , Parikh, Sahil, Parlani, Gianbattista, Patel, Rafiuddin, Patrone, Lorenzo , Portou, Mark J. , Pratesi, Giovanni , Rammos, Christos , Reijnen, Michel M.P.J. , Sakr, Ahmed , Schneider, Peter A. , Secemsky, Eric A. , Sheorain, Virendersingh K, Simonte, Gioele , Spiliοpoulos, Stavros , Stavroulakis, Konstantinos , Steiner, Sabine , Taneva, Gergana T. , Torsello, Giovanni , Troisi, Nicola , Twine, Christopher P. , Uberoi, Raman , Ucci, Alessandro , Heuvel, Daniel van den, Varcoe, Ramon Lee , Venermo, Maarit A. , Voûte, Michiel T., Ysa, August , Zeebregts, Clark J. , Zeller, Thomas , N'Dandu, Zola M.
British Journal of Surgery | April 3, 2026 | Volume: 113 | Issue: 4 | Pages: No page available
Abstract Introduction Revascularization to prevent limb loss is not feasible or represents a very high risk in a significant proportion of patients with chronic limb-threatening ischaemia (CLTI). No standard definition currently exists to define this population of patients. The aim of this study was to develop a consensus-based, multidomain definition to improve clinical assessment and reporting of studies in people with ‘no option’ (NO) or ‘poor option’ (PO) CLTI. Methods A modified Delphi process was conducted with 164 specialists from 30 countries. Two iterative survey rounds were used to reach consensus, defined as ≥70% agreement with a score of ≥7 on a nine-point scale. Results Some 164 international vascular specialists participated in the study, averaging 19 years of experience. A multidomain framework including arterial disease anatomy, biology, risk, function, and context (ABRFC) achieved 83% consensus. A ‘desert foot’ was defined as the absence of distal arterial revascularization targets on advanced non-invasive imaging, invasive digital subtraction angiography, and at least one failed endovascular revascularization attempt (81.6% agreement). Inadequate autogenous bypass conduit was defined as the lack of usable autologous vein across all four limbs (85% agreement). Patients were classified as NO for revascularization if they present with ‘desert foot’, prohibitive medical risk, a non-functional limb, or in those patients who refused arterial revascularization. PO revascularization patients combined factors such as severe infection, lack of autologous vein, or treatment non-compliance (72.1% agreement). Conclusion This consensus study established a structured, expert-validated definition of no option or poor option for revascularisation of patients with CLTI. The multidomain ABRFC framework provides a foundation for standardized clinical assessment, trial design, and future guideline development.
Outcomes of “Anterior Versus Posterior Divisional Branches of the Hypogastric Artery as Distal Landing Zone for Iliac Branch Devices”: The International Multicentric R3OYAL Registry
Lima, Guilherme Baumgardt Barbosa , Dias, Nuno , Parlani, Giambattista, Tsilimparis, Nikolaos , Timaran, Carlos H. , Kölbel, Tilo , Gargiulo, Mauro , Mani, Kevin , Tenorio, Emanuel R. , Bertoglio, Luca , Karelis, Angelos , Simonte, Gioele , D'Oria, Mario , Dias, Nuno , DeMartino, Randall, Kolbel, Tilo , Tenorio, Emanuel R , Lima, Guilherme B , D’Oria, Mario , Farber, Mark , DeMartino, Randall R. , Milner, Ross , Melissano, Germano , Maldonado, Thomas S. , Oderich, Gustavo S.
Journal of Endovascular Therapy | September 16, 2022 | Volume: 31 | Issue: 2 | Pages: 282-294
Objective: The aim of this multicentric registry was to assess the outcomes of “anteRior versus posteRior divisional bRanches Of the hYpogastric artery as distAl landing zone for iLiac branch devices (R3OYAL).” Methods: The main exposure of interest for the purpose of this study was the internal iliac artery (IIA) divisional branch (anterior vs posterior) that was used as distal landing zone. Early endpoints included technical success and adverse events. Late endpoints included survival, primary/secondary IIA patency, and IIA branch instability. Results: A total of 171 patients were included in the study, of which 50 received bilateral implantation of iliac branch devices (IBDs). This resulted in a total of 221 incorporated IIAs included in the final analysis, of which 40 were anterior divisional branches and 181 were posterior divisional branches. Technical success was high in both groups (anterior division: 98% vs posterior division: 100%, P = .18). Occurrence of any adverse event was noted in 14% of patients in both groups ( P = 1.0). The overall rate of freedom from the composite IBD branch instability did not show significant differences between patients receiving distal landing in the anterior or posterior division of the IIA at 3 years (79% vs 87%, log-rank test = .215). The 3-year estimates of IBD patency were significantly lower in patients who received distal landing in the anterior divisional branch than those who received distal landing in the posterior divisional branch (primary patency: 81% vs 96%, log-rank test = .009; secondary patency: 81% vs 97%, log-rank test < .001). Conclusions: The use of the anterior or posterior divisional branches of the IIA as distal landing zone for IBD implantation shows comparable profiles in terms of immediate technical success, perioperative safety, and side-branch instability up to 3 years. However, IBD patency at 3 years was higher when the distal landing zone was achieved within the posterior divisional branch of the IIA. Clinical Impact The results from this large multicentric registry confirm that use of the anterior or posterior divisional branches of the internal iliac artery (IIA) as distal landing zone for implantation of iliac branch devices (IBD) shows comparable profiles of safety and feasibility, thereby allowing to extend the indications for endovascular repair of aorto-iliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Although mid-term rates of device durability and branch instability seem to be similar, the rates of primary and secondary IBD patency at three years was favored when the distal landing zone was achieved in the posterior divisional branch of the IIA.