A Medical Device Daily

Seniors over the age of 80 can safely undergo diagnostic angiography and arterial interventions, such as vascular stenting and angioplasty, and do just as well as younger patients, according to a study released during the 33rd Annual Scientific Meeting of the Society of Interventional Radiology (SIR; Fairfax, Virginia).

The study indicates that seniors, 85 to 93, tolerated these procedures well, avoided surgery and could be treated as outpatients, irrespective of age. The outcomes of the treatments in the octogenarians were compared to those of 50- to 79-year-old patients who had an equivalent procedure during the same time period by the same doctor.

The study included 64 octogenarians who had arterial angioplasty and/or stenting to treat peripheral arterial disease (PAD), caused by blocked arteries in the legs, or to improve blood flow to the kidneys by opening blocked arteries that deliver blood to that organ. All were treated as outpatients and followed after discharge from the hospital.

George Hartnell, FRCP, FRCR, chief of cardiovascular and interventional radiology at Baystate Medical Center (Springfield, Massachusetts), termed the study “important news for seniors and their doctors. In some cases, doctors may be reluctant to send an older person for treatment. There’s no reason for seniors with leg pain caused by peripheral arterial disease to put up with pain, limited mobility and diminished quality of life. Likewise, treating blocked renal arteries can improve kidney function and treat high blood pressure if caused by diminished renal blood flow.”

Previously, the risks of angiography, X-ray images of the arteries with contrast and arterial interventions, such as angioplasty and stenting, were thought to increase with age, and older seniors were often excluded from interventional trials, with the assumption that they were too frail to participate.

Some physicians, both interventionalists and referring physicians, incorrectly think that octogenarians requiring these procedures should be admitted to hospitals, according to the society.

“What is an appropriate treatment at 55 is just as safe and appropriate at 85. Older seniors can be treated as outpatients, and age did not increase the risk. This is very relevant because the incidence of clogged arteries increases with age, and peripheral arterial disease affects 12–20 percent of Americans age 65 and older,” said Hartnell.

The study name is: Abstract 131, “Outpatient Arteriography and Arterial Intervention in Octogenarians. Is It Safe?”

In other reports from the SIR meeting:

• Advanced robotics from Siemens Healthcare (Malvern, Pennsylvania) provide new imaging possibilities and improve the value of chemoembolization in treating cancer, according to research presented by John Angle, associate professor of radiology, chief, Division of Angiography, University of Virginia Health System (Charlottesville).

The research employed the Siemens Artis zeego, a multi-axis C-arm that employs robotic technology to enable large-volume syngo DynaCT acquisition for liver chemoembolization. The Artis zeego is part of the new Artis zee family of interventional imaging systems introduced by Siemens.

According to Angle, the combination of the Artis zeego and large-volume syngo DynaCT enables the physician to see the whole abdomen or the entire liver for chemoembolization and biopsies, and provides reliable post-TACE assessment of lipiodol uptake.

“The Artis zeego’s support for expanded syngo DynaCT anatomical coverage enables the entire liver to be imaged without moving the patient,” said Angle. “We have found the system to be reliable, stable and very easy to use. We plan on expanding the scope of cases for which we use the Artis zeego.”

The Artis zeego, recently FDA-cleared, is designed to offer enhanced image quality and streamlined workflow across clinical environments, from body and neurointerventional radiology suites to operating rooms and hybrid rooms.

The first two facilities in North America to receive the Artis zeego for research are St. Luke’s Episcopal Hospital (Houston) and the University of Virginia Health System.

“With the increasing number of minimally invasive procedures, demand for high-end imaging systems in the operating room continues to surge,” said Claus Grill, VP, Angiography, Cardiac, and X-ray systems. “[T]he Artis zee family ... provides exceptional image quality and enhancements to assist clinicians with a variety of interventional procedures, including the ability to better see stents which are getting smaller and smaller.”

• Teleflex Medical (Research Triangle Park, North Carolina) said the NextStep Chronic Hemodialysis Catheter, debuted at the conference, is available for release in the U.S.

The Arrow NextStep is a retrograde tunneled chronic hemodialysis catheter designed to combine a step-tip catheter’s ease of insertion and a split-tip’s sustained high flow. The Arrow NextStep’s tip is designed for a smooth transition through a sheath and for over-the-wire insertion.

To reduce recirculation and deliver high flow, the Arrow NextStep’s tip has two complementary features:

First, the ports on the catheter are reversed to take better advantage of blood flow dynamics. The venous port releases blood in the SVC and the arterial port draws blood from the right atrium. Second, the ports are significantly separated to enhance flow and minimize recirculation.

Retrograde tunneling improves the ability to ideally position the catheter tip, cuff and hub.

The Arrow NextStep is designed for retrograde tunneling to help achieve best patient outcomes, Teleflex said.