CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 216 AFRICA therapeutic imagings. Various clinical factors, often known prior to an intervention, such as the location of the disease and the intended access route, can help predict and limit the radiation dose. This information may also help determine the mode of intervention or encourage alternative therapies. The most important factors affecting radiation doses of the patient are the anatomical region and the patient’s BMI. Radiation doses are higher in pelvic interventions, which may be an incentive to prefer arterial approaches that can minimise imaging of the pelvic area. We prefer the ipsilateral popliteal retrograde approach with Doppler ultrasound with the patient in the prone position as it is a safe and effective method with low complication and high success rates. References 1. Cerrahoğlu M, Şenarslan DM. İnfrainguinal tikayici periferik arter hastaliğinda endovasküler işlemler. Türkiye Klinikleri Kalp Damar Cerrahisi-Özel Konular 2018; 10(3): 51–57. 2. Hertault A, Maurel B, Midulla M, Bordier C, Desponds L, Saeed Kilani M, et al. Minimizing radiation exposure during endovascular procedures: basic knowledge, literature review, and reporting standards. Eur J Vasc Endovasc Surg 2015; 50: 21–36. 3. Nickoloff EL, Lu ZF, Dutta AK, So JC. Radiation dose descriptors: BERT, COD, DAP, and other strange creatures. Radiographics 2008; 28: 1439–1450. 4. Aboyans V, Ricco JB, Bartelink MEL, Bjorck M, Brodmann M, Cohnert T, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763–816. 5. Boc V, Boc A, Zdešar U, Blinc-Vasa A. Patients’ radiation doses during percutaneous endovascular procedures in arteries of the lower limbs. Vasa 2019; 48(2): 167. 6. Sigterman TA, Bolt LJ, Snoeijs MG, Krasznai AG, Heijboer R, Schurink GW, et al. Radiation exposure during percutaneous transluminal angioplasty for symptomatic peripheral arterial disease. Ann Vasc Surg 2016; 33: 167–172. 7. Segal E, Weinberg I, Leichter I, Klimov A, Giri J. Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity. J Vasc Surg 2013; 58(6): 1556–1562. 8. Behrendt CA, Rieß HC, Heidemann F, Diener H, Rohlffs F, Hohnhold R, et al. Radiation dosage for percutaneous PAD treatment is different in cardiovascular disciplines: results from an eleven-year populationbased registry in the metropolitan area of Hamburg. Eur J Vasc Endovasc Surg 2017; 53: 215–222. 9. Yilmaz S, Sindel T, Luleci E. Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. J Endovasc Ther 2005; 12(6): 714–722. 10. Dumantepe M. Retrograde popliteal access to percutaneous peripheral intervention for chronic total occlusion of superficial femoral arteries. Vasc Endovasc Surg 2017; 51(5): 240–246. 11. Tanyeli O. Percutaneous reconstruction techniques: popliteal artery approach for chronic total occlusion of superficial femoral and iliac arteries. In: Peripheral Arterial Disease: A Practical Approach, 2018: 27. … continued from page 211 ‘Lp(a) forms when an LDL particle binds to the protein Apo(a). Muvalaplin essentially blocks that binding from happening in the liver and therefore prevents the formation of Lp(a). It would provide an oral option for the treatment of patients with high Lp(a) levels to reduce their risk of heart disease.’ Muvalaplin lowers Lp(a) by up to 65% For this phase one clinical trial, the team recruited 114 healthy participants of different genders and ethnic backgrounds. The purpose was to assess the safety and tolerability of muvalaplin, its pharmacokinetics, as well as indicators of the drug’s effect on the target, Lp(a). Participants either received a single dose of muvalaplin, an ascending dose where the amount taken was increased over time, or a placebo for 14 days. At the end of the study, the Lp(a) levels of those who had received muvalaplin daily over the 14 days had dropped by as much as 65%. The drug was not associated with any tolerability concerns or clinically significant adverse effects. The most commonly reported side effects included headache, back pain, fatigue, abdominal pain, diarrhoea and nausea. Under-recognised heart disease risk factor Dr Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Programme at MemorialCare Saddleback Medical Centre in California, not involved in the research, said this research was definitely a step in the right direction. ‘Lp(a) is a very hot topic right now in heart disease,’ he said. ‘A number of studies are investigating how we can improve a patient’s health outcomes by covering that drug. ‘There (are) other agents that are in clinical trials right now but they’re all injections… a patient would rather get pills than injections. It’s a big step in the right direction in terms of getting people be able to just take a pill rather than an injection.’ How else to lower Lp(a) levels Right now, the only Food and Drug Administration-approved therapy for lowering Lp(a) levels is lipoprotein apheresis. This process physically removes lipoproteins from the blood and is only available for people with certain Lp(a) levels and other risk factors. Researchers are currently looking at PCSK9 inhibitors as a possible treatment and a number of drug candidates are undergoing clinical trials. Published in J Am Med Assoc Network on 28 August 2023.
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