Isolated Superior Mesenteric Artery Dissection: A Novel Etiology and a Review

Isolated superior mesenteric artery dissection (ISMAD) is a rare pathology with multifactorial etiology. The aim of this article is to provide a narrative review of the latest literature about ISMAD. Case reports, series, and recent meta-analyses were included. This review is introduced with a brief case report of a rare etiology of ISMAD, followed by a discussion of its etiology, clinical presentation, diagnosis, classification, and treatment, and we report a new cause of ISMAD, that is, blunt abdominal trauma. The etiology of ISMAD is multifactorial, consisting of anatomic, genetic, and systemic components. ISMAD is more common among middle-aged males and in East Asia. Its clinical presentation ranges from asymptomatic to mesenteric ischemia, albeit mortality remains <1%. It is diagnosed and classified mostly by computed tomography angiography, and there are five classification systems for ISMAD, though traumatic etiology may be added. The treatment of ISMAD is mostly conservative, with a success rate exceeding 90%. Endovascular stenting is second line, reserved so far for failed medical management, though its role is expanding to include earlier management of symptomatic patients, while open surgical repair is left for acute mesenteric ischemia with bowel compromise.

Proteomic profiling for detection of early-stage heart failure in the community

Background and purpose

Biomarkers may provide insight into the molecular mechanisms underlying cardiac remodelling and dysfunction. Using a targeted proteomic approach, we aimed to identify circulating biomarkers associated with early-stage heart failure and extract a proteome-based risk classifier for this condition.

Methods

575 community-based participants (mean age, 57 years; 51.7% women) underwent echocardiography and proteomic profiling (CVD II panel, Olink Proteomics). We applied partial least squares-discriminant analysis (PLS-DA) and a machine learning algorithm (extreme gradient boosting, XGBoost) to identify key proteins associated with echocardiographic abnormalities. We used Gaussian Mixture modelling for unbiased clustering to construct phenogroups based on influential proteins in PLS-DA and XGBoost.

Results

Of 87 proteins, 13 were important in PLS-DA and XGBoost modelling for detection of left ventricular (LV) remodelling, LV diastolic dysfunction and/or left atrial reservoir dysfunction: placenta growth factor, kidney injury molecule-1, prostasin, angiotensin-converting enzyme-2, galectin-9, cathepsin L1, matrix metalloproteinase-7, TNFR superfamily members 10A, 10B and 11A, interleukins-6 and 16 and alpha-1-microglobulin/bikunin precursor. Based on these proteins, the clustering algorithm divided the cohort into two distinct phenogroups, with each cluster grouping individuals with a similar protein profile. Participants belonging to the second cluster (n=118) were characterized by an unfavourable cardiovascular risk profile and adverse cardiac structure and function. The adjusted risk of presenting cardiac maladaptation was higher in this phenogroup than in the other cluster (P&lt;0.0001).

Conclusion

We identified proteins reflecting renal function, extracellular matrix remodelling, angiogenesis and inflammation to be associated with echocardiographic signs of early-stage heart failure. Focused proteomic phenomapping discriminated individuals at high risk for cardiac maladaptation in the community.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders

Temporal shift and accuracy of machine learning in heart transplant outcomes

Background

Accurate prediction of outcomes following a heart transplant is critical to explaining risks and benefits to patients and decision-making when considering potential organ offers. Given the large number of potential variables to be considered, this task may be most efficiently performed using machine learning (ML).

Purpose

We trained and tested different ML algorithms to accurately predict outcomes following a cardiac transplant using the United Network of Organ Sharing (UNOS) database.

Methods

We included 67 939 adult and pediatric patients enrolled in the UNOS database between January 1994 and December 2016 who underwent cardiac transplantation (median age 53 [IQR 38 – 60], 72.7% males). In our models, as an input, we included 114 features that have been collected from recipients and donors prior to transplant. The primary outcome was all-cause mortality at one-year post-transplant. We evaluated three different ML methods: XGBoost, Random Forest (RF) and L2 regularized logistic regression. Algorithms were trained and tested using shuffled 10-fold cross-validation (CV) as well as rolling CV. In the rolling CV, to mimic prospective procedure, ML models were trained by incrementally adding patients according to transplant year and testing models on the data in the following year. The hyperparameters, controlling the learning process, were tuned using Bayesian optimization. Prognostic accuracy for one-year all-cause mortality was characterized using the area under the receiver-operating characteristic curve (AUC).

Results

In total, 8,394 patients died within 1 year of transplant. We observed a substantial difference in prognostic accuracy between the shuffled 10-fold CV and the rolling CV. In the 10-fold CV, XGBoost and RF achieved high predictive performance with AUC of 0.848 (95% CI: 0.842–0.854) and 0.891 (95% CI: 0.886–0.896), respectively. In the rolling CV, which is a more realistic setting, AUC dropped to 0.673 (95% CI: 0.661–0.684) for XGBoost and 0.670 (0.657–0.683) for RF. Predictive performance of L2 regularized logistic regression remained stable across the two CV procedures, achieving AUC 0.669 (95% CI: 0.662–0.676) in the 10-fold shuffled CV and 0.665 (95% CI: 0.649–0.680) in the rolling CV procedure (Figure).

Conclusions

Our study suggests that ML models could be used to predict mortality in the first year post-transplant. We also show that the choice of CV procedure is crucial for evaluating ML models, particularly in data collected over a long period of time. The difference between the shuffled and rolling CV in the predictive performance of the tree-based ML models might indicate temporal dataset shift. In the rolling CV, all three methods achieved similar predictive performance.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders (FWO)

The association of soluble ACE2 change with metabolic health, body composition and proteome dynamics during a weight loss diet intervention: implications for the COVID-19 pandemic

Background

Angiotensin-converting enzyme 2 (ACE2) serves protective functions in metabolic, cardiovascular, renal and pulmonary diseases and is linked to COVID-19 pathology. We explored the association between soluble AC2 (sACE2) and metabolic health and proteome dynamics during a weight loss diet intervention.

Methods

We analyzed 457 healthy individuals (mean age 39.8±6.6) with BMI 28–40 kg/m2 who participated in the Diet Intervention Examining the Factors Interacting with Treatment Success (DIETFITS). Biochemical markers of metabolic health and 236 proteins measured by Olink CVD II, CVD III and Inflammation arrays were available at baseline and 6 months following dietary intervention. We determined clinical and routine biochemical correlates of the diet-induced change in sACE2 (ΔsACE2) using stepwise linear regression. We then combined feature selection models and multivariable-adjusted linear regression to identify protein dynamics associated with ΔsACE2.

Results

sACE2 decreased significantly on average at 6-months in the diet intervention. A stronger decline in sACE2 during the diet intervention was independently associated with female sex, lower HOMA-IR and LDL cholesterol at baseline, and a stronger decline in HOMA-IR, triglycerides, HDL-cholesterol and fat mass. In line, participants with decreasing HOMA-IR and triglycerides had significantly higher odds for a decrease in sACE2 during the diet intervention than those who did not (P≤0.0073 for both). Feature selection models linked ΔsACE2 to changes in AMBP, E-selectin, HAOX1, KIM-1, MERTK, PGF, thrombomodulin and TRAIL-R2. ΔsACE2 remained independently associated with these protein changes in multivariable-adjusted linear regression.

Conclusion

Decrease in sACE2 during a weight loss diet intervention was associated with improvements in metabolic health, fat mass and markers of angiotensin peptide metabolism, vascular injury, renal function, chronic inflammation and oxidative stress. Our findings may improve the risk stratification, prevention, and management of cardiometabolic and COVID-19-related complications.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHResearch Foundation Flanders

Production of scandium radionuclides for theranostic applications: towards standardization of quality requirements

In the frame of "precision medicine", the scandium radionuclides have recently received considerable interest, providing personalised adjustment of radiation characteristics to optimize the efficiency of medical care or therapeutic benefit for particular groups of patients. Radionuclides of scandium, namely scandium-43 and scandium-44 (43/44Sc) as positron emitters and scandium-47 (47Sc), beta-radiation emitter, seem to fit ideally into the concept of theranostic pair. This paper aims to review the work on scandium isotopes production, coordination chemistry, radiolabeling, preclinical studies and the very first clinical studies. Finally, standardized procedures for scandium-based radiopharmaceuticals have been proposed as a basis to pave the way for elaboration of the Ph.Eur. monographs for perspective scandium radionuclides.

Assessing post-exercise respiratory gas kinetics in clinical sample - a pilot study

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiopulmonary exercise testing (CPX) is established in the evaluation of patients with cardiac and pulmonary diseases, and its clinical utility seems to be expanding.  Currently the most important diagnostic and prognostic ventilatory metrics of CPX rely on the exercise phase. Nevertheless, a consistent body of evidence suggests that important information can be derived from the recovery phase, especially in the first few minutes after exercise. In this context, patients with heart failure (HF) demonstrate a slower recovery of the oxygen consumption (VO2) compared with healthy individuals. Purpose: To comprehensively investigate the behavior of respiratory gases during recovery from CPX in a diverse cohort of HF patients. Methods: All individuals who performed CPX at the department of cardiology of Stanford University Hospital were eligible for the study. Patients were included in the experimental group if they (i) were recorded for five minutes after the exercise phase of CPX and (ii) had documented heart failure. They were excluded if they had other clinical diagnoses which may be responsible for exercise intolerance or symptoms or were unable to give informed consent. Healthy controls were recruited from the local community and were included if they did not have documented or suspected disease. Respiratory gases were collected on a breath-by-breath basis and analysed after applying a 30 second rolling average filter. Metrics were analyzed as absolute values, percentage change from peak and the half-time of recovery (T ½; i.e. the duration until a metric had returned to ½ of its value at peak). Data was analyzed over time within patients and averages between groups using parametric statistical methods. In accordance with previous studies, the amount of change in a metric after exercise is presented as the "magnitude" of overshoot. Results: 32 patients with HF (11 Female, 47 ± 13 yrs) and 30 healthy subjects (14 Female, 43 ± 12 yrs) were included. A comparison of ventilatory metrics during recovery between HF and controls is depicted in Figure 1. Peak VO2 was 1135 ± 419 mL/min (13.5 ± 3.8 mL/Kg/min) vs 2408 ± 787 mL/min (32.5 ± 9.0 mL/Kg/min); P &lt;0.01. A significant difference between patients with HF and healthy subjects was found in T ½ of VO2 (111.3 ± 51.0s vs 58.0 ± 13.2s, p &lt; 0.01) and VCO2 (132.0 ± 38.8s vs 74.3 ± 21.1s, p &lt; 0.01). The magnitude of the overshoot was also found to be significantly reduced in patients with HF for VE/VO2 (41.9 ± 29.1% vs 62.1 ± 17.7%, P &lt; 0.01), RQ (25.0 ± 13.6% vs 38.7 ± 15.1%, p &lt; 0.01) and PETO2 (7.2 ± 3.3% vs 10.1 ± 4.6%, p &lt; 0.01). Finally, the magnitude of the RQ overshoot showed a moderate correlation with peak VO2 (ϱ=0.58, p &lt; 0.01). Conclusions: We observed that ventilatory kinetics measured in early recovery after CPX differ significantly between healthy subjects and patients with HF. The assessment of post exercise respiratory gases in a clinical setting may add to the prognostic and diagnostic value of CPX in heart failure.

Abstract Figure.

Colorectal Metastasis from Ovarian Neoplasm Mimicking Primary Colon Cancer

Metastasis to the colon from another primary internal malignancy is an untypical and a seldom reported entity. Direct visualization during colonoscopy is considered the gold standard of diagnosis. Pathologic diagnosis with immunohistochemical staining is essential to differentiate primary colorectal malignancy from secondary metastasis to the colon. We, hereby, present a case of a 53-year-old female status-post resection of left-sided papillary serous ovarian neoplasm who presented 2 years later with a single rectosigmoid intraluminal ulcerative mass imitating a primary colon cancer. Biopsies of the mass were consistent with metastasis from her primary ovarian carcinoma. We believe this case is unique because of the rarity of ovarian cancer metastasizing to the colon intraluminally rather than through direct locoregional invasion. Furthermore, it highlights the importance of considering secondary metastasis in patients with previous history of another primary internal malignancy.

Challenges facing COVID-19 in rural areas: An experience from Lebanon

The COVID-19 pandemic first affected Lebanon on February 21st, 2020, and one month later it reached Bcharri, a small remote town in northern Lebanon. When similar rural areas with under-equipped facilities and financial limitations are affected, outcomes could be catastrophic, raising the need for meticulous preparation and rapid response. In our study, we describe the different measures taken to prepare this town for the COVID-19 outbreak, as well as our rapid response after the first case was confirmed. We emphasize the distinctions and the needs of rural areas when facing such threats, and the importance of a proactive community and local initiatives. We also detail our contact tracing strategy and massive testing campaign, as well as our early management of patients infected with COVID-19. We hope that our experience can be reproducible in areas with similar rural settings, during the COVID-19 pandemic and future outbreaks.

Microbiological profile and antimicrobial resistance among diabetic foot infections in Lebanon

Diabetic Foot Infection (DFI) is a challenging complication of diabetes mellitus with a high burden in the Middle East where there is a marked increase in diabetes prevalence and complications. Early detection of DFI and the infectious organisms could result in the early initiation of appropriate antibiotic therapy and improved outcomes. DFI microbiological profiles differ between countries. In our region, Western guidelines are used when initiating treatment for DFI in the absence of local guidance. The purpose of our study was to determine the microbiologic profile and antimicrobial susceptibility of the DFI admissions at a large tertiary referral centre in Beirut and review other reported series in Lebanon and our region. This is a retrospective observational study of patients with DFI admitted to the American University of Beirut Medical Centre from January 2008 to June 2017. The bacteriologic isolation and antimicrobial susceptibility tests were performed according to standard microbiological methods. Between 2008 and 2017, 319 diabetic patients with DFU were admitted to AUBMC, and deep-tissue cultures were taken for 179 patients. From 179 deep tissue cultures, 314 bacterial isolates were obtained. Fifty-four percent of patients had the polymicrobial infection. Aerobic gram-negative rods (GNR) were more prevalent than gram-positive cocci (GPC) (55%, 39%, respectively). The most common isolate was Escherichia coli (15%) followed by Enterococcus (14%) and Pseudomonas aeruginosa (11%). Staphylococcus aureus isolates accounted for 9% with 50% of them being methicillin-resistant (MRSA). Among Enterobacteriaceae, 37% of isolates were fluoroquinolone-resistant, 25% were ESBL producers, and 2% were carbapenem-resistant. Antibiotic resistance was significantly associated with prior usage of antibiotics. Anaerobes were isolated in 1% and Candida species in 5% of isolates. The sensitivity, specificity, PPV, and NPV of swab culture recovery of pathogens compared with deep tissue culture were (76%, 72%, 76%, 72%) and (94%, 81%, 91%, 86%) for gram-positive and gram-negative organisms, respectively. The microbiological profile of DFI in Lebanon is comparable to other countries in the MENA region with big differences compared with the West. Therefore, it is imperative to develop local guidelines for antimicrobial treatment. The high prevalence of GNR in DFI and the high fluoroquinolone resistance should be taken into consideration when choosing empiric antibiotics. Empiric treatment for MRSA or Pseudomonas does not appear necessary except for patients with specific risk factors.

Left atrial reservoir strain in relation to metabolic and inflammatory biomarkers: a community-based study

Background

The pathophysiological mechanisms that underlie progressive left atrium (LA) remodelling and dysfunction are only partially understood. Metabolic disturbances and chronic inflammation might mediate LA dysfunction. To date, population data investigating the contribution of these processes to LA reservoir dysfunction remain scarce.

Purpose

In a large population sample, we investigated the association between LA reservoir function and a panel of 38 metabolic and inflammatory biomarkers.

Methods

In 1236 community-dwelling individuals (mean age, 51.0 years; 51.5% women), we echocardiographically assessed LA reservoir strain (LARS) using 2D speckle-tracking analysis. LA reservoir dysfunction was defined as having LARS &lt;23%. We applied partial least squares-discriminant analysis (PLS-DA) to identify biomarkers associated with LA dysfunction. We further explored the associations between LARS and selected biomarkers that were the most influential in PLS-DA, while adjusting for important clinical correlates such as age, sex, body mass index (BMI), heart rate, systolic blood pressure (BP) and antihypertensive treatment. We applied stepwise regression to identify the clinical features and circulating biomarkers most valuable for prediction of abnormal LARS.

Results

The three latent factors constructed from the panel of 38 biomarkers during PLS-DA explained 16.9% of the variation between the normal and the impaired LA function group. The PLS-DA model discriminated between normal and abnormal LA reservoir strain with 79% accuracy (P&lt;0.0001). In PLS-DA, serum uric acid, serum insulin, γ-glutamyl transferase, interleukin-6, D-dimer and triglycerides were the top biomarkers responsible for class discrimination. On average, these top biomarkers were higher in the LA dysfunction group as compared to their normal counterparts (P&lt;0.0001 for all). In multivariable-adjusted continuous analyses, LARS decreased significantly with the level of serum insulin, serum uric acid and γ-glutamyl transferase (P≤0.0035 for all). Of the clinical correlates and the top biomarkers selected in PLS-DA, stepwise regression models highlighted age, BMI, systolic BP, serum insulin, serum uric acid and interleukin-6 as the main predictors of an impaired LA reservoir function (see figure). Conjointly, these clinical and biochemical features identified LA reservoir dysfunction with an overall accuracy of 85%.

Conclusions

Circulating markers of insulin resistance, hyperuricemia and chronic inflammation were independently associated with impaired LA reservoir function. These markers may help to further unravel the pathophysiological processes behind LA maladaptation and improve the management of early LA dysfunction in the community.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders

Subclinical left atrial dysfunction profiles for prediction of cardiac outcome in the general population

Background

Echocardiographic screening for subclinical left atrial (LA) dysfunction might enhance the prediction of cardiac diseases such as atrial fibrillation (AFib) in the community. To date, however, outcome-driven definitions of early-stage LA dysfunction remain scarce.

Purpose

In a large population sample, we sought to extract outcome-driven thresholds for echocardiographic indexes of LA function to define subclinical left atrial (LA) dysfunction and assess the prognostic value of these echocardiographic criteria for prediction of cardiac events.

Methods

In 1306 community-dwelling individuals (mean age, 50.7 years; 51.6% women), we assessed LA function and left ventricular (LV) global longitudinal strain (LS) by echocardiography. Using receiver-operating curve threshold analysis, we derived outcome-driven cut-offs for LA emptying fraction (LAEF) and LA reservoir strain (LARS) that best balanced the cardiac event prediction (i.e. cut-offs yielding the highest Youden index (=sensitivity+specificity-1)). Next, we constructed LA dysfunction profiles and integrative LA/LV strain profiles based on the extracted cut-offs for LAEF and LARS and a validated definition of impaired LV global LS. We assessed the prognostic performance of these profiles in predicting the incidence of cardiac events and AFib (mean follow-up, 8.5 years).

Results

During follow-up, 93 participants experienced a cardiac event (8.3 events/1000 person-years) and 27 developed AFib (2.3 events/1000 person-years). LAEF&lt;55% and LARS&lt;23% yielded the highest Youden indexes and thus provided the most balanced prediction of incident AFib. When applying these cut-offs, abnormal LAEF and LARS were respectively present in 27.0% and 18.1% of the cohort. Abnormal LARS was independently associated with higher risk for cardiac events (hazard ratio (HR) versus normal LA phenotype: 2.11, P=0.0021). Both abnormal LAEF (HR: 2.57) and abnormal LARS (HR: 3.28) predicted incident AFib (P≤0.029). As compared to subjects free from any LA dysfunction, those with both LAEF&lt;55% and LARS&lt;23% had a significantly higher risk to develop cardiac events (HR: 2.10; P=0.014) and AFib (HR: 6.45; P=0.0036). Of the integrative LA/LV strain profiles, the concomitant presence of an impaired LARS and LV global LS independently elevated the risk for cardiac events (HR: 2.81; P=0.0012) and AFib (HR: 4.36, P=0.0071) as compared to normal counterparts. Both the degree of LA dysfunction and the integrative LA/LV strain profiles improved the prognostic accuracy beyond clinical risk models and risk scores.

Conclusions

We validated population-based and outcome-driven definitions of subclinical LA dysfunction predicting cardiac events independent of conventional risk factors. Echocardiographic screening for subclinical LA and LV systolic dysfunction might enhance the prediction of cardiac diseases such as AFib in the community, empowering clinicians to timely intervene with the disease development.

Prediction of cardiac events

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders, Internal Funds KU Leuven

COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm

Introduction

The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm.

Case description

We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology.

Conclusion

This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection.

LEARNING POINTS

Demonstration of the immunity response to COVID-19 pneumonia in an immunosuppressed patient.To highlight the management and evolution of such rare cases during this pandemic.

[Smoking cessation support workshops in medical training programs in Lebanon]

INTRODUCTION

Tobacco use is a major public health problem in our societies today. Nevertheless, effective smoking cessation interventions can reduce tobacco-related morbidity and mortality.

AIM

The aim of this study was to develop, implement, and evaluate a Competency-Based Approach (CBA) training program for residents in Lebanon aiming to improve their skills in counseling patients about smoking cessation.

METHODS

We followed a systematic educational planning starting by identification of professional tasks and competencies to acquire. A cross-sectional descriptive study was conducted for 16 residents to analyze learning needs and determine learning objectives. The workshop was chosen as a learning method. A pre-post intervention analysis made it possible to evaluate the progress.

RESULTS

Pre-intervention analysis showed that residents lacked skills and faced barriers in smoking cessation interventions (score of the items &#8220;General Knowledge&#8221;: 7.1/10; &#8220;Practices&#8221;: 6.5/10; &#8220;Skills&#8221;: 3.8/10; &#8220;Barriers&#8221;: 5.6/10). There were statistically significant improvements in all scores as well as significant decrease in barriers post-intervention (score of the items &#8220;General Knowledge&#8221;: 9.4/10; &#8220;Practices&#8221;: 9.2/10; &#8220;Skills&#8221;: 8.3/10; &#8220;Obstacles&#8221;: 2.1/10). The evaluation of the workshop was overwhelmingly positive.

CONCLUSION

A CBA workshop can improve residents&#8217; skills and effectiveness in counseling patients about smoking cessation. It should be integrated into the medical curriculum and delivered to every physician especially in a country with one of the highest rate of smoking and the weakest tobacco control strategies.

Management of Vascular Infections in Low- and Middle-Income Countries

Background: Vascular infections are rare and challenging conditions with significant deaths and morbidity. Their management necessitates a multi-disciplinary approach and substantial human and financial resources. The management selected may be influenced by the available resources in low- and middle-income countries (LMICs), where such resources may be variable. Methods: We reviewed the published literature and reviewed the management options for various vascular infections with a focus on carotid, aortic, infrainguinal, and dialysis access infections. Results: Recommendations related to prevention and treatment will be offered from the perspective of LMICs. The general principles for prevention are in compliance with established surgical site infection guidelines and minimize the use of prosthetic material. Early detection and intervention by removing all infected prosthetic material, debridement, drainage, and coverage of the infected field with vascularized tissue are essential steps in the management of the infection. Revascularization using an extra-anatomic or in situ approach is individualized based on the resources and expertise available. Conclusions: The prevention and management of vascular infections in LMICs are effective by adhering to time-proven principles even with limited resources.

Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up

INTRODUCTION

Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA.

METHODS

This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification.

RESULTS

Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS.

CONCLUSION

EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.

Vascular Complications in the Era of Transcatheter Treatment of Adult Structural Heart Disease: A Single-Center Early Experience

Transcatheter treatment is becoming the mainstay treatment for structural heart diseases (SHD) in prohibitive surgical risk patients. Recently with the encouraging results, it is being offered to regular risk patients. Peripheral vascular complications (VCs) are still inherent to these procedures due to the nature of this atherosclerotic high-risk group and the profile of the devices. This is a single-center early first year experience with such events occurring after initiating a SHD program treating severe aortic stenosis, aortic regurgitation, mitral valve prolapse and regurgitation, as well as paravalvular leaks. Out of 33 patients in this time period, 5 developed PV complications which are detailed in this article with their associated risk factors and management. These include access-related complications, closure device issues, arterial rupture post device embolization, and vessel dissection. Vascular complications of those procedures take special interest since they are associated with a worse long-term prognosis. Thus, prevention with proper planning remains of essence along with multidisciplinary management.