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Llah ST, Sharif S, Ullah S, Sheikh SA, Shah MA, Shafi OM, Dar T. Infective endocarditis surgery timing. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:16-22. [PMID: 37487789 DOI: 10.1016/j.carrev.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The optimum timing of surgical intervention in complicated left-sided infective endocarditis is not well established. Guidelines from various professional societies are not consistent regarding this. Data concerning this remains limited with conflicting results. METHODS The national inpatient database (NIS) was used to identify patients hospitalized from the year 2016 to 2020 for infective endocarditis and who underwent surgical intervention for complicated left-sided endocarditis. Primary and secondary outcomes were analyzed in patients who had surgical intervention within 7 days (early surgery group) and after 7 days (late surgery group) of the index hospitalization. RESULTS Primary outcome [composite of all-cause death, acute cerebrovascular accident (CVA), peripheral septic emboli, intracranial or intraspinal abscess, and cardiac arrest] was better in the early surgery group compared to the late surgery group 32.6 % vs 45.1 % [adjusted Odds ratio (aOR) = 0.59, 95 % Confidence interval (CI) = 0.52-0.67, P value ≪ 0.001]. This was mainly due to better incidence of acute CVA (15.7 %vs 24 %, aOR = 0.59, CI = 0.50-0.69, P value ≪ 0.001), peripheral septic emboli (18.5 % vs 27.3 %, aOR = 0.60, CI = 0.52-0.70, P value ≪ 0.001) and intracranial/intraspinal abscess (1.2 % vs 4.74 %, aOR = 0.24, CI = 0.14-0.38, P value ≪ 0.001). There is no difference in the incidence of all-cause in-hospital death (7.57 % vs 7.75 % aOR = 0.97, CI = 0.77-1.23, P value = 0.82) or cardiac arrest (3.4 % vs 3.54 %, aOR = 0.96, CI = 0.68-1.35, P value = 0.80). CONCLUSION Surgical intervention within 7 days of index hospitalization is associated with a better incidence of acute CVA, peripheral septic emboli, and intracranial or intraspinal abscess but not with a better incidence of all-cause in-hospital death.
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Affiliation(s)
- Sibghat Tul Llah
- CHI Saint Vincent Infirmary, 2 St Vincent Cir, Little Rock, AR 72205, USA.
| | - Sumaiya Sharif
- CHI Saint Vincent Hospital, 300 Werner St, Hot Springs, AR 71913, USA
| | - Sami Ullah
- International Medical College, Medical College Rd, Tongi 1711, Bangladesh
| | - Shoaib Altaf Sheikh
- ECU Health North Hospital, 250 Smith Church Rd, Roanoke Rapids, NC 27870, USA
| | - Mohamed Adil Shah
- Government Medical College, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Obeid M Shafi
- University of Arkansas, 2801 S University Ave, Little Rock, AR 72204, USA
| | - Tawseef Dar
- University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136, USA
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Ahmed A, Faisaluddin M, Elgendy IY. Association between lower extremity peripheral arterial disease and in-hospital outcomes among patients undergoing trans-catheter mitral valve edge-to-edge repair. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 37:100355. [PMID: 38510508 PMCID: PMC10945918 DOI: 10.1016/j.ahjo.2023.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 03/22/2024]
Affiliation(s)
- Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
| | - Mohammed Faisaluddin
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, KY, United States of America
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Surmann J, Meyer P, Epple J, Schmitz-Rixen T, Böckler D, Grundmann RT. Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany. Biomedicines 2023; 12:38. [PMID: 38255145 PMCID: PMC10813329 DOI: 10.3390/biomedicines12010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
AIM To present the short- and long-term outcomes of lower extremity bypass (LEB) surgery in patients with critical limb-threatening ischaemia (CLTI), comparing diabetic (DM) and non-diabetic (non-DM) patients. METHODS Retrospective analysis of anonymised data from a nationwide health insurance company (AOK). Data from 22,633 patients (DM: n = 7266; non-DM: n = 15,367; men: n = 14,523; women: n = 8110; mean patient age: 72.5 years), who underwent LEB from 2010 to 2015, were analysed. The cut-off date for follow-up was December 31, 2018 (mean follow-up period: 55 months). RESULTS Perioperative mortality was 10.0% for DM and 8.2% for non-DM (p < 0.001). Patients with crural/pedal bypasses (n = 8558) had a significantly higher perioperative mortality (10.3%) than those with above-the-knee (n = 7246; 5.8%; p < 0.001) and below-the-knee bypasses (n = 6829; 8.9%; p = 0.003). The 9-year survival rates in DM patients were significantly worse, at 21.5%, compared to non-DM, at 31.1% (p < 0.001). This applied to both PAD stage III (DM: 34.4%; non-DM: 45.7%; p < 0.001) and PAD stage IV (DM: 18.5%; non-DM: 25.0%; p < 0.001). Patients with crural/pedal bypasses had a significantly inferior survival rate (25.5%) compared to those with below-the-knee (27.7%; p < 0.001) and above-the-knee bypasses (31.7%; p < 0.001). CONCLUSION Perioperative and long-term outcomes regarding survival and major amputation rate for CLTI patients undergoing LEB are consistently worse for DM patients compared to non-DM patients.
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Affiliation(s)
- Johanna Surmann
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.S.); (P.M.); (D.B.)
| | - Philipp Meyer
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.S.); (P.M.); (D.B.)
| | - Jasmin Epple
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt am Main, 60596 Frankfurt am Main, Germany;
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, Goethe University Frankfurt, 60629 Frankfurt am Main, Germany;
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.S.); (P.M.); (D.B.)
| | - Reinhart T. Grundmann
- German Institute for Vascular Healthcare Research (DIGG), German Society for Vascular Surgery and Vascular Medicine, 10115 Berlin, Germany
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Llah ST, Sharif S, Ullah S, Sheikh SA, Shah MA, Shafi OM, Dar T. TAVR vs balloon aortic valvotomy for severe aortic stenosis and cardiogenic shock: An insight from the National Inpatient Sample database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 55:1-7. [PMID: 37208215 DOI: 10.1016/j.carrev.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Severe Aortic stenosis (AS) complicated by cardiogenic shock (CS) represents a grave clinical condition with limited treatment options. Evidence from small observation studies favors that Transcatheter Aortic Valve Replacement (TAVR) might be a feasible option in these patients in contrast to emergent Balloon Aortic Valvuloplasty (BAV) which is associated with very high short and long-term mortality. METHODS 11,405 hospitalizations with severe AS complicated by CS between 2016 and 2020 were identified using the National Inpatient Sample (NIS) Database, and patients were then stratified according to whether they received TAVR or BAV. Propensity-score matching was used to account for differences in the baseline characteristics. Primary and secondary outcomes were then compared between 3485 hospitalizations in direct TAVR group and with 3485 matched hospitalizations in the BAV group. The primary outcome was a composite of all-cause in-hospital death, acute cerebrovascular accident (CVA), and myocardial infarction (MI). Secondary outcomes and safety outcomes were also compared between the two groups. RESULTS TAVR was associated with fewer primary outcomes events as compared to BAV {36.8 % vs 56.8 %, aOR (95%CI) = 0.38(0.30-0.47)}, due to fewer all-cause in-hospital deaths {17.8 % vs 38.9 %, aOR (95%CI) =0.34 (0.26-0.43)} and MI {12.3 % vs 32.4 %, aOR (95%CI) = 0.29 (0.22-0.39)}. TAVR was associated with higher rates of acute CVA {6.17 % vs 3.44 %, aOR (95%CI) = 1.84 (1.08-3.21)} and pacemaker implantation post procedure {11.9 % vs 6.03 %, aOR (95%CI) = 2.10 (1.41-3.18)}. CONCLUSION Direct TAVR in shock and severe Aortic stenosis is a better strategy than rescue Balloon aortic valvotomy.
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Affiliation(s)
- Sibghat Tul Llah
- CHI Saint Vincent Infirmary, 2 St Vincent Cir, Little Rock, AR 72205, USA.
| | - Sumaiya Sharif
- CHI Saint Vincent Hospital, 300 Werner St, Hot Springs, AR 71913, USA
| | - Sami Ullah
- International Medical College, Medical College Rd, Tongi 1711, Bangladesh
| | - Shoaib Altaf Sheikh
- ECU Health North Hospital, 250 Smith Church Rd, Roanoke Rapids, NC 27870, USA
| | - Mohamed Adil Shah
- Government Medical College, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Obeid M Shafi
- University of Arkansas for Medical Sciences, 2801 S University Ave, Little Rock, AR 72204, USA
| | - Tawseef Dar
- University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136, USA
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Foussard N, Rouault P, Cornuault L, Reynaud A, Buys ES, Chapouly C, Gadeau AP, Couffinhal T, Mohammedi K, Renault MA. Praliciguat Promotes Ischemic Leg Reperfusion in Leptin Receptor-Deficient Mice. Circ Res 2023; 132:34-48. [PMID: 36448444 DOI: 10.1161/circresaha.122.322033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Lower-limb peripheral artery disease is one of the major complications of diabetes. Peripheral artery disease is associated with poor limb and cardiovascular prognoses, along with a dramatic decrease in life expectancy. Despite major medical advances in the treatment of diabetes, a substantial therapeutic gap remains in the peripheral artery disease population. Praliciguat is an orally available sGC (soluble guanylate cyclase) stimulator that has been reported both preclinically and in early stage clinical trials to have favorable effects in metabolic and hemodynamic outcomes, suggesting that it may have a potential beneficial effect in peripheral artery disease. METHODS We evaluated the effect of praliciguat on hind limb ischemia recovery in a mouse model of type 2 diabetes. Hind limb ischemia was induced in leptin receptor-deficient (Leprdb/db) mice by ligation and excision of the left femoral artery. Praliciguat (10 mg/kg/day) was administered in the diet starting 3 days before surgery. RESULTS Twenty-eight days after surgery, ischemic foot perfusion and function parameters were better in praliciguat-treated mice than in vehicle controls. Improved ischemic foot perfusion was not associated with either improved traditional cardiovascular risk factors (ie, weight, glycemia) or increased angiogenesis. However, treatment with praliciguat significantly increased arteriole diameter, decreased ICAM1 (intercellular adhesion molecule 1) expression, and prevented the accumulation of oxidative proangiogenic and proinflammatory muscle fibers. While investigating the mechanism underlying the beneficial effects of praliciguat therapy, we found that praliciguat significantly downregulated Myh2 and Cxcl12 mRNA expression in cultured myoblasts and that conditioned medium form praliciguat-treated myoblast decreased ICAM1 mRNA expression in endothelial cells. These results suggest that praliciguat therapy may decrease ICAM1 expression in endothelial cells by downregulating Cxcl12 in myocytes. CONCLUSIONS Our results demonstrated that praliciguat promotes blood flow recovery in the ischemic muscle of mice with type 2 diabetes, at least in part by increasing arteriole diameter and by downregulating ICAM1 expression.
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Affiliation(s)
- Ninon Foussard
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | - Paul Rouault
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | - Lauriane Cornuault
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | - Annabel Reynaud
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | | | - Candice Chapouly
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | - Alain-Pierre Gadeau
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | - Thierry Couffinhal
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | - Kamel Mohammedi
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
| | - Marie-Ange Renault
- Univ. Bordeaux, Inserm, Biology of Cardiovascular Diseases, Pessac, France (N.F., P.R., L.C., A.R., C.C., A.-P.G., T.C., K.M., M.-A.R.)
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Huang Q, Shu H, Zeng C, Qiu P, Xiong X, Lu X. Endovascular revascularisation versus surgical revascularisation in patients with lower limb atherosclerosis obliterans: a protocol for systematic review and meta-analysis with trial sequential analysis and meta-regression. BMJ Open 2022; 12:e066903. [PMID: 36600343 PMCID: PMC9743393 DOI: 10.1136/bmjopen-2022-066903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The revascularisation strategy for lower limb atherosclerosis obliterans (ASO) remains controversial. In this meta-analysis, we will summarise existing evidence to compare the long-term and short-term outcomes between endovascular revascularisation and open revascularisation for patients with ASO. METHODS Relevant randomised controlled trials (RCTs) and cohort studies are included from the following databases: MEDLINE/PubMed, Embase and the Cochrane Library. The last search time is 1 August 2022. Two reviewers will independently identify RCTs and cohort studies according to eligibility and exclusion criteria. The risk of bias of included cohort studies, and RCTs are assessed with the Newcastle-Ottawa Scale, Methodological Index of Non-randomized Studies and Cochrane Collaboration's tool, respectively. The primary outcomes include overall survival, amputation-free survival and 30-day mortality. TSA Beta Software V.0.9.5.10 is used to perform the trial sequential analysis for primary outcomes. The Grades of Recommendations, Assessment, Development and Evaluation (GRADE) tool will be used to assess the level of evidence for outcome from RCTs. Stata V.17.0 software is used to pool primary outcomes. ETHICS AND DISSEMINATION This study will be disseminated through peer-reviewed journals or conference reports. No ethical approval requirements are required because the results presented in this study are conducted based on published data. PROSPERO REGISTRATION NUMBER CRD42022359591.
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Affiliation(s)
- Qun Huang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongxin Shu
- The Second Clinical Medical School, Nanchang University, Nanchang, Jianxi, China
| | - Chuanfei Zeng
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaowei Xiong
- Department of Vascular Surgery, Nanchang First Hospital, Nanchang, Jiangxi, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Majmundar M, Patel KN, Doshi R, Anantha-Narayanan M, Kumar A, Reed GW, Puri R, Kapadia SR, Jaradat ZA, Bhatt DL, Kalra A. Comparison of 6-Month Outcomes of Endovascular vs Surgical Revascularization for Patients With Critical Limb Ischemia. JAMA Netw Open 2022; 5:e2227746. [PMID: 35984655 PMCID: PMC9391961 DOI: 10.1001/jamanetworkopen.2022.27746] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE The Bypass Versus Angioplasty for Severe Ischemia of the Leg randomized controlled trial showed comparable outcomes between endovascular revascularization (ER) and surgical revascularization (SR) for patients with critical limb ischemia (CLI). However, several observational studies showed mixed results. Most of these studies were conducted before advanced endovascular technologies were available. OBJECTIVE To compare ER and SR treatment strategies for 6-month outcomes among patients with CLI. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study used the Nationwide Readmissions Database to identify 66 277 patients with CLI who underwent ER or SR from January 1, 2016, to December 31, 2018. Data analyses were conducted from January 1, 2022, to February 8, 2022. A propensity score with 1:1 matching was applied. Patients with CLI who underwent ER or SR were identified, and those with missing information on the length of stay and/or younger than 18 years were excluded. EXPOSURES Endovascular or surgical revascularization. MAIN OUTCOMES AND MEASURES The primary outcome was a major amputation at 6 months. Significant secondary outcomes were in-hospital and 6-month mortality and an in-hospital safety composite of acute kidney injury, major bleeding, and vascular complication. Subgroup analysis was conducted for major amputation in high-volume centers. RESULTS A total of 66 277 patients were identified between 2016 and 2018 who underwent ER or SR for CLI. The Nationwide Readmissions Database does not provide racial and ethnic categories. The mean (SD) age of the cohort was 69.3 (12) years, and 62.5% of patients were male. A total of 54 546 patients (82.3%) underwent ER and 11 731 (17.7%) underwent SR. After propensity score matching, 11 106 matched pairs were found. Endovascular revascularization was associated with an 18% higher risk of major amputation compared with SR (997 of 10 090 [9.9%] vs 869 of 10 318 [8.4%]; hazard ratio, 1.18; 95% CI, 1.08-1.29; P = .001). However, no difference was observed in major amputation risk when both procedures were performed in high-volume centers. Endovascular revascularization and SR had similar mortality rates (517 of 11 106 [4.7%] vs 490 of 11 106 [4.4%]; hazard ratio, 1.06; 95% CI, 0.93-1.20; P = .39). However, the ER group had a 17% lower risk of in-hospital safety outcomes compared with the SR group (2584 of 11 106 [23.3%] vs 2979 of 11 106 [26.8%]; odds ratio, 0.83; 95% CI, 0.78-0.88; P < .001). CONCLUSIONS AND RELEVANCE The results of this study suggest that ER was safer, without any difference in mortality, but ER was associated with an increased risk of major amputation compared with SR. However, the risk of major amputation was similar when both procedures were performed at high-volume centers.
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Affiliation(s)
- Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City
| | - Kunal N. Patel
- Department of Internal Medicine, St Peter’s University Hospital, New Brunswick, New Jersey
| | - Rajkumar Doshi
- Department of Cardiology, St Joseph’s University Medical Center, Paterson, New Jersey
| | | | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ziad A. Jaradat
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis
| | - Deepak L. Bhatt
- Brigham and Women’s Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis
- Cardiovascular Institute, Kalra Hospitals, New Delhi, India
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Elbadawi A, Sedhom R, Megaly M, Eid M, Omran A, Elgendy IY. Estimate and Temporal Trends of Buerger Disease Hospitalizations in the United States. Am J Cardiol 2022; 169:158-160. [PMID: 35168750 DOI: 10.1016/j.amjcard.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Ayman Elbadawi
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ramy Sedhom
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Michael Megaly
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Mennaallah Eid
- Department of Internal Medicine, Lincoln Medical Center, New York, New York
| | - Azza Omran
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
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Arkoudis NA, Katsanos K, Inchingolo R, Paraskevopoulos I, Mariappan M, Spiliopoulos S. Quantifying tissue perfusion after peripheral endovascular procedures: Novel tissue perfusion endpoints to improve outcomes. World J Cardiol 2021; 13:381-398. [PMID: 34621485 PMCID: PMC8462037 DOI: 10.4330/wjc.v13.i9.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Peripheral artery disease (PAD) is a flow-limiting condition caused by narrowing of the peripheral arteries typically due to atherosclerosis. It affects almost 200 million people globally with patients either being asymptomatic or presenting with claudication or critical or acute limb ischemia. PAD-affected patients display increased mortality rates, rendering their management critical. Endovascular interventions have proven crucial in PAD treatment and decreasing mortality and have significantly increased over the past years. However, for the functional assessment of the outcomes of revascularization procedures for the treatment of PAD, the same tests that have been used over the past decades are still being employed. Those only allow an indirect evaluation, while an objective quantification of limb perfusion is not feasible. Standard intraarterial angiography only demonstrates post-intervention vessel patency, hence is unable to accurately estimate actual limb perfusion and is incapable of quantifying treatment outcome. Therefore, there is a significant necessity for real-time objectively measurable procedural outcomes of limb perfusion that will allow vascular experts to intraoperatively quantify and assess outcomes, thus optimizing treatment, obviating misinterpretation, and providing significantly improved clinical results. The purpose of this review is to familiarize readers with the currently available perfusion-assessment methods and to evaluate possible prospects.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Radiology Department, Interventional Radiology Unit, Attikon University General Hospital, Athens 12461, Greece
| | - Konstantinos Katsanos
- Interventional Radiology Department, Patras University Hospital, PATRAS 26441, Greece
| | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Ioannis Paraskevopoulos
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Martin Mariappan
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB15 5EY, United Kingdom
| | - Stavros Spiliopoulos
- 2nd Radiology Department, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
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Mohamad Yusoff F, Kajikawa M, Yamaji T, Takaeko Y, Hashimoto Y, Mizobuchi A, Han Y, Kishimoto S, Maruhashi T, Nakashima A, Higashi Y. Low-intensity pulsed ultrasound decreases major amputation in patients with critical limb ischemia: 5-year follow-up study. PLoS One 2021; 16:e0256504. [PMID: 34411183 PMCID: PMC8376014 DOI: 10.1371/journal.pone.0256504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
Various therapeutic strategies for angiogenesis are performed to improve symptoms in patients with critical limb ischemia (CLI). Pre-clinical studies have shown that low-intensity pulsed ultrasound (LIPUS) exposure induces angiogenesis. LIPUS may be a new stratergy for treatment of CLI. The purpose of this pilot trial was to evaluate outcomes in patients with CLI who were treated with LIPUS. Fourteen patients with CLI, who were not candidates for angioplasty or surgical revascularization, were enrolled in this study. Historical control data were obtained from the Hiroshima University PAD database. The primary endpoints were major amputation and death. The outcomes were compared in 16 lower limbs of the 14 patients with CLI who were treated with LIPUS and in 14 lower limbs of 14 patients with CLI as historical controls. All patients were followed for after 5 years after treatment with LIPUS. The mean duration of LIPUS exposure in the LIPUS group was 381± 283 days. During the 5-year follow-up periods, there were 3 major amputations and 7 deaths in the LIPUS group and there were 14 major amputations and 7 deaths in the historical control group. The overall amputation-free survival rate was significantly higher in patients who were treated with LIPUS than in historical controls. There was no significant difference between overall mortality-free survival rates in the LIPUS group and historical control group. LIPUS is a noninvasive option for therapeutic angiogenesis with the potential to reduce the incidence of major amputations in patients with CLI.
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Affiliation(s)
- Farina Mohamad Yusoff
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Takayuki Yamaji
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yuji Takaeko
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yu Hashimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Aya Mizobuchi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yiming Han
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Shinji Kishimoto
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuya Maruhashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ayumu Nakashima
- Department of Stem Cell Biology and Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
- * E-mail:
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Abstract
Effective revascularization of the patient with peripheral artery disease is about more than the procedure. The approach to the patient with symptom-limiting intermittent claudication or limb-threatening ischemia begins with understanding the population at risk and variation in clinical presentation. The urgency of revascularization varies significantly by presentation; from patients with intermittent claudication who should undergo structured exercise rehabilitation before revascularization (if needed) to those with acute limb ischemia, a medical emergency, who require revascularization within hours. Recent years have seen the rapid development of new tools including wires, catheters, drug-eluting technology, specialized balloons, and biomimetic stents. Open surgical bypass remains an important option for those with advanced disease. The strategy and techniques employed vary by clinical presentation, lesion location, and lesion severity. There is limited level 1 evidence to guide practice, but factors that determine technical success and anatomic durability are largely understood and incorporated into decision-making. Following revascularization, medical therapy to reduce adverse limb outcomes and a surveillance plan should be put in place. There are many hurdles to overcome to improve the efficacy of lower extremity revascularization, such as restenosis, calcification, microvascular disease, silent embolization, and tools for perfusion assessment. This review highlights the current state of revascularization in peripheral artery disease with an eye toward technologies at the cusp, which may significantly impact current practice.
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Affiliation(s)
- Joshua A Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (J.A.B.)
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
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12
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Díaz-Sandoval LJ. Transcending the Archetypical "Duality" of Revascularization: Are We Finally Evolving Toward the "Ultimate Truth"? JACC Cardiovasc Interv 2021; 14:675-677. [PMID: 33640384 DOI: 10.1016/j.jcin.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Larry J Díaz-Sandoval
- Department of Medicine, Division of Cardiology, Ascension Borgess Hospital, Borgess Heart Institute, Kalamazoo, Michigan, USA.
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