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Gavin KA, Weisse C, Berent AC. Stenting of the caudal aorta and aortic trifurcation for the treatment of thrombosis in 7 dogs. J Vet Intern Med 2022; 36:441-450. [PMID: 35129219 PMCID: PMC8965258 DOI: 10.1111/jvim.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kelly A. Gavin
- Department of Internal Medicine Veterinary Emergency and Referral Group Brooklyn New York USA
| | - Chick Weisse
- Department of Interventional Radiology and Endoscopy Animal Medical Center New York New York USA
| | - Allyson C. Berent
- Department of Interventional Radiology and Endoscopy Animal Medical Center New York New York USA
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Management of Extensive Aorto-Iliac Disease: A Systematic Review and Meta-Analysis of 9319 Patients. Cardiovasc Intervent Radiol 2021; 44:1518-1535. [PMID: 34279686 DOI: 10.1007/s00270-021-02785-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Despite advances in endovascular management of aorto-iliac occlusive disease (AIOD) including covered endovascular reconstruction of aortic bifurcation (CERAB) techniques, guidelines for management of symptomatic Trans-Atlantic Inter-Society Consensus (TASC II) type C/D lesions favour open surgical revascularisation. This meta-analysis investigates outcomes in patients with TASC II C/D lesions treated with open bypass procedures (OS), standard endovascular treatments (SEV) or CERAB. METHODS Multiple databases (MEDLINE, EMBASE and the Cochrane database) were searched to identify studies reporting endovascular and open treatment of extensive AIOD. Studies were independently assessed. Outcomes reported included 30-day morbidity/mortality and patency rates. RESULTS A total of 9319 patients undergoing intervention for extensive AIOD were identified from 66 studies. Median patient age was 64 years (n = 3204) for SEV, 58 years (n = 240) for CERAB and 59 years for OS (n = 5875). Pooled meta-analysis for 30-day morbidity in patients undergoing SEV, CERAB and OS was 9, 10 and 15%, respectively. Thirty-day mortality rate was 0.79, 0 and 3% in the SEV, CERAB and OS groups, respectively. In these groups, one-year primary and secondary patency was 90, 88, 96 and 96, 97, and 97% whilst three-year primary and secondary patency was 78, 82, 93 and 93, 97, 97% respectively. Five-year primary and secondary patency was 71 and 89% for SEV and 88 and 95% for OS, respectively. CERAB data were only available to 3 years. CONCLUSIONS This meta-analysis shows that thirty-day morbidity and mortality favours endovascular techniques. Primary patency remains better with OS in both early and midterms;; however, secondary patency is comparable in all groups. These findings suggest that SEV/CERAB may be considered as an alternative to OS in higher-risk patients.
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Yao C, Ning J, Li Z, Wang M, Wu R, Wang S, Chang G. Parallel Covered Stents Technique in the Treatment of Abdominal Aortic Diseases. J Vasc Interv Radiol 2020; 31:771-777. [PMID: 32127313 DOI: 10.1016/j.jvir.2019.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the safety and efficacy of the parallel covered stents technique in the treatment of anatomically challenging aortic aneurysms, pseudoaneurysms, and dissections. MATERIALS AND METHODS Data were retrospectively collected from 16 patients with abdominal aortic diseases who were treated with parallel covered stents (Gore Excluder, n = 14; Medtronic Endurant, n = 2) between January 2016 and July 2018. Patients were treated with this technique if they were unsuitable for either open repair or standard endovascular aortic repair with bifurcated stents. Such unfavorable anatomy included narrow aortic necks (≤18 mm), small vascular access (occluded or ≤6.0 mm), or compressed aortic lumens (≤18 mm). All patients were male, with a mean age of 64.7 ± 13.3 years. For true aneurysms (n = 4) and pseudoaneurysms (n = 4), the mean diameter and length of the proximal necks were 17.5 ± 2.6 mm (range, 14-21 mm) and 51.0 ± 12.5 mm (range, 39-75 mm), respectively. The minimal diameter of true lumen in cases with aortic dissection and penetrating ulcers (n = 8) was 14.8 ± 3.1 mm. Small or occluded femoral access was found in 3 patients. RESULTS Technical success was 100%. Minor type I endoleaks, which were seen on completion angiography in 5 patients, had all resolved within 3 months. There were no perioperative deaths. Postoperative complications included supraventricular tachycardia in 1 patient and pneumonia combined with heart failure in 1 patient. Patency of all stents was observed at a mean follow-up of 21.8 ± 10.1 months. CONCLUSIONS The parallel covered stents technique appears to offer a feasible solution for abdominal aortic diseases with unfavorable anatomy. Long-term follow-up is needed to further evaluate the safety and efficacy of this technique.
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Affiliation(s)
- Chen Yao
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Junjie Ning
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Zilun Li
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Mian Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Ridong Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Shenming Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Guangqi Chang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
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Trans-Atlantic Inter-Society Consensus Class D Aortoiliac Lesions: A Comparison of Endovascular and Open Surgical Outcomes. AJR Am J Roentgenol 2019; 213:696-701. [PMID: 31120778 DOI: 10.2214/ajr.18.20918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study is to compare the clinical and safety outcomes between two groups of patients with Trans-Atlantic Inter-Society Consensus class D (TASC II D) aortoiliac occlusive disease (AIOD): those with higher-risk comorbidity who underwent endovascular reconstruction and those with lower-risk comorbidity who underwent surgical bypass. MATERIALS AND METHODS. Thirty-two consecutive patients with symptomatic TASC II D AOID who underwent surgical bypass or endovascular reconstruction from 2012 to 2017 were retrospectively reviewed. Lesion characteristics, technical approach, survival, limb salvage, patency, and change in clinical symptoms were analyzed. RESULTS. Nineteen patients with higher comorbidity underwent endovascular reconstruction, whereas 13 patients with lower comorbidity underwent surgical bypass. Patients undergoing endovascular reconstruction had an older median age (67.0 vs 62.0 years; p = 0.007), higher rates of hypertension (94.7% vs 61.5%; p = 0.018) and coronary artery disease (26.3% vs 0%; p = 0.044), and advanced renal impairment (mean [± SD] chronic kidney disease stage, 1.4 ± 1.5 vs 0.7 ± 1.3; p = 0.005). There were no significant differences in Rutherford classification between the groups. During long-term follow-up of 2.76 years, endovascular reconstruction and surgical bypass showed equivalent rates of survival (89.5% vs 84.6%; p = 0.683), limb salvage (100.0% vs 92.3%; p = 0.219), and primary or primary-assisted patency (85% vs 85%; p = 0.98). Groups showed similar clinical improvements in walking distance, rest pain, and tissue loss at 30 days (95% vs 85%; p = 0.158) and at long-term follow-up (74% vs 62%; p = 0.599). CONCLUSION. For properly selected patients, the clinical outcomes of endovascular reconstruction versus surgical bypass for TASC II D AOID may be equivalent at 2.5 years after the procedure. The decreased operative risk associated with endovascular reconstruction suggests that it is the technique of choice for high-risk patients.
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Groot Jebbink E, Holewijn S, Versluis M, Grimme F, Hinnen JW, Sixt S, Angle JF, Dorigo W, Reijnen MMPJ. Meta-analysis of Individual Patient Data After Kissing Stent Treatment for Aortoiliac Occlusive Disease. J Endovasc Ther 2018; 26:31-40. [PMID: 30499352 PMCID: PMC6330696 DOI: 10.1177/1526602818810535] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate short- and long-term technical and clinical outcomes after kissing stent treatment of aortoiliac occlusive disease (AIOD) based on an individual participant data (IPD) meta-analysis. MATERIALS AND METHODS A search of the Scopus database identified 156 articles on KS treatment of AIOD; of these 22 met the inclusion criteria. Authors of 19 articles with contact information were approached to join an IPD consortium. Eight author groups responded and 5 provided anonymized data for merging into an IPD database. The number of included procedures was equal before and after 2005. The primary study outcome was the cumulative patency at 24 months. Secondary outcomes were patency at up to 60 months, complications, and changes in Rutherford category and ankle-brachial index. The predictive value of stent protrusion length, pre-/postdilation, stent type, and patient demographics on primary patency were examined with Cox proportional hazard modeling; outcomes are reported as the hazard ratio (HR). The Kaplan-Meier method was employed to estimate patency rates. RESULTS In total, 605 (40.9%) of 1480 patients presented in the literature were included in the IPD analysis. The indication for intervention was intermittent claudication in 84.2% and critical limb ischemia in 15.8%. Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) A or B in 52.8% and TASC C and D in 47.2%. The overall primary patency estimate was 81% at 24 months. Primary patency significantly increased after 2005 (p=0.005). Cox regression analysis revealed only age as a significant predictor of sustained primary patency (HR 0.60, p<0.005). Any previous endovascular intervention (HR 2.52, p=0.02) was the main predictor for loss of secondary patency; history of cardiovascular disease (HR 0.27, p=0.04) was the main predictor of sustained secondary patency. CONCLUSION The kissing stent technique has a good safety profile and acceptable patency rates up to 2 years, even in TASC C and D lesions, supporting an endovascular-first approach for AIOD.
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Affiliation(s)
- Erik Groot Jebbink
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.,2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands.,3 Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Suzanne Holewijn
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel Versluis
- 2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands.,3 Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Frederike Grimme
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jan Willem Hinnen
- 4 Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Sebastian Sixt
- 5 Cardiovascular Center, Hamburg University, Hamburg, Germany
| | - John F Angle
- 6 Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Walter Dorigo
- 7 Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy
| | - Michel M P J Reijnen
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.,2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands
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Vértes M, Juhász IZ, Nguyen TD, Veres DS, Hüttl A, Nemes B, Hüttl K, Dósa E. Stent Protrusion >20 mm Into the Aorta: A New Predictor for Restenosis After Kissing Stent Reconstruction of the Aortoiliac Bifurcation. J Endovasc Ther 2018; 25:632-639. [DOI: 10.1177/1526602818794959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine the long-term patency of aortoiliac kissing stents and to identify predisposing factors for the development of in-stent restenosis (ISR). Methods: A retrospective analysis was conducted of 105 patients (median age 60.9 years; 64 women) with symptomatic aortoiliac occlusive disease who had kissing stents implanted between 2001 and 2015. The indication for kissing stents was severe claudication in 91 (86.7%) patients and critical limb ischemia in 14 (13.3%). Lesions were TASC A in 52 (49.5%), B in 29 (27.6%), C in 4 (3.8%), and D in 20 (19%) patients. Twenty-five (23.8%) patients had heavily calcified lesions. In all, 210 stents were deployed [180 (85.7%) self-expanding and 30 (14.3%) balloon-expandable]. Follow-up included clinical evaluation, ankle-brachial index measurement, and duplex ultrasonography. Results: The median follow-up was 45 months. The primary patency rates were 93%, 86%, and 77% at 12, 24, and 60 months, respectively. Significant ISR developed in 23 (21.9%) patients (12 unilateral and 11 bilateral). Univariate Cox regression analysis revealed older age [hazard ratio (HR) 0.5, 95% confidence interval (CI) 0.31 to 0.81, p=0.004] and larger aortic diameter (HR 0.42, 95% CI 0.25 to 0.7, p<0.001) to be variables favoring long-term patency, while a longer aortic stent segment (HR 1.56, 95% CI 1.16 to 2.09, p=0.003) and a larger discrepancy between the summed stent diameters and the aortic diameter (HR 1.64, 95% CI 1.01 to 2.65, p=0.043) were associated with ISR development. Multivariate analysis showed a longer aortic stent segment to be the only significant determinant of ISR (HR 1.44, 95% CI 1.02 to 2.01, p=0.035). Conclusion: The kissing stent technique can be performed with good long-term patency. Patients whose iliac stents protrude too far into the aorta need closer follow-up.
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Affiliation(s)
- Miklós Vértes
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | | | - Tin Dat Nguyen
- Medical Faculty, Semmelweis University, Budapest, Hungary
| | - Dániel Sándor Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Artúr Hüttl
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Kálmán Hüttl
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
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Mousinho F, Mendes T, Sousa E Santos P, Azevedo AP, Mousinho G, Malcata C, Viegas E, Madureira B, Falcão F, Gomes AP, Lima F. Bisoprolol-induced thrombocytopenia: A case report. J Clin Pharm Ther 2017; 43:280-283. [PMID: 28868658 DOI: 10.1111/jcpt.12614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/07/2017] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Thrombocytopenia, not associated with bone marrow primary disease, is a common clinical problem. The possibility of drug-induced thrombocytopenia must be considered, especially in hospitalized patients. Drugs can cause thrombocytopenia by several mechanisms including direct bone marrow or other organ toxicity, and immune reactions. CASE DESCRIPTION We describe a patient presenting with thrombocytopenia likely related to bisoprolol. WHAT IS NEW AND CONCLUSION We report a case of bisoprolol-induced thrombocytopenia which resolved with drug discontinuation and steroid therapy. We review the mechanisms involved in drug-induced immune thrombocytopenia.
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Affiliation(s)
- F Mousinho
- Hematology Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - T Mendes
- Hematology Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - P Sousa E Santos
- Hematology Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - A P Azevedo
- Clinical Pathology Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,Centre for Toxicogenomics and Human Health Genetics, Oncology and Human Toxicology, Universidade Nova de Lisboa, Lisboa, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Instituto Superior de Ciências da Saúde Egas Moniz, Monte da Caparica, Portugal
| | - G Mousinho
- ImunoHemotherappy Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - C Malcata
- Portuguese Institute of Blood and Transplantation, Centro de Sangue e da Transplantação de Lisboa, Lisboa, Portugal
| | - E Viegas
- Pharmaceutical Services, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - B Madureira
- Pharmaceutical Services, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - F Falcão
- Pharmaceutical Services, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - A P Gomes
- Hematology Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - F Lima
- Hematology Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Chong AY, Doyle BJ, Jansen S, Ponosh S, Cisonni J, Sun Z. Blood flow velocity prediction in aorto-iliac stent grafts using computational fluid dynamics and Taguchi method. Comput Biol Med 2017; 84:235-246. [DOI: 10.1016/j.compbiomed.2017.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/27/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
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