1
|
Weitz JI, Haas S, Ageno W, Goldhaber SZ, Turpie AGG, Goto S, Angchaisuksiri P, Nielsen JD, Kayani G, Farjat AE, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK, Loualidi A, Colak A, Bezuidenhout A, Abdool-Carrim A, Azeddine A, Beyers A, Dees A, Mohamed A, Aksoy A, Abiko A, Watanabe A, Krichell A, Fernandez AA, Tosetto A, Khotuntsov A, Oropallo A, Slocombe A, Kelly A, Clark A, Gad A, Arouni A, Schmidt A, Berni A, Kleiban AJ, Machowski A, Kazakov A, Galvez A, Lockman A, Falanga A, Chauhan A, Riera-Mestre A, Mazzone A, D’Angelo A, Herdy A, Kato A, Salem AAEEM, Husin A, Erdelyi B, Jacobson B, Amann-Vesti B, Battaloglu B, Wilson B, Cosmi B, Francois BJ, Toufek B, Hunt B, Natha B, Mustafa B, Kho BCS, Carine B, Zidel B, Dominique B, Christophe B, Trimarco B, Luo C, Cuneo CA, Diaz CJS, Schwencke C, Cader C, Yavuz C, Zaidman CJ, Lunn C, Wu CC, Toh CH, Chiang CE, Elisa C, Hsia CH, Huang CL, Kwok CHK, Wu CC, Huang CH, Ward C, Opitz C, Jeanneret-Gris C, Ha CY, Huang CY, Bidi CL, Smith C, Brauer C, Lodigiani C, Francis C, Wu C, Staub D, Theodoro D, Poli D, Acevedo DR, Adler D, Jimenez D, Keeling D, Scott D, Imberti D, Creagh D, Helene DC, Hagemann D, Le Roux D, Skowasch D, Belenky D, Dorokhov D, Petrov D, Zateyshchikov D, Prisco D, Møller D, Kucera D, Esheiba EM, Panchenko E, Dominique E, Dogan E, Kubat E, Diaz ED, Tse EWC, Yeo E, Hashas E, Grochenig E, Tiraferri E, Blessing E, Michèle EO, Usandizaga E, Porreca E, Ferroni F, Nicolas F, Ayala-Paredes F, Koura F, Henry F, Cosmi F, Erdkamp F, Kamalov G, Dalmau GB, Damien G, Klein G, Shah G, Hollanders G, Merli G, Plassmann G, Platt G, Poirier G, Sokurenko G, Haddad G, Ali G, Agnelli G, Gan GG, Kaye-Eddie G, Le Gal G, Allen G, Esperón GAL, Jean-Paul G, Gerofke H, Elali H, Burianova H, Ohler HJ, Wang H, Darius H, Gogia HS, Striekwold H, Gibbs H, Hasanoglu H, Turker H, Franow H, Bounameaux H, De Raedt H, Schroe H, ElDin HS, Zidan H, Nakamura H, Kim HY, Lawall H, Zhu H, Tian H, Yhim HY, Cate HT, Hwang HG, Shim H, Kim I, Libov I, Sonkin I, Suchkov I, Song IC, Kiris I, Staroverov I, Looi I, De La Azuela Tenorio IM, Savas I, Gordeev I, Podpera I, Lee JH, Sathar J, Welker J, Beyer-Westendorf J, Kvasnicka J, Vanwelden J, Kim J, Svobodova J, Gujral J, Marino J, Galvar JT, Kassis J, Kuo JY, Shih JY, Kwon J, Joh JH, Park JH, Kim JS, Yang J, Krupicka J, Lastuvka J, Pumprla J, Vesely J, Souto JC, Correa JA, Duchateau J, Fletcher JP, del Toro J, del Toro J, Paez JGC, Nielsen J, Filho JDA, Saraiva J, Peromingo JAD, Lara JG, Fedele JL, Surinach JM, Chacko J, Muntaner JA, Benitez JCÁ, Abril JMH, Humphrey J, Bono J, Kanda J, Boondumrongsagoon J, Yiu KH, Chansung K, Boomars K, Burbury K, Kondo K, Karaarslan K, Takeuchi K, Kroeger K, Zrazhevskiy K, Svatopluk K, Shyu KG, Vandenbosch K, Chang KC, Chiu KM, Jean-Manuel K, Wern KJ, Ueng KC, Norasetthada L, Binet L, Chew LP, Zhang L, Cristina LM, Tick L, Schiavi LB, Wong LLL, Borges L, Botha L, Capiau L, Timmermans L, López LE, Ria L, Blasco LMH, Guzman LA, Cervera LF, Isabelle M, Bosch MM, de los Rios Ibarra M, Fernandez MN, Carrier M, Barrionuevo MR, Gamba MAA, Cattaneo M, Moia M, Bowers M, Chetanachan M, Berli MA, Fixley M, Faghih M, Stuecker M, Schul M, Banyai M, Koretzky M, Myriam M, Gaffney ME, Hirano M, Kanemoto M, Nakamura M, Tahar M, Emmanuel M, Kovacs M, Leahy M, Levy M, Munch M, Olsen M, De Pauw M, Gustin M, Van Betsbrugge M, Boyarkin M, Homza M, Koto M, Abdool-Gaffar M, Nagib MAF, Dessoki ME, Khan M, Mohamed M, Kim MH, Lee MH, Soliman M, Ahmed MS, Bary MSAE, Moustafa MA, Hameed M, Kanko M, Majumder M, Zubareva N, Mumoli N, Abdullah NAN, Makruasi N, Paruk N, Kanitsap N, Duda N, Nordin N, Nyvad O, Barbarash O, Gurbuz O, Vilamajo OG, Flores ON, Gur O, Oto O, Marchena PJ, Angchaisuksiri P, Carroll P, Lang P, MacCallum P, von Bilderling PB, Blombery P, Verhamme P, Jansky P, Bernadette P, De Vleeschauwer P, Hainaut P, Ferrini PM, Iamsai P, Christian P, Viboonjuntra P, Rojnuckarin P, Ho P, Mutirangura P, Wells R, Martinez R, Miranda RT, Kroening R, Ratsela R, Reyes RL, de Leon RFD, Wong RSM, Alikhan R, Jerwan-Keim R, Otero R, Murena-Schmidt R, Canevascini R, Ferkl R, White R, Van Herreweghe R, Santoro R, Klamroth R, Mendes R, Prosecky R, Cappelli R, Spacek R, Singh R, Griffin S, Na SH, Chunilal S, Middeldorp S, Nakazawa S, Schellong S, Toh SG, Christophe S, Isbir S, Raymundo S, Ting SK, Motte S, Aktogu SO, Donders S, Cha SI, Nam SH, Marie-Antoinette SP, Maasdorp S, Sun S, Wang S, Essameldin SM, Sholkamy SM, Kuki S, Goto S, Yoshida S, Matsuoka S, McRae S, Watt S, Patanasing S, Jean-Léopold SN, Wongkhantee S, Bang SM, Testa S, Zemek S, Behrens S, Dominique S, Mellor S, Singh SSG, Datta S, Chayangsu S, Solymoss S, Everington T, Abdel-Azim TAA, Suwanban T, Adademir T, Hart T, Béatrice T, Luvhengo T, Horacek T, Zeller T, Boussy T, Reynolds T, Biss T, Chao TH, Casabella TS, Onodera T, Numbenjapon T, Gerdes V, Cech V, Krasavin V, Tolstikhin V, Bax WA, Malek WFA, Ho WK, Ageno W, Pharr W, Jiang W, Lin WH, Zhang W, Tseng WK, Lai WT, De Backer W, Haverkamp W, Yoshida W, Korte W, Choi W, Kim YK, Tanabe Y, Ohnuma Y, Mun YC, Balthazar Y, Park Y, Shibata Y, Burov Y, Subbotin Y, Coufal Z, Yang Z, Jing Z, Jing Z, Yang Z. Cancer associated thrombosis in everyday practice: perspectives from GARFIELD-VTE. J Thromb Thrombolysis 2020; 50:267-277. [DOI: 10.1007/s11239-020-02180-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
2
|
Cohen AT, Ay C, Hainaut P, Décousus H, Hoffmann U, Gaine S, Coppens M, da Silva PM, Jimenez D, Amann-Vesti B, Brüggenjürgen B, Levy P, Bastida JL, Vicaut E, Laeis P, Fronk EM, Zierhut W, Malzer T, Bramlage P, Agnelli G. Correction to: Design and rationale of the non-interventional, edoxaban treatment in routiNe clinical prActice in patients with venous ThromboEmbolism in Europe (ETNA-VTE-Europe) study. Thromb J 2018; 16:18. [PMID: 29855634 PMCID: PMC5977454 DOI: 10.1186/s12959-018-0173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alexander T Cohen
- 1Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Cihan Ay
- 2Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Philippe Hainaut
- 3Department of General Internal Medicine, Cliniques Universitaires Saint Luc, UCL, Bruxelles, Belgium
| | - Hervé Décousus
- 4Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest En Jarez, France
| | - Ulrich Hoffmann
- Division of Angiology, Medical Clinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Sean Gaine
- 6National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michiel Coppens
- 7Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Pedro Marques da Silva
- 8Department of Internal Medicine, Arterial Investigation Unit, Hospital de Santa Marta, Lisbon, Portugal
| | - David Jimenez
- 9Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain
| | | | | | - Pierre Levy
- 12LEGOS, Université Paris - Dauphine, Paris, France
| | | | - Eric Vicaut
- 14Department of Medicine, Université Paris Descartes, Paris, France
| | - Petra Laeis
- 15Daiichi Sankyo Europe GmbH, Munich, Germany
| | | | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Berlin, Germany
| | - Giancarlo Agnelli
- 17Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | | |
Collapse
|
3
|
Zeller T, Langhoff R, Rocha-Singh KJ, Jaff MR, Blessing E, Amann-Vesti B, Krzanowski M, Peeters P, Scheinert D, Torsello G, Sixt S, Tepe G. Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004848. [PMID: 28916599 PMCID: PMC5610565 DOI: 10.1161/circinterventions.116.004848] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Background— Studies assessing drug-coated balloons (DCB) for the treatment of femoropopliteal artery disease are encouraging. However, challenging lesions, such as severely calcified, remain difficult to treat with DCB alone. Vessel preparation with directional atherectomy (DA) potentially improves outcomes of DCB. Methods and Results— DEFINITIVE AR study (Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency—A Pilot Study of Anti-Restenosis Treatment) was a multicenter randomized trial designed to estimate the effect of DA before DCB to facilitate the development of future end point-driven randomized studies. One hundred two patients with claudication or rest pain were randomly assigned 1:1 to DA+DCB (n=48) or DCB alone (n=54), and 19 additional patients with severely calcified lesions were treated with DA+DCB. Mean lesion length was 11.2±4.0 cm for DA+DCB and 9.7±4.1 cm for DCB (P=0.05). Predilation rate was 16.7% for DA+DCB versus 74.1% for DCB; postdilation rate was 6.3% for DA+DCB versus 33.3% for DCB. Technical success was superior for DA+DCB (89.6% versus 64.2%; P=0.004). Overall bail-out stenting rate was 3.7%, and rate of flow-limiting dissections was 19% for DCB and 2% for DA+DCB (P=0.01). One-year primary outcome of angiographic percent diameter stenosis was 33.6±17.7% for DA+DCB versus 36.4±17.6% for DCB (P=0.48), and clinically driven target lesion revascularization was 7.3% for DA+DCB and 8.0% for DCB (P=0.90). Duplex ultrasound patency was 84.6% for DA+DCB, 81.3% for DCB (P=0.78), and 68.8% for calcified lesions. Freedom from major adverse events at 1 year was 89.3% for DA+DCB and 90.0% for DCB (P=0.86). Conclusions— DA+DCB treatment was effective and safe, but the study was not powered to show significant differences between the 2 methods of revascularization in 1-year follow-up. An adequately powered randomized trial is warranted. Clinical Trial Registration— http://www.clinicaltrials.gov. Unique Identifier: NCT01366482.
Collapse
Affiliation(s)
- Thomas Zeller
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe).
| | - Ralf Langhoff
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Krishna J Rocha-Singh
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Michael R Jaff
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Erwin Blessing
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Beatrice Amann-Vesti
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Marek Krzanowski
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Patrick Peeters
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Dierk Scheinert
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Giovanni Torsello
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Sebastian Sixt
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | - Gunnar Tepe
- From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe)
| | | |
Collapse
|
4
|
Frick M, Baumann F, Sick B, Wilkinson IB, Amann-Vesti B, Husmann M. Sensitivities of in vivo markers of arterial organ damage in patients with peripheral atherosclerosis. VASA 2018; 47:30-35. [DOI: 10.1024/0301-1526/a000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Abstract. Background: Biomarkers of vascular diseases such as ankle-brachial index (ABI), peripheral pulse pressure (pPP), central pulse pressure (cPP), and pulse wave velocity (PWV) allow assessment of arterial organ damage (AOD). However, the utility of markers other than ABI in patients with peripheral arterial disease (PAD), which are also associated with a significant increase of cardiovascular events, remains unclear. Patients and methods: Asymptomatic (n = 21) and symptomatic patients (n = 46) with a positive sonography for PAD or history of lower limb revascularization were included. ABI, pPP, cPP, and PWV were assessed. PWV were performed using a brachial cuff-based method (aortic PWV (aPWV)) and oscillography (carotid-femoral pulse wave velocity (cfPWV)), respectively. The two methods for PWV were compared using Bland Altman analysis. Sensitivities of ABI, pPP, cPP, cfPWV, and aPWV for AOD were calculated. Results: Sixty-seven patients (35.8 % female, mean age 69, range 39–91 years) had a significantly higher aPWV than cfPWV (median 10.5 m/s (IQR: 8.8–12.65 m/s) vs. median 9.0 m/s (IQR: 7.57–10.55 m/s), p = 0.0013). There was no correlation between cfPWV and age (r = 0.311, p = 0.116). Bland Altman analysis revealed a mean difference of -1.04 (-2SD; -6.38 to + 2SD; 4.31). The sensitivities for AOD were 68.7 % for ABI, 61.2 % for aPWV, 40.3 % for cfPWV, 31.3 % for peripheral PP, and 10.4 % for central aortic PP (p < 0.001). Conclusions: Brachial-derived aPWV differs from the gold standard assessment (cfPWV), which may be underestimated in PAD due to atherosclerotic obstructions along the aorto-iliac segment. The sensitivities of noninvasive in vivo markers of AOD vary widely and tend to underestimate the actual presence of AOD.
Collapse
Affiliation(s)
- Martina Frick
- Division of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Frederic Baumann
- Division of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Beate Sick
- Institute for Biostatistics, University Zurich, Zurich, Switzerland
| | - Ian B. Wilkinson
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Marc Husmann
- Division of Angiology, University Hospital Zurich, Zurich, Switzerland
- Centre for Vascular Diseases, Zurich-Stadelhofen, Zurich, Switzerland
| |
Collapse
|
5
|
Willenberg T, Banyai M, Frank U, Baldi T, Amann-Vesti B, Baumgartner I, Spirk D, Husmann M, Kucher N. Inconsistencies in the planning of the duration of anticoagulation among outpatients with acute deep-vein thrombosis. Thromb Haemost 2017; 105:239-44. [DOI: 10.1160/th10-08-0506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/17/2010] [Indexed: 11/05/2022]
Abstract
SummaryThree-month anticoagulation is recommended to treat provoked or first distal deep-vein thrombosis (DVT), and indefinite-duration anticoagulation should be considered for patients with unprovoked proximal, un-provoked recurrent, or cancer-associated DVT. In the prospective Out-patient Treatment of Deep Vein Thrombosis in Switzerland (OTIS-DVT) Registry of 502 patients with acute objectively confirmed lower extremity DVT (59% provoked or first distal DVT; 41% unprovoked proximal, unprovoked recurrent, or cancer-associated DVT) from 53 private practices and 11 hospitals, we investigated the planned duration of anticoagulation at the time of treatment initiation. The decision to administer limited-duration anticoagulation therapy was made in 343 (68%) patients with a median duration of 107 (interquartile range 91–182) days for provoked or first distal DVT, and 182 (interquartile range 111–184) days for unprovoked proximal, unprovoked recurrent, or cancer-associated DVT. Among patients with provoked or first distal DVT, anticoagulation was recommended for <3 months in 11%, ≥3 months in 63%, and for an indefinite period in 26%. Among patients with unprovoked proximal, unprovoked recurrent, or cancer-associated DVT, anticoagulation was recommended for <6 months in 22%, 6–12 months in 38%, and for an indefinite period in 40%. Overall, there was more frequent planning of indefinite-duration therapy from hospital physicians as compared with private practice physicians (39% vs. 28%; p=0.019). Considerable inconsistency in planning the duration of anticoagulation therapy mandates an improvement in risk stratification of outpatients with acute DVT.
Collapse
|
6
|
Simon R, Loo BVD, Kovacevic T, Brockes C, Rousson V, Amann-Vesti B, Spring S, Koppensteiner R. High-dose atorvastatin in peripheral arterial disease (PAD): Effect on endothelial function, intima-media-thickness and local progression of PAD. Thromb Haemost 2017; 99:182-9. [DOI: 10.1160/th07-04-0265] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryBeneficial effects of aggressive lipid-lowering with high-dose atorvastatin (80 mg/day) have been demonstrated in patients with coronary and cerebrovascular disease. The impact of such a therapy in patients with peripheral arterial disease (PAD) is less known so far. Here we studied the effects of high-dose atorvastatin on brachial artery endothelial function, common carotid intima-media thickness (IMT) and local progression of PAD in these patients. One hundred of 500 patients screened with documented PAD were randomly assigned to receive 80 mg of atorvastatin daily for six months or to continue on conventional medical treatment. Ninety-six percent of patients in the control group were on standard statin treatment. High resolution B-mode ultrasonography was used to study brachial artery flowmediated dilation (FMD), IMT and ankle-brachial index (ABI) at baseline and at six months. FMD and IMT at baseline and at six months were 4.1 (0.06–8.6) versus 5.0 (0.76 vs. 8.1) %, p=0.96, and 0.76 (0.66–0.82) versus 0.73 (0.63–0.81) mm, p=0.41, respectively, in the atorvastatin group, and 2.66 (-1.9 – 6.9) versus 3.65 (0.0–8.6)%, p=0.02, and 0.78 (0.71–0.90) versus 0.77 (0.70–0.90) mm, p=0.48,in the control group. ABI at baseline and at six months was not different in either group. LDL cholesterol was reduced from 2.53 (2.21–3.28) to 1.86 (1.38–2.29) mM (p<0.0001) in the atorvastatin group, whereas levels remained stable in the control group [2.38 (1.94–3.16) vs.2.33 (1.82–2.84) mM, p=0.61]. Major adverse cardiovascular events occurred in 2.1% in the atorvastatin group and 1.9% in the control group (p= 0.61). In conclusion, in this pilot trial aggressive lipid-lowering with 80 mg of atorvastatin daily for six months had no effect on brachial artery FMD in patients with PAD. IMT andABI were also similar in patients with and without high-dose atorvastatin at six months.
Collapse
|
7
|
Belch J, Carlizza A, Carpentier PH, Constans J, Khan F, Wautrecht JC, Visona A, Heiss C, Brodeman M, Pécsvárady Z, Roztocil K, Colgan MP, Vasic D, Gottsäter A, Amann-Vesti B, Chraim A, Poredoš P, Olinic DM, Madaric J, Nikol S, Herrick AL, Sprynger M, Klein-Weigel P, Hafner F, Staub D, Zeman Z. ESVM guidelines – the diagnosis and management of Raynaud’s phenomenon. VASA 2017; 46:413-423. [DOI: 10.1024/0301-1526/a000661] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Regarding the clinical diagnosis of Raynaud’s phenomenon and its associated conditions, investigations and treatment are substantial, and yet no international consensus has been published regarding the medical management of patients presenting with this condition. Most knowledge on this topic derives from epidemiological surveys and observational studies; few randomized studies are available, almost all relating to drug treatment, and thus these guidelines were developed as an expert consensus document to aid in the diagnosis and management of Raynaud’s phenomenon. This consensus document starts with a clarification about the definition and terminology of Raynaud’s phenomenon and covers the differential and aetiological diagnoses as well as the symptomatic treatment.
Collapse
Affiliation(s)
- Jill Belch
- University of Dundee School of Medicine, Dundee, United Kingdom
- Writing group
| | - Anita Carlizza
- Azienda Ospedaliera S.Giovanni-Addolorata, Rome, Italy
- Writing group
| | | | | | - Faisel Khan
- University of Dundee School of Medicine, Dundee, United Kingdom
- Writing group
| | | | - Adriana Visona
- Angiology Unit, Azienda ULSS 2, Marca Trevigiana, Treviso, Italy
- ESVM board authors
| | - Christian Heiss
- Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
- ESVM board authors
| | - Marianne Brodeman
- Division of Angiology, Medical University, Graz, Austria
- ESVM board authors
| | - Zsolt Pécsvárady
- Head of 2nd Dept. of Internal Medicine, Vascular Center, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
- ESVM board authors
| | - Karel Roztocil
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
- ESVM board authors
| | - Mary-Paula Colgan
- St. James’s Hospital and Trinity College, Dublin, Ireland
- ESVM board authors
| | - Dragan Vasic
- Clinical Centre of Serbia, Belgrade, Serbia
- ESVM board authors
| | - Anders Gottsäter
- Department of Vascular Diseases, Skåne University Hospital, Sweden
- ESVM board authors
| | | | - Ali Chraim
- Department of Vascular Surgery, Cedrus Vein and Vascular Clinic, Lviv Hospital, Lviv, Ukraine
- ESVM board authors
| | - Pavel Poredoš
- University Medical Centre Ljubljana, Slovenia
- ESVM board authors
| | - Dan-Mircea Olinic
- Medical Clinic no. 1, Iuliu Hatieganu, University of Medicine and Pharmacy, Cluj-Napoca, Romania
- ESVM board authors
| | - Juraj Madaric
- National Institute of Heart and Vascular Diseases, Bratislava, Slovakia
- ESVM board authors
| | - Sigrid Nikol
- Asklepios Klinik St. Georg, Klinische und Interventionelle Angiologie, Hamburg, Germany
- ESVM board authors
| | - Ariane L. Herrick
- Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom
- Country authors
| | - Muriel Sprynger
- Cardiology-Vascular Medicine, Cardiology Department, University Hospital Liège, Liège, France
- Country authors
| | - Peter Klein-Weigel
- Helios Klinik Berlin-Buch, Klinik für Angiologie, Berlin, Germany
- Country authors
| | - Franz Hafner
- Division of Angiology, Medical University, Graz, Austria
- Country authors
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, Switzerland
- Country authors
| | - Zan Zeman
- Department of Clinical Cardiology and Angiology, Hospital Bulovka, Prague, Czech Republic
- Country authors
| |
Collapse
|
8
|
Klingenberg R, Hagenbuch N, Seifert B, Jacomella V, Von Eckardstein A, Luescher T, Amann-Vesti B, Matter C, Husmann M. P1412Cysteine-rich angiogenic inducer 61 (Cyr61) - a novel biomarker in acute limb ischaemia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
Amann-Vesti B, Meier T. [New therapies for varicose veins]. Praxis (Bern 1994) 2016; 105:801. [PMID: 27381302 DOI: 10.1024/1661-8157/a002401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Thomas Meier
- 1 Klinik für Angiologie, Universitätsspital Zürich
| |
Collapse
|
10
|
Schlager O, Gajdosova Kovacicova L, Senn O, Amann-Vesti B, Wilkinson IB, Jacomella V, Husmann M. β-Blockers and Vascular Hemodynamics in Patients With Peripheral Arterial Disease. J Clin Hypertens (Greenwich) 2016; 18:1244-1249. [PMID: 27279251 DOI: 10.1111/jch.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022]
Abstract
Aortic augmentation index (AIx) is a marker of central aortic pressure burden and is modulated by antihypertensive drugs. In patients with peripheral arterial disease (PAD) undergoing antihypertensive treatment, aortic pressures parameters, heart rate-adjusted augmentation index (AIx75), and unadjusted AIx were determined. The (aortic) systolic and diastolic blood pressure did not differ between PAD patients who were taking β-blockers (n=61) and those who were not taking β-blockers (n=80). In patients taking β-blockers, augmentation pressure and pulse pressure were higher than in patients who did not take β-blockers (augmentation pressure, P=.02; pulse pressure, P=.005). AIx75 was lower in PAD patients taking β-blockers than in patients not taking β-blockers (P=.04), while the AIx did not differ between PAD patients taking and not taking β-blockers. The present study demonstrates that β-blockers potentially affect markers of vascular hemodynamics in patients with PAD. Because these markers are surrogates of cardiovascular risk, further studies are warranted to clarify the impact of selective β-blocker treatment on clinical outcome in patients with PAD.
Collapse
Affiliation(s)
- Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Wien, Austria
| | | | - Oliver Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | | | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | | | - Marc Husmann
- Division of Angiology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Johner F, Clemens R, Husmann M, Thalhammer C, Seifert B, Amann-Vesti B. Long-term follow-up after endovascular revascularisation for acute limb ischaemia--a retrospective single-centre cohort. VASA 2016; 45:247-52. [PMID: 27129071 DOI: 10.1024/0301-1526/a000532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We evaluated the long-term outcome after endovascular revascularisation for acute limb ischaemia (ALI). PATIENTS AND METHODS From a prospectively maintained database, 318 endovascular interventions for ALI were identified between 2004 and 2010. Event history and survival were analysed using the Kaplan-Meier method and Cox regression. Endpoints were target vessel revascularisation (TVR), non-target extremity revascularisation (NTER), amputation, major vascular events, coronary artery revascularisation and amputation-free survival. RESULTS Follow-up data of 303 patients (mean age 68.5 ± 12.7 years, 40% female) were available. The mean follow-up time was 38.7 ± 26.2 months. TVR was performed in 40.1 ± 2.9% at 1 year and 66.5 ± 3.8% at 5 years. NTER at 1 and 5 years were 7.1 ± 1.5% and 29.2 ± 4%, respectively. The proportion of patients who needed major or minor amputation was 4.3 ± 1.2% after 1 year and 9 ± 2.1% after 5 years. Amputation-free survival at 1 year was 90.3 ± 1.8% and 74.8 ± 3.2% at 5 years. Coronary artery disease (HR 2.22, 95% CI 1.33 to 3.7, p = 0.002) and atrial fibrillation (HR 2.56, % CI 1.3 to 5.04, p = 0.007) were independently associated with a worse amputation-free survival. The cumulative proportion surviving one year following acute limb ischemia was 95.4 ± 1.2% and 79.7 ± 3.1% after 5 years. CONCLUSIONS Long-term amputation-free survival after successful revascularisation for ALI is high; negative predictors are coronary artery disease and atrial fibrillation.
Collapse
Affiliation(s)
- Fabian Johner
- 1 Clinic for Angiology, University Hospital Zurich, Switzerland
| | - Robert Clemens
- 1 Clinic for Angiology, University Hospital Zurich, Switzerland
| | - Marc Husmann
- 1 Clinic for Angiology, University Hospital Zurich, Switzerland
| | | | - Burkhardt Seifert
- 2 Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | | |
Collapse
|
12
|
Catalano M, Poredos P, Brodmann M, Wautrecht JC, Carpentier P, Roztocil K, Nikol S, Dimakakos EP, Marakomichelakis G, Pecsvarady Z, Carlizza A, Sieron A, Stanek A, Olinic D, Stvrtinova V, Kozak M, Agewall S, Amann-Vesti B, Gallino A, Fitzgerald P, Colgan MP. UEMS training requirements for angiology and vascular medicine: european standards of postgraduate medical specialist training (ETR Document). INT ANGIOL 2016; 35:217-231. [PMID: 26883441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Mariella Catalano
- Division of Angiology and Vascular Medicine, Board of the Union Européenne des Médicins Spécialistes, Brussels, Belgium -
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Burgstaller JM, Steurer J, Held U, Amann-Vesti B. Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis. VASA 2016; 45:141-7. [DOI: 10.1024/0301-1526/a000508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.
Collapse
Affiliation(s)
- Jakob Martin Burgstaller
- Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zürich, Switzerland
| | - Johann Steurer
- Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zürich, Switzerland
| | - Ulrike Held
- Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zürich, Switzerland
| | | |
Collapse
|
14
|
Meier TO, Jacomella V, Clemens RKJ, Amann-Vesti B. Nitrous oxide/oxygen inhalation provides effective analgesia during the administration of tumescent local anaesthesia for endovenous laser ablation. VASA 2015; 44:473-8. [DOI: 10.1024/0301-1526/a000471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Tumescent anaesthesia (TA) is an important but sometimes very painful step during endovenous thermal ablation of incompetent veins. The aim of this study was to examine whether the use of fixed 50% nitrous oxide/oxygen mixture (N2O/O2), also called equimolar mixture of oxygen and nitrous oxide, reduces pain during the application of TA. Patients and methods: Patients undergoing endovenous laser ablation (EVLA) of incompetent saphenous veins were included. Thirty consecutive patients inhaled N2O/O2 during the application of TA. Thirty consecutive patients received TA alone (controls). Patients were asked to complete a questionnaire immediately after the intervention to assess satisfaction with the intervention and pain-levels during the different steps of the intervention (0 = not at all, 10 = very much). Adverse events during the treatment were monitored. Results: 30 patients (14 men, mean age of 44 years) were included in the N2O/O2 group and 30 patients (9 men, mean age 48 years) were included in the control group. In the N2O/O2 group a significantly lower pain score was noted (mean 2.45 points, range 0 - 6) compared to the controls (mean 4.3 points, range 1 - 9, p < 0.001). Overall, 64.5 % of the patients were perfectly satisfied with the N2O/O2-Inhalation. Only 4 patients receiving N2O/O2 complained of adverse effects such as unpleasant loss of control (2 patients), headache (1 patient) and dizziness (1 patient). Conclusions: N2O/O2 is a safe and effective method to reduce pain during the application of tumescent anaesthesia for EVLA.
Collapse
|
15
|
Beckmann M, Jacomella V, Kohler M, Lachat M, Salem A, Amann-Vesti B, Husmann M. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index. PLoS One 2015; 10:e0139887. [PMID: 26452151 PMCID: PMC4599890 DOI: 10.1371/journal.pone.0139887] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/19/2015] [Indexed: 01/11/2023] Open
Abstract
Background Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. Aim To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). Methods cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. Results In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). Conclusion Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease.
Collapse
Affiliation(s)
- Marianne Beckmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Angiology Division, Department of Internal Medicine, Kantonsspital St. Gallen, St Gallen, Switzerland
- * E-mail: (MB); (MH)
| | - Vincenzo Jacomella
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Malcom Kohler
- Clinic for Pneumology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Amr Salem
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Beatrice Amann-Vesti
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marc Husmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- * E-mail: (MB); (MH)
| |
Collapse
|
16
|
Hutter I, Kovacicova L, Jacomella V, Husmann M, Clemens R, Amann-Vesti B. Cognitive function in patients with peripheral artery disease: a prospective single-center cohort study. INT ANGIOL 2015; 34:459-466. [PMID: 25394954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of the present study was to examine the association between cardiovascular comorbidities and risk factors, and cognitive function in peripheral artery disease (PAD) patients, as well as to determine the influence of cognitive function on cardiovascular outcome in a two-year follow-up. METHODS The cognitive function of 104 PAD patients was assessed using the mini-mental test (MMSE). Ankle Brachial Index (ABI), Fontaine stage, PAD localization, cardiovascular risk factors and comorbidities were taken from the electronic patient charts. A multiple logistic regression model, which included myocardial infarction (MI), stroke/transient ischemic attack (TIA), diabetes mellitus (DM), coronary heart disease (CHD) and smoking was performed to compare patients with and without cognitive impairment. All study participants were followed for two years in order to evaluate their cardiovascular outcome, mortality and revascularisation rate. RESULTS There was no significant difference in mini-mental state between asymptomatic and symptomatic PAD patients. ABI and PAD localization was not related to cognitive function. However, pre-existing stroke, TIA, coronary artery disease (CAD) or DM were associated with a lower MMSE score. When MMSE was dichotomized in ≤27 and >27 points, the presence of CAD, history of cerebrovascular events and DM was associated with a MMSE ≤27 in multivariate analysis. There was no association between MMSE and cardiovascular event rate. CONCLUSION PAD patients with CAD, stroke, TIA or DM have worse cognitive function than those without these factors. There was no evidence that cognitve function influenced cardiovascular outcome.
Collapse
Affiliation(s)
- I Hutter
- Clinic for Angiology, University Hospital, Zürich, Switzerland -
| | | | | | | | | | | |
Collapse
|
17
|
Montelione N, Pecoraro F, Puippe G, Chaykovska L, Rancic Z, Pfammatter T, Mayer D, Amann-Vesti B, Husmann MJ, Veith FJ, Mangialardi N, Lachat M. A 12-Year Experience With Chimney and Periscope Grafts for Treatment of Type I Endoleaks. J Endovasc Ther 2015; 22:568-74. [DOI: 10.1177/1526602815586972] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the midterm outcomes of chimney and/or periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). Methods: Between June 2002 and April 2014, 24 consecutive patients (mean age 73.9±9.2 years; 23 men) presenting a type I endoleak were addressed with CPGs to extend the proximal and/or distal landing zone and to maintain side branch perfusion. Indication for treatment was a type Ia endoleak in 23 (96%) patients and a type Ib endoleak in one. Median interval from the previous EVAR to endoleak treatment with CPGs was 52.2±48.9 months (range 0.2–179). All patients had proximal/distal landing zones precluding any standard endovascular reintervention. Measured outcomes included technical success and perioperative mortality and morbidity. Technical success was defined as a procedure completed as intended, with no secondary procedures within 30 days. Midterm outcomes included survival, CPG patency, endoleaks, and freedom from reintervention. Results: Technical success was 96%; a single patient required an additional procedure to seal a recurrent type Ia endoleak. Intraoperative revascularization of all 55 target vessels (2.3/patient) with CPGs was successful. One (4%) patient died within 30 days. Estimated survival at 12, 24, and 36 months was 83%; estimated CPG patency at the same intervals was 94%. Over a mean follow-up of 23.4±29 months, 6 (25%) reinterventions were performed; of these, 4 were secondary to type I endoleak. Aneurysm diameters reduced from 88.3±26 to 85.5±33 mm (p=0.49) over the mean follow-up. Conclusion: The CPG technique is a safe and effective tool for treatment of type I endoleak after previous EVAR. The CPG technique is feasible even in nonelective patients, with excellent outcomes in terms of patency. Close imaging follow-up is warranted to rule out recurrent or de novo endoleaks.
Collapse
Affiliation(s)
- Nunzio Montelione
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
- Department of Surgery “P. Valdoni,” Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Felice Pecoraro
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
- Vascular Surgery Unit, University of Palermo, AOUP “P. Giaccone,” Palermo, Italy
| | - Gilbert Puippe
- Interventional Radiology, University Hospital Zurich, Switzerland
| | - Lyubov Chaykovska
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
| | - Zoran Rancic
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
| | | | - Dieter Mayer
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
| | | | - Marc J. Husmann
- Clinic for Angiology, University Hospital Zurich, Switzerland
| | - Frank J. Veith
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
- The Cleveland Clinic, Cleveland, OH, and New York University Medical Center, New York, NY, USA
| | | | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
| |
Collapse
|
18
|
Huggenberger K, Wagner S, Lehmann S, Aeschlimann A, Amann-Vesti B, Angst F. Health and quality of life in patients with primary and secondary lymphedema of the lower extremity. VASA 2015; 44:129-37. [DOI: 10.1024/0301-1526/a000419] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Little is known about comprehensively measured health and quality of life of lower limb lymphedema (LLL). The aim of this study was to determine health and quality of life of LLL patients stratified by primary and secondary lymphedema compared to a normative population-based data stratified by age, sex and comorbidity. Patients and methods: A cross-sectional study of patients after treatment at the department of angiology of a rehabilitation clinic was conducted. Self-assessment was performed by the Short Form 36 (SF-36) and two condition-specific measures. Results: Primary LLL (n = 52) 75 % female, mean age 47.1 years) reported health comparable to normative values, e. g. SF-36 physical functioning 80.4 (norm 84.1, p = 0.512) and SF-36 vitality 62.7 (59.7, p = 0.117) (mean scores, 100 = best). Secondary LLL (n = 60, 68 % female, mean age 60.6 years) scored 68.1 (73.9, p = 0.049) and 55.2 (56.2, p = 0.800) on the corresponding scales. Mean symptoms and function scores on the specific measures ranged from 70.0 to 83.1 for primary LLL (100 = best) and from 63.3 to 80.6 for secondary LLL. Function, vitality and both SF-36 role dimensions were higher in primary LLL than in secondary LLL, (mean SF-36 vitality 62.7 versus 55.2, p = 0.035). Conclusions: Overall health and quality of life was high and comparable to the general population norms in primary LLL. The same was true for most psycho-social scales in secondary LLL whereas functionally some deficits were recorded. Cancer as the most frequent cause for secondary LLL may affect health in these dimensions. Reported negative effects of LLL seem to be well compensated, especially in primary LLL and under optimal treatment.
Collapse
Affiliation(s)
- Kai Huggenberger
- Research Department Rehabilitation Clinic RehaClinic, Bad Zurzach, Switzerland
| | - Stephan Wagner
- Department of Angilogy, Department Rehabilitation Clinic RehaClinic, Bad Zurzach, Switzerland
| | - Susanne Lehmann
- Research Department Rehabilitation Clinic RehaClinic, Bad Zurzach, Switzerland
| | - André Aeschlimann
- Research Department Rehabilitation Clinic RehaClinic, Bad Zurzach, Switzerland, and Department of Rheumatology, Rehabilitation Clinic RehaClinic, Bad Zurzach, Switzerland
| | | | - Felix Angst
- Research Department Rehabilitation Clinic RehaClinic, Bad Zurzach, Switzerland
| |
Collapse
|
19
|
Clemens R, Amann-Vesti B. Vaskuläre Malformationen. Dtsch Med Wochenschr 2015; 140:156-9. [DOI: 10.1055/s-0041-100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
20
|
Beeler PE, Eschmann E, Schumacher A, Studt JD, Amann-Vesti B, Blaser J. Impact of electronic reminders on venous thromboprophylaxis after admissions and transfers. J Am Med Inform Assoc 2014; 21:e297-303. [PMID: 24671361 DOI: 10.1136/amiajnl-2013-002225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Clinical decision support has the potential to improve prevention of venous thromboembolism (VTE). The purpose of this prospective study was to analyze the effect of electronic reminders on thromboprophylaxis rates in wards to which patients were admitted and transferred. The latter was of particular interest since patient handoffs are considered to be critical safety issues. METHODS The trial involved two study periods in the six departments of a university hospital, three of which were randomly assigned to the intervention group displaying reminders during the second period. At 6 h after admission or transfer, the algorithm checked for prophylaxis orders within 0-30 h of the patient's arrival, increasing the specificity of the displayed reminders. RESULTS The significant impact of the reminders could be seen by prophylaxis orders placed 6-24 h after admission (increasing from 8.6% (223/2579) to 12% (307/2555); p<0.0001) and transfer (increasing from 2.4% (39/1616) to 3.7% (63/1682); p=0.034). In admission wards, the rate of thromboprophylaxis increased from 62.4% to 67.7% (p<0.0001), and in transfer wards it increased from 80.2% to 84.3% (p=0.0022). Overall, the rate of prophylaxis significantly increased in the intervention group from 69.2% to 74.3% (p<0.0001). No significant changes were observed in the control group. Postponing prophylaxis checks to 6 h after admissions and transfers reduced the number of reminders by 62% and thereby minimized the risk of alert fatigue. CONCLUSIONS The reminders improved awareness of VTE prevention in both admission and transfer wards. This approach may contribute to better quality of care and safer patient handoffs.
Collapse
Affiliation(s)
- P E Beeler
- Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland
| | - E Eschmann
- Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland
| | - A Schumacher
- Division of Angiology, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland
| | - J-D Studt
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - B Amann-Vesti
- Division of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - J Blaser
- Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
21
|
Gallino A, Aboyans V, Diehm C, Cosentino F, Stricker H, Falk E, Schouten O, Lekakis J, Amann-Vesti B, Siclari F, Poredos P, Novo S, Brodmann M, Schulte KL, Vlachopoulos C, De Caterina R, Libby P, Baumgartner I. Non-coronary atherosclerosis. Eur Heart J 2014; 35:1112-9. [PMID: 24595865 DOI: 10.1093/eurheartj/ehu071] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
During the last decades, the clinical and research interest in atherosclerosis has been mostly focused on coronary arteries. After the publications of the European Society Guidelines and AHA/ACC Guidelines on Peripheral artery diseases, and of the Registry REduction in Atherothrombosis for Continued Health Registry, there has been an increased interest in atherosclerosis of the lower extremity arteries and its presence in multifocal disease. However, awareness in the general population and the medical community of non-coronary artery diseases, and of its major prognostic implications remain relatively low. The aim of this general review stemming out of an ESC Working Group on Peripheral Circulation meeting in 2011 is to enhance awareness of this complex disease highlighting the importance of the involvement of atherosclerosis at different levels with respect to clinical presentation, diagnosis, and co-existence of the disease in the distinct arterial territories. We also emphasize the need of an interdisciplinary approach to face the broad and complex spectrum of multifocal disease, and try to propose a series of tentative recommendations and measures to be implemented in non-coronary atherosclerosis.
Collapse
Affiliation(s)
- Augusto Gallino
- Division of Vascular Medicine, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Frick M, Jacomella V, Roth S, Wilkinson I, Amann-Vesti B, Husmann M. P5.12 CAROTID-FEMORAL AND BRACHIAL PULSE WAVE VELOCITY IN PERIPHERAL ARTERIAL DISEASE. Artery Res 2014. [DOI: 10.1016/j.artres.2014.09.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
23
|
Abstract
Die in der Angiologie am häufigsten verwendete Klassifikation ist sicherlich die Stadieneinteilung der chronischen peripheren arteriellen Verschlusskrankheit (PAVK). In der Schweiz wird meistens die Stadieneinteilung nach Fontaine verwendet. Die Rutherford-Klassifikation wird sich in Zukunft vielleicht auch bei uns durchsetzen, da sie in wissenschaftlichen Publikationen und im angelsächsischen Raum fast ausschließlich verwendet wird. Sie muss aber klar unterschieden werden von der Klassifizierung der akuten Ischämie nach Rutherford, die hilfreich für die Einschätzung der Prognose der Extremität ist. Die Klassifizierung diabetischer Fußulzerationen nach Wagner wird von Wundfachleuten oft verwendet. Die Kombination mit den Armstrong-Stadien hat Vorteile, da diese das Vorliegen einer Ischämie und/oder eines Infektes mitberücksichtigen. Sowohl für die chronisch venöse Insuffizienz wie auch für das postthrombotische Syndrom gibt es bisher nicht wirklich gute und einheitlich verwendete Einteilungen. Am häufigsten wird die klinische Stadieneinteilung nach Widmer angegeben, die aber nur eine sehr grobe Einteilung zulässt. Das CEAP-System ist aufwendig, weshalb man heute oft nur das „C“ angibt. Die Vortest-Wahrscheinlichkeit für das Vorliegen einer tiefen Beinvenenthrombose kann mit dem Wells-Score, den es auch für die Lungenembolie gibt, abgeschätzt werden.
Collapse
|
24
|
Gerber PA, Thalhammer C, Schmied C, Spring S, Amann-Vesti B, Spinas GA, Berneis K. Small, dense LDL particles predict changes in intima media thickness and insulin resistance in men with type 2 diabetes and prediabetes--a prospective cohort study. PLoS One 2013; 8:e72763. [PMID: 23951331 PMCID: PMC3738563 DOI: 10.1371/journal.pone.0072763] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/13/2013] [Indexed: 12/13/2022] Open
Abstract
The association of small, dense low-density lipoprotein (sdLDL) particles with an increased cardiovascular risk is well established. However, its predictive value with regard to glucose metabolism and arterial disease in patients with type 2 diabetes has not been thoroughly investigated. We conducted a prospective longitudinal cohort study in patients with (pre)diabetes who were seen at baseline and after two years. sdLDL particles were determined by gradient gel electrophoresis. Insulin resistance was estimated by using the homeostatic model assessment 2 (HOMA2). Intima media thickness (IMT) and flow-mediated dilation (FMD) were assessed by ultrasound measurements. Fifty-nine patients (mean age 63.0 ± 12.2 years) were enrolled and 39 were seen at follow-up. IMT increased in the whole cohort during follow-up. The change in IMT was predicted by the proportion of sdLDL particles at baseline (p=0.03), and the change in FMD was predicted by LDL-cholesterol levels at baseline (p=0.049). HOMA2 and changes in HOMA2 correlated with the proportion of sdLDL particles and changes in this proportion, respectively (p<0.05 for both). Serum resistin levels increased in parallel with the increasing sdLDL particle number, while serum adiponectin increased only in patients with unaltered sdLDL particle number at follow-up (p<0.01 for both). In conclusion, the proportion of small, dense LDL particles and changes in this proportion are predictive of changes in intima media thickness and insulin resistance, and are closely associated with other determinants of an adverse metabolic status. Thus, this parameter extends the individual risk assessment beyond the limitations of traditional risk markers in patients with dysglycemia.
Collapse
Affiliation(s)
- Philipp A Gerber
- Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital, Zürich, Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
25
|
Johner F, Thalhammer C, Jacomella V, Husmann M, Amann-Vesti B. Differences in cardiovascular risk factors between patients with acute limb ischemia and intermittent claudication. Angiology 2013; 65:497-500. [PMID: 23644258 DOI: 10.1177/0003319713487428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this retrospective study, cardiovascular risk factors of patients with acute limb ischemia (ALI) were compared with those of intermittent claudication (IC). Furthermore, the association of ALI with environmental temperature and/or hematocrit level was tested. A total of 436 patients treated for ALI and 832 patients with IC were included in the analysis. Diabetes (P = .0001), smoking (P < .0001), and hypertension (P < .0001) were significantly less prevalent in the patients with ALI. Patients with IC had a higher rate of coronary artery disease (P = .003), and patients with ALI had a higher rate of cerebrovascular disease (P < .0001). There was no association between the outside temperature or hematocrit level and the occurrence of ALI. The hypothesis of seasonal incidence of ALI could not be confirmed, and there was no association of ALI with the hematocrit level.
Collapse
Affiliation(s)
- Fabian Johner
- Clinic for Angiology, University Hospital Zurich, Switzerland
| | | | | | - Marc Husmann
- Clinic for Angiology, University Hospital Zurich, Switzerland
| | | |
Collapse
|
26
|
Clemens R, Amann-Vesti B, Thalhammer C. Periphere Dopplerdruckmessung. Dtsch Med Wochenschr 2013; 137:e10. [DOI: 10.1055/s-0032-1330181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. Clemens
- Klinik für Angiologie, UniversitätsSpital Zürich
| | | | | |
Collapse
|
27
|
Spirk D, Willenberg T, Aujesky D, Husmann M, Hayoz D, Baldi T, Brugger A, Amann-Vesti B, Baumgartner I, Kucher N. Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry. QJM 2012; 105:1163-9. [PMID: 22908319 DOI: 10.1093/qjmed/hcs144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice. DESIGN AND METHODS Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests. RESULTS Among the 409 (70%) patients with biomarkers or echocardiography, 210 (51%) had at least one positive test and 67 (16%) had positive biomarkers and right ventricular dysfunction. The ICU admission rates were 5.1% without vs. 5.6% with testing (P = 0.78), and thrombolysis or embolectomy were performed in 2.8% vs. 4.9%, respectively (P = 0.25). In multivariate analysis, syncope [odds ratio (OR): 3.49, 95% confidence interval (CI): 1.20-10.15; P = 0.022], tachycardia (OR: 2.31, 95% CI: 1.37-3.91; P = 0.002) and increasing age (OR: 1.02; 95% CI: 1.01-1.04; P < 0.001) were associated with testing of cardiac risk; outpatient status at the time of PE diagnosis (OR: 2.24, 95% CI: 1.49-3.36; P < 0.001), cancer (OR: 1.81, 95% CI: 1.17-2.79; P = 0.008) and provoked PE (OR: 1.58, 95% CI: 1.05-2.40; P = 0.029) were associated with its absence. CONCLUSION Although elderly patients and those with clinically severe PE were more likely to receive a biomarker test or an echocardiogram, these tools were used in only two-thirds of the patients with acute non-massive PE and rarely in combination.
Collapse
Affiliation(s)
- D Spirk
- Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Ackermann B, Amann-Vesti B, Thalhammer C. 33-jähriger Patient mit einem vibrierenden Handgelenk nach Koronarangiographie. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1327208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- B. Ackermann
- Klinik für Angiologie, UniversitätsSpital Zürich, Schweiz
| | - B. Amann-Vesti
- Klinik für Angiologie, UniversitätsSpital Zürich, Schweiz
| | - C. Thalhammer
- Klinik für Angiologie, UniversitätsSpital Zürich, Schweiz
| |
Collapse
|
29
|
Pecoraro F, Rancic Z, Lachat M, Mayer D, Amann-Vesti B, Pfammatter T, Bajardi G, Veith FJ. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg 2012; 27:113-22. [PMID: 23088809 DOI: 10.1016/j.avsg.2012.05.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 07/06/2011] [Accepted: 05/06/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND CMI is caused by chronic occlusive disease of mesenteric arteries. In such an uncommon disease, clear recommendations are strongly needed. Unfortunately, treatment options for symptomatic CMI are still controversial and no guidelines exist. METHODS A systematic literature review of the last 25-years was conducted through MEDLINE, Embase, and Cochrane Review/Trials register to identify studies reporting on CMI treatment with more than 10 patients. Primary outcomes were perioperative mortality and morbidity rates. Secondary outcomes were survival rates, primary and secondary patency rates, vessels treated, CMI recurrence, follow-up (FU), technical success (TS), and in-hospital length of stay (InH-LOS). Patients were divided into endovascular treatment (ET) or open treatment (OT) groups. Subsequently, primary and secondary outcomes were analyzed by study publication year for the interval periods 1986-2000 ("A") and 2001-2010 ("B"). Differences were assessed using the t-test and the χ(2) test. RESULTS Forty-three articles with 1,795 patients were included. Perioperative mortality and morbidity rates were lower in the ET group. No difference in survival rate was observed. Primary and secondary patencies were superior in the OT group. A greater number of vessels were revascularized in the OT group. CMI recurrence was more frequent in the ET group. FU was longer in the OT group. TS was superior in the OT group and InH-LOS was shorter in the ET group. A higher number of patients were treated by ET in the period "A." No differences in mortality and morbidity were observed between period "A" and "B" in ET and OT groups. CONCLUSIONS Considering the lower periprocedural mortality and morbidity after ET, this approach should be considered as the first treatment option in most CMI patients, especially in those with severe malnutrition. Primary OT should be restricted to cases that do not qualify for ET or good surgical risk patients with long life expectancy. Considering better long-term results of OT, ET treatment should be considered as a bridge therapy to OT in some patients requiring retreatment if ET does not preclude subsequent OT.
Collapse
Affiliation(s)
- Felice Pecoraro
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; Vascluar Surgery Unit, University Hospital P. Giaccone, Via L.Giuffrè 5, Palermo, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Mosimann K, Jacomella V, Thalhammer C, Meier TO, Kohler M, Amann-Vesti B, Husmann M. Severity of Peripheral Arterial Disease is Associated With Aortic Pressure Augmentation and Subendocardial Viability Ratio. J Clin Hypertens (Greenwich) 2012. [DOI: 10.1111/j.1751-7176.2012.00702.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Schumacher A, Jacomella V, Stüssi G, Amann-Vesti B, Corti N, Husmann M. Castleman's disease and arterial thrombosis: result of excessively elevated interleukin-6 plasma level? VASA 2012; 41:145-8. [PMID: 22403134 DOI: 10.1024/0301-1526/a000178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Morbus Castleman is a benign non-clonal lymphoproliverative disorder. Immunomodulatory and antiproliferative drugs are used to treat this plasma cell disorder. We report the case of a 46-year old female patient with multicentric Castleman's disease and limb ischemia. Thrombotic occlusions of the popliteal and tibioperoneal arteries were treated by percutaneous thrombus aspiration. We discuss the role of increased interleukin-6 plasma levels during therapy with Tocilizumab, an antibody to interleukin-6 receptor, as a potential cause for arterial thrombosis.
Collapse
|
32
|
Jacomella V, Husmann M, Thalhammer C, Uike K, Pfammatter T, Amann-Vesti B. Impact of endovascular treatment of atherosclerotic renal artery stenosis on endothelial function and arterial blood pressure. INT ANGIOL 2012; 31:70-76. [PMID: 22330627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Renovascular disease may cause arterial hypertension and decreases renal function, which both impair endothelial function. Endothelial function, a surrogate marker for cardiovascular risk, can be assessed non-invasively by ultrasound. The aim of this study was to investigate the impact of percutaneous transluminal renal artery angioplasty (PTRA) with stenting on endothelial function and arterial blood pressure in patients with renal artery stenosis (RAS). METHODS Flow mediated dilatation of the brachial artery, flow velocities and shear stress were measured with high resolution ultrasound in 24 hypertensive patients with renal artery stenosis prior and one day after revascularization by PTRA with stenting. Endothelial-independent brachial dilatation was measured after application of nitroglycerin. RESULTS Endothelial-dependent dilatation improved from 2.4±0.9% to 6.1±1.4% (P=0.03), whereas endothelial-independent dilatation did not change after PTRA. Endothelial-dependent reactive hyperemic blood flow increased from 195±40 mL/min to 536±94 mL/min (P=0.0008), whereas endothelial-independent hyperemia did not increase after revascularization. After PTRA, shear stress at rest decreased from 37±11 to 23±3 dyne/cm² (P<0.0001), and reactive hyperemic shear stress increased from 89±29 to 107±12 dyne/cm² (P=0.014). The impact of PTRA on arterial blood pressure resulted in a mean decrease of 21±5 mmHg in systolic pressure (P<0.0001), of 9±2 mmHg in diastolic pressure (P=0.03), and of 14±5 mmHg in peripheral pulse pressure (P=0.0003), respectively. CONCLUSION Endovascular treatment of renovascular disease improves endothelial function and decreases in resting shear stress.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Angioplasty, Balloon/instrumentation
- Atherosclerosis/complications
- Atherosclerosis/diagnostic imaging
- Atherosclerosis/physiopathology
- Atherosclerosis/therapy
- Blood Flow Velocity
- Blood Pressure
- Brachial Artery/diagnostic imaging
- Brachial Artery/drug effects
- Brachial Artery/physiopathology
- Compliance
- Endothelium, Vascular/diagnostic imaging
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/physiopathology
- Female
- Humans
- Hyperemia/physiopathology
- Hypertension, Renovascular/diagnostic imaging
- Hypertension, Renovascular/etiology
- Hypertension, Renovascular/physiopathology
- Hypertension, Renovascular/therapy
- Male
- Middle Aged
- Nitroglycerin/administration & dosage
- Prospective Studies
- Regional Blood Flow
- Renal Artery Obstruction/diagnostic imaging
- Renal Artery Obstruction/etiology
- Renal Artery Obstruction/physiopathology
- Renal Artery Obstruction/therapy
- Stents
- Stress, Mechanical
- Switzerland
- Treatment Outcome
- Ultrasonography, Doppler
- Vasodilation
- Vasodilator Agents/administration & dosage
Collapse
Affiliation(s)
- V Jacomella
- Clinic for Angiology, Zurich University Hospital, Raemistrasse 100, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
33
|
Clemens R, Amann-Vesti B, Thalhammer C. Periphere Dopplerdruckmessung. Dtsch Med Wochenschr 2012; 137:271-3. [DOI: 10.1055/s-0031-1298898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- R. Clemens
- Klinik für Angiologie, UniversitätsSpital Zürich
| | | | | |
Collapse
|
34
|
Brugger A, Amann-Vesti B, Thalhammer C. 34-jährige Patientin mit belastungsabhängigen Wadenschmerzen. Dtsch Med Wochenschr 2012; 137:217-8. [DOI: 10.1055/s-0032-1302479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- A. Brugger
- Klinik für Angiologie, UniversitätsSpital Zürich, Schweiz
| | - B. Amann-Vesti
- Klinik für Angiologie, UniversitätsSpital Zürich, Schweiz
| | - C. Thalhammer
- Klinik für Angiologie, UniversitätsSpital Zürich, Schweiz
| |
Collapse
|
35
|
Jacomella V, Wasila M, Husmann M, Gitzelmann G, Meier T, Amann-Vesti B. Plasma Homocysteine is Not Related to the Severity of Microangiopathy in Secondary Raynaud Phenomenon. Open Rheumatol J 2012; 5:64-8. [PMID: 22216066 PMCID: PMC3245410 DOI: 10.2174/1874312901105010064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 09/28/2011] [Accepted: 10/10/2011] [Indexed: 11/29/2022] Open
Abstract
Introduction: The role of elevated homocysteine in primary and secondary Raynaud phenomenon (RP) and in patients with atherosclerosis has been reported controversially. In secondary RP due to connective tissue disease specific alterations of nailfold capillaries might be present. An association between these microvascular changes and homocysteine has been suggested. Aim: The aim of this study was to determine whether homocysteine level differs between patients with primary and secondary RP and to test the hypothesis that homocysteine or other cardiovascular risk factors are associated with specific features of microangiopathy in secondary RP. Patients and Methods Eighty-one consecutive patients with RP referred for vascular assessment were studied by nailfold capillaroscopy. Homocysteine, C-reactive protein and cholesterol were measured and other cardiovascular risk factors and comorbidities assessed. Results: Homocysteine, C-reactive-protein and cholesterol levels did not differ between patients with primary (n=60) and secondary RP (n=21). Likewise, no differences in the prevalence of cardiovascular risk factors and comorbidities were found. In secondary RP no correlation was found between microvascular involvement and homocysteine or C-reactive protein. Conclusion: Plasma homocysteine is not different in patients with either primary or secondary RP and is therefore not a marker for the distinction of these diseases. The extent of microvascular involvement in secondary RP does not correlate with plasma homocysteine.
Collapse
|
36
|
Spirk D, Husmann M, Hayoz D, Baldi T, Frauchiger B, Engelberger R, Amann-Vesti B, Baumgartner I, Kucher N. Predictors of in-hospital mortality in elderly patients with acute venous thrombo-embolism: the SWIss Venous ThromboEmbolism Registry (SWIVTER). Eur Heart J 2011; 33:921-6. [PMID: 22036872 DOI: 10.1093/eurheartj/ehr392] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Although acute venous thrombo-embolism (VTE) often afflicts patients with advanced age, the predictors of in-hospital mortality for elderly VTE patients are unknown. METHODS AND RESULTS Among 1247 consecutive patients with acute VTE from the prospective SWIss Venous ThromboEmbolism Registry (SWIVTER), 644 (52%) were elderly (≥65 years of age). In comparison to younger patients, the elderly more often had pulmonary embolism (PE) (60 vs. 42%; P< 0.001), cancer (30 vs. 20%; P< 0.001), chronic lung disease (14 vs. 8%; P= 0.001), and congestive heart failure (12 vs. 2%; P< 0.001). Elderly VTE patients were more often hospitalized (75 vs. 52%; P< 0.001), and there was no difference in the use of thrombolysis, catheter intervention, or surgical embolectomy between the elderly and younger PE patients (5 vs. 6%; P= 0.54), despite a trend towards a higher rate of massive PE in the elderly (8 vs. 4%; P= 0.07). The overall in-hospital mortality rate was 6.6% in the elderly vs. 3.2% in the younger VTE patients (P= 0.033). Cancer was associated with in-hospital death both in the elderly [hazard ratio (HR) 4.91, 95% confidence interval (CI) 2.32-10.38; P< 0.001] and in the younger patients (HR 4.90, 95% CI 1.37-17.59; P= 0.015); massive PE was a predictor of in-hospital death in the elderly only (HR 3.77, 95% CI 1.63-8.74; P= 0.002). CONCLUSION Elderly patients had more serious VTE than younger patients, and massive PE was particularly life-threatening in the elderly.
Collapse
Affiliation(s)
- David Spirk
- Medical Affairs, Sanofi-Aventis (Suisse) SA, Meyrin, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Jacomella V, Shenoy A, Mosimann K, Kohler M, Thalhammer C, Amann-Vesti B, Husmann M. 326 IMPACT OF LOWER LIMB REVASCULARIZATION ON AORTIC AUGMENTATION INDEX AND SUBENDOCARDIAL VIABILITY RATIO IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
38
|
Spirk D, Banyai M, Jacomella V, Frank U, Baldi T, Baumgartner I, Amann-Vesti B, Kucher N, Husmann M. Outpatient management of acute deep vein thrombosis: Results from the OTIS-DVT registry. Thromb Res 2011; 127:406-10. [DOI: 10.1016/j.thromres.2011.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/20/2010] [Accepted: 01/11/2011] [Indexed: 12/01/2022]
|
39
|
Mason RH, Ruegg G, Perkins J, Hardinge M, Amann-Vesti B, Senn O, Stradling JR, Kohler M. Obstructive Sleep Apnea in Patients with Abdominal Aortic Aneurysms. Am J Respir Crit Care Med 2011; 183:668-74. [DOI: 10.1164/rccm.201001-0051oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
40
|
Willenberg T, Schumacher A, Amann-Vesti B, Jacomella V, Thalhammer C, Diehm N, Baumgartner I, Husmann M. Impact of obesity on venous hemodynamics of the lower limbs. J Vasc Surg 2010; 52:664-8. [PMID: 20576394 DOI: 10.1016/j.jvs.2010.04.023] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/01/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
|
41
|
Hafner J, Nobbe S, Partsch H, Läuchli S, Mayer D, Amann-Vesti B, Speich R, Schmid C, Burg G, French LE. Martorell Hypertensive Ischemic Leg Ulcer. ACTA ACUST UNITED AC 2010; 146:961-8. [DOI: 10.1001/archdermatol.2010.224] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
42
|
Meier TO, Schneider E, Amann-Vesti B. Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization. VASA 2010; 39:189-95. [PMID: 20464677 DOI: 10.1024/0301-1526/a000027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The popliteal artery entrapment syndrome (PAES), a rare cause for leg ischemia, is usually treated by surgical removal of the compressing structure and either venous bypass or interposition graft. However, endovascular revascularization followed by surgery to release the artery has been reported as a feasible alternative. So far long-term results of this approach are not known. We report the follow-up of three patients with PAES and thrombotic occlusion of the popliteal and calf arteries treated by local lysis, percutaneous thrombembolectomy and angioplasty followed by musculotendinous dissection. One patient had an uneventful follow-up of 11 years while the second patient developed a popliteal aneurysm four months after the index procedure. In the third patient, angioplasty of a stenosis of the popliteal artery was performed after two years. However, occlusion of the artery occurred two years later due to a small popliteal aneurysm. Endovascular revascularization followed by surgical release of the artery may be a viable alternative in the treatment of PAES especially in cases with distal embolization. However, careful follow-up by duplex ultrasound is mandatory because of the high risk of reocclusion or development of a popliteal aneurysm.
Collapse
Affiliation(s)
- T O Meier
- Clinic for Angiology, University Hospital Zurich, Switzerland.
| | | | | |
Collapse
|
43
|
Magnetti F, Thalhammer C, Hechelhammer L, Husmann M, Pfammatter T, Amann-Vesti B. Spontaneous pseudoaneurysm of a femoro-popliteal Omniflow II graft treated with a stentgraft. VASA 2010; 39:196-8. [PMID: 20464678 DOI: 10.1024/0301-1526/a000028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the case of a symptomatic spontaneous leak of a biosynthetic graft (Omniflow (II) treated endovascularly with a stentgraft. Potential degeneration of biosynthetic grafts with aneurysm formation is a well known problem with a reported incidence of up to 7 %. Implantation of a stentgraft for treatment of a pseudoaneurysm is a valuable treatment option in native arteries; however its use in Omniflow II bypass grafts has not been reported so far. Surveillance of peripheral bypass grafts with duplex ultrasound may be helpful to detect morphological alterations of the graft.
Collapse
Affiliation(s)
- F Magnetti
- Clinic for Angiology, University Hospital Zürich, Switzerland
| | | | | | | | | | | |
Collapse
|
44
|
Poloczek A, Amann-Vesti B, Thalhammer C, Meier T, Husmann M. Successful treatment of a mycotic pseudoaneurysm of the brachial artery with percutaneous ultrasound-guided thrombin injection and antibiotics. VASA 2010; 39:181-3. [PMID: 20464675 DOI: 10.1024/0301-1526/a000025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the case of a 48 year old male with human immuno-deficiency virus and hepatitis C virus infection and previous grafting of a thoracic aortic aneurysm. He returned from a trip to India with fever and in a poor physical condition. Diagnostic work-up revealed septicaemia with staphylococcus aureus, infection of the aortic graft with covered rupture of the proximal anastomosis and mitral valve endocarditis. Following antibiotic therapy, implantation of a transcutaneous endovascular aortic prosthesis and mitral valve repair were performed. During the postoperative period, the patient complained of pain and a palpable pulsating mass in the right cubital fossa. Ultrasound scan revealed a pseudoaneurysm at the brachial artery bifurcation. Since there were no signs of venous puncture in this area, we assumed this to be a mycotic pseudoaneurysm resulting from septic embolism. In the absence of clinical signs of inflammation, this pseudoaneurysm was successfully treated by ultrasound-guided thrombin injection. Irrespective of the cause for this mycotic pseudoaneurysm of the brachial artery, percutaneous ultrasound-guided thrombin closure in combination with antibiotic therapy might be a feasible, safe, cheap and minimally-invasive alternative to surgery.
Collapse
Affiliation(s)
- A Poloczek
- Swiss Cardiovascular Center, Division of Clinical and Interventional Angiology, Inselspital, University Hospital Bern, Switzerland
| | | | | | | | | |
Collapse
|
45
|
Wyss CA, Neidhart M, Altwegg L, Spanaus KS, Yonekawa K, Wischnewsky MB, Corti R, Kucher N, Roffi M, Eberli FR, Amann-Vesti B, Gay S, von Eckardstein A, Lüscher TF, Maier W. Cellular actors, Toll-like receptors, and local cytokine profile in acute coronary syndromes. Eur Heart J 2010; 31:1457-69. [PMID: 20447947 DOI: 10.1093/eurheartj/ehq084] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS Inflammation plays a key role in acute coronary syndromes (ACS). Toll-like receptors (TLR) on leucocytes mediate inflammation and immune responses. We characterized leucocytes and TLR expression within coronary thrombi and compared cytokine levels from the site of coronary occlusion with aortic blood (AB) in ACS patients. METHODS AND RESULTS In 18 ACS patients, thrombi were collected by aspiration during primary percutaneous coronary intervention. Thrombi and AB from these patients as well as AB from 10 age-matched controls without coronary artery disease were assessed by FACS analysis for cellular distribution and TLR expression. For further discrimination of ACS specificity, seven non-coronary intravascular thrombi and eight thrombi generated in vitro were analysed. In 17 additional patients, cytokine levels were determined in blood samples from the site of coronary occlusion under distal occlusion and compared with AB. In coronary thrombi from ACS, the percentage of monocytes related to the total leucocyte count was greater than in AB (47 vs. 20%, P = 0.0002). In thrombi, TLR-4 and TLR-2 were overexpressed on CD14-labelled monocytes, and TLR-2 was increased on CD66b-labelled granulocytes, in comparison with leucocytes in AB. In contrast, in vitro and non-coronary thrombi exhibited no overexpression of TLR-4. Local blood samples taken under distal occlusion revealed elevated concentrations of chemokines (IL-8, MCP-1, eotaxin, MIP-1alpha, and IP-10) and cytokines (IL-1ra, IL-6, IL-7, IL-12, IL-17, IFN-alpha, and granulocyte-macrophage colony-stimulating factor) regulating both innate and adaptive immunity (all P < 0.05). CONCLUSION In ACS patients, monocytes accumulate within thrombi and specifically overexpress TLR-4. Together with the local expression patterns of chemokines and cytokines, the increase of TLR-4 reflects a concerted activation of this inflammatory pathway at the site of coronary occlusion in ACS.
Collapse
Affiliation(s)
- Christophe A Wyss
- Department of Cardiology, Cardiovascular Center, University Hospital, Rämistrasse 100, CH - 8091 Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Georg Fröhlich
- Department of Internal Medicine, Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
| | | | | |
Collapse
|
47
|
Thalhammer C, Amann-Vesti B. 67-jähriger Mann mit Grippesymptomen und Halsschwellung. Dtsch Med Wochenschr 2009; 134:2125-6. [DOI: 10.1055/s-0029-1241902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
48
|
Thalhammer C, Amann-Vesti B. [55-year-old patient with a condition after a testicular tumor]. Dtsch Med Wochenschr 2009; 134:1227-8. [PMID: 19472095 DOI: 10.1055/s-0029-1222599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Thalhammer
- Universitätspital Zürich, Departement Innere Medizin, Klinik für Angiologie, Rämistrasse 100, Zürich, Switzerland.
| | | |
Collapse
|
49
|
Van Der Loo B, Naef F, Spring S, Rousson V, Amann-Vesti B, Koppensteiner R. Lack of major gender-related differences in patients undergoing elective endovascular or surgical repair of abdominal aortic aneurysm. INT ANGIOL 2009; 28:50-55. [PMID: 19190556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The aim of this single center retrospective study was to determine gender-related differences in patients undergoing repair of aortic aneurysm. METHODS A total of 296 consecutive patients with an abdominal aneurysm undergoing elective endovascular or surgical repair was included in the study. Among these, 24 (8.1%) were females and 272 (91.9%) were males. Demographic and clinical characteristics as well as laboratory values in terms of any potential gender-specific differences were compared. RESULTS Females were significantly older at the time of repair than males. No gender-related differences were found analysing major clinical and laboratory parameters. CONCLUSIONS The clinical and laboratory profile with which males and females present at the time of elective endovascular or surgical repair for aortic aneurysm is very similar. It does not reveal any potential gender-specific risk constellation. It eventually remains unclear why the prevalence of aortic aneurysm is higher in male than in females.
Collapse
Affiliation(s)
- B Van Der Loo
- Clinic of Angiology, Department of Medicine, University Hospital Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
50
|
Roffi M, Greutmann M, Schwarz U, Luscher TF, Eberli FR, Amann-Vesti B. Flow impairment during protected carotid artery stenting: impact of filter device design. J Endovasc Ther 2008; 15:103-9. [PMID: 18254671 DOI: 10.1583/07-2252.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the impact of filter design on blood flow impairment in the internal carotid artery (ICA) among patients undergoing carotid artery stenting (CAS) using filter-type emboli protection devices (EPD). METHODS Between July 2003 and March 2007, 115 filter-protected CAS procedures were performed at an academic institution in 107 consecutive patients (78 men; mean age 68 years, range 38-87). The Angioguard, FilterWire EZ, and Spider filters were used in 68 (59%), 32 (28%), and 15 (13%) of cases, respectively. Patient characteristics, procedural and angiographic data, and outcomes were prospectively entered into an electronic database and reviewed retrospectively along with all angiograms. RESULTS Flow impairment while the filter was in place was observed in 25 (22%) cases. The presumptive reason of flow impairment was filter obstruction in 21 (18%) instances and flow-limiting spasm at the level of the filter in 4 (4%). In all cases, flow was restored after retrieval of the filter. Flow obstruction in the ICA occurred more frequently with Angioguard (22/68; 32.3%) than with FilterWire EZ (2/32; 6.2%) or Spider (1/15; 6.7%; p = 0.004). No flow occurred in 13 (19%) procedures, all of them protected with Angioguard; no patient treated with other devices experienced this event (p = 0.007). Two (8.0%) strokes occurred in procedures associated with flow impairment, while 1 (1.1%) event was observed in the presence of preserved flow throughout the intervention (p = 0.11). CONCLUSION Flow impairment in the ICA during filter-based CAS is common and related to the type of filter used.
Collapse
Affiliation(s)
- Marco Roffi
- Andreas Gruntzig Cardiovascular Catheterization Laboratories, Department of Cardiology, University Hospital, Raemistrasse 100, Zurich, Switzerland.
| | | | | | | | | | | |
Collapse
|