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Muster V, Raggam RB, Urbanic-Purkart T, Posch F, Gütl K, Rabensteiner J, Prüller F, von Campe G, Rief M, Brodmann M, Gary T. P11.01.B Lower-extremity deep vein thrombosis and bleeding complications in primary brain tumor patients: A prospective study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.190] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Primary brain tumor patients have a high risk of venous thromboembolism (VTE). Bleeding risk with prophylactic and therapeutic anticoagulation is an important concern in these patients, and data on the management of asymptomatic VTE events in this population are lacking. The aim of this prospective study is to investigate risk and risk factors for asymptomatic lower-extremity deep-vein thrombosis (LE-DVT) in patients with primary brain tumors, and to estimate the rate of bleeding complications on full, prophylactic or no anticoagulation.
Material and Methods
We included consecutive patients with primary brain tumours undergoing surgery. Screening for asymptomatic LE-DVT by compression ultrasound (CUS) was performed pre-operatively and postoperatively within 2 months after surgery. Telephone follow-up was done 6 and 12 months after surgery. The protocol pre-specified therapeutic doses of low-molecular-weight heparin (LMWH) in case of detection of an asymptomatic LE-DVT.
Results
Fifty patients were included (female: 34%, median age 58 years, WHO grade IV tumors: 78%, prophylactic-dose LMWH at baseline: 12%). During a median observation period of 9.1 months, LE-DVT was detected in 9 patients (18%). LE-DVTs included two asymptomatic events (4%) at pre-operative screening, five asymptomatic events (10%) at postoperative screening, and two symptomatic events (4%, both 4-level LE-DVT) at telephone follow-up. This corresponded to a 12-month cumulative incidence of LE-DVT of 14.9% (95%CI: 6.4-26.6). At postoperative screening, n=10 patients were on prophylactic-dose LMWH, and one of these patients had an LE-DVT event detected by screening. The two patients with symptomatic LE-DVT were not on thromboprophylaxis at the time of event. Among a variety of investigated potential risk factors, only higher age (Odds Ratio (OR) per 5 years increase=1.46, 95%CI: 1.01-2.13, p=0.05), higher neurologic assessment in neuro-oncology (NANO) scale (OR per 1 point increase=1.59, 1.00-2.54, p=0.05), higher serum Galectin-3 levels (OR per 1ng/ml increase=1.20, 1.01-1.42, p=0.041) but not D-Dimer (OR per 1mg/L increase=1.89, 0.75-4.77, p=0.178) emerged as significant predictors of any LE-DVT. Six patients (12%) developed bleeding events, including n=3 operative intracranial bleedings without LMWH, n=1 spontaneous ventricular hemorrhage without LMWH, n=1 minor subcutaneous bleeding without LMWH, and 1 intracerebral hematoma during therapeutic-dose LMWH initiated for asymptomatic distal LE-DVT.
Conclusion
In our study we detected a high-frequency of asymptomatic LE-DVT in patients with primary brain tumours. Conversely, symptomatic LE-DVT risk was low, which may be related to prior screening. Patients with primary brain tumors appear to have LE-DVT risk factors specific to this entity. Prophylactic-dose LMWH did not show any adverse safety signals regarding bleeding.
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Affiliation(s)
- V Muster
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - R B Raggam
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | | | - F Posch
- Division of Haematology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - K Gütl
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - J Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria
| | - F Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria
| | - G von Campe
- Department of Neurosurgery, Medical University Graz , Graz , Austria
| | - M Rief
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz , Graz , Austria
| | - M Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - T Gary
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
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Muster V, Raggam R, Urbanic-Purkart T, Posch F, Gütl K, Rabensteiner J, Prüller F, von Campe G, Rief M, Brodmann M, Gary T. PO-13: Lower-extremity deep vein thrombosis and bleeding complications in primary brain tumor patients: a prospective study. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00201-8] [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: 11/16/2022]
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Belch J, Brodmann M, Baumgartner I, Binder C, Casula M, Heiss C. Lipid-Lowering and Anti-Thrombotic Therapy in Patients With Peripheral Arterial Disease: European Atherosclerosis Society/European Society of Vascular Medicine Joint Statement. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2021.12.009] [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: 10/19/2022]
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Tepe G, Brodmann M, Werner M. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Metzner T, Leitner D, Dimsity G, Gunzer F, Opriessnig P, Mellitzer K, Beck A, Sourij H, Stojakovic T, Deutschmann H, März W, Landmesser U, Brodmann M, Reishofer G, Scharnagl H, Toplak H, Silbernagel G. Short-term effects of intensive LDL-cholesterol lowering with alirocumab on vascular structure and function. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.700] [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: 10/20/2022]
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Torsello G, Stavroulakis C, Brodmann M, Micari A, Tepe G, Veroux P. Three-Year Sustained Clinical Efficacy of Drug-Coated Balloon Angioplasty in a Real-World Cohort. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Venermo M, Sprynger M, Desormais I, Björck M, Brodmann M, Cohnert T, De Carlo M, Espinola-Klein C, Kownator S, Mazzolai L, Naylor R, Vlachopoulos C, Ricco JB, Aboyans V. Follow-up of Patients After Revascularisation for Peripheral Arterial Diseases: A Consensus Document From the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society of Vascular Surgery. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.10.017] [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: 10/25/2022]
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Mustapha J, Brodmann M, Geraghty P, Saab F, Settlage R, Jaff M. Drug-Coated Versus Uncoated Percutaneous Transluminal Angioplasty in Infra-popliteal Arteries: Six-Month Results of the Lutonix BTK Trial. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.011] [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: 10/25/2022]
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Schneider P, Laird J, Doros G, Gao Q, Ansel G, Brodmann M. Mortality Not Correlated With Paclitaxel Exposure: An Independent Patient-Level Meta-analysis of a Drug-Coated Balloon. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Muntean R, Pascal DT, Rost U, Holtkotte L, Näther J, Köster F, Underberg M, Hülser T, Brodmann M. Investigation of Iridium Nanoparticles Supported on Sub-stoichiometric Titanium Oxides as Anodic Electrocatalysts in PEM Electrolysis. Part I.: Synthesis and Characterization. Top Catal 2019. [DOI: 10.1007/s11244-019-01164-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rost U, Podleschny P, Schumacher M, Muntean R, Pascal DT, Mutascu C, Koziolek J, Marginean G, Brodmann M. Long-term Stable Electrodes Based on Platinum Electrocatalysts Supported on Titanium Sintered Felt for the Use in PEM Fuel Cells. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1757-899x/416/1/012013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- M Brodmann
- Division of Angiology, Department of Internal Medicine, University Hospital Graz, Austria.
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Hackl G, Jud P, Avian A, Gary T, Deutschmann H, Seinost G, Brodmann M, Hafner F. COPART Risk Score, Endothelial Dysfunction, and Arterial Hypertension are Independent Risk Factors for Mortality in Claudicants. Eur J Vasc Endovasc Surg 2016; 52:211-7. [PMID: 27369292 DOI: 10.1016/j.ejvs.2016.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 05/17/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The COPART risk score consists of six variables to assess the prognosis of PAOD patients. The flow mediated dilation (FMD) quantifies endothelial function. The aim of this study was to evaluate the mortality prediction of these two variables in a long-term observation of claudicants. METHODS 184 consecutive claudicants were included in a prospective observational study over a median observation period of 7.9 (IQR 7.2-8.7) years. The endothelial function was assessed on the day of study inclusion using brachial FMD. RESULTS Three groups were assigned according to the COPART risk score: low risk (LR), n = 72 (39%); medium risk (MR), n = 59 (32%); and high risk (HR), n = 53 (29%). Overall survival rates differed among COPART risk score groups (p < .001, 5 year survival: LR group 83% [95% CI 74-92%]; MR group 73% [95% CI 62-84%]; HR group 57% [95% CI 43-70%]). Survivors had a significantly better median FMD than non-survivors (4.1% [IQR 1.2-6.4] vs. 1.3% [IQR 0.0-4.2]; p < .001). Also the FMD differed significantly among the three COPART risk groups (LR 4.0% [IQR 1.2-6.3], MR 2.3% [IQR 0.0-6.3], HR 1.7% [IQR 0.0-3.6]; p = .033). Finally, independent predictors for disease specific survival were COPART risk score (p = .033; MR group [HR 1.6], 95% CI 0.7-3.6; HR group [HR 2.7], 95% CI 1.2-5.8), FMD (p = .004; FMD ≤2.5 vs. >2.5, HR 2.6, 95% CI 1.4-4.9), and arterial hypertension (p = .039; HR 3.5, 95% CI 1.1-11.3). CONCLUSIONS COPART risk score, FMD, and arterial hypertension are independent long-term mortality predictors in this group of claudicants. The best mortality assessment is provided by including all three predictors.
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Affiliation(s)
- G Hackl
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Austria.
| | - P Jud
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Austria
| | - A Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Austria
| | - T Gary
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Austria
| | - H Deutschmann
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical University Graz, Austria
| | - G Seinost
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Austria
| | - M Brodmann
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Austria
| | - F Hafner
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Austria
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Wissgott C, Brodmann M, Holden A, Staffa R, Zeller T, Vasudevan T, Schneider P. Clip-optimierte Ballonangioplastie für die Unterschenkelarterien (TOBA – BTK): 6 Monats-Ergebnisse. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581493] [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: 10/22/2022]
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15
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Hackl G, Belaj K, Gary T, Rief P, Deutschmann H, Seinost G, Brodmann M, Hafner F. COPART Risk Score Predicts Long-term Mortality in Peripheral Arterial Occlusive Disease. Eur J Vasc Endovasc Surg 2015; 50:94-100. [DOI: 10.1016/j.ejvs.2015.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
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Aboyans V, Brodmann M, De Carlo M, Clement D, Mazzolai L, van Bortel L, van Sambeek MRH, Vlachopoulos C. The year in cardiology 2014: peripheral circulation. Eur Heart J 2015; 36:591-7. [DOI: 10.1093/eurheartj/ehu515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Gary T, Pichler M, Belaj K, Eller P, Hafner F, Gerger A, Brodmann M. Lymphocyte-to-monocyte ratio: a novel marker for critical limb ischemia in PAOD patients. Int J Clin Pract 2014; 68:1483-7. [PMID: 25359092 DOI: 10.1111/ijcp.12495] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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] [Received: 02/19/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The lymphocyte-to-monocyte ratio (LMR) is easily determined from the white blood cell count. Lymphocytes were previously investigated as a part of the neutrophil-to-lymphocyte ratio (NLR) in patients with atherosclerotic disease and an elevated NLR was negatively associated with cardiovascular endpoints. As monocytes play a leading role in the progression of atherosclerosis, especially in peripheral arterial occlusive disease (PAOD), we investigated LMR and its association with critical limb ischemia and other vascular endpoints in PAOD patients. METHODS AND FINDINGS We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. LMR was calculated and the cohort was divided into tertiles according to the LMR. An optimal cut-off value for the continuous LMR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI decreased significantly with an increase in LMR. An LMR of 3.1 was identified as an optimal cut-off. Two groups were categorized, one with 1021 patients (LMR < 3.1) and a second one with 1100 patients (LMR ≥ 3.1). CLI was more frequent in LMR < 3.1 patients [426 (41.7%)] than in LMR ≥ 3.1 patients [254 (23.1%)] (p < 0.001), as was also the case with prior myocardial infarction [60 (9.5%) vs. 35 (3.2%), p = 0.003] and congestive heart failure [136 (13.3%) vs. 66 (6.0%), p < 0.001). As to inflammatory parameters, C-reactive protein [median 9.0 mg/l (4.0-30.0) vs. median 4.0 mg/l (2.0-8.0)] and fibrinogen (median 438 mg/dl (350-563) vs. 372 mg/dl (316-459.5)] also differed significantly in the two patient groups (both p < 0.001). A LMR < 3.1 was associated with an odds ratio (OR) of 2.0 (95% CI 1.8-2.2, p < 0.001) for CLI, even after adjustment for other vascular risk factors. CONCLUSIONS A decreased LMR is significantly associated with a high risk for CLI and other vascular endpoints. The LMR is an easily determinable, broadly available and inexpensive marker that could be used to identify patients at high risk for vascular endpoints.
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Affiliation(s)
- T Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Brodmann M. Prime time for drug eluting balloons in SFA interventions? J Cardiovasc Surg (Torino) 2014; 55:461-464. [PMID: 24941235] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Peripheral arterial disease most commonly affects the femoropopliteal segment. Despite enormous improvements in device and treatment technology the long-term patency rate and clinical benefit of endovascular treatment in the respective vascular bed is not satisfying. Drug coated balloon technology as a treatment option in femoropopliteal disease has shown encouraging results in first-in-man trials, which have now been proven in large randomized controlled trials.
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Affiliation(s)
- M Brodmann
- Division of Angiology Medical University of Graz, Graz, Austria -
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Brodmann M, Gary T, Hafner F, Eller P, Deutschmann H, Pilger E, Seinost G. Acute wiiitis representing as thrombosis of the inferior vena cava and left pelvic veins. Phlebology 2014; 30:486-8. [DOI: 10.1177/0268355514530278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deep venous thrombosis as a result of venous wall injury provoked by trauma is a common finding. It often occurs in patients with sportive overstraining, caused by over fatigue of the body structures. In 2007, the entity of “acute wiiitis” was first described in a letter to the New England Journal of Medicine. Acute wiiitis sums up all affections, mainly skeletal and muscle affections, provoked by playing Nintendo Wii, a very common and loved video-game system. Deep venous thrombosis as a consequence of Nintendo Wii has not been described so far. We present a patient with a massive free floating thrombus of the left pelvic veins originating from the gluteal veins and reaching into the inferior vena cava after playing Nintendo Wii.
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Affiliation(s)
- M Brodmann
- Division of Angiology, Medical University Graz, Graz, Austria
| | - T Gary
- Division of Angiology, Medical University Graz, Graz, Austria
| | - F Hafner
- Division of Angiology, Medical University Graz, Graz, Austria
| | - P Eller
- Division of Angiology, Medical University Graz, Graz, Austria
| | - H Deutschmann
- Division of Vascular and Interventional Radiology, Medical University Graz, Graz, Austria
| | - E Pilger
- Division of Angiology, Medical University Graz, Graz, Austria
| | - G Seinost
- Division of Angiology, Medical University Graz, Graz, Austria
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Catalano M, Poredos P, Brodmann M, Wautrecht JC, Carpentier P, Roztocil K, Nikol S, Diamantopoulos E, Pecsvarady Z, Carlizza A, Sieron A, Stanek A, Olinic D, Stvrtinova V, Kozak M, Agewall S, Gallino A, Jaeger KA, Fitzgerald P, Colgan MP. Requirements for angiology/vascular medicine. INT ANGIOL 2013; 32:608-612. [PMID: 24212296] [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: 06/02/2023]
Affiliation(s)
- M Catalano
- UEMS Division of Angiology Vascular Medicine -
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Gary T, Belaj K, Eller P, Hackl G, Rief P, Hafner F, Froehlich H, Pilger E, Brodmann M. CHA2DS2-VASc Score and risk for reobstruction after endovascular treatment of the superficial femoral artery: differences between balloon angioplasty and stenting. Int J Cardiol 2013; 168:3088-90. [PMID: 23632114 DOI: 10.1016/j.ijcard.2013.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/06/2013] [Indexed: 11/17/2022]
Affiliation(s)
- T Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University Graz, Austria.
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Brodmann M. The angiosome concept in clinical practice: implications for patient-specific recanalization procedures. J Cardiovasc Surg (Torino) 2013; 54:567-571. [PMID: 24002385] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Below-the-knee (BTK) disease with the clinical presentation of critical limb ischemia is associated with a high rate of limb loss due to minor and major amputations. The main problem is to find a way to optimize blood flow to the critical limb area. BTK joint the down-stream diverges into 3 arms which supply different areas. Different concepts exist how optimal blood flow to the critical ischemic areas BTK can be achieved, either by treating as many vessels as can be reopened by an endovascular procedure, or by going for the two main BTK vessels, or in an outstanding situation also to treat the inflow of collaterals to achieve as much blood flow down the foot as possible. Derived from plastic surgery for the purpose of healing of flaps, the angiosome concept has been developed. An angiosome is an anatomic unit of tissue (consisting of skin, subcutaneous tissue, fascia, muscle and bone) fed by a source artery and drained by specific veins. From that point of view it can be presumed that revascularization of the source artery to the angiosome might result in better wound healing and limb salvage rates. The angiosome treatment concept of BTK disease refers to the concept in cardiology, where discrimination of reversible ischemia areas is made and respective vessels leading to these areas are treated in a distinctive way.
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Affiliation(s)
- M Brodmann
- Division of Angiology, Medical University Graz, Graz, Austria.
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Eller P, Kirsch A, Smaczny N, Sedej S, Hofmeister A, Stojakovic T, Brodmann M, Pilger E, Rosenkranz A, Eller K. Regulatory T-cells modulate ectopic calcification in nephrocalcinosis and dystrophic cardiac calcinosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2793] [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: 11/13/2022] Open
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Brodmann M. Do novel oral anticoagulants do better than standard therapy in the treatment of deep vein thrombosis? Hamostaseologie 2013; 33:218-24. [PMID: 23681109 DOI: 10.5482/hamo-13-02-0005] [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] [Received: 02/26/2013] [Accepted: 04/26/2013] [Indexed: 11/05/2022] Open
Abstract
The focus of DVT treatment is the prevention of recurrence and thrombus migration by treatment with anticoagulants. The aim is to improve outcomes by reducing clot burden and by preventing thrombus propagation, in order to prevent PE and the development of long-term complication. Actually, initial therapy is parenteral anticoagulation, mainly with low molecular weight heparin followed by a vitamin K antagonist (VKA) for triggered and idiopathic DVT. The long term treatment suggestion with a VKA is for sure the most challenging therapeutic scenario, showing all the disadvantages of VKA especially in the onset phase when therapeutic levels of VKA are difficult to achieve. The difference between VKAs and NOACs is the fact, that NOACs target a specific factor in the coagulation cascade. At time now two pathways have been chosen for treatment options, the direct inhibition of active sites of thrombin and factor Xa. Routine monitoring is not required and the drugs can be administered in fixed doses, which should increase patient adherence to long term treatment. At time now, four novel anticoagulants are called to be options for DVT treatment. Rivaroxaban, apixaban and edoxaban are direct FXa inhibitors, whereas dabigtran etexilate is a direct thrombin inhibitor.
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Affiliation(s)
- M Brodmann
- Department of Medicine, Medical University Graz, Austria.
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Hafner F, Haas E, Dejaco C, Gary T, Froehlich H, Szolar D, Thonhofer R, Brodmann M. FRI0361 Aortic aneurysm related to gca – an overestimated risk? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1488] [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: 11/04/2022]
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Abstract
Intra-arterial injections represent the most feared complication of sclerotherapy for varicose veins. We present a case of an inadvertent intra-arterial injection of polidocanol at the left medial calf in a 59-year-old woman with subsequent arterial occlusions of the posterior tibial artery and foot arteries. Despite several therapeutic interventions, lower-limb amputation could not be prevented. We conducted a PubMed search for articles reporting arterial complications related to sclerotherapy, in order to evaluate aetiology, clinical presentation, therapeutic management and outcome of sclerotherapy-associated intra-arterial injections during the past 50 years. Intra-arterial injection of a sclerosing solution was reported in 63 cases, mostly after injection near the ankle region or the distal medial calf. Clinical presentation was frequently characterized by immediate pain during injection and distal ischaemia with subsequent tissue loss. Despite several treatment approaches, amputation could not be prevented in 31 cases (52.5%). The pathophysiology of arterial complications related to intra-arterial injection and advisable therapeutic interventions are discussed. Inadvertent intra-arterial injection represents a limb-threatening complication of sclerotherapy. Target-oriented and prompt therapy seems inevitable in order to reduce the risk of permanent tissue loss and amputation.
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Affiliation(s)
- F Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Castellano G, Cafiero C, Divella C, Sallustio F, Gigante M, Gesualdo L, Kirsch AH, Smaczny N, Riegelbauer V, Sedej S, Hofmeister A, Stojakovic T, Brodmann M, Pilger E, Rosenkranz A, Eller K, Eller P, Meier P, Lucisano S, Arena A, Donato V, Fazio MR, Santoro D, Buemi M, Wornle M, Ribeiro A, Koppel S, Pircher J, Czermak T, Merkle M, Rupanagudi K, Kulkarni OP, Lichtnekert J, Darisipudi MN, Mulay SR, Schott B, Hartmann G, Anders HJ, Pletinck A, Glorieux G, Schepers E, Van Landschoot M, Eloot S, Van Biesen W, Vanholder R, Castoldi A, Oliveira V, Amano M, Aguiar C, Caricilli A, Vieira P, Burgos M, Hiyane M, Festuccia W, Camara N, Djudjaj S, Rong S, Lue H, Bajpai A, Klinkhammer B, Moeller M, Floege J, Bernhagen J, Ostendorf T, Boor P, Wornle M, Ribeiro A, Koppel S, Merkle M, Ito S, Aoki R, Hamada K, Edamatsu T, Itoh Y, Osaka M, Yoshida M, Oliva E, Maritati F, Palmisano A, Alberici F, Buzio C, Vaglio A, Grabulosa C, Cruz E, Carvalho J, Manfredi S, Canziani M, Cuppari L, Quinto B, Batista M, Cendoroglo M, Dalboni M, Wornle M, Ribeiro A, Merkle M, Niemir Z, Swierzko A, Polcyn-Adamczak M, Cedzynski M, Sokolowska A, Szala A, Baudoux T, Hougardy JM, Pozdzik A, Antoine MH, Husson C, De Prez E, Nortier J, Ni HF, Chen JF, Zhang MH, Pan MM, Liu BC, Machcinska M, Bocian K, Korczak-Kowalska G, Tami Amano M, Castoldi A, Andrade-Oliveira V, da Silva M, Miyagi MYS, Olsen Camara N, Xu L, Jin Y, Zhong F, Liu J, Dai Q, Wang W, Chen N, Grosjean F, Tribioli C, Esposito V, Catucci D, Azar G, Torreggiani M, Merlini G, Esposito C, Fell LH, Zawada AM, Rogacev KS, Seiler S, Fliser D, Heine GH, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Virzi GM, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C, Fuchs A, Eidenschink K, Steege A, Fellner C, Bollheimer C, Gronwald W, Schroeder J, Banas B, Banas MC, Zawada AM, Luthe A, Seiler SS, Rogacev K, Fliser D, Heine GH, Trimboli D, Graziani G, Haroche J, Lupica R, Fazio MR, Lucisano S, Donato V, Cernaro V, Montalto G, Pettinato G, Buemi M, Cho E, Lee JW, Kim MG, Jo SK, Cho WY, kim HK. Immune and inflammatory mechanisms. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft142] [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: 11/13/2022] Open
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Gary T, Steidl K, Belaj K, Hafner F, Froehlich H, Deutschmann H, Pilger E, Brodmann M. Unusual deep vein thrombosis sites: magnetic resonance venography in patients with negative compression ultrasound and symptomatic pulmonary embolism. Phlebology 2012. [PMID: 23202145 DOI: 10.1258/phleb.2012.012054] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the clinical characteristics of patients with pulmonary embolism (PE), negative compression ultrasound (CUS) of the lower limbs and detection of unusual deep vein thrombosis (DVT) sites by means of magnetic resonance (MR) venography. METHODS A retrospective data analysis of PE patients hospitalized at our institution from April 2009 to 2011. RESULTS From April 2009 to 2011, a total of 762 PE patients were treated at our institution. In 169 of these patients CUS for DVT was negative. In these patients MR venography was performed for further evaluation. We found venous thrombosis at unusual sites in 12 of these patients. Due to free floating thrombus masses and fear of life-threatening PE progression we inserted an inferior vena cava filter in three of these 12 patients. The leading venous thromboembolism risk factor in our patients was immobilization (5 patients, 41.7%). CONCLUSIONS We conclude that especially in patients with PE and negative CUS of the lower limbs a thrombosis of the pelvic veins should be considered in case of symptoms for venous thrombosis in this area. Further diagnostic work-up with MR venography should be scheduled in these patients especially in patients with risk factor immobilization as therapeutic consequences might occur.
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Affiliation(s)
- T Gary
- Department of Internal Medicine, Division of Angiology
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Gary T, Belaj K, Hafner F, Hackl G, Froehlich H, Pilger E, Brodmann M. A high CHA2DS2-VASc score is associated with a high risk for critical limb ischemia in peripheral arterial occlusive disease patients. Atherosclerosis 2012; 225:517-20. [DOI: 10.1016/j.atherosclerosis.2012.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/29/2012] [Accepted: 10/01/2012] [Indexed: 11/26/2022]
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Weltermann A, Brodmann M, Domanovits H, Eber B, Gottsauner-Wolf M, Halbmayer WM, Hiesmayr JM, Kyrle PA, Längle F, Roithinger FX, Watzke H, Windhager R, Wolf C, Zweiker R. Dabigatran in patients with atrial fibrillation: perioperative and periinterventional management. Wien Klin Wochenschr 2012; 124:340-7. [PMID: 22576960 PMCID: PMC3372773 DOI: 10.1007/s00508-012-0166-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 03/28/2012] [Indexed: 11/18/2022]
Abstract
In any type of invasive surgery, the patient’s individual risk of thromboembolism has to be weighed against the risk of bleeding. Based on various everyday situations in clinical routine, the purpose of the present expert recommendations is to provide appropriate perioperative and periinterventional management for patients with atrial fibrillation undergoing long-term treatment with the thrombin inhibitor dabigatran. As we currently have no routine laboratory test to measure therapeutic levels of the substance or the risk of bleeding, general measures such as a standardized documentation of the patient’s history, a sufficient time interval between the last preoperative dose and the procedure, and careful control of local hemostasis should be given special attention.
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Affiliation(s)
- A Weltermann
- Department of Medicine I, Elisabethinen Hospital Linz, Fadinger Straße 1, 4020, Linz, Austria.
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Gary T, Belaj K, Steidl K, Pichler M, Eisner F, Hafner F, Froehlich H, Samonigg H, Pilger E, Brodmann M. Asymptomatic venous thrombotic events in ambulatory cancer patients: impact on survival. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70103-2] [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: 10/28/2022]
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Brodmann M, Hafner F, Gary T, Seinost G, Pilger E. Impaired endothelial-dependent and endothelium-independent vasodilatation in patients with thromboangiitis obliterans. Clin Appl Thromb Hemost 2012; 19:33-6. [PMID: 22311632 DOI: 10.1177/1076029611435093] [Citation(s) in RCA: 8] [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: 11/16/2022] Open
Abstract
BACKGROUND Endothelial dysfunction is the key process in the development of atherosclerosis. The aim of our study was to evaluate endothelial dysfunction measured by the noninvasive technique of Celermajer that plays a role in the pathogenesis of thrombangitis obliterans. METHODS A total of 36 patients with thrombangitiis obliterans ([TAO]; mean age 44.9 ± 1.3 years) were compared with 30 healthy individuals (mean age 36.1 ± 1.8 years). High frequency ultrasound was used to measure changes in response to reactive hyperemia (leading to flow-mediated endothelium-dependent dilatation) and in response to 0.4 mg sublingual nitroglycerin ([NTG]; leading to NTG-induced, endothelium-independent dilatation). RESULTS Patients with TAO showed a lower but statistically not significant flow-mediated dilatation and a statistically significant reduced NTG-induced vasodilatation than the control group. CONCLUSION Our results suggest that both mechanisms play a role in patients with TAO, the endothelium-independent impaired vasodilatation even in a more significant way than the impaired endothelium-dependent vasodilatation.
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Affiliation(s)
- M Brodmann
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Graz, Austria.
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Hafner F, Thomas G, Froehlich H, Steidl K, Brodmann M. Effect of a sequential therapy of bosentan and iloprost versus a monotherapy with bosentan in the treatment of scleroderma related digital ulcers. INT ANGIOL 2011; 30:493-495. [PMID: 21804491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Leu HJ, Gary T, Brodmann M. Cystic medial necrosis Erdheim-Gsell. VASA 2011; 40:336; author reply 336-7. [PMID: 21780061 DOI: 10.1024/0301-1526/a000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Froehlich H, Hafner F, Binder J, Amrein K, ScharnagI H, Brodmann M, Stojakovic T. 826 SIMVASTATIN IMPROVES ENDOTHELIAL FUNCTION IN PATIENTS WITH CARDIOVASCULAR DISEASE BUT NOT IN PATIENTS WITH PERIPHERAL ARTERY DISEASE. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70827-3] [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: 11/15/2022]
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Gary T, Seinost G, Hafner F, Gorkiewicz G, Brodmann M. Cystic medial necrosis Erdheim Gsell as a rare reason for spontaneous rupture of the ascending aorta. VASA 2011; 40:147-9. [PMID: 21500180 DOI: 10.1024/0301-1526/a000085] [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
Spontaneous rupture of the ascending aorta is a life-threatening condition requiring immediate intervention. The rupture usually leads to sudden death as a result of hemopericardium or hemothorax. The underlying histopathological condition in the cases described so far was mostly an atheromatous plaque. Some other rare underlying conditions were also described. We report a case of cystic medial necrosis Erdheim Gsell as a reason for fatal spontaneous rupture of the ascending aorta.
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Affiliation(s)
- T Gary
- Medical University Graz, Graz, Austria.
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Abstract
Vipera berus has a wide geographical distribution throughout Central and Northern Europe. The symptoms after a bite usually are mild, life threatening symptoms are mainly described in children. We describe a case of popliteal vein thrombosis of the right leg after systemic envenoming with Vipera berus venom after a bite in the right hand by a female Vipera berus in the alpine region of Styria, Austria. Changes of the plasmatic coagulation system were obvious in our patient. These changes were due to an activation of the coagulation system and might be the reason for the thrombotic event in this usually healthy young male person.
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Affiliation(s)
- T Gary
- Division of Angiology, Medical University Graz, Graz, Austria.
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Kovacs G, Kqiku X, Maier R, Aberer E, Brodmann M, Graninger W, Scheidl S, Tröster N, Olschewski H. Early therapy with bosentan may reverse pulmonary vasculopathy in scleroderma patients. Pneumologie 2010. [DOI: 10.1055/s-0030-1251115] [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: 10/19/2022]
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Abstract
Anticoagulation still remains the primary therapy for venous thromboembolism (VTE) in order to prevent the most life-threatening form of VTE, pulmonary embolism (PE). Nevertheless in some patients anticoagulation is impossible. Then vena caval filters serve as a valuable second line therapy against the most feared complication of VTE, fatal PE. We want to present a patient with preceding PE and DVT in whom for the perioperative period a temporary vena caval filter was placed and who showed the complication of a nearly fatal PE. A seventy-two year-old white male was admitted for thrombolytic therapy for massive pulmonary embolism, which was performed successfully. Some hours later the patient developed gastrointestinal bleeding. An adenocarcinoma of the colon was diagnosed and an end-to-end hemicolectomy performed. A temporal caval filter (Gunther filter) was placed in the infrarenal vena cava for the perioperative period. Seven days later the patient syncopated with acute massive onset of dyspnea. A helix computertomography scan of the lung showed again massive central pulmonary embolism with right heart enlargement. An immediate pulmonary embolectomy had to be performed. Subsequent venal cavography revealed a thrombosed vena caval filter and a thrombus proximal to the filter. This case report should emphasize the fact that although a vena cava filter might be of high benefit in patients with contraindication for anticoagulation to prevent recurrent PE, in some cases it can be insufficient and lead to enormous complications.
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Affiliation(s)
- M Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Austria.
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Thonhofer R, Siegel C, Hafner F, Gotschuli G, Brodmann M. Successful bosentan treatment of critical ischaemia induced by vasculitis in an SCLE patient. Rheumatology (Oxford) 2008; 47:1729-30. [DOI: 10.1093/rheumatology/ken354] [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: 11/12/2022] Open
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41
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Dunzinger A, Hafner F, Piswanger-Sölkner J, Brodmann M, Lipp R. Acute deep venous thrombosis of the upper extremity as demonstrated by scintigraphy with (99m)Tc-apcitide. Nuklearmedizin 2008; 47:N70-N72. [PMID: 18988339] [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: 05/27/2023]
Affiliation(s)
- A Dunzinger
- Division of Nuclear Medicine, Department of Internal Medicine, Medical University Graz, Austria
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Gary T, Gries A, Pilger E, Seinost G, Brodmann M. PO19-520 COLLAGEN INDUCED ACCELERATED PLATELET AGGREGATION AS A POSSIBLE CAUSE FOR RESTENOSIS AFTER STENT IMPLANTATION IN PAOD. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71530-1] [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: 11/26/2022]
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Brodmann M, Lischnig U, Lang B, Lueger A, Pilger E, Stark G. The evaluation of the no-independent vasodilatative effect of iloprost in isolated perfused Guinea pig hind limbs. INT ANGIOL 2004; 23:72-5. [PMID: 15156133] [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: 04/29/2023]
Abstract
AIM In critical limb ischemia vasodilatators play an important role in the treatment of the disease. Considering that the endothelium is seriously damaged in these patients, we wanted to evaluate if the vasodilatative effect of iloprost does or does not depend on the endothelium by using the model of the isolated perfused guinea pig hind limb. METHODS A catheter was inserted via the distal aorta and common iliac artery. After stabilization, iloprost was administered at a dosage of 0.1 microM. In a subsequent series of experiments precontraction of the peripheral vascular bed was achieved with 40 mM KCl followed by 0.1 microM iloprost. In a 3rd series of experiments L-NAME (100 microM) was administered after the equilibration period for 30 minutes, followed by 0.1 microM iloprost. In the 4th series of experiments, after the administration of L-NAME (100 microM), KCl (40 mM) was administered to precontract the vascular bed and iloprost 0.1 microM was added. RESULTS The administration of iloprost alone and after addition of KCL induced a significant decrease in vascular resistance(-49.6+/-14.1% [x+/-SEM, n=7]). The addition of L-NAME did not affect vascular resistance. The consecutive addition of iloprost reduced vascular resistance significantly (-4.2+/-0.7% [x+/-SEM, n=7]). After addition of L-NAME 100 microM and precontraction with KCl 40 mM, iloprost once again significantly reduced peripheral vascular resistance (-51.5+/-14.4% [x+/-SEM, n=6]). Reduction of peripheral vascular resistance by iloprost was comparable to that without L-NAME. CONCLUSION Our data show that iloprost at a dosage of 0.1 microM achieves a significant reduction in peripheral vascular resistance and that the vasodilatative effect of iloprost is independent of NO. Iloprost therefore seems to be an ideal vasodilatative drug for the treatment of patients with impaired endothelial function.
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Affiliation(s)
- M Brodmann
- Division of Pharmacotherapy, Department of Internal Medicine, Karl-Franzens University, Graz, Austria.
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Brodmann M, Lipp RW, Passath A, Seinost G, Pabst E, Pilger E. The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries. Rheumatology (Oxford) 2004; 43:241-2. [PMID: 13130153 DOI: 10.1093/rheumatology/keh025] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE As one of the diagnostic criteria for giant cell arteritis affecting the temporal arteries (temporal arteritis) is still biopsy-proven vasculitis of the affected artery, the aim of our study was to evaluate the value of a non-invasive procedure, 2-(18)F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (F-18-FDG-PET), in the diagnosis of Horton's disease. METHODS During a period of 10 months, 22 consecutive patients with the clinical diagnosis of giant cell arteritis and a positive hypoechogenic halo in duplex sonography were re-examined with F-18-FDG-PET. Six patients had giant cell arteritis involving both the large arteries and the temporal arteries; five patients showed giant cell arteritis only in the large arteries without concomitant involvement of the temporal arteries, and the remaining 11 patients showed only involvement of the temporal arteries. All patients were examined by sonography and F-18-FDG-PET, which was performed before treatment with corticosteroids. RESULTS All patients with positive signs of giant cell arteritis in duplex sonography, i.e. a hypoechogenic halo in the large arteries (thoracic, subclavian, axillary, iliac, aorta), also showed elevated FDG uptake in the same vessels, with complete agreement in the anatomical distribution of changes. When positive sonography was limited to the temporal arteries, FDG-PET was completely negative in the temporal arteries and all other arterial locations. CONCLUSION PET is not yet suitable for the diagnosis of temporal arteritis and therefore cannot replace invasive biopsy. F-18-FDG-PET is well suited to the demonstration of giant cell arteritis in arteries exceeding 4 mm in diameter.
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Affiliation(s)
- M Brodmann
- Department of Internal Medicine, Division of Angiology, University Hospital, Graz, Austria.
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Brodmann M. Reply: The right place of 18FDG PET for the diagnosis of giant cell arteritis--a response to the article of Brodmann et al. Rheumatology (Oxford) 2004. [DOI: 10.1093/rheumatology/keh094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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46
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Deutschmann H, Brodmann M, Schöllnast H, Seinost G, Tiessenhausen K, Preidler KW, Pilger E, Szolar DH. Periphere arterielle Verschlusskrankheit: Vergleich der kontrastverstärkten 3D Magnetresonanzangiographie mittels Panoramatisch mit der konventionellen digitalen Subtraktionsangiographie. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827543] [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: 10/19/2022]
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Brodmann M, Passath A, Aigner R, Seinost G, Stark G, Pilger E. F18-FDG-PET as a helpful tool in the diagnosis of giant cell arteritis. Rheumatology (Oxford) 2003; 42:1264-6. [PMID: 14508046 DOI: 10.1093/rheumatology/keg317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Brodmann M, Renner W, Seinost G, Pabst E, Stark G, Pilger E. Genetic evaluation of the common variant of the endothelial nitric oxide synthase (Glu(298)-><Asp) in patients with thromboangiitis obliterans. INT ANGIOL 2002; 21:169-72. [PMID: 12110779] [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: 02/25/2023]
Abstract
BACKGROUND Nitric oxide is synthesized by endothelial nitric oxide synthase and plays a key role in adequate endothelial function. An important effect is the reduction of free radicals caused by cigarette smoking, which is the only established risk factor for thromboangiitis obliterans (TAO). In patients with TAO a genetic defect of endothelial nitric oxide synthase may therefore result in deteriorated endothelial function. The aim of our study was to evaluate whether a genetic defect of the common variant of endothelial nitric oxide synthase (Glu(298)-->Asp) can be found in a higher degree in patients with TAO compared to healthy controls. METHODS We enrolled 42 patients with TAO and 149 healthy subjects. RESULTS Nineteen patients (45.2%) showed homozygosity for Glu(298) versus 76 (51%) in the control group. The heterozygous status for Glu(298)-->Asp was found among 18 patients (42.9%) compared to 61 (40.9%) members of the control group, which was a nearly equal distribution. Homozygosity for the mutant Asp(298) was slightly elevated in the patient group with 11.9 versus 8.1% in the control group. Allele frequency for Asp(298) was 0.333. CONCLUSIONS Our data do not show elevated homozygosity for the common variant Glu(298)-->Asp in patients with TAO compared to healthy controls. The limitation of our evaluation is the small number of patients, which is a general problem when evaluating patients with TAO, as this is not a common disease.
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Affiliation(s)
- M Brodmann
- Division of Angiology, Department of Internal Medicine, Karl-Franzens University Graz, Graz, Austria.
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Renner W, Brodmann M, Pabst E, Stanger O, Wascher TC, Pilger E. The V34L polymorphism of factor XIII and peripheral arterial disease. INT ANGIOL 2002; 21:53-7. [PMID: 11941274] [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: 02/24/2023]
Abstract
BACKGROUND Factor XIII catalyzes crosslinking of fibrin in the last steps of the coagulation process. A common polymorphism in the gene for factor XIII A subunit (F13A1 V34L) has been associated with a decreased risk for coronary artery disease, cerebrovascular disease, and deep venous thrombosis. METHODS To analyze the role of this polymorphism in peripheral arterial disease (PAD) we performed a case-control study including 873 patients with documented PAD and a total of 523 controls without vascular disease. The F13A1 genotype was determined by an allele-specific polymerase chain reaction. RESULTS Genotype distribution and allele frequencies were not significantly different between patients (VV: 51.9%; VL: 40.7%; LL: 7.4%) and controls (VV: 54.7%; VL: 39.2%; LL: 6.1%). Mean age at onset of the disease was significantly higher in LL homozygous subjects than in VV homozygous subjects (67.3 versus 64.1 years, p=0.017). Heterozygous subjects had an intermediate age at onset (65.1 years), suggesting a gene-dose effect. The association of the L34 variant with onset of PAD remained significant after adjustment for other risk factors. The effect was stronger in men than in women. CONCLUSIONS We conclude that the F13A1 V34L polymorphism was not associated with the presence of PAD in our study, but may be linked to a later onset of the disease.
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Affiliation(s)
- W Renner
- Department of Medicine, Division of Angiology, Karl Franzens University, Graz, Austria.
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