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Dumas G, Danjou A, Richaud C, Spear R, Joly M, Blaise S. Feasibility of performing treadmill walking test for patients with peripheral arterial occlusive disease by the advanced practice nurses. J Med Vasc 2024; 49:90-97. [PMID: 38697715 DOI: 10.1016/j.jdmv.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/22/2024] [Indexed: 05/05/2024]
Abstract
AIM The treadmill walking test with post-exercise pressure measurement can be used as a diagnostic test and could classify peripheral arterial disease of the lower limbs. It can also exclude the diagnosis allowing to raise the possibility of differential diagnoses. In this study, we assessed the feasibility of performing treadmill test by advanced practice nurse to assess suspected lower extremity peripheral artery disease patients. DESIGN AND METHOD This is a longitudinal monocentric study to assess the feasibility of a treadmill walking test performed by an advanced practice nurse. The primary endpoint was the number of tests performed during this period. The secondary objectives were to evaluate the reasons for requesting the test, the main results obtained in terms of the test's contribution and diagnoses, and patients' clinical characteristics. RESULTS From February to May 2023, amongst 31 patients who underwent the treadmill walking test, 4 tests were able to rule out peripheral arterial disease and to detect differential diagnoses. For the remaining 27 patients, 4 had stage IIa of the Leriche classification, 23 had stage IIb, 2 of which were associated with a narrow lumbar spine. In contrast to the usual report, the APN's report on the walking test included an identification of cardiovascular risk factors, as well as a possible medical reorientation linked to the correction of a detected cardiovascular risk factor. CONCLUSION The treadmill walking test can be performed by an advanced practice nurse. He/She added a comprehensive/global patient management, with the detection of cardiovascular risk factors. This new profession led to an increase in the number of tests performed of more than 50% over the period and reduced the time to access the test.
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Affiliation(s)
- G Dumas
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - A Danjou
- Grenoble Alpes Data Institute, TIMC, UMR 5525 CNRS, University Grenoble Alpes, Grenoble, France; IFSI, CHU de Grenoble Alpes, CS10217, 38043 Grenoble cedex 9, France
| | - C Richaud
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - R Spear
- Service de Chirurgie Vasculaire, department of Vascular Surgery, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - M Joly
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - S Blaise
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France; Inserm U1300, HP2, University Grenoble Alpes, Grenoble, France.
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Stapelfeldt E, Berger B, Raak CK, Gupta S. Ayurveda for a Type 1 Diabetes Patient with Peripheral Arterial Occlusive Disease: A Case Report. Complement Med Res 2023; 31:94-102. [PMID: 37944500 DOI: 10.1159/000534992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/19/2022] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION The effect of Ayurvedic therapy in type 2 diabetes (T2D) is well documented. For people with type 1 diabetes (T1D), there is little evidence on the applicability of Ayurvedic therapy. This case illustrates the course of Ayurvedic treatment in a person with T1D accompanied by peripheral arterial occlusive disease (PAOD). CASE PRESENTATION The patient had insulin-dependent T1D since the age of 6 years. At 39 years of age, he developed progressive bilateral PAOD of the femoral arteries. He presented claudication symptoms at a walking distance of 150 m. Ten surgical interventions for recanalization have been performed. The PAOD put heavy psychological strains on the patient. He developed moderate depression with anxiety and complained of tinnitus and sleep disturbances. Through an initial outpatient Ayurvedic treatment mainly focused on dietary, lifestyle changes and phytotherapeutics, and a subsequent 6-week inpatient Ayurvedic treatment in India, a weight reduction of 12 kg, a reduction in insulin requirement to 65% of baseline, as well as a walking performance without restriction at a medium load could be achieved. The depression and inner tension retreated, and one-sided tinnitus and existing sleep disturbances dissolved completely. The lasting effect was still perceptible 5 months after the inpatient stay. CONCLUSIONS For this person with T1D with PAOD, outpatient and inpatient Ayurvedic therapy could generate a significant improvement of his situation. The case demonstrates that people with T1D can benefit from using individualized Ayurvedic therapy. This case motivates to invest in Ayurvedic research for people with T1D and complications. Einleitung Die Wirkung der ayurvedischen Therapie bei Typ-2-Diabetes (T2D) ist gut dokumentiert. Für Menschen mit Typ-1-Diabetes (T1D) gibt es kaum Belege für die Anwendbarkeit der ayurvedischen Therapie. Dieser Fall veranschaulicht den Verlauf einer ayurvedischen Behandlung bei einer Person mit T1D, begleitet von einer peripheren arteriellen Verschlusskrankheit (pAVK). Fallbericht Der Patient hatte seit seinem 6. Lebensjahr einen insulinabhängigen 'T1D'. Im Alter von 39 Jahren entwickelte er eine fortschreitende bilaterale periphere arterielle Verschlusskrankheit (pAVK) der Oberschenkelarterien. Bei einer Gehstrecke von 150 m zeigte er Claudicatio-Symptome. Es wurden 10 chirurgische Eingriffe zur Rekanalisation durchgeführt. Die pAVK stellte für den Patienten eine starke psychische Belastung dar. Er entwickelte eine mittelschwere Depression mit Angstzuständen und klagte über Tinnitus und Schlafstörungen. Durch eine erste ambulante ayurvedische Behandlung, die sich hauptsächlich auf Ernährungs-, Lebensstiländerungen und Phytotherapeutika konzentrierte, und eine anschließende 6-wöchige stationäre ayurvedische Behandlung in Indien wurde eine Gewichtsreduktion um 12 kg, eine Reduzierung des Insulinbedarfs auf 65% des Ausgangswerts sowie eine bedeutende Verbesserung der Gehstrecke erreicht. Die Depression und die innere Anspannung verschwanden, und der einseitige Tinnitus und bestehende Schlafstörungen lösten sich vollständig auf. Der nachhaltige Effekt war noch 5 Monate nach dem stationären Aufenthalt spürbar. Schlussfolgerungen Für diese Person mit T1D mit pAVK konnte eine ambulante und stationäre ayurvedische Therapie eine deutliche Verbesserung der Situation bewirken. Der Fall zeigt, dass Menschen mit T1D von einer individualisierten ayurvedischen Therapie profitieren können. Dieser Fall motiviert dazu, in die ayurvedische Forschung für Menschen mit T1D und Komplikationen zu investieren.
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Affiliation(s)
| | - Bettina Berger
- Institute of Integrative Medicine, Witten-Herdecke University, Witten, Germany
| | - Christa K Raak
- Institute of Integrative Medicine, Witten-Herdecke University, Witten, Germany
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Betge S, Engelbertz C, Espinola-Klein C, Ito W, Heiss C, Heilmeier B, Langhoff R, Malyar NM. Analysis of endovascular therapy for peripheral arterial disease in all German hospitals. VASA 2023; 52:366-378. [PMID: 37799062 DOI: 10.1024/0301-1526/a001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 10/07/2023]
Abstract
Background: The quality of vascular care has significantly improved in part by the expansion of endovascular techniques for the treatment of symptomatic peripheral artery disease (PAD) in recent years. In Germany these are primarily provided by the three disciplines of vascular surgery, angiology, and interventional radiology (IR). However, the relative contribute of angiologists to the total number of cases performed is unknown. Patients and methods: In the present study, we analysed the respective contribution of vascular surgery, angiology, and IR to the delivery of endovascular revascularisations in symptomatic PAD in Germany based on the legally mandatory quality reports representative for the reporting year 2018. Results: Vascular surgery is the most common speciality reporting procedures in German hospitals (n=579; 25.1%), followed by IR (n=264; 11.5%), angiology (n=189; 8.2%) and cardiology (n=17; 0.7%). The combination of vascular surgery and IR was reported in 202 (8.8%), vascular surgery and angiology in 167 (7.2%) and angiology and IR in 65 (2.8%) hospitals, and 63 (2.7%) hospitals reported the combination of all three disciplines. Not every department performed catheter interventions. The analysis of procedures per centre revealed that angiology centres provided the highest numbers for both basic procedures and more complex techniques such as atherectomy, rotational thrombectomy, lithoplasty, selective thrombolysis or the use of re-entry devices. In total, angiology centres provided 24.4% of the total procedures or 23.9% of the so-called basic procedures as a surrogate for patient numbers. Conclusions: While each of the disciplines contribute significantly to the endovascular procedures, angiology centres perform more procedures per centre and more complex procedures than the other disciplines highlighting the important quantitative and qualitative contribution of angiology specialists to the care of vascular patients. The inpatient catheter interventional care of patients with PAD is still too rarely carried out in a multi-disciplinary manner in Germany.
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Affiliation(s)
- Stefan Betge
- Department of Internal Medicine and Angiology, HELIOS-Hospital Salzgitter, Germany
| | | | | | - Wulf Ito
- Heart and Vascular Center, Allgäu Hospital gGmbH, Immenstadt, Germany
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Vascular Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | | | - Ralf Langhoff
- Department of Angiology, St. Gertrauden Hospital, Berlin, Germany
| | - Nasser M Malyar
- Department of Cardiology I, University Hospital Münster, Germany
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Godoy MR, Brochado-Neto FC, Matielo MF, Martins Cury MV, Manzioni R, Sacilotto R. The value of Wound, Ischemia and foot Infection classification in patients undergoing endovascular therapy. J Vasc Surg 2023; 78:1260-1269. [PMID: 37541557 DOI: 10.1016/j.jvs.2023.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This study aimed to evaluate the correlation between the Society for Vascular Surgery (SVS) Wound, Ischemia and foot infection (WIfI) classification system and clinical outcomes for 1-year limb amputation-free survival (AFS), freedom from reintervention, and wound healing rate in a cohort of patients affected by chronic limb-threatening ischemia treated exclusively by endovascular procedures. METHODS We analyzed a prospective, consecutive cohort of 203 patients (203 limbs) who underwent infrainguinal endovascular revascularization at a single center between March 2018 and January 2021. These patients were stratified into clinical stages 1 to 4 based on the SVS WIfI classification and categorized into two groups: WIfI 1 to 3 (n = 101 limbs) and WIfI 4 (n = 102 limbs). The SVS objective performance goals of 1-year limb AFS, freedom from reintervention, and wound healing were compared between the groups and assessed using the Kaplan-Meier method. Angiographic lesion characteristics and angioplasty details were compared. RESULTS The average age was 72.4 years (44.3% male, 85.2% had hypertension, 80.3% had diabetes, and 87.7% had tissue loss). There were statistical differences between the groups in 1-year limb AFS Kaplan-Meier rate between WIfI clinical stages 1 to 3 group and WIfI clinical stage 4 group (82% vs 66%, respectively; P < .001), but there was no statistical difference in freedom from reintervention and wound healing rates between the groups (70% vs 64% [P = .62] and 74% vs 79% [P = .90], respectively). Owing to angiographic lesion characteristics, femoropopliteal and infrapopliteal segment distributions were similar between the groups, but there was a statistical difference in target lesion location to tibial vessels (55.4% vs 71.6%, respectively; P = .025). CONCLUSIONS In this cohort of patients with chronic limb-threatening ischemia, SVS WIfI clinical stage 4 had worse results in the 1-year limb AFS rate, but there was no statistical difference in freedom from reintervention and wound healing rates between the groups.
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Affiliation(s)
- Marcos Roberto Godoy
- Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil
| | - Francisco Cardoso Brochado-Neto
- Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Fernando Matielo
- Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil.
| | - Marcus Vinícius Martins Cury
- Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil
| | - Renato Manzioni
- Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil
| | - Roberto Sacilotto
- Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil
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Barth U, Lehmann M, Meyer F, Halloul Z. [Topicality of the fundamental and determining importance of chronic critical ischemia of the extremities and its restorative treatment using crural/pedal bypasses in Germany and in Saxony-Anhalt]. Chirurgie (Heidelb) 2023; 94:861-869. [PMID: 37610660 PMCID: PMC10522525 DOI: 10.1007/s00104-023-01933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Currently, there is an increase in severe stages of peripheral arterial occlusive disease (PAOD) with critical ischemia. This seems to correspond to the general demographic change as well as a consequence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic of the last 3 years. The now established and accepted interventional/endovascular approach for severe lower leg PAOD in experienced hands is still considered the first-line treatment but from the authors' perspective crural/pedal venous bypass is experiencing a renaissance. MATERIAL AND METHODS Compact narrative review of the current state of crural/pedal bypass surgery in Germany and Saxony-Anhalt (SA) combined with selective references from the current scientific medical literature and own clinical experiences. RESULTS The current statistics of case-related diagnosis-related groups (DRG) data show that, especially with the occurrence of the corona pandemic, a decrease in inpatient case numbers of patients with PAOD stage IIB can be observed nationwide and also in SA. The severe PAOD stages have remained approximately the same in case numbers but increased in SA. The risk stratification based on the wound, ischemia and foot infection (WIFI) classification offers the possibility to be able to make statements about the risk of amputation, benefits and type of revascularization measures. The length of the occlusion, occlusion site of the affected vessels and degree of calcification are taken into account in the global limb anatomic staging system (GLASS) to assess the prognosis. The evaluation of the case-based hospital statistics from 2015 to 2020 showed a constant use of femorocrural/femoropedal bypass surgery in Germany as well as a slight increase in reconstruction using femorocrural bypasses in SA, which seems to correlate with the tendency for an increase in the number of cases of severe PAOD. Parameter-based objectification of the severity of critical limb ischemia should be included in the indications for placement of a crural/pedal bypass. The WIFI classification and GLASS are suitable for this purpose as a relative prognosis of success is also possible. The treatment of critical limb ischemia by crural/pedal bypass surgery continues to find a constant application in Germany and SA.
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Affiliation(s)
- Udo Barth
- Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein‑, Gefäß- und Viszeralchirurgie, Helios Klinik Jerichower Land, August-Bebel-Straße 55a, 39288, Burg, Deutschland.
- Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland, Leipziger Str. 44, 39120.
| | - M Lehmann
- Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein‑, Gefäß- und Viszeralchirurgie, Helios Klinik Jerichower Land, August-Bebel-Straße 55a, 39288, Burg, Deutschland
| | - F Meyer
- Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland, Leipziger Str. 44, 39120
| | - Z Halloul
- Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland, Leipziger Str. 44, 39120
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Blaise S, Sinniger V, Seinturier C. Literature review of transcutaneous electrical nerve stimulation in peripheral arterial occlusive disease of the lower limbs. J Med Vasc 2023; 48:116-123. [PMID: 37914456 DOI: 10.1016/j.jdmv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
The therapeutic challenge in peripheral arterial occlusive disease (PAD) is often to increase walking distance, improve pain or heal a wound when PAD is symptomatic. Walking rehabilitation or surgical revascularization techniques are limited. Others strategies as alternatives and/or complementary treatments are needed. Among alternative options, Transcutaneous Electrical Nerve Stimulations (TENS) could be of interest, both for improved walking distance or pain reduction. The Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological, mini-invasive technique involving transcutaneous electrical stimulation. However, there are other transcutaneous electrical nerve stimulation techniques based on the principle of vagus nerve stimulation with different mechanistics. Trans-auricular Vagus nerve stimulation (Ta-VNS) is another TENS technique (electrode on the external ear) which relies on the anti-inflammatory pathways of efferent and afferent vagal fibers. We propose here to review the literature of mini-invasive electrical stimulations, whatever the anatomical zone concerned, in PAD. METHOD The aim was to evaluate the use of non-invasive transcutaneous electrical stimulation therapies (regardless of location) in PAD of the lower limbs, whatever the disease grade. A review of the literature was carried out via a search of the MEDLINE/PubMed database from 1975 to 2023. The articles were selected via abstracts by checking (1) medical indications: PAD patients with claudication were retained, excluding neurological or venous claudication, PAD whatever the disease grade (intermittent claudication or critical limb ischemia [CLI]) and (2) non invasive electrical stimulations were considered (neuromuscular electrical stimulation and spinal cord stimulation were excluded) whatever the anatomical site. Non-electrical stimuli such as acupuncture and reflexotherapy were excluded. RESULTS Only 9 items were selected, including 7 studies with TENS treatment on the calf, one with trans-auricular vagus nerve stimulation and one with electro-acupuncture points of stimulation. CONCLUSION Even if the mechanisms involved are different, TENS on the calves or in the external ears show an improvement of walking distance in PAD patients with intermittent claudication. The results of the studies show few positive effects in arteriopathy but we should keep vigilant in the technics used since mechanisms are different and not fully understood. Electro-stimulation of the calf and external ear appears to be an easy-to-use and accessible therapeutic option, especially since some PAD patients are still failing to be released from pain, despite the rise of endovascular interventional techniques.
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Affiliation(s)
- S Blaise
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France; Université de Grenoble Alpes, Inserm U1300, HP2, Grenoble, France.
| | - V Sinniger
- Université de Grenoble Alpes, U1216, Grenoble Institut des Neurosciences, CHU deGrenoble Alpes, 38000 Grenoble, France
| | - C Seinturier
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France
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Gomez-Sanchez CM, Conte MS. Case planning and execution of inframalleolar bypass for chronic limb-threatening ischemia. J Vasc Surg Cases Innov Tech 2023; 9:101116. [PMID: 37152915 PMCID: PMC10160785 DOI: 10.1016/j.jvscit.2023.101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 05/09/2023] Open
Abstract
Chronic limb-threatening ischemia is challenging to treat because of the complex patient population, heterogeneity of limb presentations, and complicated arterial pathology. To meet this challenge, vascular surgeons need a broad range of skills to appropriately tailor interventions to each patient's specific needs. One tool in the armamentarium for patients with extensive arterial occlusive disease below the knee is an inframalleolar bypass. However, these procedures require a systematic approach to surgical planning and a high degree of technical competence. We describe our approach to inframalleolar bypass for limb preservation in suitable patients with advanced tibial artery disease.
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Affiliation(s)
- Clara M. Gomez-Sanchez
- Correspondence: Clara M. Gomez-Sanchez, MD, Division of Vascular and Endovascular Surgery, University of California San Francisco, 400 Parnassus Ave, A-581, San Francisco, CA 94143
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Tsai PC, Chuang WJ, Ko AMS, Chen JS, Chiu CH, Chen CH, Yeh YH. Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials. Cardiovasc Diabetol 2023; 22:57. [PMID: 36915157 PMCID: PMC10012509 DOI: 10.1186/s12933-023-01789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/03/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes are at increased risk for cardiovascular diseases. Sodium-glucose transport 2 inhibitors (SGLT2i) have been shown to enhance cardiovascular health since their debut as a second-line therapy for diabetes. Acute coronary syndrome (ACS), peripheral arterial occlusive disease (PAOD), and ischemic stroke (IS) are types of atherosclerotic cardiovascular disease (ASCVD), although the benefits of treating these disorders have not been shown consistently. METHODS We searched four databases (PubMed, Embase, the Cochrane library, and clinicaltrial.gov) for randomized clinical trials (RCTs) until November of 2022. Comparisons were made between SGLT2i-treated and control individuals with type 2 diabetes. Primary outcomes were ACS, PAOD, and IS; secondary outcomes included cardiovascular mortality and all-cause mortality. Risk ratio (RR) and 95% confidence intervals (CI) were determined using a fixed effects model. Cochrane's risk-of-bias (RoB2) instrument was used to assess the validity of each study that met the inclusion criteria. RESULTS We enrolled 79,504 patients with type 2 diabetes from 43 RCTs. There was no difference in the risk of ACS (RR = 0.97, 95% CI 0.89-1.05), PAOD (RR = 0.98, 95% CI 0.78-1.24), or IS (RR = 0.95, 95% CI 0.79-1.14) among patients who took an SGLT2i compared to those who took a placebo or oral hypoglycemic drugs. Subgroup analysis revealed that none of the SGLT2i treatments (canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) significantly altered outcomes when analyzed separately. Consistent with prior findings, SGLT2i reduced the risk of cardiovascular mortality (RR = 0.85, 95% CI 0.77-0.93) and all-cause mortality (RR = 0.88, 95% CI 0.82-0.94). CONCLUSION Our results appear to contradict the mainstream concepts regarding the cardiovascular effects of SGLT2i since we found no significant therapeutic benefits in SGLT2i to reduce the incidence of ACS, PAOD, or IS when compared to placebo or oral hypoglycemic drugs.
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Affiliation(s)
- Pei-Chien Tsai
- Department and Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
- Master's Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing st., Guishan Dist., Taoyuan City, 333, Taiwan
- Healthy Aging Research Center, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Wei-Jung Chuang
- Master's Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Albert Min-Shan Ko
- Department and Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
- Master's Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
- Healthy Aging Research Center, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
- Cardiovascular Department, Chang Gung Memorial Hospital, No. 5, Fuxing st., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Jui-Shuan Chen
- Master's Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing st., Guishan Dist., Taoyuan City, 333, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, No. 5, Fuxing st., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Chun-Han Chen
- Master's Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Department, Chang Gung Memorial Hospital, No. 5, Fuxing st., Guishan Dist., Taoyuan City, 333, Taiwan.
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 33302, Taiwan.
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Jacobi S, Heide S, Reeps C, Pablik J, Lutz B. External bleeding from femoro-crural vein bypass with aneurysmal dilation. Leg Med (Tokyo) 2023; 61:102217. [PMID: 36780708 DOI: 10.1016/j.legalmed.2023.102217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/20/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
Deaths due to external bleeding outside the hospital setting are often suspected to involve violence. However, some disease-related causes, can also lead to fatal external bleeding. While bleeding from natural body orifices is a common end stage of non-curable gastrointestinal bleeding, fatal bleeding via newly formed skin defects is quite rare and highly suspicious in light of external impact. Reliable clarification of the source and cause of bleeding is only possible in the context of an autopsy. The reported case involves the death of a man early 60 s who bled to death as a result of rupture of a femoro-crural bypass. The rupture originated from a rare true aneurysm of an autologous femoro-crural vein bypass implanted 8 years before due to peripheral arterial occlusive disease (PAD) with gangrene. The aneurysm rupture passed all subcutaneous and skin layers leading to fatal external bleeding.
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Affiliation(s)
- Sindy Jacobi
- Institute of Forensic Medicine, Medizinische Fakultät Technische Universität Dresden, Germany
| | - Steffen Heide
- Institute of Forensic Medicine, Medizinische Fakultät Technische Universität Dresden, Germany.
| | - Christian Reeps
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Jessica Pablik
- Institute of Pathology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Brigitta Lutz
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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10
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Passek K, Ronellenfitsch U, Meisenbacher K, Peters A, Böckler D. [Results of a single center vascular screening program in Germany]. Chirurgie (Heidelb) 2023; 94:342-348. [PMID: 36808496 PMCID: PMC10042912 DOI: 10.1007/s00104-023-01821-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Cardiovascular diseases are the main cause of death in Europe with a relevant socioeconomic burden. A screening program for vascular diseases in asymptomatic persons with a defined risk constellation can lead to an early diagnosis. OBJECTIVE The study examined a screening program for carotid stenosis, peripheral arterial occlusive disease (PAOD) and abdominal aortic aneurysms (AAA) in persons without any known vascular disease with respect to demographic data, risk factors, pre-existing conditions, medication intake, detection of pathological findings and/or findings requiring treatment. MATERIAL AND METHODS Test subjects were invited using various information material and filled in a questionnaire on cardiovascular risk factors. The screening took place with measurement of the ABI and duplex sonography as a monocentric prospective single arm study within 1 year. Endpoints were the prevalence of risk factors and pathological and/or results requiring treatment. RESULTS A total of 391 persons participated, 36% presented with at least 1 cardiovascular risk factor, 35.5% with 2 and 14.4% with 3 or more. The sonography showed results requiring control with a carotid stenosis of < 50-> 75% or occlusion in 9%. An AAA with a diameter of 3.0-4.5 cm was diagnosed in 0.9% and a pathological ABI < 0.9 or > 1.3 in 12.3%. The indications for a pharmacotherapy were found in 17% and no operation was recommended. CONCLUSION The practicability of a screening program for carotid stenosis, PAOD and AAA of a defined risk population was shown. Vascular pathologies that required treatment were hardly found in the catchment area of the hospital. Consequently, the implementation of this screening program in Germany based on the collected data cannot currently be recommended in this form.
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Affiliation(s)
- K Passek
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - U Ronellenfitsch
- Klinik für viszerale, Gefäß- und endokrine Chirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Deutschland
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11
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Gruschwitz P, Petritsch B, Schmid A, Schmidt AMA, Grunz JP, Kuhl PJ, Heidenreich JF, Huflage H, Bley TA, Kosmala A. Noise-optimized virtual monoenergetic reconstructions of dual-energy CT angiographies improve assessability of the lower leg arterial segments in peripheral arterial occlusive disease. Radiography (Lond) 2023; 29:19-27. [PMID: 36209641 DOI: 10.1016/j.radi.2022.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the influence of a noise optimized virtual monoenergetic reconstruction algorithm (VMI+) on the image quality and assessability of dual energy (DE) computed tomography angiography (CTA) of the lower extremity runoff. METHODS A total of 118 lower extremity runoff CTA performed on a 3rd generation DE-CT scanner in 109 patients (54 females; 75.6 ± 9.5 years) were included in this retrospective study. Axial image stacks were reconstructed with a standard 120 kV setting and VMI+ of different keV levels. Objective image quality criteria (contrast attenuation, signal-to-noise [SNR] and contrast-to-noise ratio [CNR]) were measured. Two radiologists evaluated subjective image quality regarding intraluminal attenuation and image noise using a 5-point Likert scale. Diagnostic accuracy for significant stenosis (>75%) and vessel occlusion was assessed for 120 kV and 50 keV VMI+ images rated by two radiologists. In all patients, a digital subtraction angiography (DSA) rated by on board-certified radiologist served as the standard of reference. RESULTS Intraluminal attenuation was highest in 40/50 keV VMI+ while SNR were similar to 120 kV images. In subjective assessment, intraluminal contrast of 50 keV images was deemed superior compared to 120 kV despite higher image noise. Sensitivity, specificity, and accuracy for detection of a vessel occlusion were similar in 50 keV VMI+ compared to 120 kV (70%/92%/84%; 70%/91%/83%; p < 0.001) but 13 of 118 (11%) lower leg runoffs were only assessable with 50 keV VMI+. CONCLUSION VMI+ reconstructions improve assessability of DE-CTA by increased luminal attenuation with consistent image noise, also allowing the evaluation of lower leg arterial segments inassessable with standard reconstructions. IMPLICATIONS FOR PRACTICE Providing higher intraluminal attenuation and similar image noise compared with conventional reconstructions, 50 keV VMI+ may be appropriate for routine evaluation of DE-CTA.
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Affiliation(s)
- P Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - B Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A Schmid
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A M A Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - J-P Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - P J Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - J F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - H Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - T A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A Kosmala
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
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12
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Mao J, Sedrakyan A, Goodney PP, Malone M, Cavanaugh KJ, Marinac-Dabic D, Eldrup-Jorgensen J, Bertges DJ. Editor's Choice - Real World Study of Mortality After the Use of Paclitaxel Coated Devices in Peripheral Vascular Intervention. Eur J Vasc Endovasc Surg 2023; 65:131-140. [PMID: 36007713 PMCID: PMC9839562 DOI: 10.1016/j.ejvs.2022.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This observational cohort study examined outcomes after peripheral vascular intervention (PVI) with paclitaxel coated devices (PCD) and non-PCD, and evaluated heterogeneity of treatment effect in populations of interest. METHODS The study included patients undergoing percutaneous transluminal angioplasty and or stent placement between 1 October 2015 and 31 December 2018 in the Vascular Quality Initiative Registry linked to Medicare claims. It determined differences in patient mortality and ipsilateral major amputation after PVI with PCD and non-PCD using Kaplan-Meier analyses and Cox regressions with inverse probability weighting in three cohorts: (A) patients treated for femoropopliteal or infrapopliteal occlusive disease with or without any other concurrent treatment (n = 11 452); (B) those treated for isolated superficial femoral or popliteal artery disease (n = 5 519); and (C) patients with inclusion criteria designed to approximate RCT populations (n = 2 278). RESULTS The mean age of patients was 72.3 (SD = 10.9) years, and 40.6% were female. In cohort A, patients receiving PCD had a lower mortality rate (HR 0.88, 95% CI 0.79 - 0.98) than those receiving non-PCD. There was no significant difference in mortality between groups in cohort B (HR 0.91, 95% CI 0.80 - 1.04) and cohort C (HR 1.10, 95% CI 0.84 - 1.43). Patients receiving PCD did not have a significantly elevated risk of major amputation compared with those receiving non-PCD (cohort A: HR 0.84, 95% CI 0.70 - 1.00; cohort B: HR 0.84, 95% CI 0.67 - 1.06; and cohort C: HR 1.05, 95% CI 0.51 - 2.14). CONCLUSION No increased patient mortality or major amputation was found at three years after PVI with PCD vs. non-PCD in this large, linked registry claims study, after accounting for heterogeneity of treatment effect by population. The analysis and results from three cohorts intended to mirror the cohorts of previous studies provide robust and niche real world evidence on PCD safety and help to understand and reconcile previously discrepant findings.
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Affiliation(s)
- Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip P Goodney
- Section of Vascular Surgery and the Dartmouth Institute, Dartmouth-Hitchcock Medical Centre, Lebanon, USA
| | - Misti Malone
- U.S. Food and Drug Administration, Centre for Devices and Radiological Health, Silver Spring, USA
| | - Kenneth J Cavanaugh
- U.S. Food and Drug Administration, Centre for Devices and Radiological Health, Silver Spring, USA
| | - Danica Marinac-Dabic
- U.S. Food and Drug Administration, Centre for Devices and Radiological Health, Silver Spring, USA
| | | | - Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Division of Vascular Surgery, Burlington, USA.
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Barco S, Sebastian T, Voci D, Engelberger RP, Grigorean A, Holy E, Leeger C, Münger M, Périard D, Probst E, Spescha R, Held U, Kucher N. Major adverse limb events in patients with femoro-popliteal and below-the-knee peripheral arterial disease treated with either sirolimus-coated balloon or standard uncoated balloon angioplasty: a structured protocol summary of the "SirPAD" randomized controlled trial. Trials 2022; 23:334. [PMID: 35449070 PMCID: PMC9027348 DOI: 10.1186/s13063-022-06242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/08/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peripheral arterial disease is a progressive atherosclerotic disease with symptoms ranging from an intermittent claudication to acute critical limb ischemia and amputations. Drug-coated balloons and stents were developed to prevent neo-intimal proliferation and restenosis after percutaneous transluminal angioplasty. Randomized controlled trials showed that drug-coated, notably paclitaxel-coated, devices reduce restenosis, late lumen loss, and the need for target lesion re-vascularization compared with uncoated ones. However, the size of these trials was too small to prove superiority for "hard" clinical outcomes. Moreover, available studies were characterized by too restrictive eligibility criteria. Finally, it remains unclear whether paclitaxel-coated balloons may impair long-term survival. Alternative drug-coated balloons, the so-called limus-based analogs, have been approved for clinical use in patients with peripheral arterial disease. By encapsulating sirolimus in phospholipid drug nanocarriers, they optimize adhesion properties of sirolimus and provide better bioavailability. METHODS In this investigator-initiated all-comer open-label phase III randomized controlled trial, we will evaluate whether sirolimus-coated balloon angioplasty is non-inferior and eventually superior, according to a predefined hierarchical analysis, to uncoated balloon angioplasty in adults with infra-inguinal peripheral arterial disease requiring endovascular angioplasty. Key exclusion criteria are pregnancy or breastfeeding, known intolerance or allergy to sirolimus, and participation in a clinical trial during the previous 3 months. The primary efficacy outcome is the composite of two clinically relevant non-subjective "hard" outcomes: unplanned major amputation of the target limb and endovascular or surgical target lesion re-vascularization for critical limb ischemia occurring within 1 year of randomization. The primary safety outcome includes death from all causes. DISCUSSION By focusing on clinically relevant outcomes, this study will provide useful information on the efficacy and safety of sirolimus-coated balloon catheters for infra-inguinal peripheral arterial disease in a representative ("all-comer") population of unselected patients. As regulatory agencies had raised safety concerns in patients exposed to paclitaxel-coated devices (versus uncoated ones), collect mortality data up to 5 years after randomization will be collected. TRIAL REGISTRATION ClinicalTrials.gov NCT04238546.
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Affiliation(s)
- Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
| | - Tim Sebastian
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Erik Holy
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudia Leeger
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Mario Münger
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Périard
- HFR Fribourg Cantonal Hospital: HFR Fribourg Hopital cantonal, Fribourg, Switzerland
| | - Eliane Probst
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Rebecca Spescha
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
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Søgaard R, Londero LS, Lindholt J. Geographical Variation in the Management of Peripheral Arterial Occlusive Disease: A Nationwide Danish Cohort Study. Eur J Vasc Endovasc Surg 2021; 63:72-79. [PMID: 34872816 DOI: 10.1016/j.ejvs.2021.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/17/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Equal access for equal needs is a key goal for many healthcare systems but geographical variation research has shown that this is often not the case in areas other than vascular surgery. This study assessed the variation across specialised vascular centres of an entire healthcare system in the costs and outcomes for patients having first time revascularisation for peripheral arterial occlusive disease. METHODS This was a national study of all first time revascularisations performed in the Danish healthcare system between 2009 and 2014. Episodes were identified in the Danish Vascular Registry (n = 10 300) and data on one year follow up in terms of the costs of specialised healthcare (€) and amputation status were acquired from national registers. Generalised gamma and logit regressions were used to predict margins between centres while adjusting for population heterogeneity (age, sex, education, smoking, hypertension, diabetes, use of prophylactic pharmacological therapy, indication and type of revascularisation). Cost effectiveness frontiers were used to identify efficient providers and to illustrate the cost of reducing the system level risk of amputation. RESULTS For each of the indications of chronic limb threatening and acute limb ischaemia, the one year amputation risks varied from 11% to 16% across centres (p = .003, p = .006) whereas for intermittent claudication there was no significant difference across centres. The corresponding costs of care varied across centres for all indications (p = .027, p = .028, p = .030). Linking costs and outcomes, three of seven centres were observed to provide poorer quality at higher costs. Exponentially increasing costs to obtain the maximum reduction of the amputation risk were observed. CONCLUSION The results suggest that there is substantial variation in the clinical management of peripheral arterial occlusive disease across the Danish healthcare system and that this results in very different levels of efficiency - on top of potentially unequal treatment for equal needs. Further research is warranted.
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Affiliation(s)
- Rikke Søgaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark; Department of Public Health, Aarhus University, Denmark.
| | | | - Jes Lindholt
- Department of Public Health, Aarhus University, Denmark
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Yap T, Silickas J, Weerakkody R, Lea T, Santhirakumaran G, Bremner L, Diamantopoulos A, Biasi L, Thomas S, Zayed H, Patel SD. Predictors of outcome in diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia. J Vasc Surg 2021; 75:618-624. [PMID: 34634414 DOI: 10.1016/j.jvs.2021.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The incidence of chronic limb-threatening ischemia in diabetic patients is increasing. The factors influencing outcome after infrapopliteal revascularization in these patients are largely unknown. Therefore, this study aims to identify the impact of perioperative glucose control on the long-term outcomes in this patient cohort, and furthermore to identify other factors independently associated with outcome. METHODS Consecutive diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia were identified. Patients' demographics, procedural details, daily capillary blood glucose, and hemoglobin A1C levels were collected and analyzed against the study end points using Kaplan-Meier and Cox regression analysis. RESULTS A total of 437 infrapopliteal target vessels were successfully crossed in 203 patients. Amputation-free survival by Kaplan-Meier (estimate (standard error)%) was 74 (3.3)% and 63 (3.7)%, primary patency was 61 (4.2)% and 50 (4.9)%, assisted primary patency was 69 (5.2)% and 55 (6.1)%, and secondary patency was 71 (3.8)% and 59 (4.1)% at 1 year and 2 years, respectively. Cox regression analysis showed high perioperative capillary blood glucose levels to be an independent predictor of binary restenosis (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.31-1.1.78; P = .015). Postprocedural dual-antiplatelet therapy was found to be an independent predictor of amputation-free survival (HR, 1.69; 95% CI, 1.04-2.75; P = .033), and freedom from major adverse limb events (HR: 1.96; 95% CI, 1.16-3.27; P = .023) and baseline estimated glomerular filtration rate was significantly associated with better amputation-free survival (HR, 0.52; 95% CI, 0.31-0.87; P = .014). CONCLUSIONS Poor perioperative glycemic control is associated with a higher incidence of restenosis after infrapopliteal revascularization in diabetic patients. Dual antiplatelet therapy is associated with better outcomes in this group.
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Affiliation(s)
- Trixie Yap
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom.
| | - Justinas Silickas
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Ruwan Weerakkody
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Talia Lea
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Gowthanan Santhirakumaran
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Laura Bremner
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guys' and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Lukla Biasi
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Stephen Thomas
- Department of Endocrinology and Metabolic Medicine, Guys' and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hany Zayed
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Sanjay D Patel
- Department of Vascular & Endovascular Surgery, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, United Kingdom
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Thai DQ, Jung YK, Hahn HM, Lee IJ. Factors affecting the outcome of lower extremity osteomyelitis treated with microvascular free flaps: an analysis of 65 patients. J Orthop Surg Res 2021; 16:535. [PMID: 34452615 PMCID: PMC8393737 DOI: 10.1186/s13018-021-02686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/01/2021] [Accepted: 08/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Free flaps have been a useful modality in the management of lower extremity osteomyelitis particularly in limb salvage. This study aimed to determine the factors affecting the outcome of free flap reconstruction in the treatment of osteomyelitis. Methods This retrospective study assessed 65 osteomyelitis patients treated with free flap transfer from 2015 to 2020. The treatment outcomes were evaluated in terms of the flap survival rate, recurrence rate of osteomyelitis, and amputation rate. The correlation between outcomes and comorbidities, causes of osteomyelitis, and treatment modalities was analyzed. The following factors were considered: smoking, peripheral artery occlusive disease, renal disease, diabetic foot ulcer, flap types, using antibiotic beads, and negative pressure wound therapy. Result Among the 65 patients, 21 had a severe peripheral arterial occlusive disease. Osteomyelitis developed from diabetic foot ulcers in 28 patients. Total flap failure was noted in six patients, and osteomyelitis recurrence was noted in eight patients, for which two patients underwent amputation surgery during the follow-up period. Only end-stage renal disease had a significant correlation with the recurrence rate (odds ratio = 16.5, p = 0.011). There was no significant relationship between outcomes and the other factors. Conclusion This study showed that free flaps could be safely used for the treatment of osteomyelitis in patients with comorbidities and those who had osteomyelitis developing from diabetic foot ulcers. However, care should be taken in patients diagnosed with end-stage renal disease.
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Affiliation(s)
- Duy Quang Thai
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.,Department of Plastic and Reconstructive Surgery, Hanoi Medical University, 1 Ton That Tung, Kim Lien, Dong Da, Hanoi, Vietnam
| | - Yeon Kyo Jung
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Hyung Min Hahn
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Il Jae Lee
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
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Choi H, Lee H, Lee SS, Ahn J, Joh JH, Lee MY. Association of mortality with drug-coated devices in femoropopliteal artery based on the nationwide data. Ann Surg Treat Res 2021; 101:20-27. [PMID: 34235113 PMCID: PMC8255583 DOI: 10.4174/astr.2021.101.1.20] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/11/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Drug-coated devices have been widely accepted as one of the most promising therapies for femoropopliteal artery revascularization. A recent meta-analysis showed increased mortality in patients treated with drug-coated devices. We sought to examine the association between mortality and drug-coated devices after the treatment of the femoropopliteal artery based on the Korea national administrative claims data. Methods In the National Health Insurance Service database from August 2015 to December 2017, we identified patients with femoropopliteal artery revascularization using percutaneous transluminal angioplasty (PTA), bare metal stents (BMS), drug-coated balloon (DCB), or drug-eluting stents (DES). Kaplan-Meier methods were used to estimate the survival among devices, and log-rank tests were used to evaluate differences between groups. Adjusted hazard ratios (aHRs) were computed using the inverse probability of treatment weightings (IPTW). Results There were 1,724 patients (mean age, 70.9 ± period was 552 days (interquartile range, 404-688 days). There was a difference in IPTW-adjusted mortality risk among device types (26.3% in PTA, 22.1% in BMS, 17.7% in DCB, and 17.8% in DES; P = 0.004). IPTW-adjusted Cox nproportional hazard analysis showed that drug-coated devices were associated with decreased all-cause mortality risk (aHR, 0.70; 95% confidence interval, 0.58-0.86). Conclusion Our real-world analysis showed that there was no evidence of increased all-cause mortality after femoropopliteal artery revascularization with drug-coated devices compared with non-drug-coated devices.
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Affiliation(s)
- Hyunsook Choi
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, Korea.,Department of Health Convergence, Ehwa Womans University, Seoul, Korea.,Department of Medical Device Management & Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Haine Lee
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, Korea
| | - Sang-Soo Lee
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, Korea.,Department of Medical Device Management & Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ehwa Womans University, Seoul, Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Moo-Yeol Lee
- Department of Physiology, Chung-Ang University School of Medicine, Seoul, Korea
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Rümenapf G, Morbach S, Rother U, Uhl C, Görtz H, Böckler D, Behrendt CA, Hochlenert D, Engels G, Hohneck A, Sigl M. [Diabetic foot syndrome-Part 2 : Revascularization, treatment alternatives, care structures, recurrency prophylaxis]. Chirurg 2021; 92:173-186. [PMID: 33237367 PMCID: PMC7875854 DOI: 10.1007/s00104-020-01313-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Diabetic foot syndrome (DFS) is the most frequent reason for major amputations in Germany. The majority of foot lesions are triggered by repetitive pressure in diabetic polyneuropathy. Peripheral arterial occlusive disease (PAOD) impairs wound healing and is the main risk factor for amputations. The treatment of wounds and infections as well as timely revascularization are decisive. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusion processes. Both procedures are complementary. Bypass surgery is of great importance for neuroischemic DFS. Multidisciplinary centers that provide revascularization in DFS can achieve an improvement of arterial blood flow in 90% of the cases and reduce the amputation rate by up to 80%. Due to the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of exceptional importance (podological and orthopedic technical care, foot surgery).
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Affiliation(s)
- G Rümenapf
- Oberrheinisches Gefäßzentrum Speyer, Diakonissen-Stiftungs-Krankenhaus Speyer, Paul-Egell-Straße 33, 67346, Speyer, Deutschland.
| | - S Morbach
- Abteilung Diabetologie und Angiologie, Fachbereich , Innere Medizin, Marienkrankenhaus gGmbH Soest, Soest, Deutschland
| | - U Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Görtz
- Klinik für Gefäßchirurgie, Bonifatius Hospital Lingen, Lingen, Deutschland
| | - D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C A Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - D Hochlenert
- Centrum für Diabetologie, Endoskopie und Wundheilung Köln, Köln, Deutschland
| | - G Engels
- Chirurgische Praxis am Bayenthalgürtel, Köln, Deutschland
| | - A Hohneck
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
| | - M Sigl
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
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Gouëffic Y, Pin JL, Sabatier J, Alimi Y, Steinmetz E, Magnan PE, Marret O, Kaladji A, Chavent B, Kretz B, Jobert A, Schirr-Bonnans S, Guyomarc'h B, Riche VP, du Mont LS, Tessier P. Editor's Choice - A Cost Effectiveness Analysis of Outpatient versus Inpatient Hospitalisation for Lower Extremity Arterial Disease Endovascular Revascularisation in France: A Randomised Controlled Trial. Eur J Vasc Endovasc Surg 2021; 61:447-55. [PMID: 33414066 DOI: 10.1016/j.ejvs.2020.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The AMBUVASC trial evaluated the cost effectiveness of outpatient vs. inpatient hospitalisation for endovascular repair of lower extremity arterial disease (LEAD). METHODS AMBUVASC was a national multicentre, prospective, randomised controlled trial conducted in nine public and two private French centres. The primary endpoint was the incremental cost effectiveness ratio (ICER), defined by cost per quality adjusted life year (QALY). Analysis was conducted from a societal perspective, excluding indirect costs, and considering a one month time horizon. RESULTS From 16 February 2016 to 29 May 2017, 160 patients were randomised (80 per group). A modified intention to treat analysis was performed with 153 patients (outpatient hospitalisation: n = 76; inpatient hospitalisation: n = 77). The patients mainly presented intermittent claudication (outpatient arm: 97%; inpatient arm: 92%). Rates of peri-operative complications were 20% (15 events) and 18% (14 events) for the outpatient and inpatient arms respectively (p = .81). Overall costs (difference: €187.83; 95% confidence interval [CI] -275.68-651.34) and QALYs (difference: 0.00277; 95% CI -0.00237 - 0.00791) were higher for outpatients due to more re-admissions than the inpatient arm. The mean ICER was €67 741 per QALY gained for the base case analysis with missing data imputed using multiple imputation by predictive mean matching. The outpatient procedure was not cost effective for a willingness to pay of €50 000 per QALY and the probability of being cost effective was only 59% for a €100 000/QALY threshold. CONCLUSION Outpatient hospitalisation is not cost effective compared with inpatient hospitalisation for endovascular repair of patients with claudication at a €50 000/QALY threshold.
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Rümenapf G, Morbach S, Rother U, Uhl C, Görtz H, Böckler D, Behrendt CA, Hochlenert D, Engels G, Sigl M. [Diabetic foot syndrome-Part 1 : Definition, pathophysiology, diagnostics and classification]. Chirurg 2021; 92:81-94. [PMID: 33170315 PMCID: PMC7819949 DOI: 10.1007/s00104-020-01301-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are ca. 8 million persons with diabetes mellitus living in Germany. A late sequelae of diabetes is the diabetic foot syndrome (DFS), the prevalence of which is greatly increasing. It comprises all alterations of the foot as a result of diabetic polyneuropathy as well as microvascular and macrovascular (peripheral arterial occlusive disease, PAOD) alterations. Many of the ca. 250,000 newly diagnosed diabetic foot ulcers per year become chronic wounds. Despite intensive efforts for prevention, early diagnosis and adequate wound care, ca. 13,000 persons with diabetes undergo major limb amputation in Germany every year. With consistent treatment in interdisciplinary centers and by exhausting all possible methods of wound treatment, pressure relief as well as arterial revascularization, the major amputation rate in patients with diabetic foot problems can be reduced by 80%. With a suitable strategy of prevention, the recurrence rate of foot ulcers would be reduced.
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Affiliation(s)
- G Rümenapf
- Oberrheinisches Gefäßzentrum Speyer, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Paul-Egell-Straße 33, 67346, Speyer, Deutschland.
| | - S Morbach
- Abteilung Diabetologie und Angiologie, Fachbereich Innere Medizin, Marienkrankenhaus gGmbH Soest, Soest, Deutschland
| | - U Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Görtz
- Klinik für Gefäßchirurgie, Bonifatius Hospital Lingen, Lingen, Deutschland
| | - D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C-A Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - D Hochlenert
- Centrum für Diabetologie, Endoskopie und Wundheilung Köln, Köln, Deutschland
| | - G Engels
- Chirurgische Praxis am Bayenthalgürtel, Köln, Deutschland
| | - M Sigl
- 1. Medizinische Klinik, Abteilung für Angiologie, Universitätsklinik Mannheim, Mannheim, Deutschland
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21
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Kreutzburg T, Peters F, Kuchenbecker J, Marschall U, Lee R, Kriston L, Debus ES, Behrendt CA. Editor's Choice - The GermanVasc Score: A Pragmatic Risk Score Predicts Five Year Amputation Free Survival in Patients with Peripheral Arterial Occlusive Disease. Eur J Vasc Endovasc Surg 2020; 61:248-256. [PMID: 33334671 DOI: 10.1016/j.ejvs.2020.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patients with peripheral arterial occlusive disease (PAOD) face an increased risk of both lower limb amputation and death. To date, it has been challenging to predict the long term outcomes for PAOD. The aim was to develop a risk score to predict worse five year amputation free survival (AFS). METHODS In this retrospective analysis of claims data, symptomatic PAOD patients were split into training and validation sets. Variables in the model were patient age and sex, Elixhauser comorbidities, and the 190 most common secondary diagnoses. Penalised Cox regression (least absolute shrinkage and selection operator [LASSO]) with tenfold cross validation for variable selection was performed and patients were categorised into five risk groups using the ten most important variables. All analyses were stratified by intermittent claudication (IC) and chronic limb threatening ischaemia (CLTI). RESULTS In total, 87 293 patients with PAOD (female 45.3%, mean age 71.4 ± 11.1 years) were included in the analysis. The most important variable predicting worse five year AFS was patient age >80 years. The GermanVasc score exhibited good predictive accuracy both for IC (c statistic = 0.70, 95% confidence interval [CI] 0.69-0.71) and CLTI (c statistic = 0.69, 95% CI 0.68-0.70) with adequate calibration due largely to alignment of observed and expected risk. Depending on the cumulative point score, the five year risk of amputation or death ranged from 9% (low risk) to 48% (high risk) for IC, and from 25% to 88% for CLTI. CONCLUSION The GermanVasc score predicts worse five year AFS stratified for inpatients suffering from IC and CLTI, with good predictive accuracy. By separating low from high risk patients, the GermanVasc score may support patient centred consent.
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Affiliation(s)
- Thea Kreutzburg
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Frederik Peters
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jenny Kuchenbecker
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Regent Lee
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, UK
| | - Levente Kriston
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - E Sebastian Debus
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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22
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Wang B, Pan Y, Yang G, Cui Z, Yu W, Liu H, Bai B. Sfrp5/Wnt5a and leptin/adiponectin levels in the serum and the periarterial adipose tissue of patients with peripheral arterial occlusive disease. Clin Biochem 2020; 87:46-51. [PMID: 33188773 DOI: 10.1016/j.clinbiochem.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Leptin, adiponectin, secreted frizzled-related protein 5 (Sfrp5) and wingless-type family member 5a (Wnt5a) are novel adipokines that are involved in insulin sensitivity and atherosclerosis. The aim of the present study was to investigate the serum and periarterial adipose tissue leptin/adiponectin and Sfrp5/Wnt5a levels in patients with peripheral arterial occlusive disease (PAOD). METHODS A total of 75 patients with PAOD and 39 control subjects were recruited. The serum concentrations of leptin, adiponectin, Sfrp5 and Wnt5a were measured by ELISAs, and the leptin, adiponectin, Sfrp5 and Wnt5a levels in the periarterial adipose tissue were observed by western blotting. RESULTS The serum Sfrp5 levels were significantly lower in the patients with PAOD than in the control subjects (p < 0.001) and Wnt5a levels were higher in the patients with PAOD (p < 0.001). The serum leptin levels were significantly higher in the patients with PAOD than in the control subjects (p < 0.001), and adiponectin levels were significantly lower in the patients with PAOD (p < 0.001). The serum Sfrp5 levels were associated with ABI (rs = 0.274; p = 0.018), Wnt5a (rs = -0.409; p < 0.001), adiponectin (rs = 0.244; p = 0.035) and Leptin/Adiponetin ratio (rs = -0.244; p = 0.037). The adiponectin and Sfrp5 protein levels were decreased in the periarterial adipose tissue of patients with PAOD compared with control subjects. The leptin and Wnt5a protein levels were increased in the periarterial adipose tissue of patients with PAOD compared with control subjects. CONCLUSION We demonstrated that the adiponectin and Sfrp5 levels in the serum and periarterial adipose tissue were significantly lower in the patients with PAOD than in the control subjects. The leptin and Wnt5a levels in the serum and periarterial adipose tissue were significantly higher in the patients with PAOD than in the control subjects.
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Affiliation(s)
- Biyu Wang
- The Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yu Pan
- The Department of Medical Administration, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guang Yang
- The Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zong'ao Cui
- The Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenping Yu
- The Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Liu
- The Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bing Bai
- The Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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23
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Buntinx M, Lavrijsen APM, de Fijter JW, Reinders MEJ, Schepers A, Bouwes Bavinck JN. Skin disorders indicating peripheral arterial occlusive disease and chronic venous insufficiency in organ transplant recipients. J Diabetes Complications 2020; 34:107623. [PMID: 32466875 DOI: 10.1016/j.jdiacomp.2020.107623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Peripheral arterial occlusive disease (PAOD) and chronic venous insufficiency (CVI) in organ transplant recipients (OTR) can lead to harmful outcomes. We made an inventory of cutaneous manifestations of PAOD and CVI in OTR in relation with diabetes and other potential risk factors. METHODS A prospective study in a single center was performed. OTR (n = 112) were included at the outpatient clinic to investigate clinical signs of PAOD and CVI. The most commonly associated risk factors were determined. RESULTS PAOD had been diagnosed in 15.6% and CVI in 30.0% of the patients. Diabetes was the cause of organ failure in 9.8% of the patients. Type 1 diabetes had been diagnosed in 8.9% and type 2 diabetes in 21.4% (59.1% new-onset diabetes after transplantation). Type 1 diabetes showed an increased risk for PAOD and limb amputation with hazard ratios of 11.0 (95%CI 3.0-40.2) and 9.1 (95%CI 1.4-58.6). Type 2 diabetes showed no increased risk. CONCLUSIONS Patients with a history of type 1 diabetes were at high risk for PAOD even years after a simultaneous pancreas kidney transplantation and they should remain under close observation for PAOD even though they are supposedly "cured" from their diabetes to prevent a harmful outcome.
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Affiliation(s)
- Maren Buntinx
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Adriana P M Lavrijsen
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Johan W de Fijter
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Jan N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
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Augustin AM, Thein I, Rickert N, Klink T, Bley TA, Kickuth R. Evaluation of superficial femoral artery-lesions after percutaneous transluminal angioplasty: color-coded summation images vs. monochromatic digital subtraction angiography. BMC Med Imaging 2020; 20:67. [PMID: 32552680 PMCID: PMC7302343 DOI: 10.1186/s12880-020-00468-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous transluminal angioplasty (PTA) is increasingly requested in the therapy of peripheral arterial occlusive disease. The evaluation of the technical result after balloon angioplasty with regard to bailout stenting is highly dependent on the operators´ subjective assessment and mainly based on the monochromatic digital subtraction angiography (DSA) images. The aim of this study was to compare color-coded single image as a novel diagnostic tool with monochromatic DSA for the analysis of flow limitation and need for stent implantation after PTA of superficial femoral artery (SFA) stenoses. Methods During a period of 18 months, 213 SFA lesions were treated by PTA with a standard balloon in 170 patients, resulting in a total of 193 endovascular procedures. The median age of the patients was 77 years (range, 35–96 years). Median length of the treated lesions was 10.5 cm (range, 1.0–50 cm). Three interventional radiologists retrospectively evaluated the results of balloon angioplasty with monochromatic as well as post-processed color-coded DSA images for flow limitations to decide if subsequent stent implantation was necessary. Consensus reading of two experienced interventional radiologists 2 months after the initial review served as reference standard to perform a receiver operating characteristics (ROC) analysis. Results ROC analysis for readers A, B and C showed area under the curve (AUC) values of 0.797, 0.865 and 0.804 for color-coded DSA and AUC values of 0.792, 0.843 and 0.872 for monochromatic DSA: a significant advantage of color-coded over conventional monochromatic DSA was not found for readers A and B (p > 0.05). Results of reader C were significantly better in the assessment of monochromatic images (p = 0.023). Diagnostic confidence using color-coded images was slightly higher than in monochromatic images (κ = 0.486 vs. κ = 0.459). Conclusions In this study, color coded DSA did not reveal to be superior to conventional monochromatic DSA when evaluating results of PTA and when deciding whether stent implantation is necessary or not. This technology, however, requires further experiences with special regard to homogeneously trained radiologists and to the time requirement.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
| | - Irina Thein
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Nicole Rickert
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Klink
- Department of Diagnostic and Interventional Radiology, Hospital Bayreuth GmbH, Bayreuth, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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25
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Hirsch K, Säemann M, Walter C, Taher F, Edda S, Mlekusch I, Jäger H, Assadian A, Falkensammer J. Decrease of peripheral resistance after intraoperative administration of iloprost in patients with and without type 2 diabetes mellitus and with peripheral arterial occlusive disease. Diab Vasc Dis Res 2020; 17:1479164120930589. [PMID: 32589047 PMCID: PMC7510379 DOI: 10.1177/1479164120930589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In many cases, Ilomedin® infusions are applied as part of a perioperative measure in patients with peripheral arterial occlusive disease because it makes a relevant vasodilatatory effect in patients with type 2 diabetes mellitus and with/without peripheral neuropathy. AIMS A prospective case-control study was performed to investigate the effect of prostanoids on peripheral resistance in patients with type 2 diabetes mellitus and patients without type 2 diabetes mellitus, as well as the role of peripheral neuropathy in patients undergoing arterial reconstruction. METHODS Sixty patients undergoing arterial reconstruction were enrolled. Sufficient data were collected on 38 patients. Prior to surgery, peripheral nerve conduction velocity was measured. Blood flow volume at the common femoral artery was assessed intraoperatively using a Doppler flowmeter at four time points: at baseline before arterial reconstruction (T0), after reconstruction (T1), after 5 (T2) and 10 min (T3) after intra-arterial application of 3000 ng of Ilomedin. Peripheral resistance units were calculated as a function of mean arterial pressure and flow volume using the following formula: peripheral resistance unit = mean arterial pressure (mm Hg) / flow volume (mL/min). RESULTS Ilomedin produced an immediate and significant drop of peripheral resistance in patients without type 2 diabetes mellitus as well as in patients with type 2 diabetes mellitus. Patients with peripheral neuropathy showed a less pronounced effect to Ilomedin compared to individuals with normal nerve conduction velocity.
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Affiliation(s)
- Kornelia Hirsch
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
- Kornelia Hirsch, Department of Vascular and Endovascular Surgery, Wilhelminenspital, Montleartstrasse 37, 1160 Vienna, Austria.
| | - Marcus Säemann
- Department of Nephrology, Wilhelminenspital, Vienna, Austria
| | - Corinna Walter
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Fadi Taher
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Skrinjar Edda
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Irene Mlekusch
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Heidrun Jäger
- Department of Physical Medicine, Wilhelminenspital, Vienna, Austria
| | - Afshin Assadian
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Jürgen Falkensammer
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
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Behrendt CA, Sedrakyan A, Peters F, Kreutzburg T, Schermerhorn M, Bertges DJ, Larena-Avellaneda A, L'Hoest H, Kölbel T, Debus ES. Editor's Choice - Long Term Survival after Femoropopliteal Artery Revascularisation with Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis. Eur J Vasc Endovasc Surg 2020; 59:587-596. [PMID: 31926836 DOI: 10.1016/j.ejvs.2019.12.034] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to determine the survival of patients after use of paclitaxel coated devices (PCX), as a recent meta-analysis of randomised trials reported higher mortality in patients treated with PCX balloons and stents METHODS: A retrospective health insurance claims analysis of patients covered by the second largest insurance fund in Germany, BARMER, was used to identify index femoropopliteal arterial interventions between 1 January 2010 and 31 December 2018. To ensure first PCX exposure, patients with prior deployment of PCX were excluded. The study cohort was stratified into patients with chronic limb threatening ischaemia (CLTI) and intermittent claudication (IC), then into balloons vs. stents cohorts. Within each stratum PCX were compared with uncoated devices. Propensity score matching was used to balance the study groups. Survival was evaluated using the Kaplan-Meier method and Cox regression. RESULTS There were 37 914 patients (mean age 73.3 years; 48.8% female) included in the study. The annual proportion of PCX use increased from 3% to 39% during the study period for CLTI and from 4% to 48% for IC (both p < .001). Paclitaxel coated balloons and stents were associated with improved overall survival (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.77-0.90), amputation free survival (HR 0.85, 95% CI 0.78-0.91), and freedom from major cardiovascular events (HR 0.82, 95% CI 0.77-0.89) vs. uncoated devices at five years for CLTI. In IC cohort, mortality was significantly lower after using drug coated balloons (DCB) (HR 0.87, 95% CI 0.76-0.99) or combined DCB and drug eluting stents (HR 0.88, 95% CI 0.80-0.98). CONCLUSION In this large health insurance claims analysis, rapid adoption of PCX, higher long term survival, better amputation free survival, and lower rates of major cardiovascular events were seen after their use for the treatment of CLTI.
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Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Frederik Peters
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Kreutzburg
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Schermerhorn
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
| | - Axel Larena-Avellaneda
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tilo Kölbel
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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27
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Schürmann K. [Aortic bifurcation reconstruction : Endovascular repair and alternatives]. Radiologe 2018; 58:829-36. [PMID: 30094480 DOI: 10.1007/s00117-018-0438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
CLINICAL ISSUE Aortic bifurcation disease is a manifestation of arteriosclerosis in about 95% of cases. Stenotic disease of the aortic bifurcation is a special form of peripheral arterial occlusive disease (PAOD). Men older than 60 years are particularly affected. STANDARD TREATMENT The potential of endovascular therapy has continued to increase. Hereby, the increased availability of hybrid operating suites which allow for a combined use of endovascular techniques and open surgery plays an important role. DIAGNOSTIC WORK-UP For the decision on the type of therapy and the sizing of the prosthesis, thin-slice CT angiography (CTA) of the abdominal aorta and the iliac arteries including multiplanar reconstructions in the sagittal and coronal planes is sufficient. The inguinal arteries have to be included in the CTA volume. PERFORMANCE Compared to open surgery, endovascular therapy of aortic bifurcation disease has the advantage of reduced invasiveness. ACHIEVEMENTS Treatment of aortic bifurcation disease continues to change. In daily practice, the standard treatment of complex aortic bifurcation disease is still open surgery. However, an increasing number of studies indicate that endovascular therapy and open surgery should be considered equivalent, complementary methods. PRACTICAL RECOMMENDATIONS Good quality preinterventional CTA is important for intervention planning. If you want to offer endovascular therapy as a radiologist, knowledge of interventional skills and close cooperation with clinical colleagues, particularly the vascular surgeon, is mandatory.
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Abstract
Chronic wounds often manifest as ulcers on the lower legs. The main causes of chronic leg ulcers are chronic venous insufficiency and/or peripheral arterial occlusive disease in approximately 80% of all patients. However, there are also numerous other potentially relevant factors which can cause or almost impede the healing of chronic leg ulcers. Therefore, disease such as vasculitis, livedo vasculopathy, pyoderma gangrenosum, necrobiosis lipoidica, Martorell hypertensive leg ulcer, calciphylaxis, infectious diseases, neoplasms, drugs, cutaneous artefacts and genetic defects are exemplarily presented. The successful therapy of patients with chronic leg ulcers is only possible on the basis of an adequate diagnosis. Therapeutic options include conservative, surgical and interventional treatment options. In particular the consequent implementation of compression therapy is of very great importance in the therapy of most patients with chronic leg ulcers and edema. However, a permanent effective treatment always requires a causally oriented therapy, which usually needs an interdisciplinary and interprofessional approach.
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Kim SY, Kim TH, Choi JY, Kwon YJ, Choi DH, Kim KC, Kim MJ, Hwang HK, Lee KB. Predictors for Amputation in Patients with Diabetic Foot Wound. Vasc Specialist Int 2018; 34:109-116. [PMID: 30671420 PMCID: PMC6340693 DOI: 10.5758/vsi.2018.34.4.109] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/26/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. Materials and Methods From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU). Results The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU. Conclusion This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.
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Affiliation(s)
- Se-Young Kim
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Tae Hoon Kim
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Jun-Young Choi
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Yu-Jin Kwon
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Dong Hui Choi
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Ki Chun Kim
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Min Ji Kim
- Department of Radiology, Seoul Medical Center, Seoul, Korea
| | - Ho Kyung Hwang
- Department of Radiology, Seoul Medical Center, Seoul, Korea
| | - Kyung-Bok Lee
- Department of Surgery, Seoul Medical Center, Seoul, Korea
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Olm M, Kühnl A, Knipfer E, Salvermoser M, Eckstein HH, Zimmermann A. [Operative treatment of diabetics with vascular complications : Secondary data analysis of diagnosis-related groups statistics from 2005 to 2014 in Germany]. Chirurg 2018; 89:545-51. [PMID: 29589075 DOI: 10.1007/s00104-018-0628-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In Germany approximately 40,000 amputations per year are performed on patients with diabetes mellitus, often with accompanying vascular complications. OBJECTIVE The aim of this study was to present the various degrees of severity of the vascular complications and the temporal changes of the treatment options in diabetics with vascular complications in Germany. MATERIAL AND METHODS The microdata of the diagnosis-related groups (DRG) statistics of the Federal Statistical Office were analyzed over the period from 2005 to 2014. All cases were included in which the main or secondary diagnosis of diabetes mellitus with concurrent vascular complications (diabetic angiopathy and peripheral arterial disease) was encrypted. RESULTS The median age of the 1,811,422 cases was 73 years and 62% were male. While the total number of amputations remained stable over time, there was a 41% reduction in knee-preserving and a 31% reduction in non-knee preserving major amputations with an 18% increase in minor amputations. Revascularization increased by 33% from 36 procedures in 2005 to 48 procedures per 100,000 inhabitants. The increase in revascularization was evident in the area of endovascular therapy alone where there was an increase of 78%. CONCLUSION Due to the significant increase in endovascular revascularization measures, there was a significant increase in the proportion of diabetes patients with vascular pathologies in whom revascularization was carried out. As a result, improved limb preservation was achieved despite equally high amputation rates due to increasing minor amputation rates.
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Lu MC, Hsu H, Lin CH, Koo M. Systemic vasculitis is associated with a higher risk of lower extremity amputation in patients with severe peripheral arterial occlusive disease: a secondary analysis of a nationwide, population-based health claims database. Rheumatol Int 2017; 37:1847-52. [PMID: 28951963 DOI: 10.1007/s00296-017-3828-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
Previous research has shown that diabetes mellitus increases the risk of lower extremity amputation in patients with peripheral arterial occlusive disease. However, to our knowledge, no studies have investigated whether systemic autoimmune disease, in particular systemic vasculitis is associated with a higher risk of lower extremity amputation in these patients. To investigate the association between systemic autoimmune disease and lower extremity amputation in patients with severe peripheral arterial occlusive disease based on a secondary analysis of a nationwide, population-based health claims database. Using the inpatient datafile of the Taiwan's National Health Insurance Research Database (NHIRD), we identified 432 patients with severe peripheral arterial occlusive disease that required hospitalization between 2000 and 2012. We also identified patients who had undergone lower extremity amputation and their comorbidities using the same datafile. The risk of lower extremity amputation was assessed using multiple logistic regression analysis, adjusting for age, sex, insured amount, the urbanization level of residence, and the presence of comorbidities. Among patients with severe peripheral arterial occlusive disease, those with systemic vasculitis exhibited a significant higher risk of lower extremity amputation (adjusted odds ratio [aOR] = 6.82, p < 0.001). Diabetes mellitus (aOR = 4.90, p < 0.001) and chronic obstructive pulmonary disease (aOR = 2.87, p = 0.007) were also significantly associated with a higher risk of lower extremity amputation. Among patients with severe peripheral arterial occlusive disease, a significantly higher risk of lower extremity amputation was observed in those with systemic vasculitis.
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Kostrzewa M, Kara K, Pilz L, Mueller-Muertz H, Rathmann N, Schoenberg SO, Diehl SJ. Treatment Evaluation of Flow-Limiting Stenoses of the Superficial Femoral and Popliteal Artery by Parametric Color-Coding Analysis of Digital Subtraction Angiography Series. Cardiovasc Intervent Radiol 2017; 40:1147-54. [PMID: 28488106 DOI: 10.1007/s00270-017-1670-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/24/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the hemodynamic effect of percutaneous transluminal intervention (PTI) on stenosis of the superficial femoral (SFA) and popliteal arteries (PA) using time-density curves (TDCs) derived from digital subtraction angiography (DSA) series in correlation with ultrasound peak systolic velocity ratio (PSVR) and ankle brachial index (ABI). MATERIALS AND METHODS DSA series of SFA or PA of patients with symptomatic peripheral arterial occlusive disease was obtained with a flat-panel angiography system with intention-to-treat. In DSA series acquired before and after PTI, TDCs were analyzed proximal and distal of each stenosis using parametric color coding (PCC). For correlation, ABI and PSVR measurements pre- and post-PTI were recorded for all patients. RESULTS In total, 25 stenoses of the SFA or PA were treated by PTI in 22 patients (17 male, 5 female, mean age 68 years). After treatment, peak-to-peak (PTP) times between TDCs proximal and distal to the treated vessel segment decreased statistically significantly (p = 0.01) on average from PTP = 1.9 ± 1.7 s to mean PTP = 1 ± 1 s. ABI and PSVR also changed statistically significantly after treatment (pretreatment ABI = 0.7 ± 0.2, PSVR = 4.2 ± 1.9; post-ABI = 0.9 ± 0.2, PSVR = 1.3 ± 0.4, both p < 0.05). Correlation parameters did not show a strong correlation between change in TDC and clinical parameters ABI and PSVR. CONCLUSION Using PCC for analyzing contrast medium dynamics in DSA series is clinically useful for evaluating stenoses of the SFA and PA and for immediate treatment control after PTA. LEVEL OF EVIDENCE Case series, IV.
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Behrendt CA, Heidemann F, Haustein K, Grundmann RT, Debus ES. Percutaneous endovascular treatment of infrainguinal PAOD: Results of the PSI register study in 74 German vascular centers. Gefasschirurgie 2016; 22:17-27. [PMID: 28715513 PMCID: PMC5306226 DOI: 10.1007/s00772-016-0202-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The percutaneous infrainguinal stent (PSI) register study aimed to collate all percutaneous endovascular procedures for infrainguinal peripheral arterial occlusive disease (PAOD) conducted in 74 German vascular centers between September and November 2015 (3 months). In order to obtain representative results all consecutive treatment procedures had to be submitted by the participating trial centers. Material and methods This was a prospective, nonrandomized multicenter study design. All patients suffering from intermittent claudication (IC, Fontaine stage II) or critical limb ischemia (CLI, Fontaine stages III and IV) were included. Trial centers with less than 5 cases reported within the 3‑month trial period or centers that could not ensure the submission of all treated patients were excluded. Results In the final assessment 2798 treated cases from 74 trial centers were reported of which 65 (87.8 %) centers were under the leadership of a vascular surgeon. Approximately 33 % of the interventions in centers under the leadership of vascular surgeons were conducted by radiologists. Risk factors, especially chronic renal disease, diabetes and cardiac risk factors were significantly different between patients with IC and CLI. Of the patients with Fontaine stage II PAOD 41.3 % had 3 patent crural vessels compared to only 10.8 % of patients with Fontaine stage IV. With respect to peri-interventional complications, percutaneous endovascular treatment of IC was a safe procedure with severe complications in less than 1 % and no fatalities. Only 4.5 % of the procedures were conducted under ambulatory conditions. In the supragenual region self-expanding bare metal stents, standard percutaneous transluminal angioplasty (PTA) and drug-coated balloons were the most frequently used procedures. For interventions below the knee, standard PTA was the most commonly employed treatment. Conclusion The main aim of the PSI study was to obtain a realistic picture of percutaneous endovascular techniques used to treat suprapopliteal and infrapopliteal PAOD lesions and to describe the treatment procedures used by vascular specialists in Germany. To investigate the change in trends for treatment over time, this study has to be repeated in the future in order to test how quickly the results of randomized studies can be implemented in practice. Electronic supplementary material A complete list of the PSI study collaborators is available under doi: 10.1007/s00772-016-0202-2.
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Affiliation(s)
- C-A Behrendt
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Heidemann
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Haustein
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R T Grundmann
- German Institute of Vascular Medicine and Health Research (DIGG) of the DGG, Berlin, Germany
| | - E S Debus
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
CLINICAL ISSUE Increasing understanding of the anatomy and physiology of neural structures has led to the development of surgical and percutaneous neurodestructive methods in order to target and destroy various components of afferent nociceptive pathways. The dorsal root ganglia and in particular the ganglia of the autonomous nervous system are targets for radiological interventions. The autonomous nervous system is responsible for the regulation of organ functions, sweating, visceral and blood vessel-associated pain. STANDARD RADIOLOGICAL METHODS Ganglia of the sympathetic chain and non-myelinized autonomous nerves can be irreversibly destroyed by chemical and thermal ablation. PERFORMANCE Computed tomography (CT)-guided sympathetic nerve blocks are well established interventional radiological procedures which lead to vasodilatation, reduction of sweating and reduction of pain associated with the autonomous nervous system. ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS Sympathetic blocks are applied for the treatment of various vascular diseases including critical limb ischemia. Other indications for thoracic and lumbar sympathectomy include complex regional pain syndrome (CRPS), chronic tumor associated pain and hyperhidrosis. Neurolysis of the celiac plexus is an effective palliative pain treatment particularly in patients suffering from pancreatic cancer. Percutaneous dorsal root ganglion rhizotomy can be performed in selected patients with radicular pain that is resistant to conventional pharmacological and interventional treatment.
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Affiliation(s)
- R Bale
- Sektion für Mikroinvasive Therapie Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Treitl M, Reiser MF, Treitl KM. [Stent-assisted recanalization of femoropopliteal arterial occlusive disease. Influence of stent design on patency rates]. Radiologe 2016; 56:233-9. [PMID: 26842999 DOI: 10.1007/s00117-016-0077-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/29/2022]
Abstract
BACKGROUND Despite enormous technical progress the results of endovascular treatment of the femoropopliteal vasculature are unsatisfactory and its role is still controversially discussed. In the past decade numerous new stent designs have come onto the market but it is unclear whether they have benefits with respect to patency rates. OBJECTIVES Comparison of published data on patency rates and target lesion revascularization rates after use of different stent designs in the femoropopliteal vasculature. MATERIAL AND METHODS Analysis of 25 published studies and registries from 2006 to 2015 for classical open-cell stents, interwoven stents and partially or fully covered stents. RESULTS AND CONCLUSION The published data are heterogeneous and comparative studies for different stent designs are completely missing. Over the past decade the patency rates after femoropopliteal stenting could be improved. According to available data stenting of short lesions < 5 cm does not show any benefit compared to isolated balloon angioplasty. Primary stenting is now recommended for intermediate and longer lesions > 6.4 cm. Due to the heterogeneity of published data a clear benefit for a specific stent design is not obvious; however, data for interwoven stents are promising and show a tendency towards improved patency, at least for certain lesions. Randomized controlled comparative trials are needed to confirm this result.
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Affiliation(s)
- M Treitl
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland.
| | - M F Reiser
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - K M Treitl
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland
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Fiessinger JN. [ Peripheral arterial occlusive disease]. Rev Prat 2016; 66:91-92. [PMID: 30512410] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jean-Noël Fiessinger
- Professeur émérite de médecine vasculaire, université Paris Descartes, Paris, France
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Yu JS, Park KM, Jeon YS, Cho SG, Hong KC, Shin WY, Choe YM, Shin SH, Kim KR. Midterm Outcome of Femoral Artery Stenting and Factors Affecting Patency. Vasc Specialist Int 2015; 31:115-9. [PMID: 26719837 PMCID: PMC4694182 DOI: 10.5758/vsi.2015.31.4.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/02/2015] [Revised: 10/05/2015] [Accepted: 11/03/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the early and midterm results of superficial femoral artery (SFA) stenting with self-expanding nitinol stents and to identify the factors affecting patency. MATERIALS AND METHODS SFA stenting was performed in 165 limbs of 117 patients from January 2009 to December 2013. Patients were followed-up for the first occurrence of occlusion or stenosis based on computed tomography and duplex scan results and a decrease in ankle brachial index of >15%. RESULTS During the follow-up period (mean, 15.3±3.2 months), no early thrombotic reocclusions occurred within 30 days, but in-stent restenosis developed in 78 limbs. The primary patency rates at 6, 12, 18, and 24 months were 78%, 66%, 42%, and 22%, respectively, and the secondary patency rates were 85%, 72%, 58%, and 58%, respectively. TASC II C or D lesions, stent length >8 cm, number of patent tibial arteries and diabetes were significantly associated with reintervention. CONCLUSION The midterm results of stenting for SFA occlusive disease were disappointing because the primary and secondary patency rates at two years were 22% and 58%, respectively. Reintervention after SFA stenting remains a major problem, particularly in patients with diabetes mellitus or long TASC II C or D lesions.
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Affiliation(s)
- Jae Seoung Yu
- Department of Surgery and, Inha University College of Medicine, Incheon, Korea
| | - Keun-Myoung Park
- Department of Surgery and, Inha University College of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery and, Inha University College of Medicine, Incheon, Korea
| | - Woo Young Shin
- Department of Surgery and, Inha University College of Medicine, Incheon, Korea
| | - Yun-Mee Choe
- Department of Surgery and, Inha University College of Medicine, Incheon, Korea
| | - Seok-Hwan Shin
- Department of Surgery and, Inha University College of Medicine, Incheon, Korea
| | - Kyung Rae Kim
- Department of Surgery and, Inha University College of Medicine, Incheon, Korea
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Hiratsuka M, Koyama K, Yamamoto J, Narita A, Sasakawa Y, Shimogushi H, Ogawa A, Kimura T, Mizuguchi K, Mizuno M. Skin Perfusion Pressure and the Prevalence of Atherothrombosis in Hemodialysis Patients. Ther Apher Dial 2015; 20:40-5. [PMID: 26482119 DOI: 10.1111/1744-9987.12327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/29/2022]
Abstract
End-stage renal disease is associated with atherothrombosis (ATIS), which, in turn, can promote peripheral arterial occlusive disease (PAOD), coronary artery disease (CAD), and/or cerebrovascular disease (CVD). The aim of this study was to determine whether low plantar skin perfusion pressure (SPP) was related to ATIS among 122 patients receiving maintenance hemodialysis (HD) from March to November 2013 at our outpatient facility. We routinely measured SPP and used the value for analysis. In addition, we retrospectively evaluated the prevalence of ATIS with patients categorized to CAD, CVD, or PAOD groups. Of the 122 outpatients, ATIS was diagnosed in about half (N = 60, 49.2% vs. 62, 50.8%; average SPP, 56.6 vs. 72.9 mm Hg, respectively). These data show that SPP was significantly lower in patients with ATIS (difference, 16.3 mm Hg; P < 0.001) and there was a negative relationship between average SPPs and past history of ATIS complications. When the patients were stratified by the presence of diabetes mellitus, this trend was stronger. Particularly, receiver operating characteristic analysis of HD patients with diabetes revealed a cutoff point of 53.0 mm Hg and an area under the curve value of 0.84, with a sensitivity of 77.0% and specificity of 91.3%. Therefore, we concluded that SPP enables the evaluation of not only local PAOD, but also systemic ATIS. Moreover, we found that a cutoff point of 53.0 mm Hg was useful for detection of ATIS in HD patients.
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Affiliation(s)
- Maki Hiratsuka
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Katsushi Koyama
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Jun Yamamoto
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Aiko Narita
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Yuji Sasakawa
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Hiroya Shimogushi
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Atsushi Ogawa
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Tomomi Kimura
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Ken Mizuguchi
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
| | - Masashi Mizuno
- Department of Nephrology, Kariya Toyota General Hospital, Aichi, Japan
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Lee DH, Park DS, Kim DH, Lee SH, Cho HM. Myotonic Dystrophy Type 1 Complicated With Peripheral Arterial Occlusive Disease: A Case Report. Ann Rehabil Med 2015; 39:645-8. [PMID: 26361604 PMCID: PMC4564715 DOI: 10.5535/arm.2015.39.4.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/03/2014] [Accepted: 09/17/2014] [Indexed: 11/05/2022] Open
Abstract
Myotonic dystrophy (MD) is the most common adult muscular dystrophy characterized by multi-systemic clinical manifestations involving the brain, smooth muscle, cardiovascular and endocrine systems. However, peripheral arterial occlusive disease (PAOD) is an uncommon presentation of MD type 1 (DM1), which has not been reported in recent literature. A 53-year-old female, previously confirmed as DM1, presented with vague claudication of both lower limbs. The diagnosis of PAOD based on results of ankle-brachial index, ultrasonography, and abdominal computed tomography angiography studies was followed by aortobifemoral artery bypass surgery. Although the arterial patency was restored after the operation, she did not recover from post-operative respiratory complications. Screening of PAOD is necessary for DM1 with general risk factors of occlusive arteriopathy. However, surgery should be reserved for the most severe cases.
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Affiliation(s)
- Dong Hun Lee
- Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong Sik Park
- Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang Hun Lee
- Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hee Mun Cho
- Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Zimmermann A, Senner S, Eckstein HH, Pelisek J. Histomorphological evaluation of atherosclerotic lesions in patients with peripheral artery occlusive disease. Adv Med Sci 2015; 60:236-9. [PMID: 25925508 DOI: 10.1016/j.advms.2015.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 07/30/2014] [Revised: 03/16/2015] [Accepted: 03/23/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Peripheral arterial occlusive disease (PAOD) is mainly caused by atherosclerosis of the vessel wall. These pathological changes are classified into different stages and are well described for carotid and coronary vessels, but not for PAOD. The aim of our study was to analyze plaque morphology of femoral arteries in patients with intermittent claudication and critical limb ischemia. PATIENTS AND METHODS In this retrospective study 85 atherosclerotic plaques (common and superficial femoral artery) of 71 patients with a clinical symptomatic PAOD were analyzed, by histology (01/2009-07/2010). Atherosclerotic lesions were classified according to Stary (type I-VIII). For further characterization, plaques were evaluated for the presence of collagen, elastin, calcifications, smooth muscle cells, macrophages, leucocytes, and cellularity. RESULTS The majority (91%) of atherosclerotic lesions were of advanced types according to Stary (V-VII). Atherosclerotic lesion type VI was associated with significant higher amount of inflammatory cells in comparison to all other atherosclerotic plaque types (CD45: p<0.001; CD68: p=0.013). In addition, atherosclerotic plaques with a pronounced neovascularization contained a higher amount of CD45 (p=0.015; rho=0.273) and CD68 (p=0.016; rho=0.275) positive cells. CONCLUSION Atherosclerotic lesions of femoral arteries show similar morphological changes as coronary or carotid arteries. But inflammatory cells had a higher impact on plaque progression and destabilization than any other factor.
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Affiliation(s)
- Alexander Zimmermann
- Clinic for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
| | - Simon Senner
- Clinic for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Hans-Henning Eckstein
- Clinic for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Jaroslav Pelisek
- Clinic for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Haraguchi T, Urasawa K, Nakama T, Nakagawa Y, Tan M, Koshida R, Sato K. Sheath rendezvous method: a novel distal protection technique during endovascular treatment of subclavian artery occlusions. Cardiovasc Interv Ther 2015. [PMID: 26224140 DOI: 10.1007/s12928-015-0348-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To describe an innovative distal protection technique, "sheath rendezvous method", during endovascular treatment for subclavian arterial occlusions. 4.5F and 6F guiding sheath were inserted from left brachial and common femoral artery, respectively. 0.014″ guidewire retrogradely passed through occlusion and into antegrade sheath to establish a pull-through system. 3.0 mm balloon was used to expand occlusion and anchor to deliver retrograde sheath into antegrade one. Both sheaths locked by balloon dilatation crossed occlusion until antegrade sheath passed over lesion. Balloon expandable stent was delivered within antegrade sheath. Sheath was removed, and stent was implanted. We obtained an excellent outcome without complications.
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Affiliation(s)
- Takuya Haraguchi
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan.
| | - Kazushi Urasawa
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yuya Nakagawa
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Michinao Tan
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Ryoji Koshida
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Katsuhiko Sato
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
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Partovi S, von Tengg-Kobligk H, Bhojwani N, Karmonik C, Maurer M, Robbin MR. Advanced Noncontrast MR Imaging in Musculoskeletal Radiology. Radiol Clin North Am 2015; 53:549-67. [PMID: 25953289 DOI: 10.1016/j.rcl.2015.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multiple nonmorphologic magnetic resonance sequences are available in musculoskeletal imaging that can provide additional information to better characterize and diagnose musculoskeletal disorders and diseases. These sequences include blood-oxygen-level-dependent (BOLD), arterial spin labeling (ASL), diffusion-weighted imaging (DWI), and diffusion-tensor imaging (DTI). BOLD and ASL provide different methods to evaluate skeletal muscle microperfusion. The BOLD signal reflects the ratio between oxyhemoglobin and deoxyhemoglobin. ASL uses selective tagging of inflowing blood spins in a specific region for calculating local perfusion. DWI and DTI provide information about the structural integrity of soft tissue including muscles and fibers as well as pathologies.
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Schernthaner RE, Wolf F, Mistelbauer G, Weber M, Sramek M, Groeller E, Loewe C. New hybrid reformations of peripheral CT angiography: do we still need axial images? Clin Imaging 2015; 39:603-7. [PMID: 25825345 DOI: 10.1016/j.clinimag.2015.03.005] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/16/2015] [Accepted: 03/10/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE To quantify the detectability of peripheral artery stenosis on hybrid CT angiography (CTA) reformations. METHODS Hybrid reformations were developed by combining multipath curved planar reformations (mpCPR) and maximum intensity projections (MIP). Fifty peripheral CTAs were evaluated twice: either with MIP, mpCPR and axial images or with hybrid reformations only. Digital subtraction angiography served as gold standard. RESULTS Using hybrid reformations, two independent readers detected 88.0% and 81.3% of significant stenosis, respectively. However, CTA including axial images detected statistically significant more lesions (98%). CONCLUSION Peripheral CTA reading including axial images is still recommended. Further improvement of these hybrid reformations is necessary.
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Affiliation(s)
- Ruediger Egbert Schernthaner
- Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Florian Wolf
- Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Gabriel Mistelbauer
- Institute of Computer Graphics and Algorithms, Technical University of Vienna, Favoritenstraße 9-11, 1040 Vienna, Austria.
| | - Michael Weber
- Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Milos Sramek
- Commission for Scientific Visualization, Austrian Academy of Sciences, Donau-City Straße 1, 1220 Vienna, Austria.
| | - Eduard Groeller
- Institute of Computer Graphics and Algorithms, Technical University of Vienna, Favoritenstraße 9-11, 1040 Vienna, Austria.
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Kim YA, Kim ES, Hwang HK, Lee KB, Lee S, Jung JW, Kwon YJ, Cho DH, Park SS, Yoon J, Jang YS. Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive Disease. Vasc Specialist Int 2014. [PMID: 26217631 PMCID: PMC4480317 DOI: 10.5758/vsi.2014.30.4.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Peripheral neuropathy (PN) is known as a major contributor of the worsening of ischemic symptoms and the foot ulceration in patients with peripheral arterial occlusive disease (PAOD). However, there are few studies reporting the prevalence and risk factors for PN in PAOD. This study aimed to evaluate these issues for PN and to establish the importance of screening as additional treatment target for PN in PAOD. MATERIALS AND METHODS A total of 52 limbs with PAOD were enrolled from January 2011 to December 2012. PN was divided into radiculopathy, ischemic PN (IPN), and diabetic PN (DPN), based on electromyographic findings. We investigated the prevalence of overall PN and subtypes of PN and then analyzed the risk factors. RESULTS The prevalence of overall PN in PAOD was 43 of 52 limbs (82.7%). In terms of subtypes of PN, the prevalence rate of radiculopathy and IPN was 30.8% and 23.1%, respectively. DPN showed in 22 limbs (73.3%) among 30 diabetic limbs. There was no significant correlation between each type of PN and ischemic symptoms. Our analysis showed that coronary artery disease (CAD) was a significant risk factor (P=0.01) for IPN, however, did not identify any significant risk factors for DPN. CONCLUSION This present study indicated that most patients with PAOD had PN and CAD was a risk factor for IPN. In particular, PAOD with diabetes represented a higher prevalence for DPN. Our study suggests that PN should be evaluated and considered as another treatment target in patients with PAOD.
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Affiliation(s)
- Young Ae Kim
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Eun Su Kim
- Rehabilitation Medicine, Seoul Medical Center, Seoul, Korea
| | | | - Kyung Bok Lee
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Sol Lee
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Ji Woong Jung
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Yu Jin Kwon
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Dong Hui Cho
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Sang Su Park
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Jin Yoon
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
| | - Yong-Seog Jang
- Departments of Surgery, Seoul Medical Center, Seoul, Korea
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Heo SH, Park YJ, Woo SY, Kim DI, Kim YW. Comparison of long-term results of above-the-knee femoro-popliteal bypass with autogenous vein and polytetrafluoroethylene grafts. Ann Surg Treat Res 2014; 88:28-34. [PMID: 25553322 PMCID: PMC4279987 DOI: 10.4174/astr.2015.88.1.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 06/09/2014] [Revised: 07/26/2014] [Accepted: 08/01/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To analyze the long-term results of above-the-knee femoro-popliteal bypass (ATKFPB) with vein grafts compared with polytetrafluoroethylene (PTFE) grafts. METHODS A database of patients with chronic atherosclerotic occlusive disease who underwent ATKFPB was retrospectively reviewed. Characteristics of patient and arterial lesion, and follow-up results were compared between vein grafts and PTFE grafts. Graft patency was determined by periodic examinations of duplex ultrasonography or CT angiograms. Graft patency and limb salvage rates were calculated using the Kaplan-Meier method. RESULTS In total, 253 ATKFPBs (107 vein grafts; 146 PTFE grafts; critical limb ischemia, 32%) were performed on 228 patients (mean age, 68.5 years; male, 87.7%). No significant differences were observed between the two groups with respect to demographic characteristics, characteristics of arterial lesions, or distal runoff score. During the mean follow-up period of 41 months (range, 1-122 months), 14.5% patients died, and 94% of all limbs were available for follow-up. The primary patency rates were not significantly different between the two groups at 10 years after treatment (75% vs. 42%, P = 0.330). However, the primary-assisted patency rates (88% vs. 42%, P = 0.003) and secondary patency rates (91% vs. 49%, P = 0.013) were significantly higher in the vein grafts compared with the PTFE grafts. Graft occlusion developed more often in the PTFE grafts (5.6% vs. 20.5%, P = 0.001). When graft occlusion occurred, acute limb ischemia was significantly more frequent in the PTFE grafts than in the vein grafts (0% vs. 53%, P = 0.027). CONCLUSION After ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.
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Affiliation(s)
- Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ebben HP, Nederhoed JH, Lely RJ, Meijerink MR, van der Meijs BB, Wisselink W, Yeung KK, Hoksbergen AW. Low-dose thrombolysis for thromboembolic lower extremity arterial occlusions is effective without major hemorrhagic complications. Eur J Vasc Endovasc Surg 2014; 48:551-8. [PMID: 25108710 DOI: 10.1016/j.ejvs.2014.06.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/23/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and bleeding complications associated with a low-dose thrombolysis protocol for thromboembolic lower extremity arterial occlusions. DESIGN A retrospective cohort study. MATERIALS AND METHODS A retrospective analysis was performed using data from all consecutive patients who underwent catheter-directed, intra-arterial thrombolysis for thromboembolic lower extremity arterial occlusions between January 2004 and May 2013. All patients were treated on a standard surgical ward. Endpoints were incidence of bleeding complications, duration of thrombolysis, angiographic patency rate, 30-day mortality rate, and amputation-free rate at 6 months. RESULTS Of the 171 cases analyzed, 129 cases underwent low-dose thrombolysis and 42 underwent high-dose thrombolysis. No major bleeding complications occurred in the low-dose group versus 5% in the high-dose group (p = .01). The median duration of thrombolysis was 67 hours (4-304 hours) in the low-dose and 49 hours (2-171 hours) in the high-dose group (p = .027). Angiographic patency was restored in 67% of the cases in the low-dose group versus 79% of the high-dose group (p = .17). The 30-day mortality rates were 1% in the low-dose versus 5% in the high-dose group (p = .09). However, this higher mortality rate was not related to bleeding complications. Major amputation-free rates at 6 months were 81% in the low-dose group and 88% in the high-dose group (p = .22). CONCLUSIONS Based on this data series, low-dose thrombolysis for thromboembolic lower extremity arterial occlusions is as effective as high-dose thrombolysis; however, the risk of major bleeding complications is substantially lower when using low-dose thrombolysis.
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Hsu PC, Lee WH, Chiu CA, Chu CY, Chen SC, Su HM, Lin TH, Voon WC, Lai WT, Sheu SH. R2CHADS2 score is significantly associated with ankle-brachial index <0.9 in patients without atrial fibrillation. Atherosclerosis 2014; 236:307-11. [PMID: 25119507 DOI: 10.1016/j.atherosclerosis.2014.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/18/2014] [Accepted: 07/20/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Previous studies demonstrated CHADS2 score and impaired renal function were both associated with ankle-brachial index (ABI) < 0.9 in patients without atrial fibrillation (AF). Hence, we hypothesized the R2CHADS2 score had a significant correlation with ABI < 0.9 and the aim of this study was to validate this association in non-AF patients. METHODS A total of 1482 patients without AF were included. ABI was measured using an ABI-form device. Peripheral arterial occlusive disease (PAOD) was defined as ABI < 0.9 in either leg. RESULTS Of the 1482 subjects, the prevalence of ABI < 0.9 was 5.6%. Multivariate analysis showed that increased age (odds ratio [OR], 1.049; P < 0.001), decreased estimated glomerular filtration rate (OR, 0.978; P = 0.006), and increased R2CHADS2 score (OR, 1.738; P < 0.001) were associated with ABI < 0.9. In addition, in patients with CHADS2 score ≧ 2, the presence of chronic kidney disease (CKD) was significantly associated with ABI < 0.9 (P ≦ 0.006), but in patients with CHADS2 score < 2, there was no such association (P = 0.357). CONCLUSIONS Our study demonstrated R2CHADS2 score was positively correlated with ABI < 0.9. In addition, the presence of CKD was a risk factor of ABI < 0.9 in patients with CHADS2 score ≧ 2. Hence, increased R2CHADS2 score in non-AF patients and the presence of CKD in non-AF patients with CHADS2 score ≧ 2 were useful parameters in identifying the high risk group of PAOD.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-An Chiu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Erturk M, Cakmak HA, Surgit O, Celik O, Aksu HU, Akgul O, Gurdogan M, Bulut U, Ozalp B, Akbay E, Yildirim A. Predictive value of elevated neutrophil to lymphocyte ratio for long-term cardiovascular mortality in peripheral arterial occlusive disease. J Cardiol 2014; 64:371-6. [PMID: 24685686 DOI: 10.1016/j.jjcc.2014.02.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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] [Received: 01/07/2014] [Revised: 02/06/2014] [Accepted: 02/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peripheral arterial occlusive disease (PAOD), which is common in male gender and elderly population, is related with increased cardiovascular mortality and morbidity. Neutrophil to lymphocyte ratio (NLR) has been found to be an independent predictor of cardiovascular mortality in atherosclerosis. The aim of the present study was to investigate the association between NLR and cardiovascular mortality both in patients with intermittent claudication and critical limb ischemia. METHODS In a retrospective study, 593 consecutive patients who had been admitted to the inpatient ward of the vascular department of a large tertiary training and research hospital with diagnosis of symptomatic PAOD between May 2009 and September 2012 were included. Patients were divided into two groups according to their NLR as follows: high NLR (NLR>3.0) and low NLR (NLR ≤ 3.0) groups. RESULTS During the course of the present study [median follow-up period of 20 months (interquartile range, 12-27)], 75 deaths occurred out of 508 patients (14.8%). Cardiovascular mortality was found to be significantly higher in elevated NLR group (n = 43) as compared to low NLR group (n = 32) (23.6% vs 9.8%, respectively; p < 0.001). Even after adjustment of various risk factors, NLR > 3 and age were found as independent predictors of long-term cardiovascular mortality in Cox regression analysis [hazard ratios (95% confidence interval), 2.04 (1.26-3.30) and 1.04 (1.01-1.07), p = 0.004 and p = 0.004, respectively]. CONCLUSION We demonstrated that an increased NLR was related with higher cardiovascular mortality in patients with PAOD, who were admitted with critical limb ischemia or intermittent claudication. NLR, which reflects the patient's inflammatory status, is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk scores in predicting long-term cardiovascular mortality in PAOD.
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Affiliation(s)
- Mehmet Erturk
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Huseyin Altug Cakmak
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Ozgur Surgit
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Omer Celik
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Hale Unal Aksu
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ozgur Akgul
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Umit Bulut
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Begum Ozalp
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ertan Akbay
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Aydin Yildirim
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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