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Espitia O, Del Giudice C, Hartung O, Herquelot E, Schmidt A, Sapoval M, Sobocinski J. Editor's Choice -- Survival, Limb Salvage, and Management of Patients with Lower Limb Acute Ischaemia: A French National Retrospective Observational Study. Eur J Vasc Endovasc Surg 2024; 67:631-642. [PMID: 37926151 DOI: 10.1016/j.ejvs.2023.11.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/22/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The aim was to describe the baseline characteristics of French patients referred with acute limb ischaemia (ALI), and their clinical management and outcome (death, amputation). METHODS This retrospective observational cohort study used the National Health Data System. All adults hospitalised for ALI who underwent revascularisation with an endovascular or open surgical approach between 1 January 2015 and 31 December 2020 were included and followed up until death or the end of the study (31 December 2021). A one year look back period was used to capture patients' medical history. The risks of death, and major and minor amputations were described using Kaplan-Meier and Aalen-Johansen estimators. A Cox model was used to report the adjusted association between groups and risk of death and Fine-Gray models for the risk of amputations considering the competing risk of death. RESULTS Overall, 51 390 patients (median age 70 years, 69% male) were included and had a median follow up of 2.7 years: 39 411 (76.7%) were treated with an open approach and 11 979 (23.3%) with a percutaneous endovascular approach. The preferred approach for the revascularisation varied between French regions. The one year overall survival was 78.0% and 85.2% in the surgery and endovascular groups, respectively. The surgery group had a higher risk of death (hazard ratio [HR] 1.17, 95% CI 1.12 - 1.21), a higher risk of major amputation (sub-distribution HR 1.20, 95% CI 1.10 - 1.30) and lower risk of minor amputation (sub-distribution HR 0.66, 95% CI 0.60 - 0.71) than the endovascular group. Diabetes and dialysis increased the risk of major amputation by 52% and 78%, respectively. Subsequent ALI was the third most common cause of hospital re-admission within one year. CONCLUSION ALI remains a condition at high risk of death and amputation. Individual risk factors and ALI severity need to be considered to choose between approaches. Continued prevention efforts, improved management, and access to the most suitable approach are necessary.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, F-44000 Nantes, France.
| | | | - Olivier Hartung
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire Nord, Marseille, France
| | | | | | - Marc Sapoval
- Radiologie interventionnelle, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jonathan Sobocinski
- Chirurgie vasculaire et endovasculaire, Centre Hospitalier Universitaire de Lille, Lille, France
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Hilt AD, Umans VAWM, Vossenberg TNE, Schalij MJ, Beeres SLMA. Myocardial infarction care in low and high socioeconomic environments: claims data analysis. Neth Heart J 2024; 32:118-124. [PMID: 37823980 PMCID: PMC10884367 DOI: 10.1007/s12471-023-01813-z] [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] [Accepted: 08/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND To date, claims data have not been used to study outcome differences between low and high socioeconomic status (SES) patients surviving ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in the Netherlands. AIM To evaluate STEMI and NSTEMI care among patients with low and high SES in the referral area of three Dutch percutaneous coronary intervention (PCI) centres, using claims data as a source. METHODS STEMI and NSTEMI patients treated in 2015-2017 were included. Patients' SES scores were collected based on their postal code via an open access government database. In patients with low (SES1) and high (SES4) status, revascularisation strategies and secondary prevention medication were compared. RESULTS A total of 2065 SES1 patients (age 68 ± 13 years, 58% NSTEMI) and 1639 SES4 patients (age 68 ± 13 years, 63% NSTEMI) were included. PCI use was lower in SES1 compared to SES4 in both STEMI (80% vs 84%, p < 0.012) and NSTEMI (42% vs 48%, p < 0.002) patients. Coronary artery bypass grafting was performed more often in SES1 than in SES4 in both STEMI (7% vs 4%, p = NS) and NSTEMI (11% vs 7%, p < 0.001) patients. Optimal medical therapy use in STEMI patients was higher in SES1 compared to SES4 (52% vs 46%, p = 0.01) but comparable among NSTEMI patients (39% vs 40%, p = NS). One-year mortality was comparable in SES1 and SES4 patients following STEMI (14% vs 16%, p = NS) and NSTEMI (10% vs 11%, p = NS). CONCLUSION Combined analysis of claims data and area-specific socioeconomic statistics can provide unique insight into how to improve myocardial infarction care for low and high SES patients.
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Affiliation(s)
- Alexander D Hilt
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victor A W M Umans
- Department of Cardiology, Noordwest Ziekenhuisgroep, location Alkmaar, Alkmaar, The Netherlands
| | | | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Sharma V, Choudhury A, Basavarajaiah S, Rashid M, Yuan M, Jefferey D, Vanezis AP, Sall H, Smith WHT, Parasa R, Kelly P, Kinnaird T, Mamas MA. Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study. Cardiovasc Revasc Med 2024:S1553-8389(24)00049-6. [PMID: 38395628 DOI: 10.1016/j.carrev.2024.02.008] [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: 07/14/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort. BACKGROUND There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO. METHODS Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes. RESULTS There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42-4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25-2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10-0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %. CONCLUSIONS In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes.
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Affiliation(s)
- Vinoda Sharma
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland; University of Birmingham, United Kingdom of Great Britain and Northern Ireland.
| | - Anirban Choudhury
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Sandeep Basavarajaiah
- Heartlands Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Muhammad Rashid
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Mengshi Yuan
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Jefferey
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Andrew P Vanezis
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Hanish Sall
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - William H T Smith
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Ramya Parasa
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Paul Kelly
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Tim Kinnaird
- University Hospital Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Mamas A Mamas
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
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Saratzis A, Torsello GB, Cardona-Gloria Y, Van Herzeele I, Messeder SJ, Zayed H, Torsello GF, Chisci E, Isernia G, D'Oria M, Stavroulakis K. COST Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In-Stent Restenosis or Occlusion: The COSTLY-TLR Study. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00160-6. [PMID: 38331163 DOI: 10.1016/j.ejvs.2024.02.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/10/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective. METHODS European multicentre study involving consecutive patients requiring femoropopliteal TLR (January 2017 - December 2021). The primary outcome was overall cost associated with a TLR procedure from presentation to discharge (euros). Exact costs per constituent, clinical characteristics, and early outcomes were reported. RESULTS This study included 482 TLR procedures (retrospectively, 13 hospitals, six countries): 56% were female, mean age was 75 ± 2 years, 61% were Rutherford class 5 or 6, 67% had Tosaka class 3 disease, and 16% had common femoral or iliac involvement. A total of 52% were hybrid procedures and 6% involved only open surgery. Technical success was 70%, 30 day mortality was 1%, and the 30 day major amputation rate was 4%. Most costs were due to operating time during the TLR (healthcare professionals' salaries, indirect/estate costs), with a mean of: €21 917 ± 2 110 for all procedures; €23 337 ± 8 920 for open procedures; €12 903 ± 3 108 for endovascular procedures; and €22 806 ± 3 977 for hybrid procedures. In a regression analysis, procedure duration per hour was the main parameter associated with higher overall TLR costs (coefficient, 2.77; standard error, 0.88; p < .001). The mean cost per operating minute of TLR (indirect, estate costs, all salaried staff present included) was €177 and the mean cost per night stay in hospital (outside intensive care unit) was €356. The mean cost per overnight intensive care unit stay (minimum of 8 hours per night) was €1 193. CONCLUSION The main driver of the considerable actuarial periprocedural costs associated with femoropopliteal TLR was procedural time.
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Affiliation(s)
- Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Sarah J Messeder
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Giovanni F Torsello
- Department of Interventional Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Emiliano Chisci
- Department of Vascular Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Giacomo Isernia
- Department of Vascular Surgery, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, ASUGI, Trieste, Italy
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery and Endovascular Surgery Ludwig-Maximilians University Hospital Munich, Munich, Germany.
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Fujimura N, Obara H, Takahashi A, Miyata H, Hosaka A, Obitsu Y, Zempo N, Miyata T, Azuma N, Komori K. Surgical Treatment for Popliteal Artery Entrapment Syndrome in Japan: a Retrospective, Multicentre Study Using a National Clinical Registry. Eur J Vasc Endovasc Surg 2023; 66:381-388. [PMID: 37220801 DOI: 10.1016/j.ejvs.2023.05.031] [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: 02/14/2022] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Surgical treatment is an established method for popliteal artery entrapment syndrome (PAES), which, however, mainly derives from single centre experiences where PAES cases are centralised and treated periodically. This study evaluated clinical outcomes of surgical treatment for PAES in a clinical setting where PAES cases were not centralised. METHODS Multicentre, retrospective cohort study using a national clinical registry. From a Japanese nationwide clinical registry, data for patients who underwent surgical treatment for PAES between 2013 and 2018, including 58 limbs from 41 institutes, were retrieved and evaluated. Patency was analysed using Kaplan-Meier curves. RESULTS The mean patient age was 36 ± 19 years, 78% were male, and the incidence of PAES was 0.24 limbs/centre/year, reflecting a clinical setting where PAES cases are not centralised. The most frequent arterial symptom was intermittent claudication (90%). Computed tomography was performed in 57 limbs (98%) for the diagnosis, however active manoeuvres such as dorsiflexion and plantarflexion during the examination was performed in only 13 limbs (22%), and occlusion of the popliteal artery was present in 38 limbs (66%) at diagnosis. Regarding surgical treatment, myotomy alone was performed in only seven limbs (12%), and other limbs were revascularised. Mean follow up was 26 ± 20 months, and surgical treatment was effective as it relieved symptoms in > 96% of limbs, with five year primary and secondary patency of the surgical treatment for PAES of 72% and 93%, respectively. CONCLUSION Results of surgical treatment were acceptable even in a clinical setting where PAES cases were not centralised. However, a low incidence of active manoeuvres performed during the examination and a high incidence of occlusion at diagnosis suggests there may be delayed or underdiagnosis of PAES in Japan, and increased awareness for PAES is warranted.
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Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan; Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
| | - Arata Takahashi
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Akihiro Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Centre, Tokyo, Japan
| | - Yukio Obitsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Nobuya Zempo
- Division of Vascular Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Tetsuro Miyata
- Office of Medical Education, School of Medicine, International University of Health and Welfare, Otawara, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Birmpili P, Cromwell DA, Li Q, Johal AS, Atkins E, Waton S, Pherwani AD, Williams R, Richards T, Nandhra S. The Impact of Pre-Operative Anaemia on One Year Amputation Free Survival and Re-Admissions in Patients Undergoing Vascular Surgery for Peripheral Arterial Disease: a National Vascular Registry Study. Eur J Vasc Endovasc Surg 2023; 66:204-212. [PMID: 37169135 DOI: 10.1016/j.ejvs.2023.05.003] [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: 08/21/2022] [Revised: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Anaemia is common among patients undergoing surgery, but its association with post-operative outcomes in patients with peripheral arterial disease (PAD) is unclear. The aim of this observational population based study was to examine the association between pre-operative anaemia and one year outcomes after surgical revascularisation for PAD. METHODS This study used data from the National Vascular Registry, linked with an administrative database (Hospital Episode Statistics), to identify patients who underwent open surgical lower limb revascularisation for PAD in English NHS hospitals between January 2016 and December 2019. The primary outcome was one year amputation free survival. Secondary outcomes were one year re-admission rate, 30 day re-intervention rate, 30 day ipsilateral major amputation rate and 30 day death. Flexible parametric survival analysis and generalised linear regression were performed to assess the effect of anaemia on one year outcomes. RESULTS The analysis included 13 641 patients, 57.9% of whom had no anaemia, 23.8% mild, and 18.3% moderate or severe anaemia. At one year follow up, 80.6% of patients were alive and amputation free. The risk of one year amputation or death was elevated in patients with mild anaemia (adjusted HR 1.3; 95% CI 1.15 - 1.41) and moderate or severe anaemia (aHR 1.5; 1.33 - 1.67). Patients with moderate or severe anaemia experienced more re-admissions over one year (adjusted IRR 1.31; 1.26 - 1.37) and had higher odds of 30 day re-interventions (aOR 1.22; 1.04 - 1.45), 30 day ipsilateral major amputation (aOR 1.53; 1.17 - 2.01), and 30 day death (aOR 1.39; 1.03 - 1.88) compared with patients with no anaemia. CONCLUSION Pre-operative anaemia is associated with lower one year amputation free survival and higher one year re-admission rates following surgical revascularisation in patients with PAD. Research is required to evaluate whether interventions to correct anaemia improve outcomes after lower limb revascularisation.
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Affiliation(s)
- Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, Hull, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Qiuju Li
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Amundeep S Johal
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Eleanor Atkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, Hull, UK
| | - Sam Waton
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arun D Pherwani
- Staffordshire & South Cheshire Vascular Network, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Robin Williams
- Department of Interventional Radiology, Freeman Hospital, Newcastle-upon-Tyne Hospitals, Newcastle upon Tyne, UK
| | - Toby Richards
- Department of Vascular Surgery, University of Western Australia, Perth, Australia
| | - Sandip Nandhra
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne Hospitals, Newcastle upon Tyne, UK; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
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Moradi S, Moushekhian S, Najafi E, Sedigh HS, Navabi S. Efficacy of propolis and triple antibiotic paste as intra-canal medicaments for revascularisation of immature teeth in dogs: a comparative study. Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00806-1. [PMID: 37314621 DOI: 10.1007/s40368-023-00806-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Abstract
AIM Revascularisation is a therapeutic approach for treatment of immature teeth with necrotic pulp. The conventional protocol includes application of triple antibiotic paste (TAP). The present study aimed to compare the efficacy of propolis and TAP as intra-canal medicaments for revascularisation of immature teeth in dogs. METHODOLOGY This study was conducted on 20 immature (open-apex) canine teeth in mixed breaded dogs. First, the teeth were exposed to oral environment, followed by intra-canal cleaning and shaping 2 weeks later.. The teeth were divided into two groups. The TAP group received paste comprising of ciprofloxacin, metronidazole, and minocycline (at a concentration of 100 µg/mL), while propolis (15% w/v) was used in the other group. The revascularisation procedure was done by means of sodium hypochlorite, EDTA and distilled water as final irrigant. After dehumidifying and induction of bleeding, mineral trioxide aggregate (MTA) was applied At 6-month follow-up, radiographs were evaluated by two observers regarding root length and thickness, intra-canal calcification, periapical lesions, and apex formation. Data were analysed by the Chi-square and Fisher's exact tests. RESULTS There was no significant difference between the TAP and propolis groups in root length or root thickness increase, calcification, related lesions, or apex formation (P > 0.05). CONCLUSION Findings of the present study in experimental animals revealed that the efficacy of propolis as an intra-canal medicament is comparable to that of triple antibiotic paste for revascularisation therapy.
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Affiliation(s)
- S Moradi
- Dental Materials Research Center and Department of Endodontics, Faculty of Dentisry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S Moushekhian
- Dental Materials Research Center and Department of Endodontics, Faculty of Dentisry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - E Najafi
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - H S Sedigh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - S Navabi
- Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lu YM, Lin YT, Tsai CH, Pan CH, Chen HH, Lee MC. Prognostic Factors for Attempted Finger Replantation and Revascularisation after Traumatic Amputation: A 16-Year Retrospective Cohort Study. J Hand Surg Asian Pac Vol 2023; 28:149-155. [PMID: 37120311 DOI: 10.1142/s242483552350025x] [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] [Indexed: 05/01/2023]
Abstract
Background: The aim of this study was to evaluate the impact of variant factors on finger replantation and revascularisation after traumatic amputation, which also included duty shift and the level of main operator. Methods: To determine the prognostic factors for the survival rate of finger replantation and revascularisation after traumatic finger amputation, we retrospectively reviewed the cases of finger replantation conducted from January 2001 to December 2017. Data collected consisted of the basic information of the patients, trauma-related factors, details of the operation and treatment outcomes. Descriptive statistics and data analysis was performed to assess outcomes. Results: In total, 150 patients with 198 replanted digits were enrolled in this study. The median age of the participants was 42.5 years, and 132 (88%) patients were men. The overall successful replantation rate was 86.4%. Seventy-three (36.9%) digits had Yamano type 1 injury; 110 (55.6%), Yamano type 2 injury and 15 (7.6%), Yamano type 3 injury. In total, 73 (36.9%) digits were completely amputated and 125 (63.1%) were not. Half of the replantation procedures (101, 51.0%) were performed during night shift (16:00-00:00), 69 (34.8%) during day shift (08:00-16:00) and 28 (14.1%) during graveyard shift (00:00-08:00). Multivariate logistic regression demonstrated that the trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Conclusions: The trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Other factors including duty shift and the level of operator did not reach statistically significance. Further studies must be conducted to validate the results of the current study. Level of Evidence: Level III (Prognostic).
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Affiliation(s)
- Yi-Min Lu
- TaoYuan General Hospital, Minister of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Te Lin
- Chang Gung Memorial Hospital, Keelung, Taiwan
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Zhang H, Feng J, Guo M, Liu J, Xu D, Lu Y, Zhu H, Liu M, Feng R. Management of an Isolated Left Vertebral Artery on the Arch During Zone 2 Landing Thoracic Endovascular Aortic Repair: A Multicentre Retrospective Study. Eur J Vasc Endovasc Surg 2023; 65:330-337. [PMID: 36343751 DOI: 10.1016/j.ejvs.2022.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/07/2022] [Revised: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the early and midterm outcomes of three different strategies for an isolated left vertebral artery on the arch (LVoA) revascularisation during thoracic endovascular aortic repair (TEVAR) with a proximal zone 2 landing. METHODS Between January 2016 and December 2021, 67 patients with LVoA and aortic arch pathologies who underwent zone 2 landing TEVAR at four medical centres were enrolled. These patients were divided into three groups for comparison: the novel chimney (group A, n = 28) with the right brachial-left brachial through and through (RLT) procedure; in vitro fenestration (group B, n = 24); and transposition (group C, n = 15). The flow direction and velocity of the LVoA was examined by Doppler ultrasound in the pre-, intra-, and post-operative periods. Primary outcomes were all cause mortality and new neurological symptoms. RESULTS No deaths or new neurological symptoms occurred within 30 days. Early type Ia endoleak rates were 18% (n = 5), 17% (n = 4), and 0% in groups A, B, and C, respectively (p = .22). All patients had antegrade flow of the LVoA. The mean ± standard deviation duration of follow up was 63.6 ± 4.0 months. No deaths were observed during follow up. The rates of new neurological symptoms were 0%, 8%, and 33% in groups A, B, and C, respectively. The rates of midterm type Ia endoleak were 7%, 12%, and 0% in groups A, B, and C, respectively (p = .35). Bidirectional flow rates in the LVoA were 0%, 21%, and 27% in groups A, B, and C, respectively (p = .021). Two (8%) and three (20%) patients in groups B and C underwent a secondary procedure because of mild dizziness, but this was not necessary in group A (p = .058). CONCLUSION The novel chimney technique of the RLT procedure may be feasible for patients with a LVoA requiring zone 2 anchoring. Accurate determination of the safety and feasibility of this novel technique requires larger sample sizes and longer follow up.
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Affiliation(s)
- Heng Zhang
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Mingjin Guo
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
| | - Junjun Liu
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
| | - Ding Xu
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ye Lu
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Mingyuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Birmpili P, Li Q, Johal AS, Waton S, Atkins E, Boyle JR, Chetter I, Williams R, Pherwani AD, Cromwell DA. Outcomes of Surgery for Patients with Peripheral Arterial Disease During the COVID-19 Pandemic in the United Kingdom: A Population Based Study. Eur J Vasc Endovasc Surg 2023; 65:738-746. [PMID: 36774995 PMCID: PMC9912811 DOI: 10.1016/j.ejvs.2023.02.002] [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: 05/31/2022] [Revised: 01/24/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE There is limited information on changes in the patterns of care and outcomes for patients who had vascular procedures after the first wave of the COVID-19 pandemic. The aim of this population based study was to examine the patterns of care and outcomes for vascular lower limb procedures in the UK during the COVID-19 pandemic. METHODS Lower limb revascularisations and major amputations performed from January 2019 to April 2021 in the UK and entered in the National Vascular Registry were included in the study. The primary outcome was in hospital post-operative mortality and secondary outcomes were complications and re-interventions. The study was divided into Pre-pandemic (1 January 2019 - 29 February 2020), Wave 1 (1 March - 30 June 2020), Respite (1 July - 31 October 2020), Wave 2/3 (1 November 2020 - 30 April 2021). RESULTS The study included 36 938 procedures (7 245 major amputations, 16 712 endovascular, 12 981 open revascularisations), with 15 501 procedures after March 2020, a 27.7% reduction compared with pre-pandemic. The proportion of open surgical procedures performed under general anaesthetic was lower in Wave 1 and after compared with pre-pandemic (76.7% vs. 81.9%, p < .001). Only 4.6% of patients in the cohort had SARS-CoV-2 infection (n = 708), but their in hospital post-operative mortality was 25.0% (n = 177), six times higher than patients without SARS-CoV-2 (adjusted odds ratio 5.88; 95% CI 4.80 - 7.21, p < .001). The in hospital mortality rate was higher during the pandemic than pre-pandemic after elective open and endovascular revascularisation (respectively 1.6% vs. 1.1%, p = .033, and 0.9% vs. 0.5%, p = .005) and major amputations (10.4% during Wave 2/3 vs. 7.7% pre-pandemic, p = .022). CONCLUSION There was excess post-operative mortality for patients undergoing lower limb vascular procedures during the pandemic, which was associated with SARS-CoV-2 infections. Further research should be conducted on long-term outcomes of patients operated on during the COVID-19 pandemic period.
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Affiliation(s)
- Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, Hull, UK.
| | - Qiuju Li
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Amundeep S. Johal
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Sam Waton
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Eleanor Atkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK,Hull York Medical School, Hull, UK
| | - Jonathan R. Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Ian Chetter
- Hull York Medical School, Hull, UK,Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Robin Williams
- Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Arun D. Pherwani
- Staffordshire & South Cheshire Vascular Network, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - David A. Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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11
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Abdelmegeed AG, Saied S, Hifny MA. Meat grinder hand injury in children: A report of 5 cases. ANN CHIR PLAST ESTH 2023:S0294-1260(22)00183-2. [PMID: 36642636 DOI: 10.1016/j.anplas.2022.12.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Meat grinder injury is considered one of the leading causes that may result in mutilating hand injury. It is commonly occurred in children due to negligence, limited awareness and inexperience about the machine processing and its possible complications. CASE PRESENTATION We reported five cases of grinder-induced hand injuries, presented with their hands yet firmly wedged inside the grinder. Each hand was freed from inside of the grinder by reversed turning of the machine except for one case which needed extrication with the using of a cutting torch. After releasing of the injured hand, we performed amputation at the wrist level in two cases, at metacarpophalangeal levels in one case and we could perform revascularization in two cases. CONCLUSION Meat grinder hand injuries in children is challenging, gentle and careful releasing of the hand without causing further damages along with meticulous repair of hand structure to restore hand function. The most important thing is to prevent household meat-grinder-related injuries through keeping it away from the reach of the children's hand.
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Affiliation(s)
- A G Abdelmegeed
- Plastic Surgery Department, Faculty of Medicine, Sohag University, Egypt
| | - S Saied
- Plastic Surgery Department, Faculty of Medicine, Qena University Hospital, South Valley University, Qena, Egypt
| | - M A Hifny
- Plastic Surgery Department, Faculty of Medicine, Qena University Hospital, South Valley University, Qena, Egypt.
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12
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Chuter V, Quigley F, Tosenovsky P, Ritter JC, Charles J, Cheney J, Fitridge R. Australian guideline on diagnosis and management of peripheral artery disease: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:51. [PMID: 35787293 PMCID: PMC9254685 DOI: 10.1186/s13047-022-00550-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background Peripheral artery disease (PAD) is implicated in up to 50% of diabetes-related foot ulcers (DFU) and significantly contributes to morbidity and mortality in this population. An evidence-based guideline that is relevant to the national context including consideration of the unique geographical and health care system differences between Australia and other countries, and delivery of culturally safe care to First Nations people, is urgently required to improve outcomes for patients with PAD and DFU in Australia. We aimed to identify and adapt current international guidelines for diagnosis and management of patients with PAD and DFU to develop an updated Australian guideline. Methods Using a panel of national content experts and the National Health and Medical Research Council procedures, the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines were adapted to the Australian context. The guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were applied to the IWGDF guideline for PAD by the expert panel. Recommendations were then adopted, adapted or excluded, and specific considerations for implementation, population subgroups, monitoring and future research in Australia were developed with accompanying clinical pathways provided to support guideline implementation. Results Of the 17 recommendations from the IWGDF Guideline on diagnosis, prognosis and management of PAD in patients with diabetes with and without foot ulcers, 16 were adopted for the Australian guideline and one recommendation was adapted due to the original recommendation lacking feasibility in the Australian context. In Australia we recommend all people with diabetes and DFU undergo clinical assessment for PAD with accompanying bedside testing. Further vascular imaging and possible need for revascularisation should be considered for all patients with non-healing DFU irrespective of bedside results. All centres treating DFU should have expertise in, and/or rapid access to facilities necessary to diagnose and treat PAD, and should provide multidisciplinary care post-operatively, including implementation of intensive cardiovascular risk management. Conclusions A guideline containing 17 recommendations for the diagnosis and management of PAD for Australian patients with DFU was developed with accompanying clinical pathways. As part of the adaptation of the IWGDF guideline to the Australian context, recommendations are supported by considerations for implementation, monitoring, and future research priorities, and in relation to specific subgroups including Aboriginal and Torres Strait Islander people, and geographically remote people. This manuscript has been published online in full with the authorisation of Diabetes Feet Australia and can be found on the Diabetes Feet Australia website: https://www.diabetesfeetaustralia.org/new-guidelines/. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00550-7.
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Affiliation(s)
- Vivienne Chuter
- School of Health Sciences, Western Sydney University, Campbelltown, Australia. .,Discipline of Podiatry, University of Newcastle, Ourimbah, Australia.
| | | | - Patrik Tosenovsky
- Department of Vascular & Endovascular Surgery, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Jens Carsten Ritter
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Australia.,Curtin University, School of Medicine, Perth, Australia
| | - James Charles
- First Peoples Health Unit, Griffith University, Gold Coast, Australia
| | | | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia.,Vascular and Endovascular Service, Central Adelaide Local Health Network, Adelaide, Australia
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Yavari N, Masoudkabir F, Landy MG, Pashang M, Sadeghian S, Jalali A, Shafiee A, Roayaei P, Karimi A, Abbasi K, Forouzannia SK, Salehi Omran A, Bagheri J, Ahmadi Tafti SH. Effect of Different Blood Groups on Long-Term Outcomes of Surgical Revascularisation. Heart Lung Circ 2022; 31:873-881. [PMID: 35074263 DOI: 10.1016/j.hlc.2021.11.003] [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: 08/09/2020] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND ABO blood groups are considered to be associated with cardiovascular disease. Nonetheless, the definite effect of ABO blood groups on the clinical outcome of coronary artery bypass graft surgery (CABG) is still undetermined. We evaluated whether ABO blood groups can predict long-term major adverse cardiocerebrovascular events (MACCE) in CABG patients. METHOD In this retrospective cohort study, we retrieved the clinical files of eligible patients treated with isolated CABG in our hospital between March 2007 and March 2016. We divided the patients into four ABO subgroups. The primary study endpoints were the occurrence of all-cause mortality and MACCE during long-term follow-ups. We used Cox regression survival analysis to define the association of ABO blood groups with the occurrence of MACCE. RESULTS Of 17,892 patients who underwent isolated CABG, 17,713 (mean age, 61.19±9.47 years, 74.6% male) were successfully followed, and their data used in the final analysis. Our multivariable analysis demonstrated that patients with different blood groups had similar 5-year mortality and 5-year MACCE. CONCLUSIONS Our findings suggest that in patients who underwent CABG, ABO blood groups were not associated with long-term MACCE.
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Affiliation(s)
- Negin Yavari
- Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mina Ghorbanpour Landy
- Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Roayaei
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbasali Karimi
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiomars Abbasi
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Khalil Forouzannia
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Salehi Omran
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Saratzis A, Argyriou A, Davies R, Bisdas T, Chaudhuri A, Torsello G, Stavroulakis K, Zayed H. Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry. Eur J Vasc Endovasc Surg 2022; 63:688-695. [PMID: 35337725 DOI: 10.1016/j.ejvs.2021.12.020] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report outcomes following endovascular revascularisation for severe aorto-iliac occlusive disease (AIOD) using covered (CS) or bare metal (BMS) stent(s). METHODS This was a retrospective cohort study including patients who underwent treatment with CS or BMS for AIOD between November 2012 and March 2020 in 12 European centres. Outcome measures included death, freedom from target lesion revascularisation (TLR), major amputation, and major adverse cardiac and cerebrovascular events (MACCE). RESULTS Overall, 252 patients (53% males; mean age 65 ± 10 years) were included (102 with a bare metal and 150 with a covered aortic stent); 122 (48%) presented with chronic limb threatening ischaemia (CLTI). Severe arterial calcification was noted in > 65% of patients, 70% presented with Trans-Atlantic Societies Consensus (TASC) D lesions, 32% and 46% had aortic or iliac chronic total occlusion (CTO), respectively. Median follow up was 17 months (range 6 - 40; none lost to follow up). Median inpatient stay was two days (range two to four). During the first 30 days, two patients died (both with covered aortic stents, because of cardiovascular events), none required TLR, two (1%) patients had a major amputation (all presented with CLTI), and three (1%) had a MACCE. At 17 months, mortality (BMS 14% vs. CS 7%, hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.42 - 2.26, p = .94, log rank test) and TLR (11% vs. 10%, HR 1.98, 95% CI 0.89 - 4.43, p = .095) did not differ statistically significantly between the two groups; only three patients had a major limb amputation during late follow up (all with a covered stent). In a multivariable model, the use of an aortic CS did not influence TLR. In a conditional Cox regression, however, the concomitant use of aortic and iliac CSs was associated with improved freedom from TLR. CONCLUSION Endovascular reconstruction with aortic CSs or BMSs for severe AIOD showed comparable midterm performance. The use of both aortic and iliac CSs seems to be associated with reduced TLR.
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Affiliation(s)
- Athanasios Saratzis
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Angeliki Argyriou
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany.
| | - Robert Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Theodosios Bisdas
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany; Department of Vascular and Endovascular Surgery, Athens Medical Centre, Greece
| | | | - Giovanni Torsello
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St. Thomas' NHS Foundation Trust, UK
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15
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Kelly A, Toale C, Moloney MA, Kavanagh EG. Outcomes of Acute Limb Ischaemia in Patients with Underlying Malignancy: A Systematic Review. EJVES Vasc Forum 2022; 54:13-20. [PMID: 34977837 PMCID: PMC8685981 DOI: 10.1016/j.ejvsvf.2021.10.019] [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: 01/10/2021] [Revised: 09/20/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Previous studies have demonstrated amputation and mortality rates to be 14.3% – 30% and 11.4% – 28.9%, respectively, for all patients presenting with acute limb ischaemia (ALI). Rates of ALI are higher in patients with malignancy than in those without. Despite this, there remains uncertainty with regards to the most appropriate management for patients with cancer presenting with ALI. This is because of previously published high rates of associated morbidity and mortality in this population. The aim of this review was to summarise the available evidence reporting on outcomes of ALI in patients with underlying malignancy. Method A systematic review was performed in August 2020 in accordance with the PRISMA guidelines. The Medline, Scopus, Cochrane, and Embase databases were searched with the following search string ((acute limb ischaemia) OR (acute limb ischemia)) AND ((cancer) OR (malignancy)). A total of 849 papers were identified and reviewed; six studies were included. Studies were assessed for bias using the National Institute of Health/National Heart, Lung and Blood Institute Quality Assessment Tool. Data including demographics, Rutherford classification, baseline performance scores, method of revascularisation, and peri-procedural outcomes were extracted and analysed. Data were pooled based on outcomes of interest and pooled prevalence was reported with 95% confidence intervals (CI). Results Six studies with 284 patients with cancer were included for analysis. The pooled overall risk of amputation was 15% (95% CI 5.9 – 26.9). The pooled 30 day mortality rate was 24% (95% CI 14.7 – 34.6). Conclusion Despite limitations of interstudy selection bias and some clinical heterogeneity, the included studies demonstrated acceptable short and medium term outcomes for patients with cancer undergoing revascularisation for acute limb ischaemia. This is in line with current recommendations that patients with underlying malignancy should be considered strongly for revascularisation. Review of data on acute limb ischaemia in the presence of underlying malignancy. Demonstrates acceptable short and medium term survival rates. Such patients should be considered for revascularisation.
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Affiliation(s)
- Aisling Kelly
- Department of Vascular & Endovascular Surgery, University Hospital Limerick, Limerick, Ireland.,National University of Ireland Galway, Galway, Ireland
| | - Conor Toale
- Department of Vascular & Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Michael A Moloney
- Department of Vascular & Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Eamon G Kavanagh
- Department of Vascular & Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
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16
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Gerbaud E, Bouisset F, Ferrières J. Late is not always too late for revascularization in late-presenting patients with ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2021; 114:691-693. [PMID: 34772645 DOI: 10.1016/j.acvd.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 33604 Pessac, France
| | - Frédéric Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295, INSERM, TSA 50032, 31059 Toulouse cedex 9, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295, INSERM, TSA 50032, 31059 Toulouse cedex 9, France.
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Ponkilainen VT, Vuorlaakso M, Kaartinen I, Kiiski J, Saarinen E, Huttunen TT, Paloneva J, Mattila VM. The Development of Lower Limb Amputations in Finland from 1997 to 2018: A Nationwide Retrospective Registry Study. Eur J Vasc Endovasc Surg 2021; 63:138-146. [PMID: 34774371 DOI: 10.1016/j.ejvs.2021.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/14/2021] [Revised: 08/25/2021] [Accepted: 09/19/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the rates of transfemoral, transtibial foot and toe amputations, and lower limb revascularisations in Finland between 1997 and 2018. METHODS Retrospective observational cohort study. Data from the Finnish National Hospital Discharge Register for the period 1997 - 2018 were used. The study population covered all patients 20 years and older who underwent lower limb revascularisations or amputations in private and public hospitals during the study period. All (outpatient and inpatient) amputations and revascularisations were included. The age adjusted incidence rates were based on the annual mid populations, which were obtained from the Official Statistics of Finland. Continuous variables were presented as median with interquartile range (IQR) or as mean with standard deviation. The 95% confidence intervals (CI) for the incidence rates were calculated using the Poisson exact method. All changes in incidence were calculated as relative change (%). RESULTS A total of 75 230 patients underwent 149 492 lower limb revascularisations and amputations between 1997 and 2018 in Finland. The median (IQR) age of the patients was 73 (65, 80) and 60% of the patients were men. The incidence of all endovascular lower limb revascularisations increased by 159% while the incidence of lower limb amputations increased by 25%. The most notable increase occurred in toe (84%) and foot (107%) amputations, while the incidence of transfemoral amputations remained steady and transtibial amputations decreased by 53%. The first minor-major amputation ratio (CI) increased from 1.13 (1.03 - 1.24) to 1.49 (1.36 to 1.62) during the study period. CONCLUSION The findings of this nationwide cohort study suggest that the incidence of both lower limb revascularisations and amputations is increasing. More specifically, revascularisations are more often performed endovascularly, and the incidence of transtibial amputations is declining, whereas the incidence of toe and foot amputations is increasing.
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Affiliation(s)
| | - Miska Vuorlaakso
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Ilkka Kaartinen
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - Juha Kiiski
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - Eva Saarinen
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland; The Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Juha Paloneva
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland; COXA Hospital for Joint Replacement, Tampere, Finland
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Kodama A, Takahara M, Iida O, Soga Y, Mii S, Kitano I, Deguchi J, Fukui D, Komori K, Azuma N. Health Related Quality of Life Over Time After Revascularisation in Patients With Chronic Limb Threatening Ischaemia. Eur J Vasc Endovasc Surg 2021; 62:777-785. [PMID: 34531117 DOI: 10.1016/j.ejvs.2021.06.037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/07/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Chronic limb threatening ischaemia (CLTI) decreases life expectancy and impairs health related quality of life (HR-QOL). Revascularisation is needed to relieve ischaemia and salvage limbs. Although a major goal of CLTI treatment is maintaining QOL, little information is available about changes of HR-QOL over time after revascularisation. HR-QOL with survival after revascularisation for CLTI was assessed. METHODS The clinical database of the Surgical reconstruction versus Peripheral INtervention in pAtients with critical limb isCHemia (SPINACH), a prospective multicentre observational study, was analysed. Outcome measures were disease specific QOL per the Vascular Quality of Life (VascuQOL) questionnaire and the Short Form (SF) 36 evaluated generic QOL, which were assessed at baseline and three, 12, 24, and 36 months. The outcome measure was change of QOL from baseline. The minimally important difference (half a standard deviation from baseline) was used as the cut off point for improved, worsened, and unchanged QOL. RESULTS Overall QOL was improved in 61% of patients for the VascuQOL and approximately 40% for the SF-36 component summaries at three months. However, these proportion gradually decreased to 21% - 31% at three years. In contrast, the proportion of deceased patients gradually increased over the three year follow up. Multivariable analysis revealed that pre-operative non-ambulatory status was inversely associated with improved QOL for the three month VascuQOL and SF-36 mental component summary, and surgical reconstruction was positively associated with these measurements. Advanced age and renal failure were inversely associated with improved QOL for the SF-36 mental component summary and VascuQOL at one to three years. CONCLUSION Revascularisation improved QOL. However, patients with non-ambulatory status exhibited a negative association with improved QOL at three months, and advanced age and renal failure limited benefits one to three years after revascularisation. Accumulating QOL data will be essential for post-revascularisation QOL estimation. Pre-operative assessment, including estimated QOL, is important in shared decision making for patient oriented outcomes in the treatment of CLTI patients.
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Affiliation(s)
- Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine Nagoya, Japan.
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, and Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Osamu Iida
- Cardiovascular Centre, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinsuke Mii
- Department of Vascular Surgery, Saiseikai Yahata Hopspital, Yahata, Kitakyushu, Japan
| | - Ikuro Kitano
- Wound Treatment Centre, Shin-Suma General Hospital, Kobe, Japan
| | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Centre, Kawagoe, Japan
| | | | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine Nagoya, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
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Beska B, Manoharan D, Mohammed A, Das R, Edwards R, Zaman A, Alkhalil M. Role of coronary angiogram before transcatheter aortic valve implantation. World J Cardiol 2021; 13:361-371. [PMID: 34589171 PMCID: PMC8436680 DOI: 10.4330/wjc.v13.i8.361] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coexistent coronary artery disease is commonly seen in patients undergoing transcatheter aortic valve implantation (TAVI). Previous studies showed that pre-TAVI coronary revascularisation was not associated with improved outcomes, challenging the clinical value of routine coronary angiogram (CA).
AIM To assess whether a selective approach to perform pre-TAVI CA is safe and feasible.
METHODS This was a retrospective non-randomised single-centre analysis of consecutive patients undergoing TAVI. A selective approach for performing CA tailored to patient clinical need was developed. Clinical outcomes were compared based on whether patients underwent CA. The primary endpoint was a composite of all-cause mortality, myocardial infraction, repeat CA, and re-admission with heart failure.
RESULTS Of 348 patients (average age 81 ± 7 and 57% male) were included with a median follow up of 19 (9-31) mo. One hundred and fifty-four (44%) patients, underwent CA before TAVI procedure. Patients who underwent CA were more likely to have previous myocardial infarction (MI) and previous percutaneous revascularisation. The primary endpoint was comparable between the two group (22.6% vs 22.2%; hazard ratio 1.05, 95%CI: 0.67-1.64, P = 0.82). Patients who had CA were less likely to be readmitted with heart failure (P = 0.022), but more likely to have repeat CA (P = 0.002) and MI (P = 0.007). In those who underwent CA, the presence of flow limiting lesions did not affect the incidence of primary endpoint, or its components, except for increased rate of repeat CA.
CONCLUSION Selective CA is a feasible and safe approach. The clinical value of routine CA should be challenged in future randomised trials
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Affiliation(s)
- Benjamin Beska
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
| | - Divya Manoharan
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
| | - Ashfaq Mohammed
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
| | - Rajiv Das
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
| | - Richard Edwards
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
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20
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Lee JH, Kim J, Hwang JS, Baek GH. Improvement in lunate perfusion after radial closing-wedge osteotomy in patients with Kienböck's disease. Hand Surg Rehabil 2021; 40:588-594. [PMID: 34147670 DOI: 10.1016/j.hansur.2021.06.005] [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] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/12/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Radial closing-wedge osteotomy is a widely accepted treatment for Kienböck's disease. However, despite favorable long-term clinical outcomes, its impact on lunate perfusion has not been documented. The purpose of this study was to determine whether radial closing wedge osteotomy improved lunate perfusion on gadolinium (Gd)-enhanced magnetic resonance imaging (MRI). We conducted a retrospective review of 12 patients with Kienböck's disease who received radial closing wedge osteotomy. Mean age at surgery was 25 years. Preoperative Gd-enhanced MRI was performed in 7 patients. After bone union, implants were removed and MRI was repeated. Two patients were classified as Lichtman stage IIIA, and 5 as stage IIIB. Percentage pre- to post-operative perfused lunate volume was compared on MRI. At last follow-up, mean QuickDASH score improved from 43.7 to 6.2. Pre- to post-operative lunate fragmentation, collapse and perfusion were compared qualitatively on MRI. On quantitative analysis, perfusion increased from 24% to 54% (p = 0.018) using our method of measuring percentage perfused lunate volume. The method showed satisfactory reproducibility. Investigation using Gd-enhanced MRI suggested that radial closing wedge osteotomy increases lunate perfusion.
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Affiliation(s)
- J H Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - J Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - J S Hwang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82, Gumiro 173, Beongil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - G H Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
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21
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Regas I, Saizonou I, Pichonnat M, Menez C, Menu G, El Rifai S, Echalier C, Boyer E, Loisel F, Aubry S, Obert L, Feuvrier D, Pluvy I. Influence of the level of arterial resection on the replanting and revascularization results in hand surgery: prospective study over 22 months. Hand Surg Rehabil 2021; 40:660-669. [PMID: 34111576 DOI: 10.1016/j.hansur.2021.06.002] [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: 03/24/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.
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Affiliation(s)
- I Regas
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France.
| | - I Saizonou
- Service d'Anatomo-Pathologie, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - M Pichonnat
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - C Menez
- Service d'Orthopédie et de Traumatologie, Hôpital Chaumont, 17 Avenue des Etats Unis, 52000 Chaumont, France
| | - G Menu
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - S El Rifai
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - C Echalier
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - E Boyer
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - F Loisel
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - S Aubry
- Service d'Imagerie Ostéoarticulaire, Radiologie Interventionnelle, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - L Obert
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - D Feuvrier
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - I Pluvy
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
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22
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Barthélémy O, Jobs A, Meliga E, Mueller C, Rutten FH, Siontis GCM, Thiele H, Collet JP. Questions and answers on workup diagnosis and risk stratification: a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1379-1386. [PMID: 32860030 PMCID: PMC8026278 DOI: 10.1093/eurheartj/ehaa602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Barthélémy
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique- Hôpitaux de Paris) (AP-HP), Paris, France
| | - Alexander Jobs
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Emanuele Meliga
- Interventional Cardiology, AO Mauriziano Umberto I, Turin, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frans H Rutten
- General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - George C M Siontis
- Department of Cardiology, University Hospital of Bern, Inselspital, Bern, Switzerland
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23
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Barbato E, Mehilli J, Sibbing D, Siontis GCM, Collet JP, Thiele H. Questions and answers on antithrombotic therapy and revascularization strategies in non-ST-elevation acute coronary syndrome (NSTE-ACS): a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1368-1378. [PMID: 32860046 DOI: 10.1093/eurheartj/ehaa601] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emanuele Barbato
- Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Julinda Mehilli
- Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Dirk Sibbing
- Advanced Biomedical Sciences, University Federico II, Napoli, Italy
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24
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Navarese EP, Lansky AJ, Kereiakes DJ, Kubica J, Gurbel PA, Gorog DA, Valgimigli M, Curzen N, Kandzari DE, Bonaca MP, Brouwer M, Umińska J, Jaguszewski MJ, Raggi P, Waksman R, Leon MB, Wijns W, Andreotti F. Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis. Eur Heart J 2021; 42:4638-4651. [PMID: 34002203 PMCID: PMC8669551 DOI: 10.1093/eurheartj/ehab246] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
Aims The value of elective coronary revascularisation plus medical therapy over medical therapy alone in managing stable patients with coronary artery disease is debated. We reviewed all trials comparing the two strategies in this population. Methods and results From inception through November 2020, MEDLINE, EMBASE, Google Scholar, and other databases were searched for randomised trials comparing revascularisation against medical therapy alone in clinically stable coronary artery disease patients. Treatment effects were measured by rate ratios (RRs) with 95% confidence intervals, using random-effects models. Cardiac mortality was the pre-specified primary endpoint. Spontaneous myocardial infarction (MI) and its association with cardiac mortality were secondary endpoints. Further endpoints included all-cause mortality, any MI, and stroke. Longest follow-up data were abstracted. The study is registered with PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients (10 023 randomised to revascularisation plus medical therapy and 9783 to medical therapy alone) were included. Compared with medical therapy alone, revascularisation yielded a lower risk of cardiac death [RR 0.79 (0.67–0.93), P < 0.01] and spontaneous MI [RR 0.74 (0.64–0.86), P < 0.01]. By meta-regression, the cardiac death risk reduction after revascularisation, compared with medical therapy alone, was linearly associated with follow-up duration [RR per 4-year follow-up: 0.81 (0.69–0.96), P = 0.008], spontaneous MI absolute difference (P = 0.01) and percentage of multivessel disease at baseline (P = 0.004). Trial sequential and sensitivity analyses confirmed the reliability of the cardiac mortality findings. All-cause mortality [0.94 (0.87–1.01), P = 0.11], any MI (P = 0.14), and stroke risk (P = 0.30) did not differ significantly between strategies. Conclusion In stable coronary artery disease patients, randomisation to elective coronary revascularisation plus medical therapy led to reduced cardiac mortality compared with medical therapy alone. The cardiac survival benefit after revascularisation improved with longer follow-up times and was associated with fewer spontaneous MIs.
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Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.,Faculty of Medicine, University of Alberta, Edmonton, Canada.,SIRIO MEDICINE research network, Poland
| | | | - Dean J Kereiakes
- Christ Hospital and Lindner Research Center, Cincinnati, OH, USA
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.,SIRIO MEDICINE research network, Poland
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.,Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital Universitätsspital, Bern, Switzerland
| | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton, Southampton, UK
| | - David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA, USA
| | - Marc P Bonaca
- CPC Clinical Research, University of Colorado School of Medicine, USA
| | - Marc Brouwer
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Julia Umińska
- Department of Geriatrics, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Paolo Raggi
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Martin B Leon
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Felicita Andreotti
- Direzione Scientifica, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy.,Cardiovascular Medicine, Catholic University Medical School, Rome, Italy
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25
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Stevens JR, Zamani A, Osborne JIA, Zamani R, Akrami M. Critical evaluation of stents in coronary angioplasty: a systematic review. Biomed Eng Online 2021; 20:46. [PMID: 33964954 PMCID: PMC8105986 DOI: 10.1186/s12938-021-00883-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 02/27/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary stents are routinely placed in the treatment and prophylaxis of coronary artery disease (CAD). Current coronary stent designs are prone to developing blockages: in-stent thrombosis (IST) and in-stent re-stenosis (ISR). This is a systematic review of the design of current coronary stent models, their structural properties and their modes of application, with a focus on their associated risks of IST and ISR. The primary aim of this review is to identify the best stent design features for reducing the risk of IST and ISR. To review the three major types of stents used in clinical settings today, determining best and relevant clinical practice by exploring which types and features of offer improved patient outcomes regarding coronary angioplasty. This information can potentially be used to increase the success rate of coronary angioplasty and stent technology in the future taking into account costs and benefits. METHODS Scientific databases were searched to find studies concerning stents. After the exclusion criteria were applied, 19 of the 3192 searched literature were included in this review. Studies investigating three major types of stent design were found: bare-metal stents (BMS), drug-eluting stents (DES) and bioresorbable stents (BRS). The number of participants varied between 14 and 1264. On average 77.4% were male, with a mean age of 64 years. RESULTS From the findings of these studies, it is clear that DES are superior in reducing the risk of ISR when compared to BMS. Conflicting results do not clarify whether BRS are superior to DES at reducing IST occurrence, although studies into newer BRS technologies show reducing events of IST to 0, creating a promising future for BRS showing them to be non-inferior. Thinner stents were shown to reduce IST rates, due to better re-endothelialisation. Scaffold material has also been shown to play a role with cobalt alloy stents reducing the risk of IST. This study found that thinner stents that release drugs were better at preventing re-blockages. Some dissolvable stents might be better at stopping blood clots blocking the arteries when compared to metal stents. The method and procedure of implanting the stent during coronary angioplasty influences success rate of these stents, meaning stent design is not the only significant factor to consider. CONCLUSIONS Positive developments in coronary angioplasty could be made by designing new stents that encompass all the most desirable properties of existing stent technology. Further work is needed to investigate the benefits of BRS in reducing the risk of IST compared to DES, as well as to investigate the effects of different scaffold materials on IST and ISR outcomes.
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Affiliation(s)
| | - Ava Zamani
- Medical School, University College London (UCL), London, UK
| | | | - Reza Zamani
- Medical School, College of Medicine and Health, Exeter, UK
| | - Mohammad Akrami
- Department of Mechanical Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK.
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26
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Anthrayose P, Nawal RR, Yadav S, Talwar S, Yadav S. Effect of revascularisation and apexification procedures on biomechanical behaviour of immature maxillary central incisor teeth: a three-dimensional finite element analysis study. Clin Oral Investig 2021; 25:6671-6679. [PMID: 33899155 DOI: 10.1007/s00784-021-03953-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to assess the effects of revascularisation and apexification procedures on biomechanical behaviour of immature teeth using 3-dimensional finite element analysis (3D FEA). MATERIALS AND METHODS Five 3D FEA permanent maxillary incisor models were developed from CBCT scans and available literature data: Model MT: Mature tooth, Model IT: Immature tooth (Cvek's stage 3), Model AT: Apexified tooth-mineral trioxide aggregate (MTA) apexification, Model RTB: Revascularised tooth with blood, and Model RTS: Revascularised tooth with supplementary scaffold. Using FEA, a masticatory load of 240N at 120° was simulated, and the Von Mises and maximum principal stresses within the models were evaluated. Failure index (FI) and weakening% were also calculated for each model. RESULTS On dentinal stress analysis, model MT (96.16MPa) and IT (158.38MPa) had lowest and highest stress values, respectively. Among the experimental groups, model RTS (131.12MPa) had lower stresses than AT (136.33MPa) and RTB (133.7MPa), with no significant difference among the three. Peak dentinal stresses in all the models were observed in the cervical third of the root and near the apical opening in model IT. The extent of high dentinal stress area in model RTB and RTS was lesser than that of AT. The FI and weakening% values were highest for model AT followed by RTB and RTS, among the experimental groups. However, all these treatments strengthened an immature tooth by more than 20%. CONCLUSIONS AT, RTB, and RTS treatments lowered the stress values and risk of fracture in immature teeth with no significant difference among the three groups. CLINICAL RELEVANCE Stress distribution evaluation following revascularisation/apexification was essential, with potential to influence clinical decision-making. MTA apexification and revascularisation with blood clot/supplementary scaffold lowered the stresses in immature teeth, with no significant difference among the three.
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Affiliation(s)
- Persis Anthrayose
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Seema Yadav
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Sudha Yadav
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
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27
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Naing P, Zhang M, Khine AMT, Aung HS, Chean LN, Liaw J, Bazley M, Vaidya S, Musameh MD, Khan A. Mackay Heart Failure Study: Examining the Root Causes, Compliance With Guideline-Based Therapy and Prognosis. Heart Lung Circ 2021; 30:1302-1308. [PMID: 33875377 DOI: 10.1016/j.hlc.2021.03.273] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Heart failure patients have poor outcomes comparable to some malignancies; however, the modern guideline directed medical therapy (GDMT) has improved its outcomes. The clinical characteristics and prescribers' compliance with GDMT for heart failure patients have not been studied in the Mackay region. METHODS A retrospective cohort study of 115 consecutive adult heart failure patients was conducted at our institution. RESULTS The study cohort consisted of 80% (n=92) males. Ischaemia was the leading cause accounting for 54% (n=62) of the cohort, followed by idiopathic cardiomyopathy at 32% (n=37). Drug-induced and Takotsubo cardiomyopathies were responsible for 11% and 1% respectively. Two (2) patients (2%) had valvular heart disease. Hypertension was present in 57% while diabetes and atrial fibrillation were present in 32% and 43% of patients. Fifty-nine per cent (59%) had a smoking history. All, except four patients, had reduced left ventricular ejection fraction (LVEF <50%) at diagnosis. Among patients with coronary ischaemia, 37% and 31% were revascularised with percutaneous coronary interventions and bypass graft surgeries, respectively. Renin-angiotensin-aldosterone system inhibitors and beta blockers were prescribed in 94% and 95% of the patients, respectively. Mineralocorticoid inhibitors were used in 25% while ivabradine was given to 8% of patients. Nine per cent (9%) of patients received cardiac resynchronisation therapy. Most patients had improvement in functional class and LVEF during follow-up. There were very few mortalities at 3% (n=3) at the median follow-up of 403 (IQR 239-896) days. CONCLUSION Our study has shed light on heart failure epidemiology in the Mackay region. We found excellent compliance with GDMT and good prognosis for most patients in terms of both symptom and survival.
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Affiliation(s)
- Pyi Naing
- Mackay Base Hospital, Mackay, Qld, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia; University of Notre Dame, Fremantle, WA, Australia.
| | - Michael Zhang
- Mackay Base Hospital, Mackay, Qld, Australia; James Cook University, Townsville, Qld, Australia
| | | | | | | | | | | | | | | | - Ahmed Khan
- Mackay Base Hospital, Mackay, Qld, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
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Abstract
INTRODUCTION The increasing prevalence of diabetes mellitus and advances in endovascular therapies continue to have an impact on the epidemiology and management of lower extremity arterial disease. This study describes trends in lower extremity revascularisation and major lower limb amputation in NHS England over the past two decades (2000-2019). METHODS Numbers of lower extremity endovascular interventions, open surgical procedures and major lower limb amputations performed in NHS England between 2000 and 2019 were extracted from publicly available hospital admitted patient care activity reports. Trends in intervention were assessed with linear regression models and chi-square tests for trend. RESULTS Over this period, 527,131 revascularisations and 92,053 amputations were performed. The mean age of patients was 67.5 years (standard deviation 1.6 years) and 65.3% were male. The number of lower limb revascularisation procedures increased by 402.4 units/year (95% confidence interval, CI, 290.1-514.6, p < 0.001). The number of endovascular interventions rose by 43.5% (10,912 in 2000 vs 15,657 in 2019; β = 359.5.0, 95% CI 279.3-439.8, p < 0.001) compared with no significant increase in the number of open surgical procedures (8,483 in 2000 vs 7,872 in 2019; β = 42.8, 95% CI -8.3 to 94.0, p = 0.095). The number of major lower limb amputations has decreased by 9.4% (5,418 in 2000 vs 4,907 in 2019; β = -31.0; 95% CI -49.6 to -12.5, R2 = 0.42, p = 0.003). CONCLUSIONS There has been a significant increase in the rate of lower limb revascularisation procedures associated with decreased numbers of major lower limb amputations over the past two decades. These changes in overall trends may affect both service provision and vascular surgery training planning.
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Affiliation(s)
- A Staniszewska
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Gimzewska
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Lane
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Fisch U, von Felten S, Wiencierz A, Jansen O, Howard G, Hendrikse J, Halliday A, Fraedrich G, Eckstein HH, Calvet D, Bulbulia R, Becquemin JP, Algra A, Rothwell P, Ringleb P, Mas JL, Brown MM, Brott TG, Bonati LH. Editor's Choice - Risk of Stroke before Revascularisation in Patients with Symptomatic Carotid Stenosis: A Pooled Analysis of Randomised Controlled Trials. Eur J Vasc Endovasc Surg 2021; 61:881-887. [PMID: 33827781 DOI: 10.1016/j.ejvs.2021.02.024] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/17/2021] [Accepted: 02/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Current guidelines recommending rapid revascularisation of symptomatic carotid stenosis are largely based on data from clinical trials performed at a time when best medical therapy was potentially less effective than today. The risk of stroke and its predictors among patients with symptomatic carotid stenosis awaiting revascularisation in recent randomised controlled trials (RCTs) and in medical arms of earlier RCTs was assessed. METHODS The pooled data of individual patients with symptomatic carotid stenosis randomised to stenting (CAS) or endarterectomy (CEA) in four recent RCTs, and of patients randomised to medical therapy in three earlier RCTs comparing CEA vs. medical therapy, were compared. The primary outcome event was any stroke occurring between randomisation and treatment by CAS or CEA, or within 120 days after randomisation. RESULTS A total of 4 754 patients from recent trials and 1 227 from earlier trials were included. In recent trials, patients were randomised a median of 18 (IQR 7, 50) days after the qualifying event (QE). Twenty-three suffered a stroke while waiting for revascularisation (cumulative 120 day risk 1.97%, 95% confidence interval [CI] 0.75 - 3.17). Shorter time from QE until randomisation increased stroke risk after randomisation (χ2 = 6.58, p = .011). Sixty-one patients had a stroke within 120 days of randomisation in the medical arms of earlier trials (cumulative risk 5%, 95% CI 3.8 - 6.2). Stroke risk was lower in recent than earlier trials when adjusted for time between QE and randomisation, age, severity of QE, and degree of carotid stenosis (HR 0.47, 95% CI 0.25 - 0.88, p = .019). CONCLUSION Patients with symptomatic carotid stenosis enrolled in recent large RCTs had a lower risk of stroke after randomisation than historical controls. The added benefit of carotid revascularisation to modern medical care needs to be revisited in future studies. Until then, adhering to current recommendations for early revascularisation of patients with symptomatic carotid stenosis considered to require invasive treatment is advisable.
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Affiliation(s)
- Urs Fisch
- Department of Neurology and Stroke Centre, Department of Clinical Research, University Hospital, University of Basel, Basel, Switzerland
| | - Stefanie von Felten
- Clinical Trial Unit, Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit, Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Olav Jansen
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - George Howard
- Department of Biostatistics, UAB School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Alison Halliday
- Nuffield Department of Surgery University of Oxford, Oxford, UK
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery-Vascular Centre, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - David Calvet
- Department of Neurology, Hôpital Sainte-Anne, Université Paris-Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, Paris, France
| | - Richard Bulbulia
- Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Jean-Pierre Becquemin
- Vascular Institute of Paris East, Hôspital Paul D Egine, Champigny-sur-Marne, France
| | - Ale Algra
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
| | - Peter Ringleb
- Department of Neurology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Jean-Louis Mas
- Department of Neurology, Hôpital Sainte-Anne, Université Paris-Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, Paris, France
| | - Martin M Brown
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Thomas G Brott
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Centre, Department of Clinical Research, University Hospital, University of Basel, Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK.
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Kayaokay K, Ozcan C, Bulut T, Gursoy M, Dirim Mete B. Radial shortening osteotomy vs partial capitate shortening osteotomy in Kienböck's disease: Medium-term radiological and clinical results. Hand Surg Rehabil 2021; 40:427-432. [PMID: 33775890 DOI: 10.1016/j.hansur.2021.03.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
This study aimed to compare medium-term results for partial capitate shortening (PCS) and radial shortening (RS) osteotomies on lunate bone revascularization and disease progression in patients with stage II or IIIA Kienböck's disease. Patients who underwent surgery for Kienböck's disease between March 2010 and July 2020 were retrospectively evaluated. Clinical evaluation included assessment of pain, joint range of motion, strength, DASH, visual analog scale (VAS) for pain, Modified Mayo Wrist Score (MMWS), satisfaction and time to return to work, with comparison as appropriate to the contralateral side. Preoperative and postoperative plain radiographs and magnetic resonance imaging (MRI) were used for radiological evaluation. Lichtman staging and signal changes in the lunate were evaluated using MRI. Group 1 (PCS) included 14 patients and Group 2 (RS) 14. Mean follow-up was 57.8 months (range 24-102) in Group 1 and 49.4 months (range 36-73) in Group 2. Clinical evaluation included pain on VAS, DASH score, MMWS, range of motion, and grip, palmar and key pinch strength. Regarding lunate bone vascularization, increased signal on final follow-up MRI was observed in 10 of the 14 patients in Group 1 and 7 of the 14 patients in Group 2. There was a positive correlation between revascularization and final follow-up MMWS (p = 0.006). The present study thus showed that functional scores were improved by revascularization in Kienböck's disease. Both osteotomies had clinically and radiologically satisfactory results. However, we believe that PCS osteotomy is preferable, as it leads to higher revascularization rates without increasing ulnolunate load.
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Affiliation(s)
- K Kayaokay
- Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey.
| | - C Ozcan
- Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey
| | - T Bulut
- Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey
| | - M Gursoy
- Department of Radiology, Faculty of Medicine, Izmir Democracy University, Ozmen Cd. 35390 No: 147, Buca, Izmir, Turkey
| | - B Dirim Mete
- Department of Radiology, Faculty of Medicine, Izmir Democracy University, Ozmen Cd. 35390 No: 147, Buca, Izmir, Turkey
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Bertrand C, Saulnier PJ, Potier L, Croyal M, Blanchard V, Gand E, Ragot S, Schneider F, Bocock O, Baillet-Blanco L, Velho G, Marre M, Roussel R, Rigalleau V, Hadjadj S, Mohammedi K. Plasma concentrations of lipoproteins and risk of lower-limb peripheral artery disease in people with type 2 diabetes: the SURDIAGENE study. Diabetologia 2021; 64:668-680. [PMID: 33409569 DOI: 10.1007/s00125-020-05326-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/04/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS The lipid profile has not been fully investigated in individuals with peripheral artery disease (PAD). We aimed to evaluate the relationship between plasma concentrations of lipoproteins and the prevalence of lower-limb PAD at baseline and its incidence during follow-up in people with type 2 diabetes. METHODS Plasma concentrations of total cholesterol, HDL-cholesterol, triacylglycerol and apolipoprotein (Apo) A-I, ApoA-II, ApoB-100 and Apo(a) were measured at baseline using colorimetric or MS methods in the SURDIAGENE cohort. Total cholesterol/HDL-cholesterol ratio, non-HDL-cholesterol and LDL-cholesterol were estimated using computation formulas. Logistic and Cox proportional hazard regression models were fitted to estimate OR or HR, with related 95% CI, for baseline prevalence or incidence of major PAD (lower-limb amputation or requirement of revascularisation) during follow-up by increasing lipoprotein tertiles, after adjustment for key confounders. RESULTS Among 1468 participants (women 42%, mean ± SD age 65 ± 11 years, duration of diabetes 14 ± 10 years at baseline), 129 (8.8%) had a baseline history of major PAD. Major PAD was less prevalent at baseline in the highest (vs lowest) tertile of HDL-cholesterol (OR 0.42 [95% CI 0.26, 0.71], p = 0.001) and ApoA-I (OR 0.39 [95% CI 0.23, 0.67], p = 0.0007), and more frequent in the highest tertile of total cholesterol/HDL-cholesterol ratio (OR 1.95 [95% CI 1.18, 3.24], p = 0.01). Among 1339 participants without a history of PAD at baseline, incident PAD occurred in 97 (7.2%) during a median (25th-75th percentile) duration of follow-up of 7.1 (4.4-10.7) years, corresponding to 9685 person-years and an incidence rate of 9.8 (95% CI 8.0, 12.0) per 1000 person-years. The risk of incident PAD was lower in the top (vs bottom) tertile of HDL-cholesterol (HR 0.54 [95% CI 0.30, 0.95], p = 0.03) or ApoA-I (HR 0.50 [95% CI 0.28, 0.86], p = 0.01) and higher in the top tertile of total cholesterol/HDL-cholesterol ratio (HR 2.81 [95% CI 1.61, 5.04], p = 0.0002) and non-HDL-cholesterol (HR 1.80 [95% CI 1.06, 3.12], p = 0.03). CONCLUSIONS/INTERPRETATION We reported independent associations between HDL-cholesterol, ApoA-I, total cholesterol/HDL-cholesterol ratio or non-HDL-cholesterol and the prevalence or the incidence of major PAD in people with type 2 diabetes. Our findings provide a picture of lipoprotein profile in people with type 2 diabetes. Graphical abstract.
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Affiliation(s)
- Capucine Bertrand
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Pessac, Bordeaux, France
| | - Pierre-Jean Saulnier
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France
- Inserm, CIC 1402, Poitiers, France
| | - Louis Potier
- Assistance Publique - Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Département d'Endocrinologie, Diabétologie, Nutrition, Paris, France
- UFR de Médecine, Université de Paris, Paris, France
- Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université de Paris, Paris, France
| | - Mikaël Croyal
- INRA, CHU Nantes, UMR 1280, PhAN, IMAD, Nantes Université, Nantes, France
- CRNH-O, Mass Spectrometry Core Facility, Nantes, France
| | | | - Elise Gand
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France
| | - Stéphanie Ragot
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France
- Inserm, CIC 1402, Poitiers, France
| | - Fabrice Schneider
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- Département de Chirurgie Vasculaire, CHU de Poitiers, Poitiers, France
| | - Olivia Bocock
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Pessac, Bordeaux, France
| | - Laurence Baillet-Blanco
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Pessac, Bordeaux, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université de Paris, Paris, France
| | - Michel Marre
- UFR de Médecine, Université de Paris, Paris, France
- Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université de Paris, Paris, France
- CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Ronan Roussel
- Assistance Publique - Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Département d'Endocrinologie, Diabétologie, Nutrition, Paris, France
- UFR de Médecine, Université de Paris, Paris, France
- Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université de Paris, Paris, France
| | - Vincent Rigalleau
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Pessac, Bordeaux, France
- UFR de Médecine, Université de Bordeaux, Bordeaux, France
- Centre de Recherche Inserm - Université de Bordeaux U1219 'Bordeaux Population Health', Bordeaux, France
| | - Samy Hadjadj
- Institut du Thorax, Inserm, CNRS, Université de Nantes, Nantes, France
| | - Kamel Mohammedi
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Pessac, Bordeaux, France.
- CMC Ambroise Paré, Neuilly-sur-Seine, France.
- Inserm U1034, Biologie des Maladies Cardiovasculaires, Bordeaux, France.
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Berner JE, Dearden A, Magdum AA, Crowley TP, Rankin K, Clarke MJ, Ragbir M. Safety of limb-salvaging surgery for sarcomas compromising major vessels: A 15-year single-centre outcomes study. J Plast Reconstr Aesthet Surg 2021; 74:2076-2084. [PMID: 33549508 DOI: 10.1016/j.bjps.2020.12.048] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Limb-threatening sarcomas invading major vessels present an oncological and reconstructive challenge. Curative resection involves either performing an amputation or an immediate reconstruction of the invaded vessels. We present our 15-year experience of these cases at the North of England Bone and Soft Tissue Tumour Service. MATERIALS AND METHODS A Strengthening the Reporting of Observational studies in Epidemiology (STROBE) compliant retrospective review of our prospective database was performed including patients who required major vessel reconstruction following sarcoma excision from 2003 until 2018. Patient demographic data along with tumour and histological subtypes, treatment modality, complications and outcomes were inquired. Autologous and prosthetic vessel reconstruction approaches were compared. RESULTS Nineteen patients were identified with the most common tumour locations being the thigh and groin areas. Five cases involved recurrent tumours. Clear resection margins were obtained in 15 cases. Autologous vein grafts were preferred over polytetrafluoroethylene (PTFE) prosthesis in 17 cases. A pedicled flap or free flap was required to achieve adequate soft tissue cover in six patients, while the rest underwent primary closure. Five patients lost the patency of the reconstructed vessels with one of these requiring an amputation. The estimated disease-specific survival at 5 years was 58%. DISCUSSION Limb-preservation surgery in the context of vessel compromise is not only safe, but also a functionally and psychosocially beneficial means of avoiding an amputation. We believe that careful pre-operative planning and discussion in a multidisciplinary setting is key for obtaining positive outcomes.
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Affiliation(s)
- Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Kellogg College, University of Oxford, Oxford, United Kingdom.
| | - Alexander Dearden
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ashish A Magdum
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kenneth Rankin
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michael J Clarke
- Department of Vascular Surgery, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Shiraki T, Takahara M, Iida O, Soga Y, Kodama A, Miyashita Y, Shintani Y, Endo M, Azuma N. Baseline and Updated Information on Nutritional Status in Patients With Chronic Limb Threatening Ischaemia Undergoing Revascularisation. Eur J Vasc Endovasc Surg 2021; 61:467-472. [PMID: 33358104 DOI: 10.1016/j.ejvs.2020.11.036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to assess the impact of baseline and updated nutritional status on prognosis in patients with chronic limb threatening ischaemia (CLTI) undergoing revascularisation. METHODS The clinical database of the Surgical reconstruction versus Peripheral INtervention in pAtients with critical limb isCHemia (SPINACH) study, a prospective, multicentre, observational study, was used. The current analysis included 499 patients who underwent endovascular therapy or surgical reconstruction for CLTI. Nutritional status at baseline was evaluated using the Geriatric Nutritional Risk Index (GNRI; baseline GNRI). A GNRI <82 points indicates major nutrition related risk. GNRI was also calculated at 1, 3, 6, 12, 24, and 36 months after revascularisation (updated GNRI). The association between baseline and updated GNRIs and the mortality risk was analysed with the Cox regression model. RESULTS Mean ± standard deviation (SD) GNRI at baseline was 89.9 ± 9.8 points. The proportion of patients alive with a GNRI ≥82 points was 78% (95% confidence interval [CI] 74-81) at baseline but gradually decreased during follow up, finally reaching 19% (95% CI 0-42) at 36 months. In patients with a GNRI <82 points at baseline, a GNRI of ≥82 points was increased to 37% (95% CI 6-68) 12 months after revascularisation. In the multivariable analysis, baseline and updated GNRIs were associated with a reduced mortality risk independently of each other; the adjusted hazard ratios per 1 SD were 0.80 (95% CI 0.65-0.98; p = .031) and 0.66 (95% CI 0.49-0.91; p = .015), respectively. Similar findings were observed when nutritional status was evaluated using the Controlling Nutritional Stats (CONUT) score, except for the association between its updated value and mortality risk, which marginally lost significance. CONCLUSION There was still room for improvement in nutritional status after revascularisation for patients with CLTI. Updated GNRI was associated with death independently of baseline GNRI.
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Affiliation(s)
- Tatsuya Shiraki
- Kansai Rosai Hospital Cardiovascular Centre, Amagasaki, Hyogo, Japan; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Centre, Amagasaki, Hyogo, Japan.
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Fukuoka, Japan
| | - Akio Kodama
- Department of Vascular Surgery, Nagoya University Graduate School of Medicine, Syowaku, Nagoya, Japan
| | - Yusuke Miyashita
- Department of Cardiology, Japanese Red Cross Society Nagano Hospital, Nagano, Japan
| | - Yoshiaki Shintani
- Department of Cardiology, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Masamitsu Endo
- Department of Vascular Surgery, National Hospital Organisation Kanazawa Medical Centre, Kanazawa, Ishikawa, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Patel NG, Reissis D, Mair M, Hart A, Ragbir M, Giele H, Mosahebi A, Ramakrishnan V. Safety of major reconstructive surgery during the peak of the COVID-19 pandemic in the United Kingdom and Ireland - multicentre national cohort study. J Plast Reconstr Aesthet Surg 2020; 74:1161-1172. [PMID: 33402316 PMCID: PMC7733685 DOI: 10.1016/j.bjps.2020.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/02/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
Background The safety of surgery during and after the coronavirus disease-2019 (COVID-19) pandemic is paramount. Early reports of excessive perioperative mortality in COVID-positive patients promoted the widespread avoidance of operations. However, cancelling or delaying operations for cancer, trauma, or functional restitution has resulted in increased morbidity and mortality. Methods A national multicentre cohort study of all major reconstructive operations carried out over a 12-week period of the ‘COVID-19 surge’ in the United Kingdom and Ireland was performed. Primary outcome was 30-day mortality and secondary outcome measures were major complications (Clavien-Dindo grade ≥3) and COVID-19 status of patients and healthcare professionals before and after surgery. Results A total of 418 patients underwent major reconstructive surgery with a mean operating time of 7.5 hours and 12 days’ inpatient stay. Cancer (59.8%) and trauma (29.4%) were the most common indications. COVID-19 infection was present in 4.5% of patients. The 30-day post-operative mortality was 0.2%, reflecting the death of one patient who was COVID-negative. Overall complication rate was 20.8%. COVID status did not correlate with major or minor complications. Eight healthcare professionals developed post-operative COVID-19 infection, seven of which occurred within the first three weeks. Conclusions Major reconstructive operations performed during the COVID-19 crisis have been mostly urgent cases involving all surgical specialties. This cohort is a surrogate for all major operations across all surgical specialties. Patient safety and surgical outcomes have been the same as in the pre-COVID era. With adequate precautions, major reconstructive surgery is safe for patients and staff. This study helps counsel patients of COVID-19 risks in the perioperative period.
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Affiliation(s)
- N G Patel
- Consultant Plastic and Reconstructive Surgeon, University Hospitals of Leicester, UK; University of Manitoba, Winnipeg, Canada; Department of Plastic and Reconstructive Surgery, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK.
| | - D Reissis
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK.
| | - M Mair
- Department of Otorhinolaryngology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK
| | - A Hart
- Canniesburn Plastic Surgery Unit, NHS Greater Glasgow & Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF UK.
| | - M Ragbir
- Department of Plastic and Reconstructive Surgery, Newcastle Upon Tyne Hospitals NHS Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK.
| | - H Giele
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU UK.
| | - A Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK.
| | - V Ramakrishnan
- Anglia Ruskin University, Chelmsford UK; St Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Court Road, Chelmsford, Essex, CM1 7ET UK.
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Ong JA, Low SY, Seow WT, Goh CP, Yeo TT, Chou N, Low DC, Nga V. Revascularisation surgery for paediatric moyamoya disease: The Singapore experience. J Clin Neurosci 2020; 82:207-213. [PMID: 33246909 DOI: 10.1016/j.jocn.2020.11.008] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 11/26/2022]
Abstract
Moyamoya disease (MMD) is characterized by the spontaneous occlusion of the distal internal carotid arteries and resultant neo-angiogenesis of fragile collateral blood vessels. Direct and indirect revascularization surgeries have shown to effectively reduce stroke risks in paediatric MMD, whereby the latter is a more utilised technique in children. This study was undertaken to determine the outcomes of revascularization in Singapore's multi-ethnic, Southeast Asian paediatric population. This is an ethics-approved study conducted in Singapore's 2 tertiary children hospital units: KK Women's and Children's Hospital and National University Hospital. Sixteen patients with a diagnosis of ischaemic-type MMD are recruited between 01 January 2002 to 31 January 2019; and a total of 24 surgeries are undertaken (24 cerebral hemispheres). There are 2 cases of stroke within 30 days post-surgery. However, no stroke recurrence is observed beyond 30 days after surgery in all patients. Four patients reported recurrent transient ischaemic attack symptoms in the follow-up period ranging from 3 months to 12 years. Data analyses show a statistically significant improvement in modified Rankin's Scale (mMRS) in post-operative patients from baseline to discharge, and at 3 months after surgery. Our study also observes that predictors of recurrent ischaemic events include higher pre-operative MRS, Suzuki stage and perioperative infarction. To the authors' knowledge, this is the first study to date reporting the outcomes of revascularisation in a paediatric Southeast Asian cohort.
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Affiliation(s)
- Jamie Ah Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road Level 11, 119228, Singapore
| | - Sharon Yy Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Chun Peng Goh
- Division of Neurosurgery, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Ning Chou
- Division of Neurosurgery, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - David Cy Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Vincent Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
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Moshage M, Smolka S, Achenbach S. [ISCHEMIA trial : Is coronary CT angiography the new gatekeeper?]. Radiologe 2020; 60:1109-1113. [PMID: 33211124 DOI: 10.1007/s00117-020-00775-2] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND The ISCHEMIA trial systematically compared two major principles in the therapy of coronary artery disease (CAD): medical therapy versus revascularization in patients with a positive noninvasive test for myocardial ischemia. Specifically, it was designed to answer the question whether in patients with demonstrated ischemia, after ruling out left main stenosis by coronary computed tomography angiography (CTA), a routine interventional strategy in addition to optimal medical therapy would improve clinical outcome over an initial strategy of medical therapy alone. CONCLUSION Overall, this hypothesis could not be confirmed. In several ways, the trial yields interesting information in the field of cardiac imaging. First, a positive stress test result was not associated with a prognostic benefit of revascularization. Second, even though the evaluation of coronary CTA was not part of the protocol, the good outcome achieved by using coronary CTA as a "gatekeeper" during randomization supports the potential of coronary CTA as a diagnostic tool-both first- and second-line-when CAD is suspected. However, the trial also raises new questions in the field of cardiac imaging which will need to be addressed in future studies.
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Affiliation(s)
- M Moshage
- Medizinische Klinik 2 - Kardiologie und Angiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland. .,, Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - S Smolka
- Medizinische Klinik 2 - Kardiologie und Angiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - S Achenbach
- Medizinische Klinik 2 - Kardiologie und Angiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
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Kobayashi T, Hamamoto M, Okazaki T, Hasegawa M, Takahashi S. Long Term Outcomes of Endovascular Therapy for Failing Distal Bypass Vein Grafts. Eur J Vasc Endovasc Surg 2020; 61:121-127. [PMID: 33060028 DOI: 10.1016/j.ejvs.2020.09.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/29/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although distal bypass using vein has been established with acceptable outcomes for chronic limb threatening ischaemia (CLTI), the major issue affecting long term outcomes is vein graft disease. This study aimed to analyse the peri-procedural results and long term outcomes of endovascular therapy (EVT) for failing vein grafts after distal bypass. METHODS A retrospective analysis of 113 failing vein grafts (94 patients, 113 limbs) after distal bypass between 2009 and 2019 at the study hospital. RESULTS The mean age was 74 ± 9 years and 72% of the patients were men. Of the 113 grafts, 54 grafts (48%) were detected in asymptomatic patients, 41 grafts (36%) in patients with recurrent ulcer or gangrene, and 18 grafts (16%) in patients with rest pain. The failing grafts were treated by low pressure long inflation balloon angioplasty with a mean balloon size of 3.0 ± 0.8 mm. The mean procedural time was 60 ± 29 min and procedural success was 98% (111 grafts). During the mean follow up period of 34 months, EVT was performed a median frequency of two times (range 1-11 times). The primary and assisted primary patency of the EVT revised grafts were 41% and 80% at one year, 34% and 68% at three years, 31% and 58% at five years, respectively. Of 41 limbs with recurrent ulcer or gangrene, the wound healed in 34 limbs (85%). The complete healing rate was 71% at three months and 84% at 12 months. Eight patients required major amputation, and the freedom from major amputation rate was 96% at one year and 80% at five years. CONCLUSION Long term outcomes including patency, wound healing rate, and amputation free survival after EVT for failing vein grafts were acceptable. EVT could be a viable alternative to surgical revascularisation in patients with a failing distal bypass graft for CLTI.
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Affiliation(s)
- Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
| | - Masaki Hamamoto
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Misa Hasegawa
- Department of Reconstructive and Plastic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University, Hiroshima, Japan
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Lari E, Lari A, AlQinai S, Abdulrasoul M, AlSafran S, Ameer A, Al-Sabah S. Severe ischemic complications in Covid-19-A case series. Int J Surg Case Rep 2020; 75:131-135. [PMID: 32934901 PMCID: PMC7482595 DOI: 10.1016/j.ijscr.2020.09.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Covid-19 has the propensity to result in a wide array of manifestations. Recently, thromboembolic complications of Covid-19 have been denoted in literature. We report 5 cases of Covid-19 positive patients with no significant comorbidities who developed 1st time episodes of either; acute limb ischemia or bowel ischemia. Material and methods This is a retrospective observational study analyzing the clinical characteristics and outcomes of five Covid-19 positive patients. Five patients aged 38-60 presented to our institution from 1st April to 1st June and were diagnosed with Covid-19 pneumonia, subsequently developing severe vascular complications. None of our patients included had any history of thromboembolism nor risk factors that could justify the presentations. Presentation of cases Patient 1; presented with bowel ischemia as a first presentation. Patient 2 and 3 developed unsalvageable lower limb ischemia secondary to partial to complete occlusion of infra-renal aorta. Patient 4 presented with acute upper limb ischemia due to complete occlusion of the axillary and brachial artery. Patient 5 developed bilateral lower limb unsalvageable ischemia secondary to aortic bifurcation occlusion. All patients tested Covid-19 positive upon admission, and received standard care. Discussion and conclusion The thromboembolic complications seen in our cases were devastating and resulted in significant mortality and morbidity. All vessels affected were medium-large vessels. None of our cases had any significant predisposing medical conditions or history of thromboembolic or ischemic events. A high index of suspicion is necessary when evaluating such patients regardless of thromboembolic history. Appropriate anticoagulation regimens are essential. Our cases add to the currently increasing severe thromboembolic complications of Covid-19.
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Affiliation(s)
- Eisa Lari
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Ali Lari
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait.
| | - Shamlan AlQinai
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Mahdi Abdulrasoul
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Salman AlSafran
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Ahmad Ameer
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Salman Al-Sabah
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
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Derbel B, Ziadi J, Daoud Z, Souiden S, Miri R, Ben Mrad M, Ghedira F, Ben Omrane S, Denguir R. [Arterial trauma of the upper limbs: Particularities of the population in Tunisia and risk factors for amputation]. Ann Cardiol Angeiol (Paris) 2020; 70:41-46. [PMID: 32859358 DOI: 10.1016/j.ancard.2020.03.015] [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: 08/07/2019] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY The purpose of our study was to review the population at risk of upper limb arterial injury, to determinate the rate of upper limb salvage and the predictive factors of limb loss. METHODS This was a retrospective study, involving 128 patients with upper extremity arterial trauma operated between January first, 2006 and June 30, 2017. Exclusion criteria were arterial ligation, primary limb amputation and arterial iatrogenic injuries. End points were immediate technical success, primary patency and limb salvage rate. RESULTS The average age was 27.7 years with a sex ratio M/F=41, causes of trauma were self-inflicted wounds (51%), assaults (23%), road traffic accidents (10%), work accidents (9%) and domestic accidents (7%). Injured arteries were brachial (66.5%) usually because of self-inflicted injuries; arteries of the forearm (31%) and axillery arteries (2.5%). The techniques of arterial repair were vein graft interposition in 52% of cases, end-to-end anastomosis in 23%, primary arterial repair in 21% and venous patch in 4%. Eight reconstructions occluded during the first week (6.25%). Four patients required secondary amputation and limb salvage rate was 96.8%. After a median follow-up time of 62 days, only 21% were followed at 3 months. Mechanism of injury, soft tissue loss and arterial reconstruction thromboses were selected as factors influencing the rate of limb salvage. One death occurred at day 14 secondary to multi-component poly-trauma. CONCLUSION Prompt diagnosis, appropriate multidisciplinary management of the upper extremity arterial trauma and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. Associated soft tissue injury is a poor limb salvage factor.
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Affiliation(s)
- B Derbel
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - J Ziadi
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - Z Daoud
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie.
| | - S Souiden
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - R Miri
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - M Ben Mrad
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - F Ghedira
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - S Ben Omrane
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - R Denguir
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
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Hughes V, Paige E, Welsh J, Joshy G, Banks E, Korda RJ. Education-related variation in coronary procedure rates and the contribution of private health care in Australia: a prospective cohort study. Int J Equity Health 2020; 19:139. [PMID: 32795313 PMCID: PMC7427777 DOI: 10.1186/s12939-020-01235-y] [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: 04/08/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background Contemporary Australian evidence on socioeconomic variation in secondary cardiovascular disease (CVD) care, a possible contributor to inequalities in cardiovascular disease outcomes, is lacking. This study examined the relationship between education, an individual-level indicator of socioeconomic position, and receipt of angiography and revascularisation procedures following incident hospitalisation for acute myocardial infarction (AMI) or angina, and the role of private care in this relationship. Methods Participants aged ≥45 from the New South Wales population-based 45 and Up Study with no history of prior ischaemic heart disease hospitalised for AMI or angina were followed for receipt of angiography or revascularisation within 30 days of hospital admission, ascertained through linked hospital records. Education attainment, measured on baseline survey, was categorised as low (no school certificate/qualifications), intermediate (school certificate/trade/apprenticeship/diploma) and high (university degree). Cox regression estimated the association (hazard ratios [HRs]) between education and coronary procedure receipt, adjusting for demographic and health-related factors, and testing for linear trend. Private health insurance was investigated as a mediating variable. Results Among 4454 patients with AMI, 68.3% received angiography within 30 days of admission (crude rate: 25.8/person-year) and 48.8% received revascularisation (rate: 11.7/person-year); corresponding figures among 4348 angina patients were 59.7% (rate: 17.4/person-year) and 30.8% (rate: 5.3/person-year). Procedure rates decreased with decreasing levels of education. Comparing low to high education, angiography rates were 29% lower among AMI patients (adjusted HR = 0.71, 95% CI: 0.56–0.90) and 40% lower among angina patients (0.60, 0.47–0.76). Patterns were similar for revascularisation among those with angina (0.78, 0.61–0.99) but not AMI (0.93, 0.69–1.25). After adjustment for private health insurance status, the HRs were attenuated and there was little evidence of an association between education and angiography among those admitted for AMI. Conclusions There is a socioeconomic gradient in coronary procedures with the most disadvantaged patients being less likely to receive angiography following hospital admission for AMI or angina, and revascularisation procedures for angina. Unequal access to private health care contributes to these differences. The extent to which the remaining variation is clinically appropriate, or whether angiography is being underused among people with low socioeconomic position or overused among those with higher socioeconomic position, is unclear.
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Affiliation(s)
- Veronica Hughes
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Sax Institute, Sydney, NSW, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
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Wübbeke LF, Naves CCLM, Daemen JWHC, Jacobs MJ, Mees BME. Editor's Choice - Mortality and Major Amputation after Revascularisation in Octogenarians Versus Non-Octogenarians with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2020; 60:231-241. [PMID: 32709468 DOI: 10.1016/j.ejvs.2020.04.027] [Citation(s) in RCA: 4] [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: 05/24/2019] [Revised: 03/19/2020] [Accepted: 04/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to assess the clinical outcomes after revascularisation in octogenarians with chronic limb threatening ischaemia (CLTI). METHODS This was a systematic review and meta-analysis, in which the Medline, Embase, and Cochrane Library databases were searched systematically by two independent researchers. Meta-analyses were performed to analyse one year mortality, one year major amputation, and one year amputation free survival (AFS) after revascularisation. Pooled outcome estimates were reported as percentages and odds ratio (OR) with 95% confidence intervals (CI). In addition, sensitivity and subgroup analyses were performed and the quality of evidence was determined according to the GRADE system. RESULTS The review includes 21 observational studies with patients who were treated for CLTI. Meta-analysis of 12 studies with a total of 17 118 patients was performed. A mortality rate of 32% was found in octogenarians (95% CI 27-37%), which was significantly higher than in the non-octogenarians (17%, 95% CI 11-22%/OR 2.52, 95% CI 1.93-3.29; GRADE: "low"). No significant difference in amputation rate was found (octogenarians 15%, 95% CI 11-18%; non-octogenarians 12%, 95% CI 7-14%; GRADE: "very low"). AFS was significantly lower in the octogenarian group (OR 1.55, 95% CI 1.03-2.43; GRADE: "very low"). In a subgroup analysis differentiating between endovascular and surgical revascularisation, amputation rates were comparable. For octogenarians, those treated conservatively had a mortality rate significantly higher than those treated by revascularisation (OR 1.76, 95% CI 1.19-2.60; GRADE: "very low"). No significant difference in mortality rate was found between primary amputation and revascularisation in octogenarians (OR 0.70, 95% CI 0.24-2.03; GRADE: "very low"). CONCLUSION In octogenarians with CLTI, a substantial one year mortality rate of 32% was found after revascularisation. The amputation rates were comparable between both age groups. However, only low quality evidence could be obtained supporting the results of this meta-analysis because only observational studies were available for inclusion.
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Affiliation(s)
- Lina F Wübbeke
- Department of Vascular Surgery, Maastricht University Medical Centre, the Netherlands
| | - Caroline C L M Naves
- Department of Vascular Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Jan-Willem H C Daemen
- Department of Vascular Surgery, Maastricht University Medical Centre, the Netherlands
| | - Michael J Jacobs
- Department of Vascular Surgery, Maastricht University Medical Centre, the Netherlands; European Vascular Centre, Aachen-Maastricht, Germany; European Vascular Centre, Maastricht, the Netherlands
| | - Barend M E Mees
- Department of Vascular Surgery, Maastricht University Medical Centre, the Netherlands; European Vascular Centre, Aachen-Maastricht, Germany; European Vascular Centre, Maastricht, the Netherlands.
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Doherty RJ, Caird J, Crimmins D, Kelly P, Murphy S, McGuigan C, Tubridy N, King MD, Lynch B, Webb D, O'Neill D, McCabe DJH, Boers P, O'Regan M, Moroney J, Williams DJ, Cronin S, Javadpour M. Moyamoya disease and moyamoya syndrome in Ireland: patient demographics, mode of presentation and outcomes of EC-IC bypass surgery. Ir J Med Sci 2020; 190:335-344. [PMID: 32562218 DOI: 10.1007/s11845-020-02280-w] [Citation(s) in RCA: 4] [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: 05/19/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are no previously published reports regarding the epidemiology and characteristics of moyamoya disease or syndrome in Ireland. AIMS To examine patient demographics, mode of presentation and the outcomes of extracranial-intracranial bypass surgery in the treatment of moyamoya disease and syndrome in Ireland. METHODS All patients with moyamoya disease and syndrome referred to the National Neurosurgical Centre during January 2012-January 2019 were identified through a prospective database. Demographics, clinical presentation, radiological findings, surgical procedures, postoperative complications and any strokes during follow-up were recorded. RESULTS Twenty-one patients were identified. Sixteen underwent surgery. Median age at diagnosis was 19 years. Fifteen were female. Mode of presentation was ischaemic stroke in nine, haemodynamic TIAs in eight, haemorrhage in three and incidental in one. Sixteen patients had Moyamoya disease, whereas five patients had moyamoya syndrome. Surgery was performed on 19 hemispheres in 16 patients. The surgical procedures consisted of ten direct (STA-MCA) bypasses, five indirect bypasses and four multiple burr holes. Postoperative complications included ischaemic stroke in one patient and subdural haematoma in one patient. The median follow-up period in the surgical group was 52 months; there was one new stroke during this period. Two patients required further revascularisation following recurrent TIAs. One patient died during follow-up secondary to tumour progression associated with neurofibromatosis type 1. CONCLUSIONS Moyamoya is rare but occurs in Caucasians in Ireland. It most commonly presents with ischaemic symptoms. Surgical intervention in the form of direct and indirect bypass is an effective treatment in the majority of cases.
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Affiliation(s)
- Ronan J Doherty
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - John Caird
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - Darach Crimmins
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - Peter Kelly
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall Tubridy
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Mary D King
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - Bryan Lynch
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - David Webb
- Department of Neurology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Desmond O'Neill
- Stroke Service and Departments of Neurology and Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Dominick J H McCabe
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Stroke Service and Departments of Neurology and Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
- Vascular Neurology Research Foundation, Tallaght University Hospital, Dublin, Ireland
- Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK
| | - Peter Boers
- Department of Neurology, University Hospital Limerick, Limerick, Ireland
| | - Mary O'Regan
- Department of Neurology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Joan Moroney
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
| | | | - Simon Cronin
- Department of Neurology, Cork University Hospital and University College Cork, Cork, Ireland
| | - Mohsen Javadpour
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
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Reese T, von Rittberg Y, Oldhafer KJ. Portal vein arterialization for iatrogenic embolization of the hepatic artery. An old but still useful technique? Int J Surg Case Rep 2020; 71:91-94. [PMID: 32446229 PMCID: PMC7242999 DOI: 10.1016/j.ijscr.2020.04.022] [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: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 02/04/2023] Open
Abstract
A Patient was treated with portal vein arterialization for iatrogenic occlusion of the hepatic artery after pancreatoduodenectomy. Portal vein arterialization is an old surgical method, which could be helpful to reduce the failure-to-rescue rate of patients with a dearterialised liver. Portal vein arterialization is a rare but safe technique to supply arterial blood to the liver.
Introduction Portal Vein Arterialization is a rare procedure for total de-arterialized livers to ensure arterial inflow to the liver. Presentation of case A 55-year-old male patient underwent pancreatoduodenectomy for chronic pancreatitis. One month after discharge the patient was re-admitted because of bleeding from a pseudoaneurysm of the ligated gastroduodenal artery. During radiological intervention a coil dislocated and a complete occlusion of the hepatic artery occurred. Extraction of the coil was not possible, therefore, the patient was transferred to our hospital for surgical revascularization. We performed a side-to-side running anastomosis between a branch of a mesenteric artery and the corresponding vein to supply arterial blood to the liver. The postoperative course was uneventful. Radiologic examinations showed a patent arterio-portal shunt. Discussion Portal vein arterialization might be a lifesaving procedure in complication management. Conclusion PVA is an old surgical method, which could be helpful to reduce the failure-to-rescue rate.
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Affiliation(s)
- Tim Reese
- Department of Surgery, Division of Hepatobiliary Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.
| | - York von Rittberg
- Department of Surgery, Division of Hepatobiliary Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Karl J Oldhafer
- Department of Surgery, Division of Hepatobiliary Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
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Gimbel ME, Willemsen LM, Daggelders MC, Kelder JC, Oirbans T, Beukema KF, Daeter EJ, Ten Berg JM. Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease. Neth Heart J 2020; 28:467-477. [PMID: 32333255 PMCID: PMC7431514 DOI: 10.1007/s12471-020-01415-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/18/2022] Open
Abstract
Background We sought to compare long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are predictors of adverse outcomes. Methods Patients aged ≥75 years with multivessel disease or left main disease who underwent PCI or CABG between 2012–2016 were included in this retrospective cohort study. Baseline characteristics from the index procedure were collected. Severity of coronary artery disease and completeness of revascularisation were assessed. Primary outcome was all-cause mortality, in addition we captured major adverse cardiac and cerebral events, bleedings, recurrent angina and new onset atrial fibrillation. Results A total of 597 patients were included. Median follow-up was 4 years (interquartile range 2.8–5.3 years). At baseline, patients in the PCI group more often had a previous medical history of CABG and more frequently underwent an urgent procedure compared with patients in the CABG group. Mortality at 5‑year follow-up was significantly higher in patients who underwent PCI compared with CABG (39.9% vs 25.4%, p < 0.001). Furthermore, acute coronary syndrome (ACS), repeat revascularisation and recurrent angina occurred more frequently after PCI, while occurrence of bleedings and new onset atrial fibrillation were more frequent after CABG. Neither completeness of revascularisation nor severity of coronary artery disease was a predictor for any of the outcomes. Conclusion Long-term mortality was higher in elderly patients with multivessel disease undergoing PCI compared with CABG. In addition, patients undergoing PCI had a higher risk of ACS, repeat revascularisation and recurrent angina.
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Affiliation(s)
- M E Gimbel
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - L M Willemsen
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M C Daggelders
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J C Kelder
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - T Oirbans
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - K F Beukema
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - E J Daeter
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M Ten Berg
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Wang TKM, Grey C, Jiang Y, Jackson R, Kerr A. Contrasting Trends in Acute Coronary Syndrome Hospitalisation and Coronary Revascularisation in New Zealand 2006-2016: A National Data Linkage Study (ANZACS-QI 27). Heart Lung Circ 2020; 29:1375-1385. [PMID: 31974025 DOI: 10.1016/j.hlc.2019.11.015] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/28/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evaluating trends in acute coronary syndrome (ACS) and invasive coronary procedures, including coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) can identify areas for improvement in clinical care and inform future health planning. This national data-linkage study reports trends in ACS hospitalisations and procedure rates in New Zealand between 2006 and 2016. METHODS All adult ACS hospitalisations and associated angiography and revascularisation procedures were identified from hospital discharge codes. Crude and age-standardised ACS incidence and procedure rates were calculated for each calendar year. RESULTS Between 2006 and 2016 there were 188,264 ACS admissions. During this time, there was a steady decline in hospitalisation rates, from 685 to 424 per 100,000 per year. This decline was observed in both sexes and in all age groups. There were also significant increases in coronary angiography and revascularisation rates, from 29.8% to 54.3% and 20.6% to 37.3%, respectively, between 2006 and 2016. The rate of revascularisation by PCI increased from 16.0% to 31.0%, a greater increase than revascularisation by CABG, which increased from 4.6% to 6.5%. Increases in procedures were observed in all age groups and both sexes. The proportions of coronary angiograms that resulted in revascularisation each year consistently ranged from 67 to 70% throughout the period. CONCLUSIONS Acute coronary syndrome hospitalisation rates in New Zealand decreased by nearly 40% between 2006 and 2016, while the use of coronary angiography and revascularisation after ACS nearly doubled. The similar proportions of angiograms that resulted in revascularisation each year suggests that, despite the doubling of angiograms over the 10-year study period, they are not over-utilised.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Corina Grey
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand.
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Kemp I, Appleby C, Lane S, Lisboa P, Stables RH. A comparison of angina symptoms reported by clinicians and patients, pre and post revascularisation: Insights from the Stent or Surgery Trial. Int J Cardiol 2019; 293:25-31. [PMID: 31281046 DOI: 10.1016/j.ijcard.2019.06.052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are limited data comparing the consistency of angina reporting by patients and clinicians. METHODS We performed a retrospective analysis of data from the randomised Stent or Surgery (SoS) trial. The trial required reporting of angina using the Canadian Cardiovascular Society (CCS) classification by both patients and clinicians at baseline and twelve months. We compared paired observations to describe the magnitude and direction of differences in clinician and patient reporting. The difference in CCS grade was expressed as the clinician minus patient value. We also examined the proportion of trial subjects reported as being free from angina (CCS = 0) in clinician and patient reporting. RESULTS Paired CCS data was available for 912 and 887 cases at baseline and 12 months respectively. At baseline, clinicians reported freedom from angina in a single case (1/912 = 0.1%) compared to 70/912 (7.7%) patients (Delta 7.6% 95% CI 5.8 to 9.3, P ≤0.001). At 12 months, the position was reversed, with clinicians reporting 639/887 (72%) angina free compared to 449/887 (50.6%) for patients (Delta -21.4 95% CI -17.1 to -25.8 P ≤ 0.001). For the reported CCS grade at follow-up, the weighted linear kappa for overall agreement was 0.312. Discordant reporting involved the clinician suggesting less angina rather than more (36% v 8% of cases). CONCLUSIONS These findings have implications for our perception of previous research which has, in the main, focussed on clinician reporting. This emphasises the importance of patient reporting and a need to better understand reasons for discordance.
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Affiliation(s)
- I Kemp
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, UK.
| | - C Appleby
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, UK
| | - S Lane
- Department of Biostatistics, University of Liverpool, UK
| | - P Lisboa
- Dept. of Applied Mathematics, Faculty of Engineering and Technology, Liverpool John Moores University, UK
| | - R H Stables
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, UK
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Heiskanen J, Hartikainen J, Martikainen J, Miettinen H, Hippeläinen M, Roine RP, Tolppanen AM. Purchases of medical therapy recommended for coronary artery disease before and after elective revascularisation. Eur J Clin Pharmacol 2019; 76:81-88. [PMID: 31605162 DOI: 10.1007/s00228-019-02735-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
Abstract
AIMS We studied the purchases of medical therapy recommended for coronary artery disease patients before and after elective revascularisation (percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG)). METHODS All patients who underwent an elective PCI (N = 1557) or CABG (N = 1768) at the Heart Center, Kuopio University hospital between 2007 and 2014 were included. Data were collected from the hospital's coronary register and national registers, and obtained for 3 years before and 1 year after the revascularisation. RESULTS Altogether 85.2% of PCI patients and 88.1% of CABG patients had purchased lipid-modifying agents before the procedure, and 94.9% and 96.8% during the post-procedure follow-up year, respectively. Beta-blocking agents were purchased by 84.9% of PCI patients before and by 87.9% after the procedure and by 86.3% of CABG patients before and 97.1% after the operation. Of PCI patients, 64.3% had purchased organic long-acting nitrates before the procedure and 54.4% also after the procedure. Among CABG patients, the purchase of organic long-acting nitrates fell from 59.7% before to 10.1% after the operation. The use of ADP receptor blocking agents increased in PCI patients (26.3 to 83.9%) and the use of warfarin in CABG patients (9.4 to 21.3%). Medication purchases were more common among those who had greater use of hospital services before and after the procedures. CONCLUSIONS In both PCI and CABG patients, the use of medical therapy before and after revascularisation procedure complied with current guidelines. Purchases of long-acting nitrates were common in the PCI group even after the procedure.
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Affiliation(s)
- Jari Heiskanen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, Yliopistonranta 1 C, FI-70211, Kuopio, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Janne Martikainen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, Yliopistonranta 1 C, FI-70211, Kuopio, Finland
| | | | | | - Risto P Roine
- Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Kuopio University hospital, Kuopio, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Anna-Maija Tolppanen
- Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, Yliopistonranta 1 C, FI-70211, Kuopio, Finland.
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Ng JJ, Papadimas E, Dharmaraj RB. Assessment of Flow after Lower Extremity Endovascular Revascularisation: A Feasibility Study Using Time Attenuation Curve Analysis of Digital Subtraction Angiography. EJVES Short Rep 2019; 45:1-6. [PMID: 31517074 DOI: 10.1016/j.ejvssr.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives Endovascular revascularisation is the mainstay of the treatment of lower extremity peripheral arterial disease. Improvement in perfusion after treatment is often quantified by a corresponding increment in ankle or toe brachial indices. These measurements are difficult to obtain in patients with foot wounds, and have to be performed at a separate time and setting after revascularisation. This preliminary study aimed to evaluate the use of parametric colour coding and analysis of time attenuation curves as a real time quantitative measure of perfusion after endovascular revascularisation. Methods Forty-seven consecutive patients with critical limb ischaemia were retrospectively enrolled and analysed. Parametric colour coding and generation of time attenuation curves in the main pedal vessel was performed for pre- and post-intervention digital subtraction angiograms of each patient. The change in time attenuation curve parameters was compared with the change in ankle or toe brachial indices before and after intervention. Results Comparing before and after lower extremity endovascular intervention, there were significant changes in the washout parameters derived from the time attenuation curve. The percentage of contrast decay 4 seconds after peak (I 4s) demonstrated the strongest correlation (R = .482) with the change in ankle or toe brachial indices. Conclusions Parametric colour coding and time attenuation curve analysis might be a helpful tool that can provide real time intra-procedural quantitative data on pedal perfusion which can improve clinical outcomes.
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Caines R, Cochrane A, Kelaini S, Vila-Gonzalez M, Yang C, Eleftheriadou M, Moez A, Stitt AW, Zeng L, Grieve DJ, Margariti A. The RNA-binding protein QKI controls alternative splicing in vascular cells, producing an effective model for therapy. J Cell Sci 2019; 132:jcs.230276. [PMID: 31331967 DOI: 10.1242/jcs.230276] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
Dysfunction of endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) leads to ischaemia, the central pathology of cardiovascular disease. Stem cell technology will revolutionise regenerative medicine, but a need remains to understand key mechanisms of vascular differentiation. RNA-binding proteins have emerged as novel post-transcriptional regulators of alternative splicing and we have previously shown that the RNA-binding protein Quaking (QKI) plays roles in EC differentiation. In this study, we decipher the role of the alternative splicing isoform Quaking 6 (QKI-6) to induce VSMC differentiation from induced pluripotent stem cells (iPSCs). PDGF-BB stimulation induced QKI-6, which bound to HDAC7 intron 1 via the QKI-binding motif, promoting HDAC7 splicing and iPS-VSMC differentiation. Overexpression of QKI-6 transcriptionally activated SM22 (also known as TAGLN), while QKI-6 knockdown diminished differentiation capability. VSMCs overexpressing QKI-6 demonstrated greater contractile ability, and upon combination with iPS-ECs-overexpressing the alternative splicing isoform Quaking 5 (QKI-5), exhibited higher angiogenic potential in vivo than control cells alone. This study demonstrates that QKI-6 is critical for modulation of HDAC7 splicing, regulating phenotypically and functionally robust iPS-VSMCs. These findings also highlight that the QKI isoforms hold key roles in alternative splicing, giving rise to cells which can be used in vascular therapy or for disease modelling.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Rachel Caines
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Amy Cochrane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Sophia Kelaini
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Marta Vila-Gonzalez
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Chunbo Yang
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Magdalini Eleftheriadou
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Arya Moez
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Alan W Stitt
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Lingfang Zeng
- Cardiovascular Division, King's College London, London SE5 9NU, UK
| | - David J Grieve
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - Andriana Margariti
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
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Lemma AN, Tolonen M, Vikatmaa P, Mentula P, Vikatmaa L, Kantonen I, Leppäniemi A, Sallinen V. Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric Ischaemia: The Importance of Referral Patterns and Triage. Eur J Vasc Endovasc Surg 2019; 57:842-849. [PMID: 31126834 DOI: 10.1016/j.ejvs.2019.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/26/2018] [Accepted: 01/04/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Despite modern advances in diagnosis and treatment, acute arterial mesenteric ischaemia (AMI) remains a high mortality disease. One of the key modifiable factors in AMI is the first door to operation time, but the factors attributing to this parameter are largely unknown. The aim of this study was to evaluate the factors affecting delay, with special focus on the pathways to treatment. METHODS This was a single academic centre retrospective study. Patients undergoing intervention for AMI caused by thrombosis or embolism of the superior mesenteric artery between 2006 and 2015 were identified from electronic patient records. Patients not eligible for intervention or with chronic, subacute onset, colonic only, venous, or non-occlusive mesenteric ischaemia were excluded. Patients were divided into two groups according to the first speciality examining the patient (surgical emergency room [SER], surgeon examining the patient first or non-surgical emergency room [non-SER], internist examining the patient first). The primary endpoint was first door to operation time and secondary endpoints were length of stay and 90 day mortality. RESULTS Eighty-one patients with AMI were included. Fifty patients (62%) died during the first 30 days and 53 (65%) within 90 days. Presenting first in non-SER (vs. SER) was independently associated with a first door to operation time of over 12 h (OR 3.7 [95% CI 1.3-10.2], median time 15.2 h [IQR 10.9-21.2] vs. 10.1 h [IQR 6.9-18.5], respectively, p = .025). The length of stay was shorter (median 6.5 days [4.0-10.3] vs. 10.8 days [7.0-22.3], p = .045) and 90 day mortality was lower in the SER group (50.0% vs. 74.5%, p = .025). CONCLUSIONS The first specialty that the patient encounters seems to be crucial for both delayed management and early survival of AMI. Developing fast/direct pathways to a unit with both gastrointestinal and vascular surgeons offers the possibility of improving the outcome of AMI.
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Affiliation(s)
- Aurora N Lemma
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Tolonen
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Panu Mentula
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Vikatmaa
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Kantonen
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ari Leppäniemi
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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