1,721,082 research outputs found
Oral Anticoagulant Therapy and Endovascular Procedures
Full text linkWe have read with interest the article by Wilensky et al. on “Outcomes after arterial endovascular procedures performed in patients with an elevated international normalized ratio,”1 reporting on the management of patients under oral anticoagulant therapy (OAT).
Although the authors state that no studies were published before their series, the possibility of performing peripheral arterial procedures in patients with OAT was specifically addressed in 2 studies from our institution. Specifically in the articles by Pini et al.2 and Faggioli et al.,3 we have highlighted the results achievable in carotid stenting (CAS) procedures in patients with OAT. In both studies, not only the safety of the procedure was shown, but also the advantages over traditional surgical carotid endarterectomy (CEA) and bridging therapy.
In the first paper, we have analyzed specifically 502 CAS performed in a 5-year period with 12 (2.4%) perioperative strokes, 1 (0.2%) death, no myocardial infarctions, and 4 (0.8%) access site bleeding period. Twenty patients (4.0%) under chronic OAT were submitted to CAS without perioperative bridging heparin therapy and no complications. Overall, patients under OAT had no significantly different outcome compared with patients without OAT.2
In the second paper, we have analyzed altogether 1,222 carotid revascularizations, with 711 CEAs (58.1%) and 511 CAS (41.9%). In the CEA group, 31 (4.4%) OAT patients were treated after OAT interruption and bridging heparin therapy. These patients had a significantly higher complication rate compared with patients not receiving OAT, including death, stroke, and hematoma. In CAS, the results were similar in patients receiving OAT (30[5.8%]) and patients not receiving OAT. Patients receiving unsuspended OAT who underwent CAS had better outcomes than OAT patients who underwent CEA after suppression of OAT and bridging therapy.3
As a matter of fact, our current practice includes stenting as a first option in OAT patients needing carotid revascularization. In this sense, although we advocate standard CEA as the gold standard procedure for symptomatic and asymptomatic carotid disease, there are subgroups of patients (i.e., OAT patients and patients with contralateral carotid occlusion) who benefit more from CAS.
Sistema vascolare
No full textil capitolo tratta le principali patologie del sistema vascolare arterioso e venoso degli arti, anche se le metodiche ultrasonografiche sono utilizzate con maggiore frequenza nell'analisi di altri distretti con rilevanza epidemiologica e patologica spesso preminente, come i tronchi sovraortici e i casi aorto-iliaci. vengono descritti i metodi di indagine ultrasonografica degli arti inferiori e superiori. Successivamente vengono esposte le patolgie vascolari non aterosclerotiche di interesse muscolo-articolare
Carotid disease. Clinical and morphological insights
No full texttHIS BOOK IS THE RESULT OF THE WORK OF MANY OF THE MOST RENOWNED EXPERTS IN THE FIELD, IN AN EFFORT TO SUMMARZE AND ASSESS THE CONTEMPORARY KNOWLEDGE ON THE PATHOLOGY
Intraoperative contrast enhanced ultrasound adds some important details to the endovascular aortic aneurysm repair completion control
No full textBACKGROUND:
The aim of this study was to evaluate the feasibility and utility of intraoperative contrast-enhanced ultrasound (CEUS) for early detection of endoleaks (ELs) during endovascular abdominal aortic aneurysm repair (EVAR) compared with completion digital subtraction angiography.
METHODS:
Patients undergoing elective EVAR from January 2017 to April 2018 were consecutively enrolled in this prospective study. After endograft deployment, two-digital subtraction angiography (2DSA) with orthogonal C-arm angulations (anteroposterior and sagittal view) were routinely performed. After the endovascular treatment of clear, high-flow type I/III ELs detected by 2DSA, intraoperative CEUS was carried out in sterile conditions on the surgical field before guidewire removal. Presence and type of EL were evaluated with 2DSA and CEUS. CEUS was performed with the vascular surgeon blinded to the 2DSA findings. The primary end point was the level of agreement between 2DSA and CEUS to detect any type of EL and type II EL. Agreement between two diagnostic methods was calculated using Cohen's kappa. The secondary end point was utility of CEUS for intraoperative adjunctive procedure guidance.
RESULTS:
Sixty patients were enrolled (mean age, 78 ± 6 years; 90% male). 2DSA revealed 11 ELs (18%; 1 type IA, 10 type II), and CEUS 25 ELs (42%; 2 type IA, 23 type II). 2DSA and CEUS were in agreement in 39 cases (65%; 32 no ELs, 7 type II ELs). CEUS detected 17 ELs not identified by 2DSA (28%; 2 type IA, 15 type II); 2DSA detected three ELs not identified by CEUS (5%; 3 type II). In one case, 2DSA and CEUS detected type II and type IA ELs, respectively. For EL and type II EL detection, Cohen's kappa was 0.255 and 0.250, respectively (both "fair agreement"). Intraoperative adjunctive sac embolization was performed under CEUS control in 4 cases and technical success was 100%.
CONCLUSIONS:
Intraoperative CEUS during EVAR is feasible and can detect a greater number of ELs than 2DSA, in particular type II ELs. Further studies are necessary to assess the reliability of this intraoperative diagnostic examination. In type II ELs, CEUS may represent an additional, useful tool for intraoperative sac embolization guidance
The efficacy of CO2 angiography in the endovascular treatment of an acute iliac pseudoaneurysm
No full textCO2 angiography has been used extensively for the endovascular treatment of aorto-iliac and femoral-popliteal-tibial pathologies, specifically in patients with chronic kidney disease or allergy to iodinated contrast medium (ICM). However, its use in urgent treatment of an acute pseudoaneurysm has never been described before. We report a case of a 39-year-old woman, allergic to iodine, with a recent kidney transplant, who presented in the emergency room with severe pain in the left iliac fossa. Angio CT-scan showed an acute pseudoaneurysm of the left common iliac artery. She was emergently treated with a stent-graft and CO2 was used as main contrast medium. The intraoperative angiographies performed with carbon dioxide showed very well the rupture site and the pseudoaneurysm; the latter were more clearly visible with CO2 compared with ICM. The reported case shows the efficacy of CO2 as contrast medium also in urgent settings and arterial ruptures. The lower viscosity of CO2 probably leads to an easier diffusion through the arterial lesion into the pseudoaneurysmal sac. Therefore, in this case the use of carbon dioxide not only guaranteed prevention of massive allergic reaction to iodine and preservation of postoperative renal function, but also resulted in higher image quality in the operating room
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Impact of cerebral ischemic lesions on the outcome of carotid endarterectomy
Full text linkPatients with carotid artery stenosis (CAS) are commonly defined as asymptomatic or symptomatic according with their neurological conditions, however, emerging evidences suggest stratifying patients according also with the presence of cerebral ischemic lesions (CIL). In asymptomatic patients, the presence of CIL increases the risk of future neurologic event from 1% to 4% per year, leading to a stronger indication to carotid revascularization. In symptomatic patients, the presence of CIL does not seem to influence the outcome of the carotid revascularization if the volume of the lesion is small (<4,000 mm(3)); the benefit of the revascularization is also more significant if performed within 2 weeks from the index event. However, high volume (>4,000 mm(3)) CIL are associated in some experiences with a higher risk of carotid revascularization suggesting to delay the carotid revascularization for at least 4 weeks. As a matter of fact, the evaluation of CIL dimensions and characteristics in patients with CAS gives to the physician involved in the treatment a valuable adjunctive tool in the choice of the ideal treatment
GRADUS Study: To Walk Longer and Faster - an Innovative Programme for Individuals with Peripheral Vascular Disease
No full textGRADUS is a prospective, unfunded study approved by
the ethics committee and carried out through collaboration
between the Vascular Surgery Unit of the University of
Bologna (Bologna, Italy) and the Centre for Exercise Science
and Sport of the University of Ferrara (Ferrara, Italy). Since
April 2021, a free SET programme using the Biocircuit system has been offered to patients with IC due to infrainguinal peripheral arterial disease attending a single vascular
surgery outpatient clinic. The programme included aerobic
training (warm up cycling followed by three treadmill sessions of ten minutes each) and resistance training (knee
extension, leg press, and leg curl exercises) performed
under physiotherapist supervision three times per week for
12 weeks
A systematic review and meta-analysis of the occurrence of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms
No full textObjective: The rate of endovascular repair of thoracoabdominal aortic aneurysms (TAAA-ER) has increased considerably in recent years. Although the mortality and morbidity rates have improved, the incidence of spinal cord ischemia (SCI) has not declined significantly. The aim of the present systematic review and meta-analysis was to examine the SCI rates with respect to the efficacy of the different approaches.Methods: Cohort studies and case series (>20 patients) reporting SCI rates after TAAA-ER were eligible for inclusion. The primary outcome measure was the evaluation of SCI. The moderators considered were primarily the staged vs nonstaged approach, the use of cerebrospinal fluid drainage (CSFD), and TAAA extension. The permanent SCI and mortality rates were extracted.Results: A total of 27 studies with 2333 patients were included in the meta-analysis. The pooled estimate for SCI was 11% (95% confidence interval [CI], 8%-15%; I-2, 79%). For extent I, II, III, and V TAAA, the pooled SCI rate was 13% (95% CI, 10%-17%; I-2, 69%). For extent IV TAAA, the pooled SCI rate was 6% (95% CI, 3%-10%; I-2, 62%). A staged TAAA-ER approach was used in 20 studies and a nonstaged approach in 8 (1 study had included both). A lower pooled SCI rate was identified after staged than after nonstaged TAAA-ER (9% vs 18%, respectively; P = .02). Staging was accomplished in >1 month in nine studies and <= 1 month in two studies, leading to similar SCI rates (7% vs 11%, respectively; P = .26). The method of staging (thoracic endoprosthesis or temporary aortic sac perfusion) did not affect the SCI rates. Symptomatic CSFD was associated with a similar pooled rate of SCI compared with prophylactic CSFD (10% vs 10%, respectively; P = .99). The pooled permanent SCI rate was 6% (6% for extent I, II, III, and V TAAA; and 3% for extent IV TAAA). The pooled rate of 30-day mortality was 7%, with a similar incidence for the staged and nonstaged approaches (6% vs 9%, respectively). Interstage mortality was reported in 9 studies, with a pooled estimate rate of 1.6%.Conclusions: SCI had occurred in 11% of TAAA-ER, and one half of these cases were permanent. A staged approach can reduce SCI rates independently of the timing and method adopted. The overall mortality rate for staged TAAA-ER was 7%, with one fifth of the deaths (1.6%) occurring between stages
- …
