Effect of Acute Myocardial Infarction on a Disintegrin and Metalloprotease with Thrombospondin Motif 13 and Von Willebrand Factor and Their Relationship with Markers of InflammationRead the full article
International Journal of Vascular Medicine publishes articles focusing on vascular biology and physiology, vascular imaging, endovascular intervention, as well as prevention and treatment of vascular disease.
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Automatic Continuous CRT Optimization to Improve Hemodynamic Response: An Italian Single-Center Experience
Background. Optimization of cardiac resynchronization therapy (CRT) settings after implant can improve response to therapy. In this Italian single-center experience, we investigated the rate of hemodynamic and clinical response in heart failure patients treated with continuously and automatically optimized CRT. Methods. Patients were selected from June 2015 to April 2017 according to the most recent CRT guidelines; all were in sinus rhythm at implant and received a CRT-defibrillator system equipped with SonR, which automatically optimizes AV and VV delays every week. SonR was activated just after implant and remained active during follow-up. The rate of hemodynamic response (R-HR) was defined as %, super-response (R-HSR) as %, and clinical response as a negative transition of at 6 months follow-up vs. baseline (preimplant). Results. Mean follow-up for the 31 patients (aged years; 61% male; NYHA class II/III 19%/81%; ischemic etiology 65%) was months. At baseline, LVEF was % and QRS duration ms. LBBB morphology was observed in 65%. At 6 months, R-HR was 74% (23/31), R-HSR 32% (10/31), and clinical response rate 77% (24/31). Hemodynamically, patients with ischemic etiology benefited more than those without ischemic etiology, both in terms of response (80% versus 64%) and super-response (35% versus 27%). Conclusions. Continuous automatic weekly optimization of CRT over 6 months consistently improved R-HR, R-HSR, and clinical response in NYHA class II/III heart failure patients versus baseline. Patients with ischemic etiology in particular may benefit hemodynamically from this type of CRT optimization.
Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population
Background. The role for inferior vena cava (IVC) filters in the oncology population is poorly defined. Objectives. Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. Patients/Methods. A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes. Results. 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76% of patients with retrievable filters and 69% of patients with permanent filters had an absolute contraindication to anticoagulation. 20% of patients with retrievable filters and 24% of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively. Conclusions. The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.
Systematic Review and Meta: Analysis of Aortic Graft Infections following Abdominal Aortic Aneurysm Repair
Introduction. Aortic graft infection (AGI) is a rare complication following AAA repair and is associated with high morbidity and mortality. Management is variable, and there are no evidence-based guidelines. The aim of this study was to systematically review and analyse management options for AGI. Methods. Data was collected between July and August 2018. A full HDAS search was conducted on the following databases: MEDLINE, EMBASE, CINAHL, and PUBMED. Meta-analysis was conducted using RevMan 5 software. Results. 1,365 patient outcomes were assessed (10 cohort studies and 12 comparative studies). The most common treatment was in situ replacement of the graft (ISR) followed by extra-anatomical replacement (EAR). Various grafts were used for ISR, such as fresh/cryopreserved allograft, venous graft, and prosthetic grafts. No graft material was shown to be superior. Axillobifemoral graft was the commonest type of EAR used. In the majority of cohort studies, ISR was the main treatment for AGI. There was no significant difference in the overall mortality rate (ISR vs. EAR , OR 0.93 [95% CI 0.36-2.36], ). Graft occlusion rate was significantly lower in the ISR group vs. the EAR group ( vs. OR 0.16 [95% CI 0.07-0.36], ). There was no significant difference in the amputation rate between the surgical treatments (ISR vs. EAR , OR 0.75 [95% CI 0.07-8.39], ). Discussion. In situ replacement is the preferred method of treatment as it had lower rates of occlusion. Further strong evidence is required, such as a multicentre trial to establish a management pathway for the condition.
Mechanical Occlusion Chemically Assisted Ablation (MOCA) for Saphenous Vein Insufficiency: A Meta-Analysis of a Randomized Trial
Purpose. A previous meta-analysis has conducted nonrandomized trials for mechanochemical ablation (MOCA). Since medium-term follow-up data from randomized clinical trials (RCTs) are becoming available, we chose to perform a meta-analysis of RCTs to assess the efficacy and safety of MOCA for saphenous vein insufficiency. Methods. A systematic search of all RCTs comparing the anatomical success of MOCA for saphenous vein insufficiency to thermal ablation was performed using the PubMed and Cochrane Library databases. We employed the Mantel-Haenszel random-effects meta-analysis of outcomes using RevMan 5.3. Results. Four studies (615 patients) were included in this meta-analysis. The MOCA group had 93.4% and 84.5%, whereas the thermal ablation group had 95.8% and 94.8% of anatomical success rate at 1 month (short-term) and a period of more than 6 months but less than 1-year follow-up (mid-term), respectively. According to intention-to-treat analysis, there were similar anatomical successes in MOCA and thermal ablation groups at the short-term follow-up (low-quality evidence; relative risk (95% CI, 0.94–1.03); ; ). The estimated effect of MOCA on anatomical success showed a statistically significant reduction at the mid-term follow-up (moderate-quality evidence; (95% CI, 0.84–0.95); ; ). MOCA had fewer incidence of nerve injury, deep vein thrombosis, and skin burns compared to the thermal ablation procedure (low-quality evidence; (95% CI, 0.09–1.28); ; ). Conclusion. MOCA offered fewer major complications but lesser anatomical success at the period of more than 6 months but less than 1-year follow-up than thermal ablation. Trial Registration. This trial is registered with UMIN Clinical Trial Registry (UMIN ID 000036727).
Hypothermia during Surgical Treatment of Type A Aortic Dissection: A 16 Years’ Experience
Acute aortic dissection (AAD) is among the most challenging cases for surgical treatment and requires procedural expertise for its safe conduct. Aortic surgery has undergone several changes over the last years, especially concerning cerebral protection. The brilliant results obtained with the aid of selective anterograde cerebral perfusion led to a progressive increase of circulatory arrest temperature, with the rise of safe time along with a reduction of the extracorporeal circulation time and hypothermia-related side effects. However, there is still no definitive consensus concerning the optimal range of temperature to be used during circulatory arrest. Objectives. This is a retrospective observational study, and we examined 16-year trends in the presentation, diagnosis, hospital outcome and treatment of A AAD type. In our Cardiac Surgery Unit in Policlinico Umberto I of Rome, our analysis focused on patients, who received ACP during aortic surgery and we analyzed the differences between two distinct groups based on the lowest temperature reached during CPB conduction: Lower Temperature Group (LT) ( < 24°C) versus Higher Temperature Group (HT) ( ≥ 24°C) arrest circulation temperature. Methods. Data from 241 patients enrolled between August 2002 and March 2018 were analyzed. Patients were divided according to the lowest temperature reached into 2 groups: Lower Temperature group (LT) (94 patients) and Higher Temperature Group (HT) (147 patients). Results. Our results showed a significant reduction of in-hospital mortality and in-hospital results in patients with higher CPB temperature. The global incidence of complications was statistically reduced in HT group: we found a statistical significant reduction of intestinal ischemia, and a similar trend also for other complications analyzed, such as infections. Since the two groups were similar for type of surgical procedures, we considered these differences depending on the lower temperature value reached, according to the current literature. Conclusions. We found a significantly higher mortality in patients with lower temperature during CPB and a global reduction of complications and in particular a significant reduction of intestinal ischemia in patients with higher temperature during CPB. We found a similar trend in other fields of investigations, so we can conclude that circulatory arrest performed at temperature ≥24°C nasopharyngeal temperature associated with ACP is a safe strategy for aortic surgery for AAD.
Experience in the Management of Patients with Chronic Vascular Ulcers of the Lower Limbs Using Negatively Charged Polystyrene Microspheres
Background. Chronic ulcers of the lower limbs are a socioeconomic health problem, having a high incidence in the adult population. Despite a correct etiological treatment, in addition to the multiple lesion management options available, healing percentage and speed remain low, which makes it a great therapeutic challenge. Objective. To describe the outcome and effectiveness of the use of PolyHeal® Micro in the granulation and epithelialization of chronic ulcers of the lower limbs. Methods. Descriptive observational case series of 19 patients with diagnosis of chronic vascular ulcers of the lower limbs, treated at Medical Center Nuestra IPS and Medical Center Juan Pablo II in Bogotá between March 2018 and December 2018, who received PolyHeal® Micro as topical treatment for their lesions. Patients were assessed taking into account age, sex, ulcer size, pain, wound exudate, as well as granulation and epithelialization response. Results. In this series, the mean age of patients was 67.9 years, they were mostly females (84%), and the most common location of ulcers was the internal malleolus (50%). In terms of wound severity, 47% were found to be severe, 43% moderate, and 10% mild. The median time of lesion onset was 28 weeks, with a maximum of 2080 and a minimum of 8 weeks. In total, 87% of the ulcers were of venous etiology. After 12 weeks of treatment with Polyheal, ulcers showed a significative improvement of Wollina score means: 0.80 ± 0.90–5.90 ± 1.47; . Wound area mean at the start of treatment was 31.6 cm2, and at the end of treatment was 17.85 cm2, which is equivalent to a wound area surface reduction of 54.2%, with a statistically significant value. The interquartile range showed a reduction of 64.3% in the central means of wounds. Seventy percent of the patients reached a granulation percentage greater than 70%, 17% of the lesions exhibited an improvement of 30–70%, and there was an overall granulation improvement in 87% of the patients. Concerning epithelialization, 40% of patients reached a percentage higher than 70%, and 17% of patients between 30% and 70%. Treatment time was 12 weeks in 68% of cases, with an average response time of 8.1 weeks. Based on the visual analogue scale (VAS), a reduction in patients’ perception of pain was achieved, dropping from an average of 6 (moderate to severe pain) to 2 (little pain), demonstrating an improvement in this regard. Fifty percent of the ulcers showed decreased exudate, resulting in a dry state. The patient satisfaction rate at the end of treatment was 89%. Conclusion. The use of PolyHeal® Micro for an average of 8.1 weeks of treatment showed a high rate of granulation and epithelialization in chronic ulcers of the lower limbs, improving pain perception in these patients and generating a high degree of treatment satisfaction.