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Tange FP, van den Hoven P, van Schaik J, Schepers A, van der Bogt KEA, van Rijswijk CSP, Putter H, Vahrmeijer AL, Hamming JF, van der Vorst JR. Near-Infrared Fluorescence Imaging With Indocyanine Green to Predict Clinical Outcome After Revascularization in Lower Extremity Arterial Disease. Angiology 2024; 75:884-892. [PMID: 37358400 PMCID: PMC11375904 DOI: 10.1177/00033197231186096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Contemporary quality control methods are often insufficient in predicting clinical outcomes after revascularization in lower extremity arterial disease (LEAD) patients. This study evaluates the potential of near-infrared fluorescence imaging with indocyanine green to predict the clinical outcome following revascularization. Near-infrared fluorescence imaging was performed before and within 5 days following the revascularization procedure. Clinical improvement was defined as substantial improvement of pain free walking distance, reduction of rest- and/or nocturnal pain, or tendency toward wound healing. Time-intensity curves and 8 perfusion parameters were extracted from the dorsum of the treated foot. The quantified postinterventional perfusion improvement was compared within the clinical outcome groups. Successful near-infrared fluorescence imaging was performed in 72 patients (76 limbs, 52.6% claudication, 47.4% chronic limb-threatening ischemia) including 40 endovascular- and 36 surgical/hybrid revascularizations. Clinical improvement was observed in 61 patients. All perfusion parameters showed a significant postinterventional difference in the clinical improvement group (P-values <.001), while no significant differences were seen in the group without clinical improvement (P-values .168-.929). Four parameters demonstrated significant differences in percentage improvement comparing the outcome groups (P-values within .002-.006). Near-infrared fluorescence imaging has promising additional value besides clinical parameters for predicting the clinical outcome of revascularized LEAD patients.
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Affiliation(s)
- Floris P Tange
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - Pim van den Hoven
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | | | | | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, The Netherlands
| | | | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, The Netherlands
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Alptekin GS, Erkul S, Akgul E, Cekirdekci A. The inpatient costs related to revascularization of lower extremity artery disease in terms of amputation and mortality rates. Vascular 2024; 32:653-660. [PMID: 36749662 DOI: 10.1177/17085381231156216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE With the initial utilization of endovascular treatment options in 1970s, the number of procedures performed for lower extremity artery disease (LEAD) both with open surgical (OS) and endovascular (EV) treatment increased, but this did not result in a decrease in the number of amputations. The burden of LEAD still constitutes a huge proportion among the health care costs over the world. METHODS The patients who admitted to our clinic between October 2014 and December 2019 with LEAD and required revascularization were enrolled. The total hospitalization costs related to LEAD were registered and divided into two groups as care costs and medical supplies costs. RESULTS 181 procedures were performed to 133 patients. Mean age was 63.98 ± 11.65 and 115 (86.5%) patients were male. Mean follow-up period was 31.19 ± 17.99 months (95% CI). The most frequent comorbidities were diabetes mellitus (DM) (n = 86, 66.2%) and active smoking (n = 59, 44.4%). Total costs and medical supplies costs were increased in EV group when compared with OS group ($4347.26 ± 3352.96, $3339.28 ± 3459.53 p = .005 v.s. $3318.67 ± 2874.55,$904.42 ± 1209.97 p < .001, respectively). Care costs were increased in OS group when compared with EV group ($2434.85 ± 2641.89 v.s. $1028.56 ± 1397.77 p < .001). The highest total, medical supplies, and care costs were determined in EV + OS group ($13071.32 ± 13717; $6784.91 ± 8332.04; $6286.41 ± 7652.12, respectively).Graft/wound infection related and amputation related costs were 21% of all costs. Amputation-free survival was 71.42% (95% CI) with 21 total amputations. There were linear correlations between mortality and amputation (p = .002); also between mortality and cost (p = .001). CONCLUSIONS In mid-long-term period, the care costs are increased with OS; however, EV treatment significantly increases the medical supplies and total costs. The increase in cost is correlated with poor outcome. Although the comorbidities and risk factors of these patients lead the clinicians to perform more challenging endovascular approaches, in mid-long-term period, particularly failed endovascular procedures are not promising in terms of outcomes and costs. We consider that the best-fit therapy on time is cost-effective, life and extremity-saving either, by avoiding deleterious effects of severe ischemia, such as severe pain, tissue loss, and related major adverse cardiaovascular events.
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Affiliation(s)
- Gulen S Alptekin
- Department of Cardiovascular Surgery, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Sinan Erkul
- Department of Cardiovascular Surgery, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Engin Akgul
- Department of Cardiovascular Surgery, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Ahmet Cekirdekci
- Department of Cardiovascular Surgery, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey
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Tariq M, Novak Z, Spangler EL, Passman MA, Patterson MA, Pearce BJ, Sutzko DC, Brokus SD, Busby C, Beck AW. Clinical Impact of an Enhanced Recovery Program for Lower-extremity Bypass. Ann Surg 2024; 279:1077-1081. [PMID: 38258556 DOI: 10.1097/sla.0000000000006212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To determine the association of Enhanced Recovery Program (ERP) implementation with length of stay (LOS) and perioperative outcomes after lower-extremity bypass (LEB). BACKGROUND ERPs have been shown to decrease hospital LOS and improve perioperative outcomes, but their impact on patients undergoing vascular surgery remains unknown. METHODS Patients undergoing LEB who received or did not receive care under the ERP were included; pre-ERP (January 1, 2016-May 13, 2018) and ERP (May 14, 2018-July 31, 2022). Clinicopathologic characteristics and perioperative outcomes were analyzed. RESULTS Of 393 patients who underwent LEB [pre-ERP: n = 161 (41%); ERP: n = 232 (59%)], most were males (n = 254, 64.6%), White (n = 236, 60%), and government-insured (n = 265, 67.4%). Pre-ERP patients had higher Body Mass Index (28.8 ± 6.0 vs 27.4 ± 5.7, P = 0.03) and rates of diabetes (52% vs 36%, P = 0.002). ERP patients had a shorter total [6 (3-13) vs 7 (5-14) days, P = 0.01) and postoperative LOS [5 (3-8) vs 6 (4-8) days, P < 0.001]. Stratified by indication, postoperative LOS was shorter in ERP patients with claudication (3 vs 5 days, P = 0.01), rest pain (5 vs 6 days, P = 0.02), and tissue loss (6 vs 7 days, P = 0.03). ERP patients with rest pain also had a shorter total LOS (6 vs 7 days, P = 0.04) and lower 30-day readmission rates (32%-17%, P = 0.02). After ERP implementation, the average daily oral morphine equivalents decreased [median (interquartile range): 52.5 (26.6-105.0) vs 44.12 (22.2-74.4), P = 0.019], while the rates of direct discharge to home increased (83% vs 69%, P = 0.002). CONCLUSIONS This is the largest single-center cohort study evaluating ERP in LEB, showing that ERP implementation is associated with shorter LOS and improved perioperative outcomes.
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Affiliation(s)
- Marvi Tariq
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Zdenek Novak
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily L Spangler
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marc A Passman
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark A Patterson
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin J Pearce
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Danielle C Sutzko
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara Danielle Brokus
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney Busby
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam W Beck
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Levin SR, Farber A, Goodney PP, King EG, Eslami MH, Malas MB, Patel VI, Kiang SC, Siracuse JJ. Five Year Survival in Medicare Patients Undergoing Interventions for Peripheral Arterial Disease: a Retrospective Cohort Analysis of Linked Registry Claims Data. Eur J Vasc Endovasc Surg 2023; 66:541-549. [PMID: 37543356 DOI: 10.1016/j.ejvs.2023.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/19/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To justify the up front risks of offering elective interventions for intermittent claudication (IC), patients should have reasonable life expectancy to derive durable clinical benefits. Open surgery for chronic limb threatening ischaemia (CLTI) is maximally beneficial in patients surviving ≥ 2 years. The aim was to assess long term survival after IC and CLTI interventions. METHODS In a retrospective cohort analysis, the Vascular Quality Initiative (VQI) registry from 1 January 2010 to 31 May 2021 was queried for peripheral vascular intervention (PVI), infra-inguinal bypasses (IIB), and supra-inguinal bypasses (SIB) for IC and CLTI across 286 US centres. VQI linkage to Medicare insurance claims provided five year survival data. Multivariable analysis identified factors associated with five year mortality. RESULTS There were 31 457 PVIs (44.7% IC, 55.3% CLTI), 7 978 IIBs (26.9% IC, 73.1% CLTI), and 2 149 SIBs (50.1% IC, 49.9% CLTI) recorded in the VQI. Among the PVI, IIB, and SIB cohorts, average ages were 75, 73, and 72 years, respectively. Respective five year mortality after PVI for IC and CLTI was 37.2% and 71.1%; after IIB for IC and CLTI it was 37.8% and 60%; and after SIB for IC and CLTI it was 33.8% and 53.8%. On multivariable analysis, across all procedures, end stage renal disease, CLTI, congestive heart failure, anaemia, chronic obstructive pulmonary disease, and prior amputation were independently associated with increased mortality. Pre-admission home living and pre-operative aspirin use were independently associated with decreased mortality. CONCLUSION Long term survival in Medicare patients undergoing interventions in VQI centres for peripheral arterial disease is poor. Two thirds of CLTI patients and over one third of IC patients were not alive at five years. Intervening for IC in patients with high mortality risk should be avoided. For CLTI patients identified with decreased survival likelihood, intervention durability may be less important than invasiveness. Pre-operative medical optimisation should always be undertaken.
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Affiliation(s)
- Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Centre, Boston, MA, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Centre, Boston, MA, USA
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
| | - Elizabeth G King
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Centre, Boston, MA, USA
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Virendra I Patel
- Section of Vascular Surgery and Endovascular Interventions, NYP/Columbia University Irving Medical Centre, New York, NY, USA
| | - Sharon C Kiang
- Division of Vascular and Endovascular Surgery, Loma Linda University Medical Centre, Loma Linda, CA, USA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Centre, Boston, MA, USA.
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Ricco JB, Roiger RJ, Schneider F, Guetarni F, Thaveau F, Illuminati G, Pasqua R, Chaufour X, Porterie J, Hostalrich A. Editor's Choice - Infra-inguinal Endovascular Revascularisation and Bypass Surgery for Chronic Limb Threatening Ischaemia: a Retrospective European Multicentre Cohort Study with Propensity Score Matching. Eur J Vasc Endovasc Surg 2023; 66:531-540. [PMID: 37385368 DOI: 10.1016/j.ejvs.2023.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The aim of this study was to compare the long term efficacy of lower limb bypass with that of endovascular treatment (EVT) in patients with chronic limb threatening ischaemia (CLTI). METHODS This retrospective, multicentre study evaluated the outcomes of patients with CLTI who underwent first time infra-inguinal bypass or EVT. The primary outcome was to compare amputation free survival (AFS) rates between the two propensity score matched groups. The secondary outcome was to compare wound healing within the first six months. Major adverse events were compared according to the type of revascularisation. RESULTS Overall, 793 patients fulfilled the eligibility criteria, from whom 236 propensity score matched pairs were analysed. The mean follow up was 52 months. The 236 bypass procedures included 190 autogenous bypass grafts (80.5%), 151 (64.0%) of which were infrapopliteal. Among the 236 EVT procedures, the target lesion was the femoropopliteal segment in 81 patients (34.3%), the femoropopliteal and infrapopliteal segments in 101 patients (42.8%), and the infrapopliteal segment in 54 patients (22.9%). AFS was significantly better in the bypass group at five years (60.5 ± 3.6%) compared with the EVT group (35.3 ± 3.6%) (p < .001). Major amputation occurred in 61 patients (25.8%) in the bypass group and 85 patients (36.0%) in the EVT group (HR 0.66, 95% CI 0.47 - 0.92; p = .014). The probability of healing was significantly better in the bypass group at six months compared with the EVT group (p = .003). The median length of stay was shorter for the EVT group (4 days) than for the bypass group (8 days) (p = .001). Urgent re-intervention and re-admission rates were high and did not differ significantly between the groups. CONCLUSION This study has shown that lower limb bypass surgery offered a significantly higher probability of AFS and wound healing compared with EVT in patients with CLTI.
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Affiliation(s)
- Jean-Baptiste Ricco
- Department of Clinical Research and Vascular Surgery Service, Poitiers University Hospital, Poitiers, France.
| | - Richard J Roiger
- Department of Computer Information Science, Minnesota State University, Mankato, MN, USA
| | - Fabrice Schneider
- Department of Vascular Surgery and CIC INSERM 1402, Poitiers University Hospital, Poitiers, France
| | - Farid Guetarni
- Department of Clinical Research and Data Management, Poitiers University Hospital, Poitiers, France; and CNAM, Paris, France
| | - Fabien Thaveau
- Department of Vascular Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Giulio Illuminati
- Department of Vascular Surgery, University of Rome, La Sapienza, Rome, Italy
| | - Rocco Pasqua
- Department of Vascular Surgery, University of Rome, La Sapienza, Rome, Italy
| | - Xavier Chaufour
- Department of Vascular Surgery, Toulouse University Hospital, Toulouse, France
| | - Jean Porterie
- Department of Cardiovascular Surgery, University Hospital Rangueil Toulouse, Toulouse, France
| | - Aurélien Hostalrich
- Department of Vascular Surgery, Toulouse University Hospital, Toulouse, France
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Peters F, Behrendt CA. Limb Related Outcomes of Endovascular vs. Open Surgical Revascularisation in Patients with Peripheral Arterial Occlusive Disease: A Report from the Prospective GermanVasc Cohort Study. Eur J Vasc Endovasc Surg 2023; 66:85-93. [PMID: 36972814 DOI: 10.1016/j.ejvs.2023.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/28/2023]
Abstract
OBJECTIVE The goal of this study was to compare clinical outcomes in patients with peripheral arterial occlusive disease undergoing revascularisation by peripheral endovascular intervention (EVI), bypass surgery, endarterectomy (EA), and hybrid surgery in an unselected real world setting. METHODS This was a German, prospective, multicentre, comparative cohort study, enrolling patients at hospital admission for revascularisation at 35 vascular centres with 12 months of follow up. Primary composite endpoints were major amputation or death, major adverse limb events, and any minor or major amputation. Twelve month incidences and hazard ratios (HRs) for the four subgroups and 95% confidence intervals (CIs) were estimated using Kaplan-Meier functions and Cox proportional hazard models. Sociodemographic and clinical characteristics, pharmacological treatment, and comorbidities were used to adjust for patient differentials (unique identifier ClinicalTrials.gov: NCT03098290). RESULTS In total, 4 475 patients were analysed (mean age 69 years, 69.4% males, and 31.5% suffering from chronic limb threatening ischaemia). After 12 months of follow up, 5.3% (95% CI 3.6 - 6.9%) of the patients experienced either death or major amputation, 7.2% (95% CI 4.8 - 9.6%) major adverse limb event, and 6.6% (95% CI 5.0 - 8.2%) any minor or major amputation. Compared with EVI, bypass surgery was associated with an increased risk of amputation or death (HR 2.59, 95% CI 1.75 - 3.85), major adverse limb event (HR 1.93, 95% CI 1.11 - 3.36), and any minor or major amputation (HR 2.12, 95% CI 1.42 - 3.16), and hybrid surgery with an increased risk of amputation or death (HR 2.29, 95% CI 1.27 - 4.13) and major adverse limb event (HR 1.62, 95% CI 1.03 - 2.54). After adjusting for patient differentials, no significant differences among study groups remained. CONCLUSION More favourable outcomes after EVI were completely attributed to differentials in patient characteristics and not procedure type. The current study emphasised that all competing approaches performed similarly in a real world setting.
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Affiliation(s)
- Frederik Peters
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany; Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
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Iwai T, Yamaguchi T, Ueshima D, Tobita K, Mizuno A, Fujimoto Y, Miyazaki R, Shimura T, Goto R, Murata N, Anzai H, Higashitani M. Differences in major limb outcomes by indication for lower extremity endovascular revascularization in patients receiving hemodialysis. Heart Vessels 2023; 38:488-496. [PMID: 36322238 DOI: 10.1007/s00380-022-02195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 03/07/2023]
Abstract
The incidence of lower extremity artery disease (LEAD) in patient receiving hemodialysis is remarkably higher than the general population. The treatment strategy and prognosis for LEAD patients differs depending on whether a patient has intermittent claudication (IC) or critical limb-threatening ischemia (CLTI). However, the distinction between the prognosis in HD-dependent patients with IC and CLTI has not been fully elucidated. This study is to determine whether indication of PAD has a distinct impact on major adverse cardiovascular and cerebrovascular events (MACCE) and limb events in patients receiving hemodialysis. The current study included 2321 prospectively enrolled patients from the Tokyo taMA peripheral vascular intervention research ComraDE registry (UMIN-CTR no. UMIN000015100) between September 2014 and December 2016. Out of the enrolled patients, 1644 were not receiving hemodialysis (non-HD patients) and 603 were receiving hemodialysis (HD patients). A composite of all-cause death, myocardial infarction, and stroke events defined as MACCE; while limb events were defined as a composite of unscheduled major amputation, unscheduled major lower limb surgery, acute limb ischemia, unscheduled endovascular treatment, and target lesion revascularization. Propensity score matching was applied among the non-HD and HD patients, in whole group, IC subgroup, and CLTI subgroup. Kaplan-Meier analysis was used for the analysis of outcomes for the whole group, IC subgroup, and the CLTI subgroup. CLTI accounted for 75.5% of the HD patients, whereas IC was 63.4% in the non-HD patients. The HD patients exhibited more frequent below-the-knee lesions than those in the non-HD patients in both IC (p = 0.01) and CLTI (p < 0.001) subgroups. Overall, HD patients exhibited a significantly higher rate of MACCE at 24 months. This trend was similar for limb events in whole group and CLTI subgroup. In contrast, no significant differences in outcomes for limb events were found in IC subgroup. Although, prognosis after EVT in HD patients were significantly worse than non-HD patients, comparable outcome with non-HD patients was observed in the patients treated for IC. Clinical trial registration: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR No. UMIN000015100).
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Affiliation(s)
- Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan.
| | - Daisuke Ueshima
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Kazuki Tobita
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kamakura , Kanagawa, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yo Fujimoto
- Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Tsukasa Shimura
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Ryo Goto
- Department of Cardiology, Shuuwa General Hospital, Saitama, Japan
| | - Naotaka Murata
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Anzai
- Department of Cardiology, Ota Memorial Hospital, Gunma, Japan
| | - Michiaki Higashitani
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
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8
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Bonaca MP, Hogan SE. Tradeoffs in Approach to PAD Revascularization: Shared Decision Making in the Spotlight. J Am Coll Cardiol 2023; 81:371-373. [PMID: 36697137 DOI: 10.1016/j.jacc.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Marc P Bonaca
- CPC Clinical Research, Aurora, Colorado, USA; University of Colorado, Aurora Colorado, USA; University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Shea E Hogan
- CPC Clinical Research, Aurora, Colorado, USA; University of Colorado School of Medicine, Aurora, Colorado, USA; Denver Health Hospital, Denver, Colorado, USA. https://twitter.com/SheaHogan7
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Kim SY, Lee YM, Son YJ. Factors associated with self-management after hybrid revascularization in patients with peripheral artery disease: A structural equations model. J Adv Nurs 2023; 79:170-181. [PMID: 36082905 DOI: 10.1111/jan.15440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
AIM To investigate the factors associated with self-management after hybrid revascularization in patients with lower extremity peripheral artery disease using a structural equation modelling approach. DESIGN A cross-sectional study was adopted. METHODS A total of 221 patients who underwent hybrid revascularization for peripheral artery disease of the lower limbs were included from outpatient clinics at a 1200-bed tertiary care hospital in Korea. Data were collected using a self-reported questionnaire between December 1, 2019, and August 31, 2020. Structural equation modelling was applied to test the hypothetical model. RESULTS The item mean score of participants' self-management was 6.28 (standard deviation, 0.83) out of 8. The structural equation modelling had a good fit index. Autonomy support from healthcare providers was directly associated with self-management (β = 0.20, p = 0.041). Illness perception directly (β = -0.33, p = 0.031) and indirectly (β = -0.19, p = 0.032) influenced self-management through competence and relatedness in patients with peripheral artery disease. The construct of autonomy support from healthcare providers, illness perception, competence and relatedness accounted for 49% of the variance in self-management. The Sobel test confirmed the statistically significant mediating effects of competence (z = -4.52, p < 0.001) and relatedness (z = -2.12, p < 0.001) on the relationship between illness perception and self-management. CONCLUSION Our findings revealed that autonomy support from healthcare providers and patients' illness perception directly influenced patients' self-management. Additionally, patients' illness perception can indirectly influence self-management through their perceived competence and relatedness. IMPACT Healthcare providers' autonomy support to patients may promote self-care behaviours, leading to greater autonomous motivation. Assessment of patients' illness perception before patient education is vital to designing effective self-management strategies which can improve patients' perceived competency and meaningful relatedness with healthcare providers.
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Affiliation(s)
- So-Young Kim
- Department of Nursing, Pusan National University Yangsan Hospital, Busan, South Korea
| | - Yun Mi Lee
- College of Nursing, Institute of Health Science Research, Inje University, Busan, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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10
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Qin L, Li J. Exaggerated blood pressure response to static exercise in hindlimb ischemia-reperfusion. Front Physiol 2022; 13:1048559. [PMID: 36589449 PMCID: PMC9794987 DOI: 10.3389/fphys.2022.1048559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Peripheral artery disease (PAD) reduces the blood flow supply in the affected limbs as one of the significant cardiovascular concerns. Revascularization surgery in the femoral artery plays a central role in treating PAD. Exercise is also a rehabilitation strategy suggested for PAD patients to improve vascular functions. However, the effects of limb ischemia-reperfusion (IR), one of the most predominant complications in revascularization surgery, on exercise-induced arterial blood pressure (BP) response are poorly understood. In the present study, we determined 1) the blood flow status in the hindlimb muscles of rats (plantar muscle, red and white portions of gastrocnemius) with different time points of the hindlimb IR; and 2) the BP response to static muscle contraction in rats at different time points after the blood flow reperfusion procedure. Results of this study indicated that, compared with the Sham group, the blood flow in the hindlimb muscles evaluated by Evans blue concentration was significantly reduced at 6 h of femoral artery occlusion (FAO 6 h) (vs. sham control, p < 0.05). The decreased blood flow was gradually recovered after the blood flow reperfusion for 18 (IR 18 h), 66 (IR 66 h), and 114 (IR 114 h) hours (p < 0.05 vs. FAO 6 h for all IR groups). The response of mean arterial pressure was 20 ± 4 mmHg in Sham rats (n = 7); 32 ± 10 mmHg in IR 18 h rats (n = 10); 27 ± 7 mmHg in IR 66 h rats (n = 13); 26 ± 4 mmHg in IR 114 h rats (n = 9) (p < 0.05 vs. Sham for all groups). No significant difference was observed in the peak-developed tension during muscle contraction among all the groups (p > 0.05). In conclusion, static exercise-induced BP response is exaggerated following IR. Whereas the BP response is not statistically significant but tends to decrease with a prolonged IR time, the exaggerated BP response remains through time points from post-IR 18 h-114 h.
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Affiliation(s)
- Lu Qin
- *Correspondence: Lu Qin, ; Jianhua Li,
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Anderson PB, Sen I, Welker CC, Rasmussen TE, Ramakrishna H. Critical Limb Ischemia: Update for the Cardiovascular Anesthesiologist. J Cardiothorac Vasc Anesth 2022; 36:3939-3944. [DOI: 10.1053/j.jvca.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
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Cold-Inducible RNA-Binding Protein but Not Its Antisense lncRNA Is a Direct Negative Regulator of Angiogenesis In Vitro and In Vivo via Regulation of the 14q32 angiomiRs-microRNA-329-3p and microRNA-495-3p. Int J Mol Sci 2021; 22:ijms222312678. [PMID: 34884485 PMCID: PMC8657689 DOI: 10.3390/ijms222312678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/04/2021] [Accepted: 11/20/2021] [Indexed: 12/14/2022] Open
Abstract
Inhibition of the 14q32 microRNAs, miR-329-3p and miR-495-3p, improves post-ischemic neovascularization. Cold-inducible RNA-binding protein (CIRBP) facilitates maturation of these microRNAs. We hypothesized that CIRBP deficiency improves post-ischemic angiogenesis via downregulation of 14q32 microRNA expression. We investigated these regulatory mechanisms both in vitro and in vivo. We induced hindlimb ischemia in Cirp−/− and C57Bl/6-J mice, monitored blood flow recovery with laser Doppler perfusion imaging, and assessed neovascularization via immunohistochemistry. Post-ischemic angiogenesis was enhanced in Cirp−/− mice by 34.3% with no effects on arteriogenesis. In vivo at day 7, miR-329-3p and miR-495-3p expression were downregulated in Cirp−/− mice by 40.6% and 36.2%. In HUVECs, CIRBP expression was upregulated under hypothermia, while miR-329-3p and miR-495-3p expression remained unaffected. siRNA-mediated CIRBP knockdown led to the downregulation of CIRBP-splice-variant-1 (CIRBP-SV1), CIRBP antisense long noncoding RNA (lncRNA-CIRBP-AS1), and miR-495-3p with no effects on the expression of CIRBP-SV2-4 or miR-329-3p. siRNA-mediated CIRBP knockdown improved HUVEC migration and tube formation. SiRNA-mediated lncRNA-CIRBP-AS1 knockdown had similar long-term effects. After short incubation times, however, only CIRBP knockdown affected angiogenesis, indicating that the effects of lncRNA-CIRBP-AS1 knockdown were secondary to CIRBP-SV1 downregulation. CIRBP is a negative regulator of angiogenesis in vitro and in vivo and acts, at least in part, through the regulation of miR-329-3p and miR-495-3p.
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Crea F. Thrombosis in peripheral artery disease and thrombotic thrombocytopenia after adenoviral COVID-19 vaccination. Eur Heart J 2021; 42:3995-3999. [PMID: 34649281 PMCID: PMC8524636 DOI: 10.1093/eurheartj/ehab712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Tan RP, Ryder I, Yang N, Lam YT, Santos M, Michael PL, Robinson DA, Ng MK, Wise SG. Macrophage Polarization as a Novel Therapeutic Target for Endovascular Intervention in Peripheral Artery Disease. JACC Basic Transl Sci 2021; 6:693-704. [PMID: 34466756 PMCID: PMC8385566 DOI: 10.1016/j.jacbts.2021.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022]
Abstract
Peripheral artery disease (PAD) has a significant impact on human health, affecting 200 million people globally. Advanced PAD severely diminishes quality of life, affecting mobility, and in its most severe form leads to limb amputation and death. Treatment of PAD is among the least effective of all endovascular procedures in terms of long-term efficacy. Chronic inflammation is a key driver of PAD; however, stents and coated balloons eluting antiproliferative drugs are most commonly used. As a result, neither stents nor coated balloons produce durable clinical outcomes in the superficial femoral artery, and both have recently been associated with significantly increased mortality. This review summarizes the most common clinical approaches and limitations to treating PAD and highlights the necessity to address the underlying causes of inflammation, identifying macrophages as a novel therapeutic target in the next generation of endovascular PAD intervention.
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Key Words
- BMS, bare-metal stent
- CAD, coronary artery disease
- DES, drug-eluting stent
- FP, femoropopliteal
- IL, interleukin
- MI, myocardial infarction
- PAD, peripheral artery disease
- PTA, percutaneous transluminal angioplasty
- SFA, superficial femoral artery
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- drug-eluting balloon
- drug-eluting stent
- endovascular intervention
- macrophage polarization
- paclitaxel
- peripheral arterial disease
- vascular healing
- vascular inflammation
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Affiliation(s)
- Richard P. Tan
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Address for correspondence: Dr. Richard P. Tan, Charles Perkins Centre, University of Sydney, Johns Hopkins Drive, Camperdown, Sydney, New South Wales 2006, Australia
| | - Isabelle Ryder
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nianji Yang
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Yuen Ting Lam
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Miguel Santos
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Praveesuda L. Michael
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - David A. Robinson
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Martin K. Ng
- Department of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Steven G. Wise
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- University of Sydney Nano Institute, University of Sydney, Sydney, New South Wales, Australia
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Crea F. New challenges in vascular biology and medicine: from unravelling the mechanisms of neointima formation to the prevention of amputations and of ischaemic stroke. Eur Heart J 2021; 42:1715-1719. [PMID: 33962463 DOI: 10.1093/eurheartj/ehab224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Behrendt CA. Higher long-term mortality after endovascular vs. open-surgical revascularization of peripheral artery disease in Australia and New Zealand? Eur Heart J 2021; 43:41-43. [PMID: 33742201 DOI: 10.1093/eurheartj/ehab143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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