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Sortilin/Omentin-1 ratio in Peripheral Artery Disease: a cross-sectional study on 295 unselected elderly patients. Mech Ageing Dev 2022; 205:111677. [DOI: 10.1016/j.mad.2022.111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 11/21/2022]
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Altaf N, Ariyaratne TV, Peacock A, Deltetto I, El-Hoss J, Thomas S, Taylor C, Mwipatayi BP. A Budget Impact Model for the use of Drug-Eluting Stents in Patients with Symptomatic Lower-Limb Peripheral Arterial Disease: An Australian Perspective. Cardiovasc Intervent Radiol 2021; 44:1375-1383. [PMID: 34155526 PMCID: PMC8382623 DOI: 10.1007/s00270-021-02848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/13/2021] [Indexed: 11/23/2022]
Abstract
Purpose Improvement in long-term outcomes through innovative, cost-effective medical technologies is a focus for endovascular procedures aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). The advent of drug-eluting stents (DES) has improved symptomatic PAD treatment via a reduction in high rates of target lesion revascularisation (TLR). The present study aimed to compare the 5-year financial impact of treatment with Eluvia, a new paclitaxel-eluting stent, versus treatment with Zilver PTX, a drug-coated stent, among patients in Australia by developing a budget impact model (BIM). Methods A BIM was developed from an Australian public hospital payer perspective using Australian national cost weights (AUD), published literature, and public hospital audit data. Clinical outcomes, including clinically driven TLRs (CD-TLRs), adverse events, and length of stay, were based on the 2-year results of the IMPERIAL trial, which compared Eluvia DES to Zilver PTX. Results Assuming EVP eligibility rate of 80% and DES uses rate ranging from 10 to 28% (superficial femoral artery lesions only), the 5-year model forecasted a treatment population between 14,428 and 40,399 patients. The model estimated 1499–4198 fewer CD-TLRs and 16,515–46,243 fewer hospital days with Eluvia DES use. This translated to 5-year potential savings of $4.3–$12.1 million to the Australian public hospital payer attributable to reduced CD-TLRs for Eluvia DES and $33.1–$92.6 million to Australian public hospitals owing to reduced adverse events and hospital bed days. Conclusion Eluvia DES use as treatment for symptomatic lower-limb PAD could lead to potential savings for the Australian public healthcare system based on improved patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-021-02848-8.
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Affiliation(s)
- Nishath Altaf
- Department of Vascular Surgery, Royal Perth Hospital, Royal Perth Bentley Group, Level 6, North Block, Wellington Street, Perth, WA, 6000, Australia.
| | | | | | | | - Jad El-Hoss
- Boston Scientific Corporation, Sydney, NSW, Australia
| | - Shannon Thomas
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Colman Taylor
- Health Technology Analysts, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia.,The University of NSW, Sydney, NSW, Australia
| | - Bibombe Patrice Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Royal Perth Bentley Group, Level 6, North Block, Wellington Street, Perth, WA, 6000, Australia
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Bauersachs R, Debus S, Nehler M, Huelsebeck M, Balradj J, Bowrin K, Briere JB. A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease. Angiology 2019; 71:303-314. [DOI: 10.1177/0003319719896477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with peripheral artery disease (PAD) have an increased risk of cardiovascular (CV) and limb events, but the disease is frequently underdiagnosed and treatment options are limited. This review examines the disease burden of symptomatic PAD as well as key guideline recommendations. Publications were identified using the ProQuest portal to access the Medline, Medline In-Process, and Embase databases. Search terms for symptomatic PAD were combined with terms relevant to epidemiology, burden, treatment practice, and physiopathology. Articles in English published between January 2001 and September 2016 were screened according to the population, interventions, comparator, outcomes, and study design criteria. Relevant publications (n = 200) were identified. The reported incidence and prevalence of PAD varied depending on the definitions used and the study populations. Patients generally had a poor prognosis, with an increased risk of mortality, CV, and limb events and decreased quality of life. Guideline recommendations included ankle–brachial index measurements, exercise testing, and angiography for diagnosis and risk factor modification, antiplatelets, cilostazol, exercise therapy, or surgical interventions for treatment, depending on the patient profile. The clinical, humanistic, and economic burden of disease in patients with symptomatic PAD is substantial and needs to be reduced through improved PAD management.
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Affiliation(s)
- Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmBH, Darmstadt, Germany
| | - Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery, Angiology, Endovascular Interventions, University of Hamburg-Eppendorf, Hamburg Germany
| | - Mark Nehler
- Vascular Surgery and Endovascular Therapy Faculty, University of Colorado and CPC Research, Denver, CO, USA
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A Qualitative Study Exploring Patient Concerns and Values in Chronic Limb-Threatening Ischemia. J Surg Res 2019; 243:289-300. [PMID: 31254902 DOI: 10.1016/j.jss.2019.05.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/01/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) is the debilitating end stage of peripheral artery disease, causing patients to experience low quality of life and poor health outcomes. It is unknown which aspects of care patients with CLTI value. This pilot qualitative study aims to explore patients' concerns and values related to CLTI treatment, to better inform patient-centered care. METHODS A qualitative study design was piloted to explore the experiences of patients with CLTI undergoing elective vascular surgery. In-depth, semistructured interviews were recorded preoperatively and 3 mo after discharge. Transcribed interviews were analyzed using content analysis, to derive patient-centered themes. Findings were mapped to a framework of patient-centered care. RESULTS Twelve interviews from six participants were analyzed. Five themes related to participant experiences of CLTI were identified: treatment and diagnosis, concerns about symptoms, limitations in physical function, social function, and emotional function. Participants expressed how CLTI intruded on all aspects of their lives. Framework analysis demonstrated CLTI patients valued patient-centered care relating to both relational and functional aspects of care. In particular, participants valued supportive and trustworthy care, in addition to integrated, holistic care that recognized the patient in the context of their overall health and life. CONCLUSIONS Feasibility was demonstrated for both study design and methodology. Data obtained from interviews were sufficiently "rich and thick" in quality and quantity to allow for common themes related to experience and health care values in patients with CLTI to be identified. If confirmed in future studies, these findings will enhance patient-centered care in CLTI.
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Wright MA, Steffens D, Huilgol RL. Vascular surgery trends in Australia: 2001-2015: less open surgery, less limb loss and more endovascular intervention. ANZ J Surg 2018; 89:309-313. [PMID: 30321911 DOI: 10.1111/ans.14878] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 08/04/2018] [Accepted: 08/18/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of peripheral arterial disease (PAD) in Australia is currently poorly characterized. The risk factor profile for PAD is changing with the population ageing, diabetes increasing and smoking rates declining. The management of PAD is also evolving, with advances in medical management and endovascular technique. The trends in PAD prevalence and surgical management have implications for preventative medicine, the Australian health system and vascular surgery. We report and analyse trends in PAD surgical intervention performed between 2001 and 2015. METHODS Data was extracted from the National Hospital Morbidity Database procedural item code records. Procedural numbers of endovascular lower extremity revascularization (LER); open LER; minor and major lower extremity amputations (LEA) between 2001 and 2015 in adults ≥45 years were included. Results were population-adjusted and age-stratified using census information from the Australian Bureau of Statistics to analyse changes in intervention rates. Linear regression analyses were performed to calculate the average annual change in procedures per capita (100 000). RESULTS From 2001 and 2015, per capita (100 000 population) volume of endovascular LER increased 89%, open LER decreased 70%, major LEA decreased 65% and minor LEA increased 14%. The most remarkable changes were in the ≥85-year-old cohort, with endovascular procedures per capita increasing 188%; coinciding with both open LER and major LEA decreasing by 73% between 2001 and 2015. CONCLUSIONS Australian hospital data between 2001 and 2015 shows that endovascular LER interventions and minor LEA have significantly increased per capita in Australians ≥45 years. In contrast, both open LER and major LEA rates have significantly decreased in the same cohort.
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Affiliation(s)
- Melissa Anne Wright
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia.,The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ravi Lee Huilgol
- The University of Notre Dame Australia, Sydney, New South Wales, Australia.,Department of Vascular Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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Novakovic M, Jug B, Lenasi H. Clinical impact of exercise in patients with peripheral arterial disease. Vascular 2016; 25:412-422. [PMID: 28256934 DOI: 10.1177/1708538116678752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increasing prevalence, high morbidity and mortality, and decreased health-related quality of life are hallmarks of peripheral arterial disease. About one-third of peripheral arterial disease patients have intermittent claudication with deleterious effects on everyday activities, such as walking. Exercise training improves peripheral arterial disease symptoms and is recommended as first line therapy for peripheral arterial disease. This review examines the effects of exercise training beyond improvements in walking distance, namely on vascular function, parameters of inflammation, activated hemostasis and oxidative stress, and quality of life. Exercise training not only increases walking distance and physiologic parameters in patients with peripheral arterial disease, but also improves the cardiovascular risk profile by helping patients achieve better control of hypertension, hyperglycemia, obesity and dyslipidemia, thus further reducing cardiovascular risk and the prevalence of coexistent atherosclerotic diseases. American guidelines suggest supervised exercise training, performed for a minimum of 30-45 min, at least three times per week, for at least 12 weeks. Walking is the most studied exercise modality and its efficacy in improving cardiovascular parameters in patients with peripheral arterial disease has been extensively proven. As studies have shown that supervised exercise training improves walking performance, cardiovascular parameters and quality of life in patients with peripheral arterial disease, it should be encouraged and more often prescribed.
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Affiliation(s)
- Marko Novakovic
- 1 Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- 1 Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Helena Lenasi
- 3 Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
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Serum endostatin concentrations are higher in men with symptoms of intermittent claudication. DISEASE MARKERS 2014; 2014:298239. [PMID: 24600079 PMCID: PMC3926361 DOI: 10.1155/2014/298239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 12/12/2022]
Abstract
Objectives. A cleavage fragment of collagen XVIII, endostatin, is released into the circulation and has been demonstrated to have antiangiogenic effects in animal models. We hypothesized that circulating endostatin would be increased in patients with symptoms of lower limb peripheral artery disease. Design. Cross-sectional study. Participants. Community dwelling older men.
Measurements. Intermittent claudication was defined using the Edinburgh Claudication Questionnaire (ECQ). Serum endostatin was measured by a commercial ELISA. The association of serum endostatin with intermittent claudication was examined using logistic regression adjusting for age, diabetes, hypertension, dyslipidemia, coronary heart disease, and stroke. Results. Serum endostatin was measured in 1114 men who completed the ECQ. 106 men had intermittent claudication, 291 had atypical pain, and 717 had no lower limb pain. Mean (±standard deviation) serum endostatin concentrations (ng/mL) were 145.22 ± 106.93 for men with intermittent claudication, 129.11 ± 79.80 for men with atypical pain, and 116.34 ± 66.57 for men with no lower limb pain; P < 0.001. A 70 ng/mL increase in endostatin was associated with a 1.17-fold rise in the adjusted odds of having intermittent claudication (OR 1.17, 95% confidence interval 1.00–1.37, and P = 0.050). Conclusions. Serum endostatin is raised in older men who have symptoms of intermittent claudication. The role of endostatin in the genesis and outcome of peripheral artery disease requires further investigation.
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