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Krippl P, Gasser R, Wascher T, Paulweber B, Pilger E, Renner W, Köppel H. Hemochromatosis gene (HFE) polymorphisms are not associated with peripheral arterial disease. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Renner W, Tischler R, Pilger E, Schnedl W, Roller R. Vascular Endothelial Growth Factor in Plasma of Patients Undergoing Peripheral Angioplasty. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Brodmann M, Winkler M, Wascher T, Pilger E, Renner W. The PlA1/A2 Polymorphism of Platelet Glycoprotein IIIa Is not Associated with Peripheral Arterial Disease. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Renner W, Dorr A, Pilger E, Schnedl W, Roller R. Oxidative Stress and Increase of Vascular Endothelial Growth Factor in Plasma of Patients with Peripheral Arterial Occlusive Disease. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615706] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ramschak H, Schreiber F, Stark G, Pabst E, Pilger E, Brodmann M. Venous Thrombosis after Extracorporeal Shock-wave Lithotripsy in a Patient with Heterozygous APC-Resistance. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Köppel H, Brodmann M, Pabst E, Schallmoser K, Toplak H, Wascher T, Pilger E, Renner W. Factor II G20210A and Factor V G1691A Gene Mutations and Peripheral Arterial Occlusive Disease. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613750] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryG to A mutations at positions 20210 of the prothrombin gene (F2) and 1691 of the factor V gene (F5) are established risk factors for venous thrombosis. Several factors associated with coagulation and/or fibrinolysis have been associated with arterial occlusive disease, but the role of F2 20210A and F5 1691A for arterial occlusive disease remains unclear.To investigate if F2 20210A and F5 1691A are associated with peripheral arterial occlusive disease (PAOD).We analyzed the prevalence of F2 20210A and F5 1691A alleles in 336 patients with documented PAOD at Fontaine stage II – IV and 300 controls without vascular disease. Allele frequencies in patients and controls were 0.013 and 0.022 for F2 20210A, and 0.042 and 0.045 for F5 1691, respectively, both differences being not statistically significant.Our data suggest that mutations F2 G20210A and F5 G1691A are not associated with PAOD.
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Köppel H, Renner W, Gugl A, Cichocki L, Gasser R, Wascher TC, Pilger E. The angiotensin-converting-enzyme insertion/deletion polymorphism is not related to venous thrombosis. Thromb Haemost 2017; 91:76-9. [PMID: 14691571 DOI: 10.1160/th03-05-0266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryThe insertion/deletion (I/D) polymorphism of the gene for angiotensin-converting-enzyme (ACE) is associated with ACE plasma levels and activity. Conflicting results have been reported about the relevance of this polymorphism for venous thrombosis. The aim of the present study was to analyze the role of this polymorphism for deep venous thrombosis. The study was designed as a case-control study, including 330 patients with documented deep venous thrombosis and 354 controls. ACE genotype was determined by size-analysis of polymerase chain reaction products. Results showed that, ACE genotype frequencies were similar between patients (II: 24.8%; ID: 43.3%; DD: 31.8%) and controls (II: 22.9%; ID: 50.6%; DD: 26.6%, P = 0.15).The adjusted odds ratio of carriers of the DD genotype for venous thrombosis was 1.24 (95% confidence interval 0.90–1.80).The polymorphism was furthermore not associated with age at first thromboembolic event or the occurrence of pulmonary embolism. From these results, we can conclude that the ACE I/D polymorphism is not a significant risk factor for deep venous thrombosis.
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Affiliation(s)
- Herwig Köppel
- Division of Angiology, Department of Medicine, Karl-Franzens University, Graz, Austria.
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Hackl G, Prenner A, Jud P, Hafner F, Rief P, Seinost G, Pilger E, Brodmann M. Auricular vagal nerve stimulation in peripheral arterial disease patients. VASA 2017; 46:462-470. [DOI: 10.1024/0301-1526/a000660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Auricular nerve stimulation has been proven effective in different diseases. We investigated if a conservative therapeutic alternative for claudication in peripheral arterial occlusive disease (PAD) via electroacupuncture of the outer ear can be established. Patients and methods: In this prospective, double-blinded trial an ear acupuncture using an electroacupuncture device was carried out in 40 PAD patients in Fontaine stage IIb. Twenty patients were randomized to the verum group using a fully functional electroacupuncture device, the other 20 patients received a sham device (control group). Per patient, eight cycles (1 cycle = 1 week) of electroacupuncture were performed. The primary endpoint was defined as a significantly more frequent doubling of the absolute walking distance after eight cycles in the verum group compared to controls in a standardized treadmill testing. Secondary endpoints were a significant improvement of the total score of the Walking Impairment Questionnaire (WIQ) as well as improvements in health related quality of life using the Short Form 36 Health Survey (SF-36). Results: There were no differences in baseline characteristics between the two groups. The initial walking distance significantly increased in both groups (verum group [means]: 182 [95 % CI 128–236] meters to 345 [95 % CI 227–463] meters [+ 90 %], p < 0.01; control group [means]: 159 [95 % CI 109–210] meters to 268 [95 % CI 182–366] meters [+ 69 %], p = 0.01). Twelve patients (60 %) in the verum group and five patients (25 %) in controls reached the primary endpoint of doubling walking distance (p = 0.05). The total score of WIQ significantly improved in the verum group (+ 22 %, p = 0.01) but not in controls (+ 8 %, p = 0.56). SF-36 showed significantly improvements in six out of eight categories in the verum group and only in one of eight in controls. Conclusions: Electroacupuncture of the outer ear seems to be an easy-to-use therapeutic option in an age of increasingly invasive and mechanically complex treatments for PAD patients.
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Affiliation(s)
- Gerald Hackl
- Division of Angiology, Medical University of Graz, Graz, Austria
| | - Andreas Prenner
- Division of Angiology, Medical University of Graz, Graz, Austria
| | - Philipp Jud
- Division of Angiology, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Medical University of Graz, Graz, Austria
| | - Gerald Seinost
- Division of Angiology, Medical University of Graz, Graz, Austria
| | - Ernst Pilger
- Division of Angiology, Medical University of Graz, Graz, Austria
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Rello J, Krenn CG, Locker G, Pilger E, Madl C, Balica L, Dugernier T, Laterre PF, Spapen H, Depuydt P, Vincent JL, Bogár L, Szabó Z, Völgyes B, Máñez R, Cakar N, Ramazanoglu A, Topeli A, Mastruzzo MA, Jasovich A, Remolif CG, Del Carmen Soria L, Andresen Hernandez MA, Ruiz Balart C, Krémer I, Molnár Z, von Sonnenburg F, Lyons A, Joannidis M, Burgmann H, Welte T, Klingler A, Hochreiter R, Westritschnig K. A randomized placebo-controlled phase II study of a Pseudomonas vaccine in ventilated ICU patients. Crit Care 2017; 21:22. [PMID: 28159015 PMCID: PMC5291979 DOI: 10.1186/s13054-017-1601-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022]
Abstract
Background Currently, no vaccine against Pseudomonas is available. IC43 is a new, recombinant, protein (OprF/I)-based vaccine against the opportunistic pathogen, Pseudomonas aeruginosa, a major cause of serious hospital-acquired infections. IC43 has proven immunogenicity and tolerability in healthy volunteers, patients with burns, and patients with chronic lung diseases. In order to assess the immunogenicity and safety of IC43 in patients who are most at risk of acquiring Pseudomonas infections, it was evaluated in mechanically ventilated ICU patients. Methods We conducted a randomized, placebo-controlled, partially blinded study in mechanically ventilated ICU patients. The immunogenicity of IC43 at day 14 was determined as the primary endpoint, and safety, efficacy against P. aeruginosa infections, and all-cause mortality were evaluated as secondary endpoints. Vaccinations (100 μg or 200 μg IC43 with adjuvant, or 100 μg IC43 without adjuvant, or placebo) were given twice in a 7-day interval and patients were followed up for 90 days. Results Higher OprF/I IgG antibody titers were seen at day 14 for all IC43 groups versus placebo (P < 0.0001). Seroconversion (≥4-fold increase in OprF/I IgG titer from days 0 to 14) was highest with 100 μg IC43 without adjuvant (80.6%). There were no significant differences in P. aeruginosa infection rates, with a low rate of invasive infections (pneumonia or bacteremia) in the IC43 groups (11.2-14.0%). Serious adverse events (SAEs) considered possibly related to therapy were reported by 2 patients (1.9%) in the group of 100 µg IC43 with adjuvant. Both SAEs resolved and no deaths were related to study treatment. Local tolerability symptoms were mild and rare (<5% of patients), a low rate of treatment-related treatment-emergent adverse events (3.1–10.6%) was observed in the IC43 groups. Conclusion This phase II study has shown that IC43 vaccination of ventilated ICU patients produced a significant immunogenic effect. P. aeruginosa infection rates did not differ significantly between groups. In the absence of any difference in immune response following administration of 100 μg IC43 without adjuvant compared with 200 μg IC43 with adjuvant, the 100 μg dose without adjuvant was considered for further testing of its possible benefit of improved outcomes. There were no safety or mortality concerns. Trial registration ClinicalTrials.gov, NCT00876252. Registered on 3 April 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1601-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jordi Rello
- Hospital Universitari Joan XXIII, C. Dr. Mallafrè Guasch 4, 43007, Tarragona, Spain. .,CIBERES, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain. .,Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Claus-Georg Krenn
- Medical University of Vienna, Intensive Care 13C1, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Gottfried Locker
- Department of Internal Medicine I, Medical University of Vienna, Intensive Care 13I2, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Ernst Pilger
- Intensive Care, Department of Internal Medicine, University Hospital Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Christian Madl
- Department of Internal Medicine III, Intensive Care 13H1, Medical University of Vienna, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Laura Balica
- Emergency Clinical Hospital Bucharest, Toxicology - ICU, 8 Floreasca Street, 01446, Bucharest, Romania
| | - Thierry Dugernier
- Clinique St. Pierre, Intensive Care Department, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium
| | - Pierre-Francois Laterre
- Department of CCM, St. Luc University Hospital UCL, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Herbert Spapen
- University Hospital Vrije Universiteit Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | - Jean-Louis Vincent
- Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Lajos Bogár
- University of Pécs Anesthesiology and Intensive Care Department, Ifjúság ut 13, 7624, Pécs, Hungary
| | | | - Barbara Völgyes
- Bajcsy Zsilinszky Hospital and Polyclinic, Intensive Care Unit, Maglodi út 89-91, 1106, Budapest, Hungary
| | - Rafael Máñez
- Department for Critical Care Medicine, Bellvitge University Hospital, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nahit Cakar
- Department of Anesthesiology and Reanimation, Istanbul University Capa Medical Faculty, 34390, Istanbul, Turkey
| | - Atilla Ramazanoglu
- Department of Anesthesiology, Dumlupinar Bulvari Kampus Antalya, Akdeniz University, Faculty of Medicine Hospital, 07070, Antalya, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Intensive Care Unit, Hacettepe University Hospital, 06100, Ankara, Turkey
| | - Maria A Mastruzzo
- Hospital Dr. Carlos Bocalandro, Ruta 8 No. 9100, B1657BHD Loma Hermosa, Partido 3 de Febrero, Buenos Aires, Argentina
| | - Abel Jasovich
- Sanatorio Güemes, Av. Roque Sanchez Pena 811 5°C, C1035AAP, Buenos Aires, Argentina
| | - Christian G Remolif
- Hospital "Heroes de Malvinas", Av. Ricardo Balbín 1910, B1721FJN Merlo, Buenos Aires, Argentina
| | | | - Max A Andresen Hernandez
- Hospital Clinico, Facultad de Medicina Pontificia, Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Carolina Ruiz Balart
- Hospital Dr. Sótero del Rio, Unidad de Cuidado Intensivo, Departamento de Medicina Intensiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, Santiago, Chile
| | - Ildikó Krémer
- Flor Ferenc County Hospital, Semmelweis tér 1, 2143, Kistarcsa, Hungary
| | - Zsolt Molnár
- Department of Anaesthesia and Intensive Care, University of Szeged, Semmelweis u. 6, 6720, Szeged, Hungary
| | - Frank von Sonnenburg
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Georgenstr. 5, 80799, Munich, Germany
| | - Arthur Lyons
- Clinical Research Department, Division of Virus Diseases, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Michael Joannidis
- Department of Internal Medicine, Division of Intensive Care and Emergency Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases, Medical University of Vienna, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Stadlweg 23, 6020, Innsbruck, Austria
| | - Romana Hochreiter
- Valneva Austria GmbH, Campus Vienna Biocenter 3, 1030, Vienna, Austria
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Toplak H, Ludvik B, Lechleitner M, Dieplinger H, Föger B, Paulweber B, Weber T, Watschinger B, Horn S, Wascher TC, Drexel H, Brodmann M, Pilger E, Rosenkranz A, Pohanka E, Oberbauer R, Traindl O, Roithinger FX, Metzler B, Haring HP, Kiechl S. Austrian Lipid Consensus on the management of metabolic lipid disorders to prevent vascular complications: A joint position statement issued by eight medical societies. 2016 update. Wien Klin Wochenschr 2017; 128 Suppl 2:S216-28. [PMID: 27052248 PMCID: PMC4839054 DOI: 10.1007/s00508-016-0993-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 01/09/2023]
Abstract
In 2010, eight Austrian medical societies proposed a joint position statement on the management of metabolic lipid disorders for the prevention of vascular complications. An updated and extended version of these recommendations according to the current literature is presented, referring to the primary and secondary prevention of vascular complications in adults, taking into consideration the guidelines of other societies. The "Austrian Lipid Consensus - 2016 update" provides guidance for individualized risk stratification and respective therapeutic targets, and discusses the evidence for reducing vascular endpoints with available lipid-lowering therapies. Furthermore, specific management in key patient groups is outlined, including subjects presenting with coronary, cerebrovascular, and/or peripheral atherosclerosis; diabetes mellitus and/or metabolic syndrome; nephropathy; and familial hypercholesterolemia.
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Affiliation(s)
- Hermann Toplak
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Bernhard Ludvik
- First Medical Department, Rudolfstiftung Hospital, Vienna, Austria
| | | | - Hans Dieplinger
- Department of Medical Genetics, Clinical and Molecular Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Föger
- Department of Internal Medicine, Bregenz Hospital, Bregenz, Austria
| | - Bernhard Paulweber
- First Medical Department, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Weber
- Department of Cardiology, Wels Hospital, Wels, Austria
| | - Bruno Watschinger
- Third Medical Department, Medical University of Vienna, Vienna, Austria
| | - Sabine Horn
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | | | - Heinz Drexel
- Department of Internal Medicine and Cardiology, Feldkirch Hospital, Feldkirch, Austria
| | - Marianne Brodmann
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Ernst Pilger
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Alexander Rosenkranz
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Erich Pohanka
- Medical Department, Linz General Hospital, Linz, Austria
| | | | - Otto Traindl
- First Medical Department, Mistelbach Hospital, Mistelbach, Austria
| | | | - Bernhard Metzler
- Third Medical Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Hans-Peter Haring
- First Department of Neurology, Kepler University Clinic, Linz, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Affiliation(s)
- M Brodmann
- Division of Angiology, Department of Internal Medicine, University Hospital Graz, Austria.
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Abstract
In 91 patients suffering from peripheral arterial occlusive disease (Fontaine stage IIb—IV) 125 percutaneous transluminal angioplasties (PTA) of crural arteries were performed. Eighty-six of the dilatations were done in combination with a recanalization procedure (PTA, laser angioplasty, fibrinolysis) of a femoropopliteal obstruction in order to improve outflow. PTA was performed with 5 F balloon catheters 2.5 to 4 mm in diameter in combination with steerable guide wires. A primary technical success was achieved in 41 of 42 (97.6%) vessels with a single stenosis, in 64 of 68 (94.1%) vessels with 2 or more stenoses, and 9 of 15 (60%) vessels with total occlusions (overall primary success rate 91.2%). Complications included spasm (n = 3), thrombosis (n = 2), peripheral embolization (n = 2), and dissection (n = 1). None of the complications required surgical intervention. After PTA, accumulative patency rate of 71% at 2 years and 64.2% at 3 years was achieved. These results demonstrated that PTA of crural arteries is a safe procedure with an excellent primary success rate and satisfying long-term results. Thus we believe that even arterial occlusive disease in the clinical stage Fontaine IIb should be accepted as an indication for crural PTA. Furthermore, crural PTA should be used to improve reduced peripheral outflow after femoropopliteal PTA.
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Hausegger KA, Lammer J, Hagen B, Flückiger F, Lafer M, Klein GE, Pilger E. Iliac Artery Stenting — Clinical Experience with the Palmaz Stent, Wallstent, and Strecker Stent. Acta Radiol 2016. [DOI: 10.1177/028418519203300402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A total of 82 iliac artery lesions (62 stenoses and 20 occlusions) were treated with 3 different types of endovascular metallic stents (12 lesions with the Palmaz stent, 36 with the Wallstent, and 34 with the Strecker stent). The complication rate was 12%. Occlusion of 2 Wallstents occurred 4 and 12 weeks after stent placement, respectively. Both stents were recanalized by local fibrinolysis. One Strecker stent occluded after 8 months. The observation period was 3 to 26 months (mean 9.7 months). The patency rate with secondary intervention (fibrinolysis) was 100% after 3 and 6 months, and 98% after 9 months. All 3 stent designs turned out to be effective in the treatment of complicated iliac artery occlusive disease.
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Zeller T, Beschorner U, Pilger E, Bosiers M, Deloose K, Peeters P, Scheinert D, Schulte KL, Rastan A, Brodmann M. Paclitaxel-Coated Balloon in Infrapopliteal Arteries: 12-Month Results From the BIOLUX P-II Randomized Trial (BIOTRONIK'S-First in Man study of the Passeo-18 LUX drug releasing PTA Balloon Catheter vs. the uncoated Passeo-18 PTA balloon catheter in subjects requiring revascularization of infrapopliteal arteries). JACC Cardiovasc Interv 2016; 8:1614-22. [PMID: 26493253 DOI: 10.1016/j.jcin.2015.07.011] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [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: 04/15/2015] [Revised: 06/23/2015] [Accepted: 07/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of BIOLUX P-II (BIOTRONIK'S-First in Man study of the Passeo-18 LUX drug releasing PTA Balloon Catheter vs. the uncoated Passeo-18 PTA balloon catheter in subjects requiring revascularization of infrapopliteal arteries) trial was to compare the safety and efficacy of a novel paclitaxel-coated drug-eluting balloon (DEB) versus an uncoated balloon (percutaneous transluminal angioplasty [PTA]) in de novo or native restenotic lesions of the infrapopliteal arteries in patients with claudication and critical limb ischemia. BACKGROUND DEB have shown promising results in femoropopliteal lesions, but data for infrapopliteal lesions are scarce. METHODS In this prospective, multicenter, randomized first-in-man study, 72 patients were randomized 1:1 to either a Passeo-18 Lux DEB (Biotronik AG, Buelach, Switzerland) (n = 36) or Passeo-18 PTA (n = 36). Follow-up assessments were scheduled at 1, 6, and 12 months, with angiographic assessment at 6 months. Adverse events were adjudicated by an independent clinical events committee, and angiographic parameters were assessed by an independent core laboratory. RESULTS The primary safety endpoint (a composite of all-cause mortality, target extremity major amputation, target lesion thrombosis, and target vessel revascularization at 30 days) was 0% in the DEB group versus 8.3% in the PTA group (p = 0.239). The primary performance endpoint (patency loss at 6 months) was 17.1% in the DEB group versus 26.1% in the PTA group (p = 0.298), and major amputations of the target extremity occurred in 3.3% versus 5.6% of the patients at 12 months, respectively. CONCLUSIONS The Passeo-18 Lux DEB has been proven to be safe and effective in infrapopliteal lesions with comparable outcomes to PTA.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany.
| | | | - Ernst Pilger
- Department of Angiology, Medical University Graz, Graz, Austria
| | - Marc Bosiers
- Department of Vascular Surgery, A.Z. Sint-Blasius, Dendermonde, Belgium
| | - Koen Deloose
- Department of Vascular Surgery, A.Z. Sint-Blasius, Dendermonde, Belgium
| | - Patrick Peeters
- Department of Cardiovascular & Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Dierk Scheinert
- Department of Angiology, Park-Krankenhaus Leipzig, Leipzig, Germany
| | - Karl-Ludwig Schulte
- Vascular Center Berlin, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Aljoscha Rastan
- Department of Angiology, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Schulte KL, Pilger E, Schellong S, Tan KT, Baumann F, Langhoff R, Torsello G, Zeller T, Amendt K, Brodmann M. Primary Self-EXPANDing Nitinol Stenting vs Balloon Angioplasty With Optional Bailout Stenting for the Treatment of Infrapopliteal Artery Disease in Patients With Severe Intermittent Claudication or Critical Limb Ischemia (EXPAND Study). J Endovasc Ther 2015; 22:690-7. [DOI: 10.1177/1526602815598955] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare primary placement of a self-expanding nitinol stent to percutaneous transluminal angioplasty (PTA) with bailout stenting in infrapopliteal arteries of patients with severe intermittent claudication or critical limb ischemia (CLI). Methods: In the EXPAND trial ( ClinicalTrials.gov; identifier NCT00906022), 92 patients (mean age 72.9±9.5 years; 62 men) undergoing treatment for infrapopliteal stenosis in 11 European centers were randomized 1:1 to either self-expanding nitinol stenting with the Astron Pulsar/Pulsar-18 nitinol stent or PTA with bailout stenting. The primary endpoint was sustainable clinical improvement after 12 months, defined as a ≥1-category increase for Rutherford category 3 patients or a ≥2-category increase for CLI patients (Rutherford categories 4/5) compared with baseline. Furthermore, target lesion revascularization (TLR), mortality, and amputation were assessed after 12 months. Results: Sustained clinical improvement at 1 year was observed in 74.3% of the patients treated with primary stenting and in 68.6% of the patients treated with PTA and bailout stenting (p>0.05). Kaplan-Meier estimates of freedom from TLR (76.6% and 77.6%), mortality (7.4% vs 2.1%), and amputation [8.9% (major 6.7%) vs 13.2% (major 8.7%)] at 1 year were not significantly different. Conclusion: Primary self-expanding nitinol stenting did not show statistically different clinical outcomes compared to angioplasty with bailout stenting for infrapopliteal lesions.
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Affiliation(s)
| | - Ernst Pilger
- Department of Angiology, Medical University Graz, Austria
| | | | - Kong Ten Tan
- Department of Medical Imaging, UHN Toronto General Hospital, Toronto, Ontario, Canada
| | - Frederic Baumann
- Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - Ralf Langhoff
- Department of Angiology, St. Gertrauden Krankenhaus, Berlin, Germany
| | - Giovanni Torsello
- Department of Vascular and Endovascular Surgery, University of Münster, Germany
| | - Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany
| | - Klaus Amendt
- Internal Medicine, Diakonissenkrankenhaus Mannheim, Germany
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16
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Rosenfield K, Jaff MR, White CJ, Rocha-Singh K, Mena-Hurtado C, Metzger DC, Brodmann M, Pilger E, Zeller T, Krishnan P, Gammon R, Müller-Hülsbeck S, Nehler MR, Benenati JF, Scheinert D. Trial of a Paclitaxel-Coated Balloon for Femoropopliteal Artery Disease. N Engl J Med 2015; 373:145-53. [PMID: 26106946 DOI: 10.1056/nejmoa1406235] [Citation(s) in RCA: 481] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment of peripheral artery disease with percutaneous transluminal angioplasty is limited by the occurrence of vessel recoil and restenosis. Drug-coated angioplasty balloons deliver antiproliferative agents directly to the artery, potentially improving vessel patency by reducing restenosis. METHODS In this single-blind, randomized trial conducted at 54 sites, we assigned, in a 2:1 ratio, 476 patients with symptomatic intermittent claudication or ischemic pain while at rest and angiographically significant atherosclerotic lesions to angioplasty with a paclitaxel-coated balloon or to standard angioplasty. The primary efficacy end point was primary patency of the target lesion at 12 months (defined as freedom from binary restenosis or from the need for target-lesion revascularization). The primary safety end point was a composite of freedom from perioperative death from any cause and freedom at 12 months from limb-related death (i.e., death from a medical complication related to a limb), amputation, and reintervention. RESULTS The two groups were well matched at baseline; 42.9% of the patients had diabetes, and 34.7% were current smokers. At 12 months, the rate of primary patency among patients who had undergone angioplasty with the drug-coated balloon was superior to that among patients who had undergone conventional angioplasty (65.2% vs. 52.6%, P=0.02). The proportion of patients free from primary safety events was 83.9% with the drug-coated balloon and 79.0% with standard angioplasty (P=0.005 for noninferiority). There were no significant between-group differences in functional outcomes or in the rates of death, amputation, thrombosis, or reintervention. CONCLUSIONS Among patients with symptomatic femoropopliteal peripheral artery disease, percutaneous transluminal angioplasty with a paclitaxel-coated balloon resulted in a rate of primary patency at 12 months that was higher than the rate with angioplasty with a standard balloon. The drug-coated balloon was noninferior to the standard balloon with respect to safety. (Funded by Lutonix-Bard; LEVANT 2 ClinicalTrials.gov number, NCT01412541.).
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Affiliation(s)
- Kenneth Rosenfield
- From Massachusetts General Hospital, Boston (K.R., M.R.J.); Ochsner Medical Center, New Orleans (C.J.W.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.); Yale School of Medicine, New Haven, CT (C.M.-H.); Wellmont Cardiovascular Associates Heart Institute, Kingsport, TN (D.C.M.); Medical University of Graz, Graz, Austria (M.B., E.P.); University Heart Center Freiburg-Bad Krozingen, Bad Krozingen (T.Z.), Diakonissenanstalt zu Flensburg, Flensburg (S.M.-H.), and Park-Krankenhaus Leipzig and Universitätsklinikum Leipzig, Leipzig (D.S.) - all in Germany; Mount Sinai Medical Center, New York (P.K.); Austin Heart, Austin, TX (R.G.); University of Colorado Medical Center, Denver (M.R.N.); and Baptist Cardiac and Vascular Institute, Miami (J.F.B.)
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17
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Rastan A, Krankenberg H, Baumgartner I, Blessing E, Müller-Hülsbeck S, Pilger E, Scheinert D, Lammer J, Beschorner U, Noory E, Neumann FJ, Zeller T. Stent Placement vs. Balloon Angioplasty for Popliteal Artery Treatment. J Endovasc Ther 2015; 22:22-7. [DOI: 10.1177/1526602814564386] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the 2-year technical and clinical results of primary nitinol stent placement in comparison with percutaneous transluminal angioplasty (PTA) in the treatment of de novo lesions of the popliteal artery. Methods: The ETAP study (Endovascular Treatment of Atherosclerotic Popliteal Artery Lesions: balloon angioplasty vs. primary stenting; www.ClinicalTrials.gov identifier NCT00712309) is a prospective, randomized trial that enrolled 246 patients (158 men; mean age 72 years) who were randomly assigned to receive a nitinol stent (n=119) or PTA (n=127) for lesions averaging 42.3 mm in length. The results of the primary study endpoint were published. Secondary outcome measures and endpoints included primary patency (freedom from duplex-detected target lesion restenosis), target lesion revascularization (TLR), secondary patency, changes in ankle-brachial index and Rutherford class, and event-free survival (freedom from target limb amputation, TLR, myocardial infarction, and death). Results: In total, 183 patients (89 stent and 94 PTA) were available for the 2-year analysis. The primary patency rate was significantly higher in the stent group (64.2%) than in the PTA group (31.3%, p=0.0001). TLR rates were 22.4% and 59.5%, respectively (p=0.0001). When provisional stent placement in the PTA arm was not considered as TLR and loss in patency, the differences prevailed between the study groups but were not significant (64.2% vs. 56.1% for primary patency, respectively; p=0.44). A significant improvement in ABI and Rutherford category was observed at 2 years in both groups. Conclusion: In treatment of obstructive popliteal artery lesions, provisional stenting reveals equivalent patency in comparison to primary stenting. However, the 2-year results of this trial suggest the possibility of a shift toward higher patency rates in favor of primary stenting.
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Affiliation(s)
- Aljoscha Rastan
- Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | | | | | - Erwin Blessing
- SRH Klinikum Karlsbad Langensteinbach, Karlsbad, Germany
| | | | - Ernst Pilger
- Universitätsklinik für Innere Medizin, Graz, Austria
| | | | | | - Ulrich Beschorner
- Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | - Elias Noory
- Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | | | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
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18
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Scheinert D, Brodmann M, Zeller T, Bosiers M, Peeters P, Karl-Ludwig S, Beschorner U, Pilger E. TCT-271 BIOLUX P-II: A Randomized Clinical Trial of Passeo-18 Lux Drug Releasing Balloon versus Plain Old Balloon Angioplasty for the Treatment of Infrapopliteal Artery Lesions. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Brodmann M, Gary T, Hafner F, Eller P, Deutschmann H, Pilger E, Seinost G. Acute wiiitis representing as thrombosis of the inferior vena cava and left pelvic veins. Phlebology 2014; 30:486-8. [DOI: 10.1177/0268355514530278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deep venous thrombosis as a result of venous wall injury provoked by trauma is a common finding. It often occurs in patients with sportive overstraining, caused by over fatigue of the body structures. In 2007, the entity of “acute wiiitis” was first described in a letter to the New England Journal of Medicine. Acute wiiitis sums up all affections, mainly skeletal and muscle affections, provoked by playing Nintendo Wii, a very common and loved video-game system. Deep venous thrombosis as a consequence of Nintendo Wii has not been described so far. We present a patient with a massive free floating thrombus of the left pelvic veins originating from the gluteal veins and reaching into the inferior vena cava after playing Nintendo Wii.
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Affiliation(s)
- M Brodmann
- Division of Angiology, Medical University Graz, Graz, Austria
| | - T Gary
- Division of Angiology, Medical University Graz, Graz, Austria
| | - F Hafner
- Division of Angiology, Medical University Graz, Graz, Austria
| | - P Eller
- Division of Angiology, Medical University Graz, Graz, Austria
| | - H Deutschmann
- Division of Vascular and Interventional Radiology, Medical University Graz, Graz, Austria
| | - E Pilger
- Division of Angiology, Medical University Graz, Graz, Austria
| | - G Seinost
- Division of Angiology, Medical University Graz, Graz, Austria
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20
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Brodmann M, Dorr A, Hafner F, Gary T, Froehlich H, Pilger E, Deutschmann H. Lumbar artery aneurysms as a rare cause of life threatening retroperitoneal bleeding. VASA 2013; 42:449-52. [DOI: 10.1024/0301-1526/a000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Andreas Dorr
- Division of Angiology, Medical University Graz, Austria
| | - Franz Hafner
- Division of Angiology, Medical University Graz, Austria
| | - Thomas Gary
- Division of Angiology, Medical University Graz, Austria
| | | | - Ernst Pilger
- Division of Angiology, Medical University Graz, Austria
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21
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Gary T, Belaj K, Eller P, Hackl G, Rief P, Hafner F, Froehlich H, Pilger E, Brodmann M. CHA2DS2-VASc Score and risk for reobstruction after endovascular treatment of the superficial femoral artery: differences between balloon angioplasty and stenting. Int J Cardiol 2013; 168:3088-90. [PMID: 23632114 DOI: 10.1016/j.ijcard.2013.04.081] [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: 03/26/2013] [Accepted: 04/06/2013] [Indexed: 11/17/2022]
Affiliation(s)
- T Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University Graz, Austria.
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22
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Gary T, Belaj K, Bruckenberger R, Hackl G, Hafner F, Froehlich H, Zebisch A, Pilger E, Brodmann M. Primary antiphospholipid antibody syndrome-one further aspect of thrombophilia in overweight and obese patients with venous thromboembolism. Obesity (Silver Spring) 2013; 21:E463-6. [PMID: 23671009 DOI: 10.1002/oby.20188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 11/12/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Overweight and obesity are established risk factors for venous thromboembolism (VTE). We examined the difference in the frequency of primary antiphospholipid antibody syndrome (PAPS) in VTE patients according to their BMI. DESIGN AND METHODS We included 998 VTE patients treated at our institution between 2009 and 2011 in a retrospective data analysis. Thrombophilia screening including evaluation for APS (lupus anticoagulant, anti-cardiolipin, and anti-B2-glycoprotein-I IgG and IgM antibodies) was performed in all patients. RESULTS PAPS was diagnosed in 6.8% (24/355) of normal weight (BMI < 24 kg/m2) VTE patients, in 11.1% (50/452) of overweight (BMI 25-30 kg/m2) VTE patients, and in 15.7% (30/191) of obese (BMI > 31 kg/m2) VTE patients. The difference of PAPS occurrence between these groups was statistically significant (P = 0.001). PAPS patients demonstrated higher fibrinogen levels as compared to non-PAPS patients (median 416.0 md/dl vs. 352.0 mg/dl, P = 0.001). Furthermore, fibrinogen levels increased significantly according to the body weight of patients (median normal weight patients 330.0 mg/dl vs. overweight patients 359.0 mg/dl vs. obese patients 415.0 mg/dl, P = 0.001). CONCLUSION PAPS seems to be more frequent in overweight and obese patients. As PAPS patients showed significantly higher fibrinogen levels and as fibrinogen levels increased significantly according to the body weight of patients, an elevated inflammatory state in overweight and obese patients as a reason for the increased PAPS occurrence can be assumed.
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Affiliation(s)
- Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
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23
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Eller P, Kirsch A, Smaczny N, Sedej S, Hofmeister A, Stojakovic T, Brodmann M, Pilger E, Rosenkranz A, Eller K. Regulatory T-cells modulate ectopic calcification in nephrocalcinosis and dystrophic cardiac calcinosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, Eller P, Rief P, Hackl G, Pilger E, Brodmann M. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One 2013; 8:e67688. [PMID: 23844064 PMCID: PMC3699634 DOI: 10.1371/journal.pone.0067688] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 05/19/2013] [Indexed: 12/02/2022] Open
Abstract
Background Platelet-to-Lymphocyte Ratio (PLR) is an easily applicable blood test. An elevated PLR has been associated with poor prognosis in patients with different oncologic disorder. As platelets play a key role in atherosclerosis and atherothrombosis, we investigated PLR and its association with critical limb ischemia (CLI) and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients. Methods and Findings We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. PLR was calculated and the cohort was categorized into tertiles according to the PLR. An optimal cut-off value for the continuous PLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI significantly increased with an increase in PLR. As an optimal cut-off value, a PLR of 150 was identified. Two groups were categorized, one containing 1228 patients (PLR≤150) and a second group with 893 patients (PLR>150). CLI was more frequent in PLR>150 patients (410(45.9%)) compared to PLR≤150 patients (270(22.0%)) (p<0.001), as was prior myocardial infarction (51(5.7%) vs. 42(3.5%), p = 0.02). Regarding inflammatory parameters, C-reactive protein (median 7.0 mg/l (3.0–24.25) vs. median 5.0 mg/l (2.0–10.0)) and fibrinogen (median 457 mg/dl (359.0–583.0) vs. 372 mg/dl (317.25–455.75)) also significantly differed in the two patient groups (both p<0.001). Finally, a PLR>150 was associated with an OR of 1.9 (95%CI 1.7–2.1) for CLI even after adjustment for other well-established vascular risk factors. Conclusions An increased PLR is significantly associated with patients at high risk for CLI and other cardiovascular endpoints. The PLR is a broadly available and cheap marker, which could be used to highlight patients at high risk for vascular endpoints.
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Affiliation(s)
- Thomas Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria.
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25
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Rastan A, Krankenberg H, Baumgartner I, Blessing E, Müller-Hülsbeck S, Pilger E, Scheinert D, Lammer J, Gißler M, Noory E, Neumann FJ, Zeller T. Stent Placement Versus Balloon Angioplasty for the Treatment of Obstructive Lesions of the Popliteal Artery. Circulation 2013; 127:2535-41. [DOI: 10.1161/circulationaha.113.001849] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background—
Stenting has been shown to improve patency after femoral artery revascularization compared with balloon angioplasty. Limited data are available evaluating endovascular treatment for obstructive lesions of the popliteal artery.
Methods and Results—
This prospective, randomized, multicenter trial compared primary nitinol stent placement to percutaneous transluminal balloon angioplasty in patients with peripheral artery disease Rutherford-Becker class 2 to 5 who had a de novo lesion in the popliteal artery. The primary study end point was 1-year primary patency, defined as freedom from target-lesion restenosis (luminal narrowing of ≥50%) as detected by duplex ultrasound. Secondary end points included target-lesion revascularization rate and changes in Rutherford-Becker class. Provisional stent placement was considered target-lesion revascularization and loss of primary patency. Two hundred forty-six patients were included in this trial. The mean target-lesion length was 42.3 mm. One hundred ninety-seven patients were available for the1-year follow-up. The 1-year primary patency rate was significantly higher in the group with primary nitinol stent placement (67.4%) than in the percutaneous transluminal balloon angioplasty group (44.9%,
P
=0.002). Target-lesion revascularization rates were 14.7% and 44.1%, respectively (
P
=0.0001); however, when provisional nitinol stent placement was not considered target-lesion revascularization and loss in patency, no significant differences prevailed between the study groups (67.4% versus 65.7%,
P
=0.92 for primary patency). Approximately 73% of patients in the percutaneous transluminal balloon angioplasty group and 77% in the nitinol stent group showed an improvement of ≥1 Rutherford-Becker class (
P
=0.31).
Conclusions—
Primary nitinol stent placement for obstructive lesions of the popliteal artery achieves superior acute technical success and higher 1-year primary patency only if provisional stenting is considered target-lesion revascularization. Provisional stenting as part of a percutaneous transluminal balloon angioplasty strategy has equivalent 1-year patency and should be preferred over primary stenting.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00712309.
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Affiliation(s)
- Aljoscha Rastan
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Hans Krankenberg
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Iris Baumgartner
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Erwin Blessing
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Stefan Müller-Hülsbeck
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Ernst Pilger
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Dierk Scheinert
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Johannes Lammer
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Martin Gißler
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Elias Noory
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Franz-Josef Neumann
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Thomas Zeller
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
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Brodmann M, Dorr A, Hafner F, Gary T, Froehlich H, Kvas E, Deutschmann H, Pilger E. Safety and efficacy of periprocedural anticoagulation with enoxaparin in patients undergoing peripheral endovascular revascularization. Clin Appl Thromb Hemost 2013; 20:530-5. [PMID: 23785050 DOI: 10.1177/1076029613492877] [Citation(s) in RCA: 2] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Periprocedural anticoagulation is primarily used in endovascular procedures to prevent acute reocclusion of the target vessel, but periprocedural anticoagulation might also have an impact on long-term outcome. Consecutive bleeding events are feared complications. Despite changes in peripheral endovascular revascularizations (EVRs), the periprocedural management has remained unchanged for years. Unfractionated heparin is still the treatment of choice during and immediately after EVR. MATERIALS AND METHODS We performed a prospective, single-center, open-label phase III study comparing 2 different regimes of enoxaparin peri-interventional to peripheral EVR stratified into low- and high-risk groups according to the acute and long-term reocclusion risk due to their vessel morphology. In both groups, 0.5 mg/kg of enoxaparin as a bolus was administered intravenously 10 to 15 minutes before the start of the procedure. In the low-risk group, 40 mg of enoxaparin were administered once daily for 7 days; whereas in the high-risk group, 1 mg/kg of enoxaparin was administered subcutaneously (sc) 2 times a day for 48 hours after the procedure and afterward 40 mg of enoxaparin was administered sc once daily for 5 days. RESULTS For the analysis of the per protocol population, 44 patients remained in the low-risk group and 140 in the high-risk group. Concerning the primary safety end point, a total of 25 (13.59%) bleeding events occurred until day 30; 5 (11.36%) of them in the low-risk group and 20 (14.29%) in the high-risk group (P = .809 for low vs high risk). None of the bleeding events observed were major according to Thrombolysis In Myocardial Infarction criteria. Concerning our primary efficacy end point, none of the patients showed an acute reocclusion classified as a significant decrease in ankle-brachial index (ABI) or elevated peak systolic velocity ratio confirmed by duplex sonography until day 30. Concerning the second end point of prevention of chronic reobstruction, at day 180 ABI has decreased in the low-risk group from mean 0.94 at day 30 to mean 0.89 and from 1.28 at day 30 to 0.85 after 6 months in the high-risk group. No significant reobstruction was found in the low-risk group, whereas 5 significant reobstruction events were objectified in the high-risk group, all of them in the femoropopliteal arterial segment at day 180. CONCLUSION We conclude that low-molecular-weight heparin either in a low-dose or high-dose regime during a peripheral EVR is safe concerning bleeding complications and acute reobstructions. The long-term follow-up showed no significant difference between our high- and low-risk groups concerning reobstruction. The periprocedural anticoagulation seems to have no influence on the long-term patency rate after peripheral EVR.
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Affiliation(s)
| | - A Dorr
- Division of Angiology, Medical University Graz, Graz, Austria
| | - F Hafner
- Division of Angiology, Medical University Graz, Graz, Austria
| | - T Gary
- Division of Angiology, Medical University Graz, Graz, Austria
| | - H Froehlich
- Division of Angiology, Medical University Graz, Graz, Austria
| | - E Kvas
- Independent Biostatistics, Graz, Austria
| | - H Deutschmann
- Division of Interventional Radiology, Medical University Graz, Graz, Austria
| | - E Pilger
- Division of Angiology, Medical University Graz, Graz, Austria
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Rief P, Belaj K, Smaczny N, Augustin M, Eller P, Brodmann M, Pilger E. Foreign body pulmonary embolism. Wien Klin Wochenschr 2013; 125:337-8. [PMID: 23765525 DOI: 10.1007/s00508-013-0375-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
We report a case of a foreign body embolism caused by a tip of an explanted port-a-cath system. The embolus could be removed with a gooseneck snare catheter, the patient fully recovered.
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Affiliation(s)
- Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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Kirsch AH, Smaczny N, Riegelbauer V, Sedej S, Hofmeister A, Stojakovic T, Goessler W, Brodmann M, Pilger E, Rosenkranz AR, Eller K, Eller P. Regulatory T cells improve nephrocalcinosis but not dystrophic cardiac calcinosis in DBA/2 mice. Am J Pathol 2013; 183:382-90. [PMID: 23746654 DOI: 10.1016/j.ajpath.2013.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/17/2013] [Accepted: 04/24/2013] [Indexed: 12/24/2022]
Abstract
Nephrocalcinosis is characterized by aberrant deposition of calcium in the kidneys and is seen in phosphate nephropathy, primary hyperparathyroidism, and distal renal tubular acidosis. To further evaluate the specific pathophysiologic role of T cells in ectopic calcification, we used DBA/2 mice that are prone to develop nephrocalcinosis and dystrophic cardiac calcinosis. Female DBA/2 mice were depleted of T cells (n = 10) or regulatory T cells (Tregs) (n = 15) using either an anti-CD3ɛ or an anti-CD25 monoclonal antibody and compared with isotype-treated controls (n = 9; n = 15), respectively. After this immunomodulation, the DBA/2 mice were given a high-phosphate diet for 9 days and the degree of calcification was assessed by microcomputed tomography. Successful depletion was confirmed by flow cytometry of splenocytes. In DBA/2 mice, the high-phosphate diet induced a phenotype of nephrocalcinosis and dystrophic cardiac calcinosis. T-cell depletion significantly increased renal calcification in microcomputed tomography (P = 0.022). Concordantly, Treg depletion significantly deteriorated acute phosphate nephropathy (P = 0.039) and was associated with a significantly increased mortality rate (P = 0.004). Immunomodulation had no impact on the amount of cardiac calcification. Semiquantitative histopathologic evaluations with Alizarin Red staining independently confirmed the respective radiologic measurements. In summary, our data suggest a pivotal role of T cells, particularly Tregs, in the progression of nephrocalcinosis and emphasize the fact that inflammation deteriorates the outcome in acute phosphate nephropathy.
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Affiliation(s)
- Alexander H Kirsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Castellano G, Cafiero C, Divella C, Sallustio F, Gigante M, Gesualdo L, Kirsch AH, Smaczny N, Riegelbauer V, Sedej S, Hofmeister A, Stojakovic T, Brodmann M, Pilger E, Rosenkranz A, Eller K, Eller P, Meier P, Lucisano S, Arena A, Donato V, Fazio MR, Santoro D, Buemi M, Wornle M, Ribeiro A, Koppel S, Pircher J, Czermak T, Merkle M, Rupanagudi K, Kulkarni OP, Lichtnekert J, Darisipudi MN, Mulay SR, Schott B, Hartmann G, Anders HJ, Pletinck A, Glorieux G, Schepers E, Van Landschoot M, Eloot S, Van Biesen W, Vanholder R, Castoldi A, Oliveira V, Amano M, Aguiar C, Caricilli A, Vieira P, Burgos M, Hiyane M, Festuccia W, Camara N, Djudjaj S, Rong S, Lue H, Bajpai A, Klinkhammer B, Moeller M, Floege J, Bernhagen J, Ostendorf T, Boor P, Wornle M, Ribeiro A, Koppel S, Merkle M, Ito S, Aoki R, Hamada K, Edamatsu T, Itoh Y, Osaka M, Yoshida M, Oliva E, Maritati F, Palmisano A, Alberici F, Buzio C, Vaglio A, Grabulosa C, Cruz E, Carvalho J, Manfredi S, Canziani M, Cuppari L, Quinto B, Batista M, Cendoroglo M, Dalboni M, Wornle M, Ribeiro A, Merkle M, Niemir Z, Swierzko A, Polcyn-Adamczak M, Cedzynski M, Sokolowska A, Szala A, Baudoux T, Hougardy JM, Pozdzik A, Antoine MH, Husson C, De Prez E, Nortier J, Ni HF, Chen JF, Zhang MH, Pan MM, Liu BC, Machcinska M, Bocian K, Korczak-Kowalska G, Tami Amano M, Castoldi A, Andrade-Oliveira V, da Silva M, Miyagi MYS, Olsen Camara N, Xu L, Jin Y, Zhong F, Liu J, Dai Q, Wang W, Chen N, Grosjean F, Tribioli C, Esposito V, Catucci D, Azar G, Torreggiani M, Merlini G, Esposito C, Fell LH, Zawada AM, Rogacev KS, Seiler S, Fliser D, Heine GH, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Virzi GM, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C, Fuchs A, Eidenschink K, Steege A, Fellner C, Bollheimer C, Gronwald W, Schroeder J, Banas B, Banas MC, Zawada AM, Luthe A, Seiler SS, Rogacev K, Fliser D, Heine GH, Trimboli D, Graziani G, Haroche J, Lupica R, Fazio MR, Lucisano S, Donato V, Cernaro V, Montalto G, Pettinato G, Buemi M, Cho E, Lee JW, Kim MG, Jo SK, Cho WY, kim HK. Immune and inflammatory mechanisms. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, Eller P, Pilger E, Brodmann M. Neutrophil-to-lymphocyte ratio and its association with critical limb ischemia in PAOD patients. PLoS One 2013; 8:e56745. [PMID: 23457609 PMCID: PMC3574103 DOI: 10.1371/journal.pone.0056745] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/14/2013] [Indexed: 11/18/2022] Open
Abstract
Background The Neutrophil-to-Lymphocyte ratio (NLR) is an easy to perform test from the white blood cell count. An increase in NLR has been associated with vascular endpoints reflecting inflammation in atherosclerotic lesions. Atherosclerosis is a global threat and vascular endpoints, like myocardial infarction or critical limb ischemia (CLI), are a leading cause of death in industrialized countries. We therefore investigated NLR and its association with CLI and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients. Methods and Findings We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. NLR was calculated and the cohort was divided into tertiles according to the NLR. An optimal cut-off value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI significantly increased with an increase in NLR. As an optimal cut-off a NLR of 3.95 was identified. Two groups were categorized, one containing 1441 patients (NLR≤3.95) and a second group with 680 patients (NLR>3.95). CLI was more frequent in NLR>3.95 patients (330(48.5%)) compared to NLR≤3.95 patients (350(24.3%)) (p<0.001), as were prior myocardial infarction (48(7.0%) vs. 47(3.3%), p<0.001) and stroke (73(10.7) vs. 98(6.8%), p<0.001). Regarding other inflammatory parameters, C-reactive protein (median 5.6 mg/l (2.3–19.1) vs. median 3 mg/l (1.5–5.5)) and fibrinogen (median 412 mg/dl (345.5–507.5) vs. 344 mg/dl (308–403.5)) also significantly differed in the two patient groups (both p<0.001). A NLR>3.95 was associated with an OR of 2.5 (95%CI 2.3–2.7) for CLI even after adjustment for other vascular risk factors. Conclusions An increased NLR is significantly associated with patients at high risk for CLI and other vascular endpoints. The NLR is an easy to perform test, which could be used to highlight patients at high risk for vascular endpoints.
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Affiliation(s)
- Thomas Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria.
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Gary T, Steidl K, Belaj K, Hafner F, Froehlich H, Deutschmann H, Pilger E, Brodmann M. Unusual deep vein thrombosis sites: magnetic resonance venography in patients with negative compression ultrasound and symptomatic pulmonary embolism. Phlebology 2012. [PMID: 23202145 DOI: 10.1258/phleb.2012.012054] [Citation(s) in RCA: 4] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the clinical characteristics of patients with pulmonary embolism (PE), negative compression ultrasound (CUS) of the lower limbs and detection of unusual deep vein thrombosis (DVT) sites by means of magnetic resonance (MR) venography. METHODS A retrospective data analysis of PE patients hospitalized at our institution from April 2009 to 2011. RESULTS From April 2009 to 2011, a total of 762 PE patients were treated at our institution. In 169 of these patients CUS for DVT was negative. In these patients MR venography was performed for further evaluation. We found venous thrombosis at unusual sites in 12 of these patients. Due to free floating thrombus masses and fear of life-threatening PE progression we inserted an inferior vena cava filter in three of these 12 patients. The leading venous thromboembolism risk factor in our patients was immobilization (5 patients, 41.7%). CONCLUSIONS We conclude that especially in patients with PE and negative CUS of the lower limbs a thrombosis of the pelvic veins should be considered in case of symptoms for venous thrombosis in this area. Further diagnostic work-up with MR venography should be scheduled in these patients especially in patients with risk factor immobilization as therapeutic consequences might occur.
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Affiliation(s)
- T Gary
- Department of Internal Medicine, Division of Angiology
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Gary T, Belaj K, Hafner F, Hackl G, Froehlich H, Pilger E, Brodmann M. A high CHA2DS2-VASc score is associated with a high risk for critical limb ischemia in peripheral arterial occlusive disease patients. Atherosclerosis 2012; 225:517-20. [DOI: 10.1016/j.atherosclerosis.2012.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/29/2012] [Accepted: 10/01/2012] [Indexed: 11/26/2022]
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Gary T, Belaj K, Steidl K, Pichler M, Eisner F, Hafner F, Froehlich H, Samonigg H, Pilger E, Brodmann M. Asymptomatic venous thrombotic events in ambulatory cancer patients: impact on survival. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70103-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Brodmann M, Hafner F, Gary T, Seinost G, Pilger E. Impaired endothelial-dependent and endothelium-independent vasodilatation in patients with thromboangiitis obliterans. Clin Appl Thromb Hemost 2012; 19:33-6. [PMID: 22311632 DOI: 10.1177/1076029611435093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endothelial dysfunction is the key process in the development of atherosclerosis. The aim of our study was to evaluate endothelial dysfunction measured by the noninvasive technique of Celermajer that plays a role in the pathogenesis of thrombangitis obliterans. METHODS A total of 36 patients with thrombangitiis obliterans ([TAO]; mean age 44.9 ± 1.3 years) were compared with 30 healthy individuals (mean age 36.1 ± 1.8 years). High frequency ultrasound was used to measure changes in response to reactive hyperemia (leading to flow-mediated endothelium-dependent dilatation) and in response to 0.4 mg sublingual nitroglycerin ([NTG]; leading to NTG-induced, endothelium-independent dilatation). RESULTS Patients with TAO showed a lower but statistically not significant flow-mediated dilatation and a statistically significant reduced NTG-induced vasodilatation than the control group. CONCLUSION Our results suggest that both mechanisms play a role in patients with TAO, the endothelium-independent impaired vasodilatation even in a more significant way than the impaired endothelium-dependent vasodilatation.
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Affiliation(s)
- M Brodmann
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Graz, Austria.
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Gary T, Starz I, Belaj K, Steidl K, Hafner F, Froehlich H, Pilger E, Brodmann M. Hyperlipidemia is associated with a higher pulmonary artery systolic pressure in patients after pulmonary embolism. Thromb Res 2012; 129:86-8. [DOI: 10.1016/j.thromres.2011.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 09/12/2011] [Accepted: 09/19/2011] [Indexed: 11/26/2022]
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Bahadori B, Uitz E, Mayer A, Harauer J, Dam K, Truschnig-Wilders M, Pilger E, Renner W. Polymorphisms of the hypoxia-inducible factor 1 gene and peripheral artery disease. Vasc Med 2011; 15:371-4. [PMID: 20926496 DOI: 10.1177/1358863x10379674] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypoxia-inducible factor 1 (HIF1) is a key regulator of angiogenesis and is involved in inflammation, which are two important features of the pathogenesis of peripheral artery disease (PAD). The gene for the HIF1-alpha subunit (HIF1A) carries two common mis-sense mutations, P582S (C>T, rs11549465) and A588T (G>A, rs11549467), which both have been related to increased trans-activation capacity of HIF1-alpha. The aim of the present study was to analyze the role of these polymorphisms in PAD. The study was designed as a case-control study including 917 patients with documented PAD and 969 control subjects. HIF1A genotypes were determined by exonuclease (TaqMan) assays. HIF1A P582S genotype frequencies were not significantly different between PAD patients (PP 82.2%; PS 16.5%; SS 1.3%) and control subjects (83.2%; 15.3%; 1.5%; p = 0.72). Similarly, HIF1A A588T genotype frequencies did not differ significantly between PAD patients (AA 95.9%; AT 4.1%) and control subjects (AA 96.8%; AT 3.2%; p = 0.28). In a multivariate logistic regression analysis including age, sex, smoking, diabetes, arterial hypertension and hypercholesterolemia, neither the HIF1A P582S polymorphism (odds ratio: 1.26; 95% confidence interval 0.92-1.74; p = 0.16) nor the A588T polymorphism (odds ratio: 1.17; 95% confidence interval 0.59-2.35; p = 0.66) was significantly associated with the presence of PAD. Both polymorphisms were furthermore not associated with age at onset of PAD, Fontaine stage of the disease or the ankle/brachial index of patients. We conclude that functional polymorphisms in the HIF1A gene do not contribute to susceptibility to PAD.
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Affiliation(s)
- Babak Bahadori
- Department of Internal Medicine 2, State Clinic St Poelten, St Poelten, Austria
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Gary T, Hafner F, Froehlich H, Stojakovic T, Scharnagl H, Pilger E, Brodmann M. High factor VIII activity, high plasminogen activator inhibitor 1 antigen levels and low factor XII activity contribute to a thrombophilic tendency in elderly venous thromboembolism patients. Acta Haematol 2010; 124:214-7. [PMID: 21071930 DOI: 10.1159/000321530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/08/2010] [Indexed: 11/19/2022]
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Bahadori B, Uitz E, Dehchamani D, Pilger E, Renner W. The fibrinogen gamma 10034C>T polymorphism is not associated with Peripheral Arterial Disease. Thromb Res 2010; 126:350-2. [PMID: 20709368 DOI: 10.1016/j.thromres.2010.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 06/30/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
Conversion of fibrinogen to fibrin plays an essential role in hemostasis and results in stabilization of the fibrin clot. Fibrinogen consists of three pairs of non-identical polypeptide chains, encoded by different genes (fibrinogen alpha [FGA], fibrinogen beta [FGB] and fibrinogen gamma [FGG]). A functional single nucleotide polymorphism (SNP) in the 3' untranslated region of the FGG gene (FGG 10034C>T, rs2066865) has been associated with deep venous thrombosis and myocardial infarction. Aim of the present study was to analyze the role of this polymorphism in peripheral arterial disease (PAD). The study was designed as case-control study including 891 patients with documented PAD and 777 control subjects. FGG genotypes were determined by exonuclease (TaqMan) assays. FGG genotype frequencies were not significantly different between PAD patients (CC: 57.3%, CT: 36.7%, TT: 5.8%) and control subjects (CC: 60.9%, CT: 33.5%, TT 5.6%; p=0.35). In a multivariate logistic regression analysis including age, sex, smoking, diabetes, arterial hypertension and hypercholesterolemia, the FGG 10034 T variant was not significantly associated with the presence of PAD (Odds ratio 1.07, 95% confidence interval 0.84 - 1.37; p = 0.60). The FGG 10034C>T polymorphism was furthermore not associated with age at onset of PAD. We conclude that the thrombophilic FGG 10034 T gene variant does not contribute to the genetic susceptibility to PAD.
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Affiliation(s)
- Babak Bahadori
- State Clinic St. Poelten, Department of Internal Medicine 2, St. Poelten, Austria
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Abstract
Anticoagulation still remains the primary therapy for venous thromboembolism (VTE) in order to prevent the most life-threatening form of VTE, pulmonary embolism (PE). Nevertheless in some patients anticoagulation is impossible. Then vena caval filters serve as a valuable second line therapy against the most feared complication of VTE, fatal PE. We want to present a patient with preceding PE and DVT in whom for the perioperative period a temporary vena caval filter was placed and who showed the complication of a nearly fatal PE. A seventy-two year-old white male was admitted for thrombolytic therapy for massive pulmonary embolism, which was performed successfully. Some hours later the patient developed gastrointestinal bleeding. An adenocarcinoma of the colon was diagnosed and an end-to-end hemicolectomy performed. A temporal caval filter (Gunther filter) was placed in the infrarenal vena cava for the perioperative period. Seven days later the patient syncopated with acute massive onset of dyspnea. A helix computertomography scan of the lung showed again massive central pulmonary embolism with right heart enlargement. An immediate pulmonary embolectomy had to be performed. Subsequent venal cavography revealed a thrombosed vena caval filter and a thrombus proximal to the filter. This case report should emphasize the fact that although a vena cava filter might be of high benefit in patients with contraindication for anticoagulation to prevent recurrent PE, in some cases it can be insufficient and lead to enormous complications.
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Affiliation(s)
- M Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Austria.
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Yazdani-Biuki B, Krippl P, Brickmann K, Fuerst F, Langsenlehner U, Paulweber B, Pilger E, Wascher TC, Brezinschek HP, Renner W. The Functional Promoter Polymorphism of the Coagulation Factor XII Gene is not Associated With Peripheral Arterial Disease. Angiology 2009; 61:211-5. [DOI: 10.1177/0003319709337305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Coagulation factor XII (FXII) plays a key role in both coagulation and fibrinolysis and has been associated with cardiovascular disease in some studies. Plasma FXIIa levels are strongly determined by a common functional polymorphism in the promoter of the FXII gene (F12-4C>T). To investigate the potential association of this polymorphism with peripheral arterial disease (PAD), we performed a case-control study including 668 patients with PAD and 762 controls participants without cardiovascular disease. F12 genotype frequencies were not significantly different between patients with PAD and control participants. After adjustment for classical risk factors, the odds ratio of carriers of a F12 -4T allele for PAD was 1.06 (95% confidence interval 0.86—1.32). F12 genotypes were associated with a modest increase of the mean-activated partial thromboplastin time but not with PAD stage or severity. We conclude that the functional F124C>T polymorphism is not associated with PAD.
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Affiliation(s)
| | - Peter Krippl
- Department of Internal Medicine, Regional Hospital of Fuerstenfeld, Austria
| | | | | | - Uwe Langsenlehner
- Internal Outpatient Department, Steiermaerkische Gebietskrankenkasse, Graz, Austria
| | | | - Ernst Pilger
- Division of Angiology, Medical University Graz, Austria
| | - Thomas C. Wascher
- Division of Metabolism and Vascular Biology Unit, Department of Medicine, Medical University Graz, Austria
| | | | - Wilfried Renner
- Division of Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Austria, wilfried.renner@ medunigraz.at
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Bosiers M, Peeters P, D’Archambeau O, Hendriks J, Pilger E, Düber C, Zeller T, Gussmann A, Lohle PNM, Minar E, Scheinert D, Hausegger K, Schulte KL, Verbist J, Deloose K, Lammer J. AMS INSIGHT—Absorbable Metal Stent Implantation for Treatment of Below-the-Knee Critical Limb Ischemia: 6-Month Analysis. Cardiovasc Intervent Radiol 2009. [PMCID: PMC4969817 DOI: 10.1007/s00270-009-9530-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bosiers M, Peeters P, D'Archambeau O, Hendriks J, Pilger E, Düber C, Zeller T, Gussmann A, Lohle PNM, Minar E, Scheinert D, Hausegger K, Schulte KL, Verbist J, Deloose K, Lammer J. AMS INSIGHT--absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis. Cardiovasc Intervent Radiol 2008; 32:424-35. [PMID: 19093148 PMCID: PMC2700251 DOI: 10.1007/s00270-008-9472-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 10/31/2008] [Accepted: 11/05/2008] [Indexed: 11/25/2022]
Abstract
Endoluminal treatment of infrapopliteal artery lesions is a matter of controversy. Bioabsorbable stents are discussed as a means to combine mechanical prevention of vessel recoil with the advantages of long-term perspectives. The possibility of not having a permanent metallic implant could permit the occurrence of positive remodeling with lumen enlargement to compensate for the development of new lesions. The present study was designed to investigate the safety of absorbable metal stents (AMSs) in the infrapopliteal arteries based on 1- and 6-month clinical follow-up and efficacy based on 6-month angiographic patency. One hundred seventeen patients with 149 lesions with chronic limb ischemia (CLI) were randomized to implantation of an AMS (60 patients, 74 lesions) or stand-alone percutaneous transluminal angioplasty (PTA; 57 patients, 75 lesions). Seven PTA-group patients “crossed over” to AMS stenting. The study population consisted of patients with symptomatic CLI (Rutherford categories 4 and 5) and de novo stenotic (>50%) or occlusive atherosclerotic disease of the infrapopliteal arteries who presented with a reference diameter of between 3.0 and 3.5 mm and a lesion length of <15 mm. The primary safety endpoint was defined as absence of major amputation and/or death within 30 days after index intervention and the primary efficacy endpoint was the 6-month angiographic patency rate as confirmed by core-lab quantitative vessel analysis. The 30-day complication rate was 5.3% (3/57) and 5.0% (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively. On an intention-to-treat basis, the 6-month angiographic patency rate for lesions treated with AMS (31.8%) was significantly lower (p = 0.013) than the rate for those treated with PTA (58.0%). Although the present study indicates that the AMS technology can be safely applied, it did not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels.
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Affiliation(s)
- Marc Bosiers
- Department of Vascular Surgery, AZ St-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium.
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Lammer J, Pilger E, Klein G, Hausegger C, Flueckiger F, Chen L, Mechler H. Continuous-Wave Nd:YAGv. Excimer Laser Recanalization Clinical Results in Femoral Popliteal Artery Occlusions. Semin Intervent Radiol 2008. [DOI: 10.1055/s-2008-1074636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pachler C, Plank J, Weinhandl H, Chassin LJ, Wilinska ME, Kulnik R, Kaufmann P, Smolle KH, Pilger E, Pieber TR, Ellmerer M, Hovorka R. Tight glycaemic control by an automated algorithm with time-variant sampling in medical ICU patients. Intensive Care Med 2008; 34:1224-30. [PMID: 18297268 DOI: 10.1007/s00134-008-1033-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 01/02/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Tight glycaemic control (TGC) in critically ill patients improves clinical outcome, but is difficult to establish The primary objective of the present study was to compare glucose control in medical ICU patients applying a computer-based enhanced model predictive control algorithm (eMPC) extended to include time-variant sampling against an implemented glucose management protocol. DESIGN Open randomised controlled trial. SETTING Nine-bed medical intensive care unit (ICU) in a tertiary teaching hospital. PATIENTS AND PARTICIPANTS Fifty mechanically ventilated medical ICU patients. INTERVENTIONS Patients were included for a study period of up to 72 h. Patients were randomised to the control group (n = 25), treated by an implemented insulin algorithm, or to the eMPC group (n = 25), using the laptop-based algorithm. Target range for blood glucose (BG) was 4.4-6.1 mM. Efficacy was assessed by mean BG, hyperglycaemic index (HGI) and BG sampling interval. Safety was assessed by the number of hypoglycaemic-episodes < 2.2 mM. Each participating nurse filled-in a questionnaire regarding the usability of the algorithm. MEASUREMENTS AND MAIN RESULTS BG and HGI were significantly lower in the eMPC group [BG 5.9 mM (5.5-6.3), median (IQR); HGI 0.4 mM (0.2-0.9)] than in control patients [BG 7.4 mM (6.9-8.6), p < 0.001; HGI 1.6 mM (1.1-2.4), p < 0.001]. One hypoglycaemic episode was detected in the eMPC group; no such episodes in the control group. Sampling interval was significantly shorter in the eMPC group [eMPC 117[Symbol: see text]min (+/- 34), mean (+/- SD), vs 174 min (+/- 27); p < 0.001]. Thirty-four nurses filled-in the questionnaire. Thirty answered the question of whether the algorithm could be applied in daily routine in the affirmative. CONCLUSIONS The eMPC algorithm was effective in maintaining tight glycaemic control in severely ill medical ICU patients.
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Affiliation(s)
- Christoph Pachler
- Department of Internal Medicine, Medical University Graz, Stiftingtalstrasse 24, 8010, Graz, Austria.
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Gary T, Gries A, Pilger E, Seinost G, Brodmann M. PO19-520 COLLAGEN INDUCED ACCELERATED PLATELET AGGREGATION AS A POSSIBLE CAUSE FOR RESTENOSIS AFTER STENT IMPLANTATION IN PAOD. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grünbacher G, Weger W, Marx-Neuhold E, Pilger E, Köppel H, Wascher T, März W, Renner W. The fibrinogen gamma (FGG) 10034C>T polymorphism is associated with venous thrombosis. Thromb Res 2007; 121:33-6. [PMID: 17445871 DOI: 10.1016/j.thromres.2007.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/07/2007] [Accepted: 03/08/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Thrombin-induced conversion of fibrinogen to fibrin plays an essential role in hemostasis and results in the stabilization of thrombi. Elevated plasma fibrinogen levels have been associated with both increased plasma viscosity and platelet aggregability. Recently, a haplotype-tagging single nucleotide polymorphism characterized by a C to T substitution at nucleotide 10034 of the fibrinogen gamma gene (FGG 10034C>T, rs2066865), has been proposed as a novel risk factor for deep venous thrombosis (DVT). Aim of the present study was to provide further data on the role of the FGG 10034C>T polymorphism for DVT. MATERIALS AND METHODS FGG genotypes were determined by 5'-exonuclease assay (TaqMan) in 358 patients with documented DVT and a total of 783 control subjects. RESULTS In a multivariate analysis adjusting for age, sex, presence of factor V Leiden and carriage of prothrombin 20210A, homozygosity for the FGG 10034 TT genotype yielded an odds ratio of 2.01 (95% CI 1.23-3.31; p=0.006) for DVT. CONCLUSIONS Our data confirm the primary finding that the FGG 10034C>T polymorphism is associated with DVT risk.
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Affiliation(s)
- Gerda Grünbacher
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, 8036 Graz Austria
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Affiliation(s)
- Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medizinische Universität Graz, Graz, Austria.
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Deutschmann HA, Schoellnast H, Portugaller HR, Preidler KW, Reittner P, Tillich M, Pilger E, Szolar DHM. Routine Use of Three-Dimensional Contrast-Enhanced Moving-Table MR Angiography in Patients with Peripheral Arterial Occlusive Disease: Comparison with Selective Digital Subtraction Angiography. Cardiovasc Intervent Radiol 2006; 29:762-70. [PMID: 16625410 DOI: 10.1007/s00270-004-0309-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of contrast-enhanced (CE) three-dimensional (3D) moving-table magnetic resonance (MR) angiography with that of selective digital subtraction angiography (DSA) for routine clinical investigation in patients with peripheral arterial occlusive disease. METHODS Thirty-eight patients underwent CE 3D moving-table MR angiography of the pelvic and peripheral arteries. A commercially available large-field-of-view adapter and a dedicated peripheral vascular phased-array coil were used. MR angiograms were evaluated for grade of arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of selective DSA. RESULTS Two hundred and twenty-six arterial segments in 38 patients were evaluated by both selective DSA and MR angiography. No complications related to MR angiography were observed. There was agreement in stenosis classification in 204 (90.3%) segments; MR angiography overgraded 16 (7%) segments and undergraded 6 (2.7%) segments. Compared with selective DSA, MR angiography provided high sensitivity and specificity and excellent interobserver agreement for detection of severe stenosis (97% and 95%, kappa = 0.9 +/- 0.03) and moderate stenosis (96.5% and 94.3%, kappa = 0.9 +/- 0.03). CONCLUSION Compared with selective DSA, moving-table MR angiography proved to be an accurate, noninvasive method for evaluation of peripheral arterial occlusive disease and may thus serve as an alternative to DSA in clinical routine.
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Affiliation(s)
- Hannes A Deutschmann
- Medical University Graz, Department of Radiology, University Hospital Graz, Auenbruggerplatz 9, 8036 Graz, Austria
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Brodmann M, Seinost G, Stark G, Pilger E. Aggravation of pre-existing atrioventricular block, Wenckebach type, provoked by application of X-ray contrast medium. Cardiovasc Intervent Radiol 2006; 29:1114-6. [PMID: 16988879 DOI: 10.1007/s00270-005-0133-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Significant bradycardia followed by cardiac arrest related to single bolus administration of X-ray contrast medium into a peripheral artery has not, to our knowledge, been described in the literature. METHODS AND RESULTS While performing a percutaneous transluminal angioplasty of the left superficial femoral artery in a 68-year old patient with a pre-existing atrioventricular (AV) block, Wenckebach type, he developed an AV block III after a single bolus injection of intra-arterial X-ray contrast medium. CONCLUSION We believe that application of contrast medium causes a transitory ischemia in the obstructed vessel and therefore elevation of endogenous adenosine. In the case of a previously damaged AV node this elevation of endogenous adenosine may be responsible for the development of a short period of third-degree AV block.
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Affiliation(s)
- Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Grünbacher G, Marx-Neuhold E, Pilger E, Köppel H, Renner W. The functional -4C>T polymorphism of the coagulation factor XII gene is not associated with deep venous thrombosis. J Thromb Haemost 2005; 3:2815-7. [PMID: 16359524 DOI: 10.1111/j.1538-7836.2005.01651.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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