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Almagro P, Soler-Cataluña JJ, Huerta A, González-Segura D, Cosío BG. Impact of comorbidities in COPD clinical control criteria. The CLAVE study. BMC Pulm Med 2024; 24:6. [PMID: 38166965 PMCID: PMC10759491 DOI: 10.1186/s12890-023-02758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/06/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) frequently coexists with other chronic diseases, namely comorbidities. They negatively impact prognosis, exacerbations and quality of life in COPD patients. However, no studies have been performed to explore the impact of these comorbidities on COPD clinical control criteria. RESEARCH QUESTION Determine the relationship between individualized comorbidities and COPD clinical control criteria. STUDY DESIGN AND METHODS Observational, multicenter, cross-sectional study performed in Spain involving 4801 patients with severe COPD (< 50 predicted forced expiratory volume in the first second [FEV1%]). Clinical control criteria were defined by the combination of COPD assessment test (CAT) scores (≤16 vs ≥17) and exacerbations in the previous three months (none vs ≥1). Binary logistic regression adjusted by age and FEV1% was performed to identify comorbidities potentially associated with the lack of control of COPD. Secondary endpoints were the relationship between individualized comorbidities with COPD assessment test and exacerbations within the last three months. RESULTS Most frequent comorbidities were arterial hypertension (51.2%), dyslipidemia (36.0%), diabetes (24.9%), obstructive sleep apnea-hypopnea syndrome (14.9%), anxiety (14.1%), heart failure (11.6%), depression (11.8%), atrial fibrillation (11.5%), peripheral arterial vascular disease (10.4%) and ischemic heart disease (10.1%). After age and FEV1% adjustment, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; all p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; all p < 0.001), sleep disorders (p < 0.0001), anemia (p = 0.015) and gastroesophageal reflux (p < 0.0001). These comorbidities were also related to previous exacerbations and COPD assessment test scores. INTERPRETATION Comorbidities are frequent in patients with severe COPD, negatively impacting COPD clinical control criteria. They are related to health-related quality of life measured by the COPD assessment test. Our results suggest that comorbidities should be investigated and treated in these patients to improve their clinical control. TAKE-HOME POINTS Study question: What is the impact of comorbidities on COPD clinical control criteria? RESULTS Among 4801 patients with severe COPD (27.5% controlled and 72.5% uncontrolled), after adjustment by age and FEV1%, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; p < 0.001), obstructive sleep apnea-hypopnea syndrome (p < 0.0001), anaemia (p = 0.015) and gastroesophageal reflux (p < 0.0001), which were related to previous exacerbations and COPD assessment test scores. INTERPRETATION Comorbidities are related to health-related quality of life measured by the COPD assessment test scores and history of exacerbations in the previous three months.
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Affiliation(s)
- Pere Almagro
- Multimorbidity Patients Unit. Internal Medicine Department, H. Mutua Terrassa University Hospital, Plaza del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
| | - Juan José Soler-Cataluña
- Department of Pneumology, Hospital Arnau de Vilanova-Lliria, Medicine Department, València University and CIBERES, Valencia, Spain
| | - Arturo Huerta
- Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain
| | | | - Borja G Cosío
- Department of Pneumology, H. Universitari Son Espases Hospital-IdISBa and CIBERES, Palma de Mallorca, Balearic Islands, Spain
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Desai R, Brereton B, Patta HVC, Bansal P, Jain A, Vyas A. Prevalence and impact of cannabis use disorder on acute ischemic stroke and subsequent mortality in elderly peripheral vascular disease patients: A population-based analysis in the USA (2016 - 2019). Curr Probl Cardiol 2024; 49:102162. [PMID: 37871709 DOI: 10.1016/j.cpcardiol.2023.102162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Given current evidence linking peripheral atherosclerotic disease, also known as cannabis arteritis, and acute ischemic stroke (AIS) in individuals with cannabis use disorder (CUD), we investigated the frequency and implications of CUD in relation to AIS risk and outcomes among elderly patients with peripheral vascular disease (PVD). METHODS The National Inpatient Sample (2016-2019) was used to compare geriatric patients with PVD and cannabis use disorder CUD. CUD was correlated with AIS admissions. Adjusted multivariable regression models assessed in-hospital mortality rates. RESULTS Of 5,115,824 geriatric admissions with PVD, 50.6 % were male and 77.5 % were white. 21,405 admissions had cardiovascular and CUD co-occurrence. 19.7 % of CUD patients had diabetes mellitus (DM), compared to 33.7 % of non-CUD patients. Smoking and HTN rates were comparable between groups. Patients with CUD used more recreational drugs concurrently than those without CUD. AIS prevalence was 5.2 % in CUD patients and 4.0 % in controls (p < 0.001). In the geriatric population with PVD, the presence of CUD was found to be associated with increased odds of hospitalizations due to AIS, with an adjusted odds ratio (aOR) of 1.34 (95 % confidence interval [CI] 1.18-1.52, p < 0.001). All-cause in-hospital mortality was not statistically significant, with an aOR of 0.71 (95 %CI 0.36-1.37, p = 0.302). In our study, older patients with PVD and hypertension (aOR 1.73) had a greater risk of AIS. Intriguingly, when we analyzed AIS predictors in elderly PVD patients with concurrent tobacco use disorder, we identified a counterintuitive protective effect (aOR 0.58, 95 % CI 0.42-0.79, p < 0.001). CONCLUSIONS Our findings indicate that among geriatric patients with PVD and concurrent CUD, there is a notable 34 % risk of AIS. Importantly, this risk persists despite controlling for other CVD risk factors and substance use. Further investigations are warranted to elucidate and validate the intriguing phenomenon known as the smoker's paradox.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA
| | - Brian Brereton
- Department of Medicine, Jersey General Hospital, St. Helier, Jersey
| | | | - Prerna Bansal
- Department of Medicine, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Akhil Jain
- Division of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ankit Vyas
- Division of Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
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Sjödin LS, Ottosson CC, Lapidus LJ. Knee disarticulation vs. transfemoral amputation after failed transtibial amputation: Surgical outcome and prosthetic fitting in patients with peripheral vascular disease. Prosthet Orthot Int 2024; 48:25-29. [PMID: 37910598 DOI: 10.1097/pxr.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/04/2022] [Accepted: 08/17/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Our aim was to compare transfemoral amputation (TFA) to knee disarticulation (KD) as a reamputation level after failed transtibial amputation (TTA) in patients with peripheral vascular disease and/or diabetes. METHODS We studied 152 patients undergoing reamputation, 86 TFA and 66 KD, after a failed TTA. The primary outcome was reamputation and reoperation, and secondary outcomes were prosthetic fitting and mortality. Logistic regression analyses were performed to identify factors associated with the outcome. RESULTS The reamputation rate was 36% after KD and 15% after TFA ( p = 0.004). The multivariable analysis showed that TFA was associated with a significantly reduced risk of reamputation, odds ratio (OR) = 0.31 (95% confidence interval [95% CI], 0.1-0.7). The overall reoperation rate was 38% after KD and 22% after TFA ( p = 0.03). This reduction of risk for TFA was not significant in the multivariable analysis, OR = 0.49 (95% CI, 0.2-1.0). Prosthetic limb fitting was possible in 30% after KD and 19% after TFA ( p = 0.1). Previous amputation in the contralateral leg was the only factor associated with reduced ability for prosthetic fitting in the multivariable analysis, OR = 0.15 (95% CI, 0.03-0.7). Mortality at 30 d was 17% and 53% at 1 year. No independent factors affected 30-d mortality in the multivariable analysis. CONCLUSIONS In this study, we found a significantly lower risk of reamputation after TFA compared with KD after a failed TTA. We consider TFA to be the reamputation level of choice, especially when there is a need of reducing risk of further reamputations.
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Affiliation(s)
- Lina S Sjödin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Unit of Orthopaedics, Södersjukhuset AB, Stockholm, Sweden
| | - Carin C Ottosson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Wound Centre, Södersjukhuset AB, Stockholm, Sweden
| | - Lasse J Lapidus
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Unit of Orthopaedics, Södersjukhuset AB, Stockholm, Sweden
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Schmidt BM, Keeney-Bonthrone TP, Hawes AM, Karmakar M, Frydrych LM, Cinti SK, Pop-Busui R, Delano MJ. Comorbid status in patients with osteomyelitis is associated with long-term incidence of extremity amputation. BMJ Open Diabetes Res Care 2023; 11:e003611. [PMID: 38164707 PMCID: PMC10729224 DOI: 10.1136/bmjdrc-2023-003611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Osteomyelitis is associated with significant morbidity, including amputation. There are limited data on long-term amputation rates following an osteomyelitis diagnosis. We sought to determine the incidence of amputation in patients with osteomyelitis over 2 years. RESEARCH DESIGN AND METHODS Observational cohort study of 1186 inpatients with osteomyelitis between 2004 and 2015 and stratified by osteomyelitis location status to evaluate the impact on amputation, mortality rates, readmission data, and inpatient days. RESULTS Persons with diabetes had 3.65 times greater probability of lower extremity amputation (p<0.001), readmission (p<0.001), and longer inpatient stay (p<0.001) and had higher 2-year mortality (relative risk (RR) 1.23, p=0.0027), adjusting for risk factors. Male gender (RR 1.57, p<0.001), black race (RR 1.41, p<0.05), former smoking status (RR 1.38, p<0.01), myocardial infarction (RR 1.72, p<0.001), congestive heart failure (RR 1.56, p<0.001), peripheral vascular disease (RR 2.25, p<0.001) and renal disease (RR 1.756, p<0.001) were independently associated with amputation. Male gender (RR 1.39, p<0.01), black race (RR 1.27, p<0.05), diabetes (RR 2.77, p<0.001) and peripheral vascular disease (RR 1.59, p<0.001) had increased risk of lower, not upper, extremity amputation. CONCLUSIONS Patients with osteomyelitis have higher rates of amputation and hospitalization. Clinicians must incorporate demographic and comorbid risk factors to protect against amputation.
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Affiliation(s)
- Brian M Schmidt
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Armani M Hawes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Karmakar
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynn M Frydrych
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sandro K Cinti
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rodica Pop-Busui
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matthew J Delano
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Billones AR, Imperial CR, Gutierrez-Cayetano M. Embolism from a left ventricular myxoma presenting with acute limb ischaemia. BMJ Case Rep 2023; 16:e254934. [PMID: 38050388 PMCID: PMC10693896 DOI: 10.1136/bcr-2023-254934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/06/2023] Open
Abstract
Acute limb ischaemia (ALI) secondary to cardiac myxoma is uncommon. Embolic myxoma should be considered a differential diagnosis in young patients with ALI who do not have apparent cardiovascular risk factors. A multidisciplinary approach and comprehensive care can improve outcomes and optimise the collaborative treatment of ALI. Early referral to a hospital that can provide specialised treatment for ALI helps prevent significant tissue loss and surgical complications, such as amputation.A man in his 20s presented with bilateral ALI of both lower extremities, and an arterial duplex scan revealed a thrombus occluding all arterial segments of the bilateral lower extremities. An intracardiac mass adherent to the apical and anterior interventricular septum on two-dimensional echocardiography suggested a complex myxoma. The patient was diagnosed with ALI Rutherford category III, and bilateral hip disarticulation was performed. The patient was discharged with an anticoagulant.
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Allon M, Cutter GR, Young CJ. Vascular Access-Related Distal Ischemia Requiring Intervention: Frequency, Risk Factors, and Consequences. Clin J Am Soc Nephrol 2023; 18:1592-1598. [PMID: 37707801 PMCID: PMC10723913 DOI: 10.2215/cjn.0000000000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Distal ischemia is a rare complication in patients undergoing placement of an arteriovenous (AV) fistula or AV graft. There are limited studies on its frequency, risk factors, clinical consequences, or feasibility of subsequent access. METHODS A prospective vascular access database from a large academic medical center was queried retrospectively to identify 1498 patients (mean age 56±15 years, 48% female patients, 73% Black patients) undergoing placement of at least one vascular access from 2011 to 2020. For patients who developed access-related distal ischemia requiring surgical intervention, we determined the frequency of distal ischemia, clinical risk factors, and subsequent outcomes. RESULTS Severe access-related distal ischemia occurred in 28 patients (1.9%; 95% confidence interval, 1.3% to 2.7%). The frequency was 0.2% for forearm AV fistulas, 0.9% for upper arm AV fistulas, 2.4% for forearm AV grafts, 2.2% for upper arm AV grafts, and 2.8% for thigh AV grafts. Risk factors independently associated with distal ischemia included female sex (odds ratio [OR], 3.64 [95% confidence interval, 1.52 to 8.72]), peripheral vascular disease (OR, 6.28 [2.84 to 13.87]), and coronary artery disease (OR, 2.37 [1.08 to 5.23]). Surgical interventions included ligation, excision, plication (banding), and other surgical procedures. Five patients developed tissue necrosis. A subsequent AV graft was placed in 13 patients, of whom only one (8%) developed distal ischemia requiring intervention. CONCLUSIONS Access-related distal ischemia requiring intervention was rare in this study and more common in women and patients with peripheral vascular disease or coronary artery disease. In some cases, a subsequent vascular access could be placed with a low likelihood of recurrent distal ischemia.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary R. Cutter
- Department of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlton J. Young
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Valls-Matarín J, Peradejordi-Torres RM, Del Cotillo-Fuente M. Dependency-related skin lesions in the prone critical patient. Incidence study. Enferm Clin (Engl Ed) 2023; 33:424-431. [PMID: 37898167 DOI: 10.1016/j.enfcle.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. METHOD Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. RESULTS Forty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 [61.8-71.3] vs. 64 [43-71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1-149.4] vs. 38.2 [18.8-57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01-1.05) and PVD (OR=8.9; 95%CI:1.3-58.9) as predisposing factors for developing DRSL. CONCLUSIONS There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.
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Affiliation(s)
- Josefa Valls-Matarín
- Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
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Desai R, Mellacheruvu SP, Akella SA, Mohammed AS, Saketha P, Mohammed AA, Hussain M, Bavanasi A, Gummadi J, Sunkara P. Major Adverse Cardiac and Cerebrovascular Events in Geriatric Patients with Obstructive Sleep Apnea: An Inpatient Sample Analysis. Med Sci (Basel) 2023; 11:69. [PMID: 37987324 PMCID: PMC10660682 DOI: 10.3390/medsci11040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased risk of major cardiac and cerebrovascular events (MACCE). However, data on the burden and predictors of MACCE in geriatric patients with OSA (G-OSA) remain limited. METHODS Using the National Inpatient Sample from 2018, we identified G-OSA admissions (age ≥ 65 years) and divided them into non-MACCE vs. MACCE (all-cause mortality, stroke, acute myocardial infarction, and cardiac arrest). We compared the demographics and comorbidities in both cohorts and extracted the odds ratio (multivariate analysis) of MACCE and associated in-hospital mortality. RESULTS Out of 1,141,120 geriatric obstructive sleep apnea G-OSA admissions, 9.9% (113,295) had MACCE. Males, Asians, or the Pacific Islander/Native American race, and patients from the lowest income quartile revealed a higher MACCE rate. Significant clinical predictors of MACCE in elderly OSA patients on multivariable regression analysis in decreasing odds were pulmonary circulation disease (OR 1.47, 95% CI 1.31-1.66), coagulopathy (OR 1.43, 95% CI 1.35-1.50), peripheral vascular disease (OR 1.34, 95% CI 1.28-1.40), prior sudden cardiac arrest (OR 1.34, 95% CI 1.11-1.62), prior myocardial infarction (OR 1.27, 95% CI 1.22-1.33), fluid and electrolyte imbalances (OR 1.25, 95% CI 1.20-1.29), male sex (OR 1.22, 95% CI-1.18-1.26), hyperlipidemia (OR 1.20, 95% CI 1.16-1.24), low household income (OR 1.19, CI 1.13-1.26), renal failure (OR 1.15, 95% CI 1.12-1.19), diabetes (OR 1.14, 95% CI 1.10-1.17), metastatic cancer (OR 1.14, 95% CI 1.03-1.25), and prior stroke or TIA (OR 1.12, 95% CI 1.07-1.17) (All p value < 0.05). CONCLUSIONS This study emphasizes the significant association between obstructive sleep apnea (OSA) and major cardiac and cerebrovascular events (MACCE) in the geriatric population. Among the elderly OSA patients, a substantial 9.9% were found to have MACCE, with specific demographics like males, Asian or Pacific Islander/Native American individuals, and those from the lowest income quartile being particularly vulnerable. The study sheds light on several significant clinical predictors, with pulmonary circulation disease, coagulopathy, and peripheral vascular disease topping the list. The highlighted predictors provide valuable insights for clinicians, allowing for better risk stratification and targeted interventions in this vulnerable patient cohort. Further research is essential to validate these findings and inform how tailored therapeutic approaches for geriatric OSA patients can mitigate MACCE risk. CLINICAL IMPLICATIONS Elderly individuals with a high risk for MACCE should undergo routine OSA screening using tools like the sensitive STOP-BANG Questionnaire. Implementing CPAP treatment can enhance cardiovascular outcomes in these patients.
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Affiliation(s)
- Rupak Desai
- Independent Researcher, Atlanta, GA 30033, USA;
| | | | - Sai Anusha Akella
- Department of Internal Medicine, Kakatiya Medical College, Warangal 506007, India;
| | - Adil Sarvar Mohammed
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, USA
| | - Pakhal Saketha
- Department of Internal Medicine, Bhaskar Medical College, Hyderabad 500075, India;
| | - Abdul Aziz Mohammed
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India; (A.A.M.); (M.H.)
| | - Mushfequa Hussain
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India; (A.A.M.); (M.H.)
| | - Aamani Bavanasi
- Department of Internal Medicine, Captain James A Lovell FHCC/Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - Jyotsna Gummadi
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD 21237, USA;
| | - Praveena Sunkara
- Department of Internal Medicine, Medstar Medical Group, Charlotte Hall, MD 20622, USA;
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Sato J, Yagi T, Ishii Y, Hinoura R, Kajimoto R, Kuwana T, Chiba N, Saito T, Kinoshita K. Impaired consciousness and unilateral limb movement due to acute limb ischemia complicated by acute cerebral infarction: A case report. Medicine (Baltimore) 2023; 102:e35657. [PMID: 37904351 PMCID: PMC10615444 DOI: 10.1097/md.0000000000035657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/25/2023] [Indexed: 11/01/2023] Open
Abstract
RATIONALE The symptoms of impaired consciousness and unilateral motor impairments are a perfect scenario for cerebral infarction, and a physician can easily miss the findings of limb ischemia on the patient paralyzed side even if acute limb ischemia (ALI) occurs on that side. The purpose of this case report is to reiterate the need to suspect ALI in patients with impaired consciousness who cannot complain of symptoms such as abnormal limb paresthesia or pain. PATIENT CONCERNS An 89-year-old woman with impaired consciousness and motor impairment of the left upper and lower extremities was transported to our hospital. DIAGNOSES Brain magnetic resonance imaging showed a suspected cerebral infarction in the posterior circulation; contrast-enhanced computed tomography showed occlusion of the left axillary artery and left femoral artery; and ultrasonography showed occlusion of the right popliteal artery. INTERVENTIONS Cerebral angiography was performed simultaneously with surgical thrombectomy to treat the ALI. Mechanical thrombectomy was not performed for cerebral infarction. OUTCOMES Although motor impairment of the left upper and lower extremities persisted, the patient successfully underwent limb salvage. LESSONS Both cerebral infarction and ALI require early diagnosis and treatment. This rare case of cerebral infarction complicated by ALI emphasizes the need to avoid missing the signs of ALI in patients with impaired consciousness.
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Affiliation(s)
- Jun Sato
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tsukasa Yagi
- Department of Cardiology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Yusuke Ishii
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Rei Hinoura
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Ryuta Kajimoto
- Department of Neurosurgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tsukasa Kuwana
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Nobutaka Chiba
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Takeshi Saito
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
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Cichos KH, Jordan E, Niknam K, Chen AF, Hansen EN, McGwin G, Ghanem ES. Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status. Clin Orthop Relat Res 2023; 481:2016-2025. [PMID: 36961471 PMCID: PMC10499110 DOI: 10.1097/corr.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/15/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Patients with hepatitis C virus (HCV) undergoing primary elective total joint arthroplasty (TJA) are at increased risk of postoperative complications. Patients with chronic liver disease and cirrhosis, specifically Child-Pugh Class B and C, who are undergoing general surgery have high 2-year mortality risks, approaching 60% to 80%. However, the role of Child-Pugh and Model for End-Stage Liver Disease classifications of liver status in predicting survivorship among patients with HCV undergoing elective arthroplasty has not been elucidated. QUESTION/PURPOSE What factors are independently associated with early mortality (< 2 years) in patients with HCV undergoing arthroplasty? METHODS We performed a retrospective study at three tertiary academic medical centers and identified patients with HCV undergoing primary elective TJA between January 2005 and December 2019. Patients who underwent revision TJA and simultaneous primary TJA were excluded. A total of 226 patients were eligible for inclusion in the study. A further 25% (57) were excluded because they were lost to follow-up before the minimum study requirement of 2 years of follow-up or had incomplete datasets. After the inclusion and exclusion criteria were applied, the final cohort consisted of 75% (169 of 226) of the initial patient population eligible for analysis. The mean follow-up duration was 53 ± 29 months. We compared confounding variables for mortality between patients with early mortality (16 patients) and surviving patients (153 patients), including comorbidities, HCV and liver characteristics, HCV treatment, and postoperative medical and surgical complications. Patients with early postoperative mortality were more likely to have an associated advanced Child-Pugh classification and comorbidities including peripheral vascular disease, end-stage renal disease, heart failure, and chronic obstructive pulmonary disease. However, both groups had similar 90-day and 1-year medical complication risks including myocardial infarction, stroke, pulmonary embolism, and reoperations for periprosthetic joint infection and mechanical failure. A multivariable regression analysis was performed to identify independent factors associated with early mortality, incorporating all significant variables with p < 0.05 present in the univariate analysis. RESULTS After accounting for significant variables in the univariate analysis such as peripheral vascular disease, end-stage renal disease, heart failure, chronic obstructive pulmonary disease, and liver fibrosis staging, Child-Pugh Class B or C classification was found to be the sole factor independently associated with increased odds of early (within 2 years) mortality in patients with HCV undergoing elective TJA (adjusted odds ratio 29 [95% confidence interval 5 to 174]; p < 0.001). The risk of early mortality in patients with Child-Pugh Class B or C was 64% (seven of 11) compared with 6% (nine of 158) in patients with Child-Pugh Class A (p < 0.001). CONCLUSION Patients with HCV and a Child-Pugh Class B or C at the time of elective TJA had substantially increased odds of death, regardless of liver function, cirrhosis, age, Model for End-Stage Liver Disease level, HCV treatment, and viral load status. This is similar to the risk of early mortality observed in patients with chronic liver disease undergoing abdominal and cardiac surgery. Surgeons should avoid these major elective procedures in patients with Child-Pugh Class B or C whenever possible. For patients who feel their arthritic symptoms and pain are unbearable, surgeons need to be clear that the risk of death is considerably elevated. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Kyle H. Cichos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric Jordan
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kian Niknam
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Antonia F. Chen
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erik N. Hansen
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elie S. Ghanem
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Kridin K, Valido K, Cohen JM, Cohen AD. Hidradenitis suppurativa and the risk of myocardial infarction, cerebrovascular accident, and peripheral vascular disease: a population-based study. Arch Dermatol Res 2023; 315:429-435. [PMID: 35871185 DOI: 10.1007/s00403-022-02369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/03/2022] [Revised: 06/06/2022] [Accepted: 07/02/2022] [Indexed: 11/02/2022]
Abstract
Previous studies have identified an association between myocardial infarction (MI), cerebrovascular accident (CVA), and peripheral vascular disease (PVD) in patients with hidradenitis suppurativa (HS). To evaluate the risk and prognostic outcomes of MI, CVA, and PVD in patients with HS. A population-based retrospective cohort study using the computerized database of Clalit Health Services (CHS), the largest managed care organization in Israel, was conducted to compare the incidence of MI, CVA, and PVD among patients with HS (N = 6779) with age-, sex- and ethnicity-matched control subjects (N = 33,260). Adjusted hazard ratios (HRs) were estimated by multivariate Cox regression analysis. The overall incidence rates of MI, CVA, and PVD were estimated at 2.9 (2.3-3.4), 1.3 (0.9-1.7), and 0.8 (0.6-1.1) per 1000 person-year, respectively. Patients with HS were at an increased risk of developing MI (fully-adjusted HR 1.33; 95% CI 1.04-1.68; P = 0.021), but the risk of CVA (fully-adjusted HR 0.82; 95% CI 0.59-1.14; P = 0.245) and PVD (fully-adjusted HR 1.22; 95% CI 0.80-1.87; P = 0.355) was comparable relative to controls. Compared to other patients with HS, increased risk of all-cause mortality was observed among patients with HS and comorbid MI (HR 12.56; 95% CI 7.59-20.80; P < 0.001), CVA (HR 13.33; 95% CI 7.29-24.37; P < 0.001), and PVD (HR 7.11; 95% CI 2.61-19.32; P < 0.001). Patients with HS are at an increased risk of MI, but not CVA and PVD. Awareness of these epidemiological findings is of importance for clinicians managing patients with HS.
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Affiliation(s)
- Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Poria Medical Center, Poriya, Israel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, 15 York St, New Haven, CT, 06510, USA.
| | - Arnon D Cohen
- Department of Quality Measures and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Doelare SAN, Koedam TWA, Ebben HP, Tournoij E, Hoksbergen AWJ, Yeung KK, Jongkind V. Catheter Directed Thrombolysis for Not Immediately Threatening Acute Limb Ischaemia: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2023; 65:537-545. [PMID: 36608784 DOI: 10.1016/j.ejvs.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/11/2022] [Revised: 11/29/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis reports the outcomes of catheter directed thrombolysis (CDT) in patients with not immediately threatening (Rutherford I) acute lower limb ischaemia (ALI). DATA SOURCES PubMed, Embase, and the Cochrane Library. REVIEW METHODS A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify observational studies and trials published between 1990 and 2022 reporting on the results of CDT in patients with Rutherford I ALI. A meta-analysis was performed using a random effects model with 95% confidence intervals (CIs). The outcomes of interests were treatment duration, angiographic success, bleeding complications, amputation and mortality rates, primary and secondary patency, and functional outcome expressed as pain free walking distance. RESULTS Thirty-nine studies were included, comprising 1 861 patients who received CDT for not immediately threatening ALI. Funnel plots showed an indication of publication bias, and heterogeneity was substantial. Data from 5 to 13 studies were included in the meta-analysis. The pooled treatment duration was 2 days (95% CI 1 - 2), with an angiographic success rate of 80% (95% CI 73 - 86) and a 30 day freedom of amputation rate of 98% (95% CI 92 - 100). The major bleeding rate was 5% (95% CI 2 - 14), with a 30 day mortality rate of 3% (95% CI 1 - 5). The amputation free survival rate was 71% (95% CI 62 - 80) at the one year and 63% (95% CI 51 - 73) at the three year follow up. Long term patency rates were retrieved from four studies: 48% at one year (95% CI 27 - 70). No data could be retrieved on patient walking distance. CONCLUSION Although CDT in the treatment of not immediately threatening ALI showed high angiographic success, the long term outcomes were relatively poor, with low patency and a substantial risk of major amputation. Further research is required to interpret the outcome of CDT in the context of potential confounders such as age and comorbidities.
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Affiliation(s)
- Sabrina A N Doelare
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Thomas W A Koedam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Surgery, Dijklander Hospital, Hoorn, the Netherlands
| | - Harm P Ebben
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Erik Tournoij
- Department of Surgery, Dijklander Hospital, Hoorn, the Netherlands
| | - Arjan W J Hoksbergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Kak K Yeung
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Vincent Jongkind
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Surgery, Dijklander Hospital, Hoorn, the Netherlands
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13
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Doelare SAN, Oukrich S, Ergin K, Jongkind V, Wiersema AM, Lely RJ, Ebben HP, Yeung KK, Hoksbergen AWJ. Major Bleeding During Thrombolytic Therapy for Acute Lower Limb Ischaemia: Value of Laboratory Tests for Clinical Decision Making, 17 Years of Experience. Eur J Vasc Endovasc Surg 2023; 65:398-404. [PMID: 36343749 DOI: 10.1016/j.ejvs.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 06/08/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Regular measurement of fibrinogen as dose guidance in catheter directed thrombolysis (CDT) for acute limb ischaemia (ALI) has recently been dropped from European guidelines based on inconsistent literature. This study aimed to determine whether low fibrinogen levels and high activated partial thromboplastin time (APTT) are associated with an increased major bleeding risk during CDT. METHODS All consecutive patients treated with CDT for ALI in two Dutch hospitals between January 2004 and April 2021 were analysed retrospectively. Patients were treated with two dosing regimens (low dose: 50 000 IU/hour; high dose: 100 000 IU/hour) of urokinase and, after 2018, with a single low dose regimen of alteplase (rtPA) due to urokinase manufacturing problems. The incidence of major bleeding and associated APTT and fibrinogen levels were reviewed from patient charts. RESULTS Of the 443 included cases, 277 underwent CDT with urokinase and 166 with rtPA. The incidence of major bleeding in the whole cohort was 7%. Patients with a fibrinogen levels < 1.0 g/L developed more major bleeding than those in whom the fibrinogen level did not drop below 1.0 g/L (15% vs. 6%; p = .041). Systemic heparinisation during CDT or high (> 80 seconds) APTT were not significantly associated with major bleeding. Angiographic success (47% vs. 72%; p = .003) and 30 day amputation free survival (53% vs. 82%; p < .001) were lower for cases with major bleeding. Older age (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02 - 1.11), cardiac history (OR 3.35, 95% CI 1.39 - 8.06), high dose regimens (≥ 75 000 IU/hour urokinase; OR 2.67, 95% CI 1.18 - 6.04), and fibrinogen values < 1.0 g/L (OR 5.59, 95% CI 1.98 - 15.77) were independent predictors for major bleeding during CDT. CONCLUSION High dose thrombolytic regimens and fibrinogen levels of ≤ 1.0 g/L are associated with more major bleeding during thrombolytic therapy. Major bleeding significantly worsened the clinical outcome. A prospective comparative study is needed to assess the benefit of monitoring fibrinogen levels.
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Affiliation(s)
- Sabrina A N Doelare
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Safae Oukrich
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Kübra Ergin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Vincent Jongkind
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Surgery, Dijklander Hospital, Hoorn, the Netherlands
| | - Arno M Wiersema
- Department of Surgery, Dijklander Hospital, Hoorn, the Netherlands
| | - Rutger J Lely
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Harm P Ebben
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Kak K Yeung
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Arjan W J Hoksbergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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14
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Paquette M, Bernard S, Baass A. Dysbetalipoproteinemia Is Associated With Increased Risk of Coronary and Peripheral Vascular Disease. J Clin Endocrinol Metab 2022; 108:184-190. [PMID: 36056815 DOI: 10.1210/clinem/dgac503] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/12/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Dysbetalipoproteinemia (DBL) is a disorder in which remnant lipoproteins accumulate in the plasma due to a genetic apolipoprotein E dysfunction in conjunction with the presence of secondary metabolic factors. An increased risk of both coronary and peripheral vascular disease (PVD) has been observed in these patients in retrospective studies. OBJECTIVE The primary objective was to compare the incidence of atherosclerotic cardiovascular disease (ASCVD) and PVD in a cohort of patients with DBL compared with normolipidemic controls. As a secondary objective, the incidence of ASCVD and PVD was compared between patients with DBL and patients with familial hypercholesterolemia (FH). METHODS A total of 221 patients with DBL, 725 patients with FH, and 1481 normolipidemic controls were included in the study. The data were obtained by review of medical records. RESULTS In patients with DBL, there was an overall excess risk of PVD (hazard ratio [HR] 13.58, 95% CI 4.76-38.75) and ASCVD (HR 3.55, 95% CI 2.17-5.83) (P < .0001) when compared with normolipidemic controls. When compared with patients with FH, an increased risk of PVD (HR 3.89, 95% CI 1.20-12.55, P = .02) was observed in patients with DBL. CONCLUSION We demonstrated that the risks of ASCVD and PVD in DBL are >3-fold and >13-fold higher, respectively, than normolipidemic controls. Furthermore, the risk of PVD is ∼4-fold higher in DBL than in FH. Adequate screening of DBL is imperative to improve the clinical care of these patients by preventing the development of ASCVD.
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Affiliation(s)
- Martine Paquette
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, QC, Canada
| | - Sophie Bernard
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Medicine, Division of Endocrinology, Université de Montreal, Montreal, QC, Canada
| | - Alexis Baass
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Montreal, QC, Canada
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15
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Li SR, Reitz KM, Kennedy J, Gabriel L, Phillips AR, Shireman PK, Eslami MH, Tzeng E. Epidemiology of age-, sex-, and race-specific hospitalizations for abdominal aortic aneurysms highlights gaps in current screening recommendations. J Vasc Surg 2022; 76:1216-1226.e4. [PMID: 35278654 PMCID: PMC9458770 DOI: 10.1016/j.jvs.2022.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/24/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The detection and elective repair of abdominal aortic aneurysms (AAA) guided by known risk-factor specific screening decrease AAA-related mortality. However, minimal epidemiologic data exist for AAA in female persons and racial minority groups. We established the contemporary risk of US AAA hospitalization across age, sex, and race. METHODS National Inpatient Sample and US Census (2012-2018) data were used to quantify age-, sex-, and race-specific incidences and adjusted odds ratios (aOR) of AAA hospitalizations (≥18 years), associated risk factors, and in-hospital mortality. Interaction terms evaluated subgroups. RESULTS Among 1,728,374,183 US residents during the study period (51.3% female; 78.4% White, 12.7% Black, 5.7% Asian), 211,501,703 were hospitalized (aged 57.56 ± 0.04 years; 58.4% female; 64.9% White, 14.3% Black, 2.5% Asian) of which 291,850 were for AAA (aged 73.17 ± 0.04 years; 22.6% female; 81.8% White, 5.6% Black, 1.6% Asian). An estimated 15.2 (95% CI, 15.1-15.3) and 1.7 (95% CI, 1.7-1.7) hospitalizations per 100,000 residents were for intact AAA (iAAA) and ruptured AAA (rAAA) AAA, respectively. In addition, 16.2% of iAAA (83.8% male; 79.1% White) and 18.4% of rAAA (86.4% male; 75.0% White) hospitalizations occurred in patients less than 65 years of age. For iAAA, female sex (aOR, 0.27; 95% CI, 0.27-0.28) compared with male sex and both Black (0.47; 95% CI, 0.45-0.49) and Asian (0.86; 95% CI, 0.83-0.93) persons compared with White persons had a reduced aOR for hospitalization. For rAAA, the reduced aOR persisted for female sex (0.33; 95% CI, 0.32-0.36) and for Black persons (0.52; 95% CI, 0.46-0.58). Although female sex demonstrated an overall decreased odds of AAA hospitalization, female persons who were older, Black, or had peripheral vascular disease (Pinteractions < .001) had a relative increase in AAA hospitalization aOR. Female sex (aOR, 1.54; 95% CI, 1.38-1.70), but not Black or Asian race, was associated with increased mortality which was more pronounced for iAAA (1.93; 95% CI, 1.66-2.25) than rAAA (1.29; 95% CI, 1.13-1.48]; Pinteraction < .001). CONCLUSIONS We confirmed a substantially decreased adjusted risk of AAA hospitalization for females and racial minority groups; however, aging and comorbid peripheral vascular disease decreased these differences. The disparate risk of AAA hospitalization by sex and race highlights the importance of inclusivity in future AAA studies.
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Affiliation(s)
- Shimena R Li
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Katherine M Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
| | - Jason Kennedy
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lucine Gabriel
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Amanda R Phillips
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Paula K Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX; University Health, San Antonio, TX
| | - Mohammad H Eslami
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Edith Tzeng
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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16
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Liu B, Mason AM, Sun L, Di Angelantonio E, Gill D, Burgess S. Genetically Predicted Type 2 Diabetes Mellitus Liability, Glycated Hemoglobin and Cardiovascular Diseases: A Wide-Angled Mendelian Randomization Study. Genes (Basel) 2021; 12:1644. [PMID: 34681038 PMCID: PMC8536164 DOI: 10.3390/genes12101644] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Aim: To investigate the causal effects of T2DM liability and glycated haemoglobin (HbA1c) levels on various cardiovascular disease outcomes, both in the general population and in non-diabetic individuals specifically. (2) Methods: We selected 243 variants as genetic instruments for T2DM liability and 536 variants for HbA1c. Linear Mendelian randomization analyses were performed to estimate the associations of genetically-predicted T2DM liability and HbA1c with 12 cardiovascular disease outcomes in 367,703 unrelated UK Biobank participants of European ancestries. We performed secondary analyses in participants without diabetes (HbA1c < 6.5% with no diagnosed diabetes), and in participants without diabetes or pre-diabetes (HbA1c < 5.7% with no diagnosed diabetes). (3) Results: Genetically-predicted T2DM liability was positively associated (p < 0.004, 0.05/12) with peripheral vascular disease, aortic valve stenosis, coronary artery disease, heart failure, ischaemic stroke, and any stroke. Genetically-predicted HbA1c was positively associated with coronary artery disease and any stroke. Mendelian randomization estimates generally shifted towards the null when excluding diabetic and pre-diabetic participants from analyses. (4) Conclusions: This genetic evidence supports causal effects of T2DM liability and HbA1c on a range of cardiovascular diseases, suggesting that improving glycaemic control could reduce cardiovascular risk in a general population, with greatest benefit in individuals with diabetes.
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Affiliation(s)
- Bowen Liu
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Amy M. Mason
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
| | - Luanluan Sun
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Genetics Department, Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford OX3 7FZ, UK
- Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK
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Karaçağlar E, Akgün AN, Aydınalp A, Beyazpınar DS, Sezgin A, Müderrisoğlu H. Direct aortic transcatheter aortic valve implantation. Turk Kardiyol Dern Ars 2021; 49:585-587. [PMID: 34623302 DOI: 10.5543/tkda.2021.21018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/13/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a safe and effective alternative to surgical valve replacement in intermediate and even in low-risk patient cohorts. Direct aortic (DAo) route may be used in patients with severe peripheral vascular disease. Here, we present an 88-year old patient hospitalized with cardiogenic shock. Echocardiography revealed severe aortic valve stenosis with aortic valve area 0.5 cm², mean gradient of 55 mmHg, and peak gradient 92 mmHg. TAVI was considered by the Institutional Heart Team. Multislice computed tomography (MSCT) revealed severe peripheral vascular disease, decreased calibration of abdominal aorta, and multiple large vulnerable atherosclerotic plaques. The patient was scheduled for a DAo TAVI. A 26-mm Medtronic CoreValve Evolut R valve was implanted after predilatation with median sternotomy. The patient was discharged after 96 hours. Although transfemoral (TF) access is used as the default approach for TAVI, it was contraindicated in our patient owing to severe peripheral vascular disease and decreased calibration of the abdominal aorta at its narrowest point (4.5 mm) with multiple large vulnerable atherosclerotic plaques. Careful preprocedural MSCT evaluation is essential and directly affects the success of the procedure. MSCT is also mandatory to confirm the best cannulation zone that must be met for a successful DAo TAVI.
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Affiliation(s)
- Emir Karaçağlar
- Department of Cardiology, Başkent University School of Medicine, Ankara, Turkey
| | - Arzu Neslihan Akgün
- Department of Cardiology, Başkent University School of Medicine, Ankara, Turkey
| | - Alp Aydınalp
- Department of Cardiology, Başkent University School of Medicine, Ankara, Turkey
| | - Deniz Sarp Beyazpınar
- Department of Cardiovascular Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Atila Sezgin
- Department of Cardiovascular Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Haldun Müderrisoğlu
- Department of Cardiology, Başkent University School of Medicine, Ankara, Turkey
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Leal J, Alva M, Gregory V, Hayes A, Mihaylova B, Gray AM, Holman RR, Clarke P. Estimating risk factor progression equations for the UKPDS Outcomes Model 2 (UKPDS 90). Diabet Med 2021; 38:e14656. [PMID: 34297424 DOI: 10.1111/dme.14656] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/21/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To estimate 13 equations that predict clinically plausible risk factor time paths to inform the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model version 2 (UKPDS-OM2). METHODS Data from 5102 UKPDS participants from the 20-year trial, and the 4031 survivors with 10 years further post-trial follow-up, were used to derive equations for the time paths of 13 clinical risk factors: HbA1c , systolic blood pressure, LDL-cholesterol, HDL-cholesterol, BMI, micro- or macro-albuminuria, creatinine, heart rate, white blood cell count, haemoglobin, estimated glomerular filter rate, atrial fibrillation and peripheral vascular disease (PVD). The incidence of events and death predicted by the UKPDS-OM2 when informed by the new risk factor equations was compared with the observed cumulative rates up to 25 years. RESULTS The new equations were based on 24 years of follow-up and up to 65,252 person-years of data. Women were associated with higher values of all continuous risk factors except for haemoglobin. Older age and higher BMI at diagnosis were associated with higher rates of PVD (HR 1.06 and 1.02), atrial fibrillation (HR 1.10 and 1.08) and micro- or macro-albuminuria (HR 1.01 and 1.18). Smoking was associated with higher rates of developing PVD (HR 2.38) and micro- and macro-albuminuria (HR 1.39). The UKPDS-OM2, informed by the new risk factor equations, predicted event rates for complications and death consistent with those observed. CONCLUSIONS The new equations allow risk factor time paths beyond observed data, which should improve modelling of long-term health outcomes for people with type 2 diabetes when using the UKPDS-OM2 or other models.
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Affiliation(s)
- Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria Alva
- Massive Data Institute, Georgetown University, Washington, DC, USA
| | - Vanessa Gregory
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Rury R Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Philip Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Centre Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Abstract
BACKGROUND Peripheral arterial disease (PAD) affects between 4% and 12% of people aged 55 to 70 years, and 20% of people over 70 years. A common complaint is intermittent claudication (exercise-induced lower limb pain relieved by rest). These patients have a three- to six-fold increase in cardiovascular mortality. Cilostazol is a drug licensed for the use of improving claudication distance and, if shown to reduce cardiovascular risk, could offer additional clinical benefits. This is an update of the review first published in 2007. OBJECTIVES To determine the effect of cilostazol on initial and absolute claudication distances, mortality and vascular events in patients with stable intermittent claudication. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and AMED databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries, on 9 November 2020. SELECTION CRITERIA We considered double-blind, randomised controlled trials (RCTs) of cilostazol versus placebo, or versus other drugs used to improve claudication distance in patients with stable intermittent claudication. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for selection and independently extracted data. Disagreements were resolved by discussion. We assessed the risk of bias with the Cochrane risk of bias tool. Certainty of the evidence was evaluated using GRADE. For dichotomous outcomes, we used odds ratios (ORs) with corresponding 95% confidence intervals (CIs) and for continuous outcomes we used mean differences (MDs) and 95% CIs. We pooled data using a fixed-effect model, or a random-effects model when heterogeneity was identified. Primary outcomes were initial claudication distance (ICD) and quality of life (QoL). Secondary outcomes were absolute claudication distance (ACD), revascularisation, amputation, adverse events and cardiovascular events. MAIN RESULTS We included 16 double-blind, RCTs (3972 participants) comparing cilostazol with placebo, of which five studies also compared cilostazol with pentoxifylline. Treatment duration ranged from six to 26 weeks. All participants had intermittent claudication secondary to PAD. Cilostazol dose ranged from 100 mg to 300 mg; pentoxifylline dose ranged from 800 mg to 1200 mg. The certainty of the evidence was downgraded by one level for all studies because publication bias was strongly suspected. Other reasons for downgrading were imprecision, inconsistency and selective reporting. Cilostazol versus placebo Participants taking cilostazol had a higher ICD compared with those taking placebo (MD 26.49 metres; 95% CI 18.93 to 34.05; 1722 participants; six studies; low-certainty evidence). We reported QoL measures descriptively due to insufficient statistical detail within the studies to combine the results; there was a possible indication in improvement of QoL in the cilostazol treatment groups (low-certainty evidence). Participants taking cilostazol had a higher ACD compared with those taking placebo (39.57 metres; 95% CI 21.80 to 57.33; 2360 participants; eight studies; very-low certainty evidence). The most commonly reported adverse events were headache, diarrhoea, abnormal stools, dizziness, pain and palpitations. Participants taking cilostazol had an increased odds of experiencing headache compared to participants taking placebo (OR 2.83; 95% CI 2.26 to 3.55; 2584 participants; eight studies; moderate-certainty evidence).Very few studies reported on other outcomes so conclusions on revascularisation, amputation, or cardiovascular events could not be made. Cilostazol versus pentoxifylline There was no difference detected between cilostazol and pentoxifylline for improving walking distance, both in terms of ICD (MD 20.0 metres, 95% CI -2.57 to 42.57; 417 participants; one study; low-certainty evidence); and ACD (MD 13.4 metres, 95% CI -43.50 to 70.36; 866 participants; two studies; very low-certainty evidence). One study reported on QoL; the study authors reported no difference in QoL between the treatment groups (very low-certainty evidence). No study reported on revascularisation, amputation or cardiovascular events. Cilostazol participants had an increased odds of experiencing headache compared with participants taking pentoxifylline at 24 weeks (OR 2.20, 95% CI 1.16 to 4.17; 982 participants; two studies; low-certainty evidence). AUTHORS' CONCLUSIONS Cilostazol has been shown to improve walking distance in people with intermittent claudication. However, participants taking cilostazol had higher odds of experiencing headache. There is insufficient evidence about the effectiveness of cilostazol for serious events such as amputation, revascularisation, and cardiovascular events. Despite the importance of QoL to patients, meta-analysis could not be undertaken because of differences in measures used and reporting. Very limited data indicated no difference between cilostazol and pentoxifylline for improving walking distance and data were too limited for any conclusions on other outcomes.
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Affiliation(s)
- Tamara Brown
- Cochrane Vascular, University of Edinburgh, Edinburgh, UK
| | - Rachel B Forster
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Gerard Stansby
- Northern Vascular Centre, Freeman Hospital, Newcastle, UK
| | - Marlene Stewart
- Cochrane Vascular, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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20
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Sirufo MM, Ginaldi L, De Martinis M. Peripheral Vascular Abnormalities in Anorexia Nervosa: A Psycho-Neuro-Immune-Metabolic Connection. Int J Mol Sci 2021; 22:5043. [PMID: 34068698 PMCID: PMC8126077 DOI: 10.3390/ijms22095043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 02/24/2021] [Revised: 04/27/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Immune, neuroendocrine, and autonomic nervous system dysregulation in anorexia nervosa lead to cardiovascular complications that can potentially result in increased morbidity and mortality. It is suggested that a complex non-invasive assessment of cardiovascular autonomic regulation-cardiac vagal control, sympathetic vascular activity, and cardiovascular reflex control-could represent a promising tool for early diagnosis, personalized therapy, and monitoring of therapeutic interventions in anorexia nervosa particularly at a vulnerable adolescent age. In this view, we recommend to consider in the diagnostic route, at least in the subset of patients with peripheral microvascular symptoms, a nailfold video-capillaroscopy as an easy not invasive tool for the early assessing of possible cardiovascular involvement.
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Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
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21
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Ishii K, Mizuuchi T, Yamamoto Y, Mori H, Tago M, Kato E, Hayashi H, Tahara K, Sawada T. Development of Eosinophilic Temporal Arteritis and Digital Ischemia in a Patient with Hypereosinophilic Syndrome. Intern Med 2020; 59:1323-1330. [PMID: 32101832 PMCID: PMC7303445 DOI: 10.2169/internalmedicine.3707-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We describe a case of eosinophilic temporal arteritis in a 61-year-old woman with hypereosinophilic syndrome, who developed subcutaneous nodules in the temporal areas and digital cyanosis with small nodules on the sides of her fingers. Ultrasound revealed occlusion and corkscrew-like changes of the temporal and digital arteries, respectively. Temporal artery biopsy revealed eosinophilic vasculitis without giant cell formation. Angiography showed occlusion of the ulnar and digital arteries. Administration of low-dose corticosteroid improved the temporal artery swelling and digital cyanosis. More reports of similar cases are required to characterize this type of non-giant cell eosinophilic vasculitis that affects the peripheral arteries.
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Affiliation(s)
- Kayo Ishii
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Takahiro Mizuuchi
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Yusuke Yamamoto
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Hiroaki Mori
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Mayu Tago
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Eri Kato
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Haeru Hayashi
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Koichiro Tahara
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
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22
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Black C, Fan KL, Defazio MV, Luvisa K, Reynolds K, Kotha VS, Attinger CE, Evans KK. Limb Salvage Rates and Functional Outcomes Using a Longitudinal Slit Arteriotomy End-to-Side Anastomosis for Limb-Threatening Defects in a High-Risk Patient Population. Plast Reconstr Surg 2020; 145:1302-1312. [PMID: 32332556 DOI: 10.1097/prs.0000000000006791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
BACKGROUND Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates. METHODS A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.). RESULTS One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years. CONCLUSIONS This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Cara Black
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Kenneth L Fan
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Michael V Defazio
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Kyle Luvisa
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Kyle Reynolds
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Vikas S Kotha
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Christopher E Attinger
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Karen K Evans
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
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23
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Rocha-Neves J, Ferreira A, Pereira-Neves A, Ferreira-Castro J, Macedo J, Pinto A, Sousa J, Dias-Neto M, Teixeira J. The Peripheral Artery Questionnaire Validation Of The Portuguese Version. Rev Port Cir Cardiotorac Vasc 2020; 27:23-31. [PMID: 32239822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Indexed: 06/11/2023]
Abstract
Peripheral Arterial Disease (PAD) is a prevalent condition that predisposes the patients to major cardiovascular events. The majority of patients are asymptomatic, however PAD has a great impact in the patients' lifestyle due to its chronic nature. The Peripheral Arterial Questionnaire (PAQ) is a validated tool to quantify the patients' subjective experience of the disease. The aim of this work is to validate the Portuguese version of PAQ. A retrospective study of 59 patients with aortoiliac disease Trans-Atlantic Inter Society Consensus (TASC) type D from two centers in Portugal was conducted. Only 36 patients were able to answer the PAQ and two Portuguese validated questionnaires - a disease-specific (Walk Impairment Questionnaire - WIQ) and a generic one (EuroQol 5 dimensions - 5 level EQ5D-5L). Con- vergent validity of the PAQ was evaluated by correlating the extracted PAQ subscales and Summary score with the WIQ subscales and summary score, as with EQ5D-5L Summary score and EQ5D-5L index by calculating the covariance. The Portuguese version of the peripheral artery questionnaire presented a Cronbach's α for the Summary scale of 0.913. Mean inter-item correlation for the Physical Function domain was 0.471, 0.551 for the Perceived Disability, and 0.464 for Treat- ment Satisfaction. In summary, the Portuguese version of PAQ demonstrated a good level of discrimination between patients with or without symptomatic PAD and its severity and was sensitive to the presence of risk-factors relevant for PAD.
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Affiliation(s)
- João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto; Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - André Ferreira
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal
| | - António Pereira-Neves
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto; Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - João Ferreira-Castro
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto; Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Juliana Macedo
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal
| | - Ana Pinto
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal
| | - Joel Sousa
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - José Teixeira
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal
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Đurović Sarajlić V, Totić D, Bičo Osmanagić A, Gojak R, Lincender L. Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment Planning in Critical Limb Ischemia? Psychiatr Danub 2019; 31:814-820. [PMID: 32160177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). SUBJECTS AND METHODS The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics. RESULTS Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. CONCLUSION 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.
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Affiliation(s)
- Vesna Đurović Sarajlić
- Department for Vascular and Interventional Radiology, Clinic for Radiology, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina,
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25
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Kodaira M, Sawano M, Kuno T, Numasawa Y, Noma S, Suzuki M, Imaeda S, Ueda I, Fukuda K, Kohsaka S. Outcomes of acute coronary syndrome patients with concurrent extra-cardiac vascular disease in the era of transradial coronary intervention: A retrospective multicenter cohort study. PLoS One 2019; 14:e0223215. [PMID: 31618228 PMCID: PMC6795465 DOI: 10.1371/journal.pone.0223215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background Extra-cardiac vascular diseases (ECVDs), such as cerebrovascular disease (CVD) or peripheral arterial disease (PAD), are frequently observed among patients with acute coronary syndrome (ACS). However, it is not clear how these conditions affect patient outcomes in the era of transradial coronary intervention (TRI). Methods and results Among 7,980 patients with ACS whose data were extracted from the multicenter Japanese percutaneous coronary intervention (PCI) registry between August 2008 and March 2017, 888 (11.1%) had one concurrent ECVD (either PAD [345 patients: 4.3%] or CVD [543 patients; 6.8%]), while 87 patients (1.1%) had both PAD and CVD. Overall, the presence of ECVD was associated with a higher risk of mortality (odds ratio [OR]: 1.728; 95% confidence interval [CI]: 1.183–2.524) and bleeding complications (OR: 1.430; 95% CI: 1.028–2.004). There was evidence of interaction between ECVD severity and procedural access site on bleeding complication on the additive scale (relative excess risk due to interaction: 0.669, 95% CI: -0.563–1.900) and on the multiplicative scale (OR: 2.105; 95% CI: 1.075–4.122). While the incidence of death among patients with ECVD remained constant during the study period, bleeding complications among patients with ECVD rapidly decreased from 2015 to 2017, in association with the increasing number of TRI. Conclusions Overall, the presence of ECVD was a risk factor for adverse outcomes after PCI for ACS, both mortality and bleeding complications. In the most recent years, the incidence of bleeding complications among patients with ECVD decreased significantly coinciding with the rapid increase of TRI.
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Affiliation(s)
- Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
- * E-mail:
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, United States of America
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Shohei Imaeda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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de Weger VA, Stam F. [Een rood en gezwollen gelaat na heffen van de armen]. Ned Tijdschr Geneeskd 2019; 163:D3776. [PMID: 31556494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An 82-year-old woman attended our outpatient clinic because of a swollen right arm and hoarseness. Upon raising both arms, the patient developed a red and swollen face (Pemberton's sign). An MRI of the thorax showed a large intrathoracic goitre, which compressed venous structures and limited blood flow even when she lowered her arms.
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Affiliation(s)
- Vincent A de Weger
- Noordwest Ziekenhuisgroep, afd. Interne Geneeskunde, Alkmaar
- Contact: V.A. de Weger
| | - Frank Stam
- Noordwest Ziekenhuisgroep, afd. Interne Geneeskunde, Alkmaar
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27
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Ab Mumin N, Azman RR, Chan WY. Venous congestion from brachiocephalic vein stenosis mimicking sclerotic vertebral lesions. Med J Malaysia 2019; 74:240-242. [PMID: 31256183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In central venous obstruction, vertebral marrow enhancement (VME) may be seen secondary to collateral venous flow via the vertebral venous plexus.1 There are only sporadic case reports on pseudolesions due to collateral enhancement mimicking sclerotic osseous metastasis. This abnormal vertebral enhancement may lead to erroneous diagnosis of sclerotic metastases or suspicious bone lesion which affect the management and prognosis. We describe a case of brachiocephalic vein obstruction-related vertebral body pseudolesions as identified in contrast-enhanced computed tomography (CECT) scan.
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Affiliation(s)
- N Ab Mumin
- Universiti Teknologi MARA, Faculty of Medicine, Radiology Department, Sungai Buloh, Selangor, Malaysia.
| | - R R Azman
- Universiti Malaya Medical Centre, Faculty of Medicine, Biomedical Imaging Department, Kuala Lumpur, Malaysia
| | - W Y Chan
- Universiti Malaya Medical Centre, Faculty of Medicine, Biomedical Imaging Department, Kuala Lumpur, Malaysia
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28
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Bourron O. [Lower limb arterial disease in patients with diabetes]. Rev Prat 2019; 69:620-625. [PMID: 31626417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Lower limb arteriopathy is a frequent and potentially serious complication of diabetes. In fact, it largely explains the high incidence of lower limb amputations in diabetic patients as well as a significant impairment of quality of life in the case of intermittent claudication or decubitus pain. The severity of the disease is also based on the associated cardiovascular morbidity and mortality. The diagnosis is primarily made by the clinical examination, completed by functional hemodynamic tests (ankle/brachial index, transcutaneous oxygen pressure and toe pressure) and possibly imaging tests (arterial Doppler and arteriography of the lower limbs). The treatment of lower limbs arterial disease will depend on the vascular symptomatology, the severity of the vascular lesions evaluated by the hemodynamic tests and by the anatomical characteristics of the vascular lesions.
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Affiliation(s)
- Olivier Bourron
- Sorbonne Université, service de diabétologie et métabolisme, groupe hospitalier La Pitié-Salpêtrière, Assistance publique- Hôpitaux de Paris, Paris, France
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Khan AR, Shaikh FA, Riaz A, Sophie Z, Siddiqui NA. Why do patients with limb ischaemia present late to a vascular surgeon? A prospective cohort study from the developing world. J PAK MED ASSOC 2019; 69(Suppl 1):S3-S6. [PMID: 30697009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To look into the factors responsible for delay in presentation of Iimb ischemia patients to a vascular surgeon. Methods The prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, from October 01, 2016, to August 10, 2018. Patients coming with delayed presentation of both acute and chronic limb ischemia were included. All the patients were assessed by qualified vascular surgeons. SPSS 23 was used for data analysis. Results Of the 55 patients, 33(60%) had acute and 22(40%) had chronic limb ischaemia. Mean age of acute cases was 44±23.72 years and it was 60±12.49 years for chronic cases. Overall, the commonest reason behind delay was non-referral by primary physician which was the case with 11(33.3%) patients in the acute group, and 13(59%) in the chronic group. The limb loss in the acute group was 20(60%) and 8(36%) in the chronic group.. Conclusion Delayed presentation of patients with limb ischaemia is mainly due to non-referral. A robust campaign needs to be launched to reduce the rate of limb loss.
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Affiliation(s)
- Amna Riaz Khan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Asma Riaz
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ziad Sophie
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Higson W. The value of the Lindsay Leg Club Foundation. Br J Community Nurs 2018; 23:S40-S41. [PMID: 30521359 DOI: 10.12968/bjcn.2018.23.sup12.s40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Wendy Higson
- Tissue Viability Nurse, Adam Practice Surgery, The Best Foot Forward Leg Club
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Affiliation(s)
- Alik Farber
- From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston
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Abstract
PURPOSE OF REVIEW Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control. RECENT FINDINGS Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications. Studies evaluating tight glucose control do not demonstrate improvement in clinical outcomes, although the risk for hypoglycemia increases substantially. Additional studies are needed to evaluate tight glucose goals relative to our current standard of care and the role of permissive hyperglycemia. Given the limited data to guide glycemic management in these patient populations, it is recommended that general guidelines for inpatient glycemic control be followed. Special considerations should be made to address factors that may impact glucose management, including neurological deficits and clinical changes that occur in the postoperative state.
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Affiliation(s)
- Estelle Everett
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA.
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Anselmo DS, McGuire JB, Love E, Vlahovic T. Application of Viable Cryopreserved Human Placental Membrane Grafts in the Treatment of Wounds of Diverse Etiologies: A Case Series. Wounds 2018; 30:57-61. [PMID: 29584601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED There is evidence in the literature that viable cryopreserved human placental membrane (vCHPM) grafts are effective in treating diabetic foot ulcers and venous leg ulcers. OBJECTIVE This case series presents 3 cases of chronic ulcerations - 1 arterial ulcer (AU), 1 pressure ulcer (PU), and 1 recurrence of a pyoderma gangrenosum ulcer (PGU) - that had failed previous courses of standard wound care and were subsequently treated with vCHPM to determine if the treatment is an effective modality for treating wounds of these etiologies. MATERIALS AND METHODS This retrospective review describes 3 cases in which patients with chronic wounds that had failed standard of care treatments for more than 4 weeks were subsequently treated with weekly applications of vCHPM. Each wound area was recorded and photographed on a weekly basis and wound area reduction also was charted weekly. RESULTS The PU and AU both reached full closure in 4 and 5 weeks, respectively, without complication. The patient with the PGU achieved 64% closure after 9 applications of vCHPM. CONCLUSIONS Viable CHPM is an effective treatment modality for wounds of diverse etiologies and shows better results than have been previously published with standard of care. In patients with PGUs, medical optimization and close management of comorbidities is essential in achieving optimal results.
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Affiliation(s)
| | - James B McGuire
- Director, Leonard S. Abrams Center for Advanced Wound Healing, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Ebony Love
- Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Tracey Vlahovic
- Temple University School of Podiatric Medicine, Philadelphia, PA
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Lambert CT, Jaber W. No fire in the belly: SPECT diagnosis of ruptured abdominal aortic aneurysm. J Nucl Cardiol 2018; 25:351-355. [PMID: 27966188 DOI: 10.1007/s12350-016-0746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Cameron T Lambert
- Department of Cardiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
| | - Wael Jaber
- Department of Cardiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
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Lysenko ER, Azarian AS, Griaznov OG, Amirova AV, Bushueva EV, Troitskiĭ AV. [Results of hybrid loop endarterectomy from the superficial femoral artery with the MultiTASC]. Angiol Sosud Khir 2018; 24:172-177. [PMID: 29924788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to analyse the results of hybrid loop endarterectomy from the superficial femoral artery (SFA) in its occlusion, preformed in a total of forty-two patients. Of these, 27 patients had prior to the intervention been diagnosed with stage II B ischaemia and 15 patients had been diagnosed as having critical ischaemia. Technical success of the operation amounted to 88%, with the frequency of early thromboses equalling 2.7%. In the early postoperative period, one patient died of acute myocardial infarction. The 1-, 2- and 3-year remote cumulative primary patency rate amounted to 81, 74 and 74%, respectively. There were no amputations performed within the timeframe of the follow-up period. The technique of hybrid loop endarterectomy with the MultiTASC loop followed by stenting of the proximal portion of the popliteal artery in occlusion of the SFA and stenoses of the common femoral artery has proved to be a highly efficient intervention yielding good immediate and remote results.
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Affiliation(s)
- E R Lysenko
- Federal Clinical Centre for High Medical Technologies under the Federal Medical and Biological Agency of the Russian Federation, Novogorsk, Russia; Department of Cardiovascular Surgery, Institute of Postgraduate Professional Education, Federal Medical Biophysical Centre named after A.I. Burnazyan under the Federal Medical and Biological Agency of the Russian Federation, Moscow, Russia
| | - A S Azarian
- Federal Clinical Centre for High Medical Technologies under the Federal Medical and Biological Agency of the Russian Federation, Novogorsk, Russia
| | - O G Griaznov
- Federal Clinical Centre for High Medical Technologies under the Federal Medical and Biological Agency of the Russian Federation, Novogorsk, Russia
| | - A V Amirova
- Federal Clinical Centre for High Medical Technologies under the Federal Medical and Biological Agency of the Russian Federation, Novogorsk, Russia
| | - E V Bushueva
- Federal Clinical Centre for High Medical Technologies under the Federal Medical and Biological Agency of the Russian Federation, Novogorsk, Russia; Department of Cardiovascular Surgery, Institute of Postgraduate Professional Education, Federal Medical Biophysical Centre named after A.I. Burnazyan under the Federal Medical and Biological Agency of the Russian Federation, Moscow, Russia
| | - A V Troitskiĭ
- Department of Cardiovascular Surgery, Institute of Postgraduate Professional Education, Federal Medical Biophysical Centre named after A.I. Burnazyan under the Federal Medical and Biological Agency of the Russian Federation, Moscow, Russia
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Gavrilenko AV, Kravchenko AA, Kotov AÉ, Kirichenko VV. [Hybrid reconstructions in patients with lower limb chronic ischaemia and multilevel arterial lesions]. Angiol Sosud Khir 2018; 24:183-187. [PMID: 30321165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Presented herein is a review of the literature related to performing hybrid operations for multilevel lesions of the arteries of the lower limbs. This is accompanied and followed by analysing the data on variants of stagewise use of different methods of revascularization in hybrid interventions ("open" and endovascular) on the lower extremities, as well as complications, lethality rates, and remote results as compared with the parallel parameters obtained while performing non-hybrid operations.
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Affiliation(s)
- A V Gavrilenko
- Department of Vascular Surgery, Russian Research Centre of Surgery named after Academician B.V. Petrovsky, Moscow, Russia; First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
| | - A A Kravchenko
- Department of Vascular Surgery, Russian Research Centre of Surgery named after Academician B.V. Petrovsky, Moscow, Russia
| | - A É Kotov
- Department of Vascular Surgery, Russian Research Centre of Surgery named after Academician B.V. Petrovsky, Moscow, Russia
| | - V V Kirichenko
- First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
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Esposito CJ, Popescu WM, Rinder HM, Schwartz JJ, Smith BR, Rinder CS. Increased leukocyte-platelet adhesion in patients with graft occlusion after peripheral vascular surgery. Thromb Haemost 2017; 90:1128-34. [PMID: 14652647 DOI: 10.1160/th03-04-0226] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryGraft occlusion following peripheral vascular surgery is attributable to some combination of acute thrombosis, and progression of atherosclerosis: interactions between leukocytes and activated platelets may play a role in both of these processes. This investigation measured perioperative leukocyte-platelet conjugate formation, and leukocyte and platelet activation in 46 patients undergoing surgery for lower extremity peripheral vascular disease (PVD). All patients were followed for graft patency over the next 6 months; 27 patients had grafts that remained patent while 19 had graft occlusion. On postoperative day #1 (POD#1), the graft occlusion group demonstrated a significantly greater increase in circulating levels of both mono-cyteplatelet and neutrophil (PMN)-platelet conjugates compared to the patent graft patients (p=0.015 and 0.018, respectively). PMN activation, assessed by increases in surface CD11b expression, was also significantly increased on POD#1 in the graft occlusion group compared to the patent group (p=0.026). The percentage of circulating activated (CD62P+) platelets did not differ between groups, but patients with graft occlusion demonstrated a higher percentage of younger, reticulated platelets throughout the study period (p=0.008), indicating increased platelet turnover.We conclude that in the early postoperative period, leukocyte-platelet adhesion, PMN activation, and platelet turnover are significantly greater in PVD patients who go on to develop later graft occlusion. Cellular activation and heterotypic cell interactions in peripheral vascular surgery patients may be important in the etiologies of thrombosis and/or accelerated atherosclerosis leading to graft loss.
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Affiliation(s)
- Claire J Esposito
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut 06520, USA
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Kim YM, Moon C, Goo DE, Park SB, Park JW. Lymphedema secondary to idiopathic occlusion of the subclavian and innominate veins after renal transplantation: A case report. Medicine (Baltimore) 2017; 96:e8942. [PMID: 29310388 PMCID: PMC5728789 DOI: 10.1097/md.0000000000008942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Among the causes of swelling in the extremities of renal transplantation patients, secondary lymphedema caused by complete idiopathic obstruction of large veins is rare and may be difficult to diagnose and treat. PATIENT CONCERNS A 64-year-old man presented with severe edema and pain that occurred suddenly in the right arm. DIAGNOSES The patient was diagnosed as stage-2 secondary lymphedema caused by idiopathic occlusion of the subclavian and innominate veins. INTERVENTIONS Lymphoscintigraphy and ascending venography of the right arm confirmed the diagnosis. Intensive complete decongestive therapy for lymphedema was performed. OUTCOMES Following 2 weeks of active rehabilitation, the pain level and edema status were significantly improved. LESSONS When idiopathic swelling of the extremities occurs in renal transplant patients, secondary lymphedema caused by venous occlusion may be the cause. When direct intervention for the venous occlusion proves to be difficult, a conservative approach may be helpful.
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Affiliation(s)
- Yong Min Kim
- Department of Physical Medicine and Rehabilitation
| | | | - Dong Erk Goo
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Soo Bin Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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Wong S, Morel-Kopp MC, Chen Q, Appleberg M, Ward CM, Lewis DR. Overcoming aspirin resistance: Increased platelet inhibition with combination aspirin and clopidogrel and high dose aspirin therapy in aspirin resistant patients with peripheral vascular disease. Thromb Haemost 2017; 95:1042-3. [PMID: 16732389 DOI: 10.1160/th05-12-0808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tentolouris A, Eleftheriadou I, Grigoropoulou P, Kokkinos A, Siasos G, Ntanasis-Stathopoulos I, Tentolouris N. The association between pulse wave velocity and peripheral neuropathy in patients with type 2 diabetes mellitus. J Diabetes Complications 2017; 31:1624-1629. [PMID: 28893495 DOI: 10.1016/j.jdiacomp.2017.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/08/2017] [Accepted: 07/23/2017] [Indexed: 11/24/2022]
Abstract
AIMS Diabetic peripheral neuropathy (DPN) is the most common diabetic complication, affecting up to half of the patients with type 2 diabetes mellitus (T2DM). Increased aortic stiffness, measured with the carotid-femoral pulse wave velocity (PWV), has been associated with incidence of cardiovascular disease independently of traditional risk factors. Previous data showed associations between risk factors for macroangiopathy and DPN in diabetes. However, the association between PWV and DPN is not well known. In this study we examined the association between PWV and presence as well as severity of DPN in subjects with T2DM. MATERIAL AND METHODS A total of 381 patients with T2DM were recruited. Participants were classified as having DPN and not having DPN. PWV was measured at the carotid-femoral segment with a non-invasive method using applanation tonometry. DPN was assessed by determination of the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS). RESULTS A hundred and seven participants (28.1%) had DPN. Patients with DPN were significantly more often male and older, had longer diabetes duration, higher height, larger waist circumference, higher systolic arterial blood pressure (SBP) and higher PWV (all P<0.05). Furthermore, participants with DPN were treated more often with statins and had lower low density lipoprotein cholesterol; in addition, they were treated more often with antiplatelets, b-blockers and insulin than those without DPN. Univariative logistic regression analysis demonstrated that presence of DPN was significantly associated with age, male gender, longer diabetes duration, height, waist circumference, SBP, PWV, dyslipidemia, HbA1c, retinopathy, nephropathy and peripheral arterial disease. Multivariate logistic regression analysis, after adjustment for age, gender, waist circumference, SBP, nephropathy and use of b-blockers, demonstrated that the odds [OR (95% confidence intervals)] of peripheral neuropathy were associated significantly and independently only with diabetes duration [1.044 (1.009-1.081), P=0.013], height [1.075 (1.041-1.110), P<0.001], HbA1c [1.468 (1.164-1.851), P<0.001], PWV [1.174 (1.054-1.309), P=0.004], dyslipidemia [1.941 (1.015-3.713), P=0.045], retinopathy [4.426 (2.217-8.837), P<0.001] and peripheral arterial disease [4.658 (2.264-9.584), P<0.001]. In addition, multivariate linear regression analysis, after controlling for age, gender, diabetes duration, SBP, HbA1c and nephropathy, demonstrated that an increased NDS was significantly and independently associated with height [standardized regression coefficient (beta=0.229, P<0.001)], PWV (beta=0.197, P<0.001), retinopathy (beta=0.268, P<0.001) and peripheral arterial disease (beta=0.374, P<0.001). CONCLUSION Increased PWV is associated strongly and independently not only with the presence but also with the severity of DPN in patients with T2DM, irrespective of known risk factors.
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Affiliation(s)
- Anastasios Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Pinelopi Grigoropoulou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Gerasimos Siasos
- Department of Cardiology, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
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Sahay M, Kalra S, Tiwaskar M, Ghosh S, Badani R, Bantwal G, Das AK, Dhorepatil B, Jeloka T, Khandelwal D, Nadkar MY, Saboo B, Sahay R, Unnikrishnan AG, Aggarwal S, Agrawal N, Bajaj S, Baruah MP, Chadha M, Das S, Dhamija P, Julka S, Mehta P, Shah SN, Sharma B, Muruganathan A. Indian College of Physicians Position Statement on Anemia in Metabolic Syndrome. J Assoc Physicians India 2017; 65:60-73. [PMID: 28782315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | | | | | | | - A K Das
- Pondicherry Institute of Medical Sciences, Puducherry
| | | | - Tarun Jeloka
- Aditya Birla Memorial Hospital, Pune, Maharashtra
| | | | - Milind Y Nadkar
- Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
| | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat
| | | | | | - Sameer Aggarwal
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana
| | - Navneet Agrawal
- Diabetes Obesity and Thyroid Centre, Gwalior, Madhya Pradesh
| | | | | | | | | | | | - Sandeep Julka
- Radiance - The Hormone Health Clinic, Indore, Madhya Pradesh
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Tiwaskar M. The Double Trouble: PVD and Peripheral Neuropathy in Diabetes. J Assoc Physicians India 2017; 65:11-13. [PMID: 28598041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Karuna Hospital, Mumbai, Maharashtra
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Bajaj S, Mahajan A, Grover S, Mahajan V, Goyal P, Gupta VK. Peripheral Vascular Disease in Patients with Diabetic Foot Ulcers - An Emerging Trend: A Prospective Study from North India. J Assoc Physicians India 2017; 65:14-17. [PMID: 28598042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Diabetic foot ulcer is one of the chronic complications of diabetes mellitus (DM) with 25% of patients with diabetes developing a foot ulcer during their lifetime leading to amputation. Diabetic foot is classified into 2 main types: neuropathic ulcers (NPU) and neuro-ischemic ulcer (NIU) where in addition to neuropathy peripheral vascular disease (PVD) is also present. AIMS We aimed to a) assess the prevalence of Peripheral vascular disease (PVD) in patients of type 2 diabetes mellitus (T2DM) presenting with New Diabetic Foot ulcers (DFU). b) To compare the clinical profile and risk factors responsible for development of NPU and NIU in North Indian population. SETTING AND DESIGN Cross sectional study conducted on first 100 T2DM patients presenting with new DFU in tertiary referral institute for one year period from August 2012 to July 2013. METHODS AND MATERIAL Detailed relevant clinical history including age, sex and duration of diabetes, history of smoking and hypertension (HTN) and prevalence of other complications like retinopathy, nephropathy, coronary artery disease (CAD) and stroke was obtained. Patients were examined for neuropathy, loss of pulsations, ankle brachial pressure index (ABI) and investigated for HbA1C, blood urea nitrogen (BUN) and serum creatinine. Statistical analysis used: t test, Fisher exact test and univariate analysis. RESULTS NIU was present in 30 and NPU in 70 out of 100 patients. NIU were commoner among males as compared to females (21/64 males vs 9/36 females). Strong association of smoking (20/30 patients), hypertension (24/30 patients) and longer duration of DM (14 vs 8 years) with NIU was found. Even other complications of DM like CAD (8/30 patients), stroke (4/30 patients), retinopathy (24/30 patients) and nephropathy (15/30 patients) were more prevalent in patients with NIU. CONCLUSIONS Prevalence of PVD is 30% in our study which is more than previous studies showing an increasing trend. NPU are two times more common than NIU. Hypertensive male patients with smoking habits and longer duration of T2DM are most prone to develop NIU. NIU share the similar risk factors with CAD and coexist with other complications of DM which should be looked for and treated.
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Affiliation(s)
| | - Amit Mahajan
- Consultant Diabetologist and Physician, Tagore Hospital and Heart care Centre, Jalandhar, Punjab
| | - Sumit Grover
- Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab
| | - Vijay Mahajan
- Managing Director and Head of Department, Department of Medicine, Tagore Hospital and Heart care Centre, Jalandhar, Punjab
| | | | - Vikram Kumar Gupta
- Assistant Professor, Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab
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Huang K, Ma Y, Wang J, Shi S, Fu L, Liu J, Li L, Lu H, Liang X, Liu Y, Jiang H. The correlation between transcutaneous oxygen tension and microvascular complications in type 2 diabetic patients. J Diabetes Complications 2017; 31:886-890. [PMID: 28242269 DOI: 10.1016/j.jdiacomp.2017.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/05/2017] [Accepted: 02/01/2017] [Indexed: 01/16/2023]
Abstract
AIMS This study aimed to assess whether transcutaneous oxygen tension (TcPO2) was associated with the presence of microvascular complications in type 2 diabetic (T2D) patients and whether TcPO2 could act as an independent risk factor for predicting the occurrence of microvascular events in these patients. METHODS We recruited 436 patients with T2D. Based on the presence of diabetic kidney disease, diabetic retinopathy, and/or diabetic peripheral neuropathy, the patients were divided into groups with and without microvascular complications. The differences between these 2 groups were examined using the chi-square test and the t test. The influencing factors of diabetic microangiopathy were studied using a logistic regression analysis. RESULTS The results showed that sex, diabetes duration, smoking history, TcPO2, and HbA1c were independent risk factors for the occurrence of diabetic microvascular events (P<0.05). In particular, the risk of developing microvascular complications was 10.16 times higher in patients with low TcPO2 than that in those with high TcPO2 (OR=10.157, 95% CI: 4.602-22.418). CONCLUSION This study showed that TcPO2 was significantly negatively associated with the occurrence of microvascular events in type 2 diabetic patients and that TcPO2 may be an independent risk factor for predicting the occurrence of microvascular complications in these patients. These results suggest that for type 2 diabetes mellitus with clinically reduced TcPO2, we should pay close attention to the occurrence of microvascular complications and engage in early prevention.
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Affiliation(s)
- Ke Huang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Yujin Ma
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Jie Wang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Shousen Shi
- The 150th Central Hospital of PLA, Luoyang, China
| | - Liujun Fu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Jie Liu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Liping Li
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Haibo Lu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Xiaoli Liang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Yanyun Liu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Hongwei Jiang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003.
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Mahmoud AN, Elgendy AY, Rambarat C, Mahtta D, Elgendy IY, Bavry AA. Efficacy and safety of aspirin in patients with peripheral vascular disease: An updated systematic review and meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0175283. [PMID: 28403216 PMCID: PMC5389721 DOI: 10.1371/journal.pone.0175283] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 02/03/2017] [Accepted: 03/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background Although considered a cornerstone therapy, the efficacy and safety of aspirin for prevention of ischemic events in patients with peripheral vascular disease (PVD) remains uncertain. Thus, we aimed to evaluate aspirin use in both symptomatic and asymptomatic patients with PVD. Methods An electronic search of databases was conducted from inception until January 2017 for all randomized trials comparing aspirin with either placebo or control (no aspirin) in patients with PVD. The primary efficacy outcome was all-cause mortality, and the primary safety outcome was major bleeding. Other outcomes of interest were major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), stroke and intracranial hemorrhage. Random-effects summary risk ratios (RR) were calculated using Der-Simonian and Liard model. The quality of evidence was assessed by GRADE tool and Cochrane risk of bias assessment tool. Results A total of 6,560 patients from 11 trials were included. Only two trials were considered to have low risk of bias. Compared with control, aspirin was associated with similar incidence of all-cause mortality (RR = 0.93, 95% confidence interval [CI] 0.8–1.1), MACCE (RR = 1.0, 95% CI 0.83–1.20), MI (RR = 0.91, 95% CI 0.67–1.23) and stroke (RR = 0.72, 95% CI 0.43–1.22), major bleeding (RR = 1.59, 95% CI 0.96–2.62) and intracranial hemorrhage (RR = 1.38, 95% CI 0.59–3.21). Conclusions Aspirin use in PVD might not be associated with improved cardiovascular outcomes or worse bleeding outcomes. Larger randomized trials assessing the efficacy and safety of aspirin in the contemporary era are mandatory to confirm the current findings. Guideline recommendations regarding the use of aspirin among patients with PVD need to be updated.
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Affiliation(s)
- Ahmed N. Mahmoud
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Akram Y. Elgendy
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Cecil Rambarat
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Islam Y. Elgendy
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Anthony A. Bavry
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States of America
- * E-mail:
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de M Matheus AS, Clemente ELS, de Lourdes Guimarães Rodrigues M, Torres Valença DC, Gomes MB. Assessment of microvascular endothelial function in type 1 diabetes using laser speckle contrast imaging. J Diabetes Complications 2017; 31:753-757. [PMID: 28089343 DOI: 10.1016/j.jdiacomp.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/13/2016] [Accepted: 12/29/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To test whether laser speckle contrast imaging (LSCI) coupled with physiological post-occlusive reactive hyperemia (PORH) and pharmacological iontophoresis of acetylcholine (ACh) as local vasodilator stimuli could distinguish between cutaneous microvascular responses of Type 1 Diabetes (T1DM)'s patients with endothelial dysfunction and that of healthy controls. METHODS Patients with T1DM aged ≥12years completed a clinical-epidemiological questionnaire. Data detailing patients' such as daily insulin dose, duration of diabetes, and use of pharmaceuticals such as antihypertensive drugs and statins that could interfere with endothelial function were obtained. Vascular reactivity was assessed in the forearm by LSCI and PORH at baseline and during iontophoresis of ACh using increasing anodic currents of 30, 60, 90, 120, 150 and 180μA in 10second intervals. RESULTS This study included 50 patients with T1DM and 30 control subjects. The mean resting flux did not differ between patients and control subjects. T1DM patients exhibited endothelial dysfunction upon challenge with physiological or pharmacological stimuli. The microvascular response to both ACh and PORH (i.e., maximum response at peak and amplitude) were significantly reduced in patients with diabetes compared with control subjects (p<0.001). CONCLUSION We demonstrated that endothelium-dependent skin microvascular vasodilator responses are significantly impaired in patients with T1DM compared to healthy subjects investigated using LSCI coupled with ACh iontophoresis and PORH. Additionally, we find that LSCI is a promising methodology for studying physiological vascular reactivity in T1DM.
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Gibbons CH. Treatment induced neuropathy of diabetes-Long term implications in type 1 diabetes. J Diabetes Complications 2017; 31:715-720. [PMID: 28159476 DOI: 10.1016/j.jdiacomp.2017.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/20/2016] [Accepted: 01/15/2017] [Indexed: 11/22/2022]
Abstract
AIMS/HYPOTHESIS Aggressive glucose control can result in treatment induced neuropathy of diabetes (TIND) if glycemic control is achieved too quickly. The aim of the present study is to describe the 8-year follow-up data on a cohort of individuals with type 1 diabetes who developed TIND. METHODS Twenty-six individuals with type 1 diabetes and TIND were followed longitudinally for 8years with regular quantitative measurement of pain, neurological examinations and evaluation of microvascular complications. Comprehensive neurological testing was performed after TIND and 7-8years later. RESULTS Among the 26 individuals with TIND, 19/26 had stable glycemic control and 7/26 had unstable glycemic control in long-term follow up. Those 19/26 with stable glycemic control had improvement in neuropathy, pain and microvascular complications while the 7/26 with unstable glycemic control had significant worsening of neuropathy, pain and microvascular complications (P<0.01, all tests). CONCLUSION/INTERPRETATION TIND is a poorly understood iatrogenic complication of aggressive glycemic control, although individuals with stable glycemic control tended to improve, while those with unstable glycemic control worsened. Additional studies of TIND are required to understand potential outcomes in an era of medical 'metrics' where physician reimbursement may be tied to achievement of excessively rapid glycemic control.
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Affiliation(s)
- Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Dillon MP, Quigley M, Fatone S. Outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review for the development of shared decision-making resources. Syst Rev 2017; 6:54. [PMID: 28288686 PMCID: PMC5348872 DOI: 10.1186/s13643-017-0433-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Dysvascular partial foot amputation (PFA) is a common sequel to advanced peripheral vascular disease. Helping inform difficult discussions between patients and practitioners about the level of PFA, or the decision to have a transtibial amputation (TTA) as an alternative, requires an understanding of the current research evidence on a wide range of topics including wound healing, reamputation, quality of life, mobility, functional ability, participation, pain and psychosocial outcomes, and mortality. The aim of this review was to describe a comprehensive range of outcomes of dysvascular PFA and compare these between levels of PFA and TTA. METHODS The review protocol was registered in PROSPERO (CRD42015029186). A systematic search of the literature was conducted using MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health, and Web of Science. These databases were searched using MeSH terms and keywords relating to different amputation levels and outcomes of interest. Peer reviewed studies of original research-irrespective of the study design-were included if published in English between 1 January 2000, and 31 December 2015, and included discrete cohort(s) with dysvascular PFA or PFA and TTA. Outcomes of interest were rate of wound healing and complications, rate of ipsilateral reamputation, quality of life, functional ability, mobility, pain (i.e., residual limb or phantom pain), psychosocial outcomes (i.e., depression, anxiety, body image and self-esteem), participation, and mortality rate. Included studies were independently appraised by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and identify sources of bias. Data were extracted based on the Cochrane Consumers and Communication Review Group's data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings are reported as narrative summaries given the heterogeneity of the literature, except for mortality and ipsilateral reamputation where data allowed for proportional meta-analyses. RESULTS Twenty-nine unique articles were included in the review, acknowledging that some studies reported multiple outcomes. Eighteen studies reported all-cause proportionate mortality. A smaller number of studies reported outcomes related to functional ability (two), mobility (four), quality of life (three), ipsilateral reamputation (six) as well as wound healing and complications (four). No studies related to pain, participation or psychosocial outcomes met the inclusion criteria. Subjects were typically older and male and had diabetes among other comorbidities. More detailed information about the cohorts such as race or sociodemographic factors were reported in an ad hoc manner. Common sources of bias included contamination, co-intervention, or lack of operational definition for some outcomes (e.g., wound healing) as illustrative examples. CONCLUSIONS Aside from mortality, there was limited evidence regarding outcomes of dysvascular PFA, particularly how outcomes differ between levels of PFA and TTA. Acknowledging that there is considerable uncertainty given the small body of literature on many topics where the risk of bias is high, the available evidence suggests that a large proportion of people with PFA experience delayed wound healing and ipsilateral reamputation. People with TTA have increased risk of mortality compared to those with PFA, which may reflect that those considered suitable candidates for TTA have more advanced systemic disease that also increases the risk of dying. Mobility and quality of life may be similar in people with PFA and TTA. SYSTEMATIC REVIEW REGISTRATION CRD42015029186.
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Affiliation(s)
- Michael P. Dillon
- Discipline of Prosthetics and Orthotics, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Matthew Quigley
- Discipline of Prosthetics and Orthotics, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Centre, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1100, Chicago, IL 60611 USA
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Torey J, Zaitoun A, Lalonde T, Runyon J, Mustapha J, Davis T. Infrainguinal CTO Recanalization Assessed by Intravascular Ultrasound: Results of the CENTRAL Study. J Invasive Cardiol 2016; 28:430-439. [PMID: 27743508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES CENTRAL was a prospective, multicenter, 100 patient study designed to evaluate the ability of a recanalization catheter system to cross chronic total occlusions (CTOs) of the superficial femoral artery while staying within the central vessel lumen. METHODS The primary endpoint was the successful crossing of a CTO (≥90% of the length) with the recanalization catheter in the central lumen of the superficial femoral artery in at least one-half of the studied patient population, confirmed by intravascular ultrasound. Secondary endpoints included standardized anatomic damage assessment (the TAPE method) and an assessment of the relationship between the percent of CTO crossing and TAPE scores to the rate of target-lesion revascularization (TLR) at 30 days and 6 months. RESULTS The mean age of the occlusions was 16.6 ± 22.28 months (range, 1-120 months), the average occlusion length reported by the sites was 132.1 ± 87.69 mm (range, 4-300 mm), and a majority of lesions were moderately (42.0%) or severely (32.0%) calcified. In 43/85 (50.6%) of the evaluable intravascular ultrasound images, the recanalization catheter successfully navigated the central lumen of the CTO (ie, ≥90% luminal crossing) with >50% luminal crossing in 64/85 (75.3%) of cases. The 6-month TLR rate was significantly lower in patients where the CTO was crossed ≥90% in the central vessel lumen (4.7%) compared with crossings <90% (20.6%; P=.04). The 6-month TLR rate was 3.5% in patients with a favorable TAPE score of 0-4 and 36.8% with an unfavorable TAPE score of 5-8 (P<.001). CONCLUSION Use of a recanalization catheter in complex superficial femoral artery CTO crossings achieved intraluminal crossings in >50% of cases and decreased anatomic damage, which appeared to offer a significant advantage in 6-month TLR rates.
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Affiliation(s)
- James Torey
- St. John Hospital and Medical Center, 22101 Moross Road, Detroit, MI 48236 USA.
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Kövamees O, Shemyakin A, Checa A, Wheelock CE, Lundberg JO, Östenson CG, Pernow J. Arginase Inhibition Improves Microvascular Endothelial Function in Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab 2016; 101:3952-3958. [PMID: 27399350 DOI: 10.1210/jc.2016-2007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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
OBJECTIVES The development of microvascular complications in diabetes is a complex process in which endothelial dysfunction is important. Emerging evidence suggests that arginase is a key mediator of endothelial dysfunction in type 2 diabetes mellitus by reciprocally regulating nitric oxide bioavailability. The aim of this prospective intervention study was to test the hypothesis that arginase activity is increased and that arginase inhibition improves microvascular endothelial function in patients with type 2 diabetes and microvascular dysfunction. DESIGN Microvascular endothelium-dependent and -independent dilatation was determined in patients with type 2 diabetes (n = 12) and healthy age-matched control subjects (n = 12) with laser Doppler flowmetry during iontophoretic application of acetylcholine and sodium nitroprusside, respectively, before and after administration of the arginase inhibitor Nω-hydroxy-nor-L-arginine (120 min). Plasma ratios of amino acids involved in arginase and nitric oxide synthase activities were determined. The laser Doppler flowmetry data were the primary outcome variable. RESULTS Microvascular endothelium-dependent dilatation was impaired in subjects with type 2 diabetes (P < .05). After administration of Nω-hydroxy-nor-L-arginine, microvascular endothelial function improved significantly in patients with type 2 diabetes to the level observed in healthy controls. Endothelium-independent vasodilatation did not change significantly. Subjects with type 2 diabetes had higher levels of ornithine and higher ratios of ornithine/citrulline and ornithine/arginine (P < .05), suggesting increased arginase activity. CONCLUSION Arginase inhibition improves microvascular endothelial function in patients with type 2 diabetes and microvascular dysfunction. Arginase inhibition may represent a novel therapeutic strategy to improve microvascular endothelial function in patients with type 2 diabetes.
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Affiliation(s)
- Oskar Kövamees
- Department of Medicine Unit of Cardiology (O.K., A.S., J.P.), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Medical Biochemistry and Biophysics (A.C., C.E.W.), Division of Physiological Chemistry, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Physiology and Pharmacology (J.O.L.), Karolinska Institutet, 17176 Stockholm, Sweden; and Department of Molecular Medicine and Surgery Unit of Endocrinology (C.-G.Ö.), Karolinska Institutet, and Department of Endocrinology and Diabetology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Alexey Shemyakin
- Department of Medicine Unit of Cardiology (O.K., A.S., J.P.), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Medical Biochemistry and Biophysics (A.C., C.E.W.), Division of Physiological Chemistry, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Physiology and Pharmacology (J.O.L.), Karolinska Institutet, 17176 Stockholm, Sweden; and Department of Molecular Medicine and Surgery Unit of Endocrinology (C.-G.Ö.), Karolinska Institutet, and Department of Endocrinology and Diabetology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Antonio Checa
- Department of Medicine Unit of Cardiology (O.K., A.S., J.P.), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Medical Biochemistry and Biophysics (A.C., C.E.W.), Division of Physiological Chemistry, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Physiology and Pharmacology (J.O.L.), Karolinska Institutet, 17176 Stockholm, Sweden; and Department of Molecular Medicine and Surgery Unit of Endocrinology (C.-G.Ö.), Karolinska Institutet, and Department of Endocrinology and Diabetology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Craig E Wheelock
- Department of Medicine Unit of Cardiology (O.K., A.S., J.P.), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Medical Biochemistry and Biophysics (A.C., C.E.W.), Division of Physiological Chemistry, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Physiology and Pharmacology (J.O.L.), Karolinska Institutet, 17176 Stockholm, Sweden; and Department of Molecular Medicine and Surgery Unit of Endocrinology (C.-G.Ö.), Karolinska Institutet, and Department of Endocrinology and Diabetology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Jon O Lundberg
- Department of Medicine Unit of Cardiology (O.K., A.S., J.P.), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Medical Biochemistry and Biophysics (A.C., C.E.W.), Division of Physiological Chemistry, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Physiology and Pharmacology (J.O.L.), Karolinska Institutet, 17176 Stockholm, Sweden; and Department of Molecular Medicine and Surgery Unit of Endocrinology (C.-G.Ö.), Karolinska Institutet, and Department of Endocrinology and Diabetology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Claes-Göran Östenson
- Department of Medicine Unit of Cardiology (O.K., A.S., J.P.), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Medical Biochemistry and Biophysics (A.C., C.E.W.), Division of Physiological Chemistry, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Physiology and Pharmacology (J.O.L.), Karolinska Institutet, 17176 Stockholm, Sweden; and Department of Molecular Medicine and Surgery Unit of Endocrinology (C.-G.Ö.), Karolinska Institutet, and Department of Endocrinology and Diabetology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - John Pernow
- Department of Medicine Unit of Cardiology (O.K., A.S., J.P.), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Medical Biochemistry and Biophysics (A.C., C.E.W.), Division of Physiological Chemistry, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Physiology and Pharmacology (J.O.L.), Karolinska Institutet, 17176 Stockholm, Sweden; and Department of Molecular Medicine and Surgery Unit of Endocrinology (C.-G.Ö.), Karolinska Institutet, and Department of Endocrinology and Diabetology, Karolinska University Hospital, 17176 Stockholm, Sweden
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