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Dimagli A, Malas J, Chen S, Sandner S, Schwann T, Tatoulis J, Puskas J, Bowdish ME, Gaudino M. Coronary Artery Aneurysms, Arteriovenous Malformations, and Spontaneous Dissections-A Review of the Evidence. Ann Thorac Surg 2024; 117:887-896. [PMID: 38081498 DOI: 10.1016/j.athoracsur.2023.11.033] [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: 06/15/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Coronary artery aneurysms (CAAs), coronary arteriovenous malformations (CAVMs), and spontaneous coronary artery dissections (SCADs) are rare clinical entities, and much is unknown about their natural history, prognosis, and management. METHODS A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed in March 2023 to identify published papers related to CAAs, CAVMs, and SCADs. RESULTS CAAs are found in 0.3% to 12% of patients undergoing angiography and are often associated with coronary atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and rarely by rupture (0.2%). CAAs can be managed medically, percutaneously with stents or coil embolization, and surgically. The most common surgical procedure is ligation of the aneurysm, followed by coronary artery bypass grafting. The incidence of CAVMs is 0.1% to 0.2% in patients undergoing angiography, and they are most likely associated with congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction. SCADs represent 1% to 4% of all acute coronary syndromes and typically affect young women. SCADs are strongly correlated with pregnancy, suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients should undergo revascularization either percutaneously or with coronary artery bypass grafting. CONCLUSIONS Further evidence regarding the management of these rare diseases is needed and can ideally be derived from multicenter collaborations.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sarah Chen
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, California
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schwann
- Department of Surgery, University of Massachusetts-Baystate, Springfield, Massachusetts
| | - James Tatoulis
- The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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Matsukawa H, Sowlat MM, Porto G, Spiotta AM, Sattur MG. Vertebral Artery Access Considerations in Coil Embolization of Small Superior Cerebellar Artery Aneurysm. World Neurosurg 2024; 184:29-37. [PMID: 38191058 DOI: 10.1016/j.wneu.2024.01.014] [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: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Coiling of small superior cerebellar artery aneurysms (sSCAAs) is challenging. We aimed to describe anatomic considerations in the vertebral and basilar artery (VA and BA) morphology for decision making in the coiling of sSCAAs. METHODS Eleven patients with sSCAAs (<5 mm) treated at our institution between April 2015 and February 2022 were included to show our concept of deciding access routes in the coiling of sSCAAs. The access route was decided on the basis of VA characteristics, BA curvature, and aneurysm laterality. Adequate aneurysm occlusion on angiography (Raymond-Roy grading scale I and II), good outcome (modified Rankin Score 0-2) at the last follow-up, and adverse outcomes were evaluated. RESULTS Simple coiling (n = 2), a balloon-assisted technique (n = 3), and stent-assisted technique (n = 6) were selected. At the last follow-up (median 13.0 months), adequate aneurysm occlusion and good outcome were obtained in all 9 patients (n = 10). Adverse outcomes were not observed. When VA dominance was equal, in the straight BA, the microcatheter insertion into the ipsilateral VA to the aneurysm was favorable to form a "fulcrum" on the contralateral side and obtain microcatheter stability. When an aneurysm was on the concave aspect of the curved BA, microcatheter insertion into the ipsilateral VA was favorable. As for the convex aspect's aneurysm location, the microcatheter insertion into the contralateral VA can be favored. Further, we described the VA origin classification as it relates to ease of access from a transradial approach. CONCLUSIONS Vertebrobasilar morphology may be important in deciding access routes in the coiling of sSCAAs.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosurgery, Hyogo Medical University, Nishninomya, Hyogo, Japan
| | - M-Mahdi Sowlat
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme Porto
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Mithun G Sattur
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Melissano G, Tinelli G, Soderlund T. Power is Nothing Without Control: Are Artificial Intelligence Chatbots in Vascular Diseases Tested and Verified? Eur J Vasc Endovasc Surg 2024; 67:691-692. [PMID: 38042253 DOI: 10.1016/j.ejvs.2023.11.045] [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: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Germano Melissano
- Department of Vascular Surgery, Vita-Salute San Raffaele University School of Medicine, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanni Tinelli
- Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
| | - Timo Soderlund
- Aortic Dissection Collaborative Advisory Group, Seattle, WA, USA
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Lareyre F, Poggi E, Raffort J. Moving Forward: Evaluation of Artificial Intelligence Chatbots in Vascular Diseases. Eur J Vasc Endovasc Surg 2024; 67:691. [PMID: 38040102 DOI: 10.1016/j.ejvs.2023.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, Antibes, France; Université Côte d'Azur, Inserm U1065, C3M, Nice, France.
| | - Elise Poggi
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, Antibes, France
| | - Juliette Raffort
- Université Côte d'Azur, Inserm U1065, C3M, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France; 3IA Institute, Université Côte d'Azur, Nice, France
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Yoneoka R, Takeda K, Kasai H, Sugiura T, Shikano K, Abe M, Suzuki T. A 65-Year-Old Man with Refractory Hemoptysis Associated with Chronic Progressive Pulmonary Aspergillosis Who Failed to Respond to Combined Endobronchial Occlusion and Bronchial Artery Embolization: A Case Report and Literature Review. Am J Case Rep 2024; 25:e942422. [PMID: 38527273 PMCID: PMC10946694 DOI: 10.12659/ajcr.942422] [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: 09/04/2023] [Revised: 01/26/2024] [Accepted: 01/12/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Hemoptysis due to airway hemorrhage is treated with hemostatic agents, bronchial artery embolization (BAE), or surgical resection. We present the case of a 65-year-old man with refractory hemoptysis associated with chronic progressive pulmonary aspergillosis (CPPA) who failed to respond to combined endobronchial occlusion (EBO) with endobronchial Watanabe spigot (EWS) and BAE. CASE REPORT A 63-year-old man was diagnosed with CPPA in the right upper lung and presented to our hospital 2 years later for hemoptysis at age 65. He developed severe hemoptysis during an outpatient visit, and was urgently admitted, intubated, and ventilated to prevent choking on blood clots. Chest computed tomography showed a large mass in the apical portion of the right lung, constituting apical pleural thickening and an encapsulated pleural effusion, and dilatation in the bronchial artery supplying the right upper lung lobe. Bronchoscopy revealed the right upper lobe B1-B3 as the bleeding source. The patient had recurrent hemoptysis that was not controlled by BAE or 6 EBO+EWS procedures, and he ultimately died of hypoxemia.In the literature review, EBO+EWS can effectively control hemoptysis in appropriate cases, without the need for BAE or surgical lung resection. It is less invasive, is associated with fewer adverse events than BAE or surgery, and can achieve temporary hemostasis for severe hemoptysis. CONCLUSIONS BAE and EBO+EWS were ineffective in controlling recurrent hemoptysis caused by CPPA in this case. However, a multidisciplinary approach such as attempting hemostasis with combined EBO+EWS and BAE may be a viable treatment option in severe cases of hemoptysis.
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Affiliation(s)
- Ryotaro Yoneoka
- Department of Medicine, School of Medicine, Chiba University, Chiba, Japan
| | - Kenichiro Takeda
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Education, School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohei Shikano
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mitsuhiro Abe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Secemsky EA, Aronow HD, Kwolek CJ, Meissner M, Muck PE, Parikh SA, Winokur RS, George JC, Salazar G, Murphy EH, Costantino MM, Zhou W, Li J, Lookstein R, Desai KR. Intravascular Ultrasound Use in Peripheral Arterial and Deep Venous Interventions: Multidisciplinary Expert Opinion From SCAI/AVF/AVLS/SIR/SVM/SVS. J Vasc Interv Radiol 2024; 35:335-348. [PMID: 38206255 DOI: 10.1016/j.jvir.2023.11.006] [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: 06/01/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 01/12/2024] Open
Abstract
Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable's aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.
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Affiliation(s)
- Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Herbert D Aronow
- Department of Medicine, Michigan State University, East Lansing, Michigan; Heart & Vascular Services, Henry Ford Health, Detroit, Michigan
| | - Christopher J Kwolek
- Harvard Medical School, Boston, Massachusetts; Newton-Wellesley Hospital, Wellesley, Massachusetts
| | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Patrick E Muck
- Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, Ohio
| | - Sahil A Parikh
- Center for Interventional Cardiovascular Care, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ronald S Winokur
- Weill Cornell Vein Treatment Center and Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Jon C George
- Division of Interventional Cardiology and Endovascular Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin H Murphy
- Venous and Lymphatic Center, Division of Vascular Surgery, Sanger Heart and Vascular, Atrium Health, Charlotte, North Carolina
| | | | - Wei Zhou
- Division of Vascular Surgery, University of Arizona and Banner University Medical Center, Tucson, Arizona
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Brunton N, Best PJM, Skelding KA, Cendrowski EE. Spontaneous Coronary Artery Dissection (SCAD) from an Interventionalist Perspective. Curr Cardiol Rep 2024; 26:91-96. [PMID: 38236518 PMCID: PMC10991027 DOI: 10.1007/s11886-023-02019-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), particularly among women < 50 years of age. Here, we aim to review the pathogenesis of SCAD, discuss SCAD as an initial manifestation of systemic arterial disease, and highlight invasive strategies as well as unique challenges in the care of women with SCAD. RECENT FINDINGS A paradigm shift has occurred in the care of SCAD patients in the past decade as recommendations for conservative management have become widespread. Invasive interventions are reserved for patients with hemodynamic compromise or active ischemia due to increased periprocedural complications and failure rates. Certain patient populations have been identified for larger territory infarcts and proximal disease including patients with known connective tissue disease, premenopausal women, and patients with pregnancy-associated SCAD (P-SCAD). Current recommended management of SCAD is conservative. Despite a growing awareness of SCAD and its known association with systemic arteriopathies in women, evidence-based data remains scarce. Future studies focused on identifying genetic factors, optimal medical therapy after SCAD, and techniques to minimize interventional complications are needed.
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Affiliation(s)
- Nichole Brunton
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Patricia J M Best
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | | | - Emily E Cendrowski
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
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Sorrell A, Martin CD, Ruiz M, Bates MJ, Degner B, MacCarrick G, Sears SF. Vascular Disease Patient Information Page: Coping with a serious vascular disease diagnosis. Vasc Med 2024; 29:99-102. [PMID: 38334092 DOI: 10.1177/1358863x231225465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Anne Sorrell
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Caroline D Martin
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Michelle Ruiz
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Michael J Bates
- Department of Cardiovascular Sciences, East Carolina Heart Institute at East Carolina University, Greenville, NC, USA
| | - Benjamin Degner
- Department of Cardiovascular Sciences, East Carolina Heart Institute at East Carolina University, Greenville, NC, USA
| | - Gretchen MacCarrick
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA
- Department of Cardiovascular Sciences, East Carolina Heart Institute at East Carolina University, Greenville, NC, USA
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D’Amato A, Mariani MV, Prosperi S, Colombo L, De Prisco A, Lavalle C, Mancone M, Vizza CD, Severino P. Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches. Medicina (Kaunas) 2024; 60:217. [PMID: 38399505 PMCID: PMC10889982 DOI: 10.3390/medicina60020217] [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: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction without obstructive coronary artery disease (MINOCA). It is determined by a coronary artery wall layers separation, which occurs regardless of traumatic or iatrogenic injuries. Even if it is often a missed diagnosis, its incidence is growing along with the improvement of intracoronary imaging techniques that allow for better detection. The main angiographical classification distinguishes three different forms, with slightly different prognoses at long-term follow up. SCAD is a recurrent condition, severely hampering the life quality of affected patients. The predominantly young age of patients with SCAD and the high prevalence of females among them have made the topic increasingly important, especially regarding therapeutic strategies. According to the data, the most recommended treatment is conservative, based on the use of antiplatelet agents and supportive anti-ischemic therapy. However, there are conflicting opinions concerning the need for dual antiplatelet therapy and its duration. In the case of invasive treatment, the choice between percutaneous coronary intervention and coronary artery bypass graft depends on the patient's clinical stability and the interested vessel. The purpose of the current review is to revise the pathophysiological mechanisms underlying SCAD and the current knowledge of its treatment.
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Affiliation(s)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 00161 Rome, Italy; (A.D.); (S.P.); (L.C.); (A.D.P.); (C.L.); (M.M.); (C.D.V.); (P.S.)
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Würdinger M, Schweiger V, Gilhofer T, Cammann VL, Badorff A, Koleva I, Di Vece D, Niederseer D, Candreva A, Michel J, Gotschy A, Stehli J, Stähli BE, Ghadri JR, Templin C. Twenty-five-year trends in incidence, angiographic appearance, and management of spontaneous coronary artery dissection. Int J Cardiol 2024; 395:131429. [PMID: 37827283 DOI: 10.1016/j.ijcard.2023.131429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) has been described as an infrequent cause of acute coronary syndrome (ACS). Knowledge about the disease is still limited and SCAD might still be underdiagnosed. OBJECTIVES Trends in incidence, presentation, angiographic appearance, management, and outcomes of SCAD over 25 years were analyzed. METHODS Patients with SCAD between 1997 and 2021 at the University Hospital Zurich, Switzerland, were included. Incidences were assessed as total numbers and proportions of ACS cases. Clinical data were collected from medical records and angiographic findings were reviewed. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, cardiac arrest, SCAD recurrence or progression, other myocardial infarction, and stroke. RESULTS One hundred fifty-six SCAD cases were included in this study. The incidence increased significantly in total (p < 0.001) and relative to ACS cases (p < 0.001). This was based on an increase of shorter lesions (p = 0.004), SCAD type 2 (p < 0.001), and lesions in side branches (p = 0.014), whereas lesions in the left main coronary artery and proximal segments were decreasing (p-values 0.029 and < 0.001, respectively). There was an increase in conservative therapy (p < 0.001). The rate of MACE (24%) was stable, however, there was a reduced proportion of patients with a need for intensive care treatment (p = 0.017). CONCLUSIONS SCAD represents an important entity of ACS that still might be underappreciated. The increasing incidence of SCAD is likely based on better awareness and familiarity with the disease. A lower need for intensive care treatment suggests positive effects of the increasing implementation of conservative management.
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Affiliation(s)
- Michael Würdinger
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Victor Schweiger
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Thomas Gilhofer
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Annika Badorff
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Iva Koleva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - David Niederseer
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Jonathan Michel
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alexander Gotschy
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Julia Stehli
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
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Jayaraj A, Thaggard D. The beneficial role of complex decongestive therapy in patients with symptomatic chronic iliofemoral venous obstruction with phlebolymphedema. J Vasc Surg Venous Lymphat Disord 2024; 12:101686. [PMID: 37714459 DOI: 10.1016/j.jvsv.2023.08.024] [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: 05/24/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Phlebolymphedema has been noted to be one of the most common causes of lymphedema in the lower extremity in western societies. Although complex decongestive therapy (CDT) represents the mainstay of lymphedema treatment, its role for phlebolymphedema arising from chronic iliofemoral venous obstruction (CIVO) merits further exploration. We evaluated this through the use of a protocol of CDT first for limbs with CEAP (clinical, etiologic, anatomic, pathophysiologic) clinical C3 disease and stent correction of obstruction before CDT for those with more advanced disease (CEAP C4-C6). In the present study, we analyzed the outcomes after the use of such a protocol. METHODS We analyzed prospectively collected data for 192 limbs (166 patients) that underwent treatment of quality-of-life (QoL) impairing symptoms from CIVO due to lymphoscintigraphically determined phlebolymphedema between 2017 and 2022. The characteristics evaluated included CEAP clinical class, venous clinical severity score (VCSS), grade of swelling (GOS), visual analog scale (VAS) pain score, QoL (CIVIQ-20 [20-item chronic venous disease quality of life questionnaire]), stenting for CIVO, and outcomes related to CDT and stenting. For the limbs undergoing CDT or stenting followed by CDT, the outcomes were evaluated at 6 weeks and 3, 6, and 12 months after completion of CDT. Paired and unpaired t tests, χ2 tests, and analysis of variance were used for comparisons of clinical variables. Kaplan-Meier analysis was used to evaluate stent patency, with the log-rank test used to discriminate between different curves. RESULTS Of the 192 limbs (166 patients) in the entire cohort, 74 were in the C3 group and 118 were in the C4-C6 group. The median patient age was 63 years; 57 were men and 109 were women. In the C3 group, after CDT, improvement had occurred in the VCSS and VAS pain score at 6 weeks (P < .0001) and at 3 (P < .0001), 6 (P < .0001), and 12 (P < .0001) months. Improvement in the GOS was noted at 6 (P < .0001) and 12 (P = .0005) months. The CIVIQ-20 score improved from 63 to 38 (P = .009). Nine limbs (12%) in the C3 group required stenting after CDT. In the C4-C6 group, of the 118 limbs, 75 (64%) underwent stenting only and 43 (36%) underwent stenting followed by CDT for persistent QoL impairing symptoms. For this latter group, after CDT, improvement occurred in the VCSS, GOS, and VAS pain score at 6 weeks (P < .0001) and 3 (P < .0001), 6 (P < .0001), and 12 (P < .0001) months. The CIVIQ-20 score improved from 61 to 34 (P < .0001). The primary, primary assisted, and secondary patency in the C4-C6 group at 36 months was 92%, 100%, and 100%, respectively. CONCLUSIONS For CEAP C3 patients with phlebolymphedema due to CIVO, CDT should be a part of the first line of treatment. Stenting should be reserved for those with QoL impairing symptoms despite the use of CDT. Additionally, CDT helps provide symptom relief for patients with more advanced CEAP C4-C6 disease with persistent or residual edema after stenting. Further study is warranted.
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Affiliation(s)
- Arjun Jayaraj
- The RANE Center for Venous & Lymphatic Diseases, St. Dominic Hospital, Jackson, MS.
| | - David Thaggard
- The RANE Center for Venous & Lymphatic Diseases, St. Dominic Hospital, Jackson, MS
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Calcaterra G, Bassareo PP, Barilla' F, Mehta JL. Letter on the Recent Paper "Vascular 'Long COVID': A New Vessel Disease?". Angiology 2024; 75:98. [PMID: 36964670 DOI: 10.1177/00033197231167051] [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: 03/26/2023]
Affiliation(s)
| | - Pier Paolo Bassareo
- School of Medicine, Mater Misericordiae University Hospital and Children's Health at Crumlin, University College of Dublin, Dublin, Ireland
| | - Francesco Barilla'
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Javahar L Mehta
- Division of Cardiology, University of Arkansas for Medical Sciences and the VA Medical Center, Little Rock, AR, USA
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13
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Leonard K, Mavropoulos SA, Mazurek R, Ishikawa K. Swine Model of Coronary Artery Dissection. Methods Mol Biol 2024; 2803:219-226. [PMID: 38676896 DOI: 10.1007/978-1-0716-3846-0_16] [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: 04/29/2024]
Abstract
Coronary artery dissection (CAD) is the intimal tearing of the coronary arterial wall and can be iatrogenic, spontaneous, or traumatic in origin. CAD is a rare but challenging condition that can cause significant hemodynamic compromise. Management strategies for CAD, such as the use of mechanical circulatory support devices, are available in the clinical setting. However, the incidence, etiology, and optimal management of CAD are not well-defined, emphasizing the need for adequate animal models in preclinical studies. Large animal models provide the human-like conditions necessary for testing and development of potential treatment strategies. In this chapter, we describe a method for the creation of a CAD swine model.
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Affiliation(s)
- Kyra Leonard
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Spyros A Mavropoulos
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Renata Mazurek
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kiyotake Ishikawa
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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14
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Zhou Y, Yue T, Ding Y, Tan H, Weng J, Luo S, Zheng X. Nanotechnology translation in vascular diseases: From design to the bench. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2024; 16:e1919. [PMID: 37548140 DOI: 10.1002/wnan.1919] [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] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
Atherosclerosis is a systemic pathophysiological condition contributing to the development of majority of polyvascular diseases. Nanomedicine is a novel and rapidly developing science. Due to their small size, nanoparticles are freely transported in vasculature, and have been widely employed as tools in analytical imaging techniques. Furthermore, the application of nanoparticles also allows target intervention, such as drug delivery and tissue engineering regenerative methods, in the management of major vascular diseases. Therefore, by summarizing the physical and chemical characteristics of common nanoparticles used in diagnosis and treatment of vascular diseases, we discuss the details of these applications from cellular, molecular, and in vivo perspectives in this review. Furthermore, we also summarize the status and challenges of the application of nanoparticles in clinical translation. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Implantable Materials and Surgical Technologies > Nanomaterials and Implants Therapeutic Approaches and Drug Discovery > Emerging Technologies.
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Affiliation(s)
- Yongwen Zhou
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Tong Yue
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yu Ding
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Huiling Tan
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Sihui Luo
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xueying Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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15
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Bouchard K, Lalande K, Coutinho T, Mulvagh S, Pacheco C, Liu S, Saw J, So D, Reed JL, Chiarelli A, Stragapede E, Robert H, Lappa N, Sun L, Wells G, Tulloch H. Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient-Informed Investigation. J Am Heart Assoc 2023; 12:e032141. [PMID: 38084731 PMCID: PMC10863752 DOI: 10.1161/jaha.123.032141] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient-informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities. METHODS AND RESULTS Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient-piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self-management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short- and longer-term follow-up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate. CONCLUSIONS This early-stage, pretrial research has important implications for the acute and long-term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient-oriented research.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Thais Coutinho
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Sharon Mulvagh
- Division of CardiologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Christine Pacheco
- Department of CardiologyUniversity of Montréal Hospital CentreMontréalQuebecCanada
| | - Shuangbo Liu
- Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Jacqueline Saw
- Division of CardiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Derek So
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Jennifer L. Reed
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Elisa Stragapede
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Helen Robert
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Nadia Lappa
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Louise Sun
- Stanford MedicineStanford UniversityStanfordCAUSA
| | - George Wells
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Heather Tulloch
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
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16
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Binnie K, Neubeck L, McHale S, Hanson CL. What do spontaneous coronary artery dissection survivors want to support their recovery? a qualitative study. Eur J Cardiovasc Nurs 2023; 22:814-823. [PMID: 36656922 DOI: 10.1093/eurjcn/zvad013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction predominantly affecting women aged younger than 50 years. There is limited research addressing female and male SCAD survivors' experience of, or requirements for, support post-SCAD. This study explored what SCAD survivors wanted to support recovery. METHODS AND RESULTS A qualitative study using semi-structured video and telephone interviews. Data were analysed through thematic analysis using the framework approach. We interviewed 20 participants (19 females) with a mean age of 54.6 (+/-SD 8.5 years). Three overarching themes encapsulated participants' views about support requirements. (i) Education and information. Participants thought healthcare professionals involved in diagnosis and supporting recovery required greater awareness of SCAD and the psychological effect of SCAD. They wanted accessible SCAD information immediately post-event and during the educational component of cardiac rehabilitation. (ii) Physical activity. Requirements were for advice tailored to individuals' specific needs, physical capabilities, and physical activity preferences. Participants suggested that utilizing wearable technology was helpful to encourage a safe return to activity. (iii) Psychosocial support. Participants wanted formal psychosocial support immediately post-event, during cardiac rehabilitation and in the longer term. CONCLUSION Better healthcare professional training may improve diagnosis, and increase support and awareness of SCAD. SCAD support programmes should provide early SCAD specific education utilizing online sources, individually tailor physical activity prescription, offer wearable technology to support a return to being active, and provide short- and long-term psychosocial support. As SCAD is predominately a female condition, programmes should consider female physical activity preferences.
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Affiliation(s)
- Kirsten Binnie
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
| | - Lis Neubeck
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Western Ave, Camperdown, NSW 2050, Australia
| | - Sheona McHale
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
| | - Coral L Hanson
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh EH11 4BN, UK
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17
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Ninomiya K, Serruys PW, Colombo A, Reimers B, Basavarajaiah S, Sharif F, Testa L, Di Mario C, Nerla R, Ding D, Huang J, Kotoku N, Kageyama S, Kageyama M, Sevestre E, Fezzi S, Dijkstra J, O'Leary N, Morel MA, Garg S, Cortese B, Onuma Y. A Prospective Randomized Trial Comparing Sirolimus-Coated Balloon With Paclitaxel-Coated Balloon in De Novo Small Vessels. JACC Cardiovasc Interv 2023; 16:2884-2896. [PMID: 37877914 DOI: 10.1016/j.jcin.2023.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 07/03/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND There are no data comparing sirolimus-coated balloons (SCBs [MagicTouch, Concept Medical]) to paclitaxel-coated balloons (PCBs [SeQuent Please Neo, B. Braun]) for the treatment of de novo small vessel disease (SVD). OBJECTIVES This study sought to compare quantitative coronary angiographic outcomes at 6 months after treatment of de novo SVD with a PCB or SCB. METHODS This prospective, multicenter, noninferiority trial randomized 121 patients (129 SVD lesions) to treatment with an SCB or PCB, with balloon sizing determined using optical coherence tomography. The primary endpoint was noninferiority for the 6-month angiographic net lumen gain. RESULTS Angiographic follow-up was completed in 109 (90.1%) patients in the per-protocol analysis. The mean ± SD angiographic net gains were 0.25 ± 0.40 mm with SCBs vs 0.48 ± 0.37 mm with PCBs, resulting in SCBs failing to meet the 0.30 mm criterion for noninferiority (Pnoninferiority = 0.173), with an absolute difference of -0.23 mm (95% CI: -0.37 to -0.09) secondary to a smaller late loss (0.00 ± 0.32 mm vs 0.32 ± 0.47 mm; P < 0.001) and more frequent late lumen enlargement (53.7% vs 30.0%; OR: 2.60; 95% CI: 1.22-5.67; P = 0.014) with PCBs. Binary restenosis rates were 32.8% and 12.5% following treatment with SCBs and PCBs, respectively (OR: 3.41; 95% CI: 1.36-9.44; P = 0.012). The mean angiography-derived fractional flow ratio at follow-up was 0.86 ± 0.15 following treatment with SCBs and 0.91 ± 0.09 following PCBs (P = 0.026); a fractional flow ratio ≤0.80 occurred in 13 and 5 vessels after treatment with SCBs and PCBs, respectively. CONCLUSIONS The SCB MagicTouch failed to demonstrate noninferiority for angiographic net lumen gain at 6 months compared to the PCB SeQuent Please Neo.
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Affiliation(s)
- Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Antonio Colombo
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | | | - Faisal Sharif
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Roberto Nerla
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Momoko Kageyama
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Simone Fezzi
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Neil O'Leary
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Bernardo Cortese
- Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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18
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Combaret N, Motreff P. [French National registry of spontaneous coronary artery dissections : ''DISCO registry'']. Ann Cardiol Angeiol (Paris) 2023; 72:101684. [PMID: 37890323 DOI: 10.1016/j.ancard.2023.101684] [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] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
AIM Spontaneous coronary artery dissection (SCAD) is a form of acute coronary syndrome (ACS). The aim of this registry is to assess the clinical and angiographic features of SCAD, to describe the therapeutic management and prognosis, and to identify links with other vascular diseases. METHOD From 2016 to 2018, 424 patients with a diagnosis of SCAD were included prospectively and retrospectively in 51 French cardiology centres. RESULTS 373 patients with confirmed SCAD were included. The mean age was 51.5±10.3 years with 90.6% women. 54.7% of patients had <2 cardiovascular risk factors. ACS occurred in 96.2% of patients. 84.2% of patients were managed conservatively, 15.5% interventionally and 0.3% surgically. At 1-year follow-up, recurrence of SCAD occurred in 3.3%. No deaths occurred. The association with fibro-muscular dysplasia was found in 45% of cases and genetic analysis confirmed a strong relationship between the occurrence of SCAD and gene variations at the PHACTR1 locus. CONCLUSION The DISCO registry is the largest European cohort of SCAD. It confirms that this disease mainly affects young women with few cardiovascular risk factors, and that there is a strong association with the presence of fibromuscular dysplasia (45%). Conservative management should be preferred, with a favourable prognosis (no deaths at 1 year; recurrence rate of 3.3%).
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Affiliation(s)
- N Combaret
- Service de cardiologie, Centre Hospitalier Universitaire Gabriel-Montpied, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - P Motreff
- Service de cardiologie, Centre Hospitalier Universitaire Gabriel-Montpied, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
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19
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Akita K, Malik A, Briasoulis A, Kuno T. The relationship between spontaneous coronary artery dissection and COVID-19. J Cardiovasc Med (Hagerstown) 2023; 24:933-935. [PMID: 37642654 DOI: 10.2459/jcm.0000000000001537] [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: 08/31/2023]
Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center, New York, New York
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center
- Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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20
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Shakeri A, Wang Y, Zhao Y, Landau S, Perera K, Lee J, Radisic M. Engineering Organ-on-a-Chip Systems for Vascular Diseases. Arterioscler Thromb Vasc Biol 2023; 43:2241-2255. [PMID: 37823265 PMCID: PMC10842627 DOI: 10.1161/atvbaha.123.318233] [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: 05/06/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
Vascular diseases, such as atherosclerosis and thrombosis, are major causes of morbidity and mortality worldwide. Traditional in vitro models for studying vascular diseases have limitations, as they do not fully recapitulate the complexity of the in vivo microenvironment. Organ-on-a-chip systems have emerged as a promising approach for modeling vascular diseases by incorporating multiple cell types, mechanical and biochemical cues, and fluid flow in a microscale platform. This review provides an overview of recent advancements in engineering organ-on-a-chip systems for modeling vascular diseases, including the use of microfluidic channels, ECM (extracellular matrix) scaffolds, and patient-specific cells. We also discuss the limitations and future perspectives of organ-on-a-chip for modeling vascular diseases.
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Affiliation(s)
- Amid Shakeri
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Ying Wang
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Yimu Zhao
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Shira Landau
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Kevin Perera
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jonguk Lee
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Milica Radisic
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
- Department of Chemical Engineering and Applied Chemistry; University of Toronto; Toronto; Ontario, M5S 3E5; Canada
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21
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Wang JW, Li CH, Liu JF, Li H, Guo H, Gao BL. Endovascular treatment of multiple intracranial aneurysms. Medicine (Baltimore) 2023; 102:e36340. [PMID: 38013257 PMCID: PMC10681595 DOI: 10.1097/md.0000000000036340] [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: 02/14/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Multiple intracranial aneurysms are difficult to treat. In order to investigate the effect and safety of endovascular treatment for multiple intracranial aneurysms, 54 consecutive patients with 116 multiple intracranial aneurysms treated with endovascular embolization were retrospectively enrolled. Angiography was performed immediately after embolization and at each follow-up. All clinical data were analyzed. Of the 116 aneurysms, 56 (48.3%) were embolized with coiling alone, 19 (16.4%) with stent-assisted coiling, 31 (26.7%) with stenting alone, and 10 (8.6%) with flow diverters plus coiling. After embolization, 31 (27.6%) aneurysms with stenting alone had no apparent change in size, and in the remaining 84 aneurysms, complete occlusion was achieved in 50 aneurysms (59.5%), near-complete occlusion in 26 (31.0%), and incomplete occlusion in 8 (9.5%). Thrombus formation at the aneurysm neck occurred in 3 patients (5.6%), coil protrusion in 2 (3.7%), and intraprocedural rupture in 1 (1.9%), resulting in a total complication rate of 11.1%. Follow-up angiography was performed in 44 (81.5%) patients 6 to 90 months (mean 49) later. Among 50 completely occluded aneurysms, 38 (76%) aneurysms remained completely occluded, and 4 (8%) aneurysms recurred. Among 26 aneurysms with initial near-complete occlusion, 12 (46.2%) aneurysms with neck remnant had progressive thrombosis to complete occlusion, 2 (7.7%) had no change compared with immediate occlusion, and 5 (19.2%) regrew. In conclusion, endovascular embolization with intracranial stenting and coiling is safe and effective and may play an increasingly important role in the management of multiple intracranial aneurysms.
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Affiliation(s)
- Ji-Wei Wang
- Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Cong-Hui Li
- Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jian-Feng Liu
- Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hui Li
- Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hao Guo
- Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Bu-Lang Gao
- Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
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22
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Kaddoura R, Cader FA, Ahmed A, Alasnag M. Spontaneous coronary artery dissection: an overview. Postgrad Med J 2023; 99:1226-1236. [PMID: 37773985 DOI: 10.1093/postmj/qgad086] [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: 05/02/2023] [Revised: 06/26/2023] [Indexed: 10/01/2023]
Abstract
The prevalence of spontaneous coronary artery dissection (SCAD) has increased over the last decades in young adults presenting with acute coronary syndrome. Although the diagnostic tools, including intracoronary imaging, have permitted a more accurate diagnosis of SCAD, the prognosis and overall outcomes remain dismal. Furthermore, the disproportionate sex distribution affecting more women and the underdiagnosis in many parts of the world render this pathology a persistent clinical challenge, particularly since the management remains largely supportive with a limited and controversial role for percutaneous or surgical interventions. The purpose of this review is to summarize the available literature on SCAD and to provide insights into the gaps in knowledge and areas requiring further investigation.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fathima Aaysha Cader
- Department of Cardiology, Department of Cardiology, Kettering General Hospital, Kettering, Northants, NN16 8UZ, England
| | - Ashraf Ahmed
- Department of Internal Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut 06610, United States
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital , Jeddah 21159, Saudi Arabia
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23
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Peiró Morant JF, Ramírez Torres JM, Pérez Vázquez E, Lozano Bouzón VM, Parra Valderrama A, Frías Vargas M. [Knowledge of chronic venous disease among healthcare professionals in Spain]. Semergen 2023; 49:102063. [PMID: 37619267 DOI: 10.1016/j.semerg.2023.102063] [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: 03/27/2023] [Revised: 06/24/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Chronic venous disease (CVD) is classified as the most prevalent vascular disease in humans. It has been associated with an increased incidence of cardiovascular diseases and is a strong predictor of all-cause mortality, representing a public health problem of the first magnitude. The objective of this study was to analyze the actions in the management of CVD in the daily clinical practice of health professionals in Spain. MATERIAL AND METHODS Observational, descriptive and cross-sectional study with data collection through an opinion survey of 22 questions completed electronically through a Google® form for professionals involved in chronic venous disease care. Three hundred surveys were analyzed. The quantitative variables were represented with means and standard deviation and the qualitative ones with percentages and confidence intervals. RESULTS Three hundred surveys analyzed. 65.3% were women. The most participatory age group was over 55 years of age. 85% of those surveyed considered that CVD is an underdiagnosed and undertreated disease, with an added negative impact in terms of follow-up during the Covid-19 pandemic, since 91.7% considered that it had not been adequate. 47% of the participants did not know the CEAP classification and 56.3% did not know the venous clinical severity scale (VCSS). 92.7% of physicians prescribed compression stockings and 74.7% phlebotonic drugs. Hidrosmine was the best known and most prescribed venoactive drug (51.7%). 73% of the doctors recognized that they did not use any algorithm or protocol for the diagnosis, treatment and monitoring of CVD in their usual clinical practice and 91% stated that they were not trained in their workplaces. 54.3% of the physicians believed that one of the main limitations that made follow-up of the disease difficult was the lack of coordination with the vascular surgeons. CONCLUSIONS Updating and responding to the training needs of professionals regarding CVD is essential to guarantee quality care continuity in the care of our patients.
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Rahmani G, O'Sullivan GJ. Acute and chronic venous occlusion. Br J Radiol 2023; 96:20230242. [PMID: 37750946 PMCID: PMC10607425 DOI: 10.1259/bjr.20230242] [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] [Received: 03/13/2023] [Revised: 06/04/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023] Open
Abstract
This review article provides an overview of acute and chronic venous occlusion, a condition that can cause significant morbidity and mortality if not diagnosed and treated promptly. The article begins with an introduction to the anatomy of the venous system, followed by a discussion of the causes and clinical features of venous occlusion. The diagnostic tools available for the assessment of venous occlusion, including imaging modalities such as ultrasound, CT, and MRI, are then discussed, along with their respective advantages and limitations. The article also covers the treatment options for acute and chronic venous occlusion, including anticoagulant therapy and endovascular interventions. This review aims to provide radiologists with an updated understanding of the pathophysiology, diagnosis, and management of acute and chronic venous occlusion.
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Affiliation(s)
- George Rahmani
- Department of Interventional Radiology, Galway University Hospitals, Galway, Ireland
| | - Gerard J O'Sullivan
- Department of Interventional Radiology, Galway University Hospitals, Galway, Ireland
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El Khoury R, Bush RL. Lymphedema: The understudied vascular condition of an under-represented population. J Vasc Surg Venous Lymphat Disord 2023; 11:1241-1242. [PMID: 37863548 DOI: 10.1016/j.jvsv.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Rym El Khoury
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Ruth L Bush
- Department of Educational Affairs and Department of Surgery, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX
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Espiño-Álvarez A, Vargas-Tirado M, Royuela M, Gil-Díaz A, Fuente-Cosío S, Cornejo-Saucedo MÁ, Tejero-Delgado MA, Novo-Veleiro I, Bellver-Álvarez TM, Gullón A. Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry. Rev Clin Esp 2023; 223:569-577. [PMID: 37717922 DOI: 10.1016/j.rceng.2023.09.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/27/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Vascular disease (VD) is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on VD, their characteristics and treatments being unknown. OBJECTIVE Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. MATERIAL AND METHODS The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. RESULTS One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p = 0.00) and severe cognitive impairment (30.8% vs 13.8%; p = 0.00) was significantly higher among patients who did not receive them. 19% died during admission. CONCLUSIONS Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis.
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Affiliation(s)
- A Espiño-Álvarez
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain.
| | - M Vargas-Tirado
- Servicio de Medicina Interna, Hospital Universitario General de Villalba, Villalba, Madrid, Spain
| | - M Royuela
- Servicio de Medicina Interna, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain
| | - A Gil-Díaz
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - S Fuente-Cosío
- Servicio de Medicina Interna, Hospital Universitario San Agustín, Avilés, Asturias, Spain
| | - M Á Cornejo-Saucedo
- Servicio de Medicina Interna, Hospital San Carlos, San Fernando, Cádiz, Spain
| | - M A Tejero-Delgado
- Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - I Novo-Veleiro
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - T M Bellver-Álvarez
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Hospital Virgen de la Torre, Madrid, Spain
| | - A Gullón
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain
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Jayaraj A, Thaggard D, Raju S. Inguinal intranodal lymphangiography reveals a high incidence of suprainguinal lymphatic disease in patients with leg edema undergoing stenting for symptomatic chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2023; 11:1192-1201.e2. [PMID: 37442275 DOI: 10.1016/j.jvsv.2023.06.008] [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: 03/17/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Recent studies have emphasized the important role lymphatics play in the drainage of interstitial fluid and edema prevention. Although the infrainguinal lymphatics have been studied in some depth, with patterns of pathology identified, such data above the groin are sparse, especially for patients with phlebolymphedema. The present study attempts to evaluate the status of lymphatic flow above the inguinal ligament in patients presenting with edema and undergoing stenting for symptomatic chronic iliofemoral venous obstruction (CIVO). METHODS A total of 31 lower limbs that underwent pedal lymphoscintigraphy for leg edema and subsequent stenting for symptomatic CIVO formed the study cohort. Each limb underwent intranodal lymphangiography of an ipsilateral inferior inguinal lymph node (10 mL of lipiodol) at the time of stenting. Fluoroscopic visualization of lipiodol transit was performed at 20, 40, and 60 minutes and 3 hours after injection. Enumeration of the lymph nodes and lymphatic collector vessels from above the inguinal ligament to L1, visualization of the thoracic duct, the time delay to visualization of the thoracic duct, and pathologic changes to the thoracic duct when present were all evaluated. These anomalies were independently scored, with the scores combined to generate a total suprainguinal score (range, 0-3). This score was then compared to the limb's lymphoscintigraphically derived infrainguinal score (total infrainguinal score range, 0-3) using the t test and Spearman correlation. The clinical outcomes (grade of swelling, venous clinical severity score) after stenting were appraised. RESULTS Of the 30 patients (31 limbs), 18 were women, with left laterality noted in 23 limbs. A nonthrombotic iliac vein lesion occurred in 9 limbs and post-thrombotic syndrome in 22 limbs. Of the 31 limbs, 24 (77%) had suprainguinal lymphatic disease (SLD), with 22 of the 24 limbs having severe SLD and 2, mild SLD. When SLD was compared with infrainguinal lymphatic disease, 6 limbs (19%) had the same degree of involvement above and below the groin (1 with normal and 5 with severe disease), 17 limbs (55%) had more severe SLD, and 8 limbs (26%) had more severe infrainguinal lymphatic disease. Three limbs with normal pedal lymphoscintigraphic findings had severe SLD. The Spearman correlation coefficient for the comparison of SLD and infrainguinal disease in the same limb was 0.1 (P = .69). At baseline, the limbs with severe SLD had the same degree of leg swelling and venous clinical severity score as the limbs with absent to mild SLD (P > .1) with similar improvements after stenting (P > .4). Seven limbs underwent complex decongestive therapy (all with severe SLD and concomitant severe infrainguinal disease in one) to treat significant residual leg edema, with improvement. CONCLUSIONS SLD appears to be common in patients with leg edema undergoing stenting for symptomatic CIVO. Such disease appears to affect the thoracic duct more commonly. Although patients with persistent or residual leg edema after stenting can benefit from complex decongestive therapy, further workup in the form of inguinal intranodal lymphangiography and targeted intervention might need to be considered for those who do not benefit from such therapy. Further study is warranted.
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Affiliation(s)
- Arjun Jayaraj
- The RANE Center for Venous & Lymphatic Diseases, St Dominic Hospital, Jackson, MS.
| | - David Thaggard
- The RANE Center for Venous & Lymphatic Diseases, St Dominic Hospital, Jackson, MS
| | - Seshadri Raju
- The RANE Center for Venous & Lymphatic Diseases, St Dominic Hospital, Jackson, MS
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Patail H, Sharma T, Aronow W, Haidry SA. Current challenges in treatment and management of spontaneous coronary artery dissection. Hosp Pract (1995) 2023; 51:192-198. [PMID: 37803492 DOI: 10.1080/21548331.2023.2268012] [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: 07/05/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023]
Abstract
Though an infrequent cause of acute coronary syndrome, spontaneous coronary artery dissection is an increasingly recognized cardiovascular condition predominantly seen in middle-aged females. Its pathophysiology is defined by separation of coronary arterial wall layers which cause acute coronary syndrome-like presentations with relatively high recurrence rates. Overall, there is a lack of reported literature and understanding of the short- and long-term management for spontaneous coronary artery dissection. Therapeutic approaches include, but are not limited to, percutaneous coronary intervention, surgical revascularization, antithrombotic therapy, and beta-blocker therapy. There is a significant absence of randomized control trials to help guide both interventional and medical management for spontaneous coronary artery dissection. This review is aimed to review the current literature regarding risk factors and considerations for the short- and long-term management of spontaneous coronary artery dissection.
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Affiliation(s)
- Haris Patail
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Tanya Sharma
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Syed Abbas Haidry
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Razavi MK, Rajan DK, Nordhausen CT, Bounsanga J, Holden A. Objective Performance Goals Based on a Systematic Review and Meta-Analysis of Clinical Outcomes for Bare-Metal Stents and Percutaneous Transluminal Angioplasty for Hemodialysis-Related Central Venous Obstruction. J Vasc Interv Radiol 2023; 34:1664-1673.e3. [PMID: 37302473 DOI: 10.1016/j.jvir.2023.05.036] [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] [Received: 12/28/2022] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To use safety and efficacy outcomes following treatment with percutaneous transluminal angioplasty (PTA) and/or stent placement for thoracic central venous obstruction in hemodialysis-dependent patients to establish objective performance goals (OPGs). METHODS A systematic literature review and meta-analysis were conducted for articles published between January 1, 2000, and August 31, 2021. Efficacy outcomes included primary patency rates at 6 and 12 months, and safety outcomes included adverse events (AEs) categorized as access loss, procedure-related AEs, and serious AEs (SAEs). OPGs were derived from the upper and lower bounds of the 95% confidence intervals for primary patency and SAE rates. RESULTS Of 66 articles reviewed, 17 met the inclusion criteria (PTA, n = 4; stent placement, n = 5; PTA/stent, n = 8). The 6- and 12-month primary patency rates for PTA were 50.9% and 36.7%, respectively. Based on these findings, the proposed 6- and 12-month primary patency OPGs identifying superiority against PTA were 66.5% and 52.6%, respectively, and those for noninferiority were 39.0% and 25.7%, respectively. For stent placement, the 6- and 12-month primary patency rates were 69.7% and 47.9%, respectively. The proposed 6- and 12-month primary patency OPGs identifying superiority were 82.1% and 64.1%, respectively, and those for noninferiority were 59.3% and 35.8%, respectively. SAE rates for PTA and stent placement were 3.8% and 8.1%, respectively. Proposed safety OPGs for noninferiority versus superiority for PTA and stent placement were 10.1% versus 1.4% and 13.6% versus 4.8%, respectively. CONCLUSION The OPGs derived from real-world studies of PTA and stent placement may serve as a benchmark for future interventions indicated for this patient population.
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Affiliation(s)
| | - Dheeraj K Rajan
- University Medical Imaging Toronto/University of Toronto, Toronto, Ontario, Canada
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Vedantham S, Weinberg I, Desai KR, Winokur R, Kolli KP, Patel S, Nelson K, Marston W, Azene E. Society of Interventional Radiology Position Statement on the Management of Chronic Iliofemoral Venous Obstruction with Endovascular Placement of Metallic Stents. J Vasc Interv Radiol 2023; 34:1643-1657.e6. [PMID: 37330211 DOI: 10.1016/j.jvir.2023.06.013] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE To state the position of the Society of Interventional Radiology (SIR) on the endovascular management of chronic iliofemoral venous obstruction with metallic stents. MATERIALS AND METHODS A multidisciplinary writing group with expertise in treating venous disease was convened by SIR. A comprehensive literature search was conducted to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS A total of 41 studies, including randomized trials, systematic reviews and meta-analyses, prospective single-arm studies, and retrospective studies were identified. The expert writing group developed 15 recommendations on the use of endovascular stent placement. CONCLUSIONS SIR considers the use of endovascular stent placement for chronic iliofemoral venous obstruction to be likely to help selected patients, but the risks and benefits have not been fully quantified in well-designed randomized studies. SIR recommends urgent completion of such studies. In the meantime, careful patient selection and optimization of conservative therapy are recommended prior to stent placement, with attention to appropriate stent sizing and quality procedural technique. The use of multiplanar venography with intravascular ultrasound is suggested in diagnosing and characterizing obstructive iliac vein lesions and in guiding stent therapy. After stent placement, SIR recommends close patient follow-up to ensure optimal antithrombotic therapy, durable symptom response, and early identification of adverse events.
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Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri.
| | - Ido Weinberg
- Cardiology Division, Vascular Medicine Section, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald Winokur
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Kanti Pallav Kolli
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Kari Nelson
- Department of Radiology, Orange Coast Medical Center, Fountain Valley, California
| | - William Marston
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Ezana Azene
- Gundersen Health System, La Crosse, Wisconsin
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Nadeem M, Jamshaid H, Mishra R, Ahmed N, Chandan V, Jirku P, Kolar V, Muller M. Taguchi-TOPSIS based optimization of comfort in compression stockings for vascular disorders. Sci Rep 2023; 13:15888. [PMID: 37741942 PMCID: PMC10517980 DOI: 10.1038/s41598-023-43268-7] [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: 06/18/2023] [Accepted: 09/21/2023] [Indexed: 09/25/2023] Open
Abstract
Compression stockings/socks are one of the most essential materials to treat vascular disorders in veins. However, the comfort of wearing such stockings over prolonged period of time is a major problem. There is limited research in the area of comfort optimization while retaining the compressional performance. The current work is carried out with an aim to determine the optimum level of the input factors e.g., knitting structure, plaiting yarn linear density and main yarn linear density for achieving desired stretch recovery percentage and thermo-physiological comfort properties of compression socks used in treatment of vascular disorders. Their optimum combination was determined by using Taguchi based techniques for order of preference by similarity to ideal solution i.e., TOPIS. In this study, thickness, areal density, air permeability, thermal resistance, over all moisture management capacity (OMMC), stretch and recovery % were optimized simultaneously by using Taguchi-TOPSIS method. The results showed that linear density of plaiting and main yarn has significant influence on all the comfort related properties for compression stockings/socks. The optimum sample had linear density 20 denier for Lycra covered by 70 denier of nylon 66 in the plaiting yarn. It also suggested 120 denier nylon 66 in the main yarn knitted into a plain single jersey structure. The percentage contribution of the factors i.e., structure, plaiting yarn linear density and main yarn linear density was obtained by using ANOVA which are 7%, 31% and 42% respectively. It is worth mentioning that in case of compression stockings, the main yarn linear density has more significant effect on comfort properties as compared to other independent parameters. The results were verified by experiment, and the accuracy was relatively high (maximum error 8.533%). This study helped to select suitable knit structure with the change of linear densities of plaiting yarn and main yarn for comfortable compression stocking/sock and will fulfill the potential requirement for treatment of venous/vascular disorders. The novel methodology involving TOPSIS method helped in analyzing the cumulative contribution of the input parameters to achieve optimum compression as well as comfort performance. This modern approach is based on contemporary scientific principles and statistical approximations. This study may provide benchmark solutions to complex problems involving multiple interdependent criteria.
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Affiliation(s)
- Muhammad Nadeem
- School of Engineering and Technology, National Textile University, Faisalabad, 37610, Pakistan
| | - Hafsa Jamshaid
- School of Engineering and Technology, National Textile University, Faisalabad, 37610, Pakistan.
- Protective Textile Group, National Textile University, Faisalabad, 37610, Pakistan.
| | - Rajesh Mishra
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, 16500, Suchdol, Czech Republic.
| | - Naseer Ahmed
- School of Science, National Textile University, Faisalabad, 37610, Pakistan
| | - Vijay Chandan
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, 16500, Suchdol, Czech Republic
| | - Petr Jirku
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, 16500, Suchdol, Czech Republic
| | - Viktor Kolar
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, 16500, Suchdol, Czech Republic
| | - Miroslav Muller
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, 16500, Suchdol, Czech Republic
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Gavrilov SG, Sazhin AV, Akhmetzianov R, Bredikhin RA, Krasavin GV, Mishakina NY, Vasilyiev AV. Surgical and endovascular treatment of pelvic venous disorder: Results of a multicentre retrospective cohort study. J Vasc Surg Venous Lymphat Disord 2023; 11:1045-1054. [PMID: 37150252 DOI: 10.1016/j.jvsv.2023.04.009] [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: 01/09/2023] [Revised: 02/27/2023] [Accepted: 04/08/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE In the present study, we investigated the clinical outcomes after gonadal vein resection (GVR) and gonadal vein embolization (GVE) with coils in patients with pelvic venous disorder (PeVD). We also assessed the rates of procedural complications and disease recurrence. METHODS Our multicenter retrospective cohort study included 361 female patients with PeVD-related chronic pelvic pain (CPP) and gonadal vein reflux who underwent GVR (n = 184) or GVE with coils (n = 177) from 1999 to 2020. The clinical outcomes (ie, presence and severity of CPP, procedural complications, disease recurrence) were assessed at 1 month and 1, 3, and 5 years after intervention. The pain intensity before and after treatment was assessed using a visual analog scale. All the patients underwent duplex ultrasound after GVR and GVE, and those with persistent CPP and suspected perforation of the gonadal vein by the coils were also evaluated by multiplanar pelvic venography. RESULTS GVR and GVE was associated with the reduction or elimination of CPP at 1 month after treatment in 100% and 74% of patients and postprocedural complications in 14% and 37% of patients, respectively (Р < 0.01 for both). The most common complication after either GVR or GVE was pelvic vein thrombosis (11% and 22% patients, respectively; P < .01 between groups). GVE was associated with postembolization syndrome in 20%, coil protrusion in 6%, and coil migration in 1% of patients. The long-term recurrence rate after GVR and GVE was 6% and 16%, respectively (P < .01). CONCLUSIONS Both GVR and GVE were found to be effective in treating patients with PeVD. However, GVR was associated with better efficacy in the relief of CPP and lower rates of procedural complications and disease recurrence.
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Affiliation(s)
- Sergey G Gavrilov
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia.
| | - Alexander V Sazhin
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - RustemV Akhmetzianov
- Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia; Department of Vascular Surgery, Interregional Clinical Diagnostic Center, Kazan, Russia
| | - Roman A Bredikhin
- Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia; Department of Vascular Surgery, Interregional Clinical Diagnostic Center, Kazan, Russia
| | | | - Nadezhda Yu Mishakina
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Alexey V Vasilyiev
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
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Alfonso F, Sanz-Ruiz R, Sabate M, Roura G, Velazquez M, Macaya F, Veiga G, Camacho-Freire S, Bastante T, García-Guimaraes M. Clinical Implications of TIMI Flow Grade 0/1 in Patients With Spontaneous Coronary Artery Dissection. JACC Cardiovasc Interv 2023; 16:2061-2063. [PMID: 37480894 DOI: 10.1016/j.jcin.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
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田 慈, 白 颐, 马 青, 葛 洪. [Clinical characteristics of 7 cases of hepatic portal venous gas]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:743-747. [PMID: 37534661 PMCID: PMC10398756] [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] [Received: 10/29/2021] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To summarize and analyze the clinical characteristics of patients diagnosed with hepatic portal venous gas (HPVG). METHODS This was a single center retrospective observational study. All of the patients were diagnosed with HPVG. The patients were admitted to Peking University Third Hospital from January 2017 to January 2021. Demographic characteristics, clinical manifestations, laboratory tests, abdominal imaging, treatment of the primary disease, and clinical outcomes of the patients were collected via electronic medical records. The study was approved by institutional review board and the information of all the patients was kept de-identified. RESULTS A total of seven cases were included in the study. The median age of the patients was 67 (63, 81) years. Six of the patients were male. The seven patients all presented with sudden onset of severe abdominal pain, which was the most common symptom. Six patients developed septic shock after admission. The signs of HPVG were detected by CT scans in all the patients, showing gas embolization. It might also be found as unique "aquarium sign" in abdominal ultrosonography. Four cases were caused by intestinal lesions, including acute volvulus, intestinal obstruction, and rectal abscess. Two were caused by ischemic bowel disease and the other one was caused by severe acute pancreatitis. The gas accumulation could disappear after effective anti-shock therapy and surgery (Cases 1, 2, and 6). Two patients had good postoperative outcomes, and one patient was discharged after non-surgical treatment. However, the prognosis was poor in the patients with intestinal ischemia necrosis accompanied by shock and multiple organ dysfunction (Cases 3, 4, 5, and 7 all died). CONCLUSION The HPVG patients generally have acute abdominal pain and show up at Emergency Department. The prognosis depends on the potential cause of HPVG. The mechanism and clinical management for the appearance of gas in the portal vein is not well understood. Patients complicated with shock, ascites, and peritonitis may have intestinal necrosis, which indicates surgical intervention and higher mortality. CT is the preferred diagnostic method in standard clinical practice. Physicians need to have a comprehensive understanding of the proactive diagnostic strategy, and active treatment for the primary disease.
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Affiliation(s)
- 慈 田
- />北京大学第三医院急诊科,北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 颐 白
- />北京大学第三医院急诊科,北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 青变 马
- />北京大学第三医院急诊科,北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 洪霞 葛
- />北京大学第三医院急诊科,北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
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Nelson DC, Elbarouni B, Shah AH. Multi-vessel spontaneous coronary artery dissections. Coron Artery Dis 2023; 34:374-375. [PMID: 37222219 DOI: 10.1097/mca.0000000000001255] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- David C Nelson
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Vongbunyong K, Chua F, Ghashghaei R. Pregnancy-related spontaneous coronary artery dissection: a rare cause of acute coronary syndrome in the third trimester. BMC Cardiovasc Disord 2023; 23:292. [PMID: 37291481 PMCID: PMC10251557 DOI: 10.1186/s12872-023-03323-7] [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: 01/24/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of myocardial infarction and sudden cardiac death that is mostly seen in younger patients without significant cardiac risk factors. The mechanism by which SCAD causes an acute coronary event is related to the compromise of the coronary artery lumen as a result of hematoma within the vessel wall. In comparison to their non-pregnant counterparts, when SCAD is associated with pregnancy, it has been associated with an increased risk of life-threatening arrhythmias, cardiogenic shock, and death. The underlying mechanism behind SCAD is not yet fully understood, and despite the condition's high mortality rate, it remains underdiagnosed. CASE PRESENTATION Our case features a 38-year-old woman at 29 weeks of gestation presenting with chest pain that persisted despite initial management. Coronary angiography revealed a Type 2a spontaneous dissection of the left anterior descending artery. Given the risks of percutaneous coronary intervention in SCAD management and overall clinical stability, the patient was treated with conservative management. CONCLUSION SCADs are a rare cause of acute coronary syndrome that can be found in patients without any prior cardiac risk factors. It is important to have a high index of suspicion when diagnosing SCADs given, they can cause life-threatening arrhythmias, cardiogenic shock, and death. This case highlights considerations that must be taken into account when treating P-SCAD, as opposed to SCAD in the postpartum period.
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Affiliation(s)
- Kenny Vongbunyong
- Department of Medicine, University of California, 333 The City Blvd. West, Suite 400, Orange, Irvine, CA, 92868, USA.
| | - Frederick Chua
- Department of Medicine, University of California, 333 The City Blvd. West, Suite 400, Orange, Irvine, CA, 92868, USA
| | - Roxana Ghashghaei
- Department of Medicine, Division of Cardiology, University of California, Irvine, CA, USA
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Gongolli J, Vanderschaegen A, Prahlow JA. A Case of Spontaneous Coronary Artery Dissection in the Setting of Exogenous Testosterone. Am J Forensic Med Pathol 2023; 44:122-125. [PMID: 36943719 DOI: 10.1097/paf.0000000000000821] [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: 03/23/2023]
Abstract
ABSTRACT Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, occurring when there is separation of the coronary artery walls by intramural hemorrhage creating a false lumen. This compresses the arterial lumen, compromising the ability of the coronary artery to perfuse the myocardial tissue. Spontaneous coronary artery dissection is usually fatal, with risk factors including pregnancy, young age, and female sex, birth control, and other hormonal therapies.In this case report, we describe the case of a 31-year-old biological female transitioning to male with exogenous testosterone who experienced a SCAD. Given the known risk factors for SCAD, such as pregnancy and exogenous hormone therapy, this case raises additional considerations regarding rare unintended consequences of testosterone therapy.
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Affiliation(s)
- Julita Gongolli
- From the Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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Holder TA, Alabi O, Arya S, Beach JM, Eagle K, Kim ES, Shalhub S, Gornik HL. SVM Communications: Using registries to investigate vascular disease. Vasc Med 2023; 28:257-261. [PMID: 37154392 DOI: 10.1177/1358863x231169808] [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: 05/10/2023]
Affiliation(s)
- Tara A Holder
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Olamide Alabi
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Shipra Arya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jocelyn M Beach
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kim Eagle
- Department of Medicine, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Esther Sh Kim
- Center for Women's Cardiovascular Health, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC, USA
| | - Sherene Shalhub
- Department of Surgery, Division of Vascular and Endovascular Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Heather L Gornik
- University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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39
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Fong KY, Xin L, Ng J, Loh SEK, Ng JJ, Choong AMTL. A systematic review and meta-analysis of sirolimus-eluting stents for treatment of below-the-knee arterial disease. J Vasc Surg 2023; 77:1264-1273.e3. [PMID: 36183989 DOI: 10.1016/j.jvs.2022.09.022] [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: 05/25/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to analyze the efficacy and safety of sirolimus-eluting stents (SESs) in the treatment of below-the-knee (BTK) arterial disease. METHODS An electronic literature search was conducted from inception to July 24, 2021. Retrospective, prospective, and randomized studies that had used SESs to treat BTK arterial disease and had reported the primary patency, technical success, target lesion revascularization, and/or mortality were included. Meta-analyses of the proportions were conducted to derive pooled summary statistics of the outcomes. Where Kaplan-Meier curves were provided for primary patency, a meta-analysis of the individual patient data was conducted via a graphic reconstruction tool to estimate primary patency at various follow-up points. For studies comparing SESs and bare metal stents (BMSs), a two-stage meta-analysis was performed to compare the 6-month primary patency of SESs vs BMSs. RESULTS Ten studies across 13 publications, including 995 patients, were retrieved for analysis. In the meta-analysis of proportions, across six studies (n = 339 patients), the pooled 6-month primary patency was 87.3% (95% confidence interval [CI], 81.6%-92.1%). Across seven studies (n = 283 patients), the pooled 6-month mortality was 5.4% (95% CI, 1.4%-11.2%). An individual patient data analysis of three studies (n = 282 patients) yielded a primary patency rate of 95.2% (95% CI, 92.7%-97.8%), 82.8% (95% CI, 78.3%-87.6%), 79.8% (95% CI, 75.0%-85.0%), and 79.8% (95% CI, 75.0%-85.0%) at 6, 12, 18, and 24 months, respectively. The 12-month target lesion revascularization rate across four studies (n = 324 patients) was 9.6% (95% CI, 6.4%-13.4%). In the two-stage meta-analysis of 6-month primary patency across three studies (n = 168 patients), the use of SESs was significantly favored over BMSs (risk ratio, 1.28; 95% CI, 1.12-1.46; P < .001). CONCLUSIONS The overall evidence suggests that the use of SESs appears to be safe and offers favorable outcomes for BTK arterial disease compared with BMSs.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Liu Xin
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Magdalen College, University of Oxford, Oxford, UK
| | - Josiah Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Stanley E K Loh
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Diagnostic Imaging, National University Health System, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
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40
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Soydemir E, Gündoğmuş CA, Türeli D, Andaç Baltacıoğlu N, Bayri Y, Baltacıoğlu F. Safety and efficacy of flow diverter stents in the treatment of middle cerebral artery aneurysms: a single-center experience and follow-up data. Diagn Interv Radiol 2023; 29:350-358. [PMID: 36988000 PMCID: PMC10679704 DOI: 10.4274/dir.2022.211050] [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: 10/19/2021] [Accepted: 04/04/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results. METHODS The treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches. RESULTS The mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. (P = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0-1.30) for occluded aneurysms, and 0.50 (0-1.40) for non-occluded aneurysms (P = 0.323). The median oversizing was 0.70 (0.45-1.10) in occluded integrated branches and 0.50 (0-1.40) in non-occluded branches (P = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents. CONCLUSION MCA aneurysms tend to be complex, with integrated branches and potentially wide necks. FD stents are safe and effective in the treatment of MCA aneurysms, and the patency of the side and jailed branches is preserved in most cases. Higher occlusion and lower in-stent stenosis rates are seen with longer F/U durations.
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Affiliation(s)
- Efe Soydemir
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Cemal Aydın Gündoğmuş
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Department of Radiology, Koç University Hospital, İstanbul, Turkey
| | - Derya Türeli
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | | | - Yaşar Bayri
- Department of Neurosurgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Feyyaz Baltacıoğlu
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Department of Radiology, VKV Amerikan Hospital, İstanbul, Turkey
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Smolderen KG, Samaan Z, Ward-Zimmerman B, Fucito L, Goodney P, Le V, Abu Daya H, McNeal DM, Bonaca M, Mena-Hurtado C. Integrating Psychosocial Care in the Management of Patients With Vascular Disease. J Am Coll Cardiol 2023; 81:1201-1204. [PMID: 36948738 PMCID: PMC10514776 DOI: 10.1016/j.jacc.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Kim G Smolderen
- School of Medicine, Department of Internal Medicine, Cardiovascular Medicine Section, Vascular Medicine Outcomes Program, Yale University, New Haven, Connecticut, USA; School of Medicine, Department of Psychiatry, Psychology Section, Yale University, New Haven, Connecticut, USA.
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Barbara Ward-Zimmerman
- CT Psychological Association's Health Care Reform Task Force, North Haven, Connecticut, USA
| | - Lisa Fucito
- School of Medicine, Department of Psychiatry, Psychology Section, Yale University, New Haven, Connecticut, USA
| | - Philip Goodney
- Department of Surgery, The Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Viet Le
- Department of Cardiovascular Research, Intermountain Healthcare, Intermountain Heart Institute, Murray, Utah, USA
| | - Hussein Abu Daya
- Department of Internal Medicine, Cardiovascular Diseases Division, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Demetria M McNeal
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marc Bonaca
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Carlos Mena-Hurtado
- School of Medicine, Department of Internal Medicine, Cardiovascular Medicine Section, Vascular Medicine Outcomes Program, Yale University, New Haven, Connecticut, USA. https://twitter.com/CarlosMenaYale
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42
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Kiefer J, Mazzeffi M. Complications of Vascular Disease. Anesthesiol Clin 2022; 40:587-604. [PMID: 36328617 DOI: 10.1016/j.anclin.2022.08.006] [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: 06/16/2023]
Abstract
Vascular diseases and their sequelae increase perioperative risk for noncardiac surgical patients. In this review, the authors discuss vascular diseases, their epidemiology and pathophysiology, risk stratification, and management strategies to reduce adverse perioperative outcomes.
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Affiliation(s)
- Jesse Kiefer
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania - Perelman School of Medicine, 3400 Spruce Street, Suite 680 Dulles Philadelphia, PA 19104, USA
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, USA.
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Shapiro J, Neville E, Robertson B, Rucker LG, Fellner AN, Kuhn B, Recht M, Kulwicki A, Broering M, Muck P. Novel therapy for recanalization of chronic iliocaval venous occlusion using radiofrequency. J Vasc Surg Venous Lymphat Disord 2022; 10:1288-1293. [PMID: 35963503 DOI: 10.1016/j.jvsv.2022.07.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Chronic venous disease of the lower extremities is one of the most common diseases in the United States. The sequelae of this disease process are the source of a significant amount of morbidity, and its prevalence is expected to increase in the coming decades. Interventional therapy is warranted for relief of patients with CEAP C3-C6 disease. With advances in endovascular therapy, chronic iliocaval venous occlusion (CICVO) pathology can be corrected through minimally invasive approaches with limited morbidity and mortality. However, failure to recanalize the venous system leads to high failure rates. The purpose of this study was to assess the procedural success for recanalization of CICVO in the community setting using the novel technique of the Baylis radiofrequency (RF) wire in patients who had failed previous endovascular intervention. METHODS A retrospective review of patients who underwent RF recanalization for CICVO at our institution from 2019 to 2020 was conducted. All patients had failed previous endovascular attempts at recanalization. The primary outcome was recanalization (defined as restoration of >70% of luminal patency as determined on multiplanar venography [MPV] and intravascular ultrasound [IVUS]) confirmed on both IVUS and MPV. Secondary outcomes included adjunctive interventions and complications (hematoma, pulmonary embolism, new onset renal insufficiency). RESULTS A total of 10 patients, 50% male with a mean (standard deviation) age of 58.4 (10.4), were evaluated in the study. Successful recanalization was achieved in 60% of cases, with a resolution of >70% of luminal obstruction observed using MPV and IVUS. Adjunctive interventions were performed in 70% of cases. There were no clinically significant complications or blood transfusion requirements. CONCLUSIONS New techniques and technologies continue to be developed for advanced endovascular management of CICVO, especially with the expanding market for Food and Drug Administration approved venous stents. The Baylis RF wire can assist in recanalization and treatment of patients who had failed previous endovascular therapy.
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Affiliation(s)
- Jacob Shapiro
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH.
| | - Evan Neville
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Brent Robertson
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Louis Graham Rucker
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Angela N Fellner
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Brian Kuhn
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Matthew Recht
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Aaron Kulwicki
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Mark Broering
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
| | - Patrick Muck
- Department of Vascular Surgery, Good Samaritan & Bethesda North Hospital, Cincinnati, OH
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Cosmi F. [Spontaneous coronary artery dissection: when experts should be recommended not to recommend]. G Ital Cardiol (Rome) 2022; 23:892-893. [PMID: 36300393 DOI: 10.1714/3900.38829] [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: 06/16/2023]
Affiliation(s)
- Franco Cosmi
- Già Direttore Cardiologia, Ospedale di Cortona (AR)
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45
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Adlam D. The Spontaneous Coronary Artery Dissection study group of the Association for Acute Cardiovascular Care. Eur Heart J Acute Cardiovasc Care 2022; 11:595-596. [PMID: 35792672 DOI: 10.1093/ehjacc/zuac079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- David Adlam
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
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Sheikh AB, Fudim M, Garg I, Minhas AMK, Sobotka AA, Patel MR, Eng MH, Sobotka PA. The Clinical Problem of Pelvic Venous Disorders. Interv Cardiol Clin 2022; 11:307-324. [PMID: 35710285 DOI: 10.1016/j.iccl.2022.03.003] [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] [Indexed: 06/15/2023]
Abstract
Pelvic venous disorders are inter-related pathologic conditions caused by reflux and obstruction in the pelvic veins. It can present a spectrum of clinical features based on the route of transmission of venous hypertension to either distal or caudal venous reservoirs. Imaging can help to visualize pelvic vascular and visceral structures to rule out other gynecologic, gastrointestinal, and urologic diseases. Endovascular treatment, owing to its low invasive nature and high success rate, has become the mainstay in the management of pelvic venous disorders. This article reviews the pathophysiology, clinical presentations, and diagnostic and therapeutic approaches to pelvic venous disorders.
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Affiliation(s)
- Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1021 Medical Arts Avenue NE, Albuquerque, NM 87102, USA
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA; Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC 27701, USA.
| | - Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1021 Medical Arts Avenue NE, Albuquerque, NM 87102, USA
| | - Abdul Mannan Khan Minhas
- Department of Internal Medicine, Forrest General Hospital, 6051 US 49, Hattiesburg, MS 39401, USA
| | | | - Manesh R Patel
- Division of Cardiology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA; Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC 27701, USA
| | - Marvin H Eng
- Division of Cardiology, University of Arizona, Banner University Medical Center, 1111 E McDowell Rd, Phoenix, AZ 85006, USA
| | - Paul A Sobotka
- The Ohio State University, 281 West Lane Avenue, Columbus, OH 43210, USA.
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Gowda SN, Sathyanarayanan SP, Shah A. Spontaneous Coronary Artery Dissection: An Elusive Disease of the Coronaries. Methodist Debakey Cardiovasc J 2022; 18:89-93. [PMID: 35734156 PMCID: PMC9165683 DOI: 10.14797/mdcvj.1129] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 12/04/2022] Open
Abstract
The articles in our Points to Remember column highlight important “need to know” facts about conditions that cardiovascular healthcare professionals may encounter. These may come from any medical specialty, such as nephrology or neurology. The article in this issue is provided by Swaminathan Perinkulam Sathyanarayanan, MD, Department of Internal Medicine, University of South Dakota, and Smitha Narayana Gowda, MD, and Alpesh Shah, MD, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist.
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Affiliation(s)
- Smitha Narayana Gowda
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | | | - Alpesh Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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De Maeseneer MG. New clinical practice guidelines on the management of chronic venous disease - towards new horizons. J Med Vasc 2022; 47:51-52. [PMID: 35691662 DOI: 10.1016/j.jdmv.2022.04.006] [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] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Indexed: 06/15/2023]
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Dang H, Perazzini C, Caudron S, Ravel A, Dumousset E, Chabrot P, Boyer L. High-flow priapism: Highly selective embolization of a traumatic arterio-cavernosal fistula. J Med Vasc 2022; 47:27-32. [PMID: 35393088 DOI: 10.1016/j.jdmv.2021.11.001] [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: 04/01/2021] [Accepted: 11/08/2021] [Indexed: 06/14/2023]
Abstract
We report the case of a 14-year-old man who arrived at the emergency department affected by a high-flow priapism due to a traumatic left arterial-sinusoidal fistula. After clinical examination, a colour Doppler ultrasound of the penis was performed which showed a left arterial-sinusoidal fistula measuring 7×16×30mm, with high-speed and turbulent flow. The fistula was successfully treated by three highly selective endovascular embolizations and at the 20days follow-up, clinical examination resulted normal.
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Affiliation(s)
- H Dang
- Radiology Department, University Hospital Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - C Perazzini
- Radiology Department, University Hospital Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - S Caudron
- Radiology Department, University Hospital de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - A Ravel
- Radiology Department, University Hospital Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - E Dumousset
- Radiology Department, University Hospital Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P Chabrot
- Radiology Department, University Hospital Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - L Boyer
- Radiology Department, University Hospital Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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Corbo MD, Centola A, Fortunato M, Mazzeo P, Vitale E, Della Monica D, Magnesa M, Ieva R, Cuculo A, Iacoviello M, Brunetti ND. Multivessel spontaneous coronary artery dissection and Crohn's disease. J Cardiovasc Med (Hagerstown) 2021; 22:e26-e28. [PMID: 34107504 DOI: 10.2459/jcm.0000000000001217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Pietro Mazzeo
- Department of Medical & Surgical Sciences, University of Foggia
| | - Enrica Vitale
- Department of Medical & Surgical Sciences, University of Foggia
| | | | - Michele Magnesa
- Department of Medical & Surgical Sciences, University of Foggia
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