01 diciembre 2013

RADIOLOGY. Treated Pulmonary Arteriovenous Malformations: Patterns of Persistence and Associated Retreatment Success

Catherine S. Woodward, BA, Reed E. Pyeritz, MD, PhD, Jessie L. Chittams, MS, Scott O. Trerotola, MD

Pulmonary arteriovenous malformations (PAVMs) are treated to remedy or avert the known complications of desaturation, paradoxical embolization, hemoptysis, and hemothorax (1). The standard of care in PAVM treatment is embolotherapy (1–11). Up to 25% of initially successful treatments require retreatment (1–11). PAVM persistence has been attributed to recanalization through previously placed coils, interim accessory artery growth, presence of an accessory pulmonary feeding artery, and systemic-to-pulmonary reperfusion (3–11). Previous literature has analyzed risk factors for persistence (5). This study was performed to determine the relative frequencies of persistence patterns in treated PAVMs and assess whether retreatment outcomes differ between PAVMs persisting via recanalization and those persisting via reperfusion.

01 diciembre 2013

RADIOLOGY. Comparison of Combined Transcatheter Arterial Chemoembolization and Radiofrequency Ablation with Surgical Resection by Using Propensity Score Matching in Patients with Hepatocellular Carcinoma within Milan Criteria

Yoshitaka Takuma, MD, Hiroyuki Takabatake, MD, Youichi Morimoto, MD, Nobuyuki Toshikuni, MD, Takahisa Kayahara, MD, Yasuhiro Makino, MD, Hiroshi Yamamoto, MD

Hepatocellular carcinoma (HCC) is the third leading cause of cancer death globally (1). Patients who satisfy the Milan criteria (2) (one HCC ≤5 cm or as many as three nodules <3 cm without vascular invasion or extrahepatic metastasis) are optimal candidates for liver transplantation because of their early disease stage. Among these, patients with preserved liver function (Child-Pugh class A or B disease) may also qualify for curative treatments, such as surgical resection (SR) or local ablation, because these therapies confer lower risks and costs, circumvent the need for organ donors, and avoid the need for lifelong immunosuppression (3,4). Although SR is considered the main curative treatment for early-stage HCC, SR increases the risk of postoperative liver failure beyond that seen with local ablation therapies, such as percutaneous ethanol injection, radiofrequency ablation (RFA), and microwave ablation.

01 septiembre 2014

CIRCULATION. Vitamin D Promotes Vascular Regeneration

Michael Sze Ka Wong, PhD; Matthias S. Leisegang, PhD; Christoph Kruse, MSc; Juri Vogel, MSc; Christoph Schürmann, PhD; Nathalie Dehne, PhD; Andreas Weigert, PhD; Eva Herrmann, PhD; Bernhard Brüne, PhD; Ajay M. Shah, MD, PhD; Dieter Steinhilber, PhD; Stefan Offermanns, MD; Geert Carmeliet, MD, PhD; Klaus Badenhoop, MD; Katrin Schröder, PhD; Ralf P. Brandes, MD

Background—Vitamin D deficiency in humans is frequent and has been associated with inflammation. The role of the active hormone 1,25-dihydroxycholecalciferol (1,25-dihydroxy-vitamin D3; 1,25-VitD3) in the cardiovascular system is controversial. High doses induce vascular calcification; vitamin D3 deficiency, however, has been linked to cardiovascular disease because the hormone has anti-inflammatory properties. We therefore hypothesized that 1,25-VitD3 promotes regeneration after vascular injury.

01 agosto 2014

CIRCULATION. An Aspirin a Day to Keep the Clots Away

Thomas W. Wakefield, MD; Andrea T. Obi, MD; Peter K. Henke, MD

Patients presenting with deep vein thrombosis (DVT) in the absence of any identifiable risk factors are said to have an unprovoked or idiopathic DVT. Recurrent events are much more common in these patients (10% versus ≤ 3% at 1 year) compared with patients with a DVT provoked by a reversible risk factor, and such events represent a major healthcare problem.1 Three months of anticoagulation is sufficient to decrease the risk of recurrent thrombosis related to the initial DVT. However, once therapy is discontinued, the risk for recurrence rises dramatically. It has been suggested that 30% to 50% of patients experience a recurrence at 10 years.2,3 Factors associated with a higher likelihood of recurrence are male sex, elevated D dimer, incomplete resolution of DVT, body mass index ≥30, and post-thrombotic syndrome.4 In fact, a number of tools have been developed to determine the risk of recurrence after DVT.

01 agosto 2014

CIRCULATION. Aspirin for the Prevention of Recurrent Venous Thromboembolism

John Simes, MD; Cecilia Becattini, MD; Giancarlo Agnelli, MD; John W. Eikelboom, MB, BS; Adrienne C. Kirby, MSc; Rebecca Mister, MSc; Paolo Prandoni, MD; Timothy A. Brighton, MB, BS; for the INSPIRE Study Investigators* (International Collaboration of Aspirin Trials for Recurrent Venous Thromboembolism)

Background—In patients with a first unprovoked venous thromboembolism (VTE) the risk of recurrent VTE remains high after anticoagulant treatment is discontinued. The Aspirin for the Prevention of Recurrent Venous Thromboembolism (the Warfarin and Aspirin [WARFASA]) and the Aspirin to Prevent Recurrent Venous Thromboembolism (ASPIRE) trials showed that aspirin reduces this risk, but they were not individually powered to detect treatment effects for particular outcomes or subgroups.

01 noviembre 2013

CIRCULATION. Outcomes of Patients Presenting With Acute Type A Aortic Dissection in the Setting of Prior Cardiac Surgery

Nicholas R. Teman, MD; Mark D. Peterson, MD; Mark J. Russo, MD; Marek P. Ehrlich, MD; Truls Myrmel, MD; Gilbert R. Upchurch Jr, MD; Kevin Greason, MD; Mark Fillinger, MD; Alberto Forteza, MD; George Michael Deeb, MD; Daniel G. Montgomery, MS; Kim A. Eagle, MD; Eric M. Isselbacher, MD; Christoph A. Nienaber, MD; Himanshu J. Patel, MD

Background—Prior cardiac surgery (PCS) can complicate the presentation and management of patients with type A acute aortic dissection (TAAAD). This report from the International Registry of Acute Aortic Dissection examines this hypothesis.

01 noviembre 2013

CIRCULATION. Stratified Meta-Analysis of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Hospitalized Patients

Kwok M. Ho, MPH, PhD, FRCP; Jen Aik Tan, MBBS

Background—Optimal thromboprophylaxis for patients at risk of bleeding remains uncertain. This meta-analysis assessed whether intermittent pneumatic compression (IPC) of the lower limbs was effective in reducing venous thromboembolism and whether combining pharmacological thromboprophylaxis with IPC would enhance its effectiveness.

01 noviembre 2013

CIRCULATION. Fruit and Vegetable Consumption With Risk of Abdominal Aortic Aneurysm

Otto Stackelberg, MD; Martin Björck, MD, PhD; Susanna C. Larsson, PhD; Nicola Orsini, PhD; Alicja Wolk, DMSc

Background—Dietary factors affecting the risk of developing abdominal aortic aneurysm (AAA) are scarcely investigated. The aim of this study was to investigate the associations of fruit and vegetable consumption with the risk to develop AAA.

01 noviembre 2013

CIRCULATION. Direct Quantitative Assessment of the Peripheral Artery Collateral Circulation in Patients Undergoing Angiography

Tobias Traupe, MD; Jana Ortmann, MD; Michael Stoller, MD; Iris Baumgartner, MD; Stefano F. de Marchi, MD; Christian Seiler, MD

Background—Despite the fact that numerous studies have pursued the strategy of improving collateral function in patients with peripheral artery disease, there is currently no method available to quantify collateral arterial function of the lower limb.

01 noviembre 2013

CIRCULATION. Management of Patients After Endovascular Interventions for Peripheral Artery Disease

Piotr Sobieszczyk, MD; Andrew Eisenhauer, MD

Endovascular therapy to relieve intermittent claudication or critical limb ischemia in patients with lower-extremity peripheral artery disease is now firmly established as an alternative to surgical revascularization.1 The advent of novel technologies allows percutaneous interventions of increasingly complex arterial disease previously reserved for surgical interventions.2 Although the durability of aortoiliac interventions rivals that of surgical bypass, restenosis after femoropopliteal interventions remains the Achilles’ heel of endovascular therapies.

01 noviembre 2013

CIRCULATION. Drug-Eluting Balloon in Peripheral Intervention for Below the Knee Angioplasty Evaluation (DEBATE-BTK) A Randomized Trial in Diabetic Patients With Critical Limb Ischemia

Francesco Liistro, MD; Italo Porto, MD PhD; Paolo Angioli, MD; Simone Grotti, MD; Lucia Ricci, MD; Kenneth Ducci, MD; Giovanni Falsini, MD; Giorgio Ventoruzzo, MD; Filippo Turini, MD; Guido Bellandi, MD; Leonardo Bolognese, MD

Background—The 1-year restenosis rate after balloon angioplasty of long lesions in below-the-knee arteries may be as high as 70%. Our aim was to investigate the efficacy of a paclitaxel drug-eluting balloons versus conventional percutaneous transluminal angioplasty (PTA) for the reduction of restenosis in diabetic patients with critical limb ischemia undergoing endovascular intervention of below-the-knee arteries.

01 noviembre 2013

CIRCULATION. Stent Revascularization Restores Cortical Blood Flow and Reverses Tissue Hypoxia in Atherosclerotic Renal Artery Stenosis but Fails to Reverse Inflammatory Pathways or Glomerular Filtration Rate

Ahmed Saad, MD, Sandra M.S. Herrmann, MD, John Crane, BS, James F. Glockner, MD, PhD, Michael A. Mckusick, MD, Sanjay Misra, MD, Alfonso Eirin, MD, Behzad Ebrahimi, PhD, Lilach O. Lerman, MD, PhD and Stephen C. Textor, MD

Background—Atherosclerotic renal artery stenosis (ARAS) is known to reduce renal blood flow, glomerular filtration rate (GFR) and amplify kidney hypoxia, but the relationships between these factors and tubulointerstitial injury in the poststenotic kidney are poorly understood. The purpose of this study was to examine the effect of renal revascularization in ARAS on renal tissue hypoxia and renal injury.

01 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Controlled Reperfusion Versus Conventional Treatment of the Acutely Ischemic Limb

Claudia Heilmann, MD, Claudia Schmoor, PhD, Matthias Siepe, MD, Christian Schlensak, MD, Andreas Hoh, MD, Gustav Fraedrich, MD and Friedhelm Beyersdorf, MD

Background—Amputation rates and mortality in patients with severe acute limb ischemia remain high. The protective effect of controlled reperfusion (CR) on tissue damage because of local and systemic reperfusion injury is unclear.

01 septiembre 2014

AMERICAN JOURNAL OF CARDIOLOGY. Family History as a Risk Factor for Peripheral Arterial Disease

Mahyar Khaleghi, MD , Iyad N. Isseh, MBBS , Kent R. Bailey, PhD , Iftikhar J. Kullo, MD

The association of a family history of peripheral arterial disease (PAD) with the presence of PAD is largely unknown. We conducted a case-control study of 2,296 patients with PAD (69 ± 10 years, 64% men) and 4,390 controls (66 ± 11 years, 62% men) identified from noninvasive vascular and stress testing laboratories at Mayo Clinic, Rochester, Minnesota, from October 2006 through June 2012. PAD was defined as an ankle brachial index of ≤0.9 at rest and/or after exercise, a history of lower extremity revascularization, or having poorly compressible leg arteries. Controls were patients with normal ankle brachial index or without a history of PAD. Family history of PAD was defined as having at least 1 first-degree relative who had undergone revascularization or stent placement for PAD before the age of 65 years. Logistic regression analyses were used to evaluate whether a family history of PAD was associated with the presence of PAD, independent of conventional risk factors. A family history of PAD was present more often in patients with PAD than in controls, with a resulting odds ratio (OR) of 2.20 (95% confidence interval [CI] 1.82 to 2.67). The association remained significant after adjustment for conventional risk factors (OR 1.97, 95% CI 1.60 to 2.42). The association was stronger in younger subjects (age <68 years; adjusted OR 2.46, 95% CI 1.79 to 3.38) than in older subjects (adjusted OR 1.61, 95% CI 1.22 to 2.12). A greater number of affected relatives with PAD was also associated with greater odds of presence of PAD (adjusted OR 1.86, 95% CI 1.48 to 2.33 and adjusted OR 2.56, 95% CI 1.60 to 4.11 for patients with 1 and ≥2 affected relatives with PAD, respectively). In conclusion, individuals with a family history of PAD have nearly double the odds of having PAD relative to those without such a history.

01 julio 2013

EUROPEAN HEART JOURNAL. Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis

Nasser Malyar, Torsten Fürstenberg, Jürgen Wellmann, Matthias Meyborg, Florian Lüders, Katrin Gebauer, Holger Bunzemeier, Norbert Roeder, Holger Reinecke

Aims The prevalence of peripheral arterial disease (PAD) and especially of critical limb ischaemia (CLI) is announced to rise dramatically worldwide, with a considerable impact on the health care and socio-economic systems. We aimed to characterize the recent trends in morbidity and in-hospital outcome of PAD among all hospitalized patients in the entire German population between 2005 and 2009.