AbstractObjectiveAn endovascular-first approach is usually recommended in femoropopliteal occlusive disease. However, despite high technical success, plain old balloon angioplasty (POBA) is burdened ...with high restenosis rates. To reduce this phenomenon, local delivery of drugs has been proposed by way of drug-coated balloons (DCBs). Our goal was to review the evidence for the use of DCBs in the management of femoropopliteal disease and to determine whether it is associated with improved outcomes compared with POBA. MethodsElectronic searches of PubMed (MEDLINE), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and proceedings of international conferences were performed to identify randomized controlled trials (RCTs) and observational registries evaluating the use of DCBs for femoropopliteal arterial occlusive disease. ResultsThis meta-analysis included 13 RCTs, 6 global registries, and 3 global registries focusing on long lesions. They all used paclitaxel in the DCB arm. There was heterogeneity between trials, and the frequency of stent deployment and duration of dual antiplatelet therapy differed. At 2 years, there were significantly better outcomes for DCBs in terms of target lesion revascularization (odds ratio OR, 0.29; 95% confidence interval CI, 0.20-0.40), primary patency (OR, 0.38; 95% CI, 0.27-0.54), late lumen loss (mean diameter, −0.80 mm; 95% CI, −1.44 to −0.16), and Rutherford category (OR, 0.82; 95% CI, 0.57-1.19). There was no significant difference between DCBs and POBA in amputation or change in ankle-brachial index. A subgroup analysis revealed that male patients treated with DCBs performed significantly better than female patients and that diabetics, heavily calcified lesions, and popliteal lesions performed significantly worse than nondiabetics, noncalcified and mild to moderately calcified lesions, and exclusive superficial femoral artery lesions, respectively. Secondarily stented and nonpredilated lesions did not perform significantly worse, but standard-dose (3 μg/mm 2) DCBs were significantly more effective than low-dose (2 μg/mm 2) DCBs in reducing binary restenosis. In addition, in a low-dose DCB, the polyethylene glycol excipient performed significantly better than polysorbate and sorbitol, whereas binary restenosis was significantly less frequent with the urea excipient, associated with a standard-dose DCB, compared with the polysorbate and sorbitol excipient, associated with a low-dose DCB. ConclusionsDCB angioplasty is an effective treatment associated with high procedural success. In a meta-analysis of industry-sponsored trials, it consistently reduced late lumen loss, binary restenosis, and target lesion revascularization compared with POBA alone in the treatment of femoropopliteal disease. Further independent, non-industry-sponsored RCTs are necessary to better delineate the role of DCBs in the treatment of infrainguinal occlusive disease.
RATIONALE:Klf (kruppel-like factor) 2 is critical to establish and maintain endothelial integrity.
OBJECTIVE:Therefore, determining upstream and downstream mediators of Klf2 would lead to alternative ...therapeutic targets in cardiovascular disease management.
METHODS AND RESULTS:Here we identify Dhh (desert hedgehog) as a downstream effector of Klf2, whose expression in endothelial cells (ECs) is upregulated by shear stress and decreased by inflammatory cytokines. Consequently, we show that Dhh knockdown in ECs promotes endothelial permeability and EC activation and that Dhh agonist prevents TNF-α (tumor necrosis factor alpha) or glucose-induced EC dysfunction. Moreover, we demonstrate that human critical limb ischemia, a pathological condition linked to diabetes mellitus and inflammation, is associated to major EC dysfunction. By recreating a complex model of critical limb ischemia in diabetic mice, we found that Dhh-signaling agonist significantly improved EC function without promoting angiogenesis, which subsequently improved muscle perfusion.
CONCLUSION:Restoring EC function leads to significant critical limb ischemia recovery. Dhh appears to be a promising target, downstream of Klf2, to prevent the endothelial dysfunction involved in ischemic vascular diseases.
Acute mesenteric ischemia is associated with high rates of mortality. The aim of this study was to investigate the prognostic value of the neutrophil to lymphocyte ratio (NLR) and the platelet to ...lymphocyte ratio (PLR) on 30-day outcomes in patients with acute mesenteric ischemia.
Consecutive patients who were admitted for an acute mesenteric ischemia were retrospectively included. The full white blood count at the time of admission to the hospital was recorded. The population was divided into 4 subgroups according to the quartiles of the NLR and the PLR. The 30-day outcomes including the mortality and the complications were compared among the subgroups.
In total, 106 patients were included. A surgical treatment including revascularization and/or digestive resection was performed for 56 patients (52.8%). The 30-day all-cause mortality was 72 patients (67.9%). Patients with higher PLR value (PLR >429.3) had significantly higher rate of mortality compared to the other groups (80.8% vs 46.2%, 66.7% and 77.8%, p = 0.03). No significant difference on 30-day outcome was observed among the subgroups divided according to the NLR.
The PLR, but not the NLR, is a predictive factor of 30-day mortality in patients with acute mesenteric ischemia.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We report 5 cases of vascular Q fever complicated by polymicrobial superinfection in patients who had no risk factors for acute Q fever. Q fever was diagnosed by serologic and molecular assays for ...Coxiella burnetii. We confirmed additional infections using conventional graft cultures.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Intravesical Bacillus Calmette-Guerin (BCG) is an effective treatment for in situ bladder carcinomas; however, extravesical BCG infection may occur in remote organs in patients with underlying ...primary immunodeficiency and is a potentially serious complication in 3–5% of cases. It includes granulomatous pneumonia, hepatitis as well as specific dermatological, ophthalmic, and haematopoietic manifestations. Diagnosis is difficult and often based on high clinical suspicion as in many cases Mycobacterium bovis is not isolated. This report presents a rare case of BCGaortitis treated in a tertiary care centre.
A 74 year old man, with a history of bladder cancer treated with BCG therapy over a year ago, presented with malaise, abdominal pain, anorexia, and significant weight loss for several months associated with acute on chronic renal failure and a tender aneurysm. He was diagnosed with hepatic BCGitis and pararenal BCGaortitis. He was considered too high risk for open surgery after a multidisciplinary team meeting and was treated with a four vessel physician modified endograft (PMEG) and antituberculous therapy. At seven month follow up, he was clinically well and control computed tomography showed a patent endograft with complete exclusion of the aortic aneurysm.
Infectious BCG complications after intravesical BCG administration for in situ bladder carcinomas can lead to severe early and late complications. In the present case, the patient presented with both liver and aortic BCG infection. The lack of positive microbiological data should not discourage clinicians from considering BCG infection even if several months have passed since the last BCG instillation.
•Aortic BCGitis should be considered in patients with a history of BCG therapy presenting with fever, fatigue, pain and aortic aneurysm.•Other synchronous localizations should be searched for on PET/CT.•Mycobacteria research should be mandatory in surgical samples.•Histology showing granulomas is often crucial for a definitive diagnosis.•Management often implies surgical treatment and antituberculous therapy for at least a 9-month course.
Paclitaxel-coated balloons and stents have emerged as the most promising strategy for the inhibition of neointimal hyperplasia after endovascular treatment of the femoropopliteal artery. However, a ...few months ago, cause for concern was raised in a systematic review and meta-analysis of randomized controlled trials investigating paclitaxel-coated balloon angioplasty or paclitaxel-coated metal stents in the femoral and popliteal arteries. This editorial reviews the data available to date relative to the potential increased risk of mortality after the use of drug-eluting technologies in the femoropopliteal segment.
Visceral arterial aneurysms (VAAs) are life threatening. Due to the paucity of symptoms and rarity of the disease, VAAs are underdiagnosed and underestimated. Artificial intelligence (AI) offers new ...insights into segmentation of the vascular system, and opportunities to better detect VAAs. This pilot study aimed to develop an AI based method to automatically detect VAAs from computed tomography angiography (CTA).
A hybrid method combining a feature based expert system with a supervised deep learning algorithm (convolutional neural network) was used to enable fully automatic segmentation of the abdominal vascular tree. Centrelines were built and reference diameters of each visceral artery were calculated. An abnormal dilatation (VAAs) was defined as a substantial increase in diameter at the pixel of interest compared with the mean diameter of the reference portion. The automatic software provided 3D rendered images with a flag on the identified VAA areas. The performance of the method was tested in a dataset of 33 CTA scans and compared with the ground truth provided by two human experts.
Forty-three VAAs were identified by human experts (32 in the coeliac trunk branches, eight in the superior mesenteric artery, one in the left renal, and two in the right renal arteries). The automatic system accurately detected 40 of the 43 VAAs, with a sensitivity of 0.93 and a positive predictive value of 0.51. The mean number of flag areas per CTA was 3.5 ± 1.5 and they could be reviewed and checked by a human expert in less than 30 seconds per CTA.
Although the specificity needs to be improved, this study demonstrates the potential of an AI based automatic method to develop new tools to improve screening and detection of VAAs by automatically attracting clinicians’ attention to suspicious dilatations of the visceral arteries.
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