Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) surgery are alternative treatments for infrarenal abdominal aortic aneurysm (IRAAA).
To compare OSR and EVAR for the treatment of ...IRAAA.
119 patients with IRAAA were electively operated by the same surgeon between January 1, 2006 and December 31, 2015, following selection for OSR or EVAR according to surgical risk. Complications, reinterventions, failures, and early and late mortality were analyzed.
63 OSR and 56 EVAR patients were analyzed. They were similar in terms of age (70 years), gender (92% men), and average diameter of IRAAA (6.5 cm), but with different comorbidities, surgical risk, and anatomy. EVAR was better than OSR regarding time in the operating theatre (177.5
233.3 minutes), need for transfusion (25 vs. 73%), and length of stay in ICU (1.3
3.3 days) and hospital (8.1
11.1 days). OSR allowed more associated procedures to be conducted simultaneously (19.0
1.8%). There were no significant differences between the groups with respect to complications (25.4
25.1%), reinterventions (3.2
5.2%), or early mortality (1.6
0%). During follow-up, OSR was associated with fewer revisions (3.13
4.21), angio-CTs (0.22
3.23), complications (6.4
37.5%), reinterventions (3.2
23.2%), and failures (1.6
10.7%), and had better survival (78.2
63.2%).
Correct selection of patients achieves excellent results because it avoids OSR in patients at high risk and avoids EVAR in patients with high anatomical complexity, achieving similar results in the perioperative period, but better results for OSR over the course of follow-up.
We report on the case of spontaneous rupture of an On-X-pure pyrolytic carbon mechanical valve prosthesis implanted seven years earlier, in a mitral position, at our hospital. The patient was ...admitted with valvular dysfunction and acute pulmonary edema requiring emergency surgery (prosthesis replacement); the absence of a leaflet was confirmed intraoperatively. The patient presented severe respiratory failure, which prolonged the postoperative period. A CT scan showed that the migrated leaflet was located in the aortic bifurcation with no apparent arterial lesion. Four months later, once the patient had recovered, laparotomy and aortotomy were performed in order to retrieve the leaflet, which was found to have become included (neoendothelized) in the aortic wall without compromising the latter's integrity or obstructing the blood flow. A subsequent CT scan confirmed the persistence of the leaflet in its initial position. The literature review highlights two singular facts: 1) this is the second published case of the escape of a leaflet from an On-X prosthesis (the first patient died); 2) this is the first case in which a laparotomy was performed to retrieve the leaflet but finally a decision was made to leave it in situ. Seven months later, the patient remained asymptomatic.
Intermittent claudication (IC) and its consequences have customarily been underestimated in women. Our study aimed to determine the differences on functional and quality-of-life issues between women ...and men in a large group of claudicants.
This study was an observational, cross-sectional, nonrandomized, multicenter study of 1,641 claudicants (406 women). Information was collected from patients' medical history, a physical examination, the ankle-brachial index (ABI), the Walking Impairment Questionnaire (WIQ), and the European Quality of Life Questionnaire (EQ-5D).
On average, women with IC were older than men with IC (70.0 vs. 67.8 years; p<0.001) and tended to have a different socio-occupational status. Women were more likely to be obese and less likely to smoke or have dyslipidemia (p<0.001). Women were notable for their greater prevalence of cardiac insufficiency (p=0.016) and arrhythmias (p<0.001) and a lower prevalence of ischemic cardiopathy and acute myocardial infarction (p<0.001). At the same time, there was a significantly higher level of osteoarticular diseases in women: arthrosis (p<0.001), arthritis (p<0.001), and lumbar pathology (p=0.006). All the symptoms evaluated that were associated with IC were more frequent in women (p<0.05). The mean ABI was similar in claudicant women and men. Conversely, the parameter estimates of the WIQ were significantly lower in women (by 4.3%, and 6.5%, respectively; p=0.003). Likewise, the EQ-5D score was 7% lower in women than in men (from 0.52 to 0.59; p<0.001).
Women claudicants have higher risk factors and more frequent cardiovascular comorbidity than men do. Women have a lower capacity for exercise and a poorer quality of life than male claudicants, despite having a similar ABI. These poorer outcomes in women can be partially explained by the presence of greater osteoarticular comorbidity.
Objective
The aim of this study was to assess differences in the gene expression profile of peripheral blood cells between patients with early recurrent thrombosis vs. patients without recurrent ...events after withdrawal of anticoagulant therapy for a first episode of unprovoked deep vein thrombosis (uDVT), to identify novel predictors of recurrence.
Methods
In the discovery population (N = 32), a microarray RNA assay followed by RT‐PCR confirmation were performed. In the validation population (N = 44) a multiple RT‐PCR‐based strategy was applied to assess genes differentially expressed in the discovery population.
Results
The sex‐adjusted Linear Model for Microarray Data analysis showed 102 genes differentially expressed (P < 0.01) in the discovery population. Nineteen of them underwent further confirmation in the validation population. The gene encoding for Acyl‐CoA Synthetase Family Member 2 (ACSF2) was underexpressed in recurrent DVT patients in both, the discovery (P = 0.007) and validation populations (P = 0.004). In the receiver operator characteristic (ROC) analysis, the areas under the curve of ACSF2 expression were 0.77 and 0.80, respectively.
Conclusions
For the first time an association between ACSF2 expression and the risk of recurrent DVT is suggested. Should this association be confirmed in larger prospective studies, ACSF2 could become useful for the selection of patients requiring extended anticoagulant therapy.
Diabetes mellitus (DM) and intermittent claudication (IC) are frequently associated health conditions. Our hypothesis is that the nature, severity and quality of life (QoL) of patients with IC and DM ...are worse than those of claudicant patients without diabetes.
An observational, cross-sectional and multicentre study of 920 patients with IC, divided into two groups: diabetic (n = 477) and non-diabetic (n = 443). For each group, we examined clinical and biological characteristics (including levels of glucose and lipids), the ankle-brachial index (ABI), responses to the Walking Impairment Questionnaire (WIQ) and the European Quality of Life-5 Dimensions (EQ-5D) questionnaire.
Compared with claudicant patients without diabetes, claudicants with diabetes were older (p < 0.001), more likely to be female (p = 0.006), with a higher BMI (p < 0.001), more likely to have a sedentary lifestyle (p < 0.001) and to be a non-smoker (p < 0.001). Claudicant patients with diabetes also had significantly more cardiovascular risk factors (p < 0.001), more frequent ischaemic cardiopathy (p = 0.023) and chronic renal failure (p = 0.002), and fewer prior ictus events (p = 0.003). No significant differences between groups were found with respect to blood pressure, levels of cholesterol or triglycerides. The mean ABI of diabetic-IC patients was slightly lower than IC patients without diabetes (p = 0.016). All WIQ subdomains scores were significantly lower (p < 0.001), indicating poorer walking ability, in claudicant and diabetic patients with compared with those without diabetes. The mean E5-QD global scores and the mean EQ-5D visual analogue scale in the whole series were 0.58 (SD = 0.21) and 55.04 (SD = 21.30), respectively. Both E5-QD scores were significantly lower, indicating poorer QoL, in claudicant patients with diabetes than claudicant patients without diabetes (p < 0.001).
Patients with IC and DM had more risk cardiovascular factors, cardiovascular conditions, disability and worse haemodynamic status and QoL than claudicant patients without diabetes.
Abstract
The axillary-femoral bypass is an extra-anatomical arterial reconstruction technique whose indications and complications have been thoroughly discussed in the literature. Shortening or ...lengthening of the prosthesis (by axillary artery traction or graft angulation, respectively) as a late postoperative complication of the procedure has been described only exceptionally. Here we report a kinking of the prosthesis with a very illustrative figure.
Splenic artery aneurysms are rare, potentially serious, and usually asymptomatic. Several methods are currently available to treat them, each with their own advantages and drawbacks. Therefore, its ...therapeutic paradigm has changed.
We review our database of splenic aneurysms (2009-2019) and undertake an exhaustive literature review. Demographic, clinical, diagnostic, therapeutic, early and follow-up outcome data were examined. Our experience comprised: 15 patients with 19 splenic aneurysms. 11 women (average age, 59.4 years) and 4 men (average age, 61.7 years). All asymptomatic.
At diagnosis, aneurysms had a mean cross-sectional diameter of 3.4 cm (3.2 and 3.9 for women and men, respectively), the largest measuring 8.5 cm. Two independent aneurysms were detected in four patients. Diagnoses were always incidental to a CT scan. Treatments consisted of open surgery (2 patients), endovascular surgery (10 patients: 7 embolizations, 3 covered stent) and observation/follow-up (3 patients). The cases of open surgery (with splenectomy) were carried out without postoperative morbidity. One embolization failed (requiring subsequent open surgery) and two suffered localized splenic infarction, but without further complications. In patients treated with a covered stent, the aneurysm was always excluded, without complications. There was no 30-day or follow-up (average 26.2 months) mortality. Splenic aneurysms are diagnosed more frequently and earlier (in the asymptomatic phase), albeit incidentally, than in the past.
The correct indication (identifying patients at risk) and individualization of treatment, in which endovascular techniques are the first-line option, have significantly improved morbidity and mortality outcomes in our hospital.
We hypothesized that inhibitor specificity may predict the outcome of antifactor VIII autoantibodies eradication treatment in acquired hemophilia A. Our objective was to analyze the association ...between factor VIII domains recognized by inhibitors and outcome of the immunosuppressive therapies (ISTs) in a prospective, observational study. 16 patients were recruited. Inhibitor specificities were assessed at diagnosis and throughout the study. Their association with IST outcome was addressed. First-line IST succeeded in 56% of patients. Inhibitors reacted mainly with light chain domains (69%) and/or the A2 domain (44%). 31% inhibitors recognized more than one domain. Significantly, the number of patients whose inhibitors recognized the light chain was significantly higher in the group of those who did not reach complete remission after first line IST when compared with those who did 6/7 (85.7%) vs. 4/9 (44.4%), P < 0.05. Therefore, inhibitor specificity could predict the success of IST in acquired hemophilia A.
Summary
Bleeding is a frequent complication after allogeneic haematopoietic stem cell transplantation (HSCT) and may affect survival. The purpose of this study was to determine the incidence and risk ...factors for life‐threatening bleeding after HSCT by retrospective evaluation of 491 allogeneic HSCT recipients. With a median follow‐up of 33 months, 126 out of 491 allogeneic HSCT recipients experienced a haemorrhagic event (25·7%) and 46 patients developed a life‐threatening bleeding episode (9·4%). Pulmonary and gastrointestinal bleeding were the most common sites for life‐threatening bleeding, followed by central nervous system. In multivariate analyses, the presence of severe thrombocytopenia after day +28 and the development of grade III–IV acute graft‐versus‐host disease (GVHD) or thrombotic microangiopathy (TMA) retained their association with life‐threatening bleeding events. The overall survival at 3 years among patients without bleeding was 67·1% for only 17·1% for patients with life‐threatening bleeding (P < 0·001). In conclusion, life‐threatening bleeding is a common complication after allogeneic HSCT. Prolonged severe thrombocytopenia, acute grade III–IV GVHD and TMA were associated with its development.
We have generated mouse transgenic lineages for C3G (tgC3G) and C3GΔCat (tgC3GΔCat, C3G mutant lacking the GEF domain), where the transgenes are expressed under the control of the megakaryocyte and ...platelet specific PF4 (platelet factor 4) gene promoter. Transgenic platelet activity has been analyzed through in vivo and in vitro approaches, including bleeding time, aggregation assays and flow cytometry. Both transgenes are expressed (RNA and protein) in purified platelets and megakaryocytes and do not modify the number of platelets in peripheral blood. Transgenic C3G animals showed bleeding times significantly shorter than control animals, while tgC3GΔCat mice presented a remarkable bleeding diathesis as compared to their control siblings. Accordingly, platelets from tgC3G mice showed stronger activation in response to platelet agonists such as thrombin, PMA, ADP or collagen than control platelets, while those from tgC3GΔCat animals had a lower response. In addition, we present data indicating that C3G is a mediator in the PKC pathway leading to Rap1 activation. Remarkably, a significant percentage of tgC3G mice presented a higher level of neutrophils than their control siblings. These results indicate that C3G plays an important role in platelet clotting through a mechanism involving its GEF activity and suggest that it might be also involved in neutrophil development.
► We have generated platelet-specific transgenic mice for C3G and a C3GDeltaCat mutant. ► We have analyzed the role of C3G in platelet function by in vivo and in vitro approaches. ► Transgenic C3G increases platelet activation and aggregation via Rap1. ► Platelets expressing C3GDeltaCat are impaired in activation and aggregation. ► The number of neutrophils is increased in C3G transgenic mice.
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