Purpose
The purpose of this study was to evaluate the 5-year real-world results of Supera stent implantation in below the knee prosthetic bypasses (BKPBs). All the procedures were performed because ...of a history of recurrent thrombosis of the graft and significant stenotic kinking of the prosthesis during knee flexion. A Supera stent was implanted to prevent the next potential BKPB thrombosis.
Materials and Methods
Fourteen patients were included in this single-center, retrospective observational cohort study. All patients underwent Supera stent implantation in infrainguinal prosthetic bypass between 2012 and 2017, due to a history of recurrent thrombosis and kinking of the prosthetic bypass.
Results
Prior to Supera stent implantation procedure, all the patients had more than one episode of acute limb ischemia caused by thrombosis of the BKPB. The median number of BKPB thromboses prior to Supera stent implantation was 3 and ranged from 2 to 6. Technical success was achieved in all cases. Primary patency rates at 12, 24, 36 and 60 months were 71.4%, 57.1%, 57.1% and 14.3%, respectively. Secondary patency rates at 12, 24, 36 and 60 months were 78.6%, 64.3%, 64.3% and 35.7%, respectively. One stent fracture was reported during 60-month follow-up. Major amputation was performed in 6 patients in 5-year follow-up.
Conclusion
Supera stent in treatment of recurrent thrombosis of BKBP is a safe procedure with acceptable mid-term results. However, larger and comparable prospective studies are needed for broader analysis of this procedure.
Graphical Abstract
Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective ...in limb salvage. The Supera is able to withstand increased compression, biomechanical stress and to have higher radial force. The objective of this study is to evaluate performance, durability and 3-year patency of Supera stent implantation in severe femoropopliteal disease.
A retrospective real-world analysis was performed with consideration of 77 patients that had a Supera stent implanted with femoropopliteal atherosclerotic disease at a single center. Among the 77 individuals, 92 Supera stents were implanted. Analysis of patients' demographics, lesions characteristics, reintervention rates and patency rates was performed.
The median follow-up was 33 months and ranged from 0 to 84 months. Chronic limb-threatening ischemia was observed among 43 patients. Mean lesion length was 152.8 ± 94.6 mm. Chronic total occlusions were observed in a majority of lesions. Overall, primary patency rates at 6, 12, 24 and 36 months were 85.0%, 73.6%, 59.2% and 53.2%, respectively.
The Supera stent is effective in the management of long and complex lesions. The results of patency rates were evaluated to be worse among lesions extending to the popliteal artery.
Endovascular treatment of internal carotid artery stenosis (ICAS) has gained popularity in recent years. Offering CAS, which is a controversial treatment in asymptomatic disease, may provoke patient ...distrust of the diagnosis and intervention benefit. The aim of this study was to prove that asymptomatic ICAS patients tend to show an emotional attitude to their illness, and therefore their decisions regarding carotid artery stenting are externally motivated and assessed emotionally.
This study was conducted by a questionnaire consisting of 18 half-open questions (obtained from 25 consecutive patients) in categories of self-image, attitude to illness, and decision-making regarding CAS. Descriptive analysis was performed.
Reaction: "Nothing to worry about - every illness can be cured" evidenced the rational attitude to the disease. Attitude towards oneself after receiving the unexpected information about the disease did not change. Most patients pursued a second opinion before the intervention. Most patients showed internal motivation (78.7%). Rational assessment of the decision on CAS relied on consulting and insights into the disease and the intervention-related risk compared to risk of "doing nothing"
In decision-making about CAS by asymptomatic patients, the emotional attitude to disease and negative expectations pertaining to postoperative health lead to an internally-motivated and rationally assessed decision. At least 2 conversations with the patient should be scheduled. The primary purpose of the second visit should be dissipating any doubts and repeating the arguments for the intervention. Patients should be provided with an appropriate amount of information to reduce their fear of neurological complications and mental disturbances. Conversation should be concentrated on life-quality improvement instead of controversies about the intervention.
Aim of the study was to find out whether there is a correlation between the attitude to surgery and self-efficacy, health locus of control, and own life quality assessment in abdominal aortic ...aneurysm patients. Material and methods: Thirty-six consecutive asymptomatic AAA patients qualified for elective surgery were examined. The group included 11 women and 25 men, aged 49-85 years. Four scales were applied: the Generalised Self-Efficacy Scale (GSES), the Satisfaction With Life Scale (SWLS), the Multidimensional Health Locus of Control Scale (MHLC), and a scale to find the attitude to surgery, in which “-10” stands for the maximally negative attitude, “0” - neutral, and “+10” - maximally positive. Results: Correlations between attitude towards surgery, type of surgical procedure, and repeatability of hospitalisation proved to be statistically insignificant (χ2 test values were, respectively: 9.773, p < 0.878; 6.353, p < 0.608). It was found that on average the attitude to surgery varied (SD = 6.6); however, it was generally positive and oscillated around the average (M = 6.5). The mean value of self-efficacy was high (M = 33.64, SD = 4.75). External personal health locus of control was predominant (M = 26.44, SD = 4.675), the runner-up was internal health locus of control (M = 25.08, SD = 4.02), and the last one was external impersonal health locus of control (fate/chance) (M = 24.03, SD = 4.66). The mean assessment of one’s own life quality proved to be above average (M = 23.25) but varied (SD = 6.65). Conclusions: The higher the personal resources (such as self-efficacy, the assessment of own life quality, and the internal health locus of control), the more positive the attitude towards surgery. External personal health locus of control in patients before surgery is predominant, which indicates the role of medical professionals in communication with patients.
Whether or not the source of aortic pathology is Marfan syndrome (MFS) or other processes leading to development of abdominal aorta aneurysms (AAA), the awareness of pathology may lead to an ...emotional upset and low assessment of satisfaction with life.
To assess, in regard to MFS patients with aortic pathology and to abdominal aortic aneurysm patients: 1) whether or not self-efficacy (SE) and health locus of control (HLoC) affect the patients' satisfaction with life; 2) whether the two groups of patients differ in terms of mental dispositions.
The study population consisted of 16 MFS patients with aortic pathology and 16 AAA patients, 9 men and 7 women in each group. The mean age of the MFS patients was 28.5 ±8.214, and of the AAA patients 64.25 ±7.019. The following scales were applied: Generalized Self-Efficacy Scale, Satisfaction With Life Scale, Multidimensional Health Locus of Control Scale.
Abdominal aorta aneurysms patients compared to MFS patients gave a higher rating for SE (
= 33.94 and
= 29.56), internal health locus of control (
= 25.00 and
= 21.13), external personal HL
C (
= 24.50 and
= 19.25), external impersonal HLoC (
= 23.06 and
= 18.25), and satisfaction with life (
= 22.06 and
= 20.13). Internal and external HL
C were significantly lower in MFS patients compared to AAA patients.
In patients with aortic diseases, special attention must be paid to the state of personal resources (PR). Interactions made by medical professionals should focus on enhancing PR supporting the patients' self-knowledge on their SE. This will help to improve their satisfaction with life and form a positive attitude to the illness.
The main purpose of this study was to document the radiation doses to patients during carotid stenting.
Fluoroscopy and exposure time, air kerma and dose-area product during carotid artery stenting ...in 160 patients were retrospectively reviewed with regard to body mass index, degree of stenosis and use of cerebral protection devices.
Total air kerma was lower than 0.5 Gy in 80%, 0.5-1 Gy in 17% and higher than 1 Gy (maximum 1.2) in 3% of patients. Mean total dose-area product value for carotid stenting was 54 Gy cm(2). The mean air kerma (fluoroscopy), air kerma (exposure), total air kerma and dose-area product (fluoroscopy), dose-area product (exposure), total dose-area product of patients with body mass index within the range 25-29.9 and with body mass index >30 were significantly increased compared to that of patients with body mass index 18-24.9 (H = 40.2, df = 2; p = 0.0000001 and p = 0.000003, respectively).
Carotid artery stenting is a relatively safe radiological procedure in terms of the radiation dose acquired by the patient. The main factors contributing to possible radiation overdosing are body mass index value and complexity of the carotid lesion. Proper preoperative planning in obese and complicated patients may reduce the fluoroscopy time and contribute to reduced dose acquisition.
Purpose:
The covered endovascular reconstruction of the aortic bifurcation (CERAB) technique offers an alternative for Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions involving the aortic ...bifurcation. The study aims to evaluate the outcomes of the CERAB technique for extensive aortoiliac occlusive disease (AIOD) using the BeGraft balloon-expandable covered stent (BECS).
Materials and Methods:
This is a physician-initiated, multicenter, retrospective, observational study. Between June 2017 and June 2021, all consecutive patients who underwent the CERAB procedure using the BeGraft stent (Bentley InnoMed, Hechingen, Germany) in 3 clinics were enrolled. Patients’ demographics, lesion characteristics, and procedural results were collected and retrospectively analyzed. Follow-up was done at 1, 6, and 12 months and then annually with clinical examination, ankle-brachial index (ABI), and duplex ultrasound. The primary endpoint was the patency at 12 months. Secondary endpoints included procedural-related complications, secondary patency, freedom from target lesion revascularization (TLR), and clinical improvement.
Results:
In all, 120 patients (64 men) with a median age of 65 years (range: 34–84 years) were analyzed. Most patients had extensive AIOD classified as TASC II C (n=32; 26.7%) or TASC II D (n=81; 67.5%). The median duration of the procedure was 120 minutes (interquartile range IQR: 80–180 minutes). All 454 BeGraft stents (137 aortic and 317 peripheral) were successfully delivered and deployed. The overall procedural complication rate was 14 (11.7%). The median hospital length of stay was 5 days (IQR: 3–6 days). All patients improved clinically, and the ABI increased significantly (p<0.05). The median follow-up was 19 months (range: 6–56 months). The primary patency rate, secondary patency rate, and freedom from TLR at 12 months were 94.5%, 97.3%, and 93.5%, respectively.
Conclusions:
The CERAB procedure with BeGraft BECSs has a high technical success rate, favorable patency outcomes, and low morbidity, even in relatively ill patients with extensive AIOD. Prospective randomized studies on the CERAB technique are definitely recommended.
Clinical Impact
This study evaluates the outcomes of BeGraft stents used during the covered endovascular reconstruction of the aortic bifurcation (CERAB) procedure. To date, several balloon-expandable covered stents have been used for this technique with satisfactory results. This study showed the safety and excellent patency of the CERAB technique in extensive AIOD using BeGraft balloon-expandable covered stents.
Critical lower limb ischaemia is associated with a 20% annual risk of amputation and death. It is necessary to activate patients' personal resources which comprise mental dispositions needed to ...effectively cope with the disease. The objective of the study was to evaluate the correlation between the attitude toward the vascular reconstruction and self-efficacy (SE), health locus of control (HLoC) and own life quality (QOL) assessment in patients with critical lower limb ischaemia.
The study involved 64 patients with critical lower limb ischaemia (Rutherford 4 and 5), 26 women and 38 men. Four scales were applied during primary admission: the Generalized Self-Efficacy Scale; the Satisfaction with Life Scale; the Multidimensional Health Locus of Control Scale; and the visual scale revealing attitude to vascular reconstruction.
The attitude to the vascular reconstruction was positive (
= 8.50). The lowest grades were given by those hospitalised several times during follow-up (
= 8.30); women expressed low grades (
= 7.71). An overall positive correlation was found between the positive attitude to the surgery and self-efficacy (
= .012), internal HLoC (
= .041) and external locus (
= .026). In the patients who died within six months from baseline assessment, no correlations were found. In subjects with no readmission, a correlation was found between positive attitude to surgery and the external personal HLoC (
= .023). In patients with subsequent readmissions, a correlation was found between the originally positive attitude to the surgery and poor self-efficacy (
= .009).
Patients with weak mental dispositions cannot cope with difficult situations and show a tendency to experience strong emotions, concentrating on their deficiencies, resulting in decreased motivation and feeble engagement in treatment. Poor mental disposition influences the final outcome of the vascular reconstruction.
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