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  • 1
    Online Resource
    Online Resource
    Stroke rate after thoracic endovascular aortic repair using de-airing of stentgrafts with high-volume of saline solution
    Hogrefe Publishing Group ; 2021
    In:  Vasa Vol. 50, No. 3 ( 2021-04-01), p. 186-192
    Details
    In: Vasa, Hogrefe Publishing Group, Vol. 50, No. 3 ( 2021-04-01), p. 186-192
    Abstract: Summary: Background: Our aim was to determine the rate of ischemic stroke following thoracic endovascular aortic repair (TEVAR) after reducing gas volume released during stentgraft deployment by de-airing of thoracic stentgrafts with high-volume of 0.9% heparinized saline solution. Patients and methods: A single center retrospective analysis of all consecutive patients undergoing TEVAR from 2014 to 2019 was performed. All thoracic stentgrafts were flushed with 120 ml 0.9% heparinized saline solution before implantation, according to our institutional protocol. Endpoints were in-hospital rates of ischemic stroke and spinal cord ischemia (SCI), and all-cause mortality. Results: One hundred and fifty-four patients (mean age: 66.8 ± 13.6 years, 64.9% males) were treated with TEVAR during the study period. Indications for treatment were thoracic aortic aneurysms (n = 75, 48.7%), acute type B aortic dissections (n = 46, 29.9%), aortic arch aneurysms and penetrating aortic ulcers (n = 28, 18.2%), and blunt traumatic aortic injuries (n = 5, 3.2%). Timing of procedure was urgent in 75 patients (48.7%). Proximal landing zone were zone 0–1–2 (n = 75, 48.7%), zone 3 (n = 66, 42.9%) and zone 4 (n = 13, 8.4%). Supra-aortic vessels were revascularized with custom-made fenestrated stentgrafts in 9 patients (5.8%), using chimney technique in 4 patients (2.6%), and with debranching procedures in 19 patients (12.3%). Left subclavian artery was covered without revascularization in 46 patients (29.9%). In-hospital stroke occurred in two patients (1.3%) and SCI in another two patients (1.3%). In-hospital mortality rate was 0.6%. No further in-hospital events were noted. Conclusions: De-airing of stentgrafts with high-volume of 0.9% heparinized saline solution seems to be safe and can be used as an adjunct to keep occurrence of neurological events after TEVAR as low as possible.
    Type of Medium: Online Resource
    ISSN: 0301-1526 , 1664-2872
    URL: Article
    DOI: 10.1024/0301-1526/a000937
    Language: English
    Publisher: Hogrefe Publishing Group
    Publication Date: 2021
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  • 2
    Online Resource
    Online Resource
    Gene therapy for therapeutic angiogenesis in peripheral arterial disease - a systematic review and meta-analysis of randomized, controlled trials
    Hogrefe Publishing Group ; 2013
    In:  Vasa Vol. 42, No. 5 ( 2013-09-01), p. 331-339
    Details
    In: Vasa, Hogrefe Publishing Group, Vol. 42, No. 5 ( 2013-09-01), p. 331-339
    Abstract: Hintergrund: Neben pharmakologischen, endovaskulären und chirurgischen Behandlungsmöglichkeiten wurde auch die therapeutische Angiogenese als eine neue Therapieoption für Patienten mit peripherer arterieller Verschlusskrankheit (PAVK), insbesondere mit kritischer Extremitätenischämie, postuliert. Ziel dieser Arbeit ist es, einen systematischen Review von randomisierten, kontrollierten Studien zur Gentherapie mit Wachstumsfaktoren bei PAVK durchzuführen. Patienten und Methoden: Es erfolgte eine systematische Suche in elektronischen Datenbanken, um randomisierte Studien zu identifizieren, bei denen Wachstumsfaktoren (VEGF, FGF, HGF, Del-1, HIF-1alpha) mit Hilfe von Plasmid- oder viralen Transfer durch intraarterielle oder intramuskuläre Injektionen verabreicht wurden. Die folgenden Studienendpunkte wurden erfaßt: Gesamt-Mortalität, Amputationen, Abheilung von Ulzera, Gehstrecke und Knöchel-Arm-Index. Wenn möglich, war die Durchführung einer Meta-analyse geplant. Eine Subgruppen-Analyse wurde prädefiniert für Patienten mit Claudicatio intermittens sowie kritischer Extremitätenischämie. Ergebnisse: Die systematische Suche ergab 12 passende Originalarbeiten von ursprünglich 1163 Referenzen. Insgesamt wurden 1494 Patienten (29 % Frauen) eingeschlossen. Die Mehrheit litt unter kritischer Extremitätenischämie (64 %). Zwar konnten verschiedene Endpunkte in einzelnen Arbeiten verbessert werden, doch nie in der Mehrheit der Studien. In der Meta-analyse zeigte sicher weder ein signifikanter Nutzen noch Schaden durch eine pro-angiogenetische Gentherapie für die folgenden Endpunkte: Gesamt-Mortalität (OR 0.88, 95 % CI 0.62 - 1.26), Amputationen (OR 0.64, 95 % CI 0.31 - 1.31) und Abheilung von Ulcera (OR 1.79, 95 % CI 0.8 - 4.01). Kein Unterschied wurde zwischen Patienten mit Claudicatio intermittens beziehungsweise kritischer Extremitätenischämie beobachtet. Schlussfolgerungen: Trotz vielversprechender Ergebnisse in einzelnen Studien, konnte insgesamt kein eindeutiger Nutzen einer Gentherapie mit Wachstumsfaktoren bei PAVK festgestellt werden. Dies war auch unabhängig vom Stadium der Erkrankung.
    Type of Medium: Online Resource
    ISSN: 0301-1526 , 1664-2872
    URL: Article
    DOI: 10.1024/0301-1526/a000298
    Language: English
    Publisher: Hogrefe Publishing Group
    Publication Date: 2013
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  • 3
    Online Resource
    Online Resource
    Urgent need to clarify the definition of chronic critical limb ischemia – a position paper from the European Society for Vascular Medicine
    Hogrefe Publishing Group ; 2019
    In:  Vasa Vol. 48, No. 3 ( 2019-05-01), p. 223-227
    Details
    In: Vasa, Hogrefe Publishing Group, Vol. 48, No. 3 ( 2019-05-01), p. 223-227
    Abstract: Abstract. Chronic critical lower limb ischemia (CLI) has been defined as ischemia that endangers the leg. An attempt was made to give a precise definition of CLI, based on clinical and hemodynamic data (Second European Consensus). CLI may be easily defined from a clinical point of view as rest pain of the distal foot or gangrene or ulceration. It is probably useful to add leg ulcers of other origin which do not heal because of severe ischemia, and to consider the impact of frailty on adverse outcome. From a hemodynamic viewpoint there is no consensus and most of the existing classifications are not based upon evidence. We should thus propose a definition and then validate it in a prospective cohort in order to define the patients at major risk of amputation, and also to define the categories of patients whose prognosis is improved by revascularisation. From today’s available data, it seems clear that the patients with a systolic toe pressure (STP) below 30 mmHg must be revascularised whenever possible. However other patients with clinically suspected CLI and STP above 30 mmHg must be evaluated and treated in specialised vascular units and revascularisation has to be discussed on a case by case basis, taking into account other data such as the WiFi classification for ulcers.In conclusion, many useful but at times contradictory definitions of CLI have been suggested. Only a few have taken into account evidence, and none have been validated prospectively. This paper aims to address this and to give notice that a CLI registry within Europe will be set up to prospectively validate, or not, the previous and suggested definitions of CLI.
    Type of Medium: Online Resource
    ISSN: 0301-1526 , 1664-2872
    URL: Article
    DOI: 10.1024/0301-1526/a000764
    Language: English
    Publisher: Hogrefe Publishing Group
    Publication Date: 2019
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  • 4
    Online Resource
    Online Resource
    Molecular imaging of atherosclerotic lesions by positron emission tomography - can it meet the expectations?
    Hogrefe Publishing Group ; 2016
    In:  Vasa Vol. 45, No. 2 ( 2016-04), p. 125-132
    Details
    In: Vasa, Hogrefe Publishing Group, Vol. 45, No. 2 ( 2016-04), p. 125-132
    Abstract: Abstract. Early non-invasive imaging of atherosclerosis and in particular the detection of lesions at risk with high specificity could significantly affect cardiovascular morbidity and mortality. Conventional nuclear medicine approaches, in particular using autologous radiolabeled lipoproteins, can be related to histopathological findings; however, they fail to identify lesions at risk. Positron emission tomography (PET) tracers with much better physical properties have been examined, the most detailed information being available for F-18-deoxyglucose (FDG) and F-18-sodium fluoride (NaF). These two approaches are sensitive to different biochemical mechanisms, i.e. inflammation and microcalcification. Initial enthusiasm, in particular for F-18-FDG, has disappeared, although for F-18-NaF there is some hope, but this is not a breakthrough. No tracer is available so far that is able to identify a specific characteristic of a lesion prone to rupture. Other PET tracers in the pipeline have been examined, mainly in experimental models and only a few in patients, but they failed to contribute significantly to early lesion discovery and do not support great expectations. The key question is: Do we understand what we see? Moreover, methodological problems, a lack of standardization of imaging protocols and aspects of quantification provide a wide range for potential future improvements. While monitoring a therapeutic intervention seems to be possible for both F-18-FDG and F-18-NaF, highly specific early identification of lesions at risk by PET imaging is still far away. As of today, PET is not ready for routine clinical judgment of atherosclerotic lesions at risk to rupture. Even if all these problems can be solved, radiation exposure will still remain a concern, in particular for repeated studies.
    Type of Medium: Online Resource
    ISSN: 0301-1526 , 1664-2872
    URL: Article
    DOI: 10.1024/0301-1526/a000506
    Language: English
    Publisher: Hogrefe Publishing Group
    Publication Date: 2016
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