Midaortic Syndrome due to Takayasu Arteritis in a Child with Acute Decompensated Cardiac Failure Managed by an Emergency Axillo-External Iliac Artery Bypass: A Follow-Up Case Report of Long-Term Outcomes

2020 ◽  
Vol 64 ◽  
pp. 408.e5-408.e9 ◽  
Author(s):  
Hirofumi Sugawara ◽  
Hitoshi Goto ◽  
Daijirou Akamatsu ◽  
Yoh Hamada ◽  
Ken Tsuchida ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiac Failure ◽  
Takayasu Arteritis ◽  
Iliac Artery ◽  
Artery Bypass ◽  
External Iliac Artery ◽  
Long Term Outcomes ◽  
Midaortic Syndrome

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

Abstract 2298: Impact of Preopeartive Anemia on Long-term Outcomes Following Isolated Coronary Artery Bypass Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yan Li ◽  
Zhe Zheng ◽  
Shiju Zhang ◽  
Xianqiang Wang ◽  
Huawei Gao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Total Mortality ◽  
Long Term Outcomes ◽  
Preoperative Anemia ◽  
Cabg Surgery ◽  
Repeated Revascularization

Background: The prognostic and clinical value of preopeartive anemia in patients undergoing cardiac surgery has recently been recognized. However, very limited information exists on the impact of preopeartive anemia on long-term outcomes following coronary artery bypass graft (CABG) surgery. This study aimed at examining the degree to which preopeartive anemia affects long-term outcomes after isolated CABG surgery. Methods: A unicenter study was conducted on 5488 consecutive survivors of isolated CABG between January 1999 and December 2005. Preopeartive anemia was defined according to the World Health Organization definition (hemoglobin < 13g/dL for male; hemoglobin < 12g/dL for female). Long-term outcomes of interest were total mortality, myocardial infarction (MI), repeated revascularization, and major adverse cardiac events (MACEs=total mortality or MI or repeated revascularization). These outcomes were compared after adjustment for differences in baseline risk factors among the patients. Results: 1437 (26.2%) patients had preoperative anemia. After a mean follow-up of 43.3±18.3 months, preoperative anemia was found to be an independent risk factor for total mortality (hazard ration [HR]: 1.490; 95% CI: 1.074 to 2.067; p=0.017), MI (HR: 1.595; 95% CI: 1.028 to 2.474; p=0.037) and MACEs (HR: 1.363; 95% CI: 1.059 to 1.755; p=0.016). We also found that aspirins and beta-blockers were underused in patients with anemia during follow-up. Conclusions: Preopeartive anemia has a strong negative impact on long-term outcomes following isolated CABG. Our data also suggest that the incorporation of preoperative anemia into the risk assessments of long-term outcomes after CABG is recommended. Future intense and systematic studies are needed to help ensure high-quality cardiac care of patients with anemia.

scholarly journals Long-term outcomes after coronary artery bypass surgery in patients with diabetes

2020 ◽  
Vol 30 (5) ◽  
pp. 685-690
Author(s):  
Tomas Andri Axelsson ◽  
Jonas A Adalsteinsson ◽  
Linda O Arnadottir ◽  
Dadi Helgason ◽  
Hera Johannesdottir ◽  
...  
Keyword(s):  
Overall Survival ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Patients With Diabetes

Abstract OBJECTIVES Our aim was to investigate the outcome of patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery in a whole population with main focus on long-term mortality and complications. METHODS This was a nationwide retrospective analysis of all patients who underwent isolated primary CABG in Iceland between 2001 and 2016. Overall survival together with the composite end point of major adverse cardiac and cerebrovascular events was compared between patients with diabetes and patients without diabetes during a median follow-up of 8.5 years. Multivariable regression analyses were used to evaluate the impact of diabetes on both short- and long-term outcomes. RESULTS Of a total of 2060 patients, 356 (17%) patients had diabetes. Patients with diabetes had a higher body mass index (29.9 vs 27.9 kg/m2) and more often had hypertension (83% vs 62%) and chronic kidney disease (estimated glomerular filtration rate ≤60 ml/min/1.73 m2, 21% vs 14%). Patients with diabetes had an increased risk of operative mortality [odds ratio 2.52, 95% confidence interval (CI) 1.27–4.80] when adjusted for confounders. 5-Year overall survival (85% vs 91%, P &lt; 0.001) and 5-year freedom from major adverse cardiac and cerebrovascular events were also inferior for patients with diabetes (77% vs 82%, P &lt; 0.001). Cox regression analysis adjusting for potential confounders showed that the diagnosis of diabetes significantly predicted all-cause mortality [hazard ratio (HR) 1.87, 95% CI 1.53–2.29] and increased risk of major adverse cardiac and cerebrovascular events (HR 1.47, 95% CI 1.23–1.75). CONCLUSIONS Patients with diabetes have significantly lower survival after CABG, both within 30 days and during long-term follow-up.

scholarly journals Risk-Adjusted Short- and Long-Term Outcomes for On-Pump Versus Off-Pump Coronary Artery Bypass Surgery

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Matthew L. Williams ◽  
Lawrence H. Muhlbaier ◽  
Jacob N. Schroder ◽  
Jonathan A. Hata ◽  
Eric D. Peterson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Short Term ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
To Receive

Background— Surgeons have adopted off-pump coronary artery bypass grafting (OPCAB) in an effort to reduce the morbidity of surgical revascularization. However, long-term outcome of OPCAB compared with conventional coronary artery bypass grafting (CABG) remains poorly defined. Methods and Results— Using logistic regression analysis and proportional hazards modeling, short-term and long-term outcomes (perioperative mortality and complications, risk-adjusted survival, and survival/freedom from revascularization) were investigated for patients who underwent OPCAB (641 patients) and CABG-cardiopulmonary bypass (5026 patients) from 1998 to 2003 at our institution. For these variables, follow-up was 98% complete. OPCAB patients were less likely to receive transfusion (odds ratio for OPCAB, 0.80; P =0.037), and there were trends toward improvement in other short-term outcomes compared with CABG-cardiopulmonary bypass. Long-term outcomes analysis demonstrated no difference in survival, but OPCAB patients were more likely to require repeat revascularization (OPCAB hazard ratio, 1.29; P =0.020). Conclusions— OPCAB patients were less likely to receive transfusion during their hospitalization for surgery but had higher risk for revascularization in follow-up. These results highlight the need for a large randomized, controlled trial to compare these 2 techniques.

Subcutaneous and Intramuscular Injection of Petrol (Hydrocarbon): A Case Report and Review of the Literature

2018 ◽  
Vol 23 (01) ◽  
pp. 149-152
Author(s):  
Evelyn Patricia Murphy ◽  
Deirdre Seoighe ◽  
Suzanne Beecher ◽  
Joseph F. Baker ◽  
Alan Hussey
Keyword(s):  
Case Report ◽  
Intramuscular Injection ◽  
Review Of The Literature ◽  
Hand Therapy ◽  
Long Term Outcomes ◽  
Anterior Compartment ◽  
Self Harm ◽  
Work Up

Deliberate injection of hydrocarbon remains an uncommon method of self harm. There is a paucity of information pertaining to soft tissue toxicity throughout the literature. Prompt recognition of the potential ramifications is needed to try salvage limb function. Hydrocarbon toxicity can result in multi organ failure. This case report demonstrates the recommended diagnostic approach, work up and treatment involved in such a case. A 26 year old male deliberately injected petrol into the anterior compartment of his non dominant forearm in a suicide attempt. Multidisciplinary involvement from surgeons, psychiatrists and hand therapists was needed to maximize functional outcome. He avoided systemic toxicity but required an urgent fasciotomy. He required significant follow up with hand therapy to regain usage of the limb. However his long term outcomes were poor with a power grading 3/5 in the anterior compartment muscles.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of  Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial

2018 ◽  
Vol 35 (8) ◽  
pp. 1369-1376 ◽  
Author(s):  
Eduardo Gomes Lima ◽  
David M Charytan ◽  
Whady Hueb ◽  
Diogo Freitas Cardoso de Azevedo ◽  
Cibele Larrosa Garzillo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Proportional Hazards ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Bypass Graft ◽  
Long Term Outcomes ◽  
Clinical Trial Registration ◽  
Significant Difference

Abstract Background Chronic kidney disease (CKD) is associated with a worse prognosis in patients with stable coronary artery disease (CAD); however, there is limited randomized data on long-term outcomes of CAD therapies in these patients. We evaluated long-term outcomes of CKD patients with CAD who underwent randomized therapy with medical treatment (MT) alone, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Methods Baseline estimated glomerular filtration rate (eGFR) was obtained in 611 patients randomized to one of three therapeutic strategies in the Medicine, Angioplasty, or Surgery Study II trial. Patients were categorized in preserved renal function and mild or moderate CKD groups depending on their eGFR (≥90, 89–60 and 59–30 mL/min/1.73 m2, respectively). The primary clinical endpoint, a composite of overall death and myocardial infarction, and its individual components were analyzed using proportional hazards regression (Clinical Trial registration information: http://www.controlled-trials.com. Registration number: ISRCTN66068876). Results Of 611 patients, 112 (18%) had preserved eGFR, 349 (57%) mild dysfunction and 150 (25%) moderate dysfunction. The primary endpoint occurred in 29.5, 32.4 and 44.7% (P = 0.02) for preserved eGFR, mild CKD and moderate CKD, respectively. Overall mortality incidence was 18.7, 23.8 and 39.3% for preserved eGFR, mild CKD and moderate CKD, respectively (P = 0.001). For preserved eGFR, there was no significant difference in outcomes between therapies. For mild CKD, the primary event rate was 29.4% for PCI, 29.1% for CABG and 41.1% for MT (P = 0.006) [adjusted hazard ratio (HR) = 0.26, 95% confidence interval (CI) 0.07–0.88; P = 0.03 for PCI versus MT; and adjusted HR = 0.48; 95% CI 0.31–0.76; P = 0.002 for CABG versus MT]. We also observed higher mortality rates in the MT group (28.6%) compared with PCI (24.1%) and CABG (19.0%) groups (P = 0.015) among mild CKD subjects (adjusted HR = 0.44, 95% CI 0.25–0.76; P = 0.003 for CABG versus MT; adjusted HR = 0.56, 95% CI 0.07–4.28; P = 0.58 for PCI versus MT). Results were similar with moderate CKD group but did not achieve significance. Conclusions Coronary interventional therapy, both PCI and CABG, is associated with lower rates of events compared with MT in mild CKD patients &gt;10 years of follow-up. More study is needed to confirm these benefits in moderate CKD.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

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