scholarly journals Endovascular Treatment of High-Risk Peripheral Vascular Occlusive Lesions: A Review of Current Evidence and Emerging Applications of Intravascular Lithotripsy, Atherectomy, and Paclitaxel Coated Devices

2021 ◽  
Author(s):  
Katherine M. Sanders ◽  
Peter A. Schneider ◽  
Michael S. Conte ◽  
James C. Iannuzzi
Keyword(s):  
High Risk ◽  
Endovascular Treatment ◽  
Current Evidence ◽  
Peripheral Vascular

Current evidence and prospects for medical treatment of abdominal aortic aneurysms

VASA ◽  
2005 ◽  
Vol 34 (4) ◽  
pp. 217-223 ◽  
Author(s):  
Diehm ◽  
Schmidli ◽  
Dai-Do ◽  
Baumgartner
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Current Evidence ◽  
Significant Morbidity ◽  
Abdominal Aortic ◽  
Risk Of Rupture

Abdominal aortic aneurysm (AAA) is a potentially fatal condition with risk of rupture increasing as maximum AAA diameter increases. It is agreed upon that open surgical or endovascular treatment is indicated if maximum AAA diameter exceeds 5 to 5.5cm. Continuing aneurysmal degeneration of aortoiliac arteries accounts for significant morbidity, especially in patients undergoing endovascular AAA repair. Purpose of this review is to give an overview of the current evidence of medical treatment of AAA and describe prospects of potential pharmacological approaches towards prevention of aneurysmal degeneration of small AAAs and to highlight possible adjunctive medical treatment approaches after open surgical or endovascular AAA therapy.

Using serum biomarkers for identifying unstable carotid plaque: update of current evidence

2020 ◽  
Vol 26 ◽  
Author(s):  
Areti Sofogianni ◽  
Konstantinos Tziomalos ◽  
Triantafyllia Koletsa ◽  
Apostolos G. Pitoulias ◽  
Lemonia Skoura ◽  
...  
Keyword(s):  
High Risk ◽  
Great Proportion ◽  
Current Literature ◽  
Early Identification ◽  
Carotid Plaque ◽  
Potential Role ◽  
Carotid Atherosclerosis ◽  
Serum Biomarkers ◽  
Current Evidence

: Carotid atherosclerosis is responsible for a great proportion of ischemic strokes. Early identification of unstable or vulnerable carotid plaques and therefore of patients at high risk for stroke is of significant medical and socioeconomical value. We reviewed the current literature and discuss the potential role of the most important serum biomarkers in identifying patients with carotid atherosclerosis who are at high risk for atheroembolic stroke.

scholarly journals Total pancreatectomy and pancreatic fistula: friend or foe?

2021 ◽  
Author(s):  
Roberto Salvia ◽  
Gabriella Lionetto ◽  
Giampaolo Perri ◽  
Giuseppe Malleo ◽  
Giovanni Marchegiani
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Total Pancreatectomy ◽  
Postoperative Pancreatic Fistula ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Surgical Morbidity ◽  
Pancreatic Anastomosis ◽  
Promising Tool

AbstractPostoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a promising tool to avoid the morbidity related to an extremely high-risk pancreatic anastomosis in selected patients. Surgical management of severe POPF is only required in few critical scenarios. In this context, even if anecdotal, CP might play a role as last resort in expert hands.

Decision-Making in the Scheduling of Endovascular Treatment after Brain Arteriovenous Malformation Haemorrhage: A Retrospective Single Centre Study

2011 ◽  
Vol 24 (6) ◽  
pp. 879-885 ◽  
Author(s):  
J.J. Downer ◽  
M. Cellerini ◽  
R.A. Corkill ◽  
S. Lalloo ◽  
W. Küker ◽  
...  
Keyword(s):  
Early Intervention ◽  
High Risk ◽  
Arteriovenous Malformation ◽  
Endovascular Treatment ◽  
Complication Rate ◽  
Injury Severity ◽  
Endovascular Intervention ◽  
Brain Arteriovenous Malformation ◽  
Single Centre ◽  
Significant Difference

The appropriate timing for endovascular intervention after brain arteriovenous malformation (bAVM) rupture is not known. This paper aims to determine factors that lead to early endovascular intervention and to investigate whether early intervention has the same complication rate as late intervention in a single centre. All patients who underwent endovascular treatment for a ruptured bAVM at our institution in the period January 2007 and July 2010 were included in this retrospective observational study. Of 50 patients, 33 had early endovascular intervention, defined as within 30 days of haemorrhage and the remaining 17 patients had endovascular treatment at day 30 or beyond. A greater proportion of patients treated within the first 30 days were in neurointensive care preoperatively (51.5% vs. 23.5%, p=0.07). A ‘high-risk’ angioarchitectural feature was identified in more patients who had acute intervention (78.8% vs. 11.8%, p<0.0001) and targeted embolization was also more frequent in this group (48.5% vs. 5.9%, p=0.004). Nidal aneurysms, venous varices and impaired venous outflow (venous stenosis) were the principal ‘high risk’ features. Clinically apparent complications occurred in 10.8% of procedures with permanent neurological deficit in 3.6%. There was no directly procedure-related mortality. There was no statistically significant difference in the complication rate of early procedures compared with delayed interventions (12.5% vs. 7.4%, p=0.71). Greater initial injury severity and the presence of high-risk lesion characteristics are the factors that lead to early endovascular intervention. Early intervention is associated with a higher complication rate, but this difference is not statistically significant.

scholarly journals Rates of violence in patients classified as high risk by structured risk assessment instruments

2014 ◽  
Vol 204 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Jay P. Singh ◽  
Seena Fazel ◽  
Ralitza Gueorguieva ◽  
Alec Buchanan
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Groups ◽  
Evidence Base ◽  
Assessment Tools ◽  
Current Evidence ◽  
Assessment Instruments ◽  
Individual Liberty ◽  
Current Evidence Base ◽  
Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

scholarly journals Defining “High-risk Sexual Behavior” in the Context of Substance Use

2019 ◽  
Vol 1 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Nishtha Chawla ◽  
Siddharth Sarkar
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Sexual Behavior ◽  
High Risk ◽  
Risky Sex ◽  
Current Evidence ◽  
High Risk Sexual Behavior ◽  
Immunodeficiency Virus ◽  
Definition Of ◽  
Risk Sexual Behavior

Introduction: Sexual behavior is a behavior exhibited by individuals to gratify one of their basic needs, that is the sexual need. Often the way in which sexual behavior is practiced may lead to negative consequences. However, the definition of a sexual behavior as risky varies with regards to culture, gender, age, and the threshold. Objectives: This review aims to study different definitions of high-risk sexual behavior available in literature, the differences in the prevalence of various risks associated with risky sex in substance-using population as compared to general population, and eventually formulating a tentative definition of “high-risk sexual behavior” in the context of substance use. Current evidence and results of literature search as we have entered into the epidemic of human immunodeficiency virus globally, it is important clinically as well as from the public health perspective to define high-risk sexual behavior discretely helping the researchers quantify the burden and the clinicians focus on the population at risk. High-risk sexual behavior has often been discussed and studied in various studies till date. However, literature lacks a discrete definition of high-risk sexual behavior. Risky sex (or high-risk sexual behavior) has been variably defined in different studies. Majority of the definitions in the studies focus on sexually transmitted infection, especially human immunodeficiency virus. A few studies talk about unintended pregnancies or abortions. Conclusion: The association between high-risk sexual behavior and substance use has been well established. Further research is warranted to obtain a definition which has greater precision and clinical utility, and which can be integrated in preventive and promotive pursuits.

Urgent Carotid Endarterectomy for Patients with Unstable Symptoms: Systematic Review and Meta-Analysis of Outcomes

Vascular ◽  
2009 ◽  
Vol 17 (5) ◽  
pp. 243-252 ◽  
Author(s):  
Benjamin O. Patterson ◽  
Peter J. Holt ◽  
Robert J. Hinchliffe ◽  
Matt M. Thompson ◽  
Ian M. Loftus
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Confidence Interval ◽  
Carotid Endarterectomy ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Long Term Results ◽  
Current Evidence ◽  
Ischemic Attack

Current evidence suggests that carotid endarterectomy (CEA) performed within 2 weeks of symptoms produces better long-term results than if it is delayed. Urgent endarterectomy following unstable presentations such as crescendo transient ischemic attack (cTIA) or progressive stroke has been associated with variable results. The evidence for this treatment strategy required reviewing. A systematic review of articles related to urgent CEA between 1980 and 2008 was performed. For cTIA, there was an odds ratio of 5.6 (95% confidence interval 3.3–9.7, p ≤ .0001) for combined stroke or death compared with surgery for “standard” indications. For unstable stroke, the odds ratio was 5.5 (95% confidence interval 3.1–9.3, p ≤ .0001). Patients with unstable neurologic presentations are at higher risk of complications if operated on urgently. Clearer definitions would help more precise patient selection to avoid inadvertently operating on patients with an unacceptably high risk of poor outcome.

scholarly journals A ruptured penetrating atherosclerotic ulcer of the ascending aorta: a case report of an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Josephine Chenesseau ◽  
Pierre-Antoine Barral ◽  
Philippe Piquet ◽  
Marine Gaudry
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Endovascular Treatment ◽  
Endovascular Repair ◽  
Innominate Artery ◽  
Ascending Aorta ◽  
Stent Grafts ◽  
Penetrating Atherosclerotic Ulcer ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background An endovascular approach to the management of a ruptured plaque in the ascending aorta may be an alternative to open surgery in high-risk patients. This option may become inevitable due to the number of elderly patients unfit for open cardiac surgery. There are very few stent grafts able to fit the ascending aorta and in emergency cases, most medical teams have been limited to current thoracic aortic endografts, the shortest of which measure 10 cm. Case summary We report a case of an endovascular repair of a ruptured penetrating atherosclerotic ulcer of the ascending aorta. The patient was considered for open cardiac surgery but was evaluated at a high mortality risk based on his age, his medical history, and significant calcifications on his aorta. Our vascular surgical team decided then to perform an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery. Discussion Endovascular treatment of an acute ruptured aorta is feasible in high-risk patients with thoracic endovascular stent grafts and coverage of the innominate artery. Endovascular treatment of the ascending aorta is at its infancy and in need of further research. New stent grafts designed for the ascending aorta are in progress and should increase the numbers of interventions in the years to come.

scholarly journals Effectiveness of a gentamicin impregnated collagen sponge on reducing sternal wound infections following cardiac surgery: a meta-analysis of randomised controlled trials

2012 ◽  
Vol 94 (4) ◽  
pp. 227-231 ◽  
Author(s):  
S Creanor ◽  
A Barton ◽  
A Marchbank
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Current Evidence ◽  
Controlled Trials ◽  
Wound Infections ◽  
Insufficient Evidence ◽  
Sternal Wound Infections ◽  
Randomised Controlled

INTRODUCTION Gentamicin impregnated collagen sponges are licensed for use after cardiac surgery in over 50 countries but their effectiveness at preventing sternal wound infections (SWIs) remains uncertain. The aim of this meta-analysis was to assess the current evidence for effectiveness of such sponges at preventing SWIs in patients after cardiac surgery. METHODS A systematic search of the literature was undertaken and meta-analyses were performed on the results of the identified, eligible studies. Using random effects models, odds ratios (OR) and corresponding 95% confidence intervals (Cl) were calculated for all SWIs and deep SWIs for: a) all participants, and b) participants deemed as high risk. RESULTS Three unique randomised controlled trials (published between 2005 and 2010) involving 3,994 participants met the inclusion criteria. There was insufficient evidence of a significant difference between intervention and control groups for all SWIs (all participants: OR: 0.66, 95% Cl: 0.39–1.14; high risk participants: OR: 0.60, 95% Cl: 0.24–1.52). There was insufficient evidence of a significant benefit of the sponge in deep SWIs across all participants (OR: 0.72, 95% Cl: 0.47–1.10) but some evidence of benefit in terms of reducing the incidence of deep SWIs in high risk participants (OR: 0.62, 95% Cl: 0.39–0.98). CONCLUSIONS There is insufficient evidence of the effectiveness (or otherwise) of gentamicin impregnated sponges in preventing SWIs following cardiac surgery. However, some evidence does exist that such sponges can reduce the incidence of deep infections in high risk patients.

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