scholarly journals Post PCI Vascular and Bleeding Complications in Patients with or Without CKD

2016 ◽  
Vol 01 (01) ◽  
pp. 022-027
Author(s):  
Harish Oruganti ◽  
Jyotsna Maddury
Keyword(s):  
Renal Failure ◽  
Kidney Diseases ◽  
Vascular Complications ◽  
Therapeutic Interventions ◽  
Bleeding Complications ◽  
Access Site ◽  
Chronic Kidney Diseases ◽  
Artery Disease ◽  
General Populations ◽  
Distal Embolisation

AbstractBACKGROUND: There is increasing trend of both Cardiovascular disease (CVD) and chronic kidney diseases (CKD) in general populations. The individuals with CKD are more likely to die of CVD than of kidney failure. Both diagnostic and therapeutic interventions are crucial in management of CKD patients with coronary artery disease. As CKD itself is associated with more bleeding complications we aim to study the incidence of vascular complications (vessel thrombosis, distal embolisation, dissection, poorly controlled bleeding at puncture site, pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, and development of femoral neuropathy) in Percutaneous intervention (PCI) patients with renal failure.METHODS: 950 patients who underwent PCI procedures were classified into CKD (GFR<60ml/min/m2) (n=380, 40%) and non-CKD (n=570, 60%) groups. Two groups were analyzed for the occurrence of vascular complications post PCI.RESULTS: Vascular complications were seen in 28 out of 380 patients with CKD (7.37%) and 17 out of 570 patients without CKD (2.98%). Patients with renal failure (GFR<60ml/min/m2) were found to have higher risk of vascular complications post PCI. [p = 0.03, OR = 2.588 (1.344-5.017)]. Non access site complications were more common in patients with CKD compared to non CKD. 16 patients with CKD developed non access site complications compared to 9 in patients without CKD.[p=0.001, odds ratio 2.793(1.15-6.916)CONCLUSIONS: This study demonstrates higher risk of vascular complications post-PCI in patients with CKD compared to non CKD patients. Higher incidence of non access site complications was also observed in CKD patients.

scholarly journals Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038042
Author(s):  
Thomas A Meijers ◽  
Adel Aminian ◽  
Koen Teeuwen ◽  
Marleen van Wely ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Ethics Committee ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Lesions

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

Individualizing Therapy in Patients With Chronic Kidney Disease

2008 ◽  
Vol 21 (3) ◽  
pp. 225-236
Author(s):  
Melanie S. Joy ◽  
Mary La ◽  
Bo Xiao
Keyword(s):  
Drug Disposition ◽  
Kidney Diseases ◽  
Therapeutic Interventions ◽  
Patient Specific ◽  
Patient Centered ◽  
Glomerular Diseases ◽  
Metabolizing Enzymes ◽  
Chronic Kidney Diseases ◽  
Drug Metabolizing Enzyme ◽  
Metabolizing Enzyme

Patients with chronic kidney diseases have multiple clinical abnormalities that may affect disposition of drugs, including alterations in glomerular filtration rate, excretion of plasma proteins, reductions in serum albumin, and reductions in drug metabolizing enzyme activity. Inflammation may also influence the previous factors. Concomitant drug therapies can lead to drug— drug interactions that may affect the pharmacokinetics of administered drugs. Pharmacogenomics has begun to be evaluated for effects of genotype and haplotype of drug metabolizing enzymes and transporters on drug disposition. Because of the multiple potential etiologies for alterations in drug disposition in patients with chronic kidney diseases, they require appropriate evaluation for implementation of individualized strategies in therapies to enhance efficacy and reduce toxicities. This review will highlight the disease- and patient-specific variables that are targets for patient-centered approaches to therapeutic interventions. The field of pharmacogenomics will be reviewed with reference to common therapies for transplantation and glomerular diseases.

scholarly journals Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Rafail A. Kotronias ◽  
Jonathan J.H. Bray ◽  
Skanda Rajasundaram ◽  
Flavien Vincent ◽  
Cedric Delhaye ◽  
...  
Keyword(s):  
Systematic Review ◽  
Transcatheter Aortic Valve Replacement ◽  
Ultrasound Guidance ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Bleeding Complications ◽  
Ultrasound Guided ◽  
Access Site ◽  
Transcatheter Aortic Valve ◽  
Life Threatening

Background: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. Methods: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. Results: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively). Conclusions: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42020218259.

scholarly journals Vascular Access Site Complications Do Not Correlate With Large Sheath Diameter in TAVI Procedures With New Generation Devices

2021 ◽  
Vol 8 ◽  
Author(s):  
Birgid Gonska ◽  
Christopher Reuter ◽  
Johannes Mörike ◽  
Wolfgang Rottbauer ◽  
Dominik Buckert
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Vascular Complications ◽  
Female Gender ◽  
Interventional Treatment ◽  
Access Site ◽  
Transcatheter Aortic Valve ◽  
Artery Disease ◽  
Valve Implantation ◽  
New Generation

Background: Vascular complications after transfemoral transcatheter aortic valve implantation (TAVI) are associated with morbidity and mortality. However, consistent predictors have not been identified yet. The size of the implantation sheath seems to play a role, though especially with new generation TAVI devices and their improved sheaths and delivery systems this remains uncertain.Objectives: This study aimed to determine the incidence and predictors of access site-related vascular complications (VC) in the era of new generation TAVI devices.Methods and Results: Four hundred consecutive patients receiving TAVI in an experienced tertiary care center were analyzed. VC occurred in 89 patients (22.25%) with the majority being minor VC (21%) and only 1.25% major VC. Possible predictors for VC were tested, and only peri-interventional dual antiplatelet therapy (DAPT) showed to be predictive for VC [OR 2.11 (95% CI 1.10–4.06, p = 0.025)]. The female gender [OR 0.75 (95% CI 0.44–1.3), p = 0.31], sheath to femoral artery ratio &gt;1.05 [OR 1.18 (95% CI 0.66–2.08, p = 0.58)], calcification of the access site vessel [OR 0.83 (95% CI 0.48–1.42, p = 0.48)], known peripheral artery disease [OR 0.95 (95% CI 0.4–2.25, p = 0.9)], and BMI ≥ 25 kg/m2 [OR 0.69 (95% CI 0.41–1.19, p = 0–19)] were not predictive of VC. The larger sheath with 20 French even showed less VC than the smaller sheath with 16 French [OR 0.43 (95% CI 0.25–0.74, p = 0.002)].Conclusions: Overall, the rate of major and minor VC was low in this study population (for major VC: rate of 1.25%). Predefined risk factors were not associated with the occurrence of VC, except for peri-interventional treatment with DAPT. Especially, larger sheath size could not be identified as a predictor for VC in the setting of TAVI procedures performed with contemporary devices.

scholarly journals Animal models of diabetes-associated vascular diseases: An update on available models and experimental analysis

2020 ◽  
Author(s):  
Judy Choi ◽  
Judy de Haan ◽  
Arpeeta Sharma
Keyword(s):  
Animal Models ◽  
Experimental Analysis ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Vascular Diseases ◽  
Therapeutic Interventions ◽  
Molecular Pathways ◽  
Mortality And Morbidity ◽  
Diabetic Vascular Complications ◽  
Artery Disease

Diabetes is a chronic metabolic disorder associated with the accelerated development of macrovascular (atherosclerosis, coronary artery disease) and microvascular complications (nephropathy, retinopathy and neuropathy), which remain the principal cause of mortality and morbidity in this population. Current understanding of cellular and molecular pathways of diabetes-driven vascular complications as well as therapeutic interventions have arisen from studying disease pathogenesis in animal models. Diabetes-associated vascular complications are multi-faceted, involving the interaction between various cellular and molecular pathways. Thus, the choice of an appropriate animal model to study vascular pathogenesis is important in our quest to identify innovative and mechanism-based targeted therapies to reduce the burden of diabetic complications. Herein, we provide up-to-date information on available mouse models of both Type 1 and Type 2 diabetic vascular complications as well as experimental analysis and research outputs.

scholarly journals Major Bleeding and Adverse Outcome following Percutaneous Coronary Intervention

2015 ◽  
Vol 10 (1) ◽  
pp. 22 ◽  
Author(s):  
Eric W Holroyd ◽  
Ahmad HS Mustafa ◽  
Chee W Khoo ◽  
Rob Butler ◽  
Douglas G Fraser ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Major Adverse Cardiovascular Event ◽  
Bleeding Risk ◽  
Therapeutic Interventions ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Adverse Cardiovascular Event ◽  
Access Site ◽  
Percutaneous Coronary ◽  
Major Bleeding Events

Advances in anti-thrombotic and anti-platelet therapies have improved outcomes in patients undergoing percutaneous coronary interventions (PCIs) through a reduction in ischaemic events, at the expense of peri-procedural bleeding complications. These may occur through either the access site through which the PCI was performed or through non-access-related sites. There are currently over 10 definitions of major bleeding events consisting of clinical events, changes in laboratory parameters and clinical outcomes, where different definitions will differentially influence the reported incidence of major bleeding events. Use of different major bleeding definitions has been shown to change the reported outcome of a number of therapeutic strategies in randomised controlled trials but as yet a universal bleeding definition has not gained widespread adoption in assessing the efficacy of such therapeutic interventions. Major bleeding complications are independently associated with adverse mortality and major adverse cardiovascular event (MACE) outcomes, irrespective of the definition of major bleeding used, with the worst outcomes associate with non-access-site related bleeds. We consider the mechanisms through which bleeding complications may affect longer-term outcomes and discuss bleeding avoidance strategies, including access site choice, pharmacological considerations and formal bleeding risk assessment to minimise such bleeding events.

Incidence and Predictors of Access Site Vascular Complications Following Ultrasound-Guided MANTA Closure Deployment

2021 ◽  
pp. 152660282110594
Author(s):  
Hirokazu Miyashita ◽  
Noriaki Moriyama ◽  
Mika Laine
Keyword(s):  
Academic Research ◽  
Vascular Complications ◽  
Common Femoral Artery ◽  
Anterior Wall ◽  
Vascular Complication ◽  
Bleeding Complications ◽  
Access Site ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
The Us

Purpose: There is no report on the reproducibility of the ultrasound-navigated MANTA deployment (US-MANTA) technique and little is known about predictors for US-MANTA-related vascular complication (VC). This study aimed to assess the incidence and predictors of access-site VC using the US-MANTA technique and report insights of MANTA-related VC from consecutive cases following large-bore arteriotomy. Materials and Methods: Consecutive patients who underwent transfemoral transcatheter aortic valve replacement with the US-MANTA technique from November 2018 to February 2020 were evaluated. MANTA-related VC was defined as access-site complications leading to major or minor VCs based on Valve Academic Research Consortium-2 criteria. Results: Among 378 patients, 23 cases (6.1%) of MANTA-related VC (major VC: n=7 [1.9%], minor VC: n=16 [4.2%]) were identified. No significant difference was observed in the incidence of MANTA-related VC over the observational period (first quartile: 5.3%, second: 5.4%, third: 7.4%, and fourth: 6.3%, p>.50). In 7 patients with MANTA-related major VC, 4 (57.1%) of complications resulted from incomplete apposition of the toggle due to anterior wall calcification of the common femoral artery (CFA). Anterior calcification of the CFA determined by computed tomography was identified as an independent predictor of MANTA-related VCs. Conclusions: The US-MANTA technique sustainably provides a low rate of access-site VCs following large-bore arteriotomy. Incomplete apposition of the toggle due to anterior calcification of the CFA may lead to ongoing vascular and bleeding complications.

Total flavonoid in Epimedium koreanum Nakai alleviated chronic renal failure via promoting AMPK activation

2022 ◽  
Author(s):  
Yudan Zhao ◽  
Ruiqi Zhang ◽  
Lintong Mu ◽  
Wan Yue Yang ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Global Health ◽  
Health Problem ◽  
Kidney Diseases ◽  
Ampk Activation ◽  
Cost Of Treatment ◽  
Chronic Kidney Diseases ◽  
Epimedium Koreanum Nakai ◽  
Global Health Problem

Chronic renal failure (CRF) is a result of the progression of chronic kidney diseases (CKD), a global health problem with high cost of treatment and no ideal therapy. The aim...

Sign in / Sign up

Export Citation Format

Share Document