TP5.2.5 The utility of ‘kissing’ common iliac artery stents in the management of occlusive atherosclerotic arterial disease of the aortic bifurcation

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jenna Delaney ◽  
Joshua Templeman ◽  
Keith Hussey
Keyword(s):  
Arterial Disease ◽  
Aortic Bifurcation ◽  
Technical Success ◽  
Medium Term ◽  
Major Morbidity ◽  
Number Of Patients ◽  
Co Morbidity ◽  
Procedural Success ◽  
Good Medium

Abstract Introduction A systematic review published in 2017 concluded that ‘kissing’ iliac stents to treat occlusive disease of the aortic bifurcation was associated with high technical procedural success and good medium-term patency. We have explored this in a regional vascular unit. Methods Retrospective review of patients managed with endovascular treatment of aorto-iliac segment (March 2015 to September 2020). The median follow-up was 2-years. Key outcome variables included the patency of the reconstruction and requirement for secondary intervention. Results There were 1,348 iliac endovascular procedures performed for occlusive atherosclerotic arterial disease of the aorto-iliac segment of which 56 were ‘kissing’ iliac stents. Intervention was performed for chronic limb threatening ischaemia in 29 cases. In 37 cases patients had unilateral symptoms only and in 41 cases patients had either TASC A or B lesions. Technical success was achieved in 55 cases and the median duration of admission was 1-day. At follow-up there was clinical patency in 54 cases, although there were 3 major extremity amputations performed (all on the index admission). Conclusion As with much of the work on ‘kissing’ iliac stents the number of patients is small and the group of patients variable in terms of medical co-morbidity, presenting clinical features and morphology of iliac disease. The procedure appears to have high technical success and can be achieved with little in the way of major morbidity. Medium term durability is good.

Results of the Galician registry in the treatment of complex aortoiliac aneurysms with GORE® EXCLUDER® Iliac Branch Endoprosthesis (GALIBER)

Vascular ◽  
2021 ◽  
pp. 170853812110251
Author(s):  
Alba Méndez Fernández ◽  
Jorge Fernández Noya ◽  
Nilo J Mosquera Arochena ◽  
Jorge Vidal Rey ◽  
Pablo Calvin Álvarez ◽  
...  
Keyword(s):  
Type I ◽  
Technical Success ◽  
Medium Term ◽  
Iliac Arteries ◽  
Buttock Claudication ◽  
Type Ia ◽  
Internal Iliac ◽  
Ischemic Complications ◽  
Good Medium

Objective The objective of this study is to report the medium-term results of GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE, W. L. Gore & Associates, Flagstaff, Ariz) for the treatment of aortoiliac aneurysms by using the GALIBER registry. Methods Patients with aortoiliac or isolated common iliac/hypogastric aneurysms treated with Iliac Branch Endoprosthesis device between January 2014 and May 2019 were prospectively collected from 5 centers. Demographic, clinical, and radiologic data were extracted from electronic databases. Technical success was defined as successful implantation of the Iliac Branch Endoprosthesis device with exclusion of aortoiliac aneurysm, as well as patency of Iliac Branch Endoprosthesis in the follow-up. Iliac Branch Endoprosthesis patency was evaluated by Doppler ultrasound and/or computed tomography based on the protocol of each participant center. Follow-up was 731 days +/− 499. Results Between January 2014 and May 2019, 105 iliac arteries were treated with GORE® IBE device, in 81 patients (79 men, two women; mean age 71, range 52–91). Only seven patients (8.6%) were symptomatic. 60 patients (74%) had aortic and iliac enlargement. Thirty-three patients presented bilateral iliac aneurysms (40.7%): In twenty-four (29.6%) patients, an Iliac Branch Endoprosthesis device was implanted in both sides, and in nine patients (11.1%), one Iliac Branch Endoprosthesis was used with the embolization of the contralateral hypogastric artery. Technical success was achieved in the 99% (104/105 iliac branch device implanted). There were no procedural deaths or type I or III intraoperative endoleaks observed. During the follow-up (range 55–1789 days), 28 (34.5%) type II endoleaks were observed and one (1.2%) type Ia was observed. The patency of the hypogastric arteries treated with the iliac branch device was 98.1% during the follow-up (range 55–1789 days). In 30% of the patients with contralateral hypogastric embolization, some kind of complications was observed in the embolizated side: one developed ischemic colitis and two buttock claudication. Conclusions Preservation of internal iliac artery with the Iliac Branch Endoprosthesis device can be performed safely with excellent technical success and good medium-term patency rates. These results support hypogastric preservation whenever possible to prevent ischemic complications.

Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis—The PERU registry

Vascular ◽  
2021 ◽  
pp. 170853812199259
Author(s):  
Andrés Reyes Valdivia ◽  
Arindam Chaudhuri ◽  
Ross Milner ◽  
Giovanni Pratesi ◽  
Michel MPJ Reijnen ◽  
...  
Keyword(s):  
Real World ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Ultrasound ◽  
Interquartile Range ◽  
Technical Success ◽  
Number Of Patients ◽  
Hostile Neck ◽  
Aneurysm Repair ◽  
Related Mortality

Objectives We aim to describe real-world outcomes from multicenter data about the efficacy of adjunct Heli-FX EndoAnchor usage in preventing or repairing failures during infrarenal endovascular aneurysm repair (EVAR), so-called EndoSutured-aneurysm-repair (ESAR). Methods The current study has been assigned an identifier (NCT04100499) at the US National Library of Medicine ( https://ClinicalTrials.gov ). It is an observational retrospective study of prospectively collected data from seven vascular surgery departments between June 2010 and December 2019. Patients included in the ANCHOR registry were excluded from this analysis. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each center’s practice. Follow-up imaging was scheduled according to each center’s protocol, which necessarily included either abdominal ultrasound or radiography or computed tomographic scan imaging. The main outcomes analyzed were technical success, freedom from type Ia endoleaks (IaEL), all-cause and aneurysm-related mortality, and sac variation and trends evaluated for those with at least six months imaging follow-up. Results Two hundred and seventy-five patients underwent ESAR in participating centers during the study period. After exclusions, 221 patients (184 males, 37 females, mean age 75 ± 8.3 years) were finally included for analysis. Median follow-up for the cohort was 27 (interquartile range 12–48) months. A median 6 (interquartile range 3) EndoAnchors were deployed at ESAR, 175 (79%) procedures were primary and 46 (21%) revision cases, 40 associated with type IaEL. Technical success at operation (initial), 30-day, and overall success were 89, 95.5, and 96.8%, respectively; the 30-day success was higher due to those with subsequent spontaneous proximal endoleak seal. At two years, freedom from type IaEL was 94% for the whole series; 96% and 86% for the primary and revision groups, respectively; whereas freedom from all-cause mortality, aneurysm-related mortality, and reintervention was 89%, 98%, and 87%, respectively. Sac evolution pre-ESAR was 66 ± 15.1 vs. post ESAR 61 ± 17.5 (p < 0.001) and for 180 patients with at least six-month follow-up, 92.2% of them being in a stable (51%) or regression (41%) situation. Conclusions This real-world registry demonstrates that adjunct EndoAnchor usage at EVAR achieves high rates of freedom from type IaEL at mid-term including in a high number of patients with hostile neck anatomy, with positive trends in sac-size evolution. Further data with longer follow-up may help to establish EndoAnchor usage as a routine adjunct to EVAR, especially in hostile necks.

scholarly journals Is primary endocrine therapy effective in treating the elderly, unfit patient with breast cancer?

2011 ◽  
Vol 93 (4) ◽  
pp. 286-289 ◽  
Author(s):  
G Osborn ◽  
M Jones ◽  
C Champ ◽  
K Gower-Thomas ◽  
E Vaughan-Williams
Keyword(s):  
Breast Cancer ◽  
Disease Progression ◽  
Endocrine Therapy ◽  
General Anaesthetic ◽  
Number Of Patients ◽  
Co Morbidity ◽  
Er Positive ◽  
Primary Endocrine Therapy ◽  
Positive Breast Cancer

INTRODUCTION Elderly patients with oestrogen receptor (ER)-positive breast cancer wishing to avoid surgery or those who are considered unsuitable for a general anaesthetic may be treated with primary endocrine therapy. We have reviewed all patients with ER-positive breast cancer who were initially treated with primary hormone therapy (PHT) at a district general hospital in south Wales and investigated their outcome in order to evaluate the appropriateness of this method of managing breast cancer. MATERIALS AND METHODS All patients with breast cancer who were initially treated with PHT between January 2002 and December 2008 were identified from a single consultant's prospectively maintained database. For each patient the Charlson co-morbidity index was calculated to give an estimate of ten-year survival. Patients who had died during the study period were identified from hospital and cancer registries. RESULTS A total of 83 cancers in 82 patients with a median age of 81 years (range: 62–93 years) were included. All cancers were ER-positive. Six patients (7%) had a greater than 50% chance of surviving ten years, calculated using the Charlson index. The median follow-up period was 24 months (range: 6–72 months). Twelve patients (15%) had disease progression while taking PHT. Twenty-three patients (28%) have died (median time from diagnosis to death of 10.5 months, range: 1–77 months). Two patients (2%) experienced disease progression within six months of starting PHT and the number of patients whose cancer progressed increased with increasing length of follow up. Fourteen patients (17%) eventually underwent a wide local excision under local anaesthetic. CONCLUSIONS PHT can be considered an effective treatment in this elderly, unfit population with the aim of stopping disease progression so that these patients die with their breast cancer, not of it.

Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence?

2020 ◽  
Author(s):  
Ana Moreira Ferrão ◽  
Bruno Morais ◽  
Nuno Marques ◽  
João Nóbrega ◽  
José Monteiro ◽  
...  
Keyword(s):  
Demographic Data ◽  
Early Mobilization ◽  
Functional Results ◽  
Medium Term ◽  
Suture Button ◽  
First Ray ◽  
The Mean ◽  
End Stage ◽  
Good Medium

Abstract Introduction Trapeziectomy and suture-button suspensionplasty (SBS) are a novel option to treat end-stage trapeziometacarpal (TMC) osteoarthritis. Our purpose is to evaluate our outcomes with this technique and in this setting, with a minimum of 18 months of follow-up. Materials and Methods Twenty-eight patients were included, operated between 2016 and 2018. We recorded demographic data, preoperative Eaton stage, follow-up and operative times. The patients completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and tip pinch, key pinch, and grip strength were measured. First metacarpal subsidence was calculated, and postoperative complications were documented. Results The average follow-up was 34 months. The mean QuickDASH was 32 at the final follow-up. The average strength results were 20 kg for grip, 3.6 kg for tip pinch, and 4.2 kg for key pinch. The rate of first ray subsidence was 10.7%. We encountered three complications: a hardware intolerance, a second metacarpal fracture, and a suture rupture. There was one reoperation to remove an implant. Conclusion Trapeziectomy and SBS functional results are similar to other techniques, with less subsidence of the first ray and allowing for early mobilization and fast recovery. This procedure is a safe and promising option in the treatment of TMC osteoarthritis, with good medium-term outcomes.

Colorectal cancers in United Arab Emirates nationals: The Sheik Khalifa Medical Center's experience.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 442-442 ◽  
Author(s):  
Nidal Dehni ◽  
Ali Al Hassani ◽  
Abdulrahman Nimeri
Keyword(s):  
United Arab Emirates ◽  
Screening Program ◽  
Stage Iv ◽  
Emergency Operation ◽  
Final Diagnosis ◽  
Tumor Location ◽  
Colorectal Cancers ◽  
Number Of Patients ◽  
Co Morbidity

442 Background: Previous reports suggested that colorectal cancers (CRC) appear at younger age in the United Arabs Emirates (UAE). However, these reports included nationals and expatriates in their analysis with heterogeneous population leading to biased analysis. our objective was to determine age and stage of disease in newly diagnosed UEA nationals with CRC treated at one major referral hospital in Abu Dhabi (SKMC) Methods: Charts of all patients diagnosed and/ or treated for CRC at SKMC between January 2000 and May 2011 were reviewed. Ultimately, only UEA nationals with diagnosis of adenocarcinoma of the colon and rectum were retained for further analysis. Results: Two hundreds six patients were diagnosed at SKMC as having colon or rectal carcinomas. Ninety two were expatriates and in 10 out of 113 nationals, the final diagnosis was squamous or adenosquamous carcinoma leaving 103 patients forming the population of this study. Median age was 57(10-100 years), with 59 men. The patient’s condition necessitated emergency operation in 38 and 15 either refused or were unfit for treatment mainly because of very advanced disease or severe co morbidity. The tumor location was: sigmoid: 46%, rectum: 33:, right colon :17% and 4% for descending and transverse colon. The stage of the disease was I; 4 pts, II: 16 pts, III 25 pts, IV in 49 pts and undetermined in 7. Resection was curative for 46 pts, palliative in 45, unknown in 10 and 2 refused surgery. Fifty one patients had their treatment essentially at SKMC and the others were treated both at SKMC and abroad. Average follow-up was 2 years and at last FU 39 were confirmed deceased, 29 were alive and the outcome in the remaining was unknown. Conclusions: UAE nationals with CRC presenting to our facility have relatively young age but presented with stage IV disease in half of the cases. Screening program for this population is warranted. Because a substantial number of patients had had their treatment abroad, rigorous follow-up and cancer outcome assessment was unreliable.

Typology of clinical course in bipolar disorder based on 18-month naturalistic follow-up

2012 ◽  
Vol 43 (4) ◽  
pp. 789-799 ◽  
Author(s):  
R. Uher ◽  
O. Mantere ◽  
K. Suominen ◽  
E. Isometsä
Keyword(s):  
Bipolar Disorder ◽  
Latent Class ◽  
Clinical Course ◽  
Clinical Sample ◽  
Type I ◽  
Medium Term ◽  
Phase Switching ◽  
Therapeutic Implications ◽  
Co Morbidity

BackgroundIndividual variation in the clinical course of bipolar disorder may have prognostic and therapeutic implications but is poorly reflected in current classifications. We aimed to establish a typology of the individual clinical trajectories based on detailed prospective medium-term follow-up.MethodLatent class analysis (LCA) of nine characteristics of clinical course (time depressed, severity of depression, stability of depression, time manic, severity of mania, stability of mania, mixed symptoms, mania-to-depression and depression-to-mania phase switching) derived from life charts prospectively tracking the onsets and offsets of (hypo)manic, depressive, mixed and subsyndromal episodes in a representative sample of 176 patients with bipolar disorder.ResultsThe best-fitting model separated patients with bipolar disorder into large classes of episodic bipolar (47%) and depressive type (32%), moderately sized classes characterized by prolonged hypomanias (10%) and mixed episodes (5%) and five small classes with unusual course characteristics including mania-to-depression and depression-to-mania transitions and chronic mixed affective symptoms. This empirical typology is relatively independent of the distinction between bipolar disorder type I and type II. Lifetime co-morbidity of alcohol use disorders is characteristic of the episodic bipolar course type.ConclusionsThere is potential for a new typology of clinical course based on medium-term naturalistic follow-up of a representative clinical sample of patients with bipolar disorder. Predictive validity and stability over longer follow-up periods remain to be established.

scholarly journals Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise

2019 ◽  
Vol 25 (5) ◽  
pp. 484-490 ◽  
Author(s):  
Aysun Erbahceci Salik ◽  
Hatem H Selcuk ◽  
Hasanagha Zalov ◽  
Fatih Kilinc ◽  
Musa Cirak ◽  
...  
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
High Grade ◽  
Intracranial Artery ◽  
Technical Success ◽  
Medium Term ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Angioplasty And Stenting

Purpose The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70–99%) stenosis of a major intracranial artery with Enterprise stent. Methods This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70–99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. Results A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6–72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. Conclusion In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.

Linked distal radioulnar joint arthroplasty: an analysis of the APTIS prosthesis

2014 ◽  
Vol 39 (7) ◽  
pp. 739-744 ◽  
Author(s):  
S. Kakar ◽  
T. Fox ◽  
E. Wagner ◽  
R. Berger
Keyword(s):  
Functional Outcomes ◽  
Distal Radioulnar Joint ◽  
Joint Arthroplasty ◽  
Medium Term ◽  
Viable Option ◽  
Distal Ulna ◽  
Radioulnar Joint ◽  
Number Of Patients ◽  
Good Pain Relief

Painful radioulnar convergence following resection of the distal ulna can produce substantial disability and prove a challenging surgical problem, particularly in the revision setting. The purpose of this study was to evaluate the outcome of a series of patients with chronic distal radioulnar joint instability or multiple prior procedures treated with linked distal radioulnar joint arthroplasty with the APTIS prosthesis. A series of ten patients were identified with a mean follow up of 4.0 years. At final follow-up nine of ten implants survived free from revision or removal, with patients experiencing good pain relief and functional outcomes, with reasonable overall satisfaction in all seven patients who returned the questionnaires. Despite the medium-term follow-up and small number of patients, our results suggest the linked distal radioulnar joint arthroplasty may be a viable option for treating painful radioulnar convergence following multiple failed procedures at the distal radioulnar joint.

scholarly journals Hybrid atherectomy for lower extremity peripheral arterial disease

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 60-70 ◽  
Author(s):  
Saygin Turkyilmaz ◽  
Ali Aycan Kavala
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Clinical Success ◽  
Demographic Data ◽  
Clinical Success Rate ◽  
Arterial Disease ◽  
Technical Success ◽  
Directional Atherectomy ◽  
Procedural Success ◽  
Peripheral Arterial

Objective To evaluate the effectiveness of directional atherectomy with a Phoenix atherectomy system in lower extremity peripheral arterial disease (LE-PAD). Materials and methods A retrospective review of subjects who had undergone atherectomy for severe and occluded LE-PAD. Demographic data, procedural properties, and follow-up information were recorded. The technical, procedural and clinical successes were reported. Results In total, 120 subjects were evaluated. The superficial femoral artery (SFA) group consisted of 64 subjects (53.3%), and the popliteal group consisted of 56 (46.7%) subjects. Groups did not differ in terms of age, gender, comorbid diseases and tobacco use. In both groups, four subjects (6.3% of SFA and 7.1% of the popliteal group) experienced extravasation was encountered in from the vessel during the procedure. During atherectomy, two (3.3%) of the subjects in the SFA group and one (1.9%) subject in the popliteal group experienced vessel dissection. Acute technical success in this study was 96.7% for SFA and 98.1% for the popliteal group. Overall technical success was 97.7%. In the first 72 h, three (5%) of the subjects in the SFA group and four (7.7%) of the subjects in the popliteal group experienced major adverse events. Acute procedural success in this study was 91.7% for SFA and 90.4% for the popliteal group. Overall procedural success was 91.1%. Success was defined as an improvement of at least one grade in the Rutherford classification; two (3.3%) subjects did not demonstrate improvements in the SFA group, and the clinical success rate was 96.7%. All subjects in the popliteal group demonstrated an improvement of at least one grade in the Rutherford classification, and clinical success was 100%. When the groups combined all subjects, the clinical success in this study was 98.2%. Conclusion Directional atherectomy with a Phoenix atherectomy system demonstrated comparable results with the literature.

scholarly journals Treatment patterns and achievement of the treat-to-target goals in a real-life rheumatoid arthritis patient cohort: data from 1317 patients

2020 ◽  
Vol 12 ◽  
pp. 1759720X2093713
Author(s):  
Konstantinos Thomas ◽  
Argiro Lazarini ◽  
Evripidis Kaltsonoudis ◽  
Alexandros Drosos ◽  
Ioannis Papalopoulos ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Real Life ◽  
Treatment Patterns ◽  
Treat To Target ◽  
Number Of Patients ◽  
Co Morbidity ◽  
Male Sex ◽  
Morbidity Index

Background: Data regarding the real-life predictors of low disease activity (LDA) in rheumatoid arthritis (RA) patients are limited. Our aim was to evaluate the rate and predictors of LDA and treatment patterns in RA. Methods: This was a multicenter, prospective, RA cohort study where patients were evaluated in two different time points approximately 12 months apart. Statistical analysis was performed in order to identify predictors of LDA while patterns of disease-modifying anti-rheumatic drug [DMARDs; conventional synthetic (csDMARD) or biologic (bDMARD)] and glucocorticoid (GC) use were also recorded. Results: The total number of patients included was 1317 (79% females, mean age: 62.9 years, mean disease duration: 10.3 years). After 1 year, 57% had achieved LDA (DAS28ESR<3.2) while 43% did not (34%: moderate disease activity: DAS28ESR ⩾3.2 to <5.1, 9%: high disease activity, DAS28ESR ⩾5.1). By multivariate analysis, male sex was positively associated with LDA [odds ratio (OR) = 2.29 p < 0.001] whereas advanced age (OR = 0.98, p = 0.005), high Health Assessment Questionnaire (HAQ) score (OR = 0.57, p < 0.001), use of GCs (OR = 0.75, p = 0.037) or ⩾2 bDMARDs (OR = 0.61, p = 0.002), high co-morbidity index (OR = 0.86, p = 0.011) and obesity (OR = 0.62, p = 0.002) were negative predictors of LDA. During follow-up, among active patients (DAS28ESR >3.2), 21% initiated (among csDMARDs users) and 22% switched (among bDMARDs users) their bDMARDs. Conclusion: In a real-life RA cohort, during 1 year of follow-up, 43% of patients do not reach treatment targets while only ~20% of those with active RA started or switched their bDMARDs. Male sex, younger age, lower HAQ, body mass index and co-morbidity index were independent factors associated with LDA while use of GCs or ⩾2 bDMARDs were negative predictors.

Sign in / Sign up

Export Citation Format

Share Document