Stenting for chronic obstructive venous disease: A current comprehensive meta-analysis and systematic review

Objectives The aim of this article was to summarize the efficacy and safety of venous stents in chronic obstructive venous disease (COVD) including postthrombotic syndrome (PTS) and nonthrombotic iliac vein lesions (NIVL). Methods We searched PubMed for case series (prospective and retrospective) that focused on venous stents in the treatment of COVD published between 1st January, 2000 and 15th July, 2014. Then, we analyzed the perioperative complications, subsequent antithrombotic treatment, clinical outcomes, and long-term patency of this procedure. Results Overall, 1987 patients from 14 studies were included in our study. The incidence of the 30-day thrombotic events was 2.0% (4.0% in PTS vs. 0.8% in NIVL, p = 0.0002). The rates of access site complications and stent migration were 1.7% and 1.3%, respectively. The incidence of retroperitoneal bleeding and contrast extravasation was 1.8%. Back pain was more common with a rate of 62.9%. With stent placement, there was a significant pain and edema relief in COVD patients and the clinical–etiology–anatomy–pathophysiology scores declined. The rate of ulcer healing was 72.1% (70.3% in PTS vs. 86.9% in NIVL, p = 0.0022), and the ulcer recurrence rate was 8.7%. The primary, assisted primary, and secondary patency rates were 91.4%, 95.0%, and 97.8%, respectively, at 12 months and 77.1%, 92.3%, and 94.3%, respectively, at 36 months; however, the patency rates in PTS were lower than those in NIVL. Conclusions Stents may be a relatively effective and safe approach for PTS and NIVL patients because of the low incidence of perioperative complications and satisfying long-term patency. Some outcomes of stents in NIVL patients may be better than those in PTS patients.

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Symptomatic Iliofemoral and Iliocaval Venous Thrombosis in Patients With Cancer: Endovascular Treatment

Vascular and Endovascular Surgery ◽

10.1177/1538574418789018 ◽

2018 ◽

Vol 52 (8) ◽

pp. 602-606 ◽

Cited By ~ 1

Author(s):

Martin Rabellino ◽

Pedro Moltini ◽

Vanesa Di Caro ◽

Ricardo García-Mónaco

Keyword(s):

Primary Objective ◽

Primary Patency ◽

Postthrombotic Syndrome ◽

Symptom Improvement ◽

Secondary Patency ◽

Technical Success ◽

Vein Thrombosis ◽

Patients With Cancer ◽

Long Term Follow Up

Introduction: Proximal (iliocaval and iliofemoral) deep vein thrombosis (DVT) and pulmonary thromboembolism are the second cause of death in patients with cancer. Material and Methods: A retrospective analysis was performed in 35 patients with cancer treated with endovascular therapy for proximal DVT. The primary objective was to evaluate the technical success of the procedure and the 30-day and long-term symptom improvement. Results: Thirty-five patients with a mean age of 57.7 years were treated. In 27 patients, DVT was due to tumor compression and/or invasion of the iliocaval venous axis, and in the remaining 8, it was secondary to their hypercoagulability state. The revascularization techniques used were manual catheter-directed aspiration of the thrombus plus angioplasty and stenting. Technical success was achieved in 33 patients. No complications occurred. Twenty-seven patients were followed up at 30 days posttreatment: 21 were free of postthrombotic syndrome, 4 (14.8%) had mild symptoms, and 2 (7.4%) had moderate symptoms. The mean long-term follow-up was 27.3 months, with a primary patency of 68.8% and assisted and secondary patency rates of 100%. Conclusion: Endovascular revascularization in patients with cancer with extensive and symptomatic proximal DVT is safe and efficient, with a low rate of complications. We consider that this therapy should be offered to patients with cancer with an average or long life expectancy.

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Tubularized proximally-incised plate in distal/midshaft hypospadias repair

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2017.151 ◽

2017 ◽

Vol 39 (2) ◽

Author(s):

Antonio Marte ◽

Lucia Pintozzi

Keyword(s):

Perioperative Complications ◽

Foley Catheter ◽

Case Series ◽

Functional Results ◽

Inclusion Criteria ◽

Urethral Plate ◽

Age At Surgery ◽

Long Term Follow Up

The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25<sup>th</sup> percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

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Outcomes Following Placement of Venous Stents for Treatment of Thrombotic Venous Disease

Blood ◽

10.1182/blood.v130.suppl_1.697.697 ◽

2017 ◽

Vol 130 (Suppl_1) ◽

pp. 697-697

Author(s):

Karen Breen ◽

Prakash Saha ◽

Narayan Karanunithy ◽

Beverley Hunt ◽

Alexander Cohen ◽

...

Keyword(s):

Clinical Outcome ◽

Ulcer Healing ◽

Fistula Formation ◽

Venous Disease ◽

Secondary Patency ◽

Post Thrombotic Syndrome ◽

Bayer Healthcare ◽

One Year ◽

Venous Stents

Abstract Background Endovenous stenting is a method to overcome venous outflow obstruction in the treatment of patients with acute iliofemoral deep vein thrombosis (DVT) or in those with symptomatic post-thrombotic syndrome (PTS). These treatments allow maximal luminal expansion of the caval and/or iliac venous segment leading to a reduction in venous hypertension. While there is growing enthusiasm for their use, particularly as conventional treatments usually with anticoagulation are not always effective there is however little clinical data regarding efficacy in improving clinical outcome. Objectives To determine the outcomes in patients following placement of venous stents for treatment of obstruction in acute venous thrombotic and post-thrombotic syndrome. Methods Consecutive patients with a history of DVT in whom a venous stent was inserted at two UK specialist tertiary referral centres between 2012-2015 were included. 'Acute' patients consisted of those with a fresh symptomatic iliofemoral DVT; chronic patients were those with recalcitrant PTS unresponsive to conventional therapy. Patients planned for intervention were discussed by a multidisciplinary team made up from Haematology, Interventional Radiology and Vascular Surgery. Stents were placed under general anaesthesia. Venous access was obtained using ultrasound guidance. Intravascular ultrasound (IVUS) was used to size the stent and to ensure it was fully expanded. Endophlebectomy with arterio-venous fistula formation was carried out in selected patients. All patients were given therapeutic dose low molecular weight heparin (LMWH) post procedure before transition to oral anticoagulation. Ultrasound surveillance commenced the day after the procedure and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and annually thereafter. Clinical follow-up was at 6 weeks, 6 monthly thereafter. Primary patency was defined as a patent stent with <50% diameter reduction. Primary-assisted patency was defined as a stent that had not occluded, but had required a re-intervention to maintain patency, based on imaging findings and/or symptoms. Secondary patency included stents that had blocked and were successfully re-opened. Ulcer healing or changes in Villalta Score were used as measures of clinical outcome following intervention. Results 379 venous stents were placed in 148 patients. The median age of patients was 42yrs (range: 18-81yrs), and 86 (58%) patients were female. Symptoms in the left leg were most common (116 patients, 78%). There were 60 (41%) patients who had a venous stent placed to treat an underlying stenosis following catheter directed thrombolysis of an acute iliofemoral DVT. 88 (58%) patients had stent placement to treat a post-thrombotic obstruction considered pathological for PTS. Primary, primary-assisted and secondary patency was 67%, 85% and 88% respectively at one-year in the acute DVT group (figure 1) and 64%, 86% and 86% respectively for the PTS group (figure 2). The median Villata score was 0 (range 0-14), 12 months after stenting, though new ulceration was noted in three patients in the acute DVT group. Median Villalta scores in patients without ulceration decreased from 15 (range 6-23) to 5 (range 1-22) one-year following the procedure (P<0.0001) in the PTS group with the greatest improvement in Villalta score in patients with a patent stent (P<0.0001). Ulcer healing occurred in 6 of 13 patients during follow-up. Four patients with severe pre-operative PTS developed an ulcer six-months following intervention. There was one death from cancer during follow-up, but no stent related mortality or major bleeding complications. Conclusions This is the largest reported series of outcomes of venous stents placed in patients with acute iliofemoral venous thrombosis or severe post-thrombotic syndrome. Patients had a minimum follow-up of one year Venous stenting offer potential for the treatment of patients with obstruction related to thrombotic venous disease with good clinical outcomes at one year. Further study on patient selection, outcomes and optimal anticoagulation is required. Disclosures Breen: Veniti: Speakers Bureau. Cohen: Bayer Healthcare: Employment, Speakers Bureau. Uprichard: Bayer Healthcare: Speakers Bureau. Black: Veniti: Speakers Bureau.

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Remote Iliac Artery Endarterectomy: A Case Series and Systematic Review

Journal of Endovascular Therapy ◽

10.1177/1526602817749620 ◽

2018 ◽

Vol 25 (1) ◽

pp. 140-149 ◽

Cited By ~ 1

Author(s):

Joost A. Bekken ◽

Sanne W. de Boer ◽

Rogier van der Sluijs ◽

Hidde Jongsma ◽

Jean-Paul P. M. de Vries ◽

...

Keyword(s):

Systematic Review ◽

Treatment Option ◽

Iliac Artery ◽

English Language ◽

Case Series ◽

External Iliac Artery ◽

Primary Patency ◽

Long Term Results ◽

Secondary Patency

Purpose: To evaluate the long-term results of remote iliac artery endarterectomy (RIAE) in 2 vascular referral centers and review existing literature. Methods: A retrospective analysis was conducted of 109 consecutive patients (mean age 64.2±10.7 years; 72 men) who underwent 113 RIAE procedures for lower limb ischemia from January 2004 to August 2015 at 2 vascular centers. The majority of limbs (82, 72.6%) had TASC II D lesions (31 TASC II C). Primary outcome measures were primary, assisted primary, and secondary patency. A comprehensive literature search was performed in the PubMed and EMBASE databases to identify all English-language studies published after 1990 reporting the results of RIAE. Results: Technical success was achieved in 95 (84.1%) of the 113 procedures. The complication rate was 13.7%, and 30-day mortality was 0%. At 5 years, primary patency was 78.2%, assisted primary patency was 83.4%, and secondary patency was 86.7%. Hemodynamic success was obtained in 91.7% of patients, and clinical improvement was observed in 95.2%. Freedom from major amputation was 94.7% at 5 years. The systematic review comprised 6 studies including 419 RIAEs, and pooled data showed results similar to the current study. Conclusion: For external iliac artery occlusions extending into the common femoral artery, RIAE appears to be a valuable hybrid treatment option. It combines acceptable morbidity and low mortality with good long-term patency. It has some advantages over an open surgical iliofemoral bypass or complete endovascular revascularization and could be the best treatment option in selected cases.

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Venovo venous stent for treatment of non-thrombotic or post-thrombotic iliac vein lesions – long-term efficacy and safety results from the Arnsberg venous registry

VASA ◽

10.1024/0301-1526/a000893 ◽

2021 ◽

Vol 50 (1) ◽

pp. 52-58

Author(s):

Michael K. W. Lichtenberg ◽

Wilhelm F. Stahlhoff ◽

Stefan Stahlhoff ◽

Ahmet Özkapi ◽

Frank Breuckmann ◽

...

Keyword(s):

Pulmonary Embolism ◽

Iliac Vein ◽

Stent Migration ◽

Clinical Severity ◽

Secondary Patency ◽

Outflow Obstruction ◽

Open Cell ◽

Venous Clinical Severity Score ◽

Venous Stents

Summary: Background: Endovascular venous stenting with dedicated venous stents for the treatment of chronic venous outflow obstruction is developing as efficacious alternative to conservative therapy or open surgery. However, so far, mid- and long-term evidence on effectiveness and safety is poor. Patients and methods: The prospective, single-center, observational study enrolled consecutive patients with chronic non-thrombotic iliac vein lesions (NIVL) or post-thrombotic iliofemoral obstructions (PTO). From February 2016 to April 2017, patients underwent implantation of open cell, self-expandable dedicated venous stents. Short-term symptomatic improvement, patency, and complication rate were favorable. Evaluation at 2-years included improvement in the revised venous clinical severity score (rVCSS), patency, stent migration, major target limb events, clinically important pulmonary embolism, major bleeding, and all-cause mortality. Results: A total of 79 patients (57 ± 16 years, 44 female) were evaluated. At 2 years, rVCCS improved by 4.3 ± 2.7 (p < 0.001). Substantial clinical improvement of ≥ 2 score points was achieved in 86.4% (38 of 44) of patients. Improvement was not associated with thrombotic pathogenesis (regression coefficient [B] with PTO = 0.6 [95%CI: −1.1 to 2.3], p = 0.48). At 2 years, all ulcers (in 8 of 79 patients) were healed and none recurred. Two-year primary patency was 95.5% (95%CI: 86.5 to 98.5) with no difference between NIVL- and PTO-patients (log-rank p = 0.83). Target vessel revascularization was conducted in two PTO- and one NIVL-patients in the period of 34 days to 156 days from index procedure, resulting in a secondary patency of 100%. No stent migration, target limb deep vein thrombosis, major amputation, pulmonary embolism, or death occurred. Conclusions: Venovo venous open cell self-expanding stent implantation for chronic outflow obstruction was efficacious and provided a sufficient level of safety throughout 2 years.

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Long-term health effects of antipyretic drug use in the ageing population: protocol for a systematic review

F1000Research ◽

10.12688/f1000research.27145.1 ◽

2020 ◽

Vol 9 ◽

pp. 1288

Author(s):

Seema Mahesh ◽

Esther van der Werf ◽

Mahesh Mallappa ◽

George Vithoulkas ◽

Nai Ming Lai

Keyword(s):

Systematic Review ◽

Health Effects ◽

Experimental Studies ◽

Connective Tissue Diseases ◽

Case Series ◽

The Elderly ◽

Chronic Obstructive ◽

Ageing Population ◽

Antipyretic Treatment

Background: Fever is suppressed with drugs due to discomfort and risk of organ damage. However, there is some compelling evidence for the benefits of fever. The elderly are a special population in this regard as they have a blunted fever response. The benefit-harm balance of antipyretic use in this population is unclear. This study aims to provide the synthesized best evidence regarding long-term health effects of antipyretic treatment in the elderly during infections, investigating the onset/worsening of common chronic diseases, for e.g., thyroid disorders, connective tissue diseases and chronic obstructive pulmonary disease/asthma. Methods: A systematic review will be performed to establish the best evidence available regarding antipyretic treatment in the elderly, searching databases such as Medline, Embase and Cochrane CENTRAL from their inception till date for all types of studies. Studies that consider the drugs in analgesic role will be excluded. The search will be reported following the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ (PRISMA) guidelines. Randomized control trials, quasi experimental studies, observational studies, case series and reports will be included. The primary outcome measure being onset/worsening of chronic inflammatory diseases. Other outcomes include relief of symptoms, length of hospital stay, patient satisfaction, mortality, blood/immune parameters indicative of morbidity and complications of the infection. Risk of biases in randomized studies will be assessed through the Cochrane risk of bias tool. For other study types, appropriate tools such as CASP/QUIPS/Cochrane non-randomised studies tool will be used. Meta-analysis will be conducted on the Cochrane RevMan software and where pooling of data is not possible, a narrative synthesis will be performed. Overall certainty of evidence will be assessed through the GRADE approach. Discussion: The study aims to provide evidence regarding benefit-harm balance of antipyretic use in the elderly population to inform clinical practice and future research. Systematic review registration: PROSPERO CRD42020160854

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Feedback to Prepare EMS Teams to Manage Infected Patients with COVID-19: A Case Series

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000783 ◽

2020 ◽

Vol 35 (4) ◽

pp. 451-453 ◽

Cited By ~ 2

Author(s):

Daniel Aiham Ghazali ◽

Amina Ouersighni ◽

Matthieu Gay ◽

Virginie Audebault ◽

Thomas Pavlovsky ◽

...

Keyword(s):

Medical Service ◽

Case Series ◽

Care Facility ◽

Elderly Subjects ◽

Chronic Obstructive ◽

Term Care ◽

Obstructive Pulmonary Disease ◽

Long Term Care Facility ◽

Staff Protection

AbstractCoronavirus Disease 2019 (COVID-19), a new respiratory disease, is spreading globally. In France, Emergency Medical Service (EMS) teams are mobile medicalized resuscitation teams composed of emergency physician, nurse or anesthesiologist nurse, ambulance driver, and resident. Four types of clinical cases are presented here because they have led these EMS teams to change practices in their management of patients suspected of COVID-19 infection: cardiac arrest, hypoxia on an acute pneumonia, acute chronic obstructive pulmonary disease (COPD) exacerbation with respiratory and hemodynamic disorders, and upper function disorders in a patient in a long-term care facility. The last case raised the question of COVID-19 cases with atypical forms in elderly subjects. Providers were contaminated during the management of these patients. These cases highlighted the need to review the way these EMS teams are responding to the COVID-19 pandemic, in view of heightening potential for early identification of suspicious cases, and of reinforcing the application of staff protection equipment to limit risk of contamination.

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Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8080086 ◽

2021 ◽

Vol 8 (8) ◽

pp. 86

Author(s):

Massimo Capoccia ◽

Christoph A. Nienaber ◽

Maziar Mireskandari ◽

Michael Sabetai ◽

Christopher Young ◽

...

Keyword(s):

Aortic Arch ◽

Perioperative Complications ◽

Case Series ◽

Cerebral Protection ◽

Technical Success Rate ◽

Relative Safety ◽

Safe Management ◽

Complex Patients ◽

Alternative Approach

Total arch replacement remains a very demanding surgical procedure. It can be associated with reasonable long-term outcomes but carries serious perioperative complications. Aortic arch surgery has progressed in recent years to a wider adoption of reproducible and reliable techniques. Conventional open, surgical aortic arch replacement is currently offered to the majority of patients, although hybrid and wholly endovascular techniques are gaining popularity. With regards to open arch replacement, the nuances of surgical technique, the mode of cannulation and the optimal cerebral protection protocols remain a matter of debate. We propose an alternative cannulation approach facilitated by the cooperation between cardiac and vascular surgeons. A three-way arterial cannulation including both carotid arteries and the femoral artery (or ascending aorta) is the key feature of this approach. A case series of complex patients is presented to show both the feasibility and relative safety of a standardised new approach with a 100% technical success rate and a 16% 30-day mortality. The three-way cannulation approach may have a role to play for complex and extensive procedures requiring prolonged cerebral protection. We believe that a shared skill set from cardiac and vascular specialists is essential for the safe management and successful outcomes using this adaptive technique.

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Long-Term Outcome for Covered Endovascular Reconstruction of Aortic Bifurcation for Aortoiliac Disease: A Single-Center Experience

Journal of Endovascular Therapy ◽

10.1177/15266028211028210 ◽

2021 ◽

pp. 152660282110282

Author(s):

Boris A. de Cort ◽

Pieter B. Salemans ◽

Wilbert M. Fritschy ◽

Maurice E. N. Pierie ◽

Robert C. Lind

Keyword(s):

Perioperative Complications ◽

Primary Patency ◽

Study Patient ◽

Morbidity Rate ◽

Secondary Patency ◽

Aortic Bifurcation ◽

Aortoiliac Disease ◽

Long Term Outcome

Purpose The gold standard for the treatment of complex (TASC II C and D) atherosclerotic aortoiliac lesions is still open surgical repair. Endovascular techniques have a lower mortality and morbidity rate but this comes at the cost of worse patency rates when compared with open repair. Improved short- and mid-term results have been reported using the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. The aim of this study was to report our initial experience with the CERAB technique and report long-term patency rates. Materials and Methods All patients treated with the CERAB technique between 2012 and 2018 were prospectively registered in an institutional database and included in this study. Patient demographics, characteristics, symptoms, procedural, and follow-up details were collected and analyzed retrospectively. Perioperative complications and reinterventions were also identified. The Kaplan-Meier survival method was used to assess cumulative rates of patency. Results A total of 44 patients were treated with the CERAB technique and included in this study. The majority of the treated aortoiliac occlusions were classified as complex: TASC II C (n=7; 15.9%) or TASC II D (n=25; 56.8%). Primary patency rate at 60 months was 83.3%, assisted primary patency was 90.9% and secondary patency 95%. No significant differences were found in patency rates comparing noncomplex (TASC II A and B) and complex (TASC II C and D) aortoiliac lesions. Seven patients (15.9%) required at least one additional procedure to maintain either assisted primary patency or secondary patency during follow-up. The 30-day complication rate in this series was 20.5% (n=9), of which 55.6% (n=5) were minor complications. All major 30-day complications (n=4) occurred during or directly after the CERAB procedure. Thirty-day mortality was 0%. No limb occlusions occurred within 30 days of the procedure. Conclusion Good long-term patency rates can be achieved with the CERAB technique to treat aortoiliac stenosis or occlusions while maintaining advantages associated with endovascular interventions. This remains true even when a CERAB is used to treat complex aortoiliac lesions. An endo-first approach to treat complex aortoiliac lesions seems viable.

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