Balloon Angioplasty of Infrapopliteal Arteries: A Systematic Review and Proposed Algorithm for Optimal Endovascular Therapy

2020 ◽  
Vol 27 (4) ◽  
pp. 547-564 ◽  
Author(s):  
Stefanos Giannopoulos ◽  
Ramon L. Varcoe ◽  
Michael Lichtenberg ◽  
John Rundback ◽  
Marianne Brodmann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Balloon Angioplasty ◽  
New Technologies ◽  
Neointimal Hyperplasia ◽  
Treatment Algorithm ◽  
Atheromatous Plaque ◽  
Endovascular Interventions ◽  
Medial Necrosis ◽  
Early Restenosis ◽  
Infrapopliteal Arteries

Endovascular revascularization has been increasingly utilized to treat patients with chronic limb-threatening ischemia (CLTI), particularly atherosclerotic disease in the infrapopliteal arteries. Lesions of the infrapopliteal arteries are the result of 2 different etiologies: medial calcification and intimal atheromatous plaque. Although several devices are available for endovascular treatment of infrapopliteal lesions, balloon angioplasty still comprises the mainstay of therapy due to a lack of purpose-built devices. The mechanism of balloon angioplasty consists of adventitial stretching, medial necrosis, and dissection or plaque fracture. In many cases, the diffuse nature of infrapopliteal disease and plaque complexity may lead to dissection, recoil, and early restenosis. Optimal balloon angioplasty requires careful attention to assessment of vessel calcification, appropriate vessel sizing, and the use of long balloons with prolonged inflation times, as outlined in a treatment algorithm based on this systematic review. Further development of specific devices for this arterial segment are warranted, including devices for preventing recoil (eg, dedicated atherectomy devices), treating dissections (eg, tacks, stents), and preventing neointimal hyperplasia (eg, novel drug delivery techniques and drug-eluting stents). Further understanding of infrapopliteal disease, along with the development of new technologies, will help optimize the durability of endovascular interventions and ultimately improve the limb-related outcomes of patients with CLTI.

Dissections After Infrainguinal Percutaneous Transluminal Angioplasty: A Systematic Review and Current State of Clinical Evidence

2019 ◽  
Vol 26 (4) ◽  
pp. 479-489 ◽  
Author(s):  
Ehrin J. Armstrong ◽  
Marianne Brodmann ◽  
David H. Deaton ◽  
William A. Gray ◽  
Michael R. Jaff ◽  
...  
Keyword(s):  
Systematic Review ◽  
Balloon Angioplasty ◽  
Percutaneous Transluminal Angioplasty ◽  
New Technologies ◽  
Transluminal Angioplasty ◽  
Current Data ◽  
Future Research ◽  
Economic Implications ◽  
Endovascular Interventions ◽  
Percutaneous Transluminal

Purpose: To systematically review the literature and extract information on the definitions, prevalence, implications, and treatment of dissections after infrainguinal balloon angioplasty, with a goal of summarizing current data and identifying gaps in knowledge to help direct future research. Materials and Methods: A systematic review was performed according to the PRISMA guidelines. Medline (PubMed), Scopus, and Cochrane CENTRAL databases were reviewed for prospective and retrospective studies reporting dissection identification, characterization, incidence, severity, and/or outcomes after infrainguinal balloon angioplasty up to January 30, 2019. The electronic search resulted in 288 studies. From these, 153 full-text articles were assessed, and 51 published from 1964 to 2018 were selected as relevant to this systematic review. Because of the significant between-study differences in lesion characteristics, reporting methods, and lack of core laboratory adjudication, the findings were summarized from each study, but the results were not pooled. Results: The mechanism of percutaneous transluminal angioplasty (PTA) consists of adventitial stretching, medial necrosis, and controlled dissection or plaque fracture. PTA-induced dissections can precipitate pathological high and low shear hemodynamic defects and have been implicated as a contributing factor in procedural complications as well as restenosis at the treatment site. The development of significant dissection after PTA often leads to the use of adjunctive therapies, including stent placement. Despite the ubiquitous nature of dissection after balloon angioplasty (incidence 7.4% to 84%), limited data are available to categorize dissections in the peripheral arteries and direct subsequent treatments to improve vessel patency. With the increased utilization of drug-coated balloon angioplasty, understanding the outcomes of postangioplasty dissection has become increasingly important, as the decision to treat dissections with additional strategies has therapeutic and economic implications. Conclusion: All post-PTA dissections in the femoropopliteal arteries may benefit from a treatment approach that ensures optimal hemodynamics with long-term durability in treated lesions. Further understanding the importance of postangioplasty dissections, along with the development of new technologies, will help optimize the patency of endovascular interventions.

Techniques for Endovascular Recanalization of Supra-Aortic Trunks

1996 ◽  
Vol 3 (4) ◽  
pp. 405-413 ◽  
Author(s):  
Frank J. Criado ◽  
Mordechai Twena
Keyword(s):  
Balloon Angioplasty ◽  
High Flow ◽  
Occlusive Disease ◽  
Endovascular Recanalization ◽  
Endovascular Interventions ◽  
Atherosclerotic Occlusive Disease ◽  
Angioplasty And Stenting ◽  
Aortic Lesions

The supra-aortic arteries are no stranger to endovascular interventions. Since the 1980s, interventionists have been evaluating and refining the use of transluminal techniques for recanalizing stenotic and occlusive lesions in these large-bore, high-flow vessels. The authors present their methodologies for evaluating, selecting, and treating supra-aortic lesions with balloon angioplasty and stenting. Helpful suggestions are offered for optimizing the outcome of these endovascular approaches to atherosclerotic occlusive disease in the supra-aortic trunks.

scholarly journals Foreign Language Learning Gamification Using Virtual Reality—A Systematic Review of Empirical Research

2021 ◽  
Vol 11 (5) ◽  
pp. 222
Author(s):  
Rafael Darque Pinto ◽  
Bruno Peixoto ◽  
Miguel Melo ◽  
Luciana Cabral ◽  
Maximino Bessa
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Foreign Language ◽  
Language Learning ◽  
Empirical Research ◽  
Second Language Learning ◽  
English Language ◽  
New Technologies ◽  
Foreign Language Learning ◽  
Traditional Approaches

Virtual reality has shown to have great potential as an educational tool when it comes to new learning methods. With the growth and dissemination of this technology, there is a massive opportunity for teachers to add this technology to their methods of teaching a second/foreign language, since students keep showing a growing interest in new technologies. This systematic review of empirical research aims at understanding whether the use of gaming strategies in virtual reality is beneficial for the learning of a second/foreign language or not. Results show that more than half of the articles proved that virtual reality technologies with gaming strategies can be used to learn a foreign language. It was also found that “learning” was the most evaluated dependent variable among the chosen records, augmented reality was the leading technology used, primary education and lower secondary was the most researched school stages, and the most used language to evaluate the use of gamified technology was by far the English language. Given the lack of directed investigation, it is recommended to use these technologies to support second language learning and not entirely replace traditional approaches. A research agenda is also proposed by the authors.

scholarly journals Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis

2021 ◽  
Author(s):  
Davide Bona ◽  
Francesca Lombardo ◽  
Kazuhide Matsushima ◽  
Marta Cavalli ◽  
Valerio Panizzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Treatment Algorithm ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Current Evidence ◽  
Esophageal Hiatus ◽  
Pooled Prevalence ◽  
Increased Risk ◽  
Esophagogastric Surgery

Abstract Introduction The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer. Materials and methods Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted. Results Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0–22.0%), 1.4% (95% CI = 0.8–2.2%), 35% (95% CI = 20.0–54.0%), and 5.0% (95% CI = 3.0–8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0–21.6%). Conclusions Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH.

Influential Factors for Older Users’ Acceptance of eHealth Services: an Integrated Acceptance Framework (IAF) (Preprint)

2021 ◽  
Author(s):  
Jiyeon Yu ◽  
Angelica de Antonio ◽  
Elena Villalba-Mora
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
New Technologies ◽  
Meta Analysis ◽  
Health Condition ◽  
Influential Factors ◽  
Current Status ◽  
Five Dimensions ◽  
The Impact ◽  
Acceptance Factors

BACKGROUND eHealth and Telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults’ lives, many studies have analyzed acceptance factors for this particular population. However, there is not yet a consensual framework to be used in further development and the search for solutions. OBJECTIVE This paper presents an Integrated Acceptance Framework (IAF) for the older user’s acceptance of eHealth, based on 43 studies selected through a systematic review. METHODS We conducted a four-step study. First, through a systematic review from 2010 to 2020 in the field of eHealth, the acceptance factors and basic data for analysis were extracted. Second, we carried out a thematic analysis to group the factors into themes to propose and integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Last, the differences amongst the important IAF factors were analyzed, according to the participants’ health conditions, verification time, and year. RESULTS Through the systematic review, 731 studies were founded in 5 major databases, resulting in 43 selected studies using the PRISMA methodology. First, the research methods and the acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in the Integrated Acceptance Framework. Five dimensions (i.e., personal, user-technology relational, technological, service-related, environmental) emerged with a total of 23 factors. Also, we assessed the quality of the evidence. And then, we conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and the assessment time. Finally, we assess which are the factors and dimensions that are recently becoming more important. CONCLUSIONS The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate e-Health acceptance.

scholarly journals Allergic Anaphylactic Risk in Farming Activities: A Systematic Review

2020 ◽  
Vol 17 (14) ◽  
pp. 4921 ◽  
Author(s):  
Giulio Arcangeli ◽  
Veronica Traversini ◽  
Emanuela Tomasini ◽  
Antonio Baldassarre ◽  
Luigi Isaia Lecca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Agricultural Sector ◽  
New Technologies ◽  
Farm Workers ◽  
Cochrane Library ◽  
Agriculture Sector ◽  
Allergic Disorders ◽  
Clinical Problems ◽  
Multiple Conditions ◽  
Main Clinical Manifestation

Allergic disorders in the agriculture sector are very common among farm workers, causing many injuries and occupational diseases every year. Agricultural employees are exposed to multiple conditions and various allergenic substances, which could be related to onset of anaphylactic reactions. This systematic review highlights the main clinical manifestation, the allergens that are mostly involved and the main activities that are usually involved. This research includes articles published on the major databases (PubMed, Cochrane Library, Scopus), using a combination of keywords. The online search yielded 489 references; after selection, by the authors, 36 articles (nine reviews and 27 original articles) were analyzed. From this analysis, the main clinical problems that were diagnosed in this category were respiratory (ranging from rhinitis to asthma) and dermatological (eczema, dermatitis, hives) in nature, with a wide symptomatology (from a simple local reaction to anaphylaxis). The main activities associated with these allergic conditions are harvesting or cultivation of fruit and cereals, beekeepers and people working in greenhouses. Finally, in addition to the allergens already known, new ones have emerged, including triticale, wine, spider and biological dust. For these reasons, in the agricultural sector, research needs to be amplified, considering new sectors, new technologies and new products, and ensuring a system of prevention to reduce this risk.

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