Study of endovascular treatment in obstructive aortoiliac lesions: Immediate and short-term results

Objective: Aorto-iliac occlusive disease (AIOD) is a common atherosclerotic disease causing significant morbidity. Transatlantic intersociety consensus for the management of peripheral arterial disease (TASC II) recommends endovascular therapy (ET) for better management of patients with lesions type A and B. With the advent of endovascular therapy, type C and D lesions management is becoming more feasible with endovascular therapy than open surgery for aorto-iliac occlusive disease. We aimed to evaluate patients with AOID and to describe short-term outcome of endovascular treatment for such lesions. Methods: Patients with aorto-iliac occlusive diseases who underwent endovascular therapy were enrolled in the study. Their demographic data and risk factors were recorded. Patients were followed at 3 and 6 months and their primary patency rate and symptom status were recorded. Results: We enrolled 100 patients with a mean age of 59.77 (8.75) years with the majority of patients being male. The most common presentation was claudication (59%) followed by rest pain (31%) and gangrene (20%). The majority of patients had Transatlantic inter-society consensus (TASC) II type A (44%) and type B (31%) lesions; 15% of patients had types C lesions and the remaining 10% patients had type D lesions. Access site hematoma and contrast-induced nephropathy were present in 7% and 5% of patients respectively. Stent patency rate was 97% and 95% at 3 and 6 months follow up respectively. Conclusion: Endovascular therapy in aorto-iliac occlusive disease is a safe, effective, and low-cost treatment option with a high patency rate and symptomatic improvement in the short-term.

Blunt traumatic aortic injury: CT angiography images and short review of current literature

Blunt traumatic aortic injury in high-energy motor vehicle accidents is a rare but life-threatening condition. Proper treatment after prompt and accurate diagnosis is critical to reduce the death rate. The purpose of this article was to highlight the points to be considered in blunt traumatic aortic injury due to high-energy motor vehicle accident.

Preoperative cardiopulmonary exercise testing for risk assessment before elective coronary artery bypass grafting surgery

Objective: To evaluate the feasibility and results of performing cardiopulmonary exercise test (CPET) in coronary artery disease (CAD) patients before elective coronary artery bypass grafting surgery (CABG). CPET has been increasingly employed in the evaluation of preoperative risk before noncardiac surgeries, but is still underutilized before cardiac surgery and may be useful, as clinical risk scores for preoperative assessment before cardiac surgeries have several limitations. Methods: Patients with CAD underwent CPET within 1 week before CABG. Oxygen consumption, oxygen pulse, oxygen consumption at the anaerobic threshold, minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), oxygen uptake efficiency slope (OUES) and heart rate recovery (HRR) were analyzed. The occurrence of complications during the test was recorded. Results: Twenty-eight patients (75% men), aged 61 (8) years, underwent preoperative CPET. There were no complications during CPET, even though 71.4% were interrupted by signs or symptoms of ischemia, and only 57% of the patients reached the anaerobic threshold. Conclusions: Preoperative CPET before elective CABG was feasible and safe. However, a large proportion of patients did not achieve the anaerobic threshold. Therefore, VE/VCO2 slope, OUES and HRR may be the most useful CPET variables in the preoperative period. Key words: coronary artery disease, coronary artery bypass grafting, cardiopulmonary exercise test, preoperative assessment