Outcome of selective patching following carotid endarterectomy

Objectives:Routine patch angioplasty has been advocated following carotid endarterectomy but patching can be associated with complications. This study assesses the effect of a selective patching policy based on distal internal carotid diameter on the rate of restenosis and outcome following carotid endarterectomy.Design, material and methods:A consecutive series of 213 patients underwent carotid endarterectomy performed by one surgeon. Preoperative carotid dimensions were measured intraoperatively using calipers. Following endarterectomy a 5mm Dacron patch was selectively employed if the distal internal carotid was 5mm or less (group 1, 95 patients) or 6mm or less (group 2, 118 patients). Patients underwent colour-coded Duplex scanning at 24 h, 1 week, 3, 6, 9, and 12 months, and yearly following this.Results:Overall 27 restenoses (5 residual) of 50% or greater and two occlusions developed. Patching was performed in 47% of group 1 and 61% of group 2 arteries. In group 1 14% of patched compared with 24% of non-patched arteries developed restenosis at 24 months (p = 0.4). In group 2 13% of patched compared to 11% of non-patched arteries developed restenosis at 12 months (p > 0.5). Stroke rate at 24 months were similar for patched and non-patched patients in groups 1 (p > 0.5) and 2 (p = 0.4).Conclusions:This study suggests that patch angioplasty of larger carotid arteries may be unnecessary. Randomisation of larger arteries between patch and primary closure would be required to confirm this

The effects of potassium channel openers on saphenous vein exposed to arterial flow

Objectives: To assess the sensitivity of saphenous vein to potassium channel opening drugs (KCOs). Methods: Saphenous vein, harvested at bypass surgery or high ligation for correction of varicose veins, was exposed to an in vitro flow circuit and vasomotor responses assessed by organ bath pharmacology. Outcome measures: Effective drug concentrations for 50% reduction in vein ring tension (IC50). Results: Vein rings pre-contracted with phenylephrine showed a concentration-dependent relaxation to all the KCOs tested with a potency ranking of HOE 234 > cromakalim > pinacidil > diazoxide. The relaxation to cromakalim was endothelium-independent and was inhibited by glibenclamide (an ATP-sensitive K+ channel blocker). The sensitivity of vein rings to cromakalim increased after exposure to arterial flow conditions for 90 minutes (IC50 before 1.7 ± 0.25 μM and after 0.25 ± 0.08 μM, p > 0.001). This effect was not evident after 90 min of venous flow conditions, 2.19 ± 0.49 μM. When the workload on vein, exposed to arterial flow conditions, was reduced mechanically by external stenting with PTFE the increased sensitivity to cromakalim was abolished. Conclusion: Saphenous vein has ATP-sensitive K+ channels responsive to KCOs. The increased sensitivity to cromakalim, induced by arterial flow conditions, may represent and endogenous protective mechanism limiting ischaemic damage resulting from the higher workload imposed on grafted vein

Hearing Impairment and Incident Frailty in Later Life: The Health in Men Study (HIMS)

Objectives: This study is designed to determine if hearing loss is associated with increased risk of frailty in later life. Design: A prospective cohort study. Setting and Participants: We retrieved data of a community sample of men aged 70 years and above living in the metropolitan region of Perth, Western Australia. 3,285 participants who were free of frailty at the beginning of the study were followed for up to 17 years. Data were retrieved from the Health in Men Study (HIMS) and the Western Australian Data Linkage System (WADLS). Measurements: Hearing loss was defined by self-report or by diagnosis recorded in the WADLS. Incident frailty was assessed using the Hospital Frailty Risk Score (HFRS). Results: A total of 2,348 (71.5%) men developed frailty during follow up. The adjusted hazard ratio was 1.03 (95% CI: 0.95–1.12). The majority of the participants became frail by age 90 regardless of hearing condition. The time point where half of the group become frail was delayed by 14.4 months for men without hearing loss compared with hearing impaired men. Conclusions: Hearing loss is not associated with incident frailty in men aged 70 years or older when frailty was measured by HFRS. However, this statistically non-significant result could be due to the low sensitivity of study measures. Also, we found a trend that men with hearing loss were more likely to develop frailty compared with their normal-hearing peers, suggesting a potential association between hearing loss and frailty