32 research outputs found
Revascularization approaches in patients with radiation-induced carotid stenosis: an updated systematic review and meta-analysis
Background: Ionizing radiation remains a well-known risk factor of carotid artery stenosis. The survival rates of head and neck cancer patients undergoing radiotherapy have risen owing to medical advancements in the field. As a consequence, the incidence of carotid artery stenosis in these high-risk patients has increased.Aims: In this study we sought to compare the outcomes of carotid endarterectomy (CEA) vs carotid artery stenting (CAS) for radiation-induced carotid artery stenosis.Methods: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 2020. A random-effects model meta-analysis was conducted, and odds ratios (ORs) were calculated. The I-square statistic was used to assess for heterogeneity.Results: Seven studies and 201 patients were included. Periprocedural stroke, myocardial infarction (MI), and death rates were similar between the two revascularization approaches. However, the risk for cranial nerve (CN) injury was higher in the CEA group (OR, 7.40; 95% CI, 1.58–34.59; I2 = 0%). Analysis revealed no significant difference in terms of long-term mortality (OR, 0.41; 95% CI, 0.14–1.16; I2 = 0%) and restenosis rates (OR, 0.69; 95% CI, 0.29–1.66; I2 = 0%) between CEA and CAS after a mean follow-up of 40.5 months.Conclusions: CAS and CEA appear to have a similar safety and efficacy profile in patients with radiation-induced carotid artery stenosis. Patients treated with CEA have a higher risk for periprocedural CN injuries. Future prospective studies are warranted to validate these results
Management of venous thromboembolism in pregnancy
Venous thromboembolism (VTE) in pregnancy, consisting of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major factor of maternal mortality. Several patient-specific risk factors along with the physiologic changes of pregnancy promote a state of hypercoagulability in pregnant women. Detailed assessment of all pregnant women can establish a risk profile that would guide clinical decisions, and balance potential therapeutic benefits with side effects. Differentiating between physiologic changes of pregnancy and symptoms of VTE can be challenging and warrants meticulous clinical evaluation. Timely and accurate diagnosis of VTE with proper imaging is essential for its management, and systemic anticoagulation remains the cornerstone of VTE prevention and therapy. Furthermore, advanced invasive treatment options such as inferior vena cava filters and thrombectomy can be considered for complex cases. Importantly, the risk of systemic anticoagulation should be balanced against the risk of VTE-associated morbidity and mortality for mother and fetus, and an informed decision should be made. In this review, we present an up-to-date overview of VTE management in pregnancy and the postpartum period.
Keywords: Anticoagulants; Deep venous thrombosis; Pregnancy; Pulmonary embolism; Venous thromboembolism
Treatment of chronic venous disorder: A comprehensive review
Chronic venous disorder (CVD) is highly prevalent vascular disorder
affecting up to 45% of the general population, with clinical
manifestations ranging from teleangiectasias to venous leg ulcers
(VLUs). We examined the currently available data in order to provide an
updated, comprehensive review on treatment options of CVD. We searched
MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials, and OpenGrey
databases for relevant articles in English published until November
2020. Compression treatment is the mainstay of conservative treatment.
Pharmacological treatment can provide significant symptomatic relief and
hence it should be considered as part of conservative treatment.
Transcutaneous Lacer treatment (TCL) is a safe and effective alternative
option to sclerotherapy for treatment of C1 stage. High ligation and
stripping (HL/S), ultrasound-guided foam sclerotherapy (UGFS),
endovenous thermal ablation (EVTA) systems and non thermal non tumescent
ablation (NTNT) systems are safe and efficacious first-line options for
treatment of saphenous insufficiency. Interventional treatment of
co-existing incompetent perforator veins (IPVs) is not supported by
contemporary evidence. Regarding deep venous insufficiency (DVI),
treatment of symptomatic femoroiliocaval occlusive venous disease
refractory to conservative treatment with percutaneous transluminal
venoplasty stenting has produced encouraging results
18-0034_supplementary_tables – Supplemental material for Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis
<p>Supplemental material, 18-0034_supplementary_tables for Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis by Pavlos Texakalidis, Stefanos Giannopoulos, Damianos G. Kokkinidis and Giuseppe Lanzino in Journal of Endovascular Therapy</p
Nutrition, dietary habits, and weight management to prevent and treat patients with peripheral artery disease
CRT-200.09 Preoperative Use of Statins in Carotid Artery Stenting: A Systematic Review and Meta-analysis
Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis
Nutrition, dietary habits, and weight management to prevent and treat patients with peripheral artery disease
Peripheral artery disease (PAD) affects 3%-10% of the Western
population and if remains untreated can have devastating consequences to
patients and their families. This review article analyzes how healthy
dietary habits can decrease PAD rates when applied in the general
population. The aim is to focus on dietary, nutritional and weight
management interventions in patients with established PAD. Most adults
with PAD are overweight or obese, while three out of four patients are
characterized by deficiencies in vitamins and minerals. Weight loss
interventions when needed and specialized dietary plans should be
routinely recommended in patients with PAD. Appropriate nutritional
support is of paramount importance in patients with advanced stages of
PAD (critical limb ischemia)
Abdominal aortic aneurysms and abdominal wall hernias - a systematic review and meta-analysis
Background: Abdominal wall hernias (AWHs) share common epidemiological
characteristics with abdominal aortic aneurysms (AAAs), typically
presenting in male population and older ages. Prior reports have
associated those two disease entities. Our objective was to perform a
systematic review and meta-analysis and examine whether AAA rates are
higher among patients with AWH vs controls and whether the incidence of
AWH was higher among patients with AAA vs patients without AAA. Methods:
We performed a systematic review and meta-analysis according to the
PRISMA guidelines. The Medline database was searched up to July 31,
2020. A random effects meta-analysis was performed. Results: In total,
17 articles and 738,972 participants were included in the systematic
review, while 107,578 patients were eligible for the meta-analysis.
Among four studies investigating the incidence of AAA in patients with
hernias, AAA was more common in patients with hernias, compared to
patients without hernias. [OR: 2.53, 95% CI: 1.24-5.16, I-2=81.6%].
Among thirteen studies that compared patients with known AAA vs no AAA,
the incidence of hernias was higher in patients with AAA, compared with
patients without AAA [OR: 2.27, 95% CI: 1.66-3.09, I-2=84.6%].
Conclusions: Our study findings indicate that a strong association
between AWH and AAA exists. AWHs could therefore be used as an
additional selection criterion for screening patients for AAA, apart
from age, gender, family history and smoking