Interventional Treatment Options for the Prevention of Amputation in Patients With Lower Extremity Wounds From Peripheral Arterial Disease

Background Peripheral arterial disease and related lower extremity wounds are prominent causes of amputation. Revascularization may reduce amputation rates or the amputation margin more distally in patients with peripheral arterial disease who have wounds resulting from critical limb ischemia. This study examined the association of risk factors and intervention types with amputation rates in patients with critical lower extremity arterial disease. Methods A total of 211 patients who underwent peripheral intervention because of foot wound were followed up for 12 months after the intervention. All patients had lower extremity wounds resulting from peripheral arterial disease. The effects of treatment approaches were compared in patients who underwent and did not undergo amputation. Results Revascularization of the anterior tibial artery reduced the amputation rate by 6.52 times compared with occlusion. Posterior tibial artery revascularization reduced the amputation rate by 49.95 times. Conclusion In this study of percutaneous intervention methods for prevention of amputation, the most effective option was revascularization of the posterior tibial artery and anterior tibial artery. Considering these results, treatment of critical peripheral arterial disease can be cost-effective and efficient and may shorten procedure time

Persistent Left Superior Vena Cava and Partial Anomalous Pulmonary Venous Return in an Old Asymptomatic Female Patient

Persistent left superior vena cava is a rare congenital venous anomaly. It results from failure of closure of the left anterior cardinal vein during cardiac development. It is usually asymptomatic but can be associated with other congenital cardiac defects including atrial septal defects, ventricular septal defects, endocardial cushion defects, tetralogy of Fallot and rhythm disturbances. PLSVC should be considered in the presence of a dilated coronary sinus on transthoracic echocardiography. The diagnosis can be made when injection of contrast in left antecubital vein results in enhancement of the dilated coronary sinus before right atrium. MRI, CT-scan and catheterisation can be used to confirm the diagnosis

Mid-Term Outcomes of Stent Overlap in Long Total Occluded Lesions of Superficial Femoral Artery

WOS: 000404622300002PubMed: 28649980Background: Superficial femoral artery chronic total occlusion (SCTO) is a common type of peripheral arterial disease (PAD). Endovascular therapy is a treatment approach that has a poor long-term success rate in this group. The aim of this study was to compare the mid-term results of two different uses of nitinol stents in long SCTO lesions (>100 mm): the use of one long stent or two shorter stents. Material/Methods: Of 154 patients who underwent percutaneous infrainguinal interventions from 2011 to 2014, a total of 170 CTO lesions were selected for this retrospective study analysis. The mean age of the study population was 63.4 +/- 10.4 years (range 29-89 years); 71.8% of the patients were male. Results: Patients were divided into two groups according to the number of stents used. Patients treated with a single stent were placed into group A and patients treated with two stents were placed into group B. The stent fracture rate was significantly higher in group B compared to group A (29.2% vs. 42%). Type 1 and 2 fracture rates were higher in group A, but type 3 and 5 fracture rates were significantly higher in group B. The rate of stent restenosis was significantly higher in group B compared to group A (45.1% vs. 54.5%, p=0.05). Conclusions: Mid-term patency rate was low in patients with long totally occluded superficial femoral artery (SFA) lesions. Using a long single stent had an acceptable mid-term patency rate compared to using a two stent strategy. Stent fracture seemed to be the main reason for in-stent restenosis in cases of multiple stenting. A long single stent strategy may be more appropriate and reasonable than a two stent strategy in the treatment of long SFA lesions

Preprocedural Mean Platelet Volume Level Is a Predictor of In-Stent Restenosis of the Superficial Femoral Artery Stents in Follow-Up

Background. The mean platelet volume (MPV), the most commonly used measure of the platelet size, is a cheap and easy-to-use marker of the platelet activation. We aimed to evaluate the relationship between preprocedural MPV and other hematologic blood count parameters and in-stent restenosis in patients with superficial femoral artery (SFA) stenting. Methods and Results. The consecutive 118 patients who successfully underwent endovascular stenting of the SFA were enrolled retrospectively in the study. The mean follow-up was 23 ± 12 months. The in-stent restenosis was observed in 42 patients (35.6%). There were no statistically significant differences between the restenosis group and no-restenosis group in terms of age, gender, and smoking (p=0.116, p=0.924, and p=0.428, resp.). In the restenosis group, the MPV level was markedly higher than that in the no-restenosis group, and it was statistically significant (p<0.001). According to the ROC curve analysis, the optimal cutoff value of the MPV to determine the restenosis was >8.7 fL, and the level of the MPV >8.7 fL was a strong predictor of the restenosis (p<0.001) in logistic regression analysis. Conclusions. The measurement of the preprocedural MPV levels may help to identify high-risk patients for development of the in-stent restenosis. These patients may benefit from an aggresive antiplatelet therapy and close follow-up

Brain natriuretic peptide and tumour markers in the diagnosis of non-malignant pericardial effusion

WOS: 000286460500063PubMed ID: 21190744

A rare cause of acute coronary syndromes in young adults - myeloproliferative neoplasms: A case series

WOS: 000503202800001PubMed: 31784298Introduction: Acute coronary syndromes (ACS) mostly occur in patients with traditional risk factors. Especially in young adults without major cardiovascular (CV) risk factors, one of the less common causes of ACS is myeloproliferative neoplasms (MPNs). Methods: We retrospectively collected data on 11 consecutive patients (nine men, two women, mean age 40.18 +/- 8.4 years) with a diagnosis of MPN who presented with ACS. the demographic characteristics of the study population, type of MPN, clinical manifestations, location of myocardial infarction (MI), coronary angiography findings, complete blood count and other related findings, and treatment strategy before and after diagnosis were analyzed. Results: Six patients were diagnosed with polycythemia vera, four with essential thrombocytosis and one with primary myelofibrosis. A JAK2 mutation was found in nine patients. Mean time to diagnosis of MPN was 2.81 years after presenting ACS and mean age at first MI was 32.9 +/- 6 years. Six patients had no major CV risk factors. Ten patients had anterior MI and one had inferior MI. After initiation of specific treatment for MPN, no recurrent thrombotic events were observed in a mean follow-up of 4 +/- 2.44 years. Conclusions: in young adults presenting with ACS, MPNs should be considered, especially in the absence of atherosclerotic coronary artery lesions. It is also important to pay attention to blood cell count abnormalities seen in intracoronary thrombotic events. Early diagnosis and treatment of MPNs is essential to prevent recurrence of thrombotic events and may reduce mortality and morbidity related to thrombotic complications. (C) 2019 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U

The Existence of Obesity Paradox and Effect of Obesity on In-Hospital-Outcomes on Elderly Patients Treated with Primary Percutaneous Coronary Intervention

Summary: Background: Many studies have been conducted about the existence of obesity paradox in cardiovascular diseases. But, there is limited data on elderly patients. The aim of this study is to explore the existence of the “obesity paradox” and effect of obesity in periprocedural outcomes in patients presenting with acute myocardial infarction (AMI). Methods: This study involved elderly patients (≥65 years) who admitted our clinic with AMI and treated for acute STEMI between April 2011 and November 2014. Patients were divided into two groups according to their body mass index (BMI [kg/m2]) and a BMI>30 kg/m2 was accepted as obese. We compared angiographic, electrocardiographic, echocardiographic data and in-hospital mortality between two groups. Results: A total of 127 patients were included in the study and obese (BMI>30 kg/m2) patients comprised 27.3% (47) of all AMI patients. Analysis of the acute coronary angiographic data revealed that the number of significant coronary lesions was higher in non-obese group (p:0.04). The last TIMI-3 rate was higher in the obese group (%91.5 vs %79.2, p:0.05), whilst corrected TIMI frame count was lower (26 ± 13 vs 32 ± 14, p:0.01). In multivariate analysis, the number of lesions was correlated with obesity (OR 0.47, 95%CI 0.37–0.99, p:0.04). Conclusion: In our study, obesity was associated with better coronary flow after percutaneous coronary intervention and the number of lesions was lower in obese patients compared to non-obese elderly patients treated for STEMI. Our results were consistent with the phenomenon of “the obesity paradox”. Keywords: elderly, obesity paradox, myocardial infarctio