Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion

Introduction: Fifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO) of the superficial femoral artery (SFA). Ten–fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown. Aim: To assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA. Material and methods: We included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months. Results: The study included 17 patients (7 females, 10 males) who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5%) patients and after a previously failed attempt in 13 (76.5%) patients. The procedure was successful in 15 (88.2%) patients, and unsuccessful in 2 (11.8%) patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy), 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death). The primary patency rate at 12 months was 88.2% and secondary patency 100%. Conclusions: The retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications

Safety of bivalirudin versus unfractionated heparin in endovascular revascularization of peripheral arteries in short- and long-term follow-up

Introduction: Patients with peripheral artery disease (PAD) are considered as a high-risk group for hemorrhagic events. Aim: To assess the safety of bivalirudin vs. unfractionated heparin (UFH) in percutaneous peripheral interventions (PPI) in shortand long-term follow-up. Material and methods: The retrospective single-center, observational study included 160 patients, undergoing PPI. Patients were divided into 2 groups based on the use of anticoagulation – unfractionated heparin (UFH group) or bivalirudin (Biv. group) – and observed up to 5 years. Results: The UFH group consisted of 101 patients and the Biv. group consisted of 59. We registered the following end points during in-hospital observation: 1 death (0.63% Biv, p = 0.18), 12 hematomas at puncture site (0.63% Biv. vs. 7.05% UFH, p = 0.04), 2 pseudoaneurysms (1.27% UFH, p = 0.29), thrombosis (0.63% UFH, p = 0.45), 1 bleeding from puncture site (0.63% UFH, p = 0.45). The total number of hemorrhagic complications was 1.24% in the Biv. group and 8.07% in the UFH group (p = 0.04). During longterm follow-up of 65.7 ±36.4 months the all-cause mortality rate was higher in the Biv. group (8.59% Biv vs. 0% in UFH group, p = 0.009). Regression analysis showed that bivalirudin administration is a risk factor for increased mortality risk (p = 0.003, OR = 15, 95% CI: 3.3–107.8). Conclusions: Usage of UFH was associated with a higher number of hemorrhagic complications, especially hematomas at the puncture site in comparison to patients receiving bivalirudin

Adverse CNS effects of opioid analgesics

Opioid analgesic drugs are widely used in the treatment of moderate to severe pain as well as symptomatictreatment of dyspnoea. However, the use of opioids may cause central adverse effects, such as delirium,cognitive impairment, sedation, hallucinations, myocloni, seizures, hyperalgesia, sleep and mood disorders.The ability to diagnose and properly manage the above adverse effects is important for the propertreatment of patients receiving opioid analgesics.Opioid analgesic drugs are widely used in the treatment of moderate to severe pain as well as symptomatic treatment of dyspnoea. However, the use of opioids may cause central adverse effects, such as delirium, cognitive impairment, sedation, hallucinations, myocloni, seizures, hyperalgesia, sleep and mood disorders. The ability to diagnose and properly manage the above adverse effects is important for the proper treatment of patients receiving opioid analgesics