Nutritional status and outcomes of superficial femoral artery stenting due to intermittent claudication.

BACKGROUND: The pathogenesis of in-stent restenosis is still not clear. The aim of this study was to determine the nutritional status of patients with lower limb ischemia and the risk of target lesion revascularization (TLR) after superficial femoral artery (SFA) stenting. METHODS: Numerous parameters of nutritional status assessment were compared between 70 patients undergoing SFA endovascular intervention with a self-expandable plane stent due to life-limiting intermittent claudication and 40 patients undergoing carotid artery stenting (CAS). All subjects were followed up for at least 1 year in relation to outcomes such as clinically driven TLR occurrence. RESULTS: Patients undergoing SFA stenting had a lower prevalence of overweight and obesity than those who underwent CAS (51.43% vs. 72.50%; P=0.031). An increase in Ankle-Brachial Index of >0.15 after SFA stenting (early end-point) was positively associated with greater handgrip strength (HGS), fat-free mass, skeletal muscle mass and waist-to-hip ratio. Freedom from TLR (late end-point) was significantly related to a higher waist-to-height ratio (WHtR), HGS and Geriatric Nutritional Risk Index (GNRI) Score. The 1-year risk of TLR for patients with a WHtR of ≥61.39 amounted to odds ratio; 95% confidence interval: 0.21; 0.05-0.25; P=0.021. CONCLUSIONS: Parameters of nutritional status assessment were associated with early and late outcomes of SFA stenting in patients with intermittent claudication. Abdominal fat distribution and higher HGS and GNRI scores lowered the 1-year risk of TLR. Further study is needed to determine the pathomechanism of the obesity paradox, sarcopenia and undernutrition in relation to outcomes of endovascular interventions.

Clinical risk factors for loss of stent primary patency in patients with chronic legs ischemia.

BACKGROUND: The outcome of endovascular therapy can be influenced by a number of factors, either demographic, biochemical, angiographic or procedural. Knowledge about these factors may help in the individualization of therapeutic methods, surveillance intensity, and should, ultimately, improve intervention efficacy. OBJECTIVES: The aim of this study was to estimate the effect of clinical and biochemical factors on the late outcome of lower limb artery stenting. MATERIAL AND METHODS: The medical documentation of 91 patients with at least a 1 year follow-up after the stenting of a lower limb artery was retrospectively evaluated. Uniand multivariate analyses were performed. RESULTS: Primary patency within an approximately 1.5-year follow-up amounted to 68.2%. The probability of freedom from target lesion revascularization was significantly greater in patients with dyslipidemia. According to the Cox proportional-hazards analysis, the risk of target extremity revascularization was significantly affected by the following (hazard ratio [HR], 95% confidence interval): Age (0.93, 0.88-0.99); dyslipidemia at inclusion (0.046, 0.01-0.23); LDL blood concentration (1.02; 1.01-1.04); hematocrit (1.2, 1.02-1.42); mean platelet volume (0.66, 0.44-0.99); INR (1.58, 1.13-2.21); and aPTT (1.18, 1.07-1.3). CONCLUSIONS: Endovascular treatment with stenting in patients with atherosclerotic peripheral arterial disease is effective, but the risk of primary patency loss was affected by the presence of dyslipidemia, age, and blood coagulation parameters. The effect of dyslipidemia on stent failure occurrence should be evaluated in further studies.

The association between periprocedural factors and the late outcome of percutaneous stenting of lower extremity arteries. A retrospective cohort study.

INTRODUCTION: About 20-30% of the population have peripheral artery disease. Many of them require intervention, with a percutaneous procedure currently being the first choice. However, the outcomes of these interventions need regular evaluation due to continuous progress in endovascular techniques and the devices used. AIM: The aim of this study was to analyze procedural factors influencing the outcome of endovascular intervention in patients stented for the first time due to lower extremity atherosclerosis. MATERIAL AND METHODS: The medical documentation of 91 patients with at least 1 year of follow-up after stenting of a lower limb artery was retrospectively evaluated. Uni- and multivariate analyses were performed. RESULTS: The mean observation time was 544.4 ±502.9 days. The primary patency of a stent after such a follow-up was 68.1%. Cox proportional hazard analysis revealed that the risk of target lesion revascularization was affected by the following (hazard risk, 95% confidence interval): the number of vascular segments with significant lesions (13.14, 2.28-75.8); critical limb ischemia (5.68, 1.23-26.2); localization of the target lesion in an aorto-iliac in comparison with a femoro-popliteal vascular segment (0.37, 0.14-0.7); aorto-iliac lesion class according to the TASC-II consensus (1.96, 1.1-3.8); and claudication distance (1.02, 1.01-1.03). CONCLUSIONS: The common primary patency of a stent implanted into either an aorto-iliac or a femoro-popliteal vascular segment was similar to that found in other reports. The main factors affecting the outcome of the endovascular procedures performed were mainly related to atherosclerosis severity, not to the type of technique or device used.

Improvement in health-related quality of life after therapy with omeprazole in patients with coronary artery disease and recurrent angina-like chest pain. A double-blind, placebo-controlled trial of the SF-36 survey.

BACKGROUND: Many patients with coronary artery disease (CAD) have overlapping gastroenterological causes of recurrent chest pain, mainly due to gastroesophageal reflux (GER) and aspirin-induced gastrointestinal tract damage. These symptoms can be alleviated by proton pump inhibitors (PPIs). The study addressed whether omeprazole treatment also affects general health-related quality of life (HRQL) in patients with CAD. STUDY: 48 patients with more than 50% narrowing of the coronary arteries on angiography without clinically overt gastrointestinal symptoms were studied. In a double-blind, placebo-controlled, cross-over study design, patients were randomized to take omeprazole 20 mg bid or a placebo for two weeks, and then crossed over to the other study arm. The SF-36 questionnaire was completed before treatment and again after two weeks of therapy. RESULTS: Patients treated with omeprazole in comparison to the subjects taking the placebo had significantly greater values for the SF-36 survey (which relates to both physical and mental health), as well as for bodily pain, general health perception, and physical health. In comparison to the baseline values, therapy with omeprazole led to a significant increase in the three summarized health components: total SF-36; physical and mental health; and in the following detailed health concept scores: physical functioning, limitations due to physical health problems, bodily pain and emotional well-being. CONCLUSIONS: A double dose of omeprazole improved the general HRQL in patients with CAD without severe gastrointestinal symptoms more effectively than the placebo.