A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease.

OBJECTIVE: To evaluate and compare studies reporting the outcomes of the use of covered balloon-expandable (CBE) stents for the treatment of aortoiliac occlusive disease. METHODS: A systematic literature search was conducted to identify studies that investigated the use of CBE stents for the treatment of aortoiliac occlusive disease and were published between 2000 and 2019. Baseline demographic data, procedural variables, and long-term outcomes were extracted from publications for analysis. RESULTS: A total of 15 published articles about 14 studies were included in the review. Of these, eight studies were prospective clinical trials and six studies were retrospective real-world studies. The articles included data regarding five different CBE stents, namely, the iCast/Advanta V12, Viabahn VBX, BeGraft, LifeStream, and JOSTENT. Lesion severity was higher in real-world studies, with more TransAtlantic Inter-Society Consensus Classification class D lesions and a higher percentage of occlusions. All studies showed high rates of technical success and patency over the course of 12 months. Long-term data were only available for the iCast/Advanta V12 device, which had a primary patency rate of 74.7% at 5 years. CONCLUSIONS: CBE stents are a viable treatment option for patients with complex aortoiliac lesions because of their high rates of technical success and favorable patency across all devices at 12 months. However, long-term data are only available for a single device, the iCast/Advanta V12. The results of using this device were favorable over the course of 5 years.

Sex-Related Outcomes After Endovascular Aneurysm Repair Within the Global Registry for Endovascular Aortic Treatment.

BACKGROUND: Abdominal aortic aneurysms (AAAs) are more common in men. However, women have been shown to have more short- and long-term adverse outcomes after endovascular aneurysm repair. This disparity is thought to be multifactorial, including anatomical differences, hormonal differences, older age of presentation, and a greater degree of preoperative comorbidities. METHODS: A retrospective analysis that included data for 3,758 patients from the Global Registry for Endovascular Aortic Treatment (GREAT) was conducted. Patients were recruited into GREAT between August 2010 and October 2016 and received the Gore Excluder stent graft for infrarenal AAAs repair. Cox multivariate regression analyses were performed to analyze any reintervention and device-related intervention rates. RESULTS: Of the 3,758 patients, 3,220 were male (mean age 73 years) and 538 were female (mean age 75 years). Women had higher prevalence rates of chronic obstructive pulmonary disease (P < 0.0001) and renal insufficiency (P = 0.03), whereas men had higher rates of cardiovascular comorbidities. The AAAs in women were smaller in diameter with shorter and more angulated necks. Women did not experience a significantly higher rate of endoleaks but did exhibit higher reintervention rates, including reintervention for device-related issues. In terms of mortality, aorta-related mortality was most prevalent within the first 30 days after procedure in both sexes. CONCLUSIONS: Women were treated at an older age and had a more hostile aneurysmal anatomy. Although the mortality rates were lower in women, they had significantly higher rates of reintervention, and thus higher morbidity rates after endovascular aneurysm repair.

Short-term feed deprivation rapidly induces the protein degradation pathway in skeletal muscles of young mice.

Analysis of protein kinase B (AKT) and S6 kinase1 (p70S6K) activity is widely used to assess the efficacy of interventions designed to increase or maintain skeletal muscle mass; these studies are often performed on feed-deprived mice. One problem associated with feed deprivation is that it promotes catabolism, and young or metabolically compromised mice may have less tolerance. The aim of our study was to determine the effect of various times of feed deprivation on the activity of AKT and p70S6K signaling and markers of protein catabolism in young, growing mice compared with adult mice. Young 23-d-old and adult 3-mo-old mice were feed deprived for 8, 10, and 12 h starting at 0700 h. In addition, adult mice were feed deprived for 24 h. AKT(Ser473) phosphorylation decreased by 50 and 76% from fed amounts by 10 and 12 h of feed deprivation, respectively, in young but not adult muscles. In adult muscles, feed deprivation for 24 h reduced AKT(Ser473) phosphorylation by 70%. Significant de-phosphorylation of p70S6K(Thr389) occurred in all feed-deprived young and adult mice. There was an increase in muscle RING-finger protein-1 (Murf1; 133-1245%) and muscle atrophy F-box protein or Atrogin-1 (Fbxo32; 210-2420%) mRNA in all young but not adult groups deprived of feed for 8-12 h, and there was a trend (P = 0.08) toward increased MURF1 associated with the contractile protein-enriched fraction isolated from young muscles of mice feed deprived for 12 h. This study demonstrates that skeletal muscles of young mice respond rapidly to feed deprivation by decreasing AKT activity and upregulating the protein degradation program.