The effects of dietary flaxseed on cardiac arrhythmias and claudication in patients with peripheral arterial disease 1.

Patients with peripheral artery disease (PAD) are at increased risk for cardiovascular events, and higher susceptibility for cardiac arrhythmias may be involved. The objectives of this double-blinded randomized controlled FLAX-PAD trial were to determine whether daily consumption of a diet supplemented with 30 g of milled flaxseed (or placebo) over 1 year by PAD patients has effects on the prevalence of cardiac arrhythmias and exercise capacity. Cardiac arrhythmias were assessed on a cardiac stress test and at rest. At baseline, the PAD patients had a high incidence of cardiac arrhythmias (48% in the flaxseed group and 32% in the placebo group). After 1 year, the presence of cardiac arrhythmias in the flaxseed group decreased by 2% and increased by 12% in the placebo group (P > 0.05). Electrocardiographic variables (P, PR, QRS, QT, and QTc) did not change in either group during the trial. Patients from both groups improved initial and absolute claudication distances but the intergroup difference was also not statistically significant. In summary, the prevalence of cardiac arrhythmias and physical capacity trended in a positive direction for patients ingesting flaxseed but either a larger sample size or a longer intervention with flaxseed may be required to show statistically significant differences.

Oral curcumin in elective abdominal aortic aneurysm repair: a multicentre randomized controlled trial.

BACKGROUND: Curcumin, a popular herbal supplement from the plant turmeric, has prevented ischemic reperfusion and toxin-induced injury in many animal studies and a single-centre randomized human trial. We sought to test whether perioperative oral curcumin (compared with placebo) affects the inflammatory response and risk of postrepair complications after elective abdominal aortic aneurysm repair in humans. METHODS: We conducted a parallel-group, randomized, placebo-controlled trial of patients from 10 hospitals in Canada who were scheduled to undergo elective repair of an unruptured abdominal aortic aneurysm (November 2011 to November 2014). Patients in the treatment group received perioperative oral curcumin (2000-mg doses 8 times over 4 d). Patients, health care providers and local research staff were unaware of the treatment assignment. The primary outcomes were median concentrations of 4 bio markers indicating injury and inflammation (postoperative urine interleukin-18 and perioperative rise in serum creatinine, plasma N-terminal pro-B-type natriuretic peptide and plasma high-sensitivity C-reactive protein). RESULTS: Baseline characteristics were similar in the 2 groups (606 patients overall; median age 76 yr). More than 85% of patients in each group took more than 80% of their scheduled capsules. Neither curcumin nor placebo significantly affected any of the 4 biomarkers (p > 0.05 for all comparisons). Regarding the secondary outcomes, there was a higher risk of acute kidney injury with curcumin than with placebo (17% v. 10%, p = 0.01), but no between-group difference in the median length of hospital stay (5 v. 5 days, p > 0.9) or the risk of clinical events (9% v. 9%, p = 0.9). INTERPRETATION: Curcumin had no beneficial effects when used in elective abdominal aortic aneurysm repair. These findings emphasize the importance of testing turmeric and curcumin before espousing their health benefits, as is currently done in the popular media. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT01225094.

Feasibility and Tolerability of Daily Pulse Consumption in Individuals with Peripheral Artery Disease.

The present study investigated the feasibility, tolerability, and adherence of daily consumption of whole pulses (dried beans, peas, lentils, chickpeas) by individuals with peripheral artery disease participating in an 8-week study. Study questionnaires and semi-structured interviews for 26 participants were used to determine prestudy pulse consumption and participants' experiences with respect to adherence, positive and negative effects, bowel routine, satiety, and enjoyment of the foods. Although the majority of participants rarely consumed pulses prior to the study, there was a high rate of adherence to daily consumption of the study foods for 8 weeks despite comments regarding study fatigue during the latter part of the study. Participants had no gastrointestinal side effects (42%) or experienced flatulence that resolved by week 4 (23%), whereas 62% reported improvements in their bowel pattern. By week 8 greater satiety was noted by some participants (19%), with the categories "less afternoon snacking" and "not snacking" receiving more responses. The key finding of this study was that consumption of pulses is a viable approach for this population; however, the frequency of consumption that is tolerable in the long term should be integrated with the dose and timeframe required to achieve and maintain health benefits.

Whole Soy Flour Incorporated into a Muffin and Consumed at 2 Doses of Soy Protein Does Not Lower LDL Cholesterol in a Randomized, Double-Blind Controlled Trial of Hypercholesterolemic Adults.

BACKGROUND: Soy protein may reduce coronary heart disease (CHD) risk by lowering LDL cholesterol, but few studies have assessed whether whole soy flour displays a similar effect. OBJECTIVE: The aim of this study was to assess the dose effect of whole soy flour incorporated into muffins on plasma LDL cholesterol in hypercholesterolemic adults. METHODS: Adults aged 30-70 y (n = 243) with elevated LDL cholesterol (≥3.0 and ≤5.0 mmol/L) were stratified by LDL cholesterol and randomly assigned to consume 2 soy muffins containing 25 g soy protein [high-dose soy (HDS)], 1 soy and 1 wheat muffin containing 12.5 g soy protein and 12.5 g whey protein [low-dose soy (LDS)], or 2 wheat muffins containing 25 g whey protein (control) daily for 6 wk while consuming a self-selected diet. Fasting blood samples were collected at weeks 0, 3, and 6 for analysis of plasma lipids [total, LDL, and HDL cholesterol and triglycerides (TGs)], glucose, insulin, C-reactive protein (CRP), and isoflavones. Blood pressures also were measured. Dietary intake was assessed at weeks 0 and 4 with the use of 3 d food records. Treatment effects were assessed with the use of intention-to-treat analysis with multiple imputation and LDL cholesterol as the primary outcome. RESULTS: In total, 213 (87.6%) participants completed the trial. Participants were primarily Caucasian (83%) and mostly female (63%), with a mean ± SD body mass index (in kg/m2) of 28.0 ± 4.6 and systolic and diastolic blood pressures of 122 ± 16 and 77 ± 11 mm Hg, respectively. Despite a dose-dependent increase in plasma isoflavones (P < 0.001), neither HDS nor LDS had a significant effect on LDL cholesterol compared with control (mean ± SEM changes: control, -0.04 ± 0.05 mmol/L; HDS, 0.01 ± 0.05 mmol/L; and LDS, -0.04 ± 0.06 mmol/L). There were no significant treatment effects on total or HDL cholesterol, TGs, CRP, homeostatic model assessment of insulin resistance, blood pressure, or the Framingham 10-y CHD risk score. CONCLUSION: Consuming 12.5 or 25 g protein from defatted soy flour incorporated into muffins does not reduce LDL cholesterol or other CHD risk factors in hypercholesterolemic adults. This trial was registered at clinicaltrials.gov as NCT01547585.

Dietary flaxseed independently lowers circulating cholesterol and lowers it beyond the effects of cholesterol-lowering medications alone in patients with peripheral artery disease.

BACKGROUND: Dietary flaxseed lowers cholesterol in healthy subjects with mild biomarkers of cardiovascular disease (CVD). OBJECTIVE: The aim was to investigate the effects of dietary flaxseed on plasma cholesterol in a patient population with clinically significant CVD and in those administered cholesterol-lowering medications (CLMs), primarily statins. METHODS: This double-blind, randomized, placebo-controlled trial examined the effects of a diet supplemented for 12 mo with foods that contained either 30 g of milled flaxseed [milled flaxseed treatment (FX) group; n = 58] or 30 g of whole wheat [placebo (PL) group; n = 52] in a patient population with peripheral artery disease (PAD). Plasma lipids were measured at 0, 1, 6, and 12 mo. RESULTS: Dietary flaxseed in PAD patients resulted in a 15% reduction in circulating LDL cholesterol as early as 1 mo into the trial (P = 0.05). The concentration in the FX group (2.1 ± 0.10 mmol/L) tended to be less than in the PL group (2.5 ± 0.2 mmol/L) at 6 mo (P = 0.12), but not at 12 mo (P = 0.33). Total cholesterol also tended to be lower in the FX group than in the PL group at 1 mo (11%, P = 0.05) and 6 mo (11%, P = 0.07), but not at 12 mo (P = 0.24). In a subgroup of patients taking flaxseed and CLM (n = 36), LDL-cholesterol concentrations were lowered by 8.5% ± 3.0% compared with baseline after 12 mo. This differed from the PL + CLM subgroup (n = 26), which increased by 3.0% ± 4.4% (P = 0.030) to a final concentration of 2.2 ± 0.1 mmol/L. CONCLUSIONS: Milled flaxseed lowers total and LDL cholesterol in patients with PAD and has additional LDL-cholesterol-lowering capabilities when used in conjunction with CLMs. This trial was registered at clinicaltrials.gov as NCT00781950.

Female sex does not influence 30-day stroke and mortality rates after carotid endarterectomy.

BACKGROUND: Sex-based differences in outcomes for the treatment of carotid arterial disease remains a controversial topic. The main objective of this study was to determine if gender differences influence 30-day stroke and mortality rates after carotid endarterectomy (CEA) in a large series of patients. METHODS: This is a retrospective study of all patients undergoing endarterectomy performed by a single surgeon between January 1, 1993 and December 15, 2010. The analysis included data from 1,046 CEAs (683 men and 363 women). RESULTS: There were no differences found in 30-day stroke, death, or combined stroke and death rates between women and men. The 30-day stroke rate was 1.6% for women and 1.8% for men (P = 0.98), with no significant differences between asymptomatic patients (1.7% for women vs. 1.2% for men; P = 0.70) or symptomatic patients (1.6% for women vs. 2.1% for men; P = 0.74). The 30-day mortality rate was 0.8% for women and 0.9% for men (P = 0.85) with no significant differences between asymptomatic patients (0.8% for women vs. 1.2% for men; P = 0.77) and symptomatic patients (0.8% for women vs. 0.7% for men; P = 0.84). There was a similar low risk for the combined outcome of stroke and death (1.9% for women vs. 2.2% for men; P = 0.92), with no differences between asymptomatic patients (1.7% for women vs. 1.6% for men; P = 0.89) or symptomatic patients (2.1% for women vs. 2.5% for men; P = 0.84). CONCLUSIONS: Female sex does not influence 30-day stroke and mortality rates after CEA, regardless of preoperative symptom status.

Cuspal dehiscence at a post and along the stent cloth in a bovine pericardium heart valve implanted for seven years.

A failing mitral valve prosthesis made from bovine pericardium was explanted from a 50-year-old patient. Preoperative transthoracic-echocardiography had confirmed severe mitral regurgitation due to structural failure of this HP Bio bovine pericardium heart valve prosthesis. The explanted device was examined macroscopically, by scanning electron microscopy (SEM), by light microscopy, and by transmission electron microscopy (TEM). Samples of unassembled patches of bovine pericardium were used as a pre-implantation control to better understand the changes that occurred in the structure of the pericardium following the 7 years of implantation. Examination confirmed complete dehiscence of a cusp along a valve post and the stent: This detached cusp was observed floating in the bloodstream at echocardiography. The fibrous pannus overgrowth was well developed along the stent and extended to the bottom of the cusps both on the inflow and the outflow sides. The fibrous panni were found to be poorly adhesive to the pericardium cusps and had become stiff, thus impairing the opening and closure of the valve. The structure of the pericardium cusps was severely deteriorated compared to the control bovine pericardium tissue samples. The collagen bundles were frequently broken and more stretched in the explanted device, lacking the wavy histological pattern of normal collagen fibers. However, the tissues were devoid of any calcification. In conclusion, the failure mode of this valve was the dehiscence of a cusp from a valve post and along the stent cloth in the absence calcification.

Can marine mammals be a reliable source for the manufacture of prosthetic heart valves for percutaneous surgery?

Marine mammals experience unique physiological conditions when diving. Myocardial function is sustained despite a 90% reduction of the blood flow in the coronaries. Therefore, their heart valves and pericardium could serve as a unique source of tissue for the manufacture of prosthetic heart valves. The pericardium of a stillborn pup sea lion was investigated to determine its morphology using gross observation, scanning electron microscopy (SEM), light microscopy, and transmission electron microscopy (TEM). Depending upon the site of sampling, the structure of the pericardium varied significantly. The atrial sample was well structured with wavy bundles of collagen fibers. The thickness in the atrial sample was regular with a smooth serous surface. The fibrous side of the pericardium of the auricular sample was irregular and incorporated microcapillaries. Both the sternoperitoneal ligament and the phrenoperitoneal ligament section were irregular and incorporated various amounts of adipocytes. Because of the increased amount of adipocytes, the fibrils of the collagen fibers were also observed to be occasionally agglutinated. Practically, the harvesting of pericardium would have to be restricted to the atrial surface. The presence of adipocytes in the pericardium wall makes the selection of this tissue a poor choice compared to alternative existing tissue sources.

Canadian Cardiovascular Society 2022 Guidelines for Peripheral Arterial Disease.

Patients with widespread atherosclerosis such as peripheral artery disease (PAD) have a high risk of cardiovascular and limb symptoms and complications, which affects their quality of life and longevity. Over the past 2 decades there have been substantial advances in diagnostics, pharmacotherapy, and interventions including endovascular and open surgical to aid in the management of PAD patients. To summarize the evidence regarding approaches to diagnosis, risk stratification, medical and intervention treatments for patients with PAD, guided by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework, evidence was synthesized, and assessed for quality, and recommendations provided-categorized as weak or strong for each prespecified research question. Fifty-six recommendations were made, with 27% (15/56) graded as strong recommendations with high-quality evidence, 14% (8/56) were designated as strong recommendations with moderate-quality evidence, and 20% (11/56) were strong recommendations with low quality of evidence. Conversely 39% (22/56) were classified as weak recommendations. For PAD patients, strong recommendations on the basis of high-quality evidence, include smoking cessation interventions, structured exercise programs for claudication, lipid-modifying therapy, antithrombotic therapy with a single antiplatelet agent or dual pathway inhibition with low-dose rivaroxaban and aspirin; treatment of hypertension with an angiotensin converting enzyme or angiotensin receptor blocker; and for those with diabetes, a sodium-glucose cotransporter 2 inhibitor should be considered. Furthermore, autogenous grafts are more effective than prosthetic grafts for surgical bypasses for claudication or chronic limb-threatening ischemia involving the popliteal or distal arteries. Other recommendations indicated that new endovascular techniques and hybrid procedures be considered in patients with favourable anatomy and patient factors, and finally, the evidence for perioperative risk stratification for PAD patients who undergo surgery remains weak.

Size of the proximal neck in AAAs treated with balloon-expandable stent-grafts: CTA findings in mid- to long-term follow-up.

PURPOSE: To determine the evolution of the proximal aortic neck diameter in mid- to long-term follow-up after endovascular aneurysm repair of abdominal aortic aneurysm (AAA) with a balloon-expandable stent-graft. METHODS: Thirty patients (27 men; average age 71 years, range 56-87) with infrarenal AAAs were treated with the SETA-Latecba balloon-expandable stent-graft (6 aortomonoiliac and 24 bifurcated configurations). Follow-up ranged from 4 to 8 years (mean 73.4 months). Computed tomography was done systematically before the procedure, after implantation (1-3 months), at 1 year, and annually thereafter. The last follow-up scan was utilized to measure the proximal neck for purposes of comparison with baseline and the initial post-implant scans. RESULTS: Five patients died during follow-up of causes unrelated to the procedure. No endoleaks or graft migrations were observed. The pre-deployment proximal neck diameter (a) averaged 23.4 mm (range 18-32), the diameter after deployment of the stent-graft (b) averaged 24.9 mm (range 18-34), and the most recent follow-up proximal neck measurement (c) averaged 23.8 mm (range 18-31). Comparing the last follow-up to the post-implant measurements (c-b), the neck diameter decreased in 15 (50%) patients [7 with short necks (i.e., <15 mm)] and remained unchanged (no variation) in 15 (50%) patients (4 with short necks). All patients treated with the SETA-Latecba balloon-expandable stent-graft showed stability of the proximal aortic neck diameter in mid- to long-term follow-up. CONCLUSION: The study showed that the diameter reached at initial deployment did not increase further in the long term, which supports the safety and reliability of this modular balloon-expandable stent-graft and illustrates that this device does not produce dilatation of the proximal neck after deployment. Future dilatation of the aortic neck is unlikely, and consequently, migration or delayed type I endoleak are also unlikely.

Analysis of explanted Latecba modular stent-grafts deployed transrenally to repair AAAs with short necks in 29 dogs.

Twenty-nine modular stent-grafts deployed transrenally to repair AAAs with short necks in dogs were harvested at autopsy of the animals after scheduled durations of implantations of 10 days, one month, three months, and six months. Analyses of the explanted devices included non-destructive techniques such as gross observations, X-rays CT scan, IVUS and angioscopy. Further to appropriate dissection, histological investigations were carried out by means of scanning electron microscopy (SEM) and light microscopy. All the 29 specimens were extensively encapsulated with fibrous tissues but the fibrous capsule was thin in six of them; four capsules were ulcerated. The X-rays confirmed the stability of the devices that were still straight (12), slightly bent (12) or bent (4). The modules were misaligned in only one case. IVUS and angioscopy confirmed the patency of all the stent-grafts with thin internal capsules both proximally and distally with variable capsulation in the mid-section of the grafts. The left renal artery orifices were found to be patent at dissection with no obstruction to flow. The luminal flow surface of the stent-grafts was smooth and glistening proximally and distally containing endothelial like cells and vasa-vasorum. Poor healing was noted in the aneurysm area. Transrenal deployment of this modular stent-graft is feasible and gave excellent results with regard to biofunctionality and biocompatibility. The device proved to be safe and efficient.

Transrenal deployment of a modular stent graft to repair AAAs with short necks: experiments in dogs.

Severely angulated (> 60 degrees ) or short (< 15 mm) proximal necks remain significant anatomical limitations for endovascular stent-graft repairs for abdominal aortic aneurysms. Ensuring proper proximal fixation of the stent-graft to the host artery without the short-or long-term risks of endoleak or migration represents a particular technical challenge for these anatomical circumstances. An innovative balloon expandable stent combined with a weft-knitted prosthesis was specifically designed for these situations by modelling the stent to the neck anatomy without overdistension or potential barotrauma allowing better incorporation of the device. The Latecba stent-graft consists of a 2 parts modular design. The first one, Module A, is deployed at the transrenal level and consists of a Palmaz type stent whose first half is bare and second half is sutured to a crimped weft-knitted polyester graft whose distal end holds a constriction. The second Module B is a non-crimped weft-knitted graft attached to 2 stainless steel stents. The first stent is entirely contained in the proximal textile tube, allowing fixation to module A. The second stent, which is left uncovered over the distal third, ensures proper fixation of the stent-graft distally. Following the creation of a prosthetic aneurysm in the infrarenal aorta in 32 dogs, 29 received the Latecba stent-graft for scheduled durations of 10 days, 1 month, 3 months and 6 months. Proper deployment of the stent-grafts was achieved without difficulty. All 29 animals survived and the devices were all patent at sacrifice. No device defects or migrations were observed and the stent-grafts proved to be efficient in this setting to exclude the aneurysm. Analyses of the explanted devices (gross observations, RX, CT scan, IVUS, angioscopy) confirmed the stability of this modular stent-graft. Further on-going clinical investigations are warranted to validate this concept before this stent-graft becomes commercially available without any restriction.

Analysis of sixty-two explanted Liotta bioprostheses: biocompatibility, biofunctionality, and biodurability issues.

Sixty-two explanted Liotta porcine bioprostheses were examined to review the issues related to their biocompatibility, biofunctionality, and biodurability. These bioprostheses were harvested from 56 patients with implantation times ranging from only a few hours to more than nine years of implantation. There were 10 acute and short-term (< 1 year), 20 midterm (1 < t < 5 years), and 32 long-term (> 5 years) cases. The indications for the reoperations were: hemodynamic (59), thrombosis (10), and endocarditis (3). The major indications varied according to the duration of implantation: blood infiltration, fibrin buildup, thrombosis in the short-term; endocarditis and hemodynamic insufficiency in the midterm; and mineralization and tears causing hemodynamic incompetence in the long term. Mineralization proved to be the main threat to long-term durability for porcine valves. Besides a few short-term failures, these explanted devices slowly degenerated over time and were replaced to prevent congestive heart failure. Documentation of the failure modes of these porcine valves is important since the demand for bioprostheses will increase in the future, in particular for percutaneous devices. Such bioprostheses emphasize a critical biocompatibility issue following implantation because they have the capacity to remain free of thrombus in the absence of anticoagulation. The biofunctionality appears to be adequate in the absence of subsequent pathology with restoration of normal valve function. However, the documentation of such significant long-term biodurability issues raises questions that have been addressed but not fully answered yet with the new generations of bioprostheses.

Persistent type II endoleak unrelated to an Anaconda aortic stent graft fulfilling the 3Bs requirements of biofunctionality, biodurability, and biocompatibility.

A patient was fitted with an Anaconda stent graft for which there was a persistent type II endoleak. Two subsequent attempts at embolization were unable to resolve the endoleak. The diameter of the aneurysm varied initially from 5.5 cm in diameter down to 4.8 cm but then later re-dilated to 6.1 cm, with evidence of persistent flow into the aneurysmal sac from the inferior mesenteric artery. Results from serial computed tomography scans demonstrated clear evidence of a type II endoleak that originated from the inferior mesenteric artery with outflow to a distal lumbar artery. The harvested stent graft did not show evidence of a device-related failure. The stent graft and its modular segments were found to have been properly deployed. Only a thin external capsule was evident at explantation. The internal wall of the device showed irregular and thin encapsulation with scattered mural thrombi, which were more prominent at the bifurcation of the main body of the device. Blood deposits and tissue development were sufficient to prevent blood oozing through the wall. The explanted Anaconda stent graft was devoid of any construction flaws or damage (fatigue of the textile or corrosion of the Nitinol wires) after implantation.

In-vitro assays of polymer-coated stents eluting platelet glycoprotein IIb/IIIa receptor monoclonal antibody.

The monoclonal antibody (mAb) to the platelet glycoprotein (GP) IIb/IIIa receptor has potent antiplatelet and antithrombotic characteristics shown to reduce thrombus-related major complications after coronary angioplasty. This mAb can be incorporated in drug-eluting stents capable of releasing single or multiple bioactive agents into the bloodstream and surrounding tissues. Stents eluting the monoclonal mouse anti-human platelet glycoprotein IIb/IIIa antibody SZ-262 were tested for their effectiveness in improving the blood compatibility and the antithrombotic characteristics by immunofluorescence and scanning electron microscopy (SEM). The SEM results convincingly demonstrated that the surface of the mAb eluting-stents was completely free of platelet uptake without any sign of cellular debris or proteinaceous deposits, compared with controls. The deformation index of platelets on the L-polylactic acid (L-PLA) coated stents were higher than bare Nitinol intravascular stents, as shown by SEM images. Monoclonal antibody to the platelet GP IIb/IIIa receptor, when eluting from L-PLA polymer-coated stents, effectively inhibits platelet aggregation in the stent microenvironment, thus demonstrating a potential capacity of reducing thrombosis, improving blood flow and arterial patency rates, and inhibiting cyclic blood flow variations. These results highlight the possibility of such monoclonal antibody-eluting stents to reduce or possibly eliminate thrombosis and in-stent restenosis.

Characterization of an endovascular prosthesis using the 3Bs rule (biocompatibility, biofunctionality and biodurability): a recommended protocol to investigate a device harvested at necropsy.

Numerous endovascular stent grafts to treat intrarenal aortic aneurysms are now commercially available, and many new concepts are currently in development worldwide. In order to objectively quantify their outcomes, we propose a detailed protocol to examine a reference device that was harvested from a patient who died a few hours after endovascular stent-graft deployment for an abdominal aortic aneurysm according to the 3Bs rule (biocompatibility, biofunctionality, and biodurability). Relevant patient history of this 63-year-old man included radiotherapy treatment for lung cancer. Following the patient's death, the device was harvested en bloc together with the aneurysmal sac. The analysis of the device was conducted using nondestructive testing (X-rays, CT scan, magnetic resonance imaging [MRI], and endoscopy) and destructive testing (dissection, histology, and fabric and wire component analyses). Results from the gross examination demonstrated that the outer layer of the aneurysm sac was white, stiff, and continuous without any disruption. The Xray analysis, CT scan, and MRI confirmed that the device together with its modular segments was properly deployed at implantation. Endoscopy showed that the device was deployed securely immediately distal to the renal arteries. As anticipated, thin scattered mural thrombi at the blood/foreign material interface were observed on the blood tight flow surface. There were no tears in the fabric, and the dimensions and textile structure were well preserved. The metallic wires were intact. This fatality had no association with the stent graft as the patient's death was caused by the rupture of the pulmonary artery following intensive radiotherapy. In conclusion, autopsy, nondestructive testing, and destructive testing are therefore the necessary steps to validate any explanted endovascular stent graft in terms of biocompatibility, biofunctionality, and biodurability. In this specific case, the endovascular device fulfills the 3Bs rule. The authors recommend this protocol to investigate explanted endovascular devices.

Reframing tobacco dependency management in acute care: A case study.

Effective tobacco dependence treatment within acute care tends to be inadequate. The purpose of the Utilizing best practices to Manage Acute care patients Tobacco Dependency (UMAT) was to implement and evaluate an evidence-based intervention to support healthcare staff to effectively manage nicotine withdrawal symptoms of acute surgical patients. Data collection for this one-year longitudinal case study included: relevant patient experiences and staff reported practice, medication usage, and chart review. Over the year each data source suggested changes in tobacco dependence treatment. Key changes in patient survey responses (N=55) included a decrease in daily smoking and cigarette cravings. Of patients who used nicotine replacement therapy, they reported an increase in symptom relief. Staff (N=45) were surveyed at baseline, mid-point and end of study. Reported rates of assessing smoking status did not change over the year, but assessment of withdrawal symptoms emerged as daily practice and questions about cessation diminished. Also delivery of nicotine replacement therapy products increased over the year. Chart reviews showed a shift in content from documenting smoking behavior to withdrawal symptoms and administration of nicotine replacements; also frequency of comments increased. In summary, the evidence-based intervention influenced unit norms and reframed the culture related to tobacco dependence treatment.