Treatment of complex atherosclerotic femoropopliteal artery disease with a self-expanding interwoven nitinol stent: Midterm results.

OBJECTIVE: To examine the efficacy and durability of an interwoven self-expanding nitinol stent for the treatment of superficial femoral and popliteal arteries. METHOD: Consecutive patients with severely diseased superficial femoral and popliteal arteries who received SUPERA® stents were retrospectively identified.The patients were followed for 12 months by Doppler ultrasound examinations, stent roentgenograms, and estimation of Rutherford-Becker class and ankle-brachial index. RESULTS: From July 2012 to May 2014, 42 limbs in 36 patients (mean age, 61.5 ± 7.5 years; 75% male) were treated with angioplasty and primary stenting. Total occlusions were present in 14 limbs, and 63.8% had either moderate or severe calcification. The mean (±SD) lesion length was 105 mm (±28). Primary patency was 91.4% at 6 months and 85.7% at 12 months. The ankle brachial index increased from 0.57 ± 0.19 preoperative to 0.91 ± 0.12 postoperative. There was no procedural or device-related morbidity or mortality after revascularization and only one major amputation was observed on follow-up. CONCLUSIONS: Our experience shows that, Supera stents are safe and effective in our cohort of patients, with acceptable patency rates. There were no stent fractures so far even with stenting of the femoropopliteal segments. Stent design provides a viable option for high-grade obstructive disease in the femoropopliteal artery.

Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers.

Objective Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent perforating veins (IPVs) on ulcer recurrence rates in patients with progressive lipodermatosclerosis and impending ulceration. Methods Patients with nonhealing venous ulcers of >2 months' duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Endovenous laser ablation (EVLA) of perforating veins was performed on patients with CEAP 6 disease with increasing hyperpigmentation, lipodermatosclerosis, and/or progressive malleolar pain. A minimum of 2 months of compressive therapy was attempted before endovenous ablation of IPVs. Demographic data, risk factors, CEAP classification, procedural details, and postoperative status were all recorded. Results Forty ulcers with 46 associated IPVs were treated with EVLA in 36 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (85.7%), calf (10.7%), and lateral ankle (3.5%). Endovenous laser ablation was successful in 76% (35/46) with the first laser treatment of incompetent perforator veins and 15.2% (7/46) additional ablation procedures were performed. Of the 46 treated IPVs, 42 (91.3%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 162 joule. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. Conclusion Especially in the case of liposclerotic or ulcerated skin in the affected region, PAP of IPVs is highly effective, safe, and appears to be feasible. Patients with active venous ulcers appear to benefit from EVLA of incompetent perforators in order to reduce the risk of ulcer recurrence.

Expression of Egfl7 and miRNA-126-5p in Symptomatic Carotid Artery Disease.

BACKGROUND: Neoangiogenesis inside the atherosclerotic plaques has been linked to progression of the disease. Egfl7, a key player in adult angiogenesis, was found to be upregulated in response to vascular injury in rats. Egfl7 encodes for miR-126-3p and miR-126-5p. Specific information about miRNA-126-5p and its expression in cardiovascular disease is scarce in comparison to that of miR-126-3p. OBJECTIVES: A gene expression study was conducted to investigate the levels of Egfl7 and miRNA126-5p in human carotid artery atherosclerotic plaques aiming to gain a better understanding of the role of neoangiogenesis within plaques and the mechanisms causing atherosclerosis progression. METHODS: Egfl7 and miR-126-5p levels were studied in 14 plaque samples and 14 control samples using real-time PCR. The fold change between the carotid artery plaque tissue and control tissue was calculated using the 2(-ΔΔCT) method. RESULTS: Egfl7 was upregulated in the 11 plaque samples compared to controls, while expression levels of miR-126-5p was higher in eight of the plaque samples and lower in six as compared to control samples. Upregulation of miR-126-5p expression was correlated with high low-density lipoprotein (LDL) cholesterol (p = 0.023). CONCLUSIONS: Our findings suggest that the upregulation of Egfl7 promotes neoangiogenesis within the plaques, contributing to disease progression.

Efficacy of intralesional recombinant human epidermal growth factor in chronic diabetic foot ulcers.

OBJECTIVE: The aim of this study was to explore the clinical effects of intralesional administration of an epidermal growth factor (EGF) up to complete wound closure. METHODS: Seventeen diabetic patients with full-thickness lower extremity ulcers of more than 4 weeks of evolution were enrolled in the study. Mean ulcer size was 15.5 +/- 7.5 cm(2). Intralesional injections of 75 µg of Heberprot-P three times per week for 5-8 weeks were given up to complete wound healing. RESULTS: Full granulation response was achieved in all patients in 32.4 +/- 6.6 days. Complete wound closure was obtained in 16 (94.1%) cases in 53.1 +/- 4.7 days. The most frequent adverse events were burning sensation, tremors, chills and pain at the site of administration. After 1-year follow-up, only one patient relapsed. CONCLUSIONS: Intralesional EGF administration up to complete closure can be safe, effective and suitable to improve healing of chronic diabetic foot ulcer (DFU).

Morphine is a reasonable alternative to haloperidol in the treatment of postoperative hyperactive-type delirium after cardiac surgery.

OBJECTIVES: Patients who undergo cardiac surgery have an increased risk of delirium. Currently, there are few choices of treatment for postoperative hyperactive delirium in cardiac surgical patients. The aim of this study was to assess the effect of morphine compared with a haloperidol-based regimen in hyperactive-type delirium in patients after cardiac surgery. DESIGN: A prospective, randomized clinical study. SETTING: A single community hospital. PARTICIPANTS: Fifty-three consecutive, adult, delirious patients. INTERVENTIONS: Patients were randomized into 2 groups; in group 1, patients received 5mg of haloperidol intramuscularly and in group 2, patients received 5mg of morphine sulfate intramuscularly to control delirium symptoms. MEASUREMENTS AND MAIN RESULTS: During the second and third hour of the morphine treatment, statistically low Richmond Agitation and Sedation Scale scores were found and the target Richmond Agitation and Sedation Scale scores percentages were statistically higher than those of the haloperidol group (p = 0.042 and p = 0.028, respectively). The number of patients requiring additive sedatives was significantly more in the haloperidol group when compared with the morphine group (p = 0.011). CONCLUSION: During the treatment of patients, it was determined that the patients who were receiving morphine treatment responded more quickly compared with the patients receiving haloperidol treatment. Morphine was found to be a reasonable alternative to haloperidol in the treatment of postoperative hyperactive delirious patients after cardiac surgery.

Coronary artery perforation treated with multiple bare metal stent implantation.

Although coronary artery perforations are quite rare, when they occur, the consequences are devastating. Treatment options differ according to the type, location and severity of the perforation. As a general rule severe perforations are treated with covered stents. However, when implanting a covered stent is not an option as in our case due to various reasons, multiple bare metal stent implantation may be a good option. Besides that, management of the antiplatelet and the anticoagulant therapy remains controversial. We believe that therapy should be individualized.

Effect of body mass index on early morbidity and mortality after isolated coronary artery bypass graft surgery.

OBJECTIVES: Obesity is a risk factor for morbidity after isolated coronary artery bypass grafting. This study aimed to analyze the sole effect of body mass index (BMI) on early morbidity and mortality in patients after isolated coronary artery bypass grafting. DESIGN: This study was retrospective and used an electronic database of anesthesia information management. SETTING: A single community hospital. PARTICIPANTS: The data of 803 consecutive patients after isolated on-pump coronary artery bypass grafting were analyzed retrospectively; off-pump cases were excluded. INTERVENTION: According to measured BMI, patients were divided into 5 groups: underweight (BMI <20 kg/m(2)), normal weight (BMI 20.0-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), obese (BMI 30.0-34.9 kg/m(2)), and morbidly obese (BMI >34.9 kg/m(2)). Early postoperative morbidity and mortality were evaluated using logistic regression analysis. MEASUREMENTS AND MAIN RESULTS: Early cumulative postoperative mortality was 3.9% (32 of 803 patients). Mortality was recorded in 3 underweight (n = 15, 20%, odds ratio [OR] 6.54, p = 0.001), 9 normal-weight (n = 159, 5.7%, OR 1.62, p = 0.228), 12 overweight (n = 371, 3.2%, OR 0.68, p = 0.314), 6 obese (n = 199, 3.0%, OR 0.69, p = 0.421), and 2 morbidly obese (n = 59, 3.4%, OR 0.83, p = 0.808) patients. Prolonged intensive care unit stay (p < 0.001), prolonged hospital stay (p < 0.001), and mortality (p = 0.01) were significantly more common in patients in the underweight group than in the other groups. Univariate and multivariate logistic regression analyses showed that underweight, hypertension, and chronic renal failure were independent risk factors for mortality. CONCLUSIONS: Underweight patients with a BMI <20 kg/m(2) are at increased risk of postoperative complications and mortality compared with normal-weight or overweight subjects.

Cardiac tamponade from a giant thymoma: case report.

Thymoma, the most common neoplasm of the anterior mediastinum especially in adults, accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal masses. These tumors are routinely asymptomatic for prolonged periods of time. Pericardial tamponade is a very rare initial manifestation of a thymoma. This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature.

Aortic root aneurysm after off-pump reduction aortoplasty.

We present a patient with aortic root aneurysm and severe aortic regurgitation who had a previous off-pump reduction ascending aortoplasty and external wrapping with concomitant coronary bypass grafting. Preliminary aortic dissection and erosion of the aortic intima were detected during the operation. This complication warrants the re-evaluation of the indications for reduction ascending aortoplasty and emphasizes the necessity for close follow-up.