Clinical outcomes of a balloon-expandable stent for symptomatic obstructions of the subclavian or innominate arteries.

Background: Upper-extremity peripheral arterial disease (PAD) may present with a broad spectrum of signs and symptoms. If an endovascular treatment is planned, percutaneous angioplasty and stent placement may lead to a better patency compared to percutaneous angioplasty alone. We assessed the characteristics and clinical course of patients with upper-extremity PAD who received angioplasty and a balloon-expandable stent. Patients and methods: We analyzed data from consecutive patients treated with angioplasty and placement of a balloon-expandable BeSmooth Peripheral Stent System® (Bentley, Germany) at the Angiology Department (University Hospital Zurich) between 2018 and 2022. The primary outcome was re-intervention at the target lesion within 6 months from index angioplasty and during available follow-up. The study was approved by the local ethical commission. Results: A total of 27 patients were treated. The median age was 70 (Q1-Q3: 60-74) years and 59% were men. The subclavian artery (74%) represented the most frequently treated target lesion, followed by the innominate artery (26%). The mean improvement in blood pressure in the treated arm was 21 (95%CI 7 to 35) mmHg at 24 hours and 29 (95%CI 15 to 43) mmHg at 6 months. At 6 months, 2 (8%) patients required a target lesion re-intervention. During the remaining follow-up period up to 24 months, one of these two patients required additional intervention and a total of 3 (11%) patients died due to sepsis, cancer, and unknown causes, respectively. Conclusions: Percutaneous catheter-based treatment with a balloon-expandable stent for symptomatic upper extremity PAD appeared to be effective and safe.

[Update on Pulmonary Embolism: Guideline-Based Diagnosis and Therapy of an Exemplary Case]. / Update zum Thema Lungenembolie: leitliniengerechte Diagnostik und Therapie anhand eines Fallbeispiels.

Update on Pulmonary Embolism: Guideline-Based Diagnosis and Therapy of an Exemplary Case Abstract. In the evaluation of acute pulmonary embolism, a swift and focused diagnostic process is crucial and has an impact on prognosis. An initial clinical assessment is done in haemodynamically stable patients, followed by determination of D-dimer or immediate imaging by computer tomography if the clinical (pre-test) probability is high. After confirming the diagnosis of pulmonary embolism, the most appropriate anticoagulant regiment should be selected and patients should be candidate for a structured follow-up plan. The initial anticoagulant therapy regime is determined by a number of factors, including haemodynamic stability (or potential need for reperfusion treatments), demographic characteristics and comorbidities. While anticoagulation is usually recommended for the first 3-6 months, re-evaluation of therapy after acute therapy is mandatory. In addition, the possibility of chronic thrombo-embolic pulmonary hypertension (CTEPH) or a post-PE syndrome should be considered if symptoms persist after 3-6 months.

[Update on the current diagnosis and therapy of peripheral arterial occlusive disease]. / Update über die aktuelle Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (pAVK).

Update on the current diagnosis and therapy of peripheral arterial occlusive disease Abstract. The prevalence of peripheral arterial disease (PAOD) increases with age and overall due to demographic trends. The symptoms severely reduce the quality of life. The 5-year mortality rate is even twice as high as in patients without PAOD. It is also higher than those of patients with coronary or cerebrovascular disease. Therefore it is important to identify those high-risk patients. Screening and diagnosing - not exclusion of the disease - is possible through clinical observation (pulse palpation) or with the help of simple equipment (messurement of the Ankle-Brachial-Index (ABI)) by any general practitoner. Further examination including imageing is done stepwise and with the goal of choice of best treatment. The most important part in all stages of PAOD is the treatment of cardiovascular risk factors. After lifestyle modification (smoking cessation, weight reduction and regular physical activity) several drug-assisted therapies should be considered e. g. to lower LDL-cholesterol levels < 1.8 mmol / L. and blood pressure < 130 / 80 mmHg combined with antiplatelet or anticoagulant agents.The first-line active treatment of claudicant patients is walking exercise. In patients with insufficient improvement in walking exercise and in patients with critical limb ischaemia, revasculatization is indicated. In recent years, the endovascular therapy possibilities have expended significantly through increasing experience and technological innovations also for occlusions in iliac arteries and long occlusions (> 25 cm) in the superficial femoral and popliteal artery, especially for patients with high perioperative risk. Some indications for primarly surgical therapy remain, for example long occlusions in femoro-popliteal arteries in patients with a low perioperative risk and stenosis / occlusions in the femoral bifurcation. The decision making for the optimal therapy for the patient should be taylored individually and interdisciplinary.