Use of the Endoleak-to-Aortic Density Ratio to Distinguish Direct Endoleaks from Indirect Endoleaks after Endovascular Aortic Aneurysm Repair.

PURPOSE: To define criteria to distinguish direct (type 1 or 3) from indirect endoleaks (type 2) in the arterial phase of contrast-enhanced computed tomography (CT) scans in patients with abdominal aortic aneurysms treated with endovascular aortic repair. MATERIALS AND METHODS: This retrospective study was conducted from January 2009 to October 2020 and included consecutive patients treated endovascularly for a direct endoleak or an indirect endoleak associated with an enlarging aneurysm. The following characteristics were evaluated using contrast-enhanced CT: location, size, contact with the endograft, density, morphologic criteria, collateral artery enhancement, and endoleak-to-aortic density ratio. Statistical analysis included the Mann-Whitney U test, Pearson χ2 test, Fisher exact test, receiver operating characteristic curve analysis, and multivariable logistic regression. RESULTS: Contrast-enhanced CT scans from 71 patients (87% men), who presented with 87 endoleaks (44 indirect and 43 direct endoleaks), treated by endovascular techniques were analyzed. Using visual criteria, 56% of the endoleaks were not characterizable as direct or indirect. An endoleak-to-aortic density ratio of >0.77 could properly distinguish direct from indirect endoleaks, with a theoretical accuracy of 98% (area under the receiver operating characteristic curve, 0.99), sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 96%. CONCLUSION: An endoleak-to-aortic density ratio of >0.77 in the arterial phase of contrast-enhanced CT could be a strong discriminant of a direct-type endoleak.

Paclitaxel and mortality in patients with claudication and de novo femoropopliteal lesions: a historical cohort study.

OBJECTIVE: To compare the mortality rates of patients with claudication and de novo femoropopliteal lesions treated with and without paclitaxel coated devices (PCD). BACKGROUND: A recent meta-analysis, mostly including patients with claudication and de novo femoropopliteal lesions but also with recurrent stenoses and critical limb ischemia, has shown a significant excess mortality in patients treated with PCD. METHODS: Comparison of two historical cohorts of patients presenting with claudication and de novo femoropopliteal lesions treated with and without PCD between 2008 and 2018. RESULTS: After review of 5219 arteriograms in patients presenting with peripheral artery disease, 700 consecutive patients were included consisting in 72.6% of male (n = 508). Mean age was 68.1 ± 8.5 years. 45.7% of the patients (n = 320) had a treatment including a PCD. Mean femoropopliteal lesion length was 123 ± 91 mm including 44.6% of occlusions. Patients of the control group were censored at crossover to paclitaxel when applicable. Mortality rates at 1, 2 and 5 years were 4.6%, 7.5%, 19.4% and 1.6%, 6.2%, 16.6% in the non-PCD and PCD groups respectively. The relative risks of death when using PCD were 0.35 (p = 0.03), 0.83 (p = NS) and 0.86 (p = NS) at 1, 2 and 5 years respectively. CONCLUSION: There was no excess mortality in patients with claudication and de novo femoropopliteal lesions treated with paclitaxel coated devices at 1, 2 and 5 years of follow-up in this cohort. The current study suggests that additional prospective randomized studies properly powered to study mortality are necessary.

Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation.

OBJECTIVE: The aim of this meta-analysis was to investigate the extent to which cannabis use among youths is associated with the risk of perpetrating physical violence. METHODS: Searches were conducted in PubMed, PsycINFO, Web of Science, and Google Scholar for articles published from the inception of each database to July 2019. All studies that examined both cannabis use and the perpetration of physical violence in a sample of youths and young adults <30 years old were included. The meta-analysis was performed with a random-effects model. Risk of publication bias was assessed with Egger's test. Guidelines from the Meta-Analysis of Observational Studies in Epidemiology were followed. RESULTS: After screening 11,348 potential studies, 30 study arms were included, yielding a total of 296,815 adolescents and young adults. The odds ratio for the pooled studies was 2.11 (95% CI=1.64, 2.72). The pooled odds ratios were 2.15 (95% CI=1.58, 2.94) and 2.02 (95% CI=1.26, 3.23) for the cross-sectional and longitudinal studies, respectively. Preliminary evidence suggests that the risk of violence was higher for persistent heavy users (odds ratio=2.81, 95% CI=1.68, 4.74) compared with past-year users (odds ratio=2.05, 95% CI=1.5, 2.8) and lifetime users (odds ratio=1.94, 95% CI=1.29, 2.93). The odds ratio for unadjusted studies was 2.62 (95% CI=1.89, 3.62), and for studies using odds ratios adjusted for potential confounding factors, 2.01 (95% CI=1.57, 2.56). CONCLUSIONS: These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence.