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1.
Niger J Clin Pract ; 24(4): 511-516, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33851672

RESUMO

Background: Chronic limb-threatening ischemia (CLTI) is a complex disease caused by peripheral artery disease. It is associated with ischemic foot pain (rest pain) and tissue loss in the form of chronic nonhealing foot ulcers or gangrene. CLTI has a high short-term risk of limb amputations, postoperative sepsis, and cardiovascular-related events. Aims: The present study was conducted to assess the demographic and anthropometric profile of patients with CLTI and their postoperative outcomes after 2-year follow-up at Groote Schuur Hospital, Cape Town, South Africa. Methods: This prospective descriptive pilot study, nested in a prospective cohort study, included adult patients with CLTI admitted to Groote Schuur Hospital from 1st January 2015 to 31st December 2016. Demographic data, anthropometric markers of CLTI, and the postoperative outcomes were documented using piloted and pretested vascular questionnaire. Descriptive statistics were used for baseline data, and postoperative outcomes were presented using actuarial life-table method (Kaplan-Meier analysis). Odds ratio, 95% confidence interval, and P value < 0.05 were used to test the hypothesis. Results: Thirty-seven (50.6%) patients had a BMI >25.0. The mean waist: hip ratio was 0.96. Prevalence of smoking was 86%. Limb salvage and ambulation at 1 year were 79% and 67%, respectively. Majority of the patients who were ambulant preoperatively remained ambulant postoperatively. Conclusion: Most patients had truncal obesity with a high prevalence of smoking. High postoperative ambulatory recovery among ambulant preoperative patients was a significant outcome observed in our study.


Assuntos
Isquemia , Doença Crônica , Demografia , Humanos , Isquemia/epidemiologia , Isquemia/cirurgia , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , África do Sul , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(1): e24188, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429808

RESUMO

BACKGROUND: The efficacy of double antithrombotic therapy (DAT) vs. triple antithrombotic therapy (TAT) for prevention of bleeding and ischemic events in patients with atrial fibrillation following percutaneous coronary intervention (PCI) is unclear in those subgroups defined by the 5 factors (i.e., sex, age, race, history of diabetes, and type of P2Y12 inhibitor). We aimed to assess the efficacy of DAT vs TAT in these patient subgroups. METHODS: We searched PubMed and relevant websites to include related randomized controlled trials (RCTs). Two endpoints of interest were clinically significant bleeding and major adverse cardiac events (MACE). Meta-analysis was performed stratified by 5 factors of interest (i.e., sex, age, race, history of diabetes, and type of P2Y12 inhibitor) to obtain pooled hazard ratio (HR) and 95% confidence interval (CI). Meta-regression analysis was conducted to evaluate subgroup effects. We detected publication bias by Egger test and funnel plots. RESULTS: We included 4 RCTs for meta-analysis. DAT vs TAT significantly reduced the risk of clinically significant bleeding (HR 0.56, 95% CI 0.50-0.63). This effect of DAT was observed in most subgroups of interest (HR ranged from 0.54 to 0.69), and was consistent across various subgroups defined by each of the 5 factors of interest (Psubgroup ranged from 0.290 to 0.794). DAT vs TAT led to the similar risk of MACE (HR 0.98, 95% CI 0.89-1.08). This effect of DAT was observed in all subgroups of interest (all 95% CIs of HRs were across 1.0), and was consistent across various subgroups defined by each of the 5 factors of interest (Psubgroup ranged from 0.308 to 0.828). Publication bias was found only in one subgroup. CONCLUSIONS: Compared with TAT, DAT significantly reduces the risk of clinically significant bleeding and leads to the similar risk of MACE in patients with atrial fibrillation following PCI, irrespective of sex, age, race, history of diabetes, and type of P2Y12 inhibitor used at baseline.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Hemorragia/etiologia , Isquemia/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Hemorragia/epidemiologia , Humanos , Isquemia/epidemiologia
4.
Vasc Med ; 26(2): 174-179, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332228

RESUMO

The expansion of coronavirus disease 2019 (COVID-19) prompted measures of disease containment by the Italian government with a national lockdown on March 9, 2020. The purpose of this study is to evaluate the rate of hospitalization and mode of in-hospital treatment of patients with chronic limb-threatening ischemia (CLTI) before and during lockdown in the Campania region of Italy. The study population includes all patients with CLTI hospitalized in Campania over a 10-week period: 5 weeks before and 5 weeks during lockdown (n = 453). Patients were treated medically and/or underwent urgent revascularization and/or major amputation of the lower extremities. Mean age was 69.2 ± 10.6 years and 27.6% of the patients were women. During hospitalization, 21.9% of patients were treated medically, 78.1% underwent revascularization, and 17.4% required amputations. In the weeks during the lockdown, a reduced rate of hospitalization for CLTI was observed compared with the weeks before lockdown (25 vs 74/100,000 inhabitants/year; incidence rate ratio: 0.34, 95% CI 0.32-0.37). This effect persisted to the end of the study period. An increased amputation rate in the weeks during lockdown was observed (29.3% vs 13.4%; p < 0.001). This study reports a reduced rate of CLTI-related hospitalization and an increased in-hospital amputation rate during lockdown in Campania. Ensuring appropriate treatment for patients with CLTI should be prioritized, even during disease containment measures due to the COVID-19 pandemic or other similar conditions.


Assuntos
/epidemiologia , Extremidades/fisiopatologia , Hospitalização/estatística & dados numéricos , Isquemia/epidemiologia , /patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Feminino , Humanos , Isquemia/fisiopatologia , Isquemia/virologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/virologia , Estudos Retrospectivos , Fatores de Risco
5.
Recenti Prog Med ; 111(9): 480-486, 2020 09.
Artigo em Italiano | MEDLINE | ID: mdl-32914775

RESUMO

At the end of March 2020, just over a month after the first ascertained case of CoViD-19 infection in Italy, the first reports of acute lesions of acro-ischemia appeared, especially in pre-adolescents and adolescents. These manifestations have been called in the course of these months in various ways, from "acro-ischemia acuta", "erythema pernio", "chilblains", up to characterize them more recently as "CoViD Toes". Clinical manifestations do not usually associate with other typical symptoms of Covid-19 and do not find a classical and defined serological antibody response (IgG and IgM). From a clinical point of view it is a localized and self-resolving problem of an interesting and relatively new pathogenetic model of disease in relation to a viral agent. Future studies must make us understand if there is in this specific condition a low viral load is not detectable by current methods and if this explains the inability to produce an adequate immune response for CoViD-19. It is important to determine whether the interferon immune response in some subjects can be the cause of both the low viremia and the endothelial damage so localized in the acral-site, as happens in other models of diseases (chilblain-lupus like). On the contrary, some authors believe that the acral lesions are attributable to chilblains caused by a series of favourable environmental conditions due to forced enclosure. We report the descriptive experience of 14 cases of acro-ischemia in children and adolescents observed in the territorial area of Ravenna and Rimini. The cases were subjected to the nasopharyngeal swab and to the search for antibodies with ELISA method for CoViD-19 both with negative results.


Assuntos
Infecções por Coronavirus/epidemiologia , Interferons/imunologia , Isquemia/epidemiologia , Estilo de Vida , Pneumonia Viral/epidemiologia , Adolescente , Pérnio/epidemiologia , Pérnio/etiologia , Pérnio/imunologia , Criança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Feminino , Humanos , Isquemia/etiologia , Isquemia/imunologia , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Quarentena , Dedos do Pé
6.
Eur J Vasc Endovasc Surg ; 60(5): 721-729, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32807672

RESUMO

OBJECTIVE: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.


Assuntos
Aneurisma/cirurgia , Isquemia/cirurgia , Salvamento de Membro/estatística & dados numéricos , Artéria Poplítea/patologia , Trombose/cirurgia , Doença Aguda/epidemiologia , Doença Aguda/terapia , Idoso , Amputação/estatística & dados numéricos , Aneurisma/complicações , Aneurisma/epidemiologia , Aneurisma/patologia , Austrália/epidemiologia , Brasil/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Europa (Continente)/epidemiologia , Feminino , Carga Global da Doença , Humanos , Incidência , Isquemia/epidemiologia , Isquemia/etiologia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Artéria Poplítea/cirurgia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos , Enxerto Vascular/estatística & dados numéricos , Grau de Desobstrução Vascular
7.
Arterioscler Thromb Vasc Biol ; 40(9): 2322-2331, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32698688

RESUMO

OBJECTIVE: Inflammatory markers, such as hs-CRP (high-sensitivity C-reactive protein), have been reported to be related to peripheral artery disease (PAD). Galectin-3, a biomarker of fibrosis, has been linked to vascular remodeling and atherogenesis. However, its prospective association with incident PAD is unknown; as is the influence of inflammation on the association between galectin-3 and PAD. Approach and Results: In 9851 Atherosclerosis Risk in Communities Study participants free of PAD at baseline (1996-1998), we quantified the association of galactin-3 and hs-CRP with incident PAD (hospitalizations with PAD diagnosis [International Classification of Diseases-Ninth Revision: 440.2-440.4] or leg revascularization [eg, International Classification of Diseases-Ninth Revision: 38.18]) as well as its severe form, critical limb ischemia (PAD cases with resting pain, ulcer, gangrene, or leg amputation) using Cox models. Over a median follow-up of 17.4 years, there were 316 cases of PAD including 119 critical limb ischemia cases. Log-transformed galectin-3 was associated with incident PAD (adjusted hazard ratio, 1.17 [1.05-1.31] per 1 SD increment) and critical limb ischemia (1.25 [1.05-1.49] per 1 SD increment). The association was slightly attenuated after further adjusting for hs-CRP (1.14 [1.02-1.27] and 1.22 [1.02-1.45], respectively). Log-transformed hs-CRP demonstrated robust associations with PAD and critical limb ischemia even after adjusting for galectin-3 (adjusted hazard ratio per 1 SD increment 1.34 [1.18-1.52] and 1.34 [1.09-1.65], respectively). The addition of galectin-3 and hs-CRP to traditional atherosclerotic predictors (C statistic of the base model 0.843 [0.815-0.871]) improved the risk prediction of PAD (ΔC statistics, 0.011 [0.002-0.020]). CONCLUSIONS: Galectin-3 and hs-CRP were independently associated with incident PAD in the general population, supporting the involvement of fibrosis and inflammation in the pathophysiology of PAD.


Assuntos
Proteína C-Reativa/análise , Galectina 3/sangue , Mediadores da Inflamação/sangue , Claudicação Intermitente/sangue , Isquemia/sangue , Doença Arterial Periférica/sangue , Idoso , Biomarcadores/sangue , Estado Terminal , Feminino , Fibrose , Humanos , Incidência , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/epidemiologia , Claudicação Intermitente/terapia , Isquemia/diagnóstico , Isquemia/epidemiologia , Isquemia/terapia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/terapia , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos
8.
J Endovasc Ther ; 27(4): 540-546, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32469294

RESUMO

Despite recent guideline updates on peripheral artery disease (PAD) and critical limb ischemia (CLI) treatment, the optimal treatment for CLI is still being debated. As a result, care is inconsistent, with many CLI patients undergoing an amputation prior to what many consider to be mandatory: consultation with an interdisciplinary specialty care team and a comprehensive imaging assessment. More importantly, quality imaging is critical in CLI patients with below-the-knee disease. Therefore, the CLI Global Society has put forth an interdisciplinary expert recommendation for superselective digital subtraction angiography (DSA) that includes the ankle and foot in properly indicated CLI patients to optimize limb salvage. A recommended imaging algorithm for CLI patients is included.


Assuntos
Amputação/normas , Angiografia Digital/normas , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Salvamento de Membro/normas , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Algoritmos , Amputação/efeitos adversos , Tomada de Decisão Clínica , Consenso , Estado Terminal , Técnicas de Apoio para a Decisão , Humanos , Isquemia/epidemiologia , Salvamento de Membro/efeitos adversos , Seleção de Pacientes , Doença Arterial Periférica/epidemiologia , Valor Preditivo dos Testes , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(16): e19691, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311945

RESUMO

BACKGROUND: Red cell distribution width level may have relations with the incidence and prognosis of cerebrovascular diseases. Recent researches have reported that red cell distribution width level was linked to the occurrence of stroke. However, the predicted effect of red cell distribution width in stroke is still disputed. We sought to assess the relationship between red cell distribution width and risk of stroke in this meta-analysis. METHODS: Relevant studies were picked out from the databases of Embase, PubMed, and Cochrane Library. Hazard ratio with 95% confidence interval was chosen to analyze each trial, which was extracted from results of the highest and lowest red cell distribution width group. Funnel plots, Begg and Egger test were used to assess publication bias in the meta-analysis. Stata(12.0) was utilized to perform statistic analysis in the process. RESULTS: A total of 6 studies with 5783 patients were included in this meta-analysis. The results showed that red cell distribution width level in patients with stroke was significantly higher than it in those without stroke (HR = 1.34, 95%CI:1.23-1.47, P < .001), in particular ischemic stroke(HR = 1.34,95% confidence interval:1.1-1.54, P < .001). There was no evidence of heterogeneity across the studies (P = .355, I = 5.53%). CONCLUSIONS: The higher red cell distribution width level was associated with an increased risk of stroke, especially ischemic infarction.


Assuntos
Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Índices de Eritrócitos , Humanos , Isquemia/sangue , Isquemia/epidemiologia , Fatores de Risco
11.
N Engl J Med ; 382(21): 1994-2004, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32222135

RESUMO

BACKGROUND: Patients with peripheral artery disease who have undergone lower-extremity revascularization are at high risk for major adverse limb and cardiovascular events. The efficacy and safety of rivaroxaban in this context are uncertain. METHODS: In a double-blind trial, patients with peripheral artery disease who had undergone revascularization were randomly assigned to receive rivaroxaban (2.5 mg twice daily) plus aspirin or placebo plus aspirin. The primary efficacy outcome was a composite of acute limb ischemia, major amputation for vascular causes, myocardial infarction, ischemic stroke, or death from cardiovascular causes. The principal safety outcome was major bleeding, defined according to the Thrombolysis in Myocardial Infarction (TIMI) classification; major bleeding as defined by the International Society on Thrombosis and Haemostasis (ISTH) was a secondary safety outcome. RESULTS: A total of 6564 patients underwent randomization; 3286 were assigned to the rivaroxaban group, and 3278 were assigned to the placebo group. The primary efficacy outcome occurred in 508 patients in the rivaroxaban group and in 584 in the placebo group; the Kaplan-Meier estimates of the incidence at 3 years were 17.3% and 19.9%, respectively (hazard ratio, 0.85, 95% confidence interval [CI], 0.76 to 0.96; P = 0.009). TIMI major bleeding occurred in 62 patients in the rivaroxaban group and in 44 patients in the placebo group (2.65% and 1.87%; hazard ratio, 1.43; 95% CI, 0.97 to 2.10; P = 0.07). ISTH major bleeding occurred in 140 patients in the rivaroxaban group, as compared with 100 patients in the placebo group (5.94% and 4.06%; hazard ratio, 1.42; 95% CI, 1.10 to 1.84; P = 0.007). CONCLUSIONS: In patients with peripheral artery disease who had undergone lower-extremity revascularization, rivaroxaban at a dose of 2.5 mg twice daily plus aspirin was associated with a significantly lower incidence of the composite outcome of acute limb ischemia, major amputation for vascular causes, myocardial infarction, ischemic stroke, or death from cardiovascular causes than aspirin alone. The incidence of TIMI major bleeding did not differ significantly between the groups. The incidence of ISTH major bleeding was significantly higher with rivaroxaban and aspirin than with aspirin alone. (Funded by Bayer and Janssen Pharmaceuticals; VOYAGER PAD ClinicalTrials.gov number, NCT02504216.).


Assuntos
Aspirina/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Isquemia/prevenção & controle , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Rivaroxabana/uso terapêutico , Idoso , Aspirina/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Terapia Combinada , Método Duplo-Cego , Quimioterapia Combinada , Procedimentos Endovasculares , Inibidores do Fator Xa/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Incidência , Isquemia/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/cirurgia , Inibidores da Agregação de Plaquetas/efeitos adversos , Rivaroxabana/efeitos adversos
12.
J Vasc Surg ; 72(1): 36-43, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32081484

RESUMO

OBJECTIVE: Ischemic complications (including in the lower extremity, visceral, spinal, and pelvic territories) following standard endovascular aortic repair (EVAR) are well recognized but fortunately uncommon. The incidence of such complications following fenestrated and branched aortic repair (F/BEVAR) has not been well defined in the literature. The objective of this study was to compare the incidence of ischemic complications between EVAR and F/BEVAR and to elucidate potential risk factors for these complications. METHODS: We identified all patients who underwent EVAR from 2003 to 2017 or F/BEVAR from 2012 to 2017 in the national Vascular Quality Initiative database. We assessed differences in perioperative ischemic outcomes with methods including logistic regression and inverse probability of treatment propensity score weighting, using a composite end point of lower extremity ischemia, intestinal ischemia, stroke, or new dialysis as the primary end point. RESULTS: The data comprised 35,379 EVAR patients and 3374 F/BEVAR patients. F/BEVAR patients were more likely to be female, have had previous aneurysm repairs, and be deemed unfit for open aneurysm repair; they were less likely to have ruptured aneurysms; and they had higher estimated blood losses, contrast volumes, and fluoroscopy and procedure times. The incidence of any ischemic event (7.7% vs 2.2%) as well as the incidences of the component end points of lower extremity ischemia (2.3% vs 1.0%), intestinal ischemia (2.7% vs 0.7%), stroke (1.5% vs 0.3%), and new hemodialysis (3.1% vs 0.4%) were all significantly increased (all P < .001) in F/BEVAR compared with standard EVAR. After propensity adjustment, F/BEVAR conferred increased odds of any ischemic complication (1.8), intestinal ischemia (2.0), lower extremity ischemia (1.3), new hemodialysis (10.2), and stroke (2.3). CONCLUSIONS: Rates of lower extremity ischemia, intestinal ischemia, new dialysis, and stroke each range from 0% to 1% for standard EVAR and 1% to 3% for F/BEVAR. The incidence of perioperative ischemic complications following F/BEVAR is significantly increased compared to EVAR. The real-world data in this study should help guide decision-making for surgeons and patients as well as serve as one metric for progress in device and technique development. Improvements in ischemic complications may come from continued technology development such as smaller sheaths, improved imaging to decrease procedure time and contrast volume, embolic protection, and increased operator skill with wire and catheter manipulation.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Isquemia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Canadá/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Isquemia/diagnóstico por imagem , Isquemia/terapia , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
13.
J Am Coll Cardiol ; 75(6): 608-617, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-32057375

RESUMO

BACKGROUND: Patients with peripheral artery disease (PAD) have a higher risk of major adverse cardiovascular events (MACE) compared with those without PAD. OBJECTIVES: The aim of this post hoc analysis was to evaluate sex-specific differences in MACE and limb events in the EUCLID (Examining Use of Ticagrelor in PAD) trial. METHODS: Cox proportional hazards models were used to compare time-to-event outcomes stratified by sex. Covariates were introduced after adjusted model selection. RESULTS: EUCLID enrolled 13,885 patients with PAD (28% women [n = 3,888]). PAD severity and medical treatment were comparable between sexes, whereas prior lower extremity revascularization was reported less frequently in women (54.8% vs. 57.3%; p = 0.006). Women were older (mean ± SD age: 67.8 ± 8.9 vs. 66.1 ± 8.2 years; p < 0.001) and more likely to have diabetes mellitus (p = 0.004), hypertension, hyperlipidemia, and chronic kidney disease (all p < 0.001). Over a mean follow-up of 30 months, women had a lower risk of MACE (9.5% vs. 11.2%; adjusted hazard ratio: 0.77; 95% confidence interval: 0.68 to 0.88; p < 0.001) and all-cause-mortality (7.6% vs. 9.7%; adjusted hazard ratio: 0.61; 95% confidence interval: 0.53 to 0.71; p < 0.001). In contrast, risk for major adverse limb events (2.6% vs. 3.0%) and hospitalization for acute limb ischemia (1.6% vs. 1.7%) were not different by sex. CONCLUSIONS: Although women with PAD are at lower risk for MACE and all-cause mortality, risk for limb events was similar between sexes over a mean follow-up of 30 months. Understanding sex-specific differences and dissociation between baseline cardiovascular risk and subsequent cardiovascular events requires further investigation. (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822).


Assuntos
Isquemia/epidemiologia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/complicações , Caracteres Sexuais , Idoso , Feminino , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Fatores Sexuais
14.
Environ Health ; 19(1): 1, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31898503

RESUMO

BACKGROUND: Stroke, especially ischemic stroke (IS), has been a severe public health problem around the world. However, the association between air pollution and ischemic stroke remains ambiguous. METHODS: A total of 63, 997 IS cases aged 18 years or above in Shenzhen were collected from 2008 to 2014. We used the time-stratified case-crossover design combining with distributed lag nonlinear model (DLNM) to estimate the association between air pollution and IS onset. Furthermore, this study explored the variability across gender and age groups. RESULTS: The cumulative exposure-response curves were J-shaped for SO2, NO2 and PM10, and V-shaped for O3, and crossed over the relative risk (RR) of one. The 99th, 50th (median) and 1st percentiles of concentration (µg/m3) respectively were 37.86, 10.06, 3.71 for SO2, 116.26, 41.29, 18.51 for NO2, 145.94, 48.29, 16.14 for PM10, and 111.57, 49.82, 16.00 for O3. Extreme high-SO2, high-NO2, high-PM10, high-O3, and low-O3 concentration increased the risk of IS, with the maximum RR values and 95% CIs: 1.50(1.22, 1.84) (99th vs median) at 0-12 lag days, 1.37(1.13, 1.67) (99th vs median) at 0-10 lag days, 1.26(1.04, 1.53) (99th vs median) at 0-12 lag days, 1.25(1.04, 1.49) (99th vs median) at 0-14 lag days, and 1.29(1.03, 1.61) (1st vs median) at 0-14 lag days, respectively. The statistically significant minimal RR value and 95% CI was 0.79(0.66,0.94) at 0-10 lag days for extreme low-PM10. The elderly aged over 65 years were susceptible to extreme pollution conditions. Difference from the vulnerability of males to extreme high-SO2, high-NO2 and low-O3, females were vulnerable to extreme high-PM10 and high-O3. Comparing with the elderly, adults aged 18-64 year were immune to extreme low-NO2 and low-PM10. However, no association between CO and IS onset was found. CONCLUSIONS: SO2, NO2, PM10 and O3 exerted non-linear and delayed influence on IS, and such influence varied with gender and age. These findings may have significant public health implications for the prevention of IS.


Assuntos
Poluição do Ar/efeitos adversos , Isquemia Encefálica/epidemiologia , Exposição Ambiental/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos , Isquemia Encefálica/induzido quimicamente , China/epidemiologia , Cidades , Estudos Cross-Over , Feminino , Humanos , Incidência , Isquemia/induzido quimicamente , Isquemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Dinâmica não Linear , Risco , Estações do Ano , Acidente Vascular Cerebral/induzido quimicamente , Fatores de Tempo , Adulto Jovem
15.
Mymensingh Med J ; 29(1): 43-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915334

RESUMO

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.


Assuntos
Pressão Sanguínea/fisiologia , Diabetes Mellitus/epidemiologia , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Adulto , Bangladesh/epidemiologia , Comorbidade , Feminino , Humanos , Hipertensão/diagnóstico , Isquemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural/estatística & dados numéricos , Classe Social , População Urbana/estatística & dados numéricos , Adulto Jovem
16.
Plast Reconstr Surg ; 145(2): 251e-262e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985611

RESUMO

BACKGROUND: The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. METHODS: Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained. RESULTS: One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm. CONCLUSIONS: Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Neoplasias da Mama/cirurgia , Isquemia/etiologia , Mastectomia/métodos , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Adulto , Idoso , Feminino , Humanos , Incidência , Isquemia/epidemiologia , Modelos Logísticos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/etiologia , Análise de Regressão , Fatores de Risco
17.
Eur J Vasc Endovasc Surg ; 59(2): 255-264, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31917126

RESUMO

OBJECTIVE: Acute lower limb ischaemia (ALI) as a result of popliteal artery aneurysm (PAA) thrombosis represents a significant problem. The aim of this study was to investigate outcome of intra-operative intra-arterial thrombolysis in the treatment of acute ischaemia due to PAA thrombosis in terms of major adverse limb events (MALE), overall survival, and intrahospital complications, especially those associated with bleeding. METHODS: A total of 156 patients with Rutherford grade IIa and IIb acute ischaemia resulting from PAA thrombosis were admitted between 1 January 2011 and 1 January 2017. The patients were divided into two groups, those who underwent additional treatment with intra-operative intra-arterial thrombolysis (20 patients), and those who did not (136 patients). By using covariables from baseline and angiographic characteristics, a propensity score was calculated for each patient. Each patient who underwent intra-operative thrombolysis was matched to four patients from the non-thrombolysis group. Thus, comparable patient cohorts (20 in the thrombolysis and 80 in the non-thrombolysis group) were identified for further analysis. The primary end point was MALE and the secondary endpoint all cause mortality. RESULTS: After a median follow up of 55 months, the estimated MALE rate was significantly lower in the thrombolysis group (30% vs. 65%, chi square = 10.86, p < .001, log rank test). Also, patients in the thrombolysis group had a significantly lower mortality rate (20% vs. 42.65%, chi square = 3.65, p = .05, log rank test). The thrombolysis group had wound/haematoma related interventions performed more commonly (25% in thrombolysis vs 8%, in non-thrombolysis group), but the difference was not significant (p=.013). There were no cases of major (intracranial and gastrointestinal) bleeding in either group. CONCLUSION: The data suggest that intra-operative thrombolysis in the treatment of selected patients with ALI due to PAA thrombosis has long term MALE and overall survival benefits, without a significant risk of major, life threatening bleeding complications.


Assuntos
Aneurisma/cirurgia , Arteriopatias Oclusivas/terapia , Artéria Poplítea/patologia , Terapia Trombolítica/métodos , Trombose/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Aneurisma/complicações , Aneurisma/mortalidade , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/mortalidade , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios/métodos , Isquemia/epidemiologia , Isquemia/etiologia , Isquemia/terapia , Estimativa de Kaplan-Meier , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Trombose/complicações , Trombose/mortalidade , Resultado do Tratamento , Grau de Desobstrução Vascular
18.
Am Heart J ; 220: 108-115, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31809991

RESUMO

BACKGROUND: The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies. METHODS: BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup. RESULTS: A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P = .886). In the first 2 weeks ADIR was higher than ADBR (P = .013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P = .003), whereas non-ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P = .012 and P = .022, respectively). CONCLUSIONS: In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non-ST-segment elevation ACS patients and in those discharged on ticagrelor.


Assuntos
Síndrome Coronariana Aguda/terapia , Hemorragia/epidemiologia , Isquemia/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Clopidogrel/uso terapêutico , Feminino , Hemorragia/etiologia , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/etiologia , Cloridrato de Prasugrel/uso terapêutico , Recidiva , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Ticagrelor/efeitos adversos , Ticagrelor/uso terapêutico , Fatores de Tempo
19.
Vasc Med ; 25(1): 78-87, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31621531

RESUMO

Critical limb ischemia represents the advanced stage of peripheral artery disease, a health problem with increasing prevalence. Critical limb ischemia is associated with significant mortality, limb loss, pain, and diminished health-related quality of life. Public awareness and early diagnosis are necessary for an effective treatment with early risk factor modification, smoking cessation, and exercise therapy. Herein, we present an overview of the epidemiology as well as the clinical stages of the disease, and estimate that there are 6.5 million patients with critical limb ischemia in the US, Europe, and Japan based on global population-based studies. At least 75% of these patients, accounting for approximately 4.8 million patients, are amenable to endovascular therapy.


Assuntos
Procedimentos Endovasculares , Isquemia/epidemiologia , Isquemia/terapia , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/terapia , Tomada de Decisão Clínica , Estado Terminal , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Seleção de Pacientes , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Fatores de Risco , Resultado do Tratamento
20.
Ann Vasc Surg ; 64: 239-245, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31629843

RESUMO

BACKGROUND: The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1, 2018, to enhance cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the federation. METHODS: MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot (DF) diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20, 2019. RESULTS: Response rate was 62%. The survey revealed that vascular surgeons, diabetologists, and wound care nurses made-up the core of the diabetic teams present in 76.9%, 69.3%, and 92.3% of the centers, respectively. Diabetic teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%), but only in 7.9% of cases by nurses. Duplex ultrasonography and computed tomographic angiography were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons, while nonsurgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5% vs 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3% and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4-30%) and a mean reintervention rate of 22.5%, and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor and 30.8% major). The availability of a DF clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental to reduce amputation rates. CONCLUSIONS: Especially since the introduction and spreading of new endovascular techniques for the treatment of DF, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality and it is with this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery.


Assuntos
Amputação/tendências , Pé Diabético/cirurgia , Procedimentos Endovasculares/tendências , Disparidades em Assistência à Saúde/tendências , Isquemia/terapia , Doença Arterial Periférica/terapia , Padrões de Prática em Enfermagem/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Amputação/efeitos adversos , Pé Diabético/diagnóstico por imagem , Pé Diabético/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Pesquisas sobre Serviços de Saúde , Humanos , Isquemia/diagnóstico por imagem , Isquemia/epidemiologia , Região do Mediterrâneo/epidemiologia , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente/tendências , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/epidemiologia , Papel do Médico , Reoperação/tendências , Especialização/tendências , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Cicatrização
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