Final 3-Year Study Outcomes from the Evaluation of the Zilver Vena Venous Stent for the Treatment of Symptomatic Iliofemoral Venous Outflow Obstruction (The VIVO Clinical Study).

PURPOSE: To report 3-year outcomes from a prospective, multicenter, nonrandomized, single-arm study designed to assess the safety and effectiveness of the Zilver Vena Venous Stent for the treatment of symptomatic iliofemoral venous outflow obstruction. MATERIALS AND METHODS: The VIVO study included patients with symptomatic obstruction of 1 iliofemoral venous segment (ie, 1 limb), characterized by a Clinical, Etiological, Anatomic, Pathophysiology (CEAP) clinical classification of ≥3 or a Venous Clinical Severity Score (VCSS) for pain of ≥2. Patients were retrospectively grouped based on baseline clinical presentation as postthrombotic syndrome (PTS), nonthrombotic iliac vein (NIVL) obstruction, or acute deep vein thrombosis (aDVT). Clinical improvement was assessed by change in VCSS, Venous Disability Score, Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) scores, and CEAP C classification. Stent performance was evaluated by rates of patency by ultrasound (US), freedom from clinically driven reintervention, and freedom from stent fracture. RESULTS: The 3-year results for the 243 patients in the VIVO cohort included a 90.3% rate of patency by US and a 92.6% rate of freedom from clinically driven reintervention. The 3-year rates of patency by US for the NIVL, aDVT, and PTS groups were 100%, 84.0%, and 86.1%, respectively. Sustained clinical improvement through 3 years was demonstrated by changes in VCSS, Venous Disability Score, CIVIQ-20, and CEAP C classification. No stent fractures were observed. CONCLUSIONS: The VIVO study demonstrated sustained high rates of patency and freedom from clinically driven reintervention and improvements in venous clinical symptoms through 3 years. Each patient group (NIVL, aDVT, and PTS) showed clinical improvement and sustained patency through 3 years; some variation existed among groups (eg, only the NIVL group had a 100% patency rate).

Five-year results of the STABLE II study for the endovascular treatment of complicated, acute type B aortic dissection with a composite device design.

OBJECTIVE: To provide the 5-year outcomes of the use of a composite device (proximal covered stent graft + distal bare stent) for endovascular repair of patients with acute, type B aortic dissection complicated by aortic rupture and/or malperfusion. METHODS: Study of Thoracic Aortic Type B Dissection Using Endoluminal Repair (STABLE) II was a prospective, multicenter study of the Zenith Dissection Endovascular System (William Cook Europe). Patients were enrolled between August 2012 and January 2015 at sites in the United States and Japan. Five-year follow-up was completed by January 2020. RESULTS: In total, 73 patients (mean age: 60.7 ± 10.9 years; 65.8% male) with acute type B dissection complicated by malperfusion (72.6%), rupture (21.9%), or both (5.5%) were enrolled. Patients were treated with either a composite device (79.5%) or the proximal stent graft alone (no distal bare stent, 20.5%). Dissections were more extensive in patients who received the composite device (408.9 ± 121.3 mm) than in patients who did not receive a bare stent (315.9 ± 100.1 mm). The mean follow-up was 1209.4 ± 754.6 days. Freedom from all-cause mortality was 80.3% ± 4.7% at 1 year and 68.9% ± 7.3% at 5 years. Freedom from dissection-related mortality remained at 97.1% ± 2.1% from 1-year through 5-year follow-up. Within the stent-graft region, the rate of either complete thrombosis or elimination of the false lumen increased over time (82.1% of all patients at 5 years vs 55.7% at first postprocedure computed tomography), with a higher rate at 5 years in patients who received the composite device (90.5%) compared with patients without the bare stent (57.1%). Throughout the follow-up, overall true lumen diameter increased within the stent-graft region, and overall false lumen diameter decreased. At 5 years, 20.7% of patients experienced a decrease in maximum transaortic diameter within the stent-graft region, 17.2% experienced an increase, and 62.1% experienced no change. Distal to the treated segment (but within the dissected aorta), 23.1% of patients experience no change in transaortic diameter at 5 years; a bare stent was deployed in all these patients at the procedure. Five-year freedom from all secondary intervention was 70.7% ± 7.2%. CONCLUSIONS: These 5-year outcomes indicate a low rate of dissection-related mortality for the Zenith Dissection Endovascular System in the treatment of patients with acute, complicated type B aortic dissection. Further, these data suggest a positive influence of composite device use on false lumen thrombosis. Continuous monitoring for distal aortic growth is necessary in all patients.

A step towards food security: The effect of carbon emission and the moderating influence of human capital. Evidence from Anglophone countries.

This study evaluated the influence of carbon emission, population growth, economic growth and human capital on food security (FOS) among five selected African nations (Nigeria, Ghana, Kenya, Zimbabwe, and Tanzania) by analyzing panel data from 1990 to 2021. Moreover, the study evaluated the moderation effect of human capital on the connection between carbon emission and food security. The study's initial findings confirm that the countries selected were interdependent, and the models' parameters were stationary and co-integrated. The empirical analysis from the cross-sectionally augmented autoregressive distributed lag (CS-ARDL) indicated that (1) carbon emission and population growth have an inverse connection with FOS. (2) In contrast, the results revealed that human capital and economic growth improve FOS. (3) The study outcome proved that human capital moderates the interplay between carbon emission and food security. This result means that the association between carbon emission and food security can be enhanced through the iterative role of human capital. (4) The causality analysis revealed a unidirectional connection between economic growth, population growth, human capital and food security. (5) A bidirectional causality exists between carbon emission and food security. The current analysis enriches literature studies on FOS and environment nexus by providing new insight from the five selected African countries. The study proposes an investment into human capital by African countries because it can complement and solidify the interaction between carbon emissions and food security.

Renewable energy, technological innovation, carbon emission, and life expectancy nexus: experience from the NAFTA economies.

One essential component that reflects the development of society and the economy of most countries is life expectancy (LEXP). Nevertheless, LEXP can be influenced by varying factors, including socioeconomic and medical factors. Therefore, this analysis's focal point and motivation is to explore how socioeconomic factors such as economic growth, technological innovation, carbon emission, human capital, and renewable energy affect LEXP. The study utilized panel data from 1990 to 2020 from the North American Free Trade Agreement (NAFTA), which consists of the USA, Mexico, and Canada. The initial test confirmed that the research series were stationary and cointegrated. Therefore, the research applied the cross-sectional autoregressive distributed lag (CS-ARDL) model to predict the paper's short- and long-term estimates. The empirical estimated model concluded that human capital, renewable energy, technological innovation, and economic growth boost life expectancy. Contrarily, the outcome espoused that carbon emission has an inverse association with LEXP. The causality test confirmed a unidirectional interaction between human capital, economic growth, technological innovation, and life expectancy. On the other hand, there is a bidirectional connection between carbon emission, renewable energy, and life expectancy. The research suggests that stakeholders and policy-makers strengthen and enforce air quality standards to reduce pollution from industrial emissions and vehicle exhaust and encourage using cleaner technologies to promote LEXP. The research outcome is empirically and theoretically consistent, providing an essential breakthrough for environment-health-energy and economic development policies.