1) Conservative management is generally the initial treatment for spontaneous isolated superior mesenteric artery dissection (SIDSMA), with 85-87% of patients receiving conservative care.
2) Complete or partial remodeling of the artery occurs in 49-51% of conservatively treated patients within 2 years, though endovascular stenting may increase remodeling rates to 88%.
3) Endovascular stenting results in better outcomes than conservative care for symptomatic patients, with lower recurrent symptom and mortality rates.
This randomized trial compared percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease over 5 years. At 5 years, the cumulative rate of major adverse cardiac and cerebrovascular events was not significantly different between PCI and CABG. However, ischemia-driven revascularization was significantly higher with PCI. Mortality and rates of myocardial infarction were similar with both treatments. PCI may be considered an alternative to CABG for select left main coronary artery disease patients when performed at high-volume centers.
- Of 200 asymptomatic patients with severe aortic stenosis, 140 (70%) adhered to guidelines of serial evaluations every 12 months over 3 years of follow up.
- Patients adhering to guidelines had aortic valve replacement more frequently (47.2% vs 18.3%; p=0.001) and lower incidence of heart failure hospitalization (59.2% vs 52.6%; p=0.02) compared to non-adherent patients.
- There was no difference in mortality or inpatient costs between adherent and non-adherent groups. Adherence to guidelines was associated with greater rates of aortic valve replacement and reduced heart failure hospitalization without impacting survival or costs.
Fujitani - Vasc Recon in Conjunc Panc Cancer Resec - VNVDA 2023ssuser787e5c1
Pancreatic ductal adenocarcinoma has a poor prognosis due to early metastases and late presentation, but pancreaticoduodenectomy with concomitant vascular reconstruction for borderline resectable T3 lesions may allow increased R0 resections. This study of 270 Whipple procedures found equivalent 30-day mortality and 1-year survival for cases with and without vascular reconstruction, and improved 5-year survival with reconstruction. Multiple options exist for reconstructing involved mesenterico-portal veins or visceral arteries. A consistent team experience in complex pancreatic cancer resection and vascular reconstruction is important for successful outcomes.
The document discusses recent developments in left atrial appendage closure. Key points include:
- Long term results and meta-analyses from randomized trials of warfarin vs. Watchman leading to FDA approval.
- Differences between trial populations and real-world patients.
- Results from studies of patients who cannot take oral anticoagulants.
- Technical advances in devices.
- Role of CT imaging.
This document discusses indications and techniques for carotid artery stenting (CAS). It notes that symptomatic stenosis over 70% on non-invasive imaging or over 50% on catheter angiography are indications for revascularization. Asymptomatic stenosis over 70% may also be treated if life expectancy is over 5 years and stenosis is over 80%. The technique involves pre- and post-dilation of stents with the use of protection devices to prevent embolic strokes. Results depend on the operator's experience and complications include strokes, hypotension, and restenosis. Larger trials found CAS and CEA to have similar outcomes, with CAS preferred for younger patients, though CEA is preferred in certain high risk cases.
This document summarizes techniques for endovascular treatment of aorto-iliac occlusive disease. It discusses:
1) Technical success rates are high but complications can occur, especially with chronic total occlusions. Primary stenting is preferred over PTA with provisional stenting for long lesions.
2) Patency rates at 5-10 years range from 46-96% depending on the location and type of lesion. Risk factors for restenosis include occlusion length and poor runoff.
3) Endovascular treatment has advantages over open surgery like shorter hospital stays and lower complications/mortality, though open bypass has higher long term patency. Drug-eluting devices may help address issues of rest
This document discusses the management of variceal bleeding, specifically focusing on esophageal and gastric varices. It provides an overview of endoscopic and medical therapies for controlling acute esophageal variceal bleeding such as endoscopic band ligation, sclerotherapy, and pharmacologic therapies like octreotide. For gastric varices, it describes different classification systems and challenges in managing bleeding, noting endoscopic therapies like sclerotherapy, ligation, and glue injection can control acute bleeding but have high rebleeding risks. It emphasizes a multidisciplinary approach is often needed for gastric variceal management.
DETAILS OF EVIDENCE TAVI FROM ITS EXISTENCE IN INTERVENTIONAL CARDIOLOGY TO THE SURTAVI REGISTRY ..AS AN OPTION FROM HIGH RISK UNOPERABLE PATIENTS TO INTERMEDIATE AND LOW RISK PATIENTS
This randomized trial compared percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease over 5 years. At 5 years, the cumulative rate of major adverse cardiac and cerebrovascular events was not significantly different between PCI and CABG. However, ischemia-driven revascularization was significantly higher with PCI. Mortality and rates of myocardial infarction were similar with both treatments. PCI may be considered an alternative to CABG for select left main coronary artery disease patients when performed at high-volume centers.
- Of 200 asymptomatic patients with severe aortic stenosis, 140 (70%) adhered to guidelines of serial evaluations every 12 months over 3 years of follow up.
- Patients adhering to guidelines had aortic valve replacement more frequently (47.2% vs 18.3%; p=0.001) and lower incidence of heart failure hospitalization (59.2% vs 52.6%; p=0.02) compared to non-adherent patients.
- There was no difference in mortality or inpatient costs between adherent and non-adherent groups. Adherence to guidelines was associated with greater rates of aortic valve replacement and reduced heart failure hospitalization without impacting survival or costs.
Fujitani - Vasc Recon in Conjunc Panc Cancer Resec - VNVDA 2023ssuser787e5c1
Pancreatic ductal adenocarcinoma has a poor prognosis due to early metastases and late presentation, but pancreaticoduodenectomy with concomitant vascular reconstruction for borderline resectable T3 lesions may allow increased R0 resections. This study of 270 Whipple procedures found equivalent 30-day mortality and 1-year survival for cases with and without vascular reconstruction, and improved 5-year survival with reconstruction. Multiple options exist for reconstructing involved mesenterico-portal veins or visceral arteries. A consistent team experience in complex pancreatic cancer resection and vascular reconstruction is important for successful outcomes.
The document discusses recent developments in left atrial appendage closure. Key points include:
- Long term results and meta-analyses from randomized trials of warfarin vs. Watchman leading to FDA approval.
- Differences between trial populations and real-world patients.
- Results from studies of patients who cannot take oral anticoagulants.
- Technical advances in devices.
- Role of CT imaging.
This document discusses indications and techniques for carotid artery stenting (CAS). It notes that symptomatic stenosis over 70% on non-invasive imaging or over 50% on catheter angiography are indications for revascularization. Asymptomatic stenosis over 70% may also be treated if life expectancy is over 5 years and stenosis is over 80%. The technique involves pre- and post-dilation of stents with the use of protection devices to prevent embolic strokes. Results depend on the operator's experience and complications include strokes, hypotension, and restenosis. Larger trials found CAS and CEA to have similar outcomes, with CAS preferred for younger patients, though CEA is preferred in certain high risk cases.
This document summarizes techniques for endovascular treatment of aorto-iliac occlusive disease. It discusses:
1) Technical success rates are high but complications can occur, especially with chronic total occlusions. Primary stenting is preferred over PTA with provisional stenting for long lesions.
2) Patency rates at 5-10 years range from 46-96% depending on the location and type of lesion. Risk factors for restenosis include occlusion length and poor runoff.
3) Endovascular treatment has advantages over open surgery like shorter hospital stays and lower complications/mortality, though open bypass has higher long term patency. Drug-eluting devices may help address issues of rest
This document discusses the management of variceal bleeding, specifically focusing on esophageal and gastric varices. It provides an overview of endoscopic and medical therapies for controlling acute esophageal variceal bleeding such as endoscopic band ligation, sclerotherapy, and pharmacologic therapies like octreotide. For gastric varices, it describes different classification systems and challenges in managing bleeding, noting endoscopic therapies like sclerotherapy, ligation, and glue injection can control acute bleeding but have high rebleeding risks. It emphasizes a multidisciplinary approach is often needed for gastric variceal management.
DETAILS OF EVIDENCE TAVI FROM ITS EXISTENCE IN INTERVENTIONAL CARDIOLOGY TO THE SURTAVI REGISTRY ..AS AN OPTION FROM HIGH RISK UNOPERABLE PATIENTS TO INTERMEDIATE AND LOW RISK PATIENTS
AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh 020359
Ultrasound shows promise as a diagnostic tool for giant cell arteritis (GCA) that could reduce the need for temporal artery biopsies. A large study found ultrasound had higher sensitivity (54%) than biopsy (39%) for GCA diagnosis, though lower specificity. Using ultrasound first and only doing biopsies for high-risk cases could avoid 87-98% of biopsies while maintaining high sensitivity for GCA detection. Follow-up ultrasounds may help monitor disease activity and detect relapses in GCA patients treated with steroids.
Guidelines in the management of carotid stenosisuvcd
This document provides an overview of guidelines for the management of carotid stenosis. It discusses:
1) Stroke is a major cause of death, with many caused by carotid artery disease. The risk of stroke is directly related to the degree of stenosis.
2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
3) Early trials demonstrated the benefits of carotid endarterectomy (CEA) in reducing stroke risks compared to medical management alone for symptomatic and some asymptomatic patients.
4) Later trials evaluated carotid angioplasty and stenting (CAS) as an alternative to CEA but
Here are my thoughts on the discussion questions:
Q1. The study found that the no-AC cohort had lower rates of hemorrhagic and thrombotic complications compared to the AC cohort, though the difference was not statistically significant.
Q2. The traditional approach is to anticoagulate patients on VA-ECMO based on ELSO guidelines to target an ACT of 180-220 seconds. This study evaluated a non-traditional approach of not routinely anticoagulating patients in the first 24 hours.
Q3. You're right that not reporting coagulation data for the no-AC cohort limits reliability. Without knowing coagulation status, it's difficult to fully evaluate thrombotic risk in that group
Radiofrequency ablation in thyroid diseaseManoZacMathews
This journal club discusses a prospective multi-institutional study examining the use of radiofrequency ablation (RFA) to treat benign thyroid nodules. 94 patients with benign nodules confirmed on biopsy underwent RFA and were followed for 1 year. The primary outcome was a volume reduction rate of over 50% at follow-up periods. Secondary outcomes included complication rates and sonographic features associated with treatment success. Preliminary results found a high rate of volume reduction and low complication rates, with solid composition and stiffness on elastography correlating with better response to RFA. The study aims to further evaluate the efficacy and safety of RFA as a nonsurgical option for treating benign thyroid nodules.
The document discusses the lack of consensus around treating asymptomatic carotid artery disease. While surgery reduces the risk of stroke, the absolute benefit is small given the already low risk with medical management alone. More recent data favors a purely medical approach for most asymptomatic patients. The evidence for invasive treatments like carotid endarterectomy (CEA) or stenting is considered weak, with no clear benefits shown for subgroups like women, those over 75, or different degrees of stenosis. Treating asymptomatic disease at a population level may lead to many unnecessary interventions that provide little benefit given evolving medical therapies.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
1) The CREST trial compared outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treatment of carotid artery stenosis and found they had similar rates of the primary composite outcome of periprocedural stroke, heart attack, or death as well as subsequent ipsilateral strokes.
2) Periprocedural strokes were lower in the CEA group while periprocedural heart attacks were lower in the CAS group.
3) Younger patients had slightly better outcomes with CAS while CEA remained effective, with low risks of recurrent strokes after either procedure indicating durability, especially when combined with medical therapy.
Contraindications, futility & fraility in liver transplantDr. Rohit Saini
This document discusses contraindications and factors used to assess futility for liver transplantation (LTx). It covers absolute and relative contraindications to LTx. Scores like MELD, SOFT, and UCLA are used to predict post-LTx outcomes and futility. Factors like frailty, age, comorbidities, acute liver failure criteria, and ACLF grade impact survival. The concept of a "transplantation window" in ACLF is discussed. Precipitating events, physical frailty, sarcopenia, cardiovascular disease, and pulmonary hypertension also influence futility decisions for LTx.
Deep Vein Pathophysiology: Reflux & ObstructionVein Global
By: Peter J. Pappas, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
IS STENTING TO MAINTAIN VASCULAR PATENCY GOING TO BE THE FUTUREAVATAR
This document discusses the use of stenting to maintain vascular patency for hemodialysis access and whether it will be the future standard. It notes that while stenting is established for coronary arteries, its role for arteriovenous fistulas (AVFs) and grafts (AVGs) is still controversial. The document reviews several studies that showed no benefit or increased complications from stenting AVFs/AVGs compared to angioplasty alone. However, it also discusses some limited evidence that covered stents or stents placed in specific situations like central venous stenosis may improve patency compared to angioplasty. Overall, the document questions whether stenting will become the standard given the lack of strong evidence, complications risks
4 dan atar - anticoagulation af pci - what do trials saywebevo5
Professor Dan Atar presented on anticoagulation for atrial fibrillation and percutaneous coronary intervention based on recent trial results. The WOEST trial found that dual therapy with a vitamin K antagonist (VKA) and clopidogrel reduced bleeding compared to triple therapy with a VKA, aspirin, and clopidogrel, with a potential mortality benefit. The PIONEER AF-PCI trials found that rivaroxaban dual or triple therapy was associated with significantly less bleeding than VKA triple therapy, with comparable efficacy. The RE-LY-DUAL PCI study found dabigatran dual therapy significantly reduced bleeding compared to warfarin triple therapy. Guidelines recommend balancing the risks of bleeding from
08:25 Di Mario - Recent Pubblications and ResearchEuro CTO Club
- Recent publications on CTOs from 2013-2014 focused on pathology, physiology, epidemiology, outcomes, imaging, technical approaches, and stents.
- Studies showed differences in plaque characteristics between long and short duration CTOs and impact of revascularizing CTOs on donor arteries.
- Registry data from Sweden found a 10.6% prevalence of CTOs and decreasing rates over time.
- Successful CTO PCI was associated with improved survival, less cardiac death, and reduced need for CABG compared to failed procedures.
- Imaging like IVUS and CT angiography improved technical success rates for CTO PCI.
Benign Billiary Stricture By Dr Dhaval Mangukiya
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Important Trials of the Day & Basics of Biostatistics | IACTS SCORE 2020IACTSWeb
This presentation emphasizes on the importance of biostatistics in the interpretation, analysis and design of studies and trials in the daily life of an academic surgeon. It also sheds light on some important clinical trials of the present milieu that are playing a vital role in the course that cardiothoracic surgery is taking.
Courtesy of Dr. Prasanna Simha Mohan Rao, MS, MCh, DNB, PGDHHM. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.
This presentation accompanies a video that is part of the lecture series of IACTS SCORE 2020 held at the SSSIHMS Whitefield, Bengaluru between 7th and 8th March, 2020.
This document reviews treatments for neuroendocrine tumors (NETs), including peptide receptor radionuclide therapy (PRRT). It summarizes the evidence for various NET treatment options such as surgery, somatostatin analogs, PRRT, chemotherapy, and targeted therapies. It also provides an overview of a PRRT treatment day and integrates PRRT with other NET therapies. Clinical trial data is presented demonstrating the efficacy of PRRT and targeted therapies such as everolimus and sunitinib in extending progression-free survival for NETs. The conclusion emphasizes treating NETs only when necessary and considering surgery first followed by somatostatin analogs, PRRT, intra-arterial therapies,
Triple Therapy in ACS: Recent Evidences discusses studies evaluating different antithrombotic regimens for patients with atrial fibrillation who undergo percutaneous coronary intervention. The WOEST study found that dual therapy with a vitamin K antagonist (VKA) and clopidogrel reduced bleeding compared to triple therapy with VKA, aspirin, and clopidogrel, with no increase in thrombotic risk. The ISAR-TRIPLE trial found no difference in outcomes for 6 weeks versus 6 months of triple therapy following stent implantation. PIONEER AF-PCI found that dual therapy with rivaroxaban was associated with less bleeding than triple therapy with VKA, aspirin, and a
STEMI Late Presentation - Management and practical approachSatyam Rajvanshi
1) Late presenters of STEMI (over 12 hours) make up a significant portion of STEMI patients worldwide and in India.
2) Evidence suggests that while reperfusion therapy is not beneficial for late presenters, PCI may still allow for myocardial salvage even in occluded arteries up to 72 hours from symptom onset.
3) Guidelines vary in their recommendations for revascularization of late presenters but a practical approach is to consider early revascularization for stable patients within 72 hours while stress testing those presenting after 72 hours.
1) Early revascularization through either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) improves survival rates in patients with cardiogenic shock compared to medical therapy alone.
2) There is ongoing debate about whether culprit vessel-only PCI or multivessel PCI is better for patients with cardiogenic shock and multivessel coronary artery disease. Current guidelines recommend culprit vessel PCI initially except in certain high-risk situations.
3) An integrated approach is needed using early revascularization, inotropic support, and potentially mechanical circulatory support, with involvement of multiple specialists. Cardiogenic shock continues to pose major challenges in acute cardiac care.
AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh 020359
Ultrasound shows promise as a diagnostic tool for giant cell arteritis (GCA) that could reduce the need for temporal artery biopsies. A large study found ultrasound had higher sensitivity (54%) than biopsy (39%) for GCA diagnosis, though lower specificity. Using ultrasound first and only doing biopsies for high-risk cases could avoid 87-98% of biopsies while maintaining high sensitivity for GCA detection. Follow-up ultrasounds may help monitor disease activity and detect relapses in GCA patients treated with steroids.
Guidelines in the management of carotid stenosisuvcd
This document provides an overview of guidelines for the management of carotid stenosis. It discusses:
1) Stroke is a major cause of death, with many caused by carotid artery disease. The risk of stroke is directly related to the degree of stenosis.
2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
3) Early trials demonstrated the benefits of carotid endarterectomy (CEA) in reducing stroke risks compared to medical management alone for symptomatic and some asymptomatic patients.
4) Later trials evaluated carotid angioplasty and stenting (CAS) as an alternative to CEA but
Here are my thoughts on the discussion questions:
Q1. The study found that the no-AC cohort had lower rates of hemorrhagic and thrombotic complications compared to the AC cohort, though the difference was not statistically significant.
Q2. The traditional approach is to anticoagulate patients on VA-ECMO based on ELSO guidelines to target an ACT of 180-220 seconds. This study evaluated a non-traditional approach of not routinely anticoagulating patients in the first 24 hours.
Q3. You're right that not reporting coagulation data for the no-AC cohort limits reliability. Without knowing coagulation status, it's difficult to fully evaluate thrombotic risk in that group
Radiofrequency ablation in thyroid diseaseManoZacMathews
This journal club discusses a prospective multi-institutional study examining the use of radiofrequency ablation (RFA) to treat benign thyroid nodules. 94 patients with benign nodules confirmed on biopsy underwent RFA and were followed for 1 year. The primary outcome was a volume reduction rate of over 50% at follow-up periods. Secondary outcomes included complication rates and sonographic features associated with treatment success. Preliminary results found a high rate of volume reduction and low complication rates, with solid composition and stiffness on elastography correlating with better response to RFA. The study aims to further evaluate the efficacy and safety of RFA as a nonsurgical option for treating benign thyroid nodules.
The document discusses the lack of consensus around treating asymptomatic carotid artery disease. While surgery reduces the risk of stroke, the absolute benefit is small given the already low risk with medical management alone. More recent data favors a purely medical approach for most asymptomatic patients. The evidence for invasive treatments like carotid endarterectomy (CEA) or stenting is considered weak, with no clear benefits shown for subgroups like women, those over 75, or different degrees of stenosis. Treating asymptomatic disease at a population level may lead to many unnecessary interventions that provide little benefit given evolving medical therapies.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
1) The CREST trial compared outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treatment of carotid artery stenosis and found they had similar rates of the primary composite outcome of periprocedural stroke, heart attack, or death as well as subsequent ipsilateral strokes.
2) Periprocedural strokes were lower in the CEA group while periprocedural heart attacks were lower in the CAS group.
3) Younger patients had slightly better outcomes with CAS while CEA remained effective, with low risks of recurrent strokes after either procedure indicating durability, especially when combined with medical therapy.
Contraindications, futility & fraility in liver transplantDr. Rohit Saini
This document discusses contraindications and factors used to assess futility for liver transplantation (LTx). It covers absolute and relative contraindications to LTx. Scores like MELD, SOFT, and UCLA are used to predict post-LTx outcomes and futility. Factors like frailty, age, comorbidities, acute liver failure criteria, and ACLF grade impact survival. The concept of a "transplantation window" in ACLF is discussed. Precipitating events, physical frailty, sarcopenia, cardiovascular disease, and pulmonary hypertension also influence futility decisions for LTx.
Deep Vein Pathophysiology: Reflux & ObstructionVein Global
By: Peter J. Pappas, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
IS STENTING TO MAINTAIN VASCULAR PATENCY GOING TO BE THE FUTUREAVATAR
This document discusses the use of stenting to maintain vascular patency for hemodialysis access and whether it will be the future standard. It notes that while stenting is established for coronary arteries, its role for arteriovenous fistulas (AVFs) and grafts (AVGs) is still controversial. The document reviews several studies that showed no benefit or increased complications from stenting AVFs/AVGs compared to angioplasty alone. However, it also discusses some limited evidence that covered stents or stents placed in specific situations like central venous stenosis may improve patency compared to angioplasty. Overall, the document questions whether stenting will become the standard given the lack of strong evidence, complications risks
4 dan atar - anticoagulation af pci - what do trials saywebevo5
Professor Dan Atar presented on anticoagulation for atrial fibrillation and percutaneous coronary intervention based on recent trial results. The WOEST trial found that dual therapy with a vitamin K antagonist (VKA) and clopidogrel reduced bleeding compared to triple therapy with a VKA, aspirin, and clopidogrel, with a potential mortality benefit. The PIONEER AF-PCI trials found that rivaroxaban dual or triple therapy was associated with significantly less bleeding than VKA triple therapy, with comparable efficacy. The RE-LY-DUAL PCI study found dabigatran dual therapy significantly reduced bleeding compared to warfarin triple therapy. Guidelines recommend balancing the risks of bleeding from
08:25 Di Mario - Recent Pubblications and ResearchEuro CTO Club
- Recent publications on CTOs from 2013-2014 focused on pathology, physiology, epidemiology, outcomes, imaging, technical approaches, and stents.
- Studies showed differences in plaque characteristics between long and short duration CTOs and impact of revascularizing CTOs on donor arteries.
- Registry data from Sweden found a 10.6% prevalence of CTOs and decreasing rates over time.
- Successful CTO PCI was associated with improved survival, less cardiac death, and reduced need for CABG compared to failed procedures.
- Imaging like IVUS and CT angiography improved technical success rates for CTO PCI.
Benign Billiary Stricture By Dr Dhaval Mangukiya
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Important Trials of the Day & Basics of Biostatistics | IACTS SCORE 2020IACTSWeb
This presentation emphasizes on the importance of biostatistics in the interpretation, analysis and design of studies and trials in the daily life of an academic surgeon. It also sheds light on some important clinical trials of the present milieu that are playing a vital role in the course that cardiothoracic surgery is taking.
Courtesy of Dr. Prasanna Simha Mohan Rao, MS, MCh, DNB, PGDHHM. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.
This presentation accompanies a video that is part of the lecture series of IACTS SCORE 2020 held at the SSSIHMS Whitefield, Bengaluru between 7th and 8th March, 2020.
This document reviews treatments for neuroendocrine tumors (NETs), including peptide receptor radionuclide therapy (PRRT). It summarizes the evidence for various NET treatment options such as surgery, somatostatin analogs, PRRT, chemotherapy, and targeted therapies. It also provides an overview of a PRRT treatment day and integrates PRRT with other NET therapies. Clinical trial data is presented demonstrating the efficacy of PRRT and targeted therapies such as everolimus and sunitinib in extending progression-free survival for NETs. The conclusion emphasizes treating NETs only when necessary and considering surgery first followed by somatostatin analogs, PRRT, intra-arterial therapies,
Triple Therapy in ACS: Recent Evidences discusses studies evaluating different antithrombotic regimens for patients with atrial fibrillation who undergo percutaneous coronary intervention. The WOEST study found that dual therapy with a vitamin K antagonist (VKA) and clopidogrel reduced bleeding compared to triple therapy with VKA, aspirin, and clopidogrel, with no increase in thrombotic risk. The ISAR-TRIPLE trial found no difference in outcomes for 6 weeks versus 6 months of triple therapy following stent implantation. PIONEER AF-PCI found that dual therapy with rivaroxaban was associated with less bleeding than triple therapy with VKA, aspirin, and a
STEMI Late Presentation - Management and practical approachSatyam Rajvanshi
1) Late presenters of STEMI (over 12 hours) make up a significant portion of STEMI patients worldwide and in India.
2) Evidence suggests that while reperfusion therapy is not beneficial for late presenters, PCI may still allow for myocardial salvage even in occluded arteries up to 72 hours from symptom onset.
3) Guidelines vary in their recommendations for revascularization of late presenters but a practical approach is to consider early revascularization for stable patients within 72 hours while stress testing those presenting after 72 hours.
1) Early revascularization through either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) improves survival rates in patients with cardiogenic shock compared to medical therapy alone.
2) There is ongoing debate about whether culprit vessel-only PCI or multivessel PCI is better for patients with cardiogenic shock and multivessel coronary artery disease. Current guidelines recommend culprit vessel PCI initially except in certain high-risk situations.
3) An integrated approach is needed using early revascularization, inotropic support, and potentially mechanical circulatory support, with involvement of multiple specialists. Cardiogenic shock continues to pose major challenges in acute cardiac care.
Similar to 2023-06 Vietnam SMA dissection.pdf (20)
Intervention for Arterial Pseudoaneurysmssuser787e5c1
This document discusses arterial pseudoaneurysms, including their causes, diagnosis, and treatment options. It notes that the prevalence of pseudoaneurysms has increased with more surgical and arteriographic procedures. Diagnosis can be done through imaging modalities like ultrasound, CT, and angiography. Treatment has increasingly involved minimally invasive interventional radiology techniques like embolization and stent placement, rather than surgery, due to lower risks. The document also presents six case studies of pseudoaneurysm patients treated with various interventional radiology procedures.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
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Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
2023-06 Vietnam SMA dissection.pdf
1. Comparison of Superior Mesenteric Artery Remodeling and Clinical
Outcomes between Conservative or Endovascular Treatment in
Spontaneous Isolated Superior Mesenteric Artery Dissection
I Hui Wu, MD., PhD.
Chairman, Department of Trauma Surgery
Clinical Surgical Professor
Cardiovascular Center, Surgical Department
National Taiwan University Hospital
2. Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA)
Spontaneous isolated dissection of the celiac artery (SIDCA)
A rare condition
• Incidence: 0.06-0.09%
• Lack of reliable laboratory findings
• Most cases have been reported in Asian countries
• Unknown etiology
• Mechanical stress at the anterior wall of SMA near the convex curvature
• Hypertension
• Genetic factor: heterogeneity of a chromosome locus at 5q13-14, found
to be linked to familial ascending aortic aneurysms and dissection
J Wang et a;J Vasc Surg 2018;68:1228-40
SH Heo et al. J Vasc Surg 2017;65:1142-51
JY Luan et al; J Vasc Surg 2016;63:530-6
3. • Symptoms
• Asymptomatic to acute peritonitis
• Acute abdominal pain: 78-91%
• Self remission within one week
• recurrent abdominal pain: usually 6 months after acute
onset
• Male, Asian, smokers, Hypertension, middle age
J Wang et a;J Vasc Surg 2018;68:1228-40
SH Heo et al. J Vasc Surg 2017;65:1142-51
H Kim, et al; Eur J Vasc Endovasc Surg (2018) 55, 132-137
Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA)
Spontaneous isolated dissection of the celiac artery (SIDCA)
4. • Classification
• Clinical
• Symptomatic
• Asymptomatic
• Morphological
• Only for SIDSMA
J Wang et a;J Vasc Surg 2018;68:1228-40
SH Heo et al. J Vasc Surg 2017;65:1142-51
H Kim, et al; Eur J Vasc Endovasc Surg (2018) 55, 132-137
Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA)
Spontaneous isolated dissection of the celiac artery (SIDCA)
5. Sakamoto 2007
Yun 2009
Luan 2013
Li 2014 Heo 2017
Morphologic classification of SIDSMA
• None of these classifications
can predict the clinical course
• Symptoms
• stenosis of the true lumen
• the length of dissection
6. Conservative treatment
• Bowel rest, hydration, analgesia, blood pressure control
• Antithrombotic or antiplatelet agents
• Controversial
Endovascular stenting
Open surgical repair
Treatment options for SIDCA and SIDSMA
7. Initial conservative treatment is safe
Antithrombotic therapy,
no benefits either clinical or morphologic outcomes
Loeffler JW, et al. J Vasc Surg 2017;66:202-8, Heo SH, et al. J Vasc Surg
2017;65:114-51 Jiarong Wang J Vasc Surg 2018;68:1228-40
None of them required secondary intervention
Meta-analysis, 200 pts
Jiarong Wang J Vasc Surg 2018;68:1228-40
Asymptomatic for SIDCA and SIDSMA
8. Symptomatic for SIDCA and SIDSMA
Conservative management still remained the most common initial treatment
9. Symptomatic for SIDCA and SIDSMA
Conservative management still remained the most common initial treatment
Wang JR, et al.
J Vasc Surg 2018;68:1228-40
Zhu et al.
J Endovasc Therapy 2018 ;25:640-48
Patient number 904 514
Conservative number 774(85.6%) 447 (87%)
Secondary intervention 8-12% 11.2-14.3%
All-cause mortality 1-2% at 28 months N/A
Complete or partial remodeling 49-51% N/A
Antithrombotic agents N/A No difference in conversion rate
10. Symptomatic for SIDCA and SIDSMA
Conservative management still remained the most common initial treatment
Wang JR, et al.
J Vasc Surg 2018;68:1228-40
Zhu et al.
J Endovasc Therapy 2018 ;25:640-48
Patient number 904 514
Conservative number 774(85.6%) 447 (87%)
Secondary intervention 8-12% 11.2-14.3%
All-cause mortality 1-2% at 28 months N/A
Complete or partial remodeling 49-51% N/A
Antithrombotic agents N/A No difference in conversion rate
11. Symptomatic for SIDCA and SIDSMA
Conservative management still remained the most common initial treatment
Wang JR, et al.
J Vasc Surg 2018;68:1228-40
Zhu et al.
J Endovasc Therapy 2018 ;25:640-48
Patient number 904 514
Conservative number 774(85.6%) 447 (87%)
Secondary intervention 8-12% 11.2-14.3%
All-cause mortality 1-2% at 28 months N/A
Complete or partial remodeling 49-51% N/A
Antithrombotic agents N/A No difference in conversion rate
12. Symptomatic for SIDCA and SIDSMA
Conservative management still remained the most common initial treatment
Wang JR, et al.
J Vasc Surg 2018;68:1228-40
Zhu et al.
J Endovasc Therapy 2018 ;25:640-48
Patient number 904 514
Conservative number 774(85.6%) 447 (87%)
Secondary intervention 8-12% 11.2-14.3%
All-cause mortality 1-2% at 28 months N/A
Complete or partial remodeling 49-51% N/A
Antithrombotic agents N/A No difference in conversion rate
13. Endovascular intervention
Persistent symptoms, dissection progression, bowel gangrene, and aneurysmal degeneration
16.2%-33.6% as the initial treatment
93.5-95.7%: symptom relief
2/97 (2%): required re-intervention due to ISR
Open surgery
Bowel infarction or necrosis, peritonitis, or aneurysm rupture
3.2%-5.1% as the initial treatment
3/34 (8.8%) required re-intervention due to graft thrombosis
Wang JR, et al. J Vasc Surg 2018;68:1228-40
Symptomatic for SIDCA and SIDSMA
Luan JY, et al. . J Vasc Surg 2016;63:530-6
14. Proportion achieved complete remodeling after conservative treatment
Morphologic changes of lesion vessels
SIDCA > SIDSMA
Complete remodeling: (64% VS. 25%, P<0.05)
Symptomatic > Asymptomatic (OR, 3.95; 95% CI, 1.31-11.85)
Complete remodeling
Mean time: 16 ± 16 months(range, 3-63 months) after initial
pain relief
61% within 12 months
81% within 24 months
Dissection progression or aneurysmal formation: 3%
Wang JR, et al. J Vasc Surg 2018;68:1228-40
Heo SH, et al. J Vasc Surg 2017;65:1142-51
15. Proportion achieved complete remodeling after endovascular treatment
• Single center, 2011-2016, 128 pts
• SMA stent: 87.5%
• SMA remodeling
• SIDSMA stenting group vs non-stent group: 88.3% vs 6.3%
• Primary stent patency rate: 99.1%
• Recurrent symptom
• Stent group vs non-stent group: 0.9% vs 25%
• Survival
• Stents group vs non-stent group: 95.8% vs 62.5% at three years
Morphologic changes of lesion vessels
Qiu CY, et al. Eur J Vasc Endovasc Surg 2019; 58:88-95
16. Proportion achieved complete remodeling after endovascular treatment
• Single center, 2011-2016, 128 pts
• SMA stent: 87.5%
• SMA remodeling
• SIDSMA stenting group vs non-stent group: 88.3% vs 6.3%
• Primary stent patency rate: 99.1%
• Recurrent symptom
• Stent group vs non-stent group: 0.9% vs 25%
• Survival
• Stents group vs non-stent group: 95.8% vs 62.5% at three years
Morphologic changes of lesion vessels
Qiu CY, et al. Eur J Vasc Endovasc Surg 2019; 58:88-95
17. Proportion achieved complete remodeling after endovascular treatment
• Single center, 2011-2016, 128 pts
• SMA stent: 87.5%
• SMA remodeling
• SIDSMA stenting group vs non-stent group: 88.3% vs 6.3%
• Primary stent patency rate: 99.1%
• Recurrent symptom
• Stent group vs non-stent group: 0.9% vs 25%
• Survival
• Stents group vs non-stent group: 95.8% vs 62.5% at three years
Morphologic changes of lesion vessels
Qiu CY, et al. Eur J Vasc Endovasc Surg 2019; 58:88-95
18. Proportion achieved complete remodeling after endovascular treatment
• Single center, 2011-2016, 128 pts
• SMA stent: 87.5%
• SMA remodeling
• SIDSMA stenting group vs non-stent group: 88.3% vs 6.3%
• Primary stent patency rate: 99.1%
• Recurrent symptom
• Stent group vs non-stent group: 0.9% vs 25%
• Survival
• Stents group vs non-stent group: 95.8% vs 62.5% at three years
Morphologic changes of lesion vessels
Qiu CY, et al. Eur J Vasc Endovasc Surg 2019; 58:88-95
19. Proportion achieved complete remodeling after endovascular treatment
• Single center, 2011-2016, 128 pts
• SMA stent: 87.5%
• SMA remodeling
• SIDSMA stenting group vs non-stent group: 88.3% vs 6.3%
• Primary stent patency rate: 99.1%
• Recurrent symptom
• Stent group vs non-stent group: 0.9% vs 25%
• Survival
• Stents group vs non-stent group: 95.8% vs 62.5% at three years
Morphologic changes of lesion vessels
Qiu CY, et al. Eur J Vasc Endovasc Surg 2019; 58:88-95
20. Proportion achieved complete remodeling after endovascular treatment
• Single center, 2011-2016, 128 pts
• SMA stent: 87.5%
• SMA remodeling
• SIDSMA stenting group vs non-stent group: 88.3% vs 6.3%
• Primary stent patency rate: 99.1%
• Recurrent symptom
• Stent group vs non-stent group: 0.9% vs 25%
• Survival
• Stents group vs non-stent group: 95.8% vs 62.5% at three years
Morphologic changes of lesion vessels
Qiu CY, et al. Eur J Vasc Endovasc Surg 2019; 58:88-95
21. 2007/01-2019/08, NTUH
• Intimal flap at SMA with/without false lumen thrombosis
• Concomitant aortic and SMA dissection excluded
29.41%
treatment with the preexisting medications
• Food withdrawal
• Hydration
• Analgesia
• Blood pressure control
• Consider pre-existing comorbidities to
add on antithrombotic agent
70.59%
> 2 days
progressive SMA dissection
• Brachial or femoral approach
• Self-expandable bare metal stents
• Proximal/Distal landing zone >1cm
• 3–5 mm beyond the orifice of the SMA into the aorta
• Stent size: distal 5 mm, proximal 8 mm
SAPT/DAPT
3- and 6-month intervals and annually
3- and 6-month intervals and annually
54.17% 41.67% 4.1%
Conservative 67.65% (23/34)
24. No aneurysmal change
EVT was the only significant factor for SMA
remodeling
No peri-procedure complication
25.
26. At a median follow-up of 23.3 months (range: 9.6–55.2):
• No SMA aneurysm formation
• No recurrent symptoms requiring admission
• No stent occlusion
• No new dissection
• Survival 96% (1 mortality in conservative group at 4 year unrelated to SMA dissection)
70% symptomatic, mostly abdominal pain
30% (45% in all symptomatic patients) need intervention: persistent abdominal pain
From qualitative result (remodeling or not) to quantitative data:
Endovascular SMA stent significantly promote SMA remodeling with no peri-procedure complication,
especially in patients with Yun’s IIb classification morphology
At near 2 years: no aneurysmal change, no recurrent symptoms, good survival
More patients and Longer follow up to see clinical outcome, Timing for intervention