By: Lowell S. Kabnick, MD, FACS
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Coronary calcium scoring may be a more logical way to assess cardiovascular risk than established epidemiological models. The document discusses how atherosclerosis is complex and poorly understood, making risk assessment difficult. Studies show calcium scoring independently predicts risk and enhances risk stratification beyond traditional risk factors. Large trials found higher calcium scores strongly associated with future coronary events and mortality. The document argues looking for disease through calcium scoring is more intuitive than using charts or equations without an imaging biomarker of disease. It concludes calcium scoring individualizes risk assessment better than population-based guidelines.
The document discusses coronary artery calcium scoring, which is a noninvasive test that can help predict cardiovascular risk. It provides background on how calcium builds up in coronary arteries and how calcium scores correlate with future risk of a cardiovascular event. Higher calcium scores indicate more severe atherosclerosis and greater risk. The document recommends getting a calcium score for intermediate-risk asymptomatic adults to help guide prevention and treatment. While radiation exposure is a downside, the score provides prognostic value beyond traditional risk factors and can help identify those needing lifestyle changes or medication to lower risk.
This document discusses the prevalence of carotid artery atherosclerosis and stenosis in patients with peripheral arterial disease (PAD). The main points are:
1) Over 85% of patients with PAD also had carotid plaques, indicating a high rate of co-occurrence of carotid and peripheral atherosclerosis.
2) 11.68% of patients with symptomatic PAD had significant carotid stenosis (>50%), compared to 4% of patients without PAD, showing PAD patients have an increased risk of carotid stenosis.
3) Screening for asymptomatic carotid stenosis is important for PAD patients, especially those with an ankle-brachial index <0.7, as the prevalence of asymptomatic carotid stenosis increases with lower ABI values.
This document discusses trends in vascular access sites for coronary procedures. It notes that radial access has significantly increased over time in many countries, now accounting for over 75% of procedures in some registries. Some benefits of radial access include lower mortality, major adverse cardiac and cerebrovascular events, major bleeding, and vascular complications compared to femoral access. However, it also notes there is a paradoxical increase in vascular complications with femoral access as radial access has become more prevalent. This may be due to adverse patient characteristics now associated more with femoral procedures. Overall, while radial access appears beneficial, patient factors remain an important determinant of outcomes. Operator experience with femoral access is still important.
This document presents a systematic literature review of cardiovascular disease (CVD) in Latin American patients with rheumatoid arthritis (RA). The review identified 16 relevant articles. The prevalence of CVD in Latin American RA patients was found to be 35.3%. Non-traditional risk factors for CVD in this population included genetic factors, autoantibodies, chronic inflammation, long RA duration, steroid use, familial autoimmunity, and thrombogenic factors. The review concluded that there is limited data on CVD and RA in Latin America and called for further evaluation of cardiovascular risk factors and generation of public health policies to reduce morbidity and mortality rates.
This document discusses type 2 endoleaks, which occur in about 60% of endovascular aneurysm repair (EVAR) complications. While type 2 endoleaks are the most common type of endoleak, their clinical significance is debated. The document reviews evidence that type 2 endoleaks can cause sac expansion and rupture over time. It also discusses various treatment options for type 2 endoleaks including transarterial embolization, with limited long-term success rates, and concludes that current techniques are probably not effective in the long term management of type 2 endoleaks.
The document discusses the impact of the internet on vascular surgery. It provides a brief history of the internet and outlines 15 ways that vascular surgeons can benefit from the internet, including watching operations online, accessing medical literature and research, communicating with colleagues, providing patient education and follow up, and maintaining an online presence. The internet allows vascular surgeons to have the most up-to-date information and stay on the cutting edge of developments in the field.
Coronary calcium scoring may be a more logical way to assess cardiovascular risk than established epidemiological models. The document discusses how atherosclerosis is complex and poorly understood, making risk assessment difficult. Studies show calcium scoring independently predicts risk and enhances risk stratification beyond traditional risk factors. Large trials found higher calcium scores strongly associated with future coronary events and mortality. The document argues looking for disease through calcium scoring is more intuitive than using charts or equations without an imaging biomarker of disease. It concludes calcium scoring individualizes risk assessment better than population-based guidelines.
The document discusses coronary artery calcium scoring, which is a noninvasive test that can help predict cardiovascular risk. It provides background on how calcium builds up in coronary arteries and how calcium scores correlate with future risk of a cardiovascular event. Higher calcium scores indicate more severe atherosclerosis and greater risk. The document recommends getting a calcium score for intermediate-risk asymptomatic adults to help guide prevention and treatment. While radiation exposure is a downside, the score provides prognostic value beyond traditional risk factors and can help identify those needing lifestyle changes or medication to lower risk.
This document discusses the prevalence of carotid artery atherosclerosis and stenosis in patients with peripheral arterial disease (PAD). The main points are:
1) Over 85% of patients with PAD also had carotid plaques, indicating a high rate of co-occurrence of carotid and peripheral atherosclerosis.
2) 11.68% of patients with symptomatic PAD had significant carotid stenosis (>50%), compared to 4% of patients without PAD, showing PAD patients have an increased risk of carotid stenosis.
3) Screening for asymptomatic carotid stenosis is important for PAD patients, especially those with an ankle-brachial index <0.7, as the prevalence of asymptomatic carotid stenosis increases with lower ABI values.
This document discusses trends in vascular access sites for coronary procedures. It notes that radial access has significantly increased over time in many countries, now accounting for over 75% of procedures in some registries. Some benefits of radial access include lower mortality, major adverse cardiac and cerebrovascular events, major bleeding, and vascular complications compared to femoral access. However, it also notes there is a paradoxical increase in vascular complications with femoral access as radial access has become more prevalent. This may be due to adverse patient characteristics now associated more with femoral procedures. Overall, while radial access appears beneficial, patient factors remain an important determinant of outcomes. Operator experience with femoral access is still important.
This document presents a systematic literature review of cardiovascular disease (CVD) in Latin American patients with rheumatoid arthritis (RA). The review identified 16 relevant articles. The prevalence of CVD in Latin American RA patients was found to be 35.3%. Non-traditional risk factors for CVD in this population included genetic factors, autoantibodies, chronic inflammation, long RA duration, steroid use, familial autoimmunity, and thrombogenic factors. The review concluded that there is limited data on CVD and RA in Latin America and called for further evaluation of cardiovascular risk factors and generation of public health policies to reduce morbidity and mortality rates.
This document discusses type 2 endoleaks, which occur in about 60% of endovascular aneurysm repair (EVAR) complications. While type 2 endoleaks are the most common type of endoleak, their clinical significance is debated. The document reviews evidence that type 2 endoleaks can cause sac expansion and rupture over time. It also discusses various treatment options for type 2 endoleaks including transarterial embolization, with limited long-term success rates, and concludes that current techniques are probably not effective in the long term management of type 2 endoleaks.
The document discusses the impact of the internet on vascular surgery. It provides a brief history of the internet and outlines 15 ways that vascular surgeons can benefit from the internet, including watching operations online, accessing medical literature and research, communicating with colleagues, providing patient education and follow up, and maintaining an online presence. The internet allows vascular surgeons to have the most up-to-date information and stay on the cutting edge of developments in the field.
Starting endovascular surgery in third world countriesImran Javed
Professor Dr. Imran Javed proposes starting endovascular surgery programs in third world countries. Some key hurdles include poverty, lack of specialized equipment and trained staff, and low priority of healthcare research. The plan is to first perform basic diagnostic endovascular techniques and convince hospitals of long-term benefits. Funding would come from various sources and subsidized equipment from companies. An exchange program with US universities would help train local specialists and collaborate on research over a 3 year timeline.
El documento habla sobre el tratamiento de lesiones pequeñas. Explica que existen nuevos paradigmas para el tratamiento de estas lesiones, enfocándose en estrategias preventivas para evitar la formación de nuevas lesiones y limitar o revertir las lesiones incipientes. También discute cuando se considera una lesión pequeña y los enfoques de tratamiento no operatorio versus operatorio, dependiendo del riesgo del paciente y los factores causales.
Endovascular Repair of Thoracoabdominal AneurysmPAIRS WEB
This document discusses total endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using fenestrated and branched endovascular aneurysm repair (F-EVAR/B-EVAR) techniques. It summarizes outcomes from 86 high-risk patients treated with F-EVAR/B-EVAR for TAAA between 2007-2014, finding a 30-day mortality of 2.3%, 1-year survival of 91%, and 3-year survival of 88%. The use of staged procedures was associated with reducing spinal cord ischemia from 10% to 0%. The conclusion is that F-EVAR/B-EVAR provides good outcomes for high-risk TAAA patients when
Consecutive Aneurysms Treated by Endovascular ApproachDr Vipul Gupta
Endovascular coiling is now the primary treatment approach for ruptured intracranial aneurysms based on evidence from trials like ISAT showing improved outcomes compared to clipping. The presenter's experience with 33 patients with 35 consecutive aneurysms showed high rates of aneurysm occlusion (95%) and good clinical outcomes (87.6% had mRS 0-2) when treated using a protocol-based endovascular approach with neurosurgical and critical care support. Complications were low when meticulous techniques were used along with protocols for management of issues like vasospasm.
Endovascular repair of traumatic aortic transection six years of experienceGeorge Trellopoulos
The document discusses endovascular repair of traumatic aortic transections based on the experiences of treating 12 patients. It finds that endovascular stent grafting securely excluded the traumatic transections with no mortality or paraplegia, though one patient experienced late stent graft collapse requiring reintervention. The results suggest endovascular repair may be superior to open surgery for traumatic aortic transections given its lower mortality, paraplegia, and stroke rates.
El documento describe las tres fases de la patología del Síndrome de Insuficiencia Respiratoria Aguda (SIRA): la fase exudativa, la fase proliferativa y la fase fibrótica. También explica los mecanismos de reparación y remodelación del tejido pulmonar dañado, incluyendo la proliferación y diferenciación de las células alveolares tipo II, la fagocitosis de neutrófilos apoptóticos y la resolución gradual de la fibrosis. Además, analiza el papel de la apoptosis en el
Gustavo S. Oderich discusses techniques for treating iliac artery chronic total occlusions (CTOs). He outlines the endovascular approach as widely accepted for TASC D lesions. Key points include choosing the femoral or brachial approach, using adjuncts like atherectomy for difficult lesions, and considering covered stents or stent grafting of the aortic bifurcation to improve patency rates over bare metal stents. The goal is to recanalize the occlusion and restore blood flow percutaneously when possible.
Acs0608 Fundamentals Of Endovascular Surgerymedbookonline
This document discusses fundamentals of endovascular surgery. It describes techniques for vascular access and puncture of arteries. The common femoral artery is often used for access due to its accessibility and size. The artery can be located through palpation of landmarks like the femoral head and pubic tubercle. Once located, the artery is punctured using either a single-wall or double-wall entry technique with a needle.
Endovascular repair of traumatic aortic transection six years of experienceGeorge Trellopoulos
This document discusses endovascular repair as an alternative treatment for ruptured abdominal aortic aneurysms compared to open repair. Endovascular repair has the benefits of avoiding general anesthesia, clamping, and blood loss. Several studies show endovascular repair results in lower mortality and morbidity rates compared to open repair. However, patient hemodynamic status and anatomy must meet certain criteria for endovascular repair to be feasible. Key considerations for successful endovascular repair include the patient's clinical condition, CT imaging of anatomy, type of anesthesia used, stent graft configuration, and potential use of an occlusion balloon. Long-term data is still needed but endovascular repair shows promise as an additional treatment option for ruptured abdominal aortic aneurys
- Endovascular repair is an accepted treatment for complicated Type B aortic dissection, with the goals of covering the primary entry tear, expanding the compressed true lumen, inducing false lumen thrombosis, and preventing aneurysm development or rupture.
- Key procedural considerations include defining the indication clearly, reviewing imaging to locate the primary tear, choosing the best access vessel, using techniques like blood pressure manipulation to aid deployment, and being familiar with the capabilities and limitations of the endografts used.
- There is still uncertainty around the optimal use of bare dissection stents and when TEVAR is appropriate for uncomplicated dissection. Ongoing research through randomized trials may provide answers.
Vipul Gupta discusses his experience treating complex ruptured aneurysms using endovascular techniques. He defines complex aneurysms as giant, dissecting fusiform, blister, aneurysms near the neck or with lobules, dysplastic bifurcation, or those with arteries from the sac. Gupta's experience is based on treating 451 patients over 19 years. He advocates the use of flow diverters and stent-assisted coiling to treat giant/large aneurysms. The challenges of treating fusiform-dissecting and blister aneurysms are also discussed. Close follow up is important after treatment due to the risk of continued growth. Expertise, technology, and a multidisciplinary team approach are emphasized for achieving
This document discusses lymphedema, including its classification, diagnosis, assessment, grading, and treatment options. It classifies lymphedema as primary or secondary and notes the prevalence among vascular clinic patients. Treatment options discussed include skin care, compression garments, manual lymphatic drainage, multilayer bandaging, pneumatic compression devices, drug therapy, laser therapy, and surgical options like liposuction and lymphatic reconstruction. Integrated multidisciplinary care is emphasized as most effective for managing this chronic condition long-term.
Este documento presenta información sobre los angiosomas y su importancia en la cirugía vascular. Brevemente resume:
1) Los angiosomas son territorios cutáneos irrigados por una arteria principal y sus ramas. Su concepto se ha desarrollado a lo largo de más de un siglo.
2) La vascularización de la piel se organiza en vasos cutáneos directos e indirectos, formando una red arterial continua.
3) El conocimiento de los angiosomas es fundamental para la revascularización quirúrgica, ya que permite dir
This document discusses surgical tips for bleeding control after aortic surgery. It describes two case studies of patients who underwent aortic surgery and subsequently experienced bleeding issues. Bleeding is a life-threatening complication for thoracic aortic surgery. Proper surgical technique and advances in graft materials and hemostasis techniques have helped reduce bleeding, but it remains a challenge, especially for acute aortic dissections. Both topical hemostatic agents and optimizing a patient's systemic hemostatic system can help manage bleeding.
Dr. Anil Meetei presented on endovascular surgery and its various procedures and techniques. Endovascular surgery involves minimally invasive procedures using catheters and instruments inserted into blood vessels. Some key procedures discussed included balloon angioplasty, stenting, atherectomy to remove plaque, thrombolysis to treat clots, and filters to prevent pulmonary embolism. Factors such as device sizing, access points, imaging, and complications were also reviewed.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in stable angina versus unstable coronary syndromes. The researchers found that lesions in unstable patients had greater plaque burden despite similar lumen narrowing, and were more likely to show positive arterial remodeling compared to stable lesions. This suggests that bulky, remodeled plaques may be more prone to rupture and cause acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in patients with stable angina versus unstable coronary syndromes. It found that lesions in unstable patients had greater plaque burden despite similar lumen narrowing, and a greater extent of positive arterial remodeling compared to stable patients. Lesions in unstable patients also tended to have more echolucent plaque morphology. The results suggest that bulky, remodeled plaques may be more prone to rupture and cause acute coronary syndromes.
This study examined 114 patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) to determine predictors of improvement in stroke volume index (SVI) following the procedure. Regression analyses found that higher baseline SVI and lower valvulo-arterial impedance were associated with greater improvement in SVI after TAVR. Larger aortic valve area and reductions in valvulo-arterial impedance achieved through TAVR also predicted increased SVI. The results suggest that TAVR leads to better hemodynamic outcomes for patients with low-flow states and high impedance at baseline.
The document summarizes clinical trials conducted to evaluate MultiFunction CardioGram (MCG), a computational biology approach to cardiac diagnosis, compared to coronary angiography. Over 1,000 patients across multiple centers underwent both MCG testing and angiography with results analyzed double-blind. Trials found MCG detected coronary stenosis with sensitivities of 60-80% and specificities over 75%, with areas under the ROC curve of 0.87 or higher. MCG severity scores correlated with angiographic stenosis and could stratify patients by disease severity.
Starting endovascular surgery in third world countriesImran Javed
Professor Dr. Imran Javed proposes starting endovascular surgery programs in third world countries. Some key hurdles include poverty, lack of specialized equipment and trained staff, and low priority of healthcare research. The plan is to first perform basic diagnostic endovascular techniques and convince hospitals of long-term benefits. Funding would come from various sources and subsidized equipment from companies. An exchange program with US universities would help train local specialists and collaborate on research over a 3 year timeline.
El documento habla sobre el tratamiento de lesiones pequeñas. Explica que existen nuevos paradigmas para el tratamiento de estas lesiones, enfocándose en estrategias preventivas para evitar la formación de nuevas lesiones y limitar o revertir las lesiones incipientes. También discute cuando se considera una lesión pequeña y los enfoques de tratamiento no operatorio versus operatorio, dependiendo del riesgo del paciente y los factores causales.
Endovascular Repair of Thoracoabdominal AneurysmPAIRS WEB
This document discusses total endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using fenestrated and branched endovascular aneurysm repair (F-EVAR/B-EVAR) techniques. It summarizes outcomes from 86 high-risk patients treated with F-EVAR/B-EVAR for TAAA between 2007-2014, finding a 30-day mortality of 2.3%, 1-year survival of 91%, and 3-year survival of 88%. The use of staged procedures was associated with reducing spinal cord ischemia from 10% to 0%. The conclusion is that F-EVAR/B-EVAR provides good outcomes for high-risk TAAA patients when
Consecutive Aneurysms Treated by Endovascular ApproachDr Vipul Gupta
Endovascular coiling is now the primary treatment approach for ruptured intracranial aneurysms based on evidence from trials like ISAT showing improved outcomes compared to clipping. The presenter's experience with 33 patients with 35 consecutive aneurysms showed high rates of aneurysm occlusion (95%) and good clinical outcomes (87.6% had mRS 0-2) when treated using a protocol-based endovascular approach with neurosurgical and critical care support. Complications were low when meticulous techniques were used along with protocols for management of issues like vasospasm.
Endovascular repair of traumatic aortic transection six years of experienceGeorge Trellopoulos
The document discusses endovascular repair of traumatic aortic transections based on the experiences of treating 12 patients. It finds that endovascular stent grafting securely excluded the traumatic transections with no mortality or paraplegia, though one patient experienced late stent graft collapse requiring reintervention. The results suggest endovascular repair may be superior to open surgery for traumatic aortic transections given its lower mortality, paraplegia, and stroke rates.
El documento describe las tres fases de la patología del Síndrome de Insuficiencia Respiratoria Aguda (SIRA): la fase exudativa, la fase proliferativa y la fase fibrótica. También explica los mecanismos de reparación y remodelación del tejido pulmonar dañado, incluyendo la proliferación y diferenciación de las células alveolares tipo II, la fagocitosis de neutrófilos apoptóticos y la resolución gradual de la fibrosis. Además, analiza el papel de la apoptosis en el
Gustavo S. Oderich discusses techniques for treating iliac artery chronic total occlusions (CTOs). He outlines the endovascular approach as widely accepted for TASC D lesions. Key points include choosing the femoral or brachial approach, using adjuncts like atherectomy for difficult lesions, and considering covered stents or stent grafting of the aortic bifurcation to improve patency rates over bare metal stents. The goal is to recanalize the occlusion and restore blood flow percutaneously when possible.
Acs0608 Fundamentals Of Endovascular Surgerymedbookonline
This document discusses fundamentals of endovascular surgery. It describes techniques for vascular access and puncture of arteries. The common femoral artery is often used for access due to its accessibility and size. The artery can be located through palpation of landmarks like the femoral head and pubic tubercle. Once located, the artery is punctured using either a single-wall or double-wall entry technique with a needle.
Endovascular repair of traumatic aortic transection six years of experienceGeorge Trellopoulos
This document discusses endovascular repair as an alternative treatment for ruptured abdominal aortic aneurysms compared to open repair. Endovascular repair has the benefits of avoiding general anesthesia, clamping, and blood loss. Several studies show endovascular repair results in lower mortality and morbidity rates compared to open repair. However, patient hemodynamic status and anatomy must meet certain criteria for endovascular repair to be feasible. Key considerations for successful endovascular repair include the patient's clinical condition, CT imaging of anatomy, type of anesthesia used, stent graft configuration, and potential use of an occlusion balloon. Long-term data is still needed but endovascular repair shows promise as an additional treatment option for ruptured abdominal aortic aneurys
- Endovascular repair is an accepted treatment for complicated Type B aortic dissection, with the goals of covering the primary entry tear, expanding the compressed true lumen, inducing false lumen thrombosis, and preventing aneurysm development or rupture.
- Key procedural considerations include defining the indication clearly, reviewing imaging to locate the primary tear, choosing the best access vessel, using techniques like blood pressure manipulation to aid deployment, and being familiar with the capabilities and limitations of the endografts used.
- There is still uncertainty around the optimal use of bare dissection stents and when TEVAR is appropriate for uncomplicated dissection. Ongoing research through randomized trials may provide answers.
Vipul Gupta discusses his experience treating complex ruptured aneurysms using endovascular techniques. He defines complex aneurysms as giant, dissecting fusiform, blister, aneurysms near the neck or with lobules, dysplastic bifurcation, or those with arteries from the sac. Gupta's experience is based on treating 451 patients over 19 years. He advocates the use of flow diverters and stent-assisted coiling to treat giant/large aneurysms. The challenges of treating fusiform-dissecting and blister aneurysms are also discussed. Close follow up is important after treatment due to the risk of continued growth. Expertise, technology, and a multidisciplinary team approach are emphasized for achieving
This document discusses lymphedema, including its classification, diagnosis, assessment, grading, and treatment options. It classifies lymphedema as primary or secondary and notes the prevalence among vascular clinic patients. Treatment options discussed include skin care, compression garments, manual lymphatic drainage, multilayer bandaging, pneumatic compression devices, drug therapy, laser therapy, and surgical options like liposuction and lymphatic reconstruction. Integrated multidisciplinary care is emphasized as most effective for managing this chronic condition long-term.
Este documento presenta información sobre los angiosomas y su importancia en la cirugía vascular. Brevemente resume:
1) Los angiosomas son territorios cutáneos irrigados por una arteria principal y sus ramas. Su concepto se ha desarrollado a lo largo de más de un siglo.
2) La vascularización de la piel se organiza en vasos cutáneos directos e indirectos, formando una red arterial continua.
3) El conocimiento de los angiosomas es fundamental para la revascularización quirúrgica, ya que permite dir
This document discusses surgical tips for bleeding control after aortic surgery. It describes two case studies of patients who underwent aortic surgery and subsequently experienced bleeding issues. Bleeding is a life-threatening complication for thoracic aortic surgery. Proper surgical technique and advances in graft materials and hemostasis techniques have helped reduce bleeding, but it remains a challenge, especially for acute aortic dissections. Both topical hemostatic agents and optimizing a patient's systemic hemostatic system can help manage bleeding.
Dr. Anil Meetei presented on endovascular surgery and its various procedures and techniques. Endovascular surgery involves minimally invasive procedures using catheters and instruments inserted into blood vessels. Some key procedures discussed included balloon angioplasty, stenting, atherectomy to remove plaque, thrombolysis to treat clots, and filters to prevent pulmonary embolism. Factors such as device sizing, access points, imaging, and complications were also reviewed.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in stable angina versus unstable coronary syndromes. The researchers found that lesions in unstable patients had greater plaque burden despite similar lumen narrowing, and were more likely to show positive arterial remodeling compared to stable lesions. This suggests that bulky, remodeled plaques may be more prone to rupture and cause acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in patients with stable angina versus unstable coronary syndromes. It found that lesions in unstable patients had greater plaque burden despite similar lumen narrowing, and a greater extent of positive arterial remodeling compared to stable patients. Lesions in unstable patients also tended to have more echolucent plaque morphology. The results suggest that bulky, remodeled plaques may be more prone to rupture and cause acute coronary syndromes.
This study examined 114 patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) to determine predictors of improvement in stroke volume index (SVI) following the procedure. Regression analyses found that higher baseline SVI and lower valvulo-arterial impedance were associated with greater improvement in SVI after TAVR. Larger aortic valve area and reductions in valvulo-arterial impedance achieved through TAVR also predicted increased SVI. The results suggest that TAVR leads to better hemodynamic outcomes for patients with low-flow states and high impedance at baseline.
The document summarizes clinical trials conducted to evaluate MultiFunction CardioGram (MCG), a computational biology approach to cardiac diagnosis, compared to coronary angiography. Over 1,000 patients across multiple centers underwent both MCG testing and angiography with results analyzed double-blind. Trials found MCG detected coronary stenosis with sensitivities of 60-80% and specificities over 75%, with areas under the ROC curve of 0.87 or higher. MCG severity scores correlated with angiographic stenosis and could stratify patients by disease severity.
- 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.
This study examined the impact of sarcopenia on long-term mortality in 200 patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Sarcopenia, defined as low skeletal muscle mass, was assessed on pre-operative CT scans. Patients with sarcopenia had significantly higher mortality rates than those without sarcopenia (76% vs 48%, p=0.016). On multivariate analysis, sarcopenia, hypertension, and older age were independent predictors of mortality following EVAR. The presence of sarcopenia on CT may help predict long-term survival in AAA patients undergoing EVAR.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. These findings suggest that larger plaque burdens with positive remodeling may render lesions more prone to rupture and acute coronary syndromes in unstable patients.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. This suggests that bulky, remodeled plaques may be more vulnerable to rupture, leading to acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
142 arterial remodelling in coronary syndromesSHAPE Society
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. This suggests that bulky, remodeled plaques may be more vulnerable to rupture, leading to acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. This suggests that bulky, remodeled plaques may be more vulnerable to rupture, leading to acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden, more positive arterial remodeling, and more frequently exhibited echolucent plaque morphology at the culprit lesion compared to those with stable angina. The results suggest that bulky, positively remodeled plaques may be more prone to rupture and contribute to the development of acute coronary syndromes.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. These findings suggest that larger plaque burdens with positive remodeling may render lesions more prone to rupture and acute coronary syndromes in unstable patients.
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. This suggests that bulky, remodeled plaques may be more vulnerable to rupture, leading to acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
Percutaneous Valve implantation or Operation in aortic stenosisdrucsamal
1) This document describes the case of an 80-year-old male patient with severe aortic stenosis, mitral valve disease, and reduced left ventricular function who is being evaluated for treatment.
2) Echocardiography revealed severe aortic stenosis, mild aortic regurgitation, moderate-severe mitral regurgitation, and severe tricuspid regurgitation with a reduced ejection fraction of 30%.
3) Due to his age and comorbidities, the patient is at high surgical risk. Transcatheter aortic valve implantation (TAVI) may be a safer alternative to surgical aortic valve replacement (AVR) plus mitral valve surgery.
The document discusses umbilical cord blood transplantation. It notes that umbilical cord blood is an important source of hematopoietic stem cells for transplantation. The advantages of using cord blood include faster availability, tolerance to some HLA mismatching, and lower risk of infections. However, cord blood transplants have limitations like lower cell doses and risk of graft failure or delayed engraftment. Studies show improved outcomes with higher cell doses or double cord blood transplants. Cell dose and HLA matching remain important factors for transplant success.
ANEMIA IS ASSOCIATED WITH GREATER MORBIDITY AND RESOURCE UTILIZATION IN PEDIA...Texas Children's Hospital
This study analyzed data from over 2,400 pediatric hospital admissions for systolic heart failure without congenital heart disease. It found that anemia was present in 26% of admissions and was associated with younger patient age, more systemic comorbidities like kidney and liver failure, and greater resource utilization including longer hospital stays and higher costs. While anemia was linked to worse outcomes like cardiac death on initial analysis, this association did not remain significant after accounting for other clinical factors. Overall, the study suggests anemia represents greater illness burden for pediatric heart failure patients and optimizing anemia management may help improve their outcomes.
1. The document discusses reflux in the venous system, including anatomy, physiology, diagnostic methods, and classifications. It notes that reflux can occur in the superficial or deep venous systems or in perforating veins.
2. Duplex ultrasound is a key noninvasive method for evaluating venous reflux, and standardized techniques like patient positioning and provocative maneuvers are important for reliability. Reflux patterns and durations are evaluated.
3. Reflux in the deep venous system and perforating veins is clinically significant as it can contribute to skin changes and ulceration in chronic venous insufficiency. Reflux evaluation over time can identify progression.
Thorax cardio coeur heart evaluation asymptomatic smoker p douekJFIM
The document discusses cardiovascular risk assessment in asymptomatic patients, specifically evaluating a 50-year-old asymptomatic smoker using coronary artery calcium scoring. Coronary artery calcium scoring can help reclassify patients' risk levels compared to traditional risk models and may lead patients to modify risk factors or receive preventative treatments. However, calcium scoring has limitations and its ability to improve outcomes beyond risk factor modification requires further study.
The SAFE-PCI for Women Trial was a prospective, randomized trial comparing radial versus femoral approaches for percutaneous coronary intervention (PCI) in women. 1787 women undergoing cardiac catheterization or PCI were randomized to radial or femoral access. The trial was terminated early due to lower than expected event rates. In the subgroup of women undergoing PCI (n=345 radial, n=346 femoral), there was no significant difference in the primary efficacy endpoint of bleeding or vascular complications between radial and femoral access. However, radial access was associated with a higher rate of needing conversion to femoral access. Overall, the results suggest an initial radial access strategy may be preferred for some women undergoing cardiac procedures.
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Does Multiple Axial Vein Incompetence Increase The Clinical Severity of Venous Disease?
1. Division of Vascular and Endovascular Surgery
Lowell S. Kabnick, MD, FACS
Does Multiple Axial Vein
Incompetence Increase
The Clinical Severity Of
Venous Disease?
2. Division of Vascular and Endovascular Surgery
Disclosure
.
I do not have any potential conflict of
interest
3. Patterns of saphenous reflux in
women with primary veins
590 limbs(326 women) C2 class
Reflux 80%
GSV and SSV 17%
GSV 60%
SSV 20%
Nonsaphenous 20%
Englehorn; JVS 2005;41-645-51
4. Division of Vascular and Endovascular Surgery
LOWELL S. KABNICK, MD
HAMZA RANA, MD
Clinical Severity and Number of
Superficial Axial Veins with Reflux in
Each Lower Extremeity
5. Division of Vascular and Endovascular Surgery
Study Aim:
To evaluate the association between clinical
severity of primary varicose veins and
number of superficial axial veins with
reflux for each leg
6. Division of Vascular and Endovascular Surgery
Study Design
•Single Center, Retrospective
•Patients:
•>18 yr- seen at NYU Langone Medical Center Vein
Center -November 2012 and February 2013 with baseline
data available for CEAP clinical class, VCSS, and
Venous DUS.
•Excluded were:
•Patients <18 year of age
•History of previous lower extremity superficial venous
intervention
•Deep venous thrombosis.
7. Division of Vascular and Endovascular Surgery
Predictor Variable:
•Clinical classification of CEAP
•Revised Venous Clinical Severity Score
Outcome Variable:
•Number of axial superficial veins with reflux on
venous duplex ultrasound
•Duration of reflux > 0.5 seconds
•GSV, SSV, AASV, PASV saphenous vein,
intersaphenous vein (Vein of Giacomini), and cranial
extension of small saphenous vein
•Relevant Covariates:
•Age, sex, BMI, number of pregnancies
13. Division of Vascular and Endovascular Surgery
CEAP Category & Superficial
Refluxing Veins
Cochran-Armitage Trend Test for
CEAP Categories <0.0001
There is a trend towards multiple superficial veins with
worsening CEAP class with P value of <.0001
14. Division of Vascular and Endovascular Surgery
Correlation Between Number Of
Refluxing Superficial Axial Veins And
Clinical Variables
Variable Number of Superficial
Veins with Reflux r Value
P Value
VCSS 0.43 0.01
CEAP 0.56 0.01
Age -0.04 0.56
BMI 0.09 0.23
Pearson and Spearman Coefficient (r values) Correlation
>0.5 strong
0.3-0.5 moderate
15. Univariate Logistic Regression Analysis
Variable Multiple Superficial
Axial Veins (≥2)
Odds Ratio
95% CI OR P Value
CEAP Category
CEAP C 0-2
CEAP C 3-6
0.09 0.01 0.72 0.02
11.11
VCSS 1.11 1.00 1.23 .06
Gender
Female 0.54 0.18 1.61 0.27
Age 0.99 0.96 1.03 0.81
BMI 1.03 0.95 1.12 0.40
16. Multivariate Logistic Regression Analysis
Variable Multiple Superficial
Axial Veins(≥2)
Odds Ratio
95% CI OR P Value
CEAP Category
CEAP C 0-2
CEAP C 3-6
0.10 0.01 0.88 0.03
10
VCSS 1.04 0.90 1.20 0.56
Female Vs Male 1.24 0.28 5.55 0.77
Pregnancy ≤2 Vs > 2 0.99 0.22 4.48 0.97
Age 0.99 0.95 1.03 0.79
BMI 1.01 0.92 1.13 0.72
No Interaction between
Gender, CEAP or VCSS
C 3-6 is Independent predictor for multiple superficial veins
17. Conclusions
Multiple superficial Axial veins with reflux in the
lower extremity are present in 11% of Patients
Advanced CEAP Clinical Class is an independent
predictor for multiple superficial Axial Veins with
reflux (Odds Ratio of 10 for Multiple Superficial
Axial Vein)
Revised VCSS was not statistically significant
independent predictor for multiple superficial
Axial Veins with reflux.
Editor's Notes
Percentage of patients in each CEAP category.63% ≥ C-3
83/150 ≥1 superficial Axial veins reflux (55.3%) . 10.7% with reflux in ≥2
Cochran- Armitage Trend Test for CEAP Categories <0.0001. there is trend towards multiple superficial veins with worsening CEAP class with P value of <.0001 /what is this test?
CEAP has strong positive correlation 0.5-1.0 is strong
VCSS has moderate correlation as 0.3-0.5 moderate
Age and BMI has no correlation as < 0.1 is no relation
0.1-0.29 is weak
CEAP 0-2 has .09 odds for multiple superficial veins. C3-6 has 11.11 times more odds than C0-2 to have multiple superficial veins . One unit increase in the VCSS has 1.11 odds for multiple superficial veins but not statistically significant.
C 3-6 is Independent predictor for multiple superficial veins with an odds ratio of 10 with vcss,sex, preg, age bmi in the model. One unit increase in the VCS score has 1.04 odds for mutliple superficial veins but not statistically significant in the multivariate model. Here VCSS is continuous variable. If VCSS INCREASES BY ONE POINT, ODDS RATIO FOR MULTIPLE SUPERFICIAL VEINS INCREASES BY 1.04 WITH p VALUE OF 0.56. I believe it would be better to use as continuous variable so we will be consistent with previous published literature. Where VCSS has been used as continuous variable before after the treatemnt. It was not significant even if we use VCSS as categorical variable with splitting data into QUARTILES..
No Interaction between Gender and CEAP or VCSS