International Journal of Angiology最新文献

{"title":"Clinical Profile, Management, and Outcome of Visceral Artery Pseudoaneurysms: 5-Year Experience in a Tertiary Care Hospital.","authors":"Faiz Altaf Shera, Tahleel Altaf Shera, Naseer Ahmad Choh, Mudasir H Bhat, Omair Ashraf Shah, Feroze A Shaheen, Irfan Robbani, Tariq Gojwari","doi":"10.1055/s-0043-1761292","DOIUrl":"10.1055/s-0043-1761292","url":null,"abstract":"<p><p>Visceral artery pseudoaneurysms are potentially lethal lesions and tend to rupture in a high proportion of cases, thereby warranting an immediate and active intervention. We present our experience of splanchnic visceral artery pseudoaneurysms in a university hospital over a 5-year time interval with emphasis on etiology, clinical presentation, management (endovascular/surgical), and final outcome. This was a retrospective study in which we searched our image database for pseudoaneurysms of visceral arteries over a period of 5 years. The clinical and operative details were retrieved from the medical record section of our hospital. The lesions were analyzed for the vessel of origin, size, etiology, clinical features, mode of treatment, and outcome. Twenty-seven patients with pseudoaneurysms were encountered. Pancreatitis (8) was the most common cause, followed by previous surgery (7) and trauma (6). Fifteen were managed by the interventional radiology (IR) team, 6 by surgery, and in 6 no intervention was done. Technical and clinical success was achieved in all patients in the IR group with few minor complications. Surgery and no intervention carry a high mortality in such a setting (66 and 50%, respectively). Visceral pseudoaneurysms are potentially fatal lesions, commonly encountered after trauma, pancreatitis, surgeries, and interventional procedures. These lesions are easily salvageable by minimally invasive interventional techniques (endovascular embolotherapy), and surgeries carry a lot of morbidity and mortality in such cases and a prolonged hospital stay.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"32 2","pages":"113-120"},"PeriodicalIF":0.6,"publicationDate":"2023-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10191697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9502839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Limb Ischemia after Cardiovascular Surgery: A Deadly Duo Combination with High Mortality.","authors":"Suci Indriani, Raditya Dewangga, Suko Adiarto, Taofan Siddiq, Iwan Dakota, Hananto Andriantoro, Marc Vuylsteke","doi":"10.1055/s-0043-1761290","DOIUrl":"10.1055/s-0043-1761290","url":null,"abstract":"<p><p>Acute limb ischemia (ALI) is a predictor of high morbidity and mortality. Previous studies showed that ALI developed after cardiac surgery may increase mortality. This study aimed to elucidate the clinical course and identify risk factors contributing to mortality in patients with ALI after cardiovascular surgery. This is a single-center retrospective cohort study. We analyzed data from 52 patients with ALI after cardiovascular surgery between 2016 and 2020. We evaluated the risk factors for 1-year mortality using Cox proportional hazards regression analysis. Most of the patients with ALI were male and the median age was 56 years (23-72 years). Most of the patients with ALI had coronary artery diseases. The 1-year mortality rate was 55.8% ( <i>n</i>  = 29 patients). Multivariable analysis revealed that cardiopulmonary bypass (CPB) time ≥ 100 minutes (hazard ratio [HR]: 3.067, 95% confidence interval [CI]: 1.158-8.120) and postoperative acute kidney injury (HR: 2.927, 95% CI: 1.358-6.305) were significantly increasing the risk of mortality in patients with ALI after an operation. ALI after cardiovascular surgery was associated with high 1-year mortality in our study and long CPB time and postoperative acute kidney injury contributed to the mortality.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"32 3","pages":"158-164"},"PeriodicalIF":0.6,"publicationDate":"2023-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10371910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory Care Management in Low Blood Pressure Patient with HFrEF","authors":"Fajar H. Panjaitan, D. Hasanah, E. Yonas, R. Soerarso","doi":"10.1055/s-0043-1761271","DOIUrl":"https://doi.org/10.1055/s-0043-1761271","url":null,"abstract":"Abstract Heart failure (HF) affects an estimated 38 million people globally, with most published research estimating a prevalence of 1 to 2% of the adult population. Low blood pressure (BP) is reported in 10 to 15% of patients with HF in clinical trials, although this proportion is much more frequent in routine clinical practice. Low BP in outpatients has a better outcome compared to inpatients. Low BP is often a restricting factor in the use and uptitration of guideline-directed medical therapy (GDMT). A 57-year-old male presented himself to the HF clinic with complaints of bloating, shortness of breath, and fatigue. The patient had a history of acute coronary syndrome and cardiac arrest, but the results of coronary angiography showed nonsignificant coronary artery disease. Cardiomegaly was seen on chest X-ray. Electrocardiogram showed pathologic q wave II, III, and AvF with poor r wave progression on V1-V6. The patient was admitted due to acute decompensated HF with hypotension. After the initial decongestion patient was treated with sacubitril/valsartan, bisoprolol, and spironolactone in the outpatient clinic. Patient complaints and BP slowly improved during the outpatient phase. Hypotension remains a challenge in implementing GDMT in HF patients. By following the steps according to algorithm and current guidelines, GDMT can be optimized in these patients.","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46843872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Prevalence of Pulmonary Embolism during the COVID-19 Pandemic in the US: An Infodemiological Analysis.","authors":"Camilla Mattiuzzi, Giuseppe Lippi","doi":"10.1055/s-0043-1761291","DOIUrl":"10.1055/s-0043-1761291","url":null,"abstract":"","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"32 3","pages":"193"},"PeriodicalIF":0.6,"publicationDate":"2023-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10371912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Engaging in Scientific Research during Medical Training.","authors":"Tanzim Bhuiya, Amgad N Makaryus","doi":"10.1055/s-0042-1759542","DOIUrl":"10.1055/s-0042-1759542","url":null,"abstract":"<p><p>Many components of required skills and competencies exist, and are felt to contribute to the successful completion of training for independent practice in the medical field as a physician. These requirements are documented and detailed in a temporal fashion during the training period and used for advancement during training as well as documentation of successful completion of that training. While clinical skill development that allows optimal care and treatment of patients is of utmost importance during this training, other components of the training are important and contribute to the ideal development of a well-rounded and credentialed physician. One of these other components which is very important and needs to be recognized is the engagement of medical trainees across disciplines in academic and research scholarly activity. This engagement is an important component of medical training, and the development of skills and didactics geared toward efficient and accurate performance of research is essential.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"32 3","pages":"153-157"},"PeriodicalIF":0.6,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10352053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Center Study Evaluating Long-Term Major Adverse Outcomes with the Use of Paclitaxel-Coated Balloons in Treating Infrainguinal Arterial Disease.","authors":"Nicolas W Shammas, Elizabeth Sharis, Gail A Shammas, Susan Jones-Miller","doi":"10.1055/s-0042-1759818","DOIUrl":"10.1055/s-0042-1759818","url":null,"abstract":"<p><p>Paclitaxel drug-coated balloons (DCB) have been shown to reduce target lesion revascularization (TLR) rate, but recently an association between paclitaxel and an increase in mortality at 5-year was reported. We reviewed the 5-year mortality and freedom from TLR rates from a single center among patients that received DCB. Consecutive patients that received DCB from July 8, 2015 to November 27, 2019 with follow-up obtained from medical records and review of official death certificates were reviewed. The primary objective was total mortality and TLR rates with cumulative exposure to paclitaxel-coated balloons. Demographic, angiographic, clinical, and procedural variables were collected. Causes of mortality were classified according to death certificates. Descriptive analysis was performed on all variables. Kruskal-Wallis test was used to compare the total length of DCBs in those who were alive and those who died by the end of study. Kaplan-Meier (KM) was used to plot the freedom from mortality up to 5 years. A total of 91 symptomatic patients received the Lutonix balloon at index to treat femoropopliteal arterial disease and subsequently received either Lutonix or in.PACT during the follow-up phase for additional procedures. Age was 68.4 ± 10.8 years (56.0% males). Critical limb ischemia was present in 20.9%. There was no statistical difference in mortality between the median total number of balloons used among patients who were alive versus those who died (2.5 vs. 3.0, <i>p</i> -value = 0.89). Also, there was no statistical difference in the total length of DCB balloons used between those who were alive and those who died at the end of the study (p-value = 0.39). There were no in-hospital amputation or death. At 5-year follow-up KM freedom from TLR was 78.5%. A total of 13 patients died during follow-up. Of these 10 received only the Lutonix balloon and 3 did receive both Lutonix and In.PACT. The yearly KM freedom from mortality for the Lutonix only cohort were 92.7, 89.1, 85.5, 83.6, and 81.8% at 1, 2, 3, 4, and 5 years, respectively. Freedom from TLR and mortality at 5 years appears to be favorable with the use of DCB, predominantly Lutonix balloon in this cohort. This data needs to be supported prospectively by a larger number of patients.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"32 1","pages":"48-55"},"PeriodicalIF":0.6,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10643432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Vascular Receptors in the Development of Hypertension in the Elderly Population.","authors":"Shlomo Yosef Shaulian, Amgad N Makaryus, Roman Zeltser","doi":"10.1055/s-0042-1759650","DOIUrl":"10.1055/s-0042-1759650","url":null,"abstract":"<p><p>Hypertension is a disease common in adults, with many risk factors and potentially life-threatening outcomes. Blood pressure is controlled by receptors that inform the brain about the amount of pressure inside the arteries, and the amount of oxygen and carbon dioxide in the blood, respectively. Research has revealed that baroreflex sensitivity (BRS) decreases with increasing age and that there is a high correlation between hypertension and low BRS. However, various studies with differing results have indicated that high blood pressure is what causes BRS to decline, and vice versa. Several studies have shown very conflicting results on the correlation between chemoreflex and age; there have been indications of chemoreflex having a positive, negative, and zero correlation with age. In several experiments, the surgical removal of the chemoreceptors of hypertensive rats was followed by a decrease in blood pressure. These animal experiments, and an additional noninvasive human experiment in which the chemoreceptors were temporarily \"shut off,\" are reasons why more attention should be given to chemoreceptors as a route of alleviating hypertension.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"31 4","pages":"260-266"},"PeriodicalIF":0.6,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10466868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Coronary Physiology Study in Multivessel Coronary Artery Disease","authors":"Agita Maryalda Zahidin, A. A. Alkatiri, A. S. Mangkuanom, N. Iryuza, D. Firman","doi":"10.1055/s-0042-1759620","DOIUrl":"https://doi.org/10.1055/s-0042-1759620","url":null,"abstract":"Abstract Assessment of relationship between the angiographic stenosis severity and the coronary blood flow is complex. Coronary angiography has many limitations that may impair the judgment of stenosis severity and then affect decision-making regarding intervention. Myocardial perfusion imaging by single-photon emission tomography (MPI-SPECT) is used for a long time to help clinical decisions of interventions, but has limitations, such as issues with identification of extensive coronary artery disease (CAD). Fractional flow reserve (FFR) is a gold standard index for investigating the physiological significance of a coronary stenosis. The instantaneous wave-free ratio (iFR) is a hyperemia-free measurement and easier method to achieve physiological assessment to measure the severity of coronary stenosis. We present a case of multivessel coronary artery disease (MVCAD) patient who was treated with iFR-guided percutaneous coronary intervention (PCI) and emphasize the importance of physiological assessment in PCI. A 63-year-old male with multiple cardiovascular risk factors came to our center with chief complaint of stable angina since 1 year. He underwent MPI-SPECT and the result showed 2.5% of ischemia burden. Coronary angiography showed MVCAD. Surgical conference decided to do PCI. iFR-guided PCI was performed in this case. Our case highlights the importance of iFR as an important cardiology–physiology-based tool as a guide in management decisions for MVCAD. iFR as an alternative approach to physiological study is noninferior compared with FFR-guided PCI.","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45075568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Dose Alteplase versus Conventional Anticoagulation to treat Submassive Pulmonary Embolism in Hispanic Patients.","authors":"Emily Zientek, Kelsey Talkington, Joshua Gardner, Yi Guo, Debabrata Mukherjee, Manu Rajachandran, Tariq S Siddiqui, Nils P Nickel","doi":"10.1055/s-0042-1758386","DOIUrl":"10.1055/s-0042-1758386","url":null,"abstract":"<p><p>The use of low-dose tissue plasminogen activator (tPA) in Hispanic patients with submassive pulmonary embolism (PE) is understudied. The purpose of this study is to explore the use of low-dose tPA in Hispanic patients with submissive PE compared with counterparts that received heparin alone. We retrospectively analyzed a single-center registry of patients with acute PE between 2016 and 2022. Out of 72 patients admitted for acute PE and cor pulmonale, we identified six patients that were treated with conventional anticoagulation (heparin alone) and six patients who received low-dose tPA (and heparin afterward). We analyzed if low-dose tPA was associated with differences in length of stay (LOS) and bleeding complications. Both groups were similar in regard to age, gender, and PE severity (based on Pulmonary Embolism Severity Index scores). Mean total LOS for the low-dose tPA group was 5.3 days, compared with 7.3 days in the heparin group ( <i>p</i>  = 0.29). Mean intensive care unit (ICU) LOS for the low-dose tPA group was 1.3 days compared with 3 days in the heparin group ( <i>p</i>  = 0.035). There were no clinically relevant bleeding complications documented in either the heparin or the low-dose tPA group. Low-dose tPA for submassive PE in Hispanic patients was associated with a shorter ICU LOS without a significant increase in bleeding risk. Low-dose tPA appears to be a reasonable treatment option in Hispanic patients with submassive PE who are not at high bleeding risk (<5%).</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"32 2","pages":"131-135"},"PeriodicalIF":0.6,"publicationDate":"2022-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10191688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9551568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 in an Asymptomatic Renal Transplant Recipient Employed in the Health Care Setting: A Case Report.","authors":"Harsha Adnani,&nbsp;Akshay Khatri,&nbsp;Nirav Agrawal,&nbsp;Ernesto Molmenti,&nbsp;Madhu Bhaskaran","doi":"10.1055/s-0041-1725183","DOIUrl":"https://doi.org/10.1055/s-0041-1725183","url":null,"abstract":"<p><p>During the ongoing pandemic, there have been varying presentations of coronavirus disease 2019 (COVID-19) infection, with the concern that patients who are immunosuppressed (due to underlying medical conditions and/or therapies) are at higher risk of severe disease. We report the case of an elderly renal transplant recipient working in a long-term health care facility who was being monitored by weekly surveillance testing and tested positive for COVID-19 by polymerase chain reaction (PCR) testing, despite having no clinical symptoms. He recovered with supportive care, despite being on multiple long-term immunosuppressant drugs and having multiple comorbidities. Additionally, it was found that he did not mount an antibody response, when he tested negative by serologic testing. Through this case, we wish to highlight the unique clinical scenario of asymptomatic patients who may have an underwhelming immune response to COVID-19, but may nevertheless be an important source of dissemination. We further discuss the probable mechanism of such asymptomatic presentations in immunosuppressed patients, while reinforcing the importance of self-isolation of COVID-19 patients (particularly in asymptomatic health care workers).</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"31 4","pages":"289-291"},"PeriodicalIF":0.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1725183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10466865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}