Vascular Medicine (London, England)最新文献

{"title":"Carotid artery displacement and cardiovascular disease risk in the Multi-Ethnic Study of Atherosclerosis.","authors":"Adam D Gepner,&nbsp;Robyn L McClelland,&nbsp;Claudia E Korcarz,&nbsp;Rebekah Young,&nbsp;Joel D Kaufman,&nbsp;Carol C Mitchell,&nbsp;James H Stein","doi":"10.1177/1358863X19853362","DOIUrl":"https://doi.org/10.1177/1358863X19853362","url":null,"abstract":"<p><p>Novel technology permits quantification of common carotid artery (CCA) displacement, which is traditionally ignored. We evaluated associations with CCA displacement and cardiovascular disease (CVD) risk and events in a large, multi-ethnic cohort. Right CCA longitudinal displacement (LD), transverse displacement (TD), and grayscale median (GSM) were evaluated using ultrasound speckle-tracking and texture analysis software in 2050 participants. Regression analyses were used to define relationships between CCA LD, TD, GSM, and CVD risk factors. Cox proportional hazards models were used to assess relationships between LD, TD, and incident CVD events. Participants were mean (SD) 64 (10) years old. There were 791 cases with a CVD event over a 12-year median follow-up. The mean LD was 0.29 (0.20) mm. In multivariable models including age, sex, race/ethnicity, heart rate, and CVD risk factors, LD was associated positively with active smoking (β = 0.08, <i>p</i> < 0.001) and inversely with black (β = -0.08, <i>p</i> < 0.001), Chinese (β = -0.05, <i>p</i> < 0.001), and Hispanic (β = -0.04, <i>p</i> < 0.05) race/ethnicities relative to white individuals, heart rate (β = -0.03/10 beats/min, <i>p</i> < 0.001), and diastolic blood pressure (β = -0.01/5 mmHg, <i>p</i> < 0.05). In fully adjusted models, LD and TD were associated with GSM (<i>p</i> < 0.01), but neither predicted incident CVD events (LD: hazard ratio (HR) 0.77 [0.48 to 1.24], <i>p</i> = 0.3; TD: HR 1.12 [0.8 to 1.57], <i>p</i> = 0.5). CCA LD and TD are associated with race/ethnicity and CVD risk factors but not incident CVD events. LD and TD are not measures of arterial stiffness but their association with GSM suggests that lower LD and TD may be related to structural changes within the carotid arterial wall.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"405-413"},"PeriodicalIF":3.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X19853362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37326541","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":"A randomized, placebo-controlled trial of canakinumab in patients with peripheral artery disease.","authors":"Kerry S Russell,&nbsp;Denise P Yates,&nbsp;Christopher M Kramer,&nbsp;Andrea Feller,&nbsp;Ping Mahling,&nbsp;Laurence Colin,&nbsp;Timothy Clough,&nbsp;Tianke Wang,&nbsp;Lucy LaPerna,&nbsp;Alpa Patel,&nbsp;Holger Lawall,&nbsp;Mustafa M Shennak,&nbsp;James Fulmer,&nbsp;Sigrid Nikol,&nbsp;William B Smith,&nbsp;Oliver J Müller,&nbsp;Elizabeth V Ratchford,&nbsp;Craig T Basson","doi":"10.1177/1358863X19859072","DOIUrl":"https://doi.org/10.1177/1358863X19859072","url":null,"abstract":"<p><p>Extensive atherosclerotic plaque burden in the lower extremities often leads to symptomatic peripheral artery disease (PAD) including impaired walking performance and claudication. Interleukin-1β (IL-1β) may play an important pro-inflammatory role in the pathogenesis of this disease. Interruption of IL-1β signaling was hypothesized to decrease plaque progression in the leg macrovasculature and improve the mobility of patients with PAD with intermittent claudication. Thirty-eight patients (mean age 65 years; 71% male) with symptomatic PAD (confirmed by ankle-brachial index) were randomized 1:1 to receive canakinumab (150 mg subcutaneously) or placebo monthly for up to 12 months. The mean vessel wall area (by 3.0 T black-blood magnetic resonance imaging (MRI)) of the superficial femoral artery (SFA) was used to measure plaque volume. Mobility was assessed using the 6-minute walk test. Canakinumab was safe and well tolerated. Markers of systemic inflammation (interleukin-6 and high-sensitivity C-reactive protein) fell as early as 1 month after treatment. MRI (32 patients at 3 months; 21 patients at 12 months) showed no evidence of plaque progression in the SFA in either placebo-treated or canakinumab-treated patients. Although an exploratory endpoint, placebo-adjusted maximum and pain-free walking distance (58 m) improved as early as 3 months after treatment with canakinumab when compared with placebo. Although canakinumab did not alter plaque progression in the SFA, there is an early signal that it may improve maximum and pain-free walking distance in patients with symptomatic PAD. Larger studies aimed at this endpoint will be required to definitively demonstrate this. <b>ClinicalTrials.gov Identifier: NCT01731990</b>.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"414-421"},"PeriodicalIF":3.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X19859072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37393477","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":"Pseudoxanthoma elasticum with prominent arterial calcifications evoking CD73 deficiency.","authors":"Magali Devriese,&nbsp;Anne Legrand,&nbsp;Marie-Cécile Courtois,&nbsp;Xavier Jeunemaitre,&nbsp;Juliette Albuisson","doi":"10.1177/1358863X19853360","DOIUrl":"https://doi.org/10.1177/1358863X19853360","url":null,"abstract":"<p><p>Pseudoxanthoma elasticum (PXE) is a rare disorder characterized by skin, eye, and cardiovascular lesions due to ectopic mineralization and fragmentation of elastic fibers of connective tissues. We present an atypical case of PXE with diffuse vascular calcification and negligible skin and eye lesions. The patient was a 37-year-old man suffering from severe bilateral arterial calcifications in superficial femoral and posterior tibial arteries. Eye fundoscopy and skin examination were first considered normal. This phenotype suggested first the diagnosis of Arterial Calcification due to Deficiency of CD73 (ACDC) characterized by mutations in <i>NT5E</i> gene. However, we found two variants in <i>ABCC6</i> gene, and no variant in NT5E. Skin reexamination revealed few lateral skin papules confined to the scalp. Phenotypic overlap was described in vascular calcification disorders, between GACI and PXE phenotypes, and we discuss here expansion of this overlap, including ACDC phenotype. Identification of these expanding and overlapping phenotypes was enabled by genetic screening of the corresponding genes, in a systematic approach. We propose to create a calcification next generation sequencing (NGS) panel with <i>NT5E, GGCX, ENPP1</i>, and <i>ABCC6</i> genes to improve the molecular diagnosis of vascular calcification.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"461-464"},"PeriodicalIF":3.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X19853360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37307991","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":"Images in Vascular Medicine. Rat bite fever: A rare case of critical limb ischemia.","authors":"Amanda R Frederick,&nbsp;Brian C Fowler,&nbsp;Raghu Kolluri","doi":"10.1177/1358863X19849619","DOIUrl":"https://doi.org/10.1177/1358863X19849619","url":null,"abstract":"A 24-year-old female was transferred to our facility with a 3-month history of bilateral lower extremity hemiparesis, loss of bowel and bladder control, decubitus ulcers, unexplained weight loss, and fever of unknown origin. Upon arrival, she appeared emaciated with significant dysarthria and a fever of 102°F (38.9°C). She was unable to move her lower extremities on command. Magnetic resonance imaging revealed numerous infarcts in the brain and abdomen. An echocardiogram ordered to assess for the source of emboli revealed a 4.5-cm-long mitral valve vegetation along with severe mitral regurgitation (Panel A: arrow). Mitral valve tissue analysis revealed the bacteria Streptobacillus moniliformis, the causative agent for rat bite fever.1 The bacteria is acquired from bites, scratches, consuming contaminated food, or by handling infected rodents. Symptoms include fever, rigors, migratory polyarthralgias, headache, nausea, vomiting, sore throat, and severe myalgias.2 Prior to emergency mitral valve replacement, the right lower extremity was cool to touch along with delayed capillary refill and diminished pulses. The day after surgery, an arterial duplex demonstrated tardus parvus flow from the distal external iliac artery (EIA) to the ankle, suggestive of proximal occlusion (Panel B-1: peak systolic velocity; end Rat bite fever: A rare case of critical limb ischemia","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"465-466"},"PeriodicalIF":3.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X19849619","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37264444","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":"SDF-1 plasmid treatment for patients with peripheral artery disease (STOP-PAD): Randomized, double-blind, placebo-controlled clinical trial.","authors":"Mehdi H Shishehbor,&nbsp;John Rundback,&nbsp;Matthew Bunte,&nbsp;Tarek A Hammad,&nbsp;Leslie Miller,&nbsp;Parag D Patel,&nbsp;Saihari Sadanandan,&nbsp;Michael Fitzgerald,&nbsp;Joseph Pastore,&nbsp;Vikram Kashyap,&nbsp;Timothy D Henry","doi":"10.1177/1358863X18817610","DOIUrl":"https://doi.org/10.1177/1358863X18817610","url":null,"abstract":"<p><p>The efficacy of biologic therapies in critical limb ischemia (CLI) remains elusive, in part, due to limitations in trial design and patient selection. Using a novel design, we examined the impact of complementing revascularization therapy with intramuscular JVS-100 - a non-viral gene therapy that activates endogenous regenerative repair pathways. In this double-blind, placebo-controlled, Phase 2B trial, we randomized 109 patients with CLI (Rutherford class V or VI) to 8 mg or 16 mg intramuscular injections of placebo versus JVS-100. Patients were eligible if they persistently had reduced forefoot perfusion, by toe-brachial index (TBI) or skin perfusion pressure (SPP), following successful revascularization with angiographic demonstration of tibial arterial flow to the ankle. The primary efficacy end point was a 3-month wound healing score assessed by an independent wound core laboratory. The primary safety end point was major adverse limb events (MALE). Patients' mean age was 71 years, 33% were women, 79% had diabetes, and 8% had end-stage renal disease. TBI after revascularization was 0.26, 0.27, and 0.26 among the three groups (placebo, 8 mg, and 16 mg injections, respectively). Only 26% of wounds completely healed at 3 months, without any differences between the three groups (26.5%, 26.5%, and 25%, respectively). Similarly, there were no significant changes in TBI at 3 months. Three (2.8%) patients died and two (1.8%) had major amputations. Rates of MALE at 3 months were 8.8%, 20%, and 8.3%, respectively. While safe, JVS-100 failed to improve wound healing or hemodynamic measures at 3 months. Only one-quarter of CLI wounds healed at 3 months despite successful revascularization, highlighting the need for additional research in therapies that can improve microcirculation in these patients. ClinicalTrials.gov Identifier: NCT02544204.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"200-207"},"PeriodicalIF":3.5,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X18817610","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36984120","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":"Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute pulmonary embolism: A multicenter comparison of patient-centered outcomes.","authors":"Gaurav Rao,&nbsp;Hai Xu,&nbsp;Jason J Wang,&nbsp;Andrew Galmer,&nbsp;Jay Giri,&nbsp;Michael R Jaff,&nbsp;Raghu Kolluri,&nbsp;Joe F Lau,&nbsp;Samy Selim,&nbsp;Ido Weinberg,&nbsp;Mitchell D Weinberg","doi":"10.1177/1358863X19838334","DOIUrl":"https://doi.org/10.1177/1358863X19838334","url":null,"abstract":"<p><p>Both catheter-directed thrombolysis (CDT) and ultrasound-assisted thrombolysis (USAT) are novel treatment modalities for patients presenting with acute pulmonary embolism (PE). The objective of this study was to compare clinical and quality-of-life (QOL) outcomes for patients undergoing either treatment modality. We retrospectively studied 70 consecutive patients treated with either CDT or USAT over 3 years at a multicenter health system. The primary clinical efficacy endpoint was right ventricular systolic pressure (RVSP) reduction post-procedurally. Safety endpoints were mortality and bleeding incidents based on Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries (GUSTO) criteria. Long-term QOL was assessed using the 36-Item Short-Form Health Survey (SF-36) via phone interview. Thirty-seven patients (53%) in our study underwent USAT and 33 (47%) patients were treated with conventional CDT. Among all patients studied, 96% had echocardiographic evidence for right ventricular strain on admission. Mean RVSP decreased by 18 ± 13 mmHg in the USAT group post-procedurally as compared to 14 ± 16 mmHg in the CDT group, without significant difference between groups ( p = 0.31). Rates of moderate and severe bleeding were largely identical between USAT and CDT groups (USAT: 3%; CDT: 0%; p = 0.09). There was no death in either group during admission. At long-term follow-up, there was no significant difference in QOL between both treatment modalities in all eight functional domains of SF-36. Our retrospective study demonstrated using USAT over conventional CDT for acute submassive or massive PE did not yield additional clinical, safety, or long-term QOL benefit.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"241-247"},"PeriodicalIF":3.5,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X19838334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37094399","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":"Ultrasound-accelerated thrombolysis (USAT) versus standard catheter-directed thrombolysis (CDT) for treatment of pulmonary embolism: A retrospective analysis.","authors":"Daniel P Rothschild,&nbsp;James A Goldstein,&nbsp;Joseph Ciacci,&nbsp;Terry R Bowers","doi":"10.1177/1358863X19838350","DOIUrl":"https://doi.org/10.1177/1358863X19838350","url":null,"abstract":"<p><p>Ultrasound-accelerated thrombolysis (USAT) is advocated in pulmonary embolism (PE) based on the hypothesis that adjunctive ultrasound provides superior clinical efficacy compared to standard catheter-directed thrombolysis (CDT). This retrospective study was designed to compare outcomes between the two modalities. We analyzed patients with computed tomography-diagnosed PE at our institution treated with either USAT or standard CDT. Efficacy parameters assessed included invasive pulmonary artery systolic pressure (PASP; pre- and 24 hours post-treatment), non-invasive right-to-left ventricle (RV/LV) ratio (pre- and post-treatment), and general clinical outcomes (length-of-stay, significant bleeding, and mortality). We analyzed 98 cases (62 USAT and 36 CDT), in whom massive PE was diagnosed in 7%, intermediate/high risk in 81%, and intermediate/low risk in 12%. Overall, 92% had bilateral clot and 40% saddle embolus. At 24 hours, PASP decreased similarly in both groups (CDT Δ14.7 mmHg, USAT Δ10.8 mmHg; p = 0.14). Post-treatment, CDT showed similar improvement in the RV/LV ratio (CDT Δ0.58 vs USAT Δ0.45; p = 0.07), despite the baseline ratio being greater in the CDT group, indicating more severe RV strain (1.56 ± 0.36 vs 1.40 ± 0.29; p = 0.01). Intensive care unit and hospital length-of-stays were similar in both groups. A trend toward lesser significant bleeding rates in the CDT group (8.3% vs 12.9%, p = 0.74) as well as improved survival-to-discharge (97.2% vs 91.9%, p = 0.66) was observed. Compared to USAT, standard CDT achieves similar beneficial effects on hemodynamics, RV/LV ratios, and clinical outcomes. These observations suggest that salutary clinical results may be achieved without the need for very expensive devices.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"234-240"},"PeriodicalIF":3.5,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X19838350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37092912","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":"Unique aspects of peripheral artery disease in patients with chronic kidney disease.","authors":"Nkiruka V Arinze,&nbsp;Andrew Gregory,&nbsp;Jean M Francis,&nbsp;Alik Farber,&nbsp;Vipul C Chitalia","doi":"10.1177/1358863X18824654","DOIUrl":"https://doi.org/10.1177/1358863X18824654","url":null,"abstract":"<p><p>Peripheral artery disease (PAD) represents a major health care burden. Despite the advent of screening and interventional procedures, the long-term clinical outcomes remain suboptimal, especially in patients with chronic kidney disease (CKD). While CKD and PAD share common predisposing factors, emerging studies indicate that their co-existence is not merely an association; instead, CKD represents a strong, independent risk factor for PAD. These findings implicate CKD-specific mediators of PAD that remain incompletely understood. Moreover, there is a need to understand the mechanisms underlying poor outcomes after interventions for PAD in CKD. This review discusses unique clinical aspects of PAD in patients with CKD, including high prevalence and worse outcomes after vascular interventions and the influence of renal allograft transplantation. In doing so, it also highlights underappreciated aspects of PAD in patients with CKD, such as disparities in revascularization and higher peri-procedural mortality. While previous reviews have discussed general mechanisms of PAD pathogenesis, focusing on PAD in CKD, this review underscores a need to probe for CKD-specific pathogenic pathways that may unravel novel biomarkers and therapeutic targets in PAD and ultimately improve the risk stratification and management of patients with CKD and PAD.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"251-260"},"PeriodicalIF":3.5,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X18824654","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37014459","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":"National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism.","authors":"Ayman Elbadawi,&nbsp;Amgad Mentias,&nbsp;Islam Y Elgendy,&nbsp;Ahmed H Mohamed,&nbsp;Mohammed Hz Syed,&nbsp;Gbolahan O Ogunbayo,&nbsp;Odunayo Olorunfemi,&nbsp;Igor Gosev,&nbsp;Sunil Prasad,&nbsp;Scott J Cameron","doi":"10.1177/1358863X18824650","DOIUrl":"https://doi.org/10.1177/1358863X18824650","url":null,"abstract":"<p><p>Little is known about the temporal trends and outcomes for extra-corporeal membrane oxygenation (ECMO) in patients with high-risk pulmonary embolism (PE) in the United States. We queried the National Inpatient Sample (NIS) database from 2005 to 2013 to identify patients admitted with high-risk PE. Our objective was to determine trends for ECMO use in patients with high-risk PE. We also assessed in-hospital outcomes among patients with high-risk PE receiving ECMO. We evaluated 77,809 hospitalizations for high-risk PE. There was an upward trend in the utilization of ECMO from 0.07% in 2005 to 1.1% in 2013 ( p = 0.015). ECMO was utilized more in urban teaching hospitals and large hospitals. ECMO use was associated with lower mortality in patients with massive PE ( p < 0.001). In-hospital mortality for patients receiving ECMO was 61.6%, with no change over the observational period ( p = 0.68). Our investigation revealed several independent predictors of increased mortality in patients with high-risk PE using ECMO as hemodynamic support, including: age, female sex, obesity, congestive heart failure, and chronic pulmonary disease. ECMO, therefore, as a rescue strategy or bridge to definitive treatment, may be effective in the management of high-risk PE when selecting patients with favorable clinical characteristics.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"230-233"},"PeriodicalIF":3.5,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X18824650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37185747","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":"Thirty-day readmission after endovascular or surgical revascularization for chronic mesenteric ischemia: Insights from the Nationwide Readmissions Database.","authors":"Fabio V Lima,&nbsp;Dhaval Kolte,&nbsp;David W Louis,&nbsp;Kevin F Kennedy,&nbsp;J Dawn Abbott,&nbsp;Peter A Soukas,&nbsp;Omar N Hyder,&nbsp;Shafiq T Mamdani,&nbsp;Herbert D Aronow","doi":"10.1177/1358863X18816816","DOIUrl":"https://doi.org/10.1177/1358863X18816816","url":null,"abstract":"<p><p>There are limited contemporary data on readmission after revascularization for chronic mesenteric ischemia (CMI). This study aimed to determine the rates, reasons, predictors, and costs of 30-day readmission after endovascular or surgical revascularization for CMI. Patients with CMI discharged after endovascular or surgical revascularization during 2013 to 2014 were identified from the Nationwide Readmissions Database. The rates, reasons, length of stay, and costs of 30-day all-cause, non-elective, readmission were determined using weighted national estimates. Independent predictors of 30-day readmission were determined using hierarchical logistic regression. Among 4671 patients with CMI who underwent mesenteric revascularization, 19.5% were readmitted within 30 days after discharge at a median time of 10 days. More than 25% of readmissions were for cardiovascular or cerebrovascular conditions, most of which were for peripheral or visceral atherosclerosis and congestive heart failure. Independent predictors of 30-day readmission included non-elective index admission, chronic kidney disease (CKD), and discharge to home healthcare or to a skilled nursing facility. Revascularization modality did not independently predict readmission. In a nationwide, retrospective analysis of patients with CMI undergoing revascularization, approximately one in five were readmitted within 30 days. Predictors were largely non-modifiable and included non-elective index admission, CKD, and discharge disposition.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"216-223"},"PeriodicalIF":3.5,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X18816816","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36544247","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}