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1.
Vasc Health Risk Manag ; 18: 603-615, 2022.
Article in English | MEDLINE | ID: covidwho-1978925

ABSTRACT

Background: It is unknown at this time whether Jetstream atherectomy (JET) and paclitaxel-coated balloon (PCB) provides a superior outcome to balloon angioplasty (PTA) followed by PCB in treating femoropopliteal (FP) arterial disease. Methods: The JET-RANGER study was a multicenter (eleven US centers) randomized trial, core lab-adjudicated, designed to demonstrate the superiority of JET + PCB versus PTA + PCB in treating FP arterial disease. The study intended to enroll 255 patients, but was stopped early because of poor enrollment due to COVID-19 and concerns about the association of paclitaxel with mortality. The data are thus considered exploratory. A total of 47 patients (48 lesions) with claudication (80.9%) or rest pain/ulcerations (19.2%) were randomly assigned 2:1 to JET + PCB (n=31) or PTA + PCB (n=16). The In.PACT (Medtronic) and Ranger (Boston Scientific) PCBs were used. Freedom from target-lesion revascularization (TLR) was evaluated at 1 year. Analysis was performed on intention to treat. Results: Mean lesion length was 10.8±4.3 cm for JET + PCB and 11.2±7.6 cm for PTA + PCB (P=0.858). There were no other differences in demographic or angiographic variables between the two groups. Procedural success was superior with JET + PCB (87.1%) vs PTA + PCB alone (52.9%; P=0.0147). Overall bailout stenting rate was 17% (0 JET + DCB versus 50% PCB, P<0.0001). There was no distal embolization requiring treatment. There was no amputation or death in either group. Using KM analysis, the primary end point of freedom from TLR (bailout stent considered a TLR) at 1 year was 100% and 43.8% (P<0.0001) for JET + PCB versus PTA + PCB, respectively. When bailout stent was not considered a TLR, freedom from TLR was 100% and 93.7%, respectively (P=0.327). Conclusion: A high rate of freedom from TLR was seen in the JET + PCB arm and the PTA + DCB arm at 1-year follow-up, with a significant reduction in bailout stenting following vessel prepping with the Jetstream.


Subject(s)
Angioplasty, Balloon , COVID-19 , Peripheral Arterial Disease , Angioplasty, Balloon/adverse effects , Atherectomy , Coated Materials, Biocompatible , Humans , Paclitaxel/adverse effects , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/therapy , Popliteal Artery/diagnostic imaging , Prospective Studies , Time Factors , Treatment Outcome , Vascular Patency
2.
Khirurgiia (Mosk) ; (5): 126-134, 2022.
Article in Russian | MEDLINE | ID: covidwho-1863437

ABSTRACT

The authors report hybrid treatment of a patient with angina pectoris class II, multiple previous reconstructive interventions on the aortofemoral segment and chronic ischemia of the left lower limb stage IV and concomitant COVID-19. Coronary angiography was performed after regression of infectious disease under antiviral therapy. Occlusion of the left anterior descending artery was observed that required LAD stenting. On the next day, hybrid revascularization of the lower extremities was implemented: thrombectomy and endarterectomy from the branch of the aorto-femoral bypass graft and deep femoral artery at the first stage, stenting of the orifice of proximal branch of aorto-femoral bypass graft at the second stage, endarterectomy from superficial femoral artery, recanalization and stenting of superficial femoral artery and popliteal artery at the third stage and prosthetic- femoral bypass with autologous vein at the fourth stage. Postoperative angiography revealed patent stents and no residual stenoses. The choice in favor of these procedures and step-by-step approach has been substantiated. The authors emphasized effectiveness and safety of this treatment strategy.


Subject(s)
Arterial Occlusive Diseases , COVID-19 , Peripheral Vascular Diseases , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Ischemia/diagnosis , Ischemia/etiology , Ischemia/surgery , Popliteal Artery/surgery , Retrospective Studies , Stents , Treatment Outcome , Vascular Patency
3.
J Vasc Surg Venous Lymphat Disord ; 9(3): 676-682.e2, 2021 05.
Article in English | MEDLINE | ID: covidwho-1454341

ABSTRACT

BACKGROUND: Iliac vein compression (IVC) is a common condition in patients with varicose veins (VVs) of the legs. IVC has been classified into three grades in previous studies. Grade II IVC is defined by >50% stenosis without the development of collateral circulation. The purpose of the present study was to investigate the outcomes of radiofrequency ablation (RFA) for patients with VVs combined with grade II IVC. METHODS: A retrospective analysis was conducted of 339 patients who had undergone RFA for VVs of the left leg from March 2017 to January 2019. Duplex ultrasonography, computed tomography venography, and venography were performed to evaluate for grade II IVC. All the patients were divided into two groups. Group 1 included patients with VVs only, and group 2, patients with VVs combined with grade II IVC. Propensity score matching was used to ensure an even distribution of confounding factors between groups. The venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ) score were recorded during the 12-month follow-up. Occlusion of the truncal veins was evaluated using duplex ultrasound scans. RESULTS: Using 1:1 propensity score matching, 50 pairs of patients were enrolled in the present analysis. The average age of groups 1 and 2 was 58.7 ± 13.1 and 60.1 ± 7.1 years, respectively. The VCSS had decreased significantly from baseline to 12 months postoperatively (group 1, from 5 to 1; group 2, from 4 to 1; P < .01). A significant increase in the CIVIQ score was found between the baseline and 12-month evaluations for both groups (group 1, from 62.5 to 69; group 2, from 63 to 70; P < .01). The truncal occlusion rate was 98% in both groups at 12 months. No significant differences were found between the two groups in the VCSS, CIVIQ score, procedure complications, or occlusion rate during the 12-month follow-up. CONCLUSIONS: RFA is effective for patients with VVs combined with grade II IVC.


Subject(s)
Catheter Ablation , Iliac Vein/physiopathology , May-Thurner Syndrome/physiopathology , Saphenous Vein/surgery , Varicose Veins/surgery , Vascular Patency , Venous Insufficiency/surgery , Adult , Aged , Catheter Ablation/adverse effects , Constriction, Pathologic , Female , Humans , Iliac Vein/diagnostic imaging , Ligation , Male , May-Thurner Syndrome/diagnostic imaging , Middle Aged , Recurrence , Retrospective Studies , Risk Factors , Saphenous Vein/diagnostic imaging , Saphenous Vein/physiopathology , Sclerotherapy , Severity of Illness Index , Time Factors , Treatment Outcome , Varicose Veins/diagnostic imaging , Varicose Veins/physiopathology , Venous Insufficiency/diagnostic imaging , Venous Insufficiency/physiopathology
4.
J Vasc Surg ; 75(2): 408-415.e1, 2022 02.
Article in English | MEDLINE | ID: covidwho-1440240

ABSTRACT

OBJECTIVE: COVID-19 infection results in a hypercoagulable state predisposing patients to thrombotic events. We report the 3- and 6-month follow-up of 27 patients who experienced acute arterial thrombotic events in the setting of COVID-19 infection. METHODS: Data were prospectively collected and maintained for all vascular surgery consultations in the Mount Sinai Health System from patients who presented between March 16 and May 5, 2020. RESULTS: Twenty-seven patients experienced arterial thrombotic events. The average length of stay was 13.3 ± 15.4 days. Fourteen patients were treated with open surgical intervention, six were treated with endovascular intervention, and seven were treated with anticoagulation only. At 3-month follow-up, 11 patients (40.7%) were deceased. Nine patients who expired did so during the initial hospital stay. The 3-month cumulative primary patency rate for all interventions was 72.2%, and the 3-month primary patency rates for open surgical and endovascular interventions were 66.7 and 83.3, respectively. There were 9 (33.3%) readmissions within 3 months. Six-month follow-up was available in 25 (92.6%) patients. At 6-month follow-up, 12 (48.0%) patients were deceased, and the cumulative primary patency rate was 61.9%. The 6-month primary patency rates of open surgical and endovascular interventions were 66.7% and 55.6%, respectively. The limb-salvage rate at both 3 and 6 months was 89.2%. CONCLUSIONS: Patients with COVID-19 infections who experienced thrombotic events saw high complication and mortality rates with relatively low patency rates.


Subject(s)
COVID-19/complications , SARS-CoV-2 , Thrombosis/etiology , Vascular Patency/physiology , Acute Disease , Aged , COVID-19/epidemiology , Computed Tomography Angiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Risk Factors , Thrombosis/diagnosis , Thrombosis/physiopathology
5.
Vascular ; 30(3): 500-508, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1247555

ABSTRACT

OBJECTIVE: To report the results of a single-centre in the treatment of extensive aorto-iliac occlusive disease (AIOD) by the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. METHODS: A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients treated with CERAB technique for AIOD between January 2016 and December 2019 in San Giovanni-Addolorata Hospital (Rome, Italy). Clinical examination, duplex ultrasound with ankle-brachial index measurement and contrast-enhanced computed tomography angiography were performed preoperatively. A clinical and ultrasound follow-up was carried out at one month and then half yearly after the intervention to evaluate patients' clinical status, limb salvage, target lesion revascularization rate, primary and secondary patency rate. RESULTS: During the study period, 24 patients (14 men, 58.3%; 10 women, 41.7%; median age 59 years, range 37-79 years) underwent CERAB for AIOD (TASC II C 29.2%, TASC II D 70.8%). Indications for treatment were: intermittent claudication in 18 patients (75%) and critical limb ischemia in 6 (25%). Technical success was achieved in all cases. Perioperative minor complications occurred in three cases (12.5%). One patient reported an intraoperative iliac rupture requiring adjunctive covered stenting. Median hospital length of stay was two days (range 1-9). No patient died perioperatively nor at the last follow-up. At a median follow-up of 18 months (range 6-48 months), mean ankle-brachial index increased significantly (from 0.62 ± 0.15 before the procedure to 0.84 ± 0.18) (P < 0.001) and target lesion revascularization rate was 12.5%. At two years, the limb salvage rate was 100%, and primary and secondary patency rates were 87.5% and 100%, respectively. CONCLUSION: CERAB technique demonstrated to be effective at the mid-term follow-up with low rate of complications and short length of stay. Long-term results and more robust data are needed to affirm this technique as the first-line treatment for extensive AIOD. However, it could become the preferred option especially in fragile patients and during contemporary COVID-19 pandemic due to the current limitations in vascular and critical care bed capacity.


Subject(s)
Aortic Diseases , Arterial Occlusive Diseases , COVID-19 , Endovascular Procedures , Leriche Syndrome , Adult , Aged , Aortic Diseases/diagnostic imaging , Aortic Diseases/etiology , Aortic Diseases/surgery , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/surgery , Endovascular Procedures/adverse effects , Female , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/surgery , Male , Middle Aged , Pandemics , Retrospective Studies , Stents , Treatment Outcome , Vascular Patency
6.
Braz J Cardiovasc Surg ; 35(5): 757-763, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-884149

ABSTRACT

It has been reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces endothelial inflammation, therefore facilitating the progression of endothelial and vascular dysfunction in coronavirus disease 2019 (COVID-19) patients. Coronary artery bypass grafting (CABG) involves mainly the use of the saphenous vein (SV) and internal mammary artery as graft material in the stenosed coronary arteries. Unfortunately, graft patency of the SV is low due to endothelial dysfunction and inflammation. We propose that SARS-CoV-2 might cause vascular inflammation, endothelial dysfunction, and thrombosis in coronary artery bypass graft vessels by binding angiotensin-converting enzyme 2 receptor. Therefore, in this Special Article, we consider the potential influence of COVID-19 on the patency rates of coronary artery bypass graft vessels, mainly with reference to the SV. Moreover, we discuss the technique of SV graft harvesting and the therapeutic potential of focusing on endothelial dysfunction, vascular inflammation, and thrombosis for protecting coronary artery bypass grafts in COVID-19 infected CABG patients.


Subject(s)
COVID-19/complications , Coronary Artery Bypass , Graft Occlusion, Vascular/virology , Vascular Patency , Endothelium, Vascular/physiopathology , Humans , Inflammation/physiopathology , SARS-CoV-2 , Saphenous Vein/surgery , Thrombosis/physiopathology , Treatment Outcome
7.
Ann Vasc Surg ; 70: 297-301, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-733967

ABSTRACT

SARS-CoV-2 (COVID-19) patients with associated thromboembolic events have demonstrated poor outcomes despite the use of anticoagulation therapy and surgical intervention. We present a COVID-19 patient with acute limb ischemia, secondary to extensive thrombosis of an aortic aneurysm, iliac arteries, and infrainguinal arteries. Initial treatment with systemic thrombolysis, which restored patency of the aortoiliac occlusion, was followed by open thrombectomies of the infrainguinal occlusions.


Subject(s)
Aortic Aneurysm, Abdominal/complications , Arterial Occlusive Diseases/drug therapy , COVID-19/complications , Fibrinolytic Agents/administration & dosage , Iliac Artery , Thrombolytic Therapy , Thrombosis/drug therapy , Tissue Plasminogen Activator/administration & dosage , Aged , Aortic Aneurysm, Abdominal/diagnostic imaging , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/physiopathology , COVID-19/diagnosis , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/physiopathology , Infusions, Intravenous , Male , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/physiopathology , Treatment Outcome , Vascular Patency
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