Outcomes of endovascular treatment for popliteal artery disease.

Background: Finding the appropriate endovascular revascularization strategy for patients with peripheral artery disease and a popliteal artery lesion remains particulary challenging. Data regarding predictors for a beneficial outcome are scarce. Patients and methods: All endovascular procedures of popliteal artery lesions (n=227) performed in 197 patients between February 2009 and May 2018 at our institution were retrospectively analyzed. Hemodynamically relevant restenosis represented the primary endpoint. Results: The overall technical success rate was 98% and yielded 99% for stenoses (n=145) and 97% for occlusions (n=82). In a median follow-up of 10 months, the overall rate of restenosis was 23%. After 1 and 2 years, the primary patency rates were 76% and 55% and the secondary patency rate was 100%, respectively. The estimated probability of restenosis was significantly higher in stented lesions (stent vs. no stent; 36.0% vs. 19.1%; p=0.030). Multivariate analysis identified stent implantation (hazard ratio: 2.4; overall P=0.010) and diabetes (hazard ratio 2.0; P=0.023) as significant predictors for the development of restenosis. Conclusions: Endovascular therapy for popliteal artery disease was associated with high technical success rates and accompanied with a promising mid-term outcome, particularly in lesions treated with balloon angioplasty alone.

A case report of RASA1-associated inherited lymphoedema with recurrent life-threatening lymphangitis.

BACKGROUND: Most cases of lymphoedema are secondary to other causes, while cases of primary lymphoedema, in particular that of congenital origin, are uncommon. Limited genetic disorders are so far known to be associated with lymphatic malformation including mutations in RASA1. This clinical case highlights the possible complications of RASA1-associated lymphatic malformation in a female suffering from recurrent life-threatening septic lymphangitis. CASE SUMMARY: A 23-year-old female patient presented with congenital lymphoedema of the lower right extremity. At the age of eight, she first suffered from an episode of lymphangitis. Thereafter, she developed recurrent episodes of lymphangitis predominately occurring during menstruation and culminating into severe and life-threatening septicaemias. Due to the menstrual association, endometriosis was suspected but could not be confirmed. Furthermore, angiography could not detect any sign of arteriovenous fistula. Single-Photon-Emission-Computed-Tomography confirmed absent major lymphatics of the right leg with severely impaired and prolonged dermal lymphatic backflow. Genetic testing identified a disease-causing variant in the RASA1 gene. DISCUSSION: To our knowledge, this is the first case of recurrent septic lymphangitis with close relation to menstruation in a female with RASA1-associated lymphatic malformation. Due to the possible de novo or somatic origin of a pathogenic variant, a genetic disease should be considered in spite of an unremarkable family history or a localized lymphoedema. Although there is no curative therapy available yet, the knowledge of the underlying genetic defect is important for interdisciplinary patient care and might be crucial for individual molecular therapies in the future.

Significant prevalence of peripheral artery disease in patients with disturbed wound healing following elective foot and ankle surgery: Results from the ABI-PRIORY (ABI as a PRedictor of Impaired wound healing after ORthopedic surgerY) trial.

Disturbed wound healing (DWH) following elective foot and ankle surgery is associated with a number of known risk factors. The purpose of this study was to determine if peripheral artery disease (PAD) is a potential risk factor that contributes to an increase in postoperative DWH. In a case-control study, we analyzed all patients undergoing elective foot and ankle surgery between January 1, 2014 and December 31, 2017 at two institutions and identified 51 patients with postoperative DWH. After matching with 51 control patients without DWH, all 102 patients were evaluated for PAD. The prevalence of PAD was significantly higher in the DWH group compared to the control group (41.2% vs 19.6%, p < 0.01). This difference was even more distinctive for patients with any abnormal ankle-brachial index (ABI) (51.0% vs 19.6%, p < 0.001). After adjustment for diabetes, hypertension, hypercholesterolemia, and smoking, any abnormal ABI or a history of PAD remained an independent risk factor for DWH (odds ratio 3.28; 95% CI 1.24-8.71). In this dual-center study, postoperative DWH was associated with significantly higher rates of PAD. These findings suggest that preoperative evaluation for PAD could be a helpful tool to identify patients at high risk for postoperative wound complications undergoing foot and ankle surgery. This trial is registered with drks.de, number DRKS00012580.

Endovascular therapy of subclavian artery occlusive disease involving the vertebral artery origin.

Background: While the majority of subclavian artery (SA) lesions are localized in the proximal segment, the evidence in patients with medial SA disease involving the vertebral artery (VA) origin are scarce. PATIENTS AND METHODS: We retrospectively analyzed all patients who underwent percutaneous revascularization of the SA at our institution. RESULTS: A total of 196 patients were retrospectively analyzed. The majority of SA lesions (n = 163, 83 %) were located in the proximal segment, whereas 28 lesions (14 %) were located in the medial segment, and only 5 lesions (3 %) involved the distal segment. Procedural success was high for both stenosis (96 %) and occlusion (89 %) and did not differ depending on lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 patients), and bifurcation stenting of the SA and VA using T-stenting technique (9 patients). Outcome after a median of 12 months showed no significant differences in freedom from restenosis between proximal and medial lesions (90 % vs. 95 %; p = 0.67). CONCLUSIONS: Endovascular revascularization of SA disease with medial segments involving the VA origin required more complex techniques and showed long-term patency rates comparable to those in lesions located within the proximal SA.

Predictors of patient satisfaction after cardiac pacemaker implantation or ICD implantation.

BACKGROUND AND AIM OF THE STUDY: The study aimed to identify predictors of satisfaction of patients receiving a cardiac pacemaker or an implantable cardioverter-defibrillator (ICD). METHODS: This was a cross-sectional study measuring patient satisfaction postdischarge by using a mailed questionnaire. Study participants included a random sample of hospitalized patients who had undergone implantation of a pacemaker or ICD in 30 hospitals in Germany. RESULTS: Data from 548 respondents (response rate 17.3%) were available for analyses. Logistic regression analysis revealed the following factors associated with satisfaction of inpatients (P < .05): outcome of treatment (odds ratio [OR] = 11.51, 95% confidence interval [CI] = 4.62-28.64), individualized medical care by physicians (OR = 5.04, 95% CI = 2.13-11.92), kindness of nurses (OR = 4.83, 95% CI = 1.52-15.42), and physicians (OR = 3.46, 95% CI = 1.03-11.65), organization of procedures and operations, respectively (OR = 4.45, 95% CI = 1.85-10.75) and thoroughness of the discharge instructions (OR = 2.69, 95% CI = 1.17-6.20). CONCLUSIONS: This study identified six predictors of satisfaction among pacemaker and ICD patients that can be addressed by healthcare providers to increase patients' evaluation of the hospitalization. Identified predictors of satisfaction are alterable by health care professionals and, thus, should be focused on to increase satisfaction ratings of patients who have undergone implantation of a pacemaker or ICD.

Imaging Neuronal Activity in the Optic Tectum of Late Stage Larval Zebrafish.

The zebrafish is an established model to study the development and function of visual neuronal circuits in vivo, largely due to their optical accessibility at embryonic and larval stages. In the past decade multiple experimental paradigms have been developed to study visually-driven behaviours, particularly those regulated by the optic tectum, the main visual centre in lower vertebrates. With few exceptions these techniques are limited to young larvae (7-9 days post-fertilisation, dpf). However, many forms of visually-driven behaviour, such as shoaling, emerge at later developmental stages. Consequently, there is a need for an experimental paradigm to image the visual system in zebrafish larvae beyond 9 dpf. Here, we show that using NBT:GCaMP3 line allows for imaging neuronal activity in the optic tectum in late stage larvae until at least 21 dpf. Utilising this line, we have characterised the receptive field properties of tectal neurons of the 2-3 weeks old fish in the cell bodies and the neuropil. The NBT:GCaMP3 line provides a complementary approach and additional opportunities to study neuronal activity in late stage zebrafish larvae.

Age-related differences in the P3 amplitude in change blindness.

Observers often miss visual changes in the environment when they co-occur with other visual disruptions. This phenomenon is called change blindness. Previous research has shown that change blindness increases with age. The aim of the current study was to explore the role of post-perceptual stimulus processing in age differences. Therefore, the P3 component of the event-related potential was measured while younger, middle-aged, and older participants performed a change detection task under different task demands. Older adults detected fewer changes than younger adults, even when the task was very easy. Detected changes elicited greater P3 amplitudes than undetected changes in younger adults. This effect was reduced or even absent for middle-aged and older participants, irrespective of task demands. Because this P3 effect is supposed to reflect participants' confidence in change detection, less confidence in own responses may explain the decline of change detection performance in normal aging.