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1.
Vasc Endovascular Surg ; 57(5): 485-489, 2023 Jul.
Article in English | MEDLINE | ID: mdl-36475999

ABSTRACT

Heavily calcified arterial lesions are difficult to treat in an endovascular manner with conventional techniques due to limited arterial compliance. Intravascular lithotripsy offers a novel minimally invasive therapeutic option through endovascular emission of acoustic waves, fracturing calcium deposits and facilitating lesion dilation. We present the case of a successful application of the Shockwave intravascular lithotripsy system (IVL®, Shockwave Medical Inc) in a heavily calcified stenosis of the right renal artery in a patient with a coral reef aorta.


Subject(s)
Lithotripsy , Renal Artery Obstruction , Vascular Calcification , Humans , Treatment Outcome , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/etiology , Renal Artery Obstruction/therapy , Constriction, Pathologic/therapy , Lithotripsy/methods , Arteries , Vascular Calcification/diagnostic imaging , Vascular Calcification/therapy
2.
Acta Chir Belg ; 122(5): 328-333, 2022 Oct.
Article in English | MEDLINE | ID: mdl-33820485

ABSTRACT

OBJECTIVE/BACKGROUND: Carotid artery stenting (CAS) is a valuable solution for the treatment of carotid artery stenosis in a high-risk patient population for carotid endarterectomy (CEA). In literature however, there are concerns about the death and stroke rates of CAS in the 'real world' practice. Since Belgium is a small country with a broad offer of medical care, and there is no reimbursement for CAS, only small numbers of patients can be treated per vascular department. METHODS: In our department 45 CAS were performed from January 2006 until May 2018. Patient characteristics, indication for treatment and choice of treatment, minor stroke, major stroke and death rates were analyzed retrospectively. RESULTS: Of these patients 8/45 (18%) had a symptomatic carotid artery stenosis and 37/45 (82%) had an asymptomatic stenosis. A total minor stroke rate of 3/45 (6.6%) was recorded, but no major stroke (0%) or death (0%). Of the 37 patients who were asymptomatic at the start, 1 suffered a minor stroke (1/37, 2.7%) peri-operatively. CONCLUSION: Real world data from a low volume center show that CAS performed in patients with high risk for CEA yields acceptable outcome that is comparable to the literature. Since CAS is a delicate procedure we advice to centralize the procedure to an dedicated experienced interventionalist and to perform rigorous quality control of your 'real world' data.


Subject(s)
Carotid Stenosis , Endarterectomy, Carotid , Stroke , Belgium , Carotid Arteries/surgery , Carotid Stenosis/surgery , Endarterectomy, Carotid/adverse effects , Humans , Retrospective Studies , Risk Assessment , Risk Factors , Stents/adverse effects , Stroke/etiology , Stroke/prevention & control , Time Factors , Treatment Outcome
3.
Clin Case Rep ; 9(9): e04739, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34484772

ABSTRACT

Transcarotid percutaneous coronary intervention is feasible and safe and can be considered as an ultimate alternative in cases where conventional peripheral vascular access is unavailable.

4.
Ann Vasc Surg ; 61: 466.e13-466.e17, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31336161

ABSTRACT

Multiple simple renal cysts have been linked to aortic aneurysm and connective tissue disease by different authors. We present a case of a 64-year-old male patient with multilevel, rapid progressive aneurysmatic disease. Over a period of 11 years, he sequentially developed a symptomatic infrarenal aortic aneurysm of 100 mm, a juxtarenal progression of the aneurysm up to 61 mm, an aneurysm on the descending thoracic aorta of 73 mm, and a common iliac aneurysm of 53 mm. In addition, he developed an aneurysm of 69 mm of the left superficial femoral artery and an aneurysm of 53 mm of the right profunda femoris artery. Although the exact relationship between multiple simple renal cysts and arterial aneurysm formation is not known, there is a suggestion that they can be a marker for arterial aneurysmatic disease. We therefore would advocate a more thorough follow-up in case of aneurysmatic disease in a patient with known multiple simple renal cysts.


Subject(s)
Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Thoracic/complications , Femoral Artery , Iliac Aneurysm/complications , Kidney Diseases, Cystic/complications , Peripheral Arterial Disease/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Disease Progression , Endovascular Procedures/instrumentation , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Iliac Aneurysm/diagnostic imaging , Iliac Aneurysm/surgery , Kidney Diseases, Cystic/diagnostic imaging , Male , Middle Aged , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/surgery , Stents , Treatment Outcome
5.
Eur J Clin Invest ; 48(11): e13023, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30156710

ABSTRACT

Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries, mostly involving renal and cervical arteries. As a result of better and more systematic screening, it appears that involvement of the splanchnic vascular bed is more frequent than originally assumed. We review epidemiology, pathogenesis, clinical picture as well as diagnosis and treatment of visceral artery (VA) FMD. The clinical picture is very diverse, and diagnosis is based on CT-, MR- or conventional catheter-based angiography. Involvement of VAs generally occurs among patients with multi-vessel FMD. Therefore, screening for VA FMD is advised especially in renal artery (RA) FMD and in case of aneurysms and/or dissections. Treatment depends on the clinical picture. However, the level of evidence is low, and much of the common practice is extrapolated from visceral atherosclerotic disease.


Subject(s)
Asymptomatic Diseases , Fibromuscular Dysplasia/diagnosis , Aged , Aged, 80 and over , Angiography/methods , Early Diagnosis , Emergencies , Emergency Treatment/methods , Female , Fibromuscular Dysplasia/etiology , Fibromuscular Dysplasia/therapy , Healthy Lifestyle , Humans , Male , Platelet Aggregation Inhibitors/therapeutic use , Reperfusion , Viscera/blood supply
6.
Acta Chir Belg ; 117(6): 394-397, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29084477

ABSTRACT

PURPOSE: We explored an innovative technique in treating mycotic aortic aneurysms. CASE REPORT: A patient presenting with severe back pain, vague abdominal pain, weight loss and decline in general health, was diagnosed with a contained-rupture of a suprarenal mycotic aortic aneurysm, as a complication of spondylodiscitis. Since the patient's health condition was too poor to perform an open aortic repair, we choose an alternative treatment option by coiling the aneurysm with the jailing technique. CONCLUSION: We observed a good clinical outcome.


Subject(s)
Aging , Aneurysm, Infected/surgery , Aortic Aneurysm, Abdominal/surgery , Stents , Aged, 80 and over , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/microbiology , Aortic Rupture , Discitis/diagnostic imaging , Discitis/microbiology , Emergencies , Endovascular Procedures/methods , Humans , Lumbar Vertebrae , Male , Thoracic Vertebrae , Treatment Outcome
7.
J Cardiovasc Surg (Torino) ; 58(4): 528-534, 2017 Aug.
Article in English | MEDLINE | ID: mdl-27727202

ABSTRACT

BACKGROUND: Several trials have shown that drug coated balloon (DCB) angioplasty reduce the rates of restenosis in the femoropopliteal artery. This controlled, prospective, multicenter study was designed to demonstrate the efficacy of DCB to inhibit restenosis of the infrainguinal arteries in an exclusive diabetic population. METHODS: Between 2012 and 2014, 106 diabetic patients with symptomatic peripheral arterial disease (PAD) were enrolled at 11 sites in Belgium, 54 treated with DCB angioplasty and 52 treated with plain old balloon angioplasty (POBA). The primary endpoint of the study are the primary patency, mean diameter restenosis and binary restenosis of the treated sites at 6 months without re-intervention in the interim. RESULTS: The 6-month mean diameter restenosis was significantly lower in the DCB arm than in the POBA group (29±36% vs. 46±35%, P=0.032) and the binary (≥50% diameter stenosis) restenosis rate was signicantly lower in DCB patients compared with the POBA's (27% vs. 49%, P=0.03). The primary patency was significantly better in the paclitaxel coated balloon group (73% vs. 51%, P=0.03). The 6-month adverse effects rates were 5.5% in the POBA and 5.7% in the DCB arm. CONCLUSIONS: The treatment of diabetic PAD of the infra-inguinal arteries with the DCB provides a bettter primary patency rate compared with the plain old balloon angioplasty. The use of DCB did not increase the number of major adverse clinical events when compared with those seen with the use of the uncoated balloons.


Subject(s)
Angioplasty, Balloon/instrumentation , Cardiovascular Agents/administration & dosage , Coated Materials, Biocompatible , Diabetic Angiopathies/therapy , Paclitaxel/administration & dosage , Peripheral Arterial Disease/therapy , Vascular Access Devices , Aged , Aged, 80 and over , Angioplasty, Balloon/adverse effects , Belgium , Cardiovascular Agents/adverse effects , Diabetic Angiopathies/diagnostic imaging , Diabetic Angiopathies/physiopathology , Equipment Design , Female , Humans , Male , Middle Aged , Paclitaxel/adverse effects , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Prospective Studies , Recurrence , Risk Factors , Time Factors , Treatment Outcome , Vascular Patency
8.
Acta Chir Belg ; 116(6): 367-371, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27397037

ABSTRACT

BACKGROUND: Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading, but treatment is not invariably successful. Achilles tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture. We assessed the feasibility and clinical outcome of a comparative minimal invasive procedure: the gastrocnemius fascia release. This technique targets the same goals but is performed under local anaesthesia and allows immediate postoperative weight bearing and ambulation. METHODS: Diabetic patients with plantar neuropathic ulcers Wagner grade 2 or 3 were recruited from our diabetic foot clinic. Patients with infected wounds or untreatable peripheral arterial disease were excluded from the study. Conservative treatment with off-loading and local wound care was attempted for six weeks and surgical procedure only contemplated upon failure. Primary end-points were improved range of dorsiflexion and time to healing. Secondary end-points were local ulcer recurrences, new plantar ulcers, and minor or major amputation. Post-operative follow-up was 12 months. RESULTS: Seven patients were included in the study. An improvement in dorsiflexion of 10.4° (mean) was recorded post-operatively (p < 0.01). After 30 days, complete healing was accomplished in six of the seven patients. Long-term results were excellent as no ulcer recurrence or amputation was noted. CONCLUSIONS: Gastrocnemius fascia release under local anaesthesia can be performed safely in diabetic patients with plantar neuropathic ulcers under the metatarsal heads. Clinical outcome is excellent and long-term results promising.


Subject(s)
Achilles Tendon/surgery , Anesthesia, Local/methods , Diabetic Nephropathies/complications , Fasciotomy/methods , Foot Ulcer/surgery , Adult , Aged , Female , Follow-Up Studies , Foot Ulcer/etiology , Humans , Male , Middle Aged , Time Factors
9.
Int J Vasc Med ; 2014: 672897, 2014.
Article in English | MEDLINE | ID: mdl-24624299

ABSTRACT

Purpose. Angiosome-guided revascularization is an approach that improves wound healing but requires a surgeon to determine which angiosomes are ischemic. This process can be more difficult than anticipated because diabetic foot (DF) wounds vary greatly in quantity, morphology, and topography. This paper explores to what extent the heterogeneous presentation of DF wounds impedes development of a proper revascularization strategy. Methods. Data was retrieved from a registry of patients scheduled for below-the-knee (BTK) revascularization. Photographs of the foot and historic benchmark diagrams were used to assign wounds to their respective angiosomes. Results. In 185 limbs we detected 345 wounds. Toe wounds (53.9%) could not be designated to a specific angiosome due to dual blood supply. Ambiguity in wound stratification into angiosomes was highest at the heel, achilles tendon, and lateral/medial side of the foot and lowest for malleolar wounds. In 18.4% of the DF, at least some wounds could not confidently be categorized. Proximal wounds (coinciding with toe wounds) further steered revascularization strategy in 63.6%. Multiple wounds required multiple BTK revascularization in 8.6%. Conclusion. The heterogeneous presentation in diabetic foot wounds hampers unambiguous identification of ischemic angiosomes, and as such diminishes the capacity of the angiosome model to optimize revascularization strategy.

10.
Ann Vasc Surg ; 28(4): 901-7, 2014 May.
Article in English | MEDLINE | ID: mdl-24362259

ABSTRACT

BACKGROUND: Medical complications may prolong the hospital stay after elective carotid endarterectomy (CEA). We prospectively assessed the social and medical feasibility and safety of patient discharge on the first postoperative day after elective CEA and unplanned readmissions. METHODS: Between June 2011 and January 2012, 57 consecutive patients scheduled for elective CEA were enrolled with the aim of discharge on the first postoperative day if there were no medical contraindications and on the condition that the patient should not be left alone during the first day and night at home. CEA was carried out under local or general anesthesia. After discharge, the patients were contacted to ascertain the occurrence of arterial hypertension, cerebral hyperperfusion, focal cerebral ischemia, or hospital readmission. RESULTS: Sixty-two CEA were carried out in 57 patients (33 men and 24 women ranging in age from 51-89 years). The indications for CEA were: asymptomatic high grade stenosis in 27, hemispheric transient ischemic attack in 12, amaurosis fugax in 6, recovered stroke in 16, and nonlateralizing signs in 1. There were no cases of perioperative stroke or death. Discharge on the first postoperative day was achieved in 45 cases (73%). In 15 cases (24%), discharge was on the second postoperative day because of the absence of a relative (12 cases) or for medical reasons (3 cases). Discharge was on day 3 in 1 case, and on day 10 in another, both for medical reasons. No cases of severe arterial hypertension, stroke, mortality, or readmission for reasons related to the CEA procedure were recorded up to postoperative day 30. CONCLUSION: In this study, the majority of patients undergoing elective CEA were discharged safely on the first postoperative day. Social reasons, rather than medical reasons, underlied most cases of later discharge. There were no unplanned readmissions for complications of CEA.


Subject(s)
Endarterectomy, Carotid , Length of Stay , Patient Discharge , Aged , Aged, 80 and over , Caregivers , Elective Surgical Procedures , Endarterectomy, Carotid/adverse effects , Feasibility Studies , Female , Humans , Male , Middle Aged , Patient Readmission , Postoperative Complications/etiology , Prospective Studies , Risk Assessment , Risk Factors , Social Environment , Time Factors , Treatment Outcome
11.
Vasc Endovascular Surg ; 47(5): 383-6, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23640473

ABSTRACT

PURPOSE: Subintimal crossing of total occlusions and acquiring reentry into the true lumen may be hazardous in highly calcified lesions, with or without the use of expensive reentry devices. Even when desirable, intraluminal crossing may not be feasible, because the guidewire tends to follow a path of least resistance between the intimal plaque and the adventitia. TECHNIQUE: A standard percutaneous transluminal angioplasty balloon is positioned just above the proximal cap of the occlusion and insufflated to 6 atmosphere. The balloon is used (1) to increase guidewire support close to the lesion and (2) for centralization purposes (limiting lateral movement of the guidewire). The ultra stiff back end of a regular guidewire can then be used to target the center of the cap while repeatedly pounding against it until it breaches. CONCLUSIONS: The balloon-assisted battering ram technique may be attempted if intraluminal crossing is warranted before resorting to other complicated, expensive devices.


Subject(s)
Angioplasty, Balloon/methods , Arterial Occlusive Diseases/therapy , Ischemia/therapy , Lower Extremity/blood supply , Aged , Angioplasty, Balloon/instrumentation , Arterial Occlusive Diseases/diagnosis , Chronic Disease , Critical Illness , Female , Humans , Ischemia/diagnosis , Radiography, Interventional , Treatment Outcome , Vascular Access Devices
12.
Ann Vasc Surg ; 26(6): 833-8, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22727062

ABSTRACT

BACKGROUND: Lymphocutaneous fistulas occurring after vascular procedures of the lower limb are a rare, but frustrating, complication. Many treatment options exist, but may lead to inconsistent results, with infection, delayed wound healing, and prolonged hospital stay. We present a simple surgical treatment of wound closure and drainage. METHODS: In this single-center, single-intervention, observational clinical study (case series), prospectively collected data of 23 consecutive lymphocutaneous fistulas in 22 patients (19 male and three female; age, 42 to 91 years) treated between June 2005 and October 2008 were retrospectively analyzed. Twenty-two fistulas were situated in the groin and one at the knee incision. The standardized therapy consisted of the installation of a Redon to drain the lymph, and accurate closure of the wound. Postoperatively, drainage was maintained for 21 days: suction Redon drainage for the first 7 days, passive Redon drainage for the next 7 days, and further drainage in a pouch after removal of the drain for the last 7 days. RESULTS: In 19 of the initial 23 lymphocutaneous fistulas, the whole drainage procedure was completed, with healing of the wound, without infection, recurrence, or lymphocele formation after 1 year of follow-up. In these cases, there had been a steady decrease of daily lymph drainage: a mean of 163.4 (standard error on the mean, 39.6) mL on the first day of suction, 56.8 (15.5) mL on the first day of passive drainage, 11.6 (4.3) mL on the last day of passive drainage, and 2.1 (0.9) mL on the 21st day when the drainage treatment was stopped. In four fistulas, this treatment was considered a failure because of inadvertent early drain removal (two cases), infection (one case), and lymphorrhea recurrence with wound breakdown (one case). CONCLUSION: This standardized surgical therapy, consisting of accurate wound closure and 3 weeks of drainage, allowed the healing of 19 of 23 postoperative lymphocutaneous fistulas (an 82.6 % success rate), without infection, recurrence, or lymphocele formation after 1 year of follow up.


Subject(s)
Cutaneous Fistula/therapy , Drainage , Fistula/therapy , Lower Extremity/blood supply , Lymphatic Diseases/therapy , Vascular Surgical Procedures/adverse effects , Wound Closure Techniques , Adult , Aged , Aged, 80 and over , Cutaneous Fistula/etiology , Cutaneous Fistula/surgery , Female , Fistula/etiology , Fistula/surgery , Humans , Lymphatic Diseases/etiology , Lymphatic Diseases/surgery , Lymphocele/etiology , Lymphocele/therapy , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome
13.
J Vasc Access ; 13(1): 86-90, 2012.
Article in English | MEDLINE | ID: mdl-21786240

ABSTRACT

PURPOSE: To determine how many procedures a surgical trainee requires before they are able to place a tunneled double-lumen dialysis catheter safely on their own. METHODS: Surgical trainees unfamiliar with the procedure received a pre-operative briefing in which we explained 1) why, how, and in what particular order each operational step should be executed and 2) what the possible pitfalls/complications are. Next, an experienced surgeon demonstrated the procedure with the trainee scrubbed-in as their assistant. The trainee then performed all successive procedures, while the supervising surgeon acted as a silent observer and intervened only when an error was made. We recorded all errors as well as near misses and noted if they were severe, recurrent or unanticipated. At least three procedures were required but training was continued until less than three errors were made. RESULTS: Ten trainees were included in the study. On average, a trainee made 11.9 mistakes during 3.4 procedures in a time span of 28.2 days. Only three trainees performed their last procedure flawlessly. The number of errors decreased exponentially from the first procedure onwards (P<.001). A statistically significant correlation was found between the number of mistakes and the number of days since the last procedure (P<.035). Unanticipated errors most frequently involved erroneous fluoroscopy interpretation, flushing with blood-contaminated saline, and incorrect volume injection for the heparin lock. CONCLUSIONS: A theoretically well-prepared surgical trainee should be able to perform the placement of a tunneled dialysis catheter safely after four procedures. Training is more efficient when procedures follow each other quickly.


Subject(s)
Catheterization, Central Venous/instrumentation , Catheters, Indwelling , Clinical Competence , Learning Curve , Adult , Aged , Aged, 80 and over , Analysis of Variance , Belgium , Catheterization, Central Venous/adverse effects , Equipment Design , Female , Humans , Male , Middle Aged , Task Performance and Analysis , Teaching/methods , Time Factors , Young Adult
14.
Ann Vasc Surg ; 25(6): 770-7, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21514102

ABSTRACT

BACKGROUND: The ankle--brachial index (ABI) is a simple, noninvasive, widely used test that detects peripheral arterial disease (PAD). In patients with diabetes, the ABI is notoriously unreliable and this is usually attributed to medial calcinosis, which stiffens the arteries and renders them poorly compressible. However, the distribution of atherosclerotic lesions in those with diabetes is different as well: lesions predominantly reside in below-the-knee (BTK) arteries. To what extent this contributes to the unreliability of the ABI is unknown. The aims of this study were (1) to confirm the notion that the ABI poorly predicts PAD in the diabetic foot, (2) to determine whether arterial calcifications can be blamed, and (3) to establish the role of the distribution of atherosclerotic lesions. METHODS: We studied 187 lower extremities with a diabetic foot that had an intra-arterial angiography and an ABI. The extent of atherosclerosis on angiography was rated by scoring all arterial segments from the aorta to the foot conforming to the Joint Vascular Societies reporting standard. Arterial calcification was assessed using a 4-level severity scale based on the number and length of calcified arterial segments as seen on plain X-ray. The ABI was calculated using four arterial pressures (two brachial, dorsal pedal, and tibial posterior arteries). To prove that the standard ABI is ill-designed to detect atherosclerosis located in BTK arteries, we postulated that an ABI that incorporated more information about these arteries would correlate better with angiographic atherosclerotic disease. To this end, we compared the standard ABI (which only uses the highest distal pressure available and neglects the pressure in other BTK arteries) with two alternatively calculated ABIs: one using the lowest pressure as numerator, and one with the average of both pressures while assuming a pressure of 0 for arteries that were not found by Doppler. RESULTS: The ABI could be determined in 123 cases (65.7%), mean ABI was 0.92. Analysis of the angiographies showed that atherosclerotic lesions had a high predilection for BTK arteries. The correlation between ABI and angiographic PAD was weak (Pearson correlation coefficient r = -0.487). Arterial calcification was absent in 36.9%, and considered to be light (5.4%), moderate (17.1%), or heavy (40.6%). Patients with moderate or heavy calcifications were grouped together and considered to have calcified arteries. These individuals had a lower ABI (p < 0.013), more advanced atherosclerotic disease (p < 0.001), and a higher interbrachial pressure differential (p < 0.017). Of all the ABIs tested, the one that used both distal pressures correlated best (r = -0.554) with atherosclerotic disease. Irrespective of how the ABI was calculated, patients without calcifications consistently had a better correlation with atherosclerotic disease than those with calcified arteries. CONCLUSION: The ABI underestimated angiographic atherosclerotic disease in this population of patients that we thought had PAD causing tissue loss. Calcifications were frequently present and indeed can be partly blamed for the unreliability of the ABI, but the distribution of atherosclerotic disease can be held responsible as well: the ABI is hampered by design because it is meant to detect a drop in pressure caused by the additive effect of serially located lesions in the arterial tree. In the diabetic foot, where lesions tend to be situated in BTK arteries (which lie parallel to each other), the pressure measured in one distal artery is less representative of atherosclerotic disease in the lower extremity.


Subject(s)
Ankle Brachial Index , Blood Pressure , Calcinosis/diagnosis , Diabetic Foot/diagnosis , Peripheral Arterial Disease/diagnosis , Aged , Belgium , Calcinosis/diagnostic imaging , Calcinosis/physiopathology , Chi-Square Distribution , Diabetic Foot/diagnostic imaging , Diabetic Foot/physiopathology , Female , Humans , Male , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Predictive Value of Tests , Radiography , Regression Analysis , Reproducibility of Results , Ultrasonography, Doppler
15.
Vasc Endovascular Surg ; 45(1): 28-32, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21156716

ABSTRACT

PURPOSE: The aim of the study was to compare the outcome after carotid endarterectomy (CEA) in patients with and without diabetes mellitus. METHODS: We prospectively recorded the data from patients who underwent CEA. A patient was considered diabetic when he reported the use of antidiabetic medication. De novo diagnosis of diabetes was defined as the first demonstration of a fasting glucose serum concentration >126 mg/dL or >200 mg/dL after glucose load. An early adverse outcome was defined as the occurrence of ipsilateral minor or major stroke and/or death during the 30-day postoperative period. RESULTS: The stroke and death rate was significantly higher in diabetic patients (n = 380) compared to the controls (n = 971; 4.5% versus 1.5%, P = .002). Multivariate analysis showed a significant association between the presence of diabetes and 30-day stroke and death rate (OR 2.94, CI 1.46-5.97, P = .003). CONCLUSIONS: Diabetic patients are at greater risk for perioperative stroke and death.


Subject(s)
Carotid Artery Diseases/surgery , Diabetes Mellitus , Endarterectomy, Carotid/adverse effects , Aged , Belgium , Blood Glucose/metabolism , Carotid Artery Diseases/mortality , Case-Control Studies , Chi-Square Distribution , Diabetes Mellitus/blood , Diabetes Mellitus/drug therapy , Diabetes Mellitus/mortality , Endarterectomy, Carotid/mortality , Female , Humans , Hypoglycemic Agents/therapeutic use , Logistic Models , Male , Middle Aged , Odds Ratio , Prospective Studies , Risk Assessment , Risk Factors , Stroke/etiology , Time Factors , Treatment Outcome
16.
Vasc Endovascular Surg ; 42(2): 122-7, 2008.
Article in English | MEDLINE | ID: mdl-18421029

ABSTRACT

OBJECTIVES: There is evidence that inflammation plays a role in the pathogenesis of atherosclerosis. We compared levels of inflammatory markers between patients undergoing carotid endarterectomy (CEA) and controls, and between patients with symptomatic and asymptomatic internal carotid artery (ICA) stenosis. MATERIALS AND METHODS: A total of 180 patients with ICA stenosis were compared with 180 age-matched and sex-matched controls. The biomarkers evaluated were high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule 1, soluble vascular cell adhesion molecule 1 (sVCAM-1), and interleukin-6 (IL-6). RESULTS: The levels of hs-CRP, sVCAM-1, and IL-6 in the CEA group were significantly higher than in the control group (1.87 mg/mL vs 1.44 mg/mL, P = .011; 1408 ng/dL vs 672 ng/dL, P < .001; 11.9 pg/mL vs 6.3 pg/mL, P < .001). Multivariate linear regression analysis, adjusted for all clinical and physiologic parameters, showed a significant association between ICA stenosis and hs-CRP, sVCAM-1, and IL-6 concentrations. Analysis of symptomatic (n = 101) and asymptomatic (n = 79) ICA stenosis did not detect a difference in levels of these markers. CONCLUSIONS: Our study suggests that inflammatory markers could serve as markers for ICA atherosclerosis but are not useful to identify carotid plaque at risk for symptomatic conversion.


Subject(s)
Carotid Artery, Internal/pathology , Carotid Stenosis/blood , Inflammation Mediators/blood , Aged , Aged, 80 and over , Biomarkers/blood , C-Reactive Protein/metabolism , Carotid Artery, Internal/surgery , Carotid Stenosis/pathology , Carotid Stenosis/surgery , Case-Control Studies , Endarterectomy, Carotid , Female , Humans , Interleukin-6/blood , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Up-Regulation , Vascular Cell Adhesion Molecule-1/blood
17.
Eur J Endocrinol ; 156(6): 687-93, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17535869

ABSTRACT

OBJECTIVE: To study the endogenous sex hormone levels in natural postmenopausal women and their association with the presence of internal carotid artery (ICA) atherosclerosis. DESIGN: Case-control study METHODS: We compared 56 patients with severe ICA atherosclerosis referred for carotid artery endarterectomy (CEA) with 56 age-matched control subjects free of severe atherosclerotic disease. The presence of atherosclerosis was determined by high-resolution B-mode ultrasound. Metabolic parameters and sex hormones were measured or calculated: total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, quantitative insulin sensitivity check index, insulin resistance index, IGF-I, DHEA, DHEA sulfate (DHEA-S), free testosterone, total testosterone, estrone, estradiol, androstenedione, and sex hormone-binding globulin. RESULTS: The cases had statistically significant lower levels of both total testosterone (0.23 +/- 0.12 vs 0.31 +/- 0.20 microg/l, P = 0.043) and free testosterone (3.42 +/- 1.94 vs 4.59 +/- 2.97 ng/l, P = 0.009) and significantly lower levels of androstenedione (625.3 +/- 168.7 vs 697.0 +/- 211.9 ng/l, P = 0.017) when compared with controls. Multivariate linear regression analysis, adjusted for traditional cardiovascular risk factors, baseline and physiologic characteristics, showed a significant inverse relationship between both serum free testosterone (beta = -0.234, P = 0.028) and androstenedione (beta = -0.241, P = 0.028) levels with the presence of severe atherosclerosis of ICA. CONCLUSIONS: The study provides evidence of a positive association between low serum androgen levels and severe ICA atherosclerosis in postmenopausal women. It suggests that higher, but physiological, levels of androgens in postmenopausal women have a protective role in the development of atherosclerosis of ICA.


Subject(s)
Carotid Artery Diseases/metabolism , Carotid Artery Diseases/surgery , Endarterectomy, Carotid , Gonadal Steroid Hormones/blood , Postmenopause/metabolism , Aged , Androstenedione/blood , Blood Glucose , Dehydroepiandrosterone/blood , Dehydroepiandrosterone Sulfate/blood , Estradiol/blood , Estrone/blood , Female , Humans , Insulin/blood , Lipoproteins, HDL/blood , Lipoproteins, LDL/blood , Middle Aged , Severity of Illness Index , Sex Hormone-Binding Globulin/metabolism , Testosterone/blood , Triglycerides/blood
18.
Surg Neurol ; 67(5): 467-71; discussion 471, 2007 May.
Article in English | MEDLINE | ID: mdl-17445605

ABSTRACT

BACKGROUND: The study was conducted to detect possible differences in patient characteristics, in early outcome, and in predictors for 30-day combined stroke and death rate between younger and older patients undergoing CEA. METHODS: Between March 1988 and November 2005, we recorded prospectively the data from every patient who underwent carotid artery surgery. Cardiovascular risk factors, comorbidities, anesthetic and surgical techniques, outcome, and survival were reviewed and compared between <75 age and >or=75 age group. RESULTS: We performed 1028 procedures in 742 patient. A total of 286 carotid endarterectomies were done in 213 patients 75 years or older. The number of cardiovascular risk factors per patient decreased with age. The risk factors tobacco use, hyperlipidemia, and the combination tobacco, hypertension, and hyperlipidemia were predominant in the younger group. Hypertension as only risk factor and the combination hypertension and hyperlipidemia were more present in the older group. The perioperative combined minor and major stroke and death rate was 2.8% in both groups. Attendant predictors for adverse outcome in the >or=75 age group were female sex and the combination of the risk factors diabetes, tobacco use, and hypertension. CONCLUSIONS: The type, the number, and the combinations of cardiovascular risk factors and the predictors for adverse outcome are different in the 2 age groups. Our observations indicate that people 75 years or older with small number of cardiovascular risk factors can undergo CEA with the same risk of perioperative stroke and death as the younger patients.


Subject(s)
Aging , Carotid Stenosis/surgery , Endarterectomy, Carotid/statistics & numerical data , Postoperative Complications/etiology , Adult , Age Factors , Aged , Aged, 80 and over , Aging/pathology , Cardiovascular Diseases/epidemiology , Carotid Stenosis/epidemiology , Carotid Stenosis/physiopathology , Comorbidity , Endarterectomy, Carotid/adverse effects , Female , Humans , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Male , Middle Aged , Postoperative Complications/physiopathology , Prospective Studies , Risk Assessment , Risk Factors , Sex Distribution , Sex Factors , Stroke/etiology , Stroke/physiopathology , Tobacco Use Disorder/epidemiology
19.
Ann Vasc Surg ; 20(5): 609-13, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16741650

ABSTRACT

We compared early outcome after carotid endarterectomy (CEA) in patients (n = 857 with 1,011 CEA interventions) with and without chronic renal insufficiency (CRI). Two groups were compared: a group with normal renal function (n = 909) and a group with CRI (creatinine >/=1.5 mg/dL and clearance of

Subject(s)
Carotid Stenosis/mortality , Carotid Stenosis/surgery , Endarterectomy, Carotid/adverse effects , Renal Insufficiency, Chronic/mortality , Stroke/etiology , Aged , Belgium/epidemiology , Carotid Stenosis/complications , Female , Heart Diseases/complications , Humans , Hypertension/complications , Incidence , Logistic Models , Male , Mortality/trends , Odds Ratio , Patient Selection , Prospective Studies , Renal Insufficiency, Chronic/complications , Risk Assessment , Risk Factors , Smoking/adverse effects , Stroke/epidemiology , Time Factors , Treatment Outcome
20.
Reg Anesth Pain Med ; 29(4): 312-6, 2004.
Article in English | MEDLINE | ID: mdl-15305249

ABSTRACT

OBJECTIVE: To examine the effect of 225 mg (7.5 mg/mL), 150 mg (5 mg/mL), and 112.5 mg (3.75 mg/mL) ropivacaine on quality of cervical plexus block during carotid endarterectomy. METHODS: Patients (n = 93) scheduled for carotid endarterectomy were randomized to receive a cervical plexus block with deep infiltration of 10 mL and superficial infiltration of 20-mL volumes of ropivacaine 7.5, 5.0, or 3.75 mg/mL. Pain, coughing, hemodynamic consequences of the block, postoperative visual analog scores, and pain satisfaction index were recorded. If necessary, anesthesia supplements with aliquots of 3 mL lidocaine 1% were given during surgery. RESULTS: Incidences of coughing and hoarseness were similar in all groups. More local anesthetic infiltrations were required in the ropivacaine 3.75-mg/mL and 5-mg/mL groups. Postoperatively, no intragroup differences were observed. A trend toward better pain satisfaction was observed in the ropivacaine 7.5-mg/mL group. CONCLUSION: The best quality of cervical plexus block associated with the smallest incidence of pain for patients undergoing carotid endarterectomy was obtained with 30 mL of 225 mg and 150 mg of ropivacaine, respectively.


Subject(s)
Amides/therapeutic use , Anesthetics, Local/therapeutic use , Cervical Plexus/drug effects , Endarterectomy, Carotid/methods , Nerve Block/methods , Aged , Amides/adverse effects , Analysis of Variance , Anesthetics, Local/adverse effects , Dose-Response Relationship, Drug , Female , Humans , Male , Pain/prevention & control , Patient Satisfaction , Ropivacaine , Treatment Outcome
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