Readability of patient educational materials in venous thrombosis: analysis of the 2021 ESVS guidelines and comparison with other medical societies information.

BACKGROUND: In order for patients to comprehend health related information, it must be written at a level that can be readily understood by the intended population. During 2021 the European Society for Vascular Surgery (ESVS) published a sub-section about information for patients into its Guidelines on the Management of Venous Thrombosis. METHODS: Nine readability measures were used to evaluate the patient educational material regarding venous thrombosis published by seven medical societies: ESVS, Society for Vascular Medicine (SVM), Society for Vascular Surgery (SVS), Vascular Society for Great Britain and Ireland (VS), Australia and New Zealand Society for Vascular Surgery (ANZSVS), Canadian Society for Vascular Surgery (CSVS) and American Heart Association (AHA). RESULTS: The mean reading grade level (RGL) for all the 58 recommendations was 10.61 (range 6.4-14.5) and the mean Flesch Reading Ease (FRE) was 56.10 (51.3-62.9), corresponding to a "fairly difficult" reading level. The mean RGL of the ESVS recommendations (11.45, 95% CI, 9.90-13.00) was significantly higher than the others. Post-hoc analysis determined a significant difference between the ESVS and the SVS (10.86, 95% CI, 9.84-11.91) recommendations (P=0.005). All the patient's education information published by the medical societies presented a RGL higher than recommended. The fifteen sub-sections of the information for patients included into the ESVS clinical guidelines presented a mean RGL above 9.5 points, revealing that no one (0%) was written at or below the recommended GRL. The mean FRE was 47.63 (28.2-61.6), corresponding to a "difficult" reading level. CONCLUSIONS: Venous thrombosis patient educational materials produced by leading medical societies have readability scores that are above the recommended levels. The innovative patient's information included into the ESVS venous thrombosis guidelines represents an important advance in the amelioration of the medical information for patients, but their readability should be improved to adapt the understanding to the general population.

Bull horn vascular injuries in popular celebrations: A 40-year retrospective analysis.

OBJECTIVE: The aim of the present study was to analyze and report the clinical presentation and treatment at a single center of bull horn vascular injuries (BHVIs) that had occurred during popular celebrations in the past four decades. Thus, we investigated BHVIs in a high-volume academic center in Spain. METHODS: All the patients with a BHVI admitted between January 1980 and January 2021 were retrospectively enrolled in the present study. Data collection included demographics, injury profile, and outcomes. The primary outcome was in-hospital mortality. The hospital and intensive care unit lengths of stay, rates of reintervention, postoperative complications, and mortality were also analyzed. Data were collected from the electronic and/or digitized medical history records. RESULTS: A total of 296 patients were included in the present analysis. The mean patient age was 33.4 years (range, 17-91 years), and 93.9% were men. Of the 296 patients, 126 (42.6%) had experienced a complication, and 57 (19.3%) had required reoperation. The overall in-hospital mortality was 5.1%. The risk factors for mortality were arterial injury (odds ratio [OR], 5.11; 95% confidence interval [CI], 1.45-23.3; P = .009), injury to the abdominal region (OR, 3.45; 95% CI, 1.11-14.54; P = .038), American Society of Anesthesiologists classification IV (OR, 3.27; 95% CI, 1.87-17.83; P = .004), and age >65 years (OR, 3.13; 95% CI, 1.38-10.04; P = .001). Statistically significant differences were found between bull horn arterial injuries and arterial plus concomitant venous injuries in the intensive care unit length of stay (4.9 ± 13.3 days vs 3.1 ± 12.6 days; P = .024), hospital length of stay (12.0 ± 8.2 days vs 10.1 ± 6.3 days; P = .007), postoperative complications (45.2% vs 30.6%; P = .002), and mortality (3.4% vs 1.9%; P = .001). CONCLUSIONS: The morbidity and mortality from BHVIs have remained high for the past 40 years. Popular celebrations with bulls constitute an etiology of vascular trauma that can have dire consequences.

The Psychological Impact of the COVID-19 Pandemic in Spain: A Longitudinal Study.

BACKGROUND: This study aims to longitudinally assess the psychological impact of the COVID-19 pandemic in the general Spanish population. It uses four assessment points: two weeks after the start of confinement, one month after, two months after, and one year after the first evaluation. METHODS: Evaluations were conducted through an online survey, with a sample of 3,480 people at the first data collection and 1,041, 569, and 550 people at successive evaluation points. Depressive symptoms (PHQ-2), anxiety (GAD-2), post-traumatic stress (PCL-C-2), social support (EMAS), loneliness (UCLA-3), and discrimination (InDI-d) were evaluated. RESULTS: Significant changes were found in the variables depression and anxiety with a greater presence of this kind of symptomatology after one year (p < .01). There were also significant changes in the variable social support, which showed a substantial reduction after one year (p < .001). Similarly, there were significant variations in the variable intersectional discrimination (p < .001), with greater levels of discrimination. The temporal models show no significant differences in terms of post-traumatic symptomatology (p = .12) or loneliness (p = .19). CONCLUSIONS: The pandemic had a negative impact on mental health and these effects were further exacerbated one year later.

The Psychological Impact of the COVID-19 Pandemic in Spain: A Longitudinal Study / Impacto Psicológico de la Pandemia de la COVID-19 en España: un Estudio Longitudinal

Background: This study aims to longitudinally assess the psychologicalimpact of the COVID-19 pandemic in the general Spanish population.It uses four assessment points: two weeks after the start of confinement,one month after, two months after, and one year after the first evaluation.Methods: Evaluations were conducted through an online survey, with asample of 3,480 people at the first data collection and 1,041, 569, and 550people at successive evaluation points. Depressive symptoms (PHQ-2),anxiety (GAD-2), post-traumatic stress (PCL-C-2), social support (EMAS),loneliness (UCLA-3), and discrimination (InDI-d) were evaluated.Results: Significant changes were found in the variables depression and anxiety witha greater presence of this kind of symptomatology after one year (p < .01).There were also significant changes in the variable social support, whichshowed a substantial reduction after one year (p < .001). Similarly, therewere significant variations in the variable intersectional discrimination (p <.001), with greater levels of discrimination. The temporal models show nosignificant differences in terms of post-traumatic symptomatology (p = .12)or loneliness (p = .19). Conclusions: The pandemic had a negative impacton mental health and these effects were further exacerbated one year later.

Antecedentes: el objetivo es evaluar el impactopsicológico de la pandemia generada por la COVID-19 en la poblacióngeneral española longitudinalmente en cuatro momentos: tras dos semanasdel inicio del confinamiento, al mes, a los dos meses y al año. Método: lasevaluaciones se realizaron mediante una encuesta online, se siguió a unamuestra de 3.480 personas en la primera recogida de datos y de 1.041, 569y 550 personas en los sucesivos momentos de evaluación. Se evaluó lapresencia de síntomas depresivos (PHQ-2), de ansiedad (GAD-2), de estréspostraumático (PCL-C-2), el apoyo social (EMAS), la soledad (UCLA-3)y la discriminación (InDI-D). Resultados: se han producido cambios significativos en las variables de depresión y ansiedad con una presenciamayor de dicha sintomatología al año (p < .01), así como en la variable deapoyo social, que muestra una reducción significativa un año después (p <.001), y en la discriminación interseccional, con una mayor discriminación (p < .001). Los modelos temporales no muestran diferencias significativasen cuanto a sintomatología postraumática (p = .12) ni soledad (p = .19).Conclusiones: la pandemia ha tenido un impacto negativo en la saludmental y estos efectos son todavía peores un año después.

Central Nervous System Toxoplasmosis and Cytomegalovirus Colitis in an Asymptomatic HIV Positive Patient.

Human immunodeficiency virus (HIV) associated opportunistic infections are complications of patients with advanced HIV infection who are unaware of their disease or non-compliant with antiretroviral therapy. HIV patients with low CD4 count, generally less than 200 cells/µL, are at risk of developing opportunistic infections. We report a case of a 53-year-old male diagnosed with opportunistic infections, Toxoplasma gondii and cytomegalovirus (CMV). His initial presentation was central nervous system Toxoplasmosis and he later developed CMV colitis. Both are consequences of his undiagnosed advanced HIV status. The patient was promptly treated with appropriate medications for both conditions. The patient's HIV status is well controlled with highly active antiretroviral therapy (HAART) and his CD4 count is improving. It further exhibits the significance of adequate screening protocols and the importance of early treatment for HIV patients.

Vascular calcification progression in patients with end-stage chronic kidney disease.

BACKGROUND: Intima media thickness (IMT), vascular calcifications and ankle-brachial pressure index (ABPI) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients. METHODS: Between January 2018 and March 2019, a physician-initiated, nonrandomized, prospective study was conducted. Carotid IMT, vascular calcifications analysis values and measurements of the ABPI, were made at baseline and after 1-year of follow-up. RESULTS: A total of 284 patients, 152 patients with dialysis (100 hemodialysis (HD) and 52 CAPD (continuous ambulatory peritoneal dialysis)) and 132 patients with stage 4 chronic kidney disease (control group), were included (55% male, 67 [29-88] years). The values of carotid IMT at baseline were higher in the HD group than in the CAPD group (1.10±0.08 mm vs. 0.08±0.04 mm, P=0.004). Adragao and Kauppila scores were higher in the HD group than in the CAPD group (2.56±2.10 vs. 1.08±2.02, P=0.009; and 7.40±6.86 vs. 4.44±5.26, P<0.001; respectively). These differences remained after 1-year of follow-up. Pathological ABPI after 1-year follow-up was more prevalent in the HD group than in the CAPD or control groups (32.0% vs. 19.4% vs. 7.7%, respectively, P=0.042). Multivariate regression analysis revealed that age, gender, dialysis type and LDLc were independent predictors for carotid IMT increase; age, dialysis type and smoking for vascular calcifications increase on Adragao Score; and dialysis type on Kauppila Score. Only the dialysis type was the independent predictor for all vascular calcifications markers. CONCLUSIONS: Dialysis, particularly HD, is an independent risk factor for cardiovascular calcification increase in ESRD patients.

Effects of COVID-19 lockdown on perceived discrimination and internalized stigma in people with previous mental disorder diagnoses in Spain.

COVID-19 disease control efforts and consequences are likely to be complicated by the impact of fear and stigmatization of the novel coronavirus. These complications may also worsen due to the potential compounding of COVID-19 related stigma with stigmatization associated with previously diagnosed conditions. This exploratory study analyzes the experiences of the stigma associated with COVID-19 lockdown in people with different previous diagnoses 2 and 5 weeks after the beginning of the state of emergency in Spain. Gender and age were controlled as covariables and 1,052 people participated in the study. The diagnosis groups were: Psychiatry and mental health (n = 71), Cardiovascular disease (n = 42), Neurological disease (n = 23), Lung disease (n = 53), and No diagnosis (n = 863). The instruments used to measure the stigma were the Intersectional Day-to-Day Discrimination Index and two items of the Internalized Stigma of Mental Illness scale. Analysis of covariance of repeated measures and analysis of variance, including Scheffe's post hoc test, were performed. We found significant differences in stigma among the first and second evaluation. Regarding the previous diagnosis, no differences were found at Time 1, but significant differences were found at Time 2, with those having a previous psychiatric or mental health diagnosis reporting higher levels of perceived discrimination and internalized stigmatization. Our results suggest that people with previous stigmatizing conditions might be more vulnerable to experiencing stigma in a confinement situation. In order to reduce the burden of the COVID-19 stigma, health interventions should also consider the resulting intersection of effects on internalized stigma and perceived discrimination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Complete Aortic Endovascular Repair.

Patients unfit for open repair after development a postdissection aortic arch and thoraco-abdominal aneurysm after open ascending aortic replacement for type A dissection would have no other treatment options. We report the case of a 75-year-old man with a type A aortic dissection treated by ascending aortic replacement. The patient presented an enlargement of the downstream aorta and thoraco-abdominal aneurysm 6-months after. This patient underwent a three-stage surgical sessions, open surgery for extraanatomical supra-aortic trunks reconstruction, endovascular branched treatment of ascending, arch and descending aorta and another one to perform an endovascular fenestrated reconstruction of thoraco-abdominal and infrarenal aorta.

Mönckeberg's Disease of the Lower Limb.

Vascular calcification represents a group of several pathological states of differing aetiologies. Mönckeberg medial sclerosis is considered to be more widespread in the lower abdominal region and lower limbs. We present a 59-years-old male patient presented right foot gangrene. At physical exploration, femoral and popliteal pulses were presented and the ankle-brachial pressure index was 0.45, and the toe-brachial index was 0.33. The patient underwent distal angioplasty of anterior and posterior tibial arteries and due to inaccurate evolution a transmetatarsal amputation was required. Mönckeberg's medial sclerosis is diagnosed with an ABI>1.1, however, questions have been raised about the validity and the role of ABI in diagnosis of Mönckeberg's medial sclerosis. Colour-doppler vascular ultrasound allow a non-invasive technique widely available to detect vascular calcification and to differentiation between Mönckeberg's medial sclerosis and the atherosclerosis-related lesions.

Endovascular Treatment of Venous Bypass Graft Pseudoaneurysm with the New Solaris Self-Expanding Covered Stent.

Nonanastomotic pseudoaneurysm formation after vascular reconstruction is a rarely encountered problem. Covered stent graft constitutes a minimal approach. To our knowledge, the present study constitutes the first case of implantation of Solaris stent graft in Europe. A 69-year-old man with severe cardiac dysfunction presented a pseudoaneurysm of a popliteal to popliteal artery reversed saphenous vein bypass graft. The patient was successfully treated by the percutaneous placement of a Solaris self-expanding covered stent. The postimplantation arteriogram demonstrated exclusion of the pseudoaneurysm, complete apposition of the stent, and adequate runoff. No complications occurred, and the patient was discharged from the hospital one day later receiving 75 mg of clopidogrel. Endovascular exclusion by covered stent deployment offers a safe, rapid, and minimally invasive alternative to open surgical resection in patients with lower limb venous graft pseudoaneurysm. The Solaris covered stent provides a new catheter-based device with adequate navigability and exceptional accurate delivery system.

Geometric and hemodynamic analysis of fenestrated and multibranched aortic endografts.

OBJECTIVE: The objective of this study was to determine the influence of hemodynamic force on the development of type III endoleak and branch thrombosis after complex endovascular thoracoabdominal aortic aneurysm repair. METHODS: Patients with thoracoabdominal aortic aneurysm, within surgical range, treated with a fenestrated or branched endovascular aneurysm repair from 2014 to 2018 and with 3-month control computed tomography angiography were selected. Demographic variables, aneurysm anatomy, and endograft conformation were analyzed retrospectively from a prospective registry. The hemodynamic force was calculated using the mass and momentum conservation equations. RESULTS: Twenty-eight patients were included; the mean follow-up period was 24.7 ± 19.3 months. There were 102 abdominal vessels successfully catheterized (19 celiac arteries, 29 superior mesenteric arteries, 27 right renal arteries, 26 left renal arteries, and 1 polar renal artery). The rate of type III endoleak was 11.5% (n = 12); six cases were associated with branches that received two stents (P < .001). A higher rate of endoleak was observed with wider stents (8.50 ± 1.0 mm vs 7.17 ± 1.3 mm; P = .001) but not with longer stents (P = .530). All cases of type III endoleak affected visceral arteries (eight celiac arteries and four superior mesenteric arteries). The freedom from type III endoleak at 24 months was 86%. The rate of thrombosis was 5.9% (n = 6). A higher rate of thrombosis was observed in smaller vessels (5.00 ± 1.3 mm vs 7.16 ± 1.8 mm; P = .001), with higher stent oversizing (36.87% ± 23.6% vs 5.52% ± 15.0%; P < .001), and with a higher angle of curvature (124.33 ± 86.1 degrees vs 57.71 ± 27.9 degrees; P < .001). All cases of thrombosis were related to renal arteries (two left renal arteries, two right renal arteries, and two polar renal arteries). The freedom from thrombosis at 24 months was 92%. The area under the curve for the angle of curvature was 0.802 (95% confidence interval, 0.661-0.943; P = .013), and the cutoff point was established at 59.5 degrees (sensitivity, 100%; specificity, 60.4%). The receiver operating characteristic curve for the stent oversize showed an area under the curve of 0.903 (95% confidence interval, 0.821-0.984; P = .001), and the cutoff point was 14.5% (sensitivity, 100%; specificity, 77.1%). A higher hemodynamic force was associated with thrombosis (23.35 × 10-3 N ± 18.7 × 10-3 N vs 12.31 × 10-3 N ± 6.8 × 10-3 N; P = .001) but not with endoleak (P = .796). The freedom from endoleak and thrombosis at 24 months was 86% and 90%, respectively. CONCLUSIONS: Longer stents should be preferred to avoid type III endoleak. A higher angle of curvature leads to a higher hemodynamic force that results in a higher rate of thrombosis. Accordingly, we recommend maintaining the angle of curvature under 59.9 degrees. Small vessels and excessive stent oversizing entail a higher risk of thrombosis; as such, we advise a maximum stent oversize of 14.5%. Renal arteries are more susceptible to thrombosis, whereas visceral arteries are more prone to endoleak.

Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome.

BACKGROUND: Reports our experience for the first 50 cases of use of Supera stent for popliteal atherosclerotic lesions treatment. METHODS: This prospective single-arm trial enrolled the first 50 limbs (46 patients) treated in our center with a Supera stent for symptomatic atherosclerotic disease of the popliteal artery. Also, a follow-up of 36 months is reported. RESULTS: The mean preoperative ankle-brachial index increased from 0.38 ± 0.37 before intervention to 0.63 ± 0.46 postoperatively at 12 months (P = 0.014), 0.66 ± 0.39 at 24 months (P = 0.023), and 0.74 ± 0.46 at 36 months (P = 0.029). Primary patency at 12, 24, and 36 months were 89.6%, 72.3%, and 70.2%, and primary assisted patency was 93.8%, 87.2%, and 85.1%, respectively, by Kaplan-Meier estimates. After 3 years of follow-up, age <75 years (P = 0.034) and Trans-Atlantic Inter-Society Consensus (TASC)-II D lesions (P = 0.041) constituted risk factors for stent occlusion. During the follow-up of the patients, none of them developed stent fracture as evidenced on plain radiographs during follow-up. Implantation defects did not constitute a risk factor for stent restenosis. CONCLUSIONS: Based on the results of this study, Supera stent has shown an excellent 3-year patency in this difficult-to-treat anatomic segment. In our experience, younger patients and complex lesions (TASC-II type D) were positive significant predictors for restenosis. In our cohort, post deployment stent conformation did not influence patency. Nevertheless, further investigations, including randomized studies comparing the Supera stent with other stent platforms, drug eluting angioplasty, or atherectomy devices, are mandatory.

Total Laparoscopic Inferior Mesenteric Artery Ligation and Direct Sac Puncture Embolization Technique for Treatment of Type II Endoleak.

Type II endoleak relates to aneurysm perfusion through a patent branch vessel. Reintervention for type II endoleak should be considered in the presence of significant aneurysm growth. Recurrences and subsequent reinterventions are frequent by occult type II endoleaks through feeder arterial branches. We report a case of a patient with a type II endoleak due to inferior mesenteric artery (IMA) patency associated with aneurysm sac growth after an unsuccessfully attempt of transarterial embolization. Laparoscopic ligation of the IMA with direct sac puncture embolization was performed. The postoperative and 1-year follow-up computed tomography angiography scan demonstrated no endoleak signs and aneurysm sac shrinkage. The proposed modification of this technique constitutes a novel approach to this entity. Total laparoscopic IMA ligation and direct sac puncture embolization technique may increase the success rate for the treatment of endoleaks type II by excluding the recurrences. This technique may offer a safe, feasible, and minimally invasive approach for type II endoleaks when other endovascular techniques are unsuccessful.

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