Viabahn for femoropopliteal in-stent restenosis.

BACKGROUND AND OBJECTIVES: In-stent restenosis in the femoropopliteal artery is common (20%-40%). Treatment of in-stent restenosis is challenged by poor patency rate. An ePTFE-covered stent-graft (Viabahn) is inert with a very small pore size that does not allow for significant tissue in-growth. Use of a Viabahn stent-graft may improve the patency rate in the treatment of in-stent restenosis. DESIGN AND SETTING: A retrospective chart review of the use of Viabahn stent grafts implanted in patients with symptomatic femoropopliteal artery in-stent restenosis performed from January 2004 to December 2008. PATIENTS AND METHODS: We measured the primary patency rate using duplex ultrasound at 1 year and 3 years. We also examined the rate of secondary patency, acute limb ischemia and amputation. RESULTS: Twenty-seven cases with in-stent restenosis of the femoropopliteal artery treated by Viabahn stentgraft were identified. The average lesion length was 24.5 cm; 52% of the lesions were total occlusion and 37% had critical limb ischemia. The 1- and 3-year primary patency rates were 85.1% and 81.4%, respectively. The secondary patency rate was 96%. All recurrent in-stent restenoses were focal at the proximal and distal edges and none had stent fracture. CONCLUSION: Our single center experience in a small number of patients showed a favorable patency of ePTFE-covered stent-graft for treatment of patients with in-stent restenosis in the femoropopliteal artery.

Association between off-label use of drug-eluting stents and subsequent stent thrombosis: a case-control analysis.

OBJECTIVES: We sought to examine the association between off-label drug-eluting stent (DES) use and stent thrombosis (ST) in unselected patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: DES are frequently used in clinical and angiographic scenarios not initially tested and approved by the FDA (off-label use) resulting in lingering concerns about the higher risk of ST in these situations. METHODS: Out of 5,383 patients undergoing PCI at a single center between 2004 and 2006, 380 had death or myocardial infarction within 1 year. After adjudication using Academic Research Consortium definitions, patients with possible, probable or definite ST were termed cases. Cases were matched with controls, free of ST at 1 year, using geographic and temporal similarities. Off-label usage was defined using manufacturer's instructions and other standard criteria. RESULTS: Overall, the proportion of off-label usage was higher among cases than controls (58% vs. 43%; p = 0.002) and both cases with definite/probable ST (77% vs. 59%; p = 0.08) and possible ST (54% vs. 37%; p = 0.002) had a higher off-label use than respective controls. Off-label use among cases with ST remained higher within the following subgroups: off-label by manufacturer's criteria (36% vs. 27%; p = 0.05), left main stent implantation (2% vs. 0%; p = 0.01), ostial (12% vs. 6%; p = 0.04) and bifurcated lesions (26% vs. 9%; p < 0.001). In multivariate analysis, being a case independently predicted off-label use (OR 1.68, 95% CI: 1.10-2.57; p = 0.02). CONCLUSIONS: In this case-control analysis, off-label use of DES was independently associated with ST within 1 year, although the increased risk was moderate.

Serum brain natriuretic peptide level in a patient with chronic obstructive pulmonary disease and chronic heart failure.

A 52-year-old woman with chronic obstructive pulmonary disease (COPD) and chronic heart failure presented in respiratory distress. Physical examination could not differentiate COPD exacerbation from chronic heart failure decompensation. As her serum B-type natriuretic peptide level was 1030 pg/mL, she was initially treated for chronic heart failure decompensation. Serum B-type natriuretic peptide level fell to 308 pg/mL, but respiratory distress persisted. She was then treated with intravenous solumedrol for COPD exacerbation. Respiratory distress rapidly resolved. Serum B-type natriuretic peptide level is useful to detect heart failure in the presence of COPD but does not substitute for clinical judgment to initiate proper management.

Outcomes of chronic heart failure.

BACKGROUND: Outcomes related to chronic heart failure (HF) remain relatively poor, despite advances in pharmacological therapy and medical and nursing care. Experts agree that outpatient care may be among the factors that affect HF outcomes. We hypothesized that the method by which outpatient care is delivered may affect outcomes in this patient population. METHODS: A prospective, randomized design was used to compare HF outcomes from 216 patients randomized to 1 of 2 home health care delivery methods for 3 months after discharge. Care was delivered by the home nurse visit (HNV) or the nurse telemanagement (NTM) method. In the latter, patients used transtelephonic home monitoring devices to measure their weight, blood pressure, heart rate, and oxygen saturation. These data were transmitted daily to a secure Internet site. An advanced-practice nurse worked collaboratively with a cardiologist and subsequently treated patients via the telephone. Both delivery methods used the same HF-specific clinical guidelines to direct care. Outcomes include HF readmissions and length of stay, anxiety, depression, self-efficacy, and quality of life. Data were primarily tested using a 2-group analysis of variance (ANOVA). We used a repeated-measures ANOVA to conduct preintervention-postintervention analyses. RESULTS: After 3 months, patients in the NTM group (n = 108; mean +/- SD age, 62.9 +/- 13.2 years; 83% African American; 64% female) had fewer HF readmissions (13 vs 24; P

Evaluación de los conocimientos de prevención en una población no hospitalaria / Evaluation of the knowledge of prevention in a population non hospitalary

Se intenta determinar el nivel de conocimientos sobre la prevención, su definición, forma y medios de implementación en una población determinada, excluyéndose de la misma el personal médico y paramédico. Se diseño un estudio transversal, tipo descriptivo, aplicando una encuesta dirigida y personalizada a mil personas. Observándose que el 98 por ciento de la población maneja el concepto básico de consulta preventiva, pero no conocen suficientemente los beneficios que derivan de la misma. El 58 por ciento de la muestra acudió por lo menos a un control médico, el grupo etario entre 21-30 años con 50,9 por ciento. La relación de consultas realizadas por género se inclinaron hacia el sexo femenino y la patología, enfermedades de transmisión sexual con 76,2 por ciento. Por último la prensa y los folletos resultaron la fuente de información preventiva más urilizada por lo cual se sugiere optimizar estos medios para aumentar el área de influencia de los mismos