Predictors of sling revision after mid-urethral sling procedures: a case-control study.

OBJECTIVE: To identify patient characteristics and surgical factors predictive of complications requiring mid-urethral sling (MUS) revision/removal. DESIGN: Case-control study. SETTING: Tertiary academic centre in Canada. POPULATION: One hundred and seven women undergoing MUS revision/removal between 2005 and 2016 were matched with 214 controls by date of index MUS procedure (2:1 ratio). METHODS: Data on patient and surgical factors were obtained via manual electronic and paper chart review. Three sets of pre-specified simple and multivariable logistic regression models were fitted to: (1) examine previously reported risk factors for MUS revision after primary surgical treatment; (2) identify preoperative predictors of MUS complications requiring revision/removal; and (3) identify surgical factors associated with this outcome after adjusting for potential confounding factors. MAIN OUTCOME MEASURES: Crude and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for patient and surgical factors. RESULTS: The median time to MUS revision was 153 days (interquartile range, IQR 49-432 days). Active smoking status (OR 2.29, 95% CI 1.13-4.63, P = 0.03), having had a previous hysterectomy (OR 3.88, 95% CI 2.02-7.46, P < 0.01), and undergoing concomitant pelvic organ prolapse surgery at the time of the index MUS procedure (OR 2.63, 95% CI 1.32-5.52, P < 0.01) were independently associated with the need for MUS revision/removal. Sling type (obturator versus retropubic), method of tensioning (to cough versus over instrument), anaesthetic type, and estimated blood loss were not associated with this outcome in the analysis presented here. CONCLUSIONS: Active smoking status, having had a previous hysterectomy, and undergoing concomitant surgery for pelvic organ prolapse are risk factors for requiring subsequent MUS revision/removal. TWEETABLE ABSTRACT: Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery.

Endovascular treatment of femoropopliteal steno-obstructive disease with percutaneous transluminal angioplasty: midterm results.

PURPOSE: This study aimed to evaluate midterm outcomes of conventional percutaneous transluminal angioplasty (PTA) in the treatment of femoropopliteal steno-obstructive disease and assess the effect of risk factors on patency rates. MATERIALS AND METHODS: One hundred consecutive patients with femoropopliteal steno-obstructive disease underwent PTA, for a total of 104 procedures. Presence of cardiovascular risk factors, TransAtlantic Inter-Society Consensus (TASC) classification, runoff status, pre-and postprocedural clinical data and procedure outcome were recorded. Follow-up consisted of clinical assessment and colour Doppler ultrasonography at 1, 6 and 12 months. RESULTS: Technical success was 96% (96/100). Seven lesions required stent placement. Primary and secondary patency rates were 82.7% and 88.8% at 6 months and 74.3% and 81.5% at 12 months, respectively. Primary patency rates at 12 months were significantly higher for TASC A-B-C lesions than for TASC D lesions (p < 0.05). Primary patency rates at 12 months were 61.6% and 78.8% (p<0.05) for poor or adequate runoff status, respectively. CONCLUSIONS: Conventional PTA is a minimally invasive alternative to bypass surgery for treating TASC A-C atherosclerotic lesions in the presence of adequate runoff.

Correlation between computed tomography findings of leukoaraiosis and 24-hour blood pressure variability in elderly subjects.

BACKGROUND AND PURPOSE: Leukoaraiosis (LA) has been defined as low attenuation areas involving only the periventricular white matter, in the mild form, and extending to the subcortical region in the severe form. This study evaluates, in elderly patients, if brain computed tomography (CT) evidence of LA significantly correlates with the findings of 24-hour, blood pressure monitoring. METHODS: Sixtysix neurologically nondiseased elderly patients underwent CT examination of the brain and 24-hour ambulatory blood pressure monitoring. The patients were divided in two groups (patients with none-to-mild LA in group 1; patients with severe LA in group 2) based on CT findings evaluated at level of foramina of Monro, body of lateral ventricles, and frontoparietal white matter (centrum semiovale). CT findings were compared with main 24-hour ambulatory blood pressure monitoring results (systolic and diastolic blood pressure and heart rate values). RESULTS: Patients with severe LA showed a wider variability both in blood pressure and heart rate; in particular, major oscillations were found during the nighttime period. No significant 24-hour blood pressure variability was found in group 1. CONCLUSION: Increased blood pressure variability can play a role in the pathogenesis of LA.