The effects of successful intervention on quality of life in patients with varying degrees of lower-limb ischaemia.
(25/1210)
OBJECTIVES: to assess the quality of life after successful intervention among patients with varying degrees of lower-limb ischaemia in comparison with healthy controls and the respondents>> degree of sense of coherence. MATERIALS AND METHODS: one hundred and twelve patients and 102 healthy controls were assessed for quality of life (Nottingham Health Profile) and sense of coherence. MAIN RESULTS: successful angioplasty or surgical intervention led to an improved quality of life at 6 months, in particular with regard to pain, sleep, physical mobility, hobbies and holiday and to a level similar to healthy controls in sleep, social isolation, paid employment and family relationships. It remained at a significantly lower level than that of healthy controls with regard to pain, emotional reactions, physical mobility, energy, housework, hobbies, holidays, sex and social life. Critical ischaemia patients did not reach the same level of quality of life as the claudicants or the healthy controls. CONCLUSION: successful treatment for chronic limb ischaemia improved the quality of life significantly, more so in claudicants than in patients with critical ischaemia. The degree to which the quality of life improved was associated with the patients>> sense of coherence and their ankle pressure. (+info)
BACKGROUND: the aim of this study is to determine the medium-term results following successful remote superficial-femoral endarterectomy (RSFE). SETTING: district general hospital in United Kingdom. METHODS: RSFE comprises a single incision over the origin of the superficial femoral artery. The endarterectomy is carried out in a closed fashion from above. The cut end of distal atheroma is secured with a stent. Twenty-five limbs were followed up with three monthly duplex scans and angiography if any abnormality was suggested. All patients presented with intermittent claudication; in addition three had rest pain and three ulceration or gangrene. The length of atheromatous core removed was 10-30 cm. RESULTS: all patients had a follow-up of at least one year (range 12-27 months). Eleven arteries developed 14 stenoses. Nine became apparent within nine months of RSFE. The cumulative risk of stenoses developing in patent arteries was 24% at 6 and 63% at 12 months. Eleven angioplasties (PTA) of these stenoses were undertaken. Nine of these remain patent at a median of 12 months after PTA. At one year primary patency was 10 of 25 (40%), primary-assisted patency 18 of 25 (72%) and secondary patency 19 of 25 (76%) and at two years 29%, 57% and 57% respectively. CONCLUSIONS: RSFE is worth considering for superficial femoral artery occlusive disease, particularly in high-risk patients without suitable vein and with limited life expectancy. Careful duplex surveillance is important. Until stenoses can be prevented, the widespread use of RSFE cannot be recommended. (+info)
Aorto-coronary dissection during angioplasty in a patient with myxedema.
(27/1210)
A 67-year-old man with overt hypothyroidism and medically controlled hypertension was admitted for coronary angiography because of exertional angina. His triiodothyronine (T3) and thyroxine (T4) levels had been low for 4 years. Although signs and symptoms of hypothyroidism were apparent, his hypercholesterolemia was mild. Coronary angiography revealed an eccentric stenosis in the distal portion of the right coronary artery and it was decided to perform angioplasty because his angina had continued in spite of medication. The dissection appeared at the lesion site after the first nominal inflation, and a subsequent image disclosed a spiral dissection from the dilated site to the aortic sinus and peripheral coronary artery. Although emergency stenting could not prevent the extension near the origin of the brachiocephalic artery, the false lumen thrombosed and then diminished with conservative therapy. Aorto-coronary dissection is potentially life-threatening and has been recently reported as a complication during cardiac catheterization procedures. Chronic hypothyroid insufficiency may be one of the risk factors for this complication. (+info)
Carotid angioplasty and stenting: current status.
(28/1210)
Carotid angioplasty and stenting has recently emerged as a popular alternative to endarterectomy for the treatment of carotid atherosclerosis. Carotid endarterectomy has been scientifically validated, but many believe carotid angioplasty and stenting to be a less invasive, less expensive and equally safe and effective method of treatment. The evidence for and against the use of each procedure will be discussed. (+info)
A prospective study of changes in aneurysm and graft length after endovascular exclusion of AAA using balloon and self-expanding endograft systems.
(29/1210)
PURPOSE: Longitudinal shrinkage of aneurysms post-endovascular repair, employing unvalidated measurement techniques has been held to account for endograft disruption. In this study we record changes in aneurysm length, diameter and volume using the gold standard of calibrated spiral CT angiography (SCTA). METHOD: From 179 patients with AAA scanned by SCTA, 68 were selected for endografting. Twenty-seven had PTFE home-made prostheses while 41 patients had Talent endografts. SCTA was performed on the fifth postoperative day and 6-monthly intervals thereafter. The distance between the lowest renal artery and the aortic bifurcation (VBL - vertical body length) and the luminal centre line length (LCL) were measured. Maximal sac diameters and volumes were recorded using 3DCT reconstruction. RESULTS: Significant increase was noted in VBL (3.2) mm for PTFE-treated patients accompanied by an increase in sac volume at day 5 (12.5 ml). No changes in LCL or maximal diameters were evident. At 1.5 years further lengthening of both VBL (6.4 mm) and LCL (9.3 mm) was unaccompanied by sac diameter/volume changes. Talent patients - no changes in VBL or LCL were evident. Volumes and maximal AP and transverse diameters showed marked shrinkage: AP -11. 2 mm; transverse -2.6 mm; volumes by -35.5 ml at 6 months. CONCLUSION: With PTFE increase in VBL but not graft length, without concurrent changes in maximal diameters at day 5, is commensurate with increase in sac volume; after 1.5 years graft lengthening overtakes aortic lengthening. In Talent patients VBL/graft length remained unchanged. There is no evidence for longitudinal aneurysmal contracture. Volumes and maximal diameters for the Talent endograft but not for PTFE show shrinkage. (+info)
Targeting patients undergoing angioplasty for thrombus inhibition: a cost-effectiveness and decision support model.
(30/1210)
BACKGROUND: In recent clinical trials, glycoprotein IIb/IIIa blockers have demonstrated effectiveness in preventing adverse events after angioplasty in high-risk patients. However, uncertainty exists regarding the cost-effective selection of patients to receive antiplatelet therapy. METHODS AND RESULTS: All 4962 patients at Emory University Hospitals who underwent coronary intervention procedures (n=6062) from 1993 to 1995 were studied. Multivariate models to predict death and the composite of death, Q-wave and non-Q-wave myocardial infarction, and emergency additional revascularization were developed. Hospital costs and professional costs were determined. A cost-effectiveness analysis with therapy targeted to high-risk patients was performed. If patients with a >5% probability of events received antiplatelet therapy that reduced events by 24% and cost $1000, 40.1% of patients would receive therapy; complications would be reduced from 6.39% to 5.37%, and cost would increase $261 from $10343 to $10604, or $25504 per event prevented. The marginal cost per event prevented by moving from a 7% to a 5% probability of an event cutoff would be $57 799. CONCLUSIONS: For high-risk patients, there may be cost savings; for low-risk patients, therapy may not be cost effective; and for patients in the midrange (between 5% and 7% probability of an adverse event), events may be prevented at an acceptable level of cost. (+info)
Claviculectomy for subclavian venous repair: long-term functional results.
(31/1210)
OBJECTIVES: The purpose of this study was to determine the long-term functional results after medial claviculectomy and venous patch angioplasty or bypass grafting using internal jugular vein after incomplete thrombolysis of effort thrombosis of the subclavian vein. METHODS: The records of 11 patients with effort thrombosis who were treated over the past 9 years were reviewed. Patients have been followed up between 3 and 9 years at 6-month intervals with duplex imaging and contrast venography when indicated and have had an orthopedic evaluation of their shoulder function. RESULTS: All reconstructed veins are patent, and only one patient complains of any arm swelling after prolonged usage. This patient is one of three with postphlebitic changes at the site of repair and has similar findings in her basilic vein. All patients have returned to their prethrombosis vocation without limitation. Four of the 11 patients have jobs requiring heavy physical labor. No patient describes any limitations of shoulder function, but one man who works as a diesel mechanic complains of shoulder aching with overuse with repetitive pulling. Three patients describe upper extremity paresthesias when lying on the operated side. Two patients (one man and one woman) are bothered by the large scar and indentation at the site of the incision. Every patient considers the overall result completely successful from a functional standpoint. CONCLUSIONS: Early subclavian venous repair performed through a medial claviculectomy is a durable operation with excellent long-term functional results. Half of the patients noted minor but significant symptoms, but all are uniformly able to return to normal function. (+info)
Optimization of nonviral gene transfer of vascular smooth muscle cells in vitro and in vivo.
(32/1210)
Gene therapy strategies for the prevention of restenosis postangioplasty are promising. Nonviral gene transfer to the arterial wall in vivo has so far been limited by poor efficiency. This study aimed to optimize transfection of primary vascular smooth muscle cells using cationic nonviral formulations based on cholesterol derivates (DC-, DAC-, DCQ-, and Sp-Chol), double-chained amphiphils (LipofectAMINE, DOTMA, DOSGA, DOSPER, and DOCSPER), or heterogeneous reagents (Superfect, Effectene, and Tfx-50). Estimation of transfection efficiencies was performed using galactosidase assays at different ratios of transfection reagent to plasmid DNA with reporter gene. Toxicity was monitored by analyzing cell metabolism. Transfer efficiency and safety were determined in a porcine restenosis model for local gene therapy using morphometry, histology, galactosidase assays, and reverse-transcriptase polymerase chain reaction. The highest in vitro transfection efficiency was achieved using the recently developed DOCSPER liposomes, with transfer rates of at least 20% in vascular smooth muscle cells. Transfer efficiency was further enhanced up to 20% by complexing with poly-L-lysine. Transfection efficiency in vivo in a porcine restenosis model was up to 15% of adventitial cells using DOCSPER versus 0.1% using LipofectAMINE. Toxicity in vivo and in vitro was lowest using DOCSPER. Increased biological effects were demonstrated following optimization of transfer conditions. (+info)