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Journal of Vascular Surgery Aug 2022Studies have investigated the effects of gender on vascular surgery care. However, to the best of our knowledge, no comprehensive synthesis of the literature has been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies have investigated the effects of gender on vascular surgery care. However, to the best of our knowledge, no comprehensive synthesis of the literature has been performed on the presentation severity and postoperative outcomes for abdominal aortic aneurysms (AAAs), carotid artery stenosis (CAS), peripheral artery disease (PAD), and type B aortic dissection (TBAD). We conducted a systematic review and meta-analysis of the sex and gender differences in the presentation severity and outcomes for patients who had undergone major vascular surgery.
METHODS
The MEDLINE, Embase, and Cochrane CENTRAL databases were searched from their inception to December 2020. All observational studies and randomized controlled trials that had evaluated the gender differences in presentation severity or outcomes for patients who had undergone open or endovascular AAA or TBAD repair, carotid endarterectomy or stenting, or lower extremity bypass or angioplasty were included. The presentation severity was defined as follows: AAA (symptomatic or ruptured vs asymptomatic), carotid artery disease (symptomatic vs asymptomatic), PAD (chronic limb-threatening ischemia [CLTI] vs claudication), and TBAD (complicated vs uncomplicated). The postoperative outcomes included long-term mortality, stroke, amputation, revascularization, and graft and/or stent thrombosis. A random effects model was used to derive the odds ratios (ORs), risk ratios (RRs), and 95% confidence intervals (CIs).
RESULTS
A total of 236 studies met the inclusion criteria for our systematic review. Of the 236 studies, 86 (n = 2,099,534 patients), 62 (n = 2,300,888 patients), 28 (n = 2,394,143 patients), and 4 (n = 4525 patients) had evaluated the effects of gender on the outcomes for patients with AAA, CAS, PAD, and TBAD, respectively. The female patients were more likely to have presented with a ruptured AAA (OR, 1.18; 95% CI, 1.09-1.28) and CLTI (OR, 1.10; 95% CI, 1.02-1.19) than were the male patients. The all-cause mortality for those with an AAA (RR, 1.35; 95% CI, 1.20-1.52) and those with PAD (RR, 1.14; 95% CI, 1.05-1.23) was higher for the women. However, the female patients with CAS had had lower all-cause mortality (RR, 0.85; 95% CI, 0.76-0.94). No sex differences were found in the TBAD outcomes.
CONCLUSIONS
We found that female patients who had undergone vascular surgery were associated with more severe disease at presentation, with a greater proportion of ruptured AAAs and CLTI. This potentially contributes to the higher mortality rates for female patients with AAAs and PAD compared with male patients. Future studies are needed to evaluate the reasons for these disparities, and greater efforts are required to support women in receiving more timely vascular surgical care.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Carotid Stenosis; Endovascular Procedures; Female; Humans; Male; Peripheral Arterial Disease; Risk Factors; Sex Factors; Treatment Outcome
PubMed: 35257798
DOI: 10.1016/j.jvs.2022.02.030 -
Journal of Neurology Mar 2020Stenting is a common endovascular therapy for symptomatic intracranial arterial stenosis (ICAS). We sought to update the evaluation of global short-term safety and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stenting is a common endovascular therapy for symptomatic intracranial arterial stenosis (ICAS). We sought to update the evaluation of global short-term safety and long-term efficacy outcomes after stenting for symptomatic ICAS and explore their distributional characteristics.
METHODS
Major databases including Cochrane Library, MEDLINE, EMBASE were systematically searched from January 1st, 2005, for RCTs and observational studies which reported short- and long-term outcomes after stenting for symptomatic ICAS. Each outcome was pooled with meta-analysis and the impacts of study location, publication time, and other population characteristics were further assessed by the univariate and multivariate Poisson regression analyses.
RESULTS
A total of 8408 patients were identified in 92 studies from 16 countries across five WHO regions. The estimated rate of short-term stroke or death was 6.68% (95% CI 5.60-8.36%), and the rate of long-term stroke or death was 4.43% (95% CI 2.61-6.60%). After adjustment of age, sex, study location, preprocedual stenosis, publication period and study design, multivariate regression analysis showed that the rate of short-term stroke or death was different between Western and Eastern countries (10.27% versus 5.52%, p = 0.018). The rates of short-term, stroke, ischemic stroke and long-term death were also significantly higher in Western compared to Eastern countries.
CONCLUSION
This systematic review provided the worldwide profile of short- and long-term outcomes of stenting for symptomatic ICAS. The generally acceptable outcomes indicate that stenting may still be feasible in selected patients. Regional disparity calls for more cautious decisions and future studies.
Topics: Constriction, Pathologic; Endovascular Procedures; Humans; Intracranial Arteriosclerosis; Stents; Treatment Outcome
PubMed: 30612142
DOI: 10.1007/s00415-018-09176-x -
Journal of Endovascular Therapy : An... Apr 2022Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients.
METHODS
A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed.
RESULTS
Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17-1.19; =2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40-0.90; =5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29-14.95; =5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29-1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41-251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14-0.32; =5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75-1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection.
CONCLUSION
The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.
Topics: Angioplasty; Humans; Kidney Transplantation; Renal Artery Obstruction; Retrospective Studies; Stents; Treatment Outcome
PubMed: 34399594
DOI: 10.1177/15266028211038593 -
Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis.Stroke Nov 2015We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis. (Review)
Review
BACKGROUND AND PURPOSE
We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis.
METHODS
We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 6 authors to determine clinical scenarios covered, recommendations given, and scientific evidence used.
RESULTS
Thirty-four eligible guidelines were identified from 23 different regions/countries in 6 languages. Of 28 guidelines with asymptomatic carotid artery stenosis procedural recommendations, 24 (86%) endorsed CEA (recommended it should or may be provided) for ≈50% to 99% average-surgical-risk asymptomatic carotid artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%) endorsed medical treatment alone. For asymptomatic carotid artery stenosis patients considered high-CEA-risk because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 13 guidelines (46%). Thirty-one of 33 guidelines (94%) with symptomatic carotid artery stenosis procedural recommendations endorsed CEA for patients with ≈50% to 99% average-CEA-risk symptomatic carotid artery stenosis, 19 (58%) endorsed CAS and 9 (27%) opposed CAS. For high-CEA-risk symptomatic carotid artery stenosis because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 27 guidelines (82%). Guideline procedural recommendations were based only on results of trials in which patients were randomized 12 to 34 years ago, rarely reflected medical treatment improvements and often understated potential CAS hazards. Qualifying terminology summarizing recommendations or evidence lacked standardization, impeding guideline interpretation, and comparison.
CONCLUSIONS
This systematic review has identified many opportunities to modernize and otherwise improve carotid stenosis management guidelines.
Topics: Angioplasty; Asymptomatic Diseases; Carotid Stenosis; Disease Management; Endarterectomy, Carotid; Humans; Ischemic Attack, Transient; Practice Guidelines as Topic; Risk Assessment; Stents; Stroke; Treatment Outcome
PubMed: 26451020
DOI: 10.1161/STROKEAHA.115.003390 -
Head & Neck May 2020Radiation to the head and neck is a well-established risk factor for the development of carotid artery stenosis. Our objective was to identify the prevalence, incidence,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Radiation to the head and neck is a well-established risk factor for the development of carotid artery stenosis. Our objective was to identify the prevalence, incidence, and degree of carotid stenosis in patients with a history of head and neck irradiation.
METHODS
This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted.
RESULTS
Nineteen studies comprising 1479 patients were included. The prevalence of carotid stenosis >50%, >70%, and carotid occlusion was 25% (95% CI: 19%-32%), 12% (95% CI: 7%-17%), and 4% (95% CI: 2%-8%), respectively. The cumulative 12-month incidence of carotid stenosis >50% was 4% (95% CI: 2%-5%), the 24-month was 12% (95% CI: 9%-15%), and the 36-month was 21% (95% CI: 9%-36%).
CONCLUSIONS
The yearly incidence of carotid stenosis >50% increased every year during the first 3 years following radiotherapy. We propose routine yearly Doppler ultrasound screening beginning 1 year after head and neck radiotherapy.
Topics: Carotid Artery Diseases; Carotid Stenosis; Head and Neck Neoplasms; Humans; Prevalence; Radiotherapy; Risk Factors
PubMed: 32048781
DOI: 10.1002/hed.26102 -
Heart & Lung : the Journal of Critical... 2017We aimed to evaluate the safety and feasibility of PCI (percutaneous coronary intervention) for coronary artery disease (CAD) in patients undergoing transcatheter aortic... (Meta-Analysis)
Meta-Analysis Review
We aimed to evaluate the safety and feasibility of PCI (percutaneous coronary intervention) for coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) by performing a meta-analysis. A systemic search of the database was performed. Studies were included comparing TAVR versus TAVR with PCI for significant CAD in patients undergoing TAVR for severe aortic stenosis. The primary outcome was 30 day mortality and secondary outcomes were myocardial infarction, stroke, life threatening bleeding, major access site vascular complications and renal failure. There were no significant differences in 30 day and six months-one year mortality between TAVR and TAVR with PCI group. There were also no significant differences in myocardial infarction, stroke, and life threatening bleeding and major access site vascular complications between the two groups. PCI in addition to TAVR in patients with concomitant severe aortic stenosis and CAD is safe and feasible and does not increase procedural risk.
Topics: Aortic Valve; Aortic Valve Stenosis; Coronary Artery Disease; Feasibility Studies; Global Health; Humans; Kaplan-Meier Estimate; Percutaneous Coronary Intervention; Severity of Illness Index; Survival Rate; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 28088437
DOI: 10.1016/j.hrtlng.2016.12.003 -
Intractable & Rare Diseases Research Aug 2023Ortner's syndrome (OS), also called cardiovocal syndrome, is a rare condition hallmarked by left recurrent laryngeal nerve palsy due to underlying cardiopulmonary... (Review)
Review
Ortner's syndrome (OS), also called cardiovocal syndrome, is a rare condition hallmarked by left recurrent laryngeal nerve palsy due to underlying cardiopulmonary disease. The purpose of this review is to systemically analyze the existing literature for cases of OS to outline typical presentation, methods of diagnosis, and management of these patients. Case reports, case series, and cohort studies describing OS between 1955 and 2021 were identified. Individual manuscripts were reviewed for clinical features, presentation, and management. A total of 117 patient cases were gathered from 92 published articles. Common symptoms included hoarseness, dyspnea, cough, and dysphagia. The most common associated comorbidity was aortic aneurysm (41%), followed by pulmonary hypertension (35%), mitral stenosis (17%), and hypertension (12%). Among those who were managed surgical intervention, 85.4% reported improvement in their hoarseness. While historically OS was associated with mitral stenosis, in recent decades, aortic aneurysms and dilation of the pulmonary artery from pulmonary hypertension have emerged as primary etiologies of OS. Therefore, OS should be considered in any patient presenting with hoarseness and history of cardiopulmonary disease. Surgical intervention in appropriate candidates resolves OS in most cases.
PubMed: 37662622
DOI: 10.5582/irdr.2023.01047 -
Vascular Medicine (London, England) Dec 2019Segmental arterial mediolysis (SAM) is a rare but serious nonatherosclerotic, noninflammatory vasculopathy of unknown etiology that often results in dissection,...
Segmental arterial mediolysis (SAM) is a rare but serious nonatherosclerotic, noninflammatory vasculopathy of unknown etiology that often results in dissection, aneurysm, occlusion, or stenosis of, primarily, the abdominal arteries. Current literature lacks consensus on diagnostic criteria and management options for SAM. This review summarizes 143 cases and aims to advance appropriate recognition and management of SAM. Literature review of all relevant SAM case studies from 2005 to 2018 yielded 126 individual SAM cases from 66 reports. We identified 17 additional SAM cases from our center, bringing our analysis to 143 patients. Patients with SAM were most commonly men (68%) in their 60s. Hypertension (43%), tobacco use (12%), and hyperlipidemia (12%) were common comorbidities. Abdominal pain (80%) and intraabdominal bleeding (50%) were the most common presenting symptoms. Computed tomography was the most frequently used imaging method (78%), and histology was available in 44% of cases. The most commonly affected vessels were the superior mesenteric (53%), hepatic (45%), celiac (36%), renal (26%), and splenic (25%) arteries with aneurysm (76%), dissection (61%), and arterial rupture (46%). Treatments included coil embolization (28%), abdominal organ surgery (24%), open arterial repair (21%), and medical management (20%). Case-specific treatment modalities yielded symptom relief in the vast majority (91%) of patients, with a mortality rate of 7%.
Topics: Abdomen; Adult; Aged; Aged, 80 and over; Aortic Dissection; Aortic Aneurysm, Abdominal; Aortic Rupture; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 31793853
DOI: 10.1177/1358863X19873410 -
Journal of Clinical Neuroscience :... Jan 2023Endovascular stenting has emerged as an effective treatment for patients with symptomatic vertebral artery origin stenosis (VAOS), but the incidence of severe restenosis... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Endovascular stenting has emerged as an effective treatment for patients with symptomatic vertebral artery origin stenosis (VAOS), but the incidence of severe restenosis is concerning. Angioplasty alone with a drug-coated balloon (DCB) is a potential treatment for VAOS. The purpose of this systematic review and meta-analysis was to assess the utility of DCB angioplasty for VAOS.
METHODS
A systematic search of the Medline (PubMed), Embase, CNKI, and Cochrane databases for studies on the treatment of VAOS by DCB angioplasty published in English and Chinese before June 15, 2022 was conducted. Data were extracted using standardized methods. The incidence rates of restenosis, technical success, and perioperative complication in the follow-up period were pooled using Freeman-Tukey double arcsine transformation with random or fixed-effect models. Tests for heterogeneity and publication bias were performed.
RESULTS
A total of seven studies containing 159 patients were included in this review and meta-analysis. The pre-treatment stenosis rate of the vertebral artery in the DCB group ranged from 70.0 % to 86.3 %, and the median follow-up time ranged from 6.0 to 14.1 months. The pooled restenosis incidence was 11.9 % (95 % CI: 3.4 %-23.4 %; I = 59 %, p = 0.02) during the follow-up period. The pooled technical success rate was 96.6 % (95 % CI: 91.4 %-99.7 %; I = 37 %, p = 0.14). The overall perioperative complication rate was 2.9 % (95 % CI: 0.3 %-6.9 %; I = 0 %, p = 0.64). According to the funnel diagram and Egger's test, there was no evidence of publication bias.
CONCLUSION
It is suggested in this review and meta-analysis that angioplasty with DCB may be a potential treatment for VAOS. However, randomized studies including a large representative sample of VAOS patients are needed to validate our findings.
Topics: Humans; Constriction, Pathologic; Vertebral Artery; Angioplasty, Balloon, Coronary; Angioplasty, Balloon; Treatment Outcome; Coated Materials, Biocompatible
PubMed: 36527812
DOI: 10.1016/j.jocn.2022.12.004 -
European Journal of Vascular and... Dec 2022Since the first description of the median arcuate ligament syndrome (MALS), the existence for the syndrome and the efficacy of treatment for it have been questioned. (Review)
Review
OBJECTIVE
Since the first description of the median arcuate ligament syndrome (MALS), the existence for the syndrome and the efficacy of treatment for it have been questioned.
METHODS
A systematic review conforming to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted, with a broader view on treatment for MALS including any kind of coeliac artery release, coeliac plexus resection, and coeliac plexus blockage, irrespective of age. Online databases were used to identify papers published between 1963 and July 2021. The inclusion criteria were abdominal symptoms, proof of MALS on imaging, and articles reporting at least three patients. Primary outcomes were symptom relief and quality of life (QoL).
RESULTS
Thirty-eight studies describing 880 adult patients and six studies describing 195 paediatric patients were included. The majority of the adult studies reported symptom relief of more than 70% from three to 228 months after treatment. Two adult studies showed an improved QoL after treatment. Half of the paediatric studies reported symptom relief of more than 70% from six to 62 months after laparoscopic coeliac artery release, and four studies reported an improved QoL. Thirty-five (92%) adult studies and five (83%) paediatric studies scored a high or unclear risk of bias for the majority of the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) items. The meaning of coeliac plexus resection or blockage could not be substantiated.
CONCLUSION
This systematic review suggests a sustainable symptom relief of more than 70% after treatment for MALS in the majority of adult and paediatric studies; however, owing to the heterogeneity of the inclusion criteria and outcome parameters, the risk of bias was high and a formal meta-analysis could not be performed. To improve care for patients with MALS the next steps would be to deal with reporting standards, outcome definitions, and consensus descriptions of the intervention(s), after which an appropriate randomised controlled trial should be performed.
Topics: Adult; Humans; Child; Median Arcuate Ligament Syndrome; Quality of Life; Constriction, Pathologic; Celiac Artery; Decompression, Surgical
PubMed: 36075541
DOI: 10.1016/j.ejvs.2022.08.033