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Journal of Vascular Surgery Jul 2018Long-term patency of arteriovenous fistulas (AVFs) is critical for hemodialysis vascular access. We compared the efficacy of a one-stage vs two-stage approach to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Long-term patency of arteriovenous fistulas (AVFs) is critical for hemodialysis vascular access. We compared the efficacy of a one-stage vs two-stage approach to brachiobasilic AVF creation by primarily investigating primary and secondary patency rates. We hypothesize that the two-stage is superior to the one-stage procedure in terms of efficacy and safety.
METHODS
This review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed on MEDLINE, EMBASE, Google Scholar, and Cochrane Database. Risk of bias and quality assessment scores were both performed based on previously validated tool.
RESULTS
The systematic search revealed a total of 242 publications for possible inclusion. On the basis of title and abstract review, two randomized controlled trials and nine case-cohort series fit our inclusion criteria. There were no statistically significant differences in failure rates (pooled risk ratio [RR], 1.10; 95% confidence interval [CI], 0.79-1.55; P = .25), 1-year primary patency rates (RR, 1.31; 95% CI, 0.83-2.06; P = .24), 1-year secondary patency rates (RR, 0.97; 95% CI, 0.54-1.77) and 2-year secondary patency rates (RR, 1.19; 95% CI, 0.54-2.63; P = .67) between both groups. However, the two-stage procedure had significantly improved 2-year primary patency rates (RR, 2.50; 95% CI, 1.66-3.74; P < .00001). There were no differences in steal syndrome, hematoma, infection, pseudoaneuryms, or stenosis, although there was a trend toward an increased incidence of postoperative thrombosis (RR, 1.81; 95% CI, 0.95-3.45; P = .07) in one-stage procedures.
CONCLUSIONS
With improved 2-year primary patency rates and the absence of significant differences in complications, this study suggests potential benefit of a two-stage over a one-stage procedure for brachiobasilic AVF creation. However, rather than being a definitive answer, our results merely highlight the continuing need for an adequately powered, well-designed, randomized controlled trial to interrogate this question further.
Topics: Adult; Aged; Arteriovenous Shunt, Surgical; Brachial Artery; Chi-Square Distribution; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Odds Ratio; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome; Upper Extremity; Vascular Patency; Veins
PubMed: 29937034
DOI: 10.1016/j.jvs.2018.03.428 -
The Journal of Thoracic and... Jan 2016Despite an increasing interest in pediatric aortic valve repair, aortic valve replacement in children may be unavoidable. The evidence on outcome after pediatric aortic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Despite an increasing interest in pediatric aortic valve repair, aortic valve replacement in children may be unavoidable. The evidence on outcome after pediatric aortic valve replacement is limited and usually reported in small case series. This systematic review and meta-analysis aims to provide an overview of reported outcome of pediatric patients after aortic valve replacement.
METHODS
A systematic literature search for publications reporting outcome after pediatric aortic valve replacement published between January 1990 and May 2015 was conducted. Studies written in English with a study size of more than 30 patients were included.
RESULTS
Thirty-four publications reporting on 42 cohorts were included in this review: 26 concerning the Ross procedure (n = 2409), 13 concerning mechanical prosthesis aortic valve replacement (n = 696), and 3 concerning homograft aortic valve replacement (n = 224). There were no studies on bioprostheses that met our inclusion criteria. The pooled mean patient age was 9.4 years, 12.8 years, and 8.9 years for Ross, mechanical prosthesis, and homograft recipients, respectively. Pooled mean follow-up was 6.6 years. The Ross procedure was associated with lower early (4.20%; 95% confidence interval [CI], 3.37-5.22 vs 7.34%; 95% CI, 5.21-10.34 vs 12.82%; 95% CI, 8.91-18.46) and late mortality (0.64%/y; 95% CI, 0.49-0.84 vs 1.23%/y; 95% CI, 0.85-1.79 vs 1.59%/y; 95% CI, 1.03-2.46) compared with mechanical prosthesis aortic valve replacement and homograft aortic valve replacement, respectively. No significantly different aortic valve reoperation rates were observed between the Ross procedure and mechanical prosthesis aortic valve replacement (1.60%/y; 95% CI, 1.27-2.02 vs 1.07%/y; 95% CI, 0.68-1.68, respectively), whereas homograft aortic valve replacement was associated with significantly higher aortic valve reoperation rates (5.44%/y; 95% CI, 4.24-6.98). The Ross procedure-associated right ventricular outflow tract reoperation rate was 1.91% per year (95% CI, 1.50-2.44).
CONCLUSIONS
This systematic review illustrates that all currently available aortic valve substitutes are associated with suboptimal results in children, reflecting the urgent need for reliable and durable repair techniques and innovative replacement solutions for this challenging group of patients.
Topics: Adolescent; Age Factors; Allografts; Aortic Valve; Chi-Square Distribution; Child; Child, Preschool; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Infant; Postoperative Complications; Prosthesis Design; Reoperation; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26541831
DOI: 10.1016/j.jtcvs.2015.09.083 -
Fertility and Sterility Feb 2018To provide an evidence-based assessment of metabolic syndrome, hypertension, and hyperlipidemia in first-degree relatives of women with polycystic ovary syndrome (PCOS). (Meta-Analysis)
Meta-Analysis Review
Metabolic syndrome, hypertension, and hyperlipidemia in mothers, fathers, sisters, and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis.
OBJECTIVE
To provide an evidence-based assessment of metabolic syndrome, hypertension, and hyperlipidemia in first-degree relatives of women with polycystic ovary syndrome (PCOS).
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Mothers, fathers, sisters, and brothers of women with and without PCOS.
INTERVENTION(S)
An electronic-based search with the use of PubMed from 1960 to June 2015 and cross-checked references of relevant articles.
MAIN OUTCOME MEASURE(S)
Metabolic syndrome, hypertension and dyslipidemia, and surrogate markers, including systolic blood pressure (BP), diastolic BP, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides.
RESULT(S)
Fourteen of 3,346 studies were included in the meta-analysis. Prevalence of the following was significantly increased in relatives of women with PCOS: metabolic syndrome (risk ratio [RR] 1.78 [95% confidence interval 1.37, 2.30] in mothers, 1.43 [1.12, 1.81] in fathers, and 1.50 [1.12, 2.00] in sisters), hypertension (RR 1.93 [1.58, 2.35] in fathers, 2.92 [1.92, 4.45] in sisters), and dyslipidemia (RR 3.86 [2.54, 5.85] in brothers and 1.29 [1.11, 1.50] in fathers). Moreover, systolic BP (mothers, sisters, and brothers), total cholesterol (mothers and sisters), low-density lipoprotein cholesterol (sisters), and triglycerides (mothers and sisters) were significantly higher in first-degree relatives of PCOS probands than in controls.
CONCLUSION(S)
Our results show evidence of clustering for metabolic syndrome, hypertension, and dyslipidemia in mothers, fathers, sisters, and brothers of women with PCOS.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO 2016 CRD42016048557.
Topics: Adolescent; Adult; Chi-Square Distribution; Cluster Analysis; Evidence-Based Medicine; Family; Female; Genetic Predisposition to Disease; Heredity; Humans; Hyperlipidemias; Hypertension; Male; Metabolic Syndrome; Middle Aged; Odds Ratio; Pedigree; Phenotype; Polycystic Ovary Syndrome; Prevalence; Risk Assessment; Risk Factors; Young Adult
PubMed: 29331234
DOI: 10.1016/j.fertnstert.2017.10.018 -
Seminars in Vascular Surgery Dec 2016The aim of this study was to evaluate the efficacy of heparin-bonded vascular grafts to offer improved outcomes compared with standard prosthetic grafts in access... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to evaluate the efficacy of heparin-bonded vascular grafts to offer improved outcomes compared with standard prosthetic grafts in access surgery. A systematic review and meta-analysis was performed and eight studies (seven observational studies and one randomized controlled trial) were included. The pooled 6-month and 1-year primary patency was not significantly different between heparin-bonded arteriovenous (AV) grafts and standard prosthetic AV grafts in seven studies reporting on 1,209 access procedures. The assisted primary patency and secondary patency at 1-year was not significantly different either. Heparin-bonded AV grafts offer no distinct advantage over standard prosthetic AV grafts and their preferential use in access surgery cannot be recommended based on the available evidence.
Topics: Anticoagulants; Arteriovenous Shunt, Surgical; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; Coated Materials, Biocompatible; Evidence-Based Medicine; Graft Occlusion, Vascular; Heparin; Humans; Odds Ratio; Renal Dialysis; Renal Insufficiency, Chronic; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 28779786
DOI: 10.1053/j.semvascsurg.2016.08.003 -
Heart (British Cardiac Society) Dec 2017Atrial fibrillation (AF) is an emerging global epidemic associated with significant morbidity and mortality. Whilst other chronic cardiovascular conditions have... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Atrial fibrillation (AF) is an emerging global epidemic associated with significant morbidity and mortality. Whilst other chronic cardiovascular conditions have demonstrated enhanced patient outcomes from coordinated systems of care, the use of this approach in AF is a comparatively new concept. Recent evidence has suggested that the integrated care approach may be of benefit in the AF population, yet has not been widely implemented in routine clinical practice. We sought to undertake a systematic review and meta-analysis to evaluate the impact of integrated care approaches to care delivery in the AF population on outcomes including mortality, hospitalisations, emergency department visits, cerebrovascular events and patient-reported outcomes.
METHODS
PubMed, Embase and CINAHL databases were searched until February 2016 to identify papers addressing the impact of integrated care in the AF population. Three studies, with a total study population of 1383, were identified that compared integrated care approaches with usual care in AF populations.
RESULTS
Use of this approach was associated with a reduction in all-cause mortality (OR 0.51, 95% CI 0.32 to 0.80, p=0.003) and cardiovascular hospitalisations (OR 0.58, 95% CI 0.44 to 0.77, p=0.0002) but did not significantly impact on AF-related hospitalisations (OR 0.82, 95% CI 0.56 to 1.19, p=0.29) or cerebrovascular events (OR 1.00, 95% CI 0.48 to 2.09, p=1.00).
CONCLUSIONS
The use of the integrated care approach in AF is associated with reduced cardiovascular hospitalisations and all-cause mortality. Further research is needed to identify optimal settings, methods and components of delivering integrated care to the burgeoning AF population.
Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Cause of Death; Cerebrovascular Disorders; Chi-Square Distribution; Delivery of Health Care, Integrated; Female; Hospitalization; Humans; Male; Middle Aged; Odds Ratio; Risk Factors; Treatment Outcome
PubMed: 28490616
DOI: 10.1136/heartjnl-2016-310952 -
Journal of Vascular Surgery Jan 2015Open repair is the gold standard management for juxtarenal aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) is indicated for high-risk patients. The long-term... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Open repair is the gold standard management for juxtarenal aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) is indicated for high-risk patients. The long-term outcomes of FEVAR are largely unknown, and there is no Level I comparative evidence. This systematic review and meta-analysis of case series compares elective juxtarenal aneurysm surgery by open repair and FEVAR.
METHODS
A systematic literature search was conducted for all published studies on elective repair of juxtarenal aneurysms by FEVAR and open repair. The MEDLINE, EMBASE, and Cochrane databases were searched from 1947 to April 2013. The exclusion criteria were case series of <10 patients or ruptured aneurysms. The primary outcomes were perioperative mortality and postoperative renal insufficiency. The secondary outcomes were secondary reinterventions and long-term survival.
RESULTS
We identified 35 case series with data on 2326 patients. Perioperative mortality was 4.1% in open repair and FEVAR case series (odds ratio for open repair with FEVAR, 1.059; 95% confidence interval, 0.642-1.747; P = .822). Postoperative renal insufficiency was not significantly different (odds ratio for open repair with FEVAR, 1.136; 95% confidence interval, 0.754-1.713; P = .542). FEVAR patients had higher rates of secondary reintervention, renal impairment during follow-up, and a lower long-term survival compared with open repair patients.
CONCLUSIONS
FEVAR and open repair have similar short-term outcomes but have diverging long-term outcomes that may be secondary to the selection bias of FEVAR being offered to high-risk patients. FEVAR is a favorable option in high-risk patients, and open repair remains viable as the gold standard.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; Elective Surgical Procedures; Endovascular Procedures; Humans; Kaplan-Meier Estimate; Odds Ratio; Postoperative Complications; Prosthesis Design; Reoperation; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25240242
DOI: 10.1016/j.jvs.2014.08.068 -
Journal of Vascular Surgery Nov 2015Interruption of the hypogastric artery by ligation, embolization, or coverage frequently results in ischemic complications. The aim of this study was to compare the rate... (Review)
Review
OBJECTIVE
Interruption of the hypogastric artery by ligation, embolization, or coverage frequently results in ischemic complications. The aim of this study was to compare the rate and risk factors for the development of ischemic complications after interruption of the hypogastric artery in obstetrics and gynecology (OBG), vascular surgery, oncology, and trauma patients.
METHODS
MEDLINE, Ovid, and Scopus were searched for articles containing data of patients who underwent interruption of the hypogastric artery. Based on the indication, details of the procedure, and complications developed, data were categorized and a systematic review was done to evaluate any significant differences.
RESULTS
A total of 394 patients (median age, 48.5 years) from 124 papers were included in the study; 31% of the study population was male and 69% was female. Indication for interruption was OBG related in 53.3%, vascular surgery related in 25.1%, oncology related in 17.5%, and trauma related in 4.1% of patients. Overall ischemic complication rate was 22.6%, comprising buttock claudication in 12.2%, buttock necrosis in 4.8%, erectile dysfunction in 2.7%, spinal cord ischemia in 4.0%, colonic ischemia in 2.5%, and bladder necrosis in 0.8%. Complications were fewer in patients younger than the median age of 48.5 years (12.8%) compared with those older than the median age (36.3%; P < .01), women compared with men (13.1% vs 41.7%; P < .01), OBG patients compared with vascular surgery patients (9.5% vs 37.4%; P < .01), patients after ligation compared with embolization (9.4% vs 31.0%; P < .01), and proximal interruption compared with distal interruption (19.6% vs 51.4%; P < .01). No significant difference in complications was seen after bilateral interruption compared with unilateral interruption (20.6% vs 27.1%; P > .05). Similarly, no significant difference in complication rate was seen with the type of embolization material used. Among OBG patients, ligations resulted in fewer complications compared with embolization (4.1% vs 16.7%; P < .01). Among vascular surgery patients, bilateral embolization resulted in a higher rate of complications compared with bilateral ligation (83.3% vs 30.5%; P < .01). Among oncology patients, fewer complications were seen after proximal interruption compared with distal interruption (25.5% vs 75%; P = .01). No significant differences in outcome were seen with regard to gender, laterality, and material used for embolization when patients were compared within each specialty.
CONCLUSIONS
Interruption of the hypogastric artery is relatively safe in young and OBG patients compared with vascular surgery and oncology patients. Ligation of the hypogastric arteries is preferred to embolization, and proximal embolization should be preferred to distal embolization to decrease the risk of ischemic complications. Randomized controlled trials with larger sample size are needed to definitively elucidate clear risk factors for development of complications after hypogastric artery interruption.
Topics: Adolescent; Adult; Age Factors; Aged; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; Embolization, Therapeutic; Female; Humans; Iliac Artery; Ischemia; Ligation; Logistic Models; Male; Middle Aged; Odds Ratio; Pelvis; Regional Blood Flow; Risk Assessment; Risk Factors; Treatment Outcome; Young Adult
PubMed: 26386508
DOI: 10.1016/j.jvs.2015.08.053 -
Urologia Internationalis 2015To analyze current evidence comparing the safety and outcomes of regional and global ischemia for partial nephrectomy (PN). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze current evidence comparing the safety and outcomes of regional and global ischemia for partial nephrectomy (PN).
MATERIALS AND METHODS
A systematic search of the PubMed and Web of Science databases was conducted in May 2014 to identify studies comparing the safety and outcomes of regional and global ischemia for PN. A systematic review and meta-analysis was also performed.
RESULTS
Six retrospective observational studies were selected for the analysis, including 363 patients who underwent PN (162 regional ischemia and 201 global ischemia cases). Operation times were not statistically different [weighted mean difference (WMD) = 20.35 min, 95% CI: -0.28-40.97, p = 0.05], but estimated blood loss was significantly higher in the regional ischemia group (WMD = 52.04 ml, 95% CI: 14.30-89.78, p = 0.007) than in the global ischemia group. Complication rates [odds ratio (OR) = 1.16; 95% CI: 0.63-2.15, p = 0.63] and blood transfusion rates (OR = 1.85; 95% CI: 0.86-4.01, p = 0.12) of the two groups were not significantly different. The regional ischemia group showed better postoperative renal function (WMD = 4.23 ml/min, 95% CI: 2.61-5.85, p < 0.00001) than the global ischemia group, and all cases in the regional ischemia group showed negative margins.
CONCLUSIONS
Regional ischemia is as safe to perform as global ischemia, and the former leads to better postoperative renal functions than the latter. These findings support the application of regional ischemia for PN.
Topics: Blood Loss, Surgical; Blood Transfusion; Bloodless Medical and Surgical Procedures; Chi-Square Distribution; Humans; Nephrectomy; Odds Ratio; Operative Time; Reperfusion Injury; Risk Factors; Time Factors; Treatment Outcome; Warm Ischemia
PubMed: 25427979
DOI: 10.1159/000367997 -
Water Research Feb 2023A detailed characterization of residential water consumption is essential for ensuring urban water systems' capability to cope with changing water resources availability... (Review)
Review
A detailed characterization of residential water consumption is essential for ensuring urban water systems' capability to cope with changing water resources availability and water demands induced by growing population, urbanization, and climate change. Several studies have been conducted in the last decades to investigate the characteristics of residential water consumption with data at a sufficiently fine temporal resolution for grasping individual end uses of water. In this paper, we systematically review 114 studies to provide a comprehensive overview of the state-of-the-art research about water consumption at the end-use level. Specifically, we contribute with: (1) an in-depth discussion of the most relevant findings of each study, highlighting which water end-use characteristics were so far prioritized for investigation in different case studies and water demand modelling and management studies from around the world; and (2) a multi-level analysis to qualitatively and quantitatively compare the most common results available in the literature, i.e. daily per capita end-use water consumption, end-use parameter average values and statistical distributions, end-use daily profiles, end-use determinants, and considerations about efficiency and diffusion of water-saving end uses. Our findings can support water utilities, consumers, and researchers (1) in understanding which key aspects of water end uses were primarily investigated in the last decades; and (2) in exploring their main features considering different geographical, cultural, and socio-economic regions of the world.
Topics: Water; Urbanization; Water Supply; Water Resources
PubMed: 36640613
DOI: 10.1016/j.watres.2022.119500 -
Journal of the American Heart... Oct 2015Optimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT),... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Optimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE), and assess whether venous thromboembolism (VTE) prophylaxis was effective in reducing VTE without complications after cardiac surgery.
METHODS AND RESULTS
Two reviewers independently searched and assessed the quality and outcomes of randomized, controlled trials (RCTs) and observational studies on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane controlled trial register (1966 to December 2014). Sixty-eight studies provided data on VTE outcomes or complications related to thromboprophylaxis after cardiac surgery. The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta-analyses. VTE prophylaxis was associated with a reduced risk of PE (relative risk [RR], 0.45; 95% confidence interval [CI], 0.28-0.72; P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28-0.71; P=0.0006) compared to the control without significant heterogeneity. Median incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were 3.2% (0.6-8.1), 0.6% (0.3-2.9), and 0.3% (0.08-1.7), respectively. Previous history of VTE, obesity, left or right ventricular failure, and prolonged bed rest, mechanical ventilation, or use of a central venous catheter were common risk factors for VTE. Bleeding or cardiac tamponade requiring reoperation owing to pharmacological VTE prophylaxis alone, without systemic anticoagulation, was not observed.
CONCLUSIONS
Unless proven otherwise by adequately powered RCTs, initiating pharmacological VTE prophylaxis as soon as possible after cardiac surgery for patients who have no active bleeding is highly recommended.
Topics: Anticoagulants; Cardiac Surgical Procedures; Chi-Square Distribution; Fibrinolytic Agents; Hemorrhage; Humans; Incidence; Odds Ratio; Pulmonary Embolism; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Venous Thromboembolism; Venous Thrombosis
PubMed: 26504150
DOI: 10.1161/JAHA.115.002652