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Journal of Vascular Surgery Feb 2023Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life... (Review)
Review
BACKGROUND
Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs.
METHODS
A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes.
RESULTS
Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months.
CONCLUSIONS
This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
Topics: Humans; Male; Middle Aged; Aged; Female; Endoleak; Aorta, Thoracic; Subclavian Artery; Aortic Rupture; Endovascular Procedures; Diverticulum; Treatment Outcome
PubMed: 35850164
DOI: 10.1016/j.jvs.2022.07.010 -
BMC Pregnancy and Childbirth Sep 2023The association between uterine artery Doppler (UtA) measurements and small for gestational age (SGA) has not been quantitatively analyzed throughout the whole... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association between uterine artery Doppler (UtA) measurements and small for gestational age (SGA) has not been quantitatively analyzed throughout the whole pregnancy. This systematic review and meta-analysis aims to comprehensively explore the association between UtA measurements and SGA in the first, second, and third trimesters.
METHODS
Studies were searched from Pubmed, Embase, Cochrane Library, and Web of Science. Weighted mean difference (WMD), odds ratio (OR), and relative risk (RR) with 95% confidence interval (CI) were used as the effect size. Heterogeneity of all effect sizes was tested and quantified using I statistics. Sensitivity analysis was conducted for all outcomes, and publication bias was evaluated using Begg's test.
RESULTS
A total of 41 studies were finally included in our meta-analysis. In the first trimester, mean PI was significantly higher in the SGA group than the non-SGA group (WMD: 0.31, 95%CI: 0.19-0.44). In the second trimester, odds of notch presence (OR: 2.54, 95%CI: 2.10-3.08), mean PI (WMD: 0.21, 95%CI: 0.12-0.30), and mean RI (WMD: 0.05, 95%CI: 0.05-0.06) were higher in the SGA group. Also, abnormal UtA measurements were associated with the increased odds of SGA (all P < 0.05). In the third trimester, PI z-score (WMD: 0.62, 95%CI: 0.33-0.91) and PI MoM (WMD: 0.08, 95%CI: 0.06-0.09) showed a significant increase in the SGA group. The odds of SGA were higher in the women with mean PI > 95% (OR: 6.03, 95%CI: 3.24-11.24).
CONCLUSIONS
Abnormal UtA measurements were associated with high odds of SGA, suggesting that UtA might be an adjunctive screening method for SGA in the whole pregnancy.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Uterine Artery; Infant, Small for Gestational Age; Dental Care; Odds Ratio; Pelvis
PubMed: 37704965
DOI: 10.1186/s12884-023-05968-w -
Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis.Critical Care (London, England) Sep 2023Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially modifying the operative performance of fluid responsiveness predictors commonly used in clinical practice.
METHODS
A sensitive strategy was conducted in the Medline and Embase databases to search for prospective studies assessing the operative performance of pulse pressure variation, stroke volume variation, passive leg raising (PLR), end-expiratory occlusion test (EEOT), mini-fluid challenge, and tidal volume challenge to predict fluid responsiveness in critically ill and acutely ill surgical patients published between January 1999 and February 2023. Adjusted diagnostic odds ratios (DORs) were calculated by subgroup analyses (inverse variance method) and meta-regression (test of moderators). Variables potentially modifying the operative performance of such predictor tests were classified as technical and clinical.
RESULTS
A total of 149 studies were included in the analysis. The volume used during fluid loading, the method used to assess variations in macrovascular flow (cardiac output, stroke volume, aortic blood flow, volume‒time integral, etc.) in response to PLR/EEOT, and the apneic time selected during the EEOT were identified as technical variables modifying the operative performance of such fluid responsiveness predictor tests (p < 0.05 for all adjusted vs. unadjusted DORs). In addition, the operative performance of fluid responsiveness predictors was also influenced by clinical variables such as the positive end-expiratory pressure (in the case of EEOT) and the dose of norepinephrine used during the fluid responsiveness assessment for PLR and EEOT (for all adjusted vs. unadjusted DORs).
CONCLUSION
Prediction of fluid responsiveness in critically and acutely ill patients is strongly influenced by a number of technical and clinical aspects. Such factors should be considered for individual intervention decisions.
Topics: Humans; Prospective Studies; Aorta; Blood Pressure; Cardiac Output; Databases, Factual
PubMed: 37730622
DOI: 10.1186/s13054-023-04629-w -
Tomography (Ann Arbor, Mich.) Jul 2022The aim of this study was to investigate the features of partial anomalous left pulmonary artery (PALPA) and differences between cases with posterior versus anterior a... (Review)
Review
The aim of this study was to investigate the features of partial anomalous left pulmonary artery (PALPA) and differences between cases with posterior versus anterior a nomalous vessels in relation to the tracheobronchial tree. We hypothesized that statistical significance was dependent on the course of the anomalous vessel due to airway compression in the posterior type. This study included cases obtained from the literature ( = 33) and an institution teaching file ( = 2). Information collected: age, sex, medical history, additional anomalies, anomalous vessel course, and respiratory symptoms. Data were analyzed with independent samples -test and Fisher's exact test. PALPAs were more commonly anterior than posterior. Mean age: 5.3 years (SD = 12.4) for anterior and 6.8 years (SD = 18.5) for posterior ( = 0.77). Respiratory symptoms: 20% of anterior and 60% of posterior cases ( = 0.032). Tracheobronchial anomalies: 35% of anterior and 60% of posterior cases ( = 0.182). Non-cardiac and non-tracheobronchial anomalies: 30% of anterior and 47% of posterior cases ( = 0.511). Kabuki syndrome: 25% of anterior and 6.7% of posterior cases ( = 0.207). In conclusion, respiratory symptoms were the only significant difference between anterior and posterior PALPA types.
Topics: Abnormalities, Multiple; Child, Preschool; Heart Defects, Congenital; Humans; Pulmonary Artery; Vascular Malformations; Vestibular Diseases
PubMed: 36006061
DOI: 10.3390/tomography8040163 -
Surgical Neurology International 2022Nontraumatic true superficial temporal artery aneurysm (STAA) is rare, and its characteristics and pathogenesis are unclear. (Review)
Review
BACKGROUND
Nontraumatic true superficial temporal artery aneurysm (STAA) is rare, and its characteristics and pathogenesis are unclear.
METHODS
We report a case of STAA and performed a systematic review of PubMed, Scopus, and Web of Science using the keyword "superficial temporal artery aneurysm" to include studies on STAA reported through July 2022. We excluded studies on STAA associated with trauma, arterial dissection, infection, or vasculitis.
RESULTS
A 63-year-old woman who underwent left superficial temporal artery (STA)-middle cerebral artery bypass surgery 8 years previously was diagnosed with an aneurysm located at the left STA. The blood flow volume estimated by ultrasonography was higher in the left STA than in the contralateral counterpart (114 mL/min vs. 32 mL/min). She underwent clipping surgery to prevent aneurysmal rupture without sequela. The lesion was diagnosed as a true aneurysm by histology. The systematic review identified 63 cases (including the present case) of nontraumatic true STAA. The median age of the patients was 57 (interquartile range [IQR]: 41-70) years. Most (90.5%) cases were detected as a palpable mass. Aneurysmal rupture occurred in only 1 (1.6%) case, despite the large size of aneurysms (median size: 13 [IQR: 8-20] mm) and the high frequency (33.3%) of aneurysmal growth during observation. Most (93.7%) patients underwent surgical resection of STAA without sequela.
CONCLUSION
Our findings suggest that the pathogenesis of true STAA is promoted by hemodynamic stress. The systematic review clarified patients' and aneurysmal characteristics and treatment outcomes, providing further insight into the pathogenesis of nontraumatic true STAA.
PubMed: 36600761
DOI: 10.25259/SNI_848_2022 -
Journal of Vascular Surgery Aug 2022Clostridium septicum bacteremia is often associated with occult malignancies (approximately 80%), especially of the right colon. Furthermore, inflammation of the aortic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Clostridium septicum bacteremia is often associated with occult malignancies (approximately 80%), especially of the right colon. Furthermore, inflammation of the aortic wall can rapidly lead to aneurysm induction through bacterial seeding into atheromatous lesions with consecutive life-threatening rupture. We summarize all published data on this rare and lethal disease to evaluate therapeutic approaches and give valid treatment recommendations because there are no guidelines.
METHODS
A systematic review of the literature was conducted screening EMBASE and MEDLINE databases following the PRISMA guidelines with search period from first description to August 25, 2021.
RESULTS
There were 72 cases of C septicum aortitis reported in 64 publications. Endovascular aortic repair (EVAR) was performed in a minority of patients (n = 6) unfit for surgery but lacked long-term survivors. Antibiotic treatment was beneficial in a bridge to surgery concept, but up to now harbored a 6-month mortality rate of 100% (median overall survival, 0.5 months) when no additional aortic repair was performed. Open aortic repair was the only potential curative approach but was accompanied with a 90-day-mortality of 26.7% (4/15).
CONCLUSIONS
Open aortic repair combined with perioperative antibiotic treatment should be offered to all patients as the only potentially curative approach. If applicable, resection of a coexisting colonic tumor should be performed after successful aortic repair. Alternatively, long-term antibiotic treatment can be offered to patients unfit for surgery in a palliative setting. Endovascular aortic repair has been performed on a minority of patients with a high risk for stent graft infection and should remain a salvage strategy when therapeutic pressure demands acute intervention in patients unfit for surgery.
Topics: Anti-Bacterial Agents; Aorta; Aortic Aneurysm, Abdominal; Aortitis; Blood Vessel Prosthesis Implantation; Clostridium septicum; Endovascular Procedures; Humans; Stents; Treatment Outcome
PubMed: 35358668
DOI: 10.1016/j.jvs.2022.02.029 -
Journal of Research in Medical Sciences... 2020Exercise can improve coronary blood flow in a healthy heart, but the vascular response of patients with coronary artery disease (CAD) is different. The aim of this study... (Review)
Review
BACKGROUND
Exercise can improve coronary blood flow in a healthy heart, but the vascular response of patients with coronary artery disease (CAD) is different. The aim of this study was to systematically review the chronic effects of exercise on coronary arterial function in CAD patients.
MATERIALS AND METHODS
Six electronic databases (PubMed, ScienceDirect, "Scopus," Web of Science, EMBASE, and Google Scholar) covering publications from 1986 to 2019 were systematically searched with related keywords. Studies were included if they investigated changes in blood flow and coronary artery diameter in response to chronic exercise training in patients with CAD. A total of 5421 studies were assessed for quality and outcomes, and finally five studies met criteria for inclusion. For metaanalysis, the results of the studies were pooled using the randomeffects model. The heterogeneity between the studies was checked using index.
RESULTS
The total sample population consisted of 108 CAD patients. According to the findings of this study, coronary artery function in adaptation with exercise showed that a period of exercise leads to statistically significant improvement in coronary flow velocity reserve (z = 3.15, = 0.002; standardized mean difference [SMD] =2.33, 95% confidence interval [CI]: 0.88-3.78) (containing six trials). In addition, vasodilatory response of coronary arteries in response to endothelium-independent vasodilator nitroglycerin was investigated in three studies (containing four trials). A meta-analysis showed that performing chronic aerobic exercises did not make a significant change in the endothelium-independent vasodilator ( = 0.83, = 0.40; SMD = -0.36, 95% CI: -1.21-0.49).
CONCLUSION
Based on the results of the present study, aerobic exercises improve the endothelial function of coronary arteries and thereby the vascular vasomotion function, while the results of this meta-analysis showed no change in arterial smooth muscle's function by chronic aerobic exercises. This study reflects the lack of high- and medium-quality reports about the chronic effects of anaerobic and resistance exercises and the various methods of aerobic exercise on cardiovascular function.
PubMed: 33088313
DOI: 10.4103/jrms.JRMS_580_18 -
Annals of Anatomy = Anatomischer... Aug 2023The infrapyloric artery (IPA) supplies the pylorus and the large curvature of the antrum. Its common origin points include the gastroduodenal artery (GDA) and right... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The infrapyloric artery (IPA) supplies the pylorus and the large curvature of the antrum. Its common origin points include the gastroduodenal artery (GDA) and right gastroepiploic artery (RGEA). The prevalence of variations in IPA origins can be of interest to gastric cancer surgeons who wish to increase their understanding of this vessel. The primary aim of this study was to perform a systematic review and meta-analysis on the origin of the IPA. The secondary aims were to assess imaging identification accuracy, to identify IPA morphological features, and to explore the relationship of IPA origin and clinicopathological characteristics.
METHODS
Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched through March 2023. There were no constraints based on language, publication status, or patient demographics. Database search, data extraction and risk of bias assessment were performed independently by two reviewers. The point of origin of the IPA was the primary outcome. Secondary outcomes were imaging identification accuracy, relationship between IPA origin and clinicopathological characteristics, and IPA morphological features. A random-effects meta-analysis of the prevalence of different IPA origins was conducted. Secondary outcomes were narratively synthesized given the heterogeneity of studies reporting on these.
RESULTS
A total of 7279 records were screened in the initial search. Seven studies were included in the meta-analysis, assessing 998 patients. The IPA arose most frequently from the anterior superior pancreaticoduodenal artery (ASPDA), with a pooled prevalence of 40.4% (95% CI 17.1-55.8%), followed by the RGEA with a pooled prevalence of 27.6% (95% CI 8.7-43.7%), and the GDA with a pooled prevalence of 23.7% (95% CI 6.4-39.7%). Cases of multiple IPAs had a pooled prevalence of 4.9% (95% CI 0-14.3%). The IPA was absent in 2.6% (95% CI 0-10.3%) of cases and arose from the posterior superior pancreaticoduodenal artery (PSPDA) in the remaining 0.8% (95% CI 0 - 6.1%). Distance between the pylorus and the proximal branch of the IPA and distance from the pylorus to the first gastric branch of the RGEA when the IPA originated from the ASPDA and RGEA were longer than when the IPA originated from the GDA. The IPA is a small vessel (<1 mm), and its origin is not related to clinicopathological characteristics including patient sex, age, and tumor stage and location.
CONCLUSIONS
Surgeons must be aware of the most common origin points of the IPA. Recommendations for future study include the stratification of IPA origin according to demographic characteristics, and further investigation into IPA morphological parameters such as tortuosity, course and relation to adjacent lymph nodes, aiding the creation of a standardized classification system pertaining to the anatomy of this vessel.
Topics: Humans; Pylorus; Stomach Neoplasms; Lymph Nodes; Hepatic Artery
PubMed: 37207852
DOI: 10.1016/j.aanat.2023.152109 -
International Angiology : a Journal of... Oct 2020Carotid artery stenting (CAS) via a transcarotid revascularization (TCAR) approach has emerged as an alternative when carotid endarterectomy or conventional CAS is... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Carotid artery stenting (CAS) via a transcarotid revascularization (TCAR) approach has emerged as an alternative when carotid endarterectomy or conventional CAS is contraindicated. The present study was conducted to assess the feasibility and safety of TCAR in patients with carotid artery stenosis.
EVIDENCE ACQUISITION
A systematic review of the literature was performed, according to PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses), using PubMed, EMBASE and CENTRAL databases. The primary outcomes included technical success, perioperative neurological event, myocardial ischemic events, death and their composite. Operational duration, flow reversal time and any local procedure related complication (carotid dissection and cranial nerve injury) were also recorded.
EVIDENCE SYNTHESIS
Twenty-three studies were included, reporting on 3130 patients, undergoing TCAR. Thirty-five per cent of them were symptomatic. Technical success was 98% (95% CI: 0.97-0.99; P=0.11, I=32%). Early (30-day) new neurological event rate was estimated at 2% (95% CI: 0.01-0.02; P=1.0, I=0%, respectively) while early death rate was 1% (95% CI: 0.00-0.01; P=1.0, I=0%). Myocardial ischemic (MI) event rate was 1% (95% CI, 0.00-0.01, P=0.97, I=6.6%). The composite outcome of neurological event/MI/death at 30-day follow-up was 2% (95% CI: 0.01-0.02, P=0.79, I=14%). Carotid dissection rate during the intervention was 2% (95% CI: 0.01-0.03, P=0.58, I=2.9%) while the post-operatively detected cranial nerve injury rate was 1% (95% CI, 0.00-0.01, P=1.0, I=0%). Regarding the technical aspects of the procedures, operational and flow reversal time were at 73.8 min and 13.7 min, respectively (95% CI: 68.2-79.3, P=0.18, I=37.6% and 95% CI: 11.3-16.1, P=0.48, I=0%, respectively).
CONCLUSIONS
TCAR is feasible with high technical success rate. The procedure presents low incidence of local complications, neurological events, myocardial complications and mortality during the early postoperative period and should be considered an acceptable alternative for patients treated for carotid artery stenosis.
Topics: Carotid Arteries; Carotid Stenosis; Endarterectomy, Carotid; Endovascular Procedures; Humans; Myocardial Infarction; Risk Factors; Stents; Stroke; Treatment Outcome
PubMed: 32536113
DOI: 10.23736/S0392-9590.20.04434-X -
Current Problems in Cardiology Mar 2022Cardiovascular injury with SARS-CoV-2 infection is well known. Several studies have outlined baseline characteristics in patients presenting with STEMI and SARS-CoV-2.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cardiovascular injury with SARS-CoV-2 infection is well known. Several studies have outlined baseline characteristics in patients presenting with STEMI and SARS-CoV-2. Paucity in data exists in selective coronary involvement in patients with STEMI and SARS-CoV-2 during the COVID-19 pandemic.
METHODS
A systematic search and meta-analysis of studies meeting the inclusion and exclusion criteria obtained from MEDLINE, Scopus, and Cochrane databases was performed utilizing PRISMA criteria. The main outcome was likelihood of coronary artery involvement among patients with STEMI and SARS-CoV-2 versus without SARS-CoV-2. The primary adverse outcome measured was in-hospital mortality.
RESULTS
The final analysis included 5 observational studies with a total of 2,266 patients. There was no statistical significance in LM (OR 1.40; 95% CI: 0.68, 2.90), LAD (OR 1.09; 95% CI 0.83, 1.43), LCX (OR 1.17; 95% CI: 0.75, 1.85), or RCA (OR 0.59; 95% CI: 0.30, 1.17) disease among the 2 groups. LAD disease was the most prevalent coronary involvement among patients with STEMI and SARS-CoV-2 (49.6%). Higher in-hospital mortality was observed in the STEMI and SARS-CoV-2 group (OR 5.24; 95% CI: 3.63, 7.56).
CONCLUSIONS
Our analysis demonstrated no statistical significance in selective coronary involvement in patients with STEMI and SARS-CoV-2 during the COVID-19 pandemic. The higher mortality among patients with SARS-CoV-2 and STEMI has been noted in prior studies with concerns being late presentation due to fear of infection, delayed care time, and poor resource allocation. Focus should be placed on identifying and managing comorbidities to reduce mortality.
Topics: COVID-19; Coronary Vessels; Humans; Pandemics; Percutaneous Coronary Intervention; SARS-CoV-2; ST Elevation Myocardial Infarction
PubMed: 34718033
DOI: 10.1016/j.cpcardiol.2021.101032