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Journal of Thoracic Imaging Nov 2016Coronary-pulmonary arterial fistulas (CPAFs) are rare coronary artery anomalies that have been described only in limited case reports. This study aims to evaluate the... (Review)
Review
PURPOSE
Coronary-pulmonary arterial fistulas (CPAFs) are rare coronary artery anomalies that have been described only in limited case reports. This study aims to evaluate the clinical presentation and imaging findings of CPAFs collected from 6 participating medical centers along with CPAFs reported in the literature, to discern any general trends present in CPAFs.
MATERIALS AND METHODS
A total of 25 cases of CPAF diagnosed by coronary computed tomography angiography were collected across 6 participating institutions. In addition, utilizing a PubMed literature search, 78 additional CPAF cases were obtained. The imaging findings and relevant clinical history were reviewed.
RESULTS
Of the 103 CPAF patients, 60 (63% of patients with sex known) were male, with ages ranging from newborn to 88 years (mean=46.1 y). The most common symptoms reported were chest pain (n=40, 39%) and dyspnea (n=26, 25%), with a murmur as the most common physical examination finding (n=38, 37%). The most common coronary artery of origin for a CPAF was the left main/left anterior descending (n=87, 84%), followed by the right coronary artery (n=39, 38%). The fistula most commonly terminated in the main pulmonary artery (n=92, 89%). Multiple CPAFs were present in 46 cases (45%). Coronary artery aneurysms were identified in 20 cases (19%). Pediatric CPAF cases were usually associated with pulmonary atresia with ventricular septal defect.
CONCLUSIONS
CPAFs are seen in a variety of clinical settings, from infants with advanced congenital heart disease to elderly patients who have undergone revascularization surgery. Although coronary artery fistulas have previously been described as rarely involving multiple coronary arteries, with the right coronary artery being most often involved, our series demonstrates that multiple fistulas are commonly present, with the most common pattern being between the left main/left anterior descending and the main pulmonary trunk.
Topics: Arterio-Arterial Fistula; Computed Tomography Angiography; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Humans; Pulmonary Artery
PubMed: 27768631
DOI: 10.1097/RTI.0000000000000232 -
The Journal of Laryngology and Otology Dec 2017There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of... (Comparative Study)
Comparative Study Review
BACKGROUND
There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery.
METHOD
A systematic review of the literature was performed using a standardised published methodology and custom database search strategy.
RESULTS
Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73-100 per cent and 75-92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1-1.5 per cent). No articles directly compared the two techniques.
CONCLUSION
Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.
Topics: Adult; Arteries; Cautery; Embolization, Therapeutic; Epistaxis; Humans; Ligation; Nose; Radiology, Interventional; Treatment Outcome
PubMed: 29280696
DOI: 10.1017/S0022215117002079 -
The Journal of Vascular Access Jul 2022A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated.
OBJECTIVE
To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis.
DATA SOURCES
Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively.
STUDY ELIGIBILITY CRITERIA
Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years.
STUDY APPRAISAL AND SYNTHESIS METHODS
Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31-069, = 0.002, = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37-1.13, = 0.12, = 0% and RR: 0.88, 95% CI: 0.48-1.63, = 0.001, = 0%, respectively).
LIMITATIONS
Only eight case-control studies met inclusion criteria.
CONCLUSION
This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.
Topics: Adolescent; Adult; Arterial Occlusive Diseases; Coronary Angiography; Hematoma; Humans; Middle Aged; Percutaneous Coronary Intervention; Radial Artery
PubMed: 33789519
DOI: 10.1177/11297298211005256 -
Vascular Pharmacology Nov 2018A systematic review and meta-analysis was performed to test candidate therapeutic approaches in pulmonary hypertension (PH). The efficacy of 522 interventions with >200... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis was performed to test candidate therapeutic approaches in pulmonary hypertension (PH). The efficacy of 522 interventions with >200 unregistered drugs was tested on 7254 animals. We propose a modified formula to assess meta-data that concerns the contribution of PH animal model to the denoted efficacy of tested agents. The measure of efficacy expressed as a response ratio for right ventricle systolic pressure was 0.48 (95% CI, 0.46-0.50; P < 0.00001), mean pulmonary artery pressure was 0.54 (0.52-0.56; P < 0.00001), right ventricle hypertrophy was 0.49 (0.48-0.51; P < 0.00001) and pulmonary artery wall thickness was 0.58 (0.56-0.61; P < 0.00001). Only 41 out of 522 interventions were ineffective. The most potent agents to improve both haemodynamic and hypertrophic parameters were ATP-sensitive potassium channel openers with iptakalim, Rho/ROCK inhibitors with fasudil, RAAS regulators with adenosine and ACE2 activators, and anti-inflammatories with n-3 polyunsaturated fatty acids and NF-кB inhibitors.
Topics: Animals; Antihypertensive Agents; Arterial Pressure; Disease Models, Animal; Hypertension, Pulmonary; Hypertrophy, Right Ventricular; Molecular Targeted Therapy; Pulmonary Artery; Signal Transduction; Vascular Remodeling; Ventricular Function, Right; Ventricular Remodeling
PubMed: 30145225
DOI: 10.1016/j.vph.2018.08.004 -
Journal of Vascular and Interventional... Apr 2023To estimate the rates of technical success and adverse events of vascular closure devices (VCDs) in the brachial artery and compare the rates of adverse events with... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To estimate the rates of technical success and adverse events of vascular closure devices (VCDs) in the brachial artery and compare the rates of adverse events with manual compression.
MATERIALS AND METHODS
MEDLINE and Embase were searched for observational studies examining VCDs in the brachial artery. Meta-analyses were performed using random effects for the following outcomes: (a) technical success, (b) hematoma at the access site, (c) pseudoaneurysm, (d) local neurological adverse events, and (e) total number of adverse events. A pairwise meta-analysis compared VCD with manual compression for the outcomes of hematoma and the total number of adverse events.
RESULTS
Of 1,761 eligible records, 16 studies including 510 access sites were included. Primary procedures performed were peripheral arterial disease interventions, percutaneous coronary intervention, and endovascular thrombectomy for ischemic stroke. The technical success rate was 93% (95% CI, 87%-96%; I = 47%). Data on the following adverse events were obtained via meta-analysis: (a) hematoma, 9% (5%-15%; I = 54%); (b) stenosis or occlusion at access site, 3% (1%-14%; I = 51%); (c) infection, 0% (0%-5%; I = 0%); (d) pseudoaneurysm, 4% (1%-13%; I = 61%); (e) local neurological adverse events, 5% (2%-13%; I = 54%); and (f) total number of adverse events, 15% (10%-22%; I = 51%). Angio-Seal success rate was 96% (93%-98%; I = 0%), whereas the ExoSeal success rate was 93% (69%-99%; I = 61%). When comparing VCD and manual compression, there was no difference in hematoma formation (relative risk, 0.75; 95% CI, 0.35-1.63; I = 0%; P = .47) or the total number of adverse events (relative risk, 0.75; 95% CI, 0.35-1.58; I = 76%; P = .45).
CONCLUSIONS
Despite being off-label, studies suggest that VCDs in the brachial artery have a high technical success rate. There was no significant difference in adverse events between VCDs and manual compression in the brachial artery.
Topics: Humans; Vascular Closure Devices; Brachial Artery; Aneurysm, False; Femoral Artery; Hematoma; Treatment Outcome; Hemostatic Techniques
PubMed: 36526077
DOI: 10.1016/j.jvir.2022.12.022 -
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 Nov 2020Downstream remodeling of the spiral arteries (SpA) decreases utero-placental resistance drastically, allowing sustained and increased blood flow to the placenta under... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Downstream remodeling of the spiral arteries (SpA) decreases utero-placental resistance drastically, allowing sustained and increased blood flow to the placenta under all circumstances. We systematically evaluated available reports to visualize adaptation of spiral arteries throughout pregnancy by ultra-sonographic measurements and evaluated when this process is completed.
METHODS
A systematic review and meta-analysis of spiral artery flow (pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV)) was performed. English written articles were obtained from Pubmed, EMBASE and Cochrane Library and included articles were assessed on quality and risk of bias. Weighted means of Doppler indices were calculated using a random-effects model.
RESULTS
In healthy pregnancies, PI and RI decreased from 0.80 (95% CI: 0.70-0.89) and 0.50 (95% CI: 0.47-0.54) in the first trimester to 0.50 (95% CI: 0.45-0.55, p < 0.001) and 0.39 (95% CI: 0.37-0.42, p < 0.001) in the second trimester and to 0.49 (95% CI: 0.44-0.53, p = 0.752) and 0.36 (95% CI: 0.35-0.38, p = 0.037) in the third trimester, respectively. In parallel, PSV altered from 0.22 m/s (95% CI: 0.13-0.30 m/s) to 0.28 m/s (95% CI: 0.17-0.40 m/s, p = 0.377) and to 0.25 m/s (95% CI: 0.20-0.30 m/s, p = 0.560) in the three trimesters. In absence of second and third trimester Doppler data in complicated gestation, only a difference in PI was observed between complicated and healthy pregnancies during the first trimester (1.49 vs 0.80, p < 0.001). Although individual studies have identified differences in PI between SpA located in the central part of the placental bed versus those located at its periphery, this meta-analysis could not confirm this (p = 0.349).
CONCLUSIONS
This review and meta-analysis concludes that an observed decrease of SpA PI and RI from the first towards the second trimester parallels the physiological trophoblast invasion converting SpA during early gestation, a process completed in the midst of the second trimester. Higher PI was found in SpA of complicated pregnancies compared to healthy pregnancies, possibly reflecting suboptimal utero-placental circulation. Longitudinal studies examining comprehensively the predictive value of spiral artery Doppler for complicated pregnancies are yet to be carried out.
Topics: Arteries; Blood Flow Velocity; Female; Hemodynamics; Humans; Placenta; Placental Circulation; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Ultrasonography, Doppler; Uterus; Vascular Resistance
PubMed: 33176723
DOI: 10.1186/s12884-020-03150-0 -
Journal of Vascular Surgery Jul 2018The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants.
METHODS
A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed.
RESULTS
A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations.
CONCLUSIONS
Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.
Topics: Aneurysm; Aorta, Thoracic; Black People; Brachiocephalic Trunk; Cardiovascular Abnormalities; Carotid Arteries; Humans; Incidence; Prevalence; Prognosis; Subclavian Artery; Vertebral Artery
PubMed: 28865978
DOI: 10.1016/j.jvs.2017.06.097 -
Vascular Medicine (London, England) Oct 2017The formation of a fistula between the internal mammary artery and the pulmonary vasculature (IMA-to-PV) is a rare anomaly. The etiology can be congenital; however, most... (Review)
Review
The formation of a fistula between the internal mammary artery and the pulmonary vasculature (IMA-to-PV) is a rare anomaly. The etiology can be congenital; however, most recent cases have been associated with coronary artery bypass grafting, trauma, inflammatory conditions, chronic infections, or neoplasia. The knowledge base on the formation of these fistulas is derived primarily from case reports. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage these cases, and the treatment of an IMA-to-PV fistula is controversial. To our knowledge, this report is the first to review 80 cases of IMA-to-PV fistulas reported in the literature. We describe the etiologies, clinical presentation, and management of these fistulas.
Topics: Adult; Arterio-Arterial Fistula; Arteriovenous Fistula; Female; Humans; Iatrogenic Disease; Male; Mammary Arteries; Middle Aged; Pulmonary Artery; Pulmonary Veins; Risk Factors; Treatment Outcome; Vascular System Injuries
PubMed: 28990495
DOI: 10.1177/1358863X17724262 -
Archivio Italiano Di Urologia,... Oct 2023Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases.
METHODS
The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis.
RESULTS
A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis.
CONCLUSIONS
AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.
Topics: Humans; Male; Child; Adolescent; Varicocele; Semen; Spermatic Cord; Testicular Hydrocele; Laparoscopy; Arteries; Treatment Outcome; Retrospective Studies
PubMed: 37791548
DOI: 10.4081/aiua.2023.11627