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Annals of Vascular Surgery Sep 2022The treatment of infrainguinal peripheral arterial disease often involves complex lesions requiring stent implantation. It is common knowledge that stent length is a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The treatment of infrainguinal peripheral arterial disease often involves complex lesions requiring stent implantation. It is common knowledge that stent length is a negative predictor for restenosis. We investigated the efficacy and safety of spot stenting for the treatment of femoropopliteal lesions.
METHODS
We carried out a systematic review for articles published by December 2021 regarding spot stenting in the treatment of peripheral arterial disease. Primary endpoints included primary patency (PP) and freedom from target lesion revascularization (TLR) 12 months postoperatively. We performed a meta-analysis of aggregate data for PP, TLR and technical success and a subgroup analysis between devices dedicated to spot stenting and conventional devices. Following the individual participant data (IPD) extraction, we performed a 2 stage time to event IPD meta-analysis for PP and TLR. Plotting of hazard estimates was performed by applying the Epanechnikov Kernel function.
RESULTS
Five studies with 818 patients, 965 lesions and a mean lesion length of 169.2 mm were included. Chronic total occlusions comprised 51.7% of the treated lesions while, 80% of the lesions involved the popliteal artery. The pooled PP 12 months post-operatively is 80.72% (95% confidence interval [CI]: 77.67-83.45) (I = 36%), 95% prediction interval (PI) (67.94-89.00). The subgroup analysis between devices dedicated to spot stenting and conventional devices produced similar results of 80.93% (95% CI: 77.17-84.19) (I = 0%) and 80.30% (95% CI: 74.72-84.90) (I = 62%), respectively. The pooled TLR rate is 13.06% (95% CI: 10.69-15.86) (I = 53%). The pooled technical success rate is 98.77% (95% CI: 97.50-99.40) (I = 18%). The IPD meta-analysis produced statistically significant results favoring spot stenting over long stenting for both primary endpoints. Primary patency hazard ratio (HR) 2.04. (95% CI: 1.25-3.32) (I = 0%, t = 0). TLR, HR 1.97 (95% CI: 1.02-3.79) (I = 0%, t = 0). Plotting of hazard estimates produced diametrically opposite courses for the spot and long stenting curves. The hazards cross over at about 6 months, and at about 10 months when long stenting group faces the highest risk for loss of patency, spot stenting hazard reaches near zero values. The curves for TLR portray similar findings.
CONCLUSIONS
Spot stenting is a safe and effective strategy for the treatment of femoropopliteal arterial disease with acceptable short and mid-term primary patency and freedom from TLR rates. Long stenting of the femoral artery doubles the risk of patency loss and TLR compared to spot stenting. The risk of patency loss and TLR in femoral artery spot stenting appears 4 months after the intervention and reaches near zero values at 8 months.
Topics: Angioplasty, Balloon; Femoral Artery; Humans; Lower Extremity; Peripheral Arterial Disease; Popliteal Artery; Stents; Treatment Outcome; Vascular Patency
PubMed: 35398197
DOI: 10.1016/j.avsg.2022.03.031 -
Acta Ortopedica Mexicana 2023aneurysms are focal and permanent dilations of an artery; in pseudoaneurysms, the normal layers of the blood vessel are replaced by fibrous tissue. Due to their low...
INTRODUCTION
aneurysms are focal and permanent dilations of an artery; in pseudoaneurysms, the normal layers of the blood vessel are replaced by fibrous tissue. Due to their low incidence, as well as the diagnostic and therapeutic challenge they represent; our objective is to present the clinical case of a pseudoaneurysm of a digital artery of the hand and to carry out a systematic review of this pathology.
MATERIAL AND METHODS
literature search in Medline, using the terms "digital artery" and "aneurysm." Studies of vascular dilation pathology affecting the hand and fingers were incorporated. Studies with pathology of proximal involvement of the hand were excluded.
CASE PRESENTATION
a 79-year-old female patient who, after a sharp force trauma to the fifth finger of the left hand, develops a rapidly growing necrotic tumor. She had ultrasound and angiography that suggested hematoma. Surgical management was decided, during which it was observed that the tumor involved ulnar collateral digital artery of the fifth finger. The lesion and the arterial segment involved were resected. Post-surgical course without complications. The histopathological diagnosis of pseudoaneurysm of the lesion was confirmed.
DISCUSSION
traumatic etiology is the most frequent cause of digital aneurysms. Risk factors for pseudoaneurysms include sharp force trauma and alterations of the coagulation pathways, as in the case presented.
CONCLUSION
the pseudoaneurysm of a digital artery is a rare pathology with great variability of therapeutic management. Surgical resection of the lesion with vascular flow reconstruction is the recommended treatment.
Topics: Female; Humans; Aged; Aneurysm, False; Arteries; Aneurysm; Ultrasonography; Neoplasms
PubMed: 38052440
DOI: No ID Found -
Journal of Stomatology, Oral and... Jun 2023The aim of this study is to compare the outcomes of Supraclavicular Artery Island (SAI) Flap versus Free Tissue Transfer for head and neck reconstruction. (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of this study is to compare the outcomes of Supraclavicular Artery Island (SAI) Flap versus Free Tissue Transfer for head and neck reconstruction.
METHODS
We performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database according to the PRISMA guidelines. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed.
RESULTS
Eight studies, reporting a total of 402 patients and same number of flaps, 165 of which underwent reconstruction using supraclavicular artery island flap and 237 reconstructed with free tissue transfer were identified. No statistically significant differences were observed regarding major complications, total flap necrosis, partial flap necrosis, post operative fistula formation, donor site dehiscence, recipient site dehiscence and total flap area.
CONCLUSION
Supraclavicular artery island flap and free tissue transfer seem to be comparable when used in head and neck reconstruction.
Topics: Humans; Plastic Surgery Procedures; Head and Neck Neoplasms; Surgical Flaps; Arteries; Postoperative Complications; Necrosis
PubMed: 36681121
DOI: 10.1016/j.jormas.2023.101391 -
Annals of Vascular Surgery Sep 2022Recent evidence raised the concern that paclitaxel-containing therapy was associated with an increased risk of mortality in patients with peripheral artery diseases... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent evidence raised the concern that paclitaxel-containing therapy was associated with an increased risk of mortality in patients with peripheral artery diseases (PADs). However, it is unclear whether drug-eluting stent (DES) versus drug-coated balloon (DCB) have a different effect on mortality of PAD patients. Our study aimed to systematically review current literature comparing clinical outcomes of patients treated with DES versus DCB for PAD.
METHODS
MEDLINE and Embase were searched for eligible studies from January 2000 to December 31, 2020. Randomized controlled trials (RCTs) or cohort studies that reported outcomes of DES versus DCB were included in our study. The primary outcome was 12-month all-cause mortality. A random-effect model was used to pool the odds ratios (ORs) and related 95% confidence intervals (CIs).
RESULTS
Our review included 7 studies, involving 2 RCTs and 5 cohort studies. A total of 4,237 patients with DES and 9,234 patients with DCB were analyzed. All included cohort studies were of high quality with Newcastle-Ottawa scores from 7 to 8. No significant difference in 12-month all-cause mortality was found between DES and DCB without significant heterogeneity (OR 1.02, 95% CI 0.91-1.14, I = 0%). As for primary patency, no significant difference between treatments was observed (OR 1.27, 95% CI 0.75-2.15, I = 55%). Similar results were observed for freedom from target lesion revascularization (OR 0.94, 95% CI 0.64-1.40, I = 0%).
CONCLUSIONS
This systematic review and meta-analysis suggest that no significant difference in 12-month all-cause mortality was found between DES and DCB. Primary patency and freedom from target lesion revascularization of lower extremity PAD were also comparable between the 2 groups.
Topics: Angioplasty, Balloon; Coated Materials, Biocompatible; Drug-Eluting Stents; Femoral Artery; Humans; Lower Extremity; Paclitaxel; Peripheral Arterial Disease; Popliteal Artery; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35561891
DOI: 10.1016/j.avsg.2022.04.039 -
Polski Przeglad Chirurgiczny Aug 2022<b>Introduction:</b> The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical...
<b>Introduction:</b> The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical attributes of the vessel lead to higher rates of restenosis, stent fracture, and occlusion. Some surgeons consider the popliteal artery as a no stenting zone. Many specialists favor percutaneous transluminal angioplasty to be the first line of endovascular treatment in the popliteal artery with bail-out stent implantation if the results are suboptimal. The Supera peripheral stent system is a novel stent that has been manufactured with a high degree of flexibility and supposedly might be appropriate for implantation in the popliteal artery. </br></br> <b>Aim:</b> Evaluation of the performance of Supera stent in isolated popliteal artery disease in comparison to other methods of treatment. </br></br> <b>Methods:</b> As many as 92 articles were found in the databases and after full-text review, 4 studies matched the inclusion criteria and were evaluated. </br></br> <b>Results:</b> Primary patency rates of Supera implantation in an isolated popliteal artery at 12 months ranged from 68% to 90%. In all four studies, no stent fractures were observed. Only one study provided longer follow-up than 12 months and evaluated the performance of the Supera stent 36 months after implantation. </br></br> <b>Conclusion:</b> In conclusion, mentioned studies show promising and superior to other stent patency rates of the Supera stent regarding popliteal artery lesions. What is more, no stent fracture is promising regarding longer follow-up. However, more studies with longer follow-ups and direct comparison to other methods are required to fully evaluate Supera's performance in the popliteal artery.
Topics: Humans; Femoral Artery; Peripheral Arterial Disease; Popliteal Artery; Risk Factors; Stents; Treatment Outcome; Vascular Patency
PubMed: 36807095
DOI: 10.5604/01.3001.0015.9578 -
Heart Failure Clinics Jan 2023Main pulmonary vascular diseases (PVD) with precapillary pulmonary hypertension (PH) are pulmonary arterial and chronic thromboembolic PH. Guidelines recommend... (Meta-Analysis)
Meta-Analysis Review
Main pulmonary vascular diseases (PVD) with precapillary pulmonary hypertension (PH) are pulmonary arterial and chronic thromboembolic PH. Guidelines recommend supplemental oxygen therapy (SOT) for severely hypoxemic patients with PH, but evidence is scarce. The authors performed a systematic review and where possible meta-analyses on the effects of SOT on hemodynamics and exercise performance in patients with PVD. In PVD, short-term SOT significantly improved mean pulmonary artery pressure and exercise performance. There is growing evidence on the benefit of long-term SOT for selected patients with PVD regarding exercise capacity and maybe even survival.
Topics: Humans; Pulmonary Circulation; Vascular Diseases; Hypertension, Pulmonary; Pulmonary Artery; Hemodynamics; Oxygen
PubMed: 36922056
DOI: 10.1016/j.hfc.2022.11.001 -
Annals of Plastic Surgery May 2023Autologous breast reconstruction remains a versatile option to produce a natural appearing breast after mastectomy. The deep inferior epigastric perforator remains the... (Meta-Analysis)
Meta-Analysis
A Systematic Review and Meta-Analysis Comparing the Clinical Outcomes of Profunda Artery Perforator Versus Gracilis Thigh Flap as a Second Choice for Autologous Breast Reconstruction.
PURPOSE
Autologous breast reconstruction remains a versatile option to produce a natural appearing breast after mastectomy. The deep inferior epigastric perforator remains the most commonly used flap choice, but when this donor site is unsuitable or unavailable, the transverse upper gracilis (TUG) or profunda artery perforator (PAP) flaps are popular secondary alternatives. We conduct a meta-analysis to better understand patient outcomes and adverse events in secondary flap selection in breast reconstruction.
METHODS
A systematic search was conducted on MEDLINE and Embase for all articles published on TUG and/or PAP flaps for oncological breast reconstruction in postmastectomy patients. A proportional meta-analysis was conducted to statistically compare outcomes between PAP and TUG flaps.
RESULTS
The TUG and PAP flaps were noted to have similar reported rates of success and incidences of hematoma, flap loss, and flap healing (P > 0.05). The TUG flap was noted to have significantly more vascular complications (venous thrombosis, venous congestion, and arterial thrombosis) than the PAP flap (5.0% vs 0.6%, P < 0.01) and significantly greater rates of unplanned reoperations in the acute postoperative period (4.4% vs 1.8%, P = 0.04). Infection, seroma, fat necrosis, donor healing complications, and rates of additional procedures all exhibited high degree of heterogeneity precluding mathematical synthesis of outcomes across studies.
CONCLUSIONS
Compared with TUG flaps, PAP flaps have fewer vascular complications and fewer unplanned reoperations in the acute postoperative period. There is need for greater homogeneity in reported outcomes between studies to enable for synthesis of other variables important in determining flap success.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Thigh; Perforator Flap; Retrospective Studies; Mammaplasty; Arteries; Cardiovascular Diseases
PubMed: 37227406
DOI: 10.1097/SAP.0000000000003226 -
BMC Ophthalmology Dec 2016Colour Doppler analysis of ophthalmic vessels has been proposed as a promising tool in the diagnosis of various eye diseases, but the available diagnostic evidence has... (Review)
Review
Colour Doppler analysis of ophthalmic vessels in the diagnosis of carotic artery and retinal vein occlusion, diabetic retinopathy and glaucoma: systematic review of test accuracy studies.
BACKGROUND
Colour Doppler analysis of ophthalmic vessels has been proposed as a promising tool in the diagnosis of various eye diseases, but the available diagnostic evidence has not yet been assessed systematically. We performed a comprehensive systematic review of the literature on the diagnostic properties of Colour Doppler imaging (CDI) assessing ophthalmic vessels and provide an inventory of the available evidence.
METHODS
Eligible papers were searched electronically in (Pre) Medline, Embase and Scopus, and via cross-checking of reference lists. The minimum requirement to be included was the availability of original data and the possibility to construct a two-by-two table. Study selection, critical appraisal using the QUADAS II instrument and extraction of salient study characteristics was made in duplicate. Sensitivity and specificity was computed for each study.
RESULTS
We included 11 studies (15 two-by-two tables) of moderate methodological quality enrolling 820 participants (range 30 to 118). In 44.4% participants were female (range 37-59% in specific subgroups). CDI was assessed for internal carotid stenosis, diabetic retinopathy, glaucoma, and branch or central retinal vein occlusion diagnosis. There was insufficient data to pool the results for specific illnesses. For the assessments of ophthalmic arteries, mean sensitivity was 0.69 (range 0.27-0.96) with a corresponding mean specificity of 0.83 (range 0.70-0.96). Mean sensitivity of the central retinal artery assessments was 0.58 (range 0.31-0.84) and the corresponding mean specificity was 0.82 (range 0.63-0.94).
CONCLUSIONS
Robust assessments of the diagnostic value of colour Doppler analysis remain uncommon, limiting the possibilities to extrapolate its true potential for clinical practice. PROSPERO 2014:CRD42014014027.
Topics: Carotid Artery Diseases; Diabetic Retinopathy; Glaucoma; Humans; Ophthalmic Artery; Regional Blood Flow; Retinal Artery; Retinal Vein Occlusion; Sensitivity and Specificity; Ultrasonography, Doppler, Color
PubMed: 27927176
DOI: 10.1186/s12886-016-0384-0 -
European Journal of Vascular and... Jul 2014The aim of this systematic review was to evaluate outcomes of direct revascularisation (DR) versus indirect revascularisation (IR) of infrapopliteal arteries to the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review was to evaluate outcomes of direct revascularisation (DR) versus indirect revascularisation (IR) of infrapopliteal arteries to the affected angiosome for critical limb ischaemia. Both open and endovascular techniques were included.
METHODS
A systematic review of key electronic journal databases was undertaken from inception to 22 March 2014. Studies comparing DR versus IR in patients with localised tissue loss were included. Meta-analysis was performed for wound healing, limb salvage, mortality, and re-intervention rates, with numerous sensitivity analyses. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
RESULTS
Fifteen cohort studies reporting on 1,868 individual limbs were included (endovascular revascularisation, 1,284 limbs; surgical revascularisation, 508 limbs; both methods, 76 limbs). GRADE quality of evidence was low or very low for all outcomes. DR resulted in improved wound healing rates compared with IR (odds ratio [OR] 0.40, 95% confidence interval [CI] 0.29-0.54) and improved limb salvage rates (OR 0.24, 95% CI 0.13-0.45), although this latter effect was lost on high-quality study sensitivity analysis. Wound healing and limb salvage was improved for both open and endovascular intervention. There was no effect on mortality (OR 0.77, 95% CI 0.50-1.19) or reintervention rates (OR: 0.44, 95% CI 0.10-1.88).
CONCLUSION
DR of the tibial vessels appears to result in improved wound healing and limb salvage rates compared with IR, with no effect on mortality or reintervention rates. However, the quality of evidence on which these conclusions are based on is low.
Topics: Chi-Square Distribution; Endovascular Procedures; Humans; Limb Salvage; Odds Ratio; Peripheral Arterial Disease; Popliteal Artery; Risk Factors; Tibial Arteries; Time Factors; Treatment Outcome; Vascular Surgical Procedures; Wound Healing
PubMed: 24841052
DOI: 10.1016/j.ejvs.2014.04.002 -
World Neurosurgery Apr 2021Penetrating vertebral artery injuries (VAIs) are rare but devastating trauma for which the approach to treatment varies greatly. The literature on treatment modalities... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Penetrating vertebral artery injuries (VAIs) are rare but devastating trauma for which the approach to treatment varies greatly. The literature on treatment modalities is limited to case reports, case series, and 1 review, with the majority of cases being treated surgically. However, with the advent of digital subtraction angiography, treatment has shifted toward less invasive endovascular modalities that allows one to assess the flow and risks of sacrificing the vertebral artery (VA).
METHODS
In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses, a systematic review of VAI was performed. Two case reports were also detailed. Using a multidisciplinary team, a decision algorithm was proposed for approaching penetrating VAIs.
RESULTS
We identified 169 patients. Of the penetrating VAI, the majority were occlusions, most commonly managed conservatively. Other injuries including pseudoaneurysm, dissection, transection, and arterial-venous fistula were treated predominantly endovascularly and occasionally with the surgical exploration/ligation. Most endovascular treatments included embolization without significant stroke or complication from VA sacrifice. However, there are incidences in which VA sacrifice should be avoided and these scenarios can be better delineated with digital subtraction angiography to assess flow and anatomy.
CONCLUSIONS
This systematic review not only details the updated treatment options but also provides a decision algorithm for the treatment of penetrating VAI. It highlights the shifting treatment options of penetrating VAI to endovascular therapy, as well as details VAI variants that may suggest stenting over embolization.
Topics: Algorithms; Clinical Decision-Making; Head Injuries, Penetrating; Humans; Vertebral Artery
PubMed: 33460818
DOI: 10.1016/j.wneu.2021.01.021