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Circulation. Cardiovascular Imaging Sep 2015Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the... (Review)
Review
Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the morphological substrate or the extent of PHV pathology. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) have emerged as new potential imaging modalities for valve prostheses. We present an overview of the possibilities and pitfalls of CT and MRI for PHV assessment based on a systematic literature review of all experimental and patient studies. For this, a comprehensive systematic search was performed in PubMed and Embase on March 24, 2015, containing CT/MRI and PHV synonyms. Our final selection yielded 82 articles on surgical valves. CT allowed adequate assessment of most modern PHVs and complemented echocardiography in detecting the obstruction cause (pannus or thrombus), bioprosthesis calcifications, and endocarditis extent (valve dehiscence and pseudoaneurysms). No clear advantage over echocardiography was found for the detection of vegetations or periprosthetic regurgitation. Whereas MRI metal artifacts may preclude direct prosthesis analysis, MRI provided information on PHV-related flow patterns and velocities. MRI demonstrated abnormal asymmetrical flow patterns in PHV obstruction and allowed prosthetic regurgitation assessment. Hence, CT shows great clinical relevance as a complementary imaging tool for the diagnostic work-up of patients with suspected PHV obstruction and endocarditis. MRI shows potential for functional PHV assessment although more studies are required to provide diagnostic reference values to allow discrimination of normal from pathological conditions.
Topics: Echocardiography; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valves; Humans; Magnetic Resonance Imaging, Cine; Multimodal Imaging; Tomography, X-Ray Computed
PubMed: 26353926
DOI: 10.1161/CIRCIMAGING.115.003703 -
International Journal of Surgery... Nov 2020Current treatment approaches for acute type B aortic dissection (TBAD) are diversified. Thoracic endovascular aortic repair (TEVAR) as an effective and convenient... (Comparative Study)
Comparative Study Meta-Analysis
Comparison of the efficacy and safety of thoracic endovascular aortic repair with open surgical repair and optimal medical therapy for acute type B aortic dissection: A systematic review and meta-analysis.
BACKGROUND
Current treatment approaches for acute type B aortic dissection (TBAD) are diversified. Thoracic endovascular aortic repair (TEVAR) as an effective and convenient intervention has been adopted extensively. However, the superior efficacy and safety of TEVAR have not yet been well evaluated. This meta-analysis was designed to comprehensively compare the efficacy and safety of TEVAR with open surgical repair and optimal medical therapy for acute type B aortic dissection.
METHODS
A systematic search of PubMed, Embase, Cochrane Library and Web of Science up to April 1, 2020 was conducted for relevant studies that compared the efficacy of TEVAR and other conventional interventions in the treatment of TBAD. The primary outcomes were early mortality and midterm or long term survival. The secondary outcomes included early complications and other late outcomes. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2.
RESULTS
A total of 18 studies including 12,789 patients were identified. 30-day/in-hospital mortality was significantly lower in TBAD patients with TEVAR than open surgical repair (OSR), with a pooled OR of 0.54 (95% CI 0.43-0.68; P < 0.00001). Compared with optimal medical therapy (OMT), TEVAR experienced lower incidence of long-term death (≥5-yr mortality), with a pooled OR of 0.46 (95% CI 0.24-0.86; P = 0.02). However, no significant difference between TEVAR and OSR or OMT in long-term survival was found. Compared with OSR, lower incidence of cardiac and pulmonary complications as well as shorter length of stay were observed in TEVAR. Compared with OMT, TEVAR showed higher rate of paraplegia or paraparesis, higher complete thrombosis of the false lumen, as well as longer length of ICU stay.
CONCLUSIONS
Our analysis shows that TEVAR may be favorable in reducing 30-day/in-hospital mortality (than OSR) and long-term mortality (than OMT). TEVAR experienced equal efficacy with OSR and OMT in long-term survival. TEVAR showed higher rate of paraplegia or paraparesis, higher complete thrombosis of the false lumen, as well as longer length of ICU stay than OMT; and lower incidence of cardiac and pulmonary complications as well as shorter length of stay than OSR. However, TEVAR indicated similar incidence of other complications and outcomes with OSR and OMT. Further studies especially randomized clinical trials are needed to comprehensively compare the efficacy TEVAR.
Topics: Adult; Aged; Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Endovascular Procedures; Female; Hospital Mortality; Humans; Male; Middle Aged
PubMed: 32927144
DOI: 10.1016/j.ijsu.2020.08.051 -
The Journal of Cardiovascular Surgery Oct 2010Acute complicated type B aortic dissection is a life-threatening condition. We summarized all published studies for TEVAR among patients with acute complicated typ B... (Meta-Analysis)
Meta-Analysis Review
Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: a systematic review and meta-analysis of case series and comparative studies.
AIM
Acute complicated type B aortic dissection is a life-threatening condition. We summarized all published studies for TEVAR among patients with acute complicated typ B aortic dissection (TBAD) with respect to clinical success, complications, and outcomes. Furthermore, we determined whether TEVAR reduces death and morbidity compared with open repair for TBAD.
METHODS
Studies were identified from a literature search using various databases, and included studies when three or more patients were reported and at least in-hospital mortality was reported. Data from comparative studies of TEVAR versus open repair of the descending aorta in TBAD were combined through meta-analysis.
RESULTS
Seventy-six observational studies involving 1951 patients were included in the present meta-analysis. In-hospital mortality was 11.5% and other major complications (i.e., stroke (6.3%), paraplegia (4.9%), retrograde type A aortic dissection (7%), renal impairment including dialysis (6.9%), bowel infarction (4.1%), vascular problems including major amputation (2.5%)) occurred less frequently. Long-term follow-up was limited to a mean of 24 months. During this time, endovascular reintervention was required in 11.3%, surgical reintervention in 7.7%, and late aortic rupture was calculated for 3.2% of cases. A complete false lumen thrombosis was estimated to occur in 76.1% of cases. In comparative studies, 30-day/in-hospital mortality (OR=0.256, P=0.001) and paraplegia/paraparesis (OR=0.256, P=0.001) were significantly reduced for TEVAR versus open repair. In addition to that, the rate of vascular complications was reduced for TEVAR (OR=0.373, P=0.036). There was no significant difference between TEVAR and open repair in patients with acute complicated TBAD for the following outcomes: late mortality, reintervention rate, renal dysfunction (including dialysis), and stroke rate.
CONCLUSION
This summary analysis suggests that endovascular treatment of complicated acute type B aortic dissection produces favourable initial outcomes and would seem to be a great addition to the treatment options for this condition. Further study of long-term outcomes is required.
Topics: Aortic Dissection; Aortic Aneurysm; Aortic Rupture; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Hospital Mortality; Humans; Kidney Diseases; Odds Ratio; Paraplegia; Reoperation; Risk Assessment; Risk Factors; Stroke; Time Factors; Treatment Outcome
PubMed: 20924323
DOI: No ID Found -
Infection Jun 2024The landscape of Pseudomonas infective endocarditis (IE) is evolving with the widespread use of cardiac implantable devices and hospital-acquired infections. This... (Review)
Review
BACKGROUND
The landscape of Pseudomonas infective endocarditis (IE) is evolving with the widespread use of cardiac implantable devices and hospital-acquired infections. This systematic review aimed to evaluate the emerging risk factors and outcomes in Pseudomonas IE.
METHODS
A literature search was performed in major electronic databases (PubMed, Scopus, and Google Scholar) with appropriate keywords and combinations till November 2023. We recorded data for risk factors, diagnostic and treatment modalities. This study is registered with PROSPERO, CRD42023442807.
RESULTS
A total of 218 cases (131 articles) were included. Intravenous drug use (IDUs) and prosthetic valve endocarditis (PVE) were major risk factors for IE (37.6% and 22%). However, the prosthetic valve was the predominant risk factor in the last two decades (23.5%). Paravalvular complications (paravalvular leak, abscess, or pseudoaneurysm) were described in 40 cases (18%), and the vast majority belonged to the aortic valve (70%). The mean time from symptom onset to presentation was 14 days. The incidence of difficult-to-treat resistant (DTR) pseudomonas was 7.4%. Valve replacement was performed in 57.3% of cases. Combination antibiotics were used in most cases (77%), with the aminoglycosides-based combination being the most frequently used (66%). The overall mortality rate was 26.1%. The recurrence rate was 11.2%. Almost half of these patients were IDUs (47%), and most had aortic valve endocarditis (76%).
CONCLUSIONS
This review highlights the changing epidemiology of Pseudomonas endocarditis with the emergence of prosthetic valve infections. Acute presentation and associated high mortality are characteristic of Pseudomonas IE and require aggressive diagnostic and therapeutic approach.
PubMed: 38856808
DOI: 10.1007/s15010-024-02311-z -
The Cochrane Database of Systematic... Nov 2013Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, but sometimes definitive treatment... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, but sometimes definitive treatment is needed. Surgery has traditionally been considered the 'gold standard' treatment, although it is not without risk in patients with severe cardiovascular disease. Less invasive treatment options such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. This is an update of a Cochrane review first published in 2006.
OBJECTIVES
To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as blind manual or mechanical compression, ultrasound-guided compression, or percutaneous thrombin injection.
SEARCH METHODS
For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9).
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review.
DATA COLLECTION AND ANALYSIS
Four studies were included in the analyses comparing: manual compression versus ultrasound-guided compression; ultrasound-guided application of a mechanical device (FemoStop) versus blind application; and ultrasound-guided compression versus percutaneous thrombin injection (two studies). There were no studies with a surgical intervention arm. Data were extracted independently by both authors.
MAIN RESULTS
Compression (manual or FemoStop) was effective in achieving pseudoaneurysm thrombosis although ultrasound-guided application failed to confer any benefit (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.88 to 1.04).Percutaneous thrombin injection was more effective than a single session of ultrasound-guided compression in achieving primary pseudoaneurysm thrombosis within individual RCTs but merged data failed to show statistical significance (RR 2.81; 95% CI 0.44 to 18.13). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported apart from one deep vein thrombosis in the compression group.
AUTHORS' CONCLUSIONS
The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use compression (blind or ultrasound-guided) as first-line treatment, reserving thrombin injection for those in whom the compression procedure fails.
Topics: Aneurysm, False; Endovascular Procedures; Femoral Artery; Hemostatics; Humans; Pressure; Randomized Controlled Trials as Topic; Thrombin; Ultrasonic Therapy; Ultrasonography, Interventional
PubMed: 24293322
DOI: 10.1002/14651858.CD004981.pub4 -
Journal of Vascular Surgery Nov 2008The autogenous arteriovenous access for chronic hemodialysis is recommended over the prosthetic access because of its longer lifespan. However, more than half of the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The autogenous arteriovenous access for chronic hemodialysis is recommended over the prosthetic access because of its longer lifespan. However, more than half of the United States dialysis patients receive a prosthetic access. We conducted a systematic review to summarize the best available evidence comparing the two accesses types in terms of patient-important outcomes.
METHODS
We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and SCOPUS) and included randomized controlled trials and controlled cohort studies. We pooled data for each outcome using a random effects model to estimate the relative risk (RR) and its associated 95% confidence interval (CI). We estimated inconsistency caused by true differences between studies using the I(2) statistic.
RESULTS
Eighty-three studies, of which 80 were nonrandomized, met eligibility criteria. Compared with the prosthetic access, the autogenous access was associated with a significant reduction in the risk of death (RR, 0.76; 95% CI, 0.67-0.86; I(2) = 48%, 27 studies) and access infection (RR, 0.18; 95% CI, 0.11-0.31; I(2) = 93%, 43 studies), and a nonsignificant reduction in the risk of postoperative complications (hematoma, bleeding, pseudoaneurysm and steal syndrome, RR 0.73; 95% CI, 0.48-1.16; I(2) = 65%, 31 studies) and length of hospitalization (pooled weighted mean difference -3.8 days; 95% CI, -7.8 to 0.2; P = .06). The autogenous access also had better primary and secondary patency at 12 and 36 months.
CONCLUSION
Low-quality evidence from inconsistent studies with limited protection against bias shows that autogenous access for chronic hemodialysis is superior to prosthetic access.
Topics: Arteriovenous Shunt, Surgical; Blood Vessel Prosthesis; Humans; Renal Dialysis; Transplantation, Autologous
PubMed: 19000592
DOI: 10.1016/j.jvs.2008.08.044 -
The Journal of Vascular Access Jan 2024Data comparing MANTA device with Perclose device for large bore arterial access closure is limited. We performed meta-analysis to compare safety and efficacy of the two... (Review)
Review
Data comparing MANTA device with Perclose device for large bore arterial access closure is limited. We performed meta-analysis to compare safety and efficacy of the two devices in large (⩾14 Fr sheath) arteriotomy closure post-TAVR. Relevant studies were identified via PubMed, Cochrane, and EMBASE databases until June, 2022. Data was analyzed using random effect model to calculate relative odds of VARC-2 defined access-site complications and short-term (in-hospital or 30-day) mortality. A total of 12 studies (2 RCT and 10 observational studies) comprising 2339 patients were included. The odds of major vascular complications (OR 0.99, 95% CI 0.51-1.92; = 0.98); life threatening and major bleeding (OR 0.77, 95% CI 0.45-1.33; = 0.35); minor vascular complications (OR 1.37, 95% CI 0.63-2.99; = 0.43); minor bleeding (OR 0.94, 95% CI 0.57-1.56; = 0.82); device failure (OR 0.74, 95% CI 0.49-1.11; = 0.14); hematoma formation (OR 0.76, 95% CI 0.33-1.75; = 0.52); dissection, stenosis, occlusion, or pseudoaneurysm (OR 1.08, 95% CI 0.71-1.62; = 0.73) and short-term mortality (OR 1.01, 95% CI 0.55-1.84; = 0.98) between both devices were similar. MANTA device has a similar efficacy and safety profile compared to Perclose device.
PubMed: 38189215
DOI: 10.1177/11297298231222314 -
The Annals of Thoracic Surgery Feb 2014Endovascular treatments of Stanford type B aortic dissection may help to promote aortic remodeling and reduce the incidence of aortic-related complications. The aim of... (Review)
Review
BACKGROUND
Endovascular treatments of Stanford type B aortic dissection may help to promote aortic remodeling and reduce the incidence of aortic-related complications. The aim of this study was to review published literature describing aortic remodeling after endovascular treatment of aortic dissection.
METHODS
A systematic review of the literature was performed which was compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The type of aortic morphology measurements made and the methods used to make them were characterized. The endpoints of interest were the change in these measurements over time.
RESULTS
After initial screening, 77 articles were identified; 16 of which met the inclusion criteria. Few studies used three-dimensional reconstruction software and none had validated their measurement protocol. True lumen (TL) and false lumen (FL) diameters, areas, and in some cases volumes were measured. Studies assessed the aorta at a variety of different levels and over different periods of follow-up. Acute dissection patients displayed more consistent degree of remodeling (thoracic FL thrombosis in 80% to 90%) than chronic dissection patients (38% to 91%). Less remodeling was seen below the diaphragm in both groups.
CONCLUSIONS
Aortic remodeling after treatment for dissection is described in a highly heterogeneous manner. Despite this there appears to be a greater degree of complete FL resolution in patients with acute dissection than chronic. Factors such as length of aortic coverage and timing of treatment may explain the variation seen in the chronic dissection group. Consensus-based reporting standards are required to synthesize evidence and inform clinical decisions regarding patient selection and operative timing.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Endovascular Procedures; Humans; Treatment Outcome
PubMed: 24360089
DOI: 10.1016/j.athoracsur.2013.07.128 -
Journal of Vascular Surgery Jun 2020True profunda femoris artery aneurysm (TPFAA) is rare. Most cases of profunda femoris artery aneurysm are classified as pseudoaneurysms. TPFAAs are mostly asymptomatic,...
OBJECTIVE
True profunda femoris artery aneurysm (TPFAA) is rare. Most cases of profunda femoris artery aneurysm are classified as pseudoaneurysms. TPFAAs are mostly asymptomatic, but some are manifested with pain, swelling, paresthesia, gait and movement disturbances, thrombosis, and rupture. There is a paucity of evidence on the effectiveness of diagnostic and therapeutic measures for management of TPFAA. The aim of this paper was to systematically review the incidence, diagnosis, and management of TPFAA.
METHODS
A comprehensive systematic review on the diagnosis and management of TPFAAs was conducted by a search through PubMed, Cochrane, Embase, and Google Scholar databases to identify and to evaluate publications on TPFAA since 2012. Only publications on TPFAA were included in this review.
RESULTS
A total of 19 publications published from 2012 were included in the review. The studies were 18 case reports and a cadaver study reporting 27 TPFAAs in 26 patients with a mean age of 69.6 years. Rupture was reported in 18.5% of the cases (n = 5); the conventional clinical presentation of unruptured TPFAA was reported in 48% of cases (n = 13), with 40.9% of unruptured aneurysms being asymptomatic (n = 9). Computed tomography angiography was used as a diagnostic tool in 85.2% of the cases (n = 23); Doppler ultrasound was applied in 33.3% of cases (n = 9). The common therapeutic approaches were resection and revascularization (n = 13 [48.1%]) and ligation or resection without reconstruction (n = 6 [22.2%]). Cumulative analysis for cases reported before and after 2012 yielded similar results.
CONCLUSIONS
Review of the current literature supports that computed tomography angiography and Doppler ultrasound are the mainstay diagnostic approaches for TPFAA. Surgical repair through ligation, resection, and revascularization remains the most common and effective therapeutic procedure. Endovascular embolization is recommended for aneurysms when surgery is not tenable because of the patient's comorbidities and the aneurysm's anatomy.
Topics: Adult; Aged; Aged, 80 and over; Aneurysm; Computed Tomography Angiography; Female; Femoral Artery; Humans; Incidence; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Treatment Outcome; Ultrasonography, Doppler; Vascular Surgical Procedures
PubMed: 31882317
DOI: 10.1016/j.jvs.2019.10.086 -
European Journal of Vascular and... Jun 2016To compare results of ultrasound based techniques (ultrasound guided compression-(UGC) versus ultrasound guided thrombin injection (UGTI)) to treat iatrogenic... (Comparative Study)
Comparative Study Meta-Analysis Review
Ultrasound Guided Compression Versus Ultrasound Guided Thrombin Injection for the Treatment of Post-Catheterization Femoral Pseudoaneurysms: Systematic Review and Meta-Analysis of Comparative Studies.
OBJECTIVE
To compare results of ultrasound based techniques (ultrasound guided compression-(UGC) versus ultrasound guided thrombin injection (UGTI)) to treat iatrogenic post-catheterization femoral pseudoaneurysms.
METHODS
The study design involved a systematic review of the literature and meta-analysis of comparative studies. The MEDLINE, CENTRAL, and OpenGray databases were searched up to October 2015. Primary outcome measure was efficacy, while other outcomes examined were safety (complication rate), duration of the procedure, length of hospitalization, and cost of methods. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI).
RESULTS
Two randomized control trials and 11 observational studies were included in the analysis. Overall, 786 and 318 subjects underwent UGC and UGTI respectively. The latter modality resulted in a significantly higher success rate (97.4% vs. 69.3%, OR 0.06, 95% CI 0.03-0.11) while the complication rate for both techniques was very low (0.69% vs. 0.78%, OR 1.77, 95% CI 0.40-7.88). Data regarding procedural duration and length of hospitalization were very scarce, favoring UGTI (procedural time: MD 35.53 min, 9.11-63.95, length of hospitalization MD 1.99 days, -0.31-4.29). Scarcity of data did not allow proper cost analysis, but two studies suggested that UGTI may offer reduced treatment costs.
CONCLUSION
Available evidence suggests that UGTI is superior in terms of efficacy and as safe as UGC and thus should be used as the primary modality for the treatment of post-catheterization femoral pseudoaneurysms.
Topics: Catheterization; Databases, Factual; Femoral Artery; Humans; Postoperative Complications; Thrombin; Ultrasonography
PubMed: 27026390
DOI: 10.1016/j.ejvs.2016.02.012