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  1 / 1001 MEDLINE  
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[PMID]:29443753
[Au] Autor:Lee M; Ryu JS; Suh CH; Hyun IY
[Ad] Endereço:Departments of Nuclear Medicine.
[Ti] Título:Intense 18F-FDG activity in aortoiliac bypass graft mimicking infection: A case report.
[So] Source:Medicine (Baltimore);97(7):e9876, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) has the potential to become an important imaging tool for the diagnosis of suspected aortoiliac bypass graft infection (AGI). PATIENT CONCERNS: A 76-year-old man presented with incidental findings of intense F-FDG activity in previous operation site of aortobiiliac bypass graft in the initial staging of small cell lung cancer (SCLC). DIAGNOSES: Based on F-FDG PET/CT examination, preliminary differential diagnosis was AGI. INTERVENTIONS: We performed laboratory tests and Galliun-citrate (Ga) single photon emission computed tomography/computed tomography (SPECT/CT). OUTCOMES: He had no constitutional symptoms and abnormal laboratory test results suggesting AGI. CT scan of the abdomen and pelvis showed no abnormal findings. Also, Ga planar scintigraphy and SPECT/CT imaging of the abdomen and pelvis failed to show abnormal Ga uptake in the same site of aortobiiliac bypass graft with F-FDG uptake. LESSONS: We present a case with postoperative inflammatory aortobiiliac bypass graft which was misdiagnosed as AGI based on intense F-FDG activity seen at PET/CT imaging.
[Mh] Termos MeSH primário: Fluordesoxiglucose F18/uso terapêutico
Neoplasias Pulmonares/patologia
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos
Infecções Relacionadas à Prótese/diagnóstico
Carcinoma de Pequenas Células do Pulmão/patologia
Enxerto Vascular
[Mh] Termos MeSH secundário: Idoso
Aorta Abdominal/diagnóstico por imagem
Aorta Abdominal/cirurgia
Aneurisma da Aorta Abdominal/cirurgia
Diagnóstico Diferencial
Seres Humanos
Artéria Ilíaca/diagnóstico por imagem
Artéria Ilíaca/cirurgia
Achados Incidentais
Masculino
Estadiamento de Neoplasias
Compostos Radiofarmacêuticos/uso terapêutico
Reprodutibilidade dos Testes
Enxerto Vascular/efeitos adversos
Enxerto Vascular/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Radiopharmaceuticals); 0Z5B2CJX4D (Fluorodeoxyglucose F18)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009876


  2 / 1001 MEDLINE  
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[PMID]:29182836
[Au] Autor:Kobayashi S
[Ti] Título:[CKD and Progression of PAD.]
[So] Source:Nihon Naika Gakkai Zasshi;105(5):842-849, 2016 May.
[Is] ISSN:0021-5384
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Mh] Termos MeSH primário: Doença Arterial Periférica/terapia
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Progressão da Doença
Seres Humanos
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/etiologia
Diálise Renal
Fatores de Risco
Calcificação Vascular
Enxerto Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


  3 / 1001 MEDLINE  
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[PMID]:28457324
[Au] Autor:Hu H; Huang B; Zhao J; Wang W; Guo Q; Ma Y
[Ad] Endereço:Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
[Ti] Título:Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis.
[So] Source:J Surg Res;210:169-176, 2017 Apr.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Alveolar echinococcosis (AE) is characterized by a slow-growing infiltrative neoplasm that is often unresectable by traditional methods because of strong adhesions and invasion to adjacent structures. We present our experience with liver autotransplantation and retrohepatic inferior vena cava (RHIVC) reconstruction using autogenous veins in patients with this end-stage parasitic disease. METHODS: Twelve patients with hepatic AE and extensive RHIVC, hepatic vein, and/or hilar invasion underwent ex vivo liver resection and RHIVC reconstruction using autogenous veins followed by autotransplantation in the West China Hospital of Sichuan University from 2013 to 2016. RESULTS: The mean weight of the harvested liver graft was 537 g (range: 390-900 g), the mean anhepatic time was 216 min (range, 120-310 min), and the mean operation time was 13.6 h (range, 10.5-19.5 h). The main postoperative complication was bile leakage. The mean postoperative hospital stay was 16.4 d (range, 10.0-37.0 d), and the median follow-up time was 15.5 mo (range, 1.0-32.0 mo). All patients were alive at the latest follow-up. The vascular patency rate was 100%, and no residual disease, recurrence, or metastasis was detected. CONCLUSIONS: To our knowledge, liver autotransplantation and RHIVC reconstruction using autogenous veins are rarely performed for patients with end-stage hepatic AE. This technique requires no organ donor, allogeneic, or artificial vessel implantation, postoperative immunosuppressive therapy, or long-term postoperative anticoagulant treatment. These benefits may make the treatment of select end-stage hepatic AE patients more affordable and effective.
[Mh] Termos MeSH primário: Equinococose Hepática/cirurgia
Transplante de Fígado/métodos
Enxerto Vascular/métodos
Veia Cava Inferior/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Transplante Autólogo
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


  4 / 1001 MEDLINE  
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[PMID]:29381933
[Au] Autor:Tang S; Niu G; Fang D; Yan Z; Zhang B; Li X; Yang M; Zhou L
[Ad] Endereço:Department of Urology, Peking University First Hospital, Institute of Urology, Peking, University.
[Ti] Título:The diagnosis and endovascular therapy of renal artery aneurysm: A 32-patient case report.
[So] Source:Medicine (Baltimore);96(47):e8615, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Renal aneurysm is a rare disease with the atypical symptoms and mostly diagnosed by imaging modalities. Endovascular therapy is a one of treatment methods. PATIENT CONCERNS: A retrospective analysis of 32 patients with renal artery aneurysm, from June 2010 to May 2016 in our hospital, was made in our study. All of them underwent therapy, and the effects and perioperative characteristics of it were analyzed. DIAGNOSIS: 32 patients were taken contrast-enhanced CT and diuretic renal dynamic imaging to evaluate the state of illness. INTERVENTIONS: The preoperative blood creatinine, perioperative hemoglobin and relief of hypertension were performed. OUTCOMES: The preoperative blood creatinine was slightly increasing, while the perioperative hemoglobin was slightly decreasing. The relieving hypertension was performed in 9 of patients. LESSONS: Endovascular therapy is a mature and feasible treatment method. There is little effect on hemoglobin and renal function in postoperation, while it can also decrease the blood pressure.
[Mh] Termos MeSH primário: Aneurisma
Angioplastia com Balão
Procedimentos Endovasculares/métodos
Rim
Enxerto Vascular
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Aneurisma/diagnóstico
Aneurisma/fisiopatologia
Aneurisma/cirurgia
Angiografia Digital/métodos
Angioplastia com Balão/instrumentação
Angioplastia com Balão/métodos
China
Angiografia por Tomografia Computadorizada/métodos
Feminino
Seres Humanos
Rim/irrigação sanguínea
Rim/diagnóstico por imagem
Rim/fisiopatologia
Testes de Função Renal/métodos
Masculino
Meia-Idade
Avaliação de Processos e Resultados (Cuidados de Saúde)
Assistência Perioperatória/métodos
Assistência Perioperatória/estatística & dados numéricos
Artéria Renal/diagnóstico por imagem
Artéria Renal/fisiopatologia
Artéria Renal/cirurgia
Stents
Enxerto Vascular/instrumentação
Enxerto Vascular/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008615


  5 / 1001 MEDLINE  
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[PMID]:29235151
[Au] Autor:Changwei R; Sun L; Xu S; Lai Y
[Ad] Endereço:Department of Cardiovascular Surgery Center, Capital Medical University, Beijing Anzhen Hospital, Beijing, China.
[Ti] Título:One-stage ascending-to-abdominal aortic bypass with concomitant aortic valve procedures for aortic coarctation combined with aortic valve pathology in adult patients.
[So] Source:J Card Surg;32(12):817-821, 2017 Dec.
[Is] ISSN:1540-8191
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This study aims to evaluate the results of one-stage ascending-to-abdominal aortic bypass and aortic valve replacement for concomitant aortic coarctation combined with aortic valve pathology. METHODS: From June 2009 to March 2017, 28 consecutive adult patients (23 males and five females) with aortic coarctation combined with aortic valve pathology underwent one-stage ascending-to-abdominal aorta bypass and aortic valve replacement or a Bentall procedure. Patients were followed for a mean of 45.5 ± 26.5 months (range 3-96 months). RESULT: All patients successfully underwent the one-stage procedure. No early deaths were recorded. The mean aortic cross-clamp and cardiopulmonary bypass times were 71 ± 23 and 113 ± 37 mins, respectively. Re-exploration for bleeding was performed on one patient (3.6%). The average post-operative hospital stay was 15.9 ± 4.9 days and the average operation time was 5.2 h. No paraplegia or stroke was observed. The blood pressure gradient of the upper and lower extremities significantly decreased (P < 0.001). Systolic blood pressure decreased from 158 ± 36 mmHg pre-operatively to 121 ± 18 mmHg post-operatively. No deaths or significant gradients between the upper and lower extremities occurred during follow-up. No death and complications of bypass grafts occurred during follow-up. CONCLUSION: Ascending-to-abdominal aortic bypass and concomitant aortic valve procedures are a suitable therapeutic option for severe aortic coarctation combined with aortic valve pathology in adult patients.
[Mh] Termos MeSH primário: Aorta/cirurgia
Coartação Aórtica/cirurgia
Insuficiência da Valva Aórtica/cirurgia
Estenose da Valva Aórtica/cirurgia
Implante de Prótese de Valva Cardíaca/métodos
Enxerto Vascular/métodos
[Mh] Termos MeSH secundário: Adulto
Coartação Aórtica/complicações
Insuficiência da Valva Aórtica/complicações
Estenose da Valva Aórtica/complicações
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE
[do] DOI:10.1111/jocs.13505


  6 / 1001 MEDLINE  
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[PMID]:29280859
[Au] Autor:Largo RD; Selber JC; Garvey PB; Chang EI; Hanasono MM; Yu P; Butler CE; Baumann DP
[Ad] Endereço:Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
[Ti] Título:Outcome Analysis of Free Flap Salvage in Outpatients Presenting with Microvascular Compromise.
[So] Source:Plast Reconstr Surg;141(1):20e-27e, 2018 01.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. METHODS: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. RESULTS: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room. Also, 261 patients (4 percent) suffered from microvascular compromise, of whom 110 (1 percent) experienced total flap loss. The authors identified 17 patients (10 breast cancer patients and seven head and neck cancer patients) who had vascular flap compromise and underwent reoperation after hospital discharge (median, 10 days; range, 4 to 107 days) after free flap reconstruction. Of these 17 patients, nine breast cancer patients and two head and neck cancer patients underwent flap salvage attempts. Salvage procedures included thrombectomy, thrombolytic and heparin injections, and reanastomoses (11 patients); vein grafting (four patients); vein supercharging with cephalic turndown (two patients); and change of recipient vessels (two patients). Sixteen of the 17 patients (94 percent) experienced total flap loss, and one patient (6 percent) had partial flap loss requiring long-lasting wound treatment. CONCLUSIONS: Outpatient free flap salvage has a low success rate regardless of flap type, recipient site, or patient population. The authors' study suggests that immediate second-line reconstruction is more effective for late-onset flap vascular crisis than extensive flap salvage procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
[Mh] Termos MeSH primário: Retalhos de Tecido Biológico/irrigação sanguínea
Isquemia/terapia
Microvasos
Complicações Pós-Operatórias/terapia
Procedimentos Cirúrgicos Reconstrutivos
Terapia de Salvação/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Fibrinolíticos/uso terapêutico
Retalhos de Tecido Biológico/cirurgia
Seres Humanos
Isquemia/etiologia
Masculino
Microvasos/cirurgia
Meia-Idade
Procedimentos Cirúrgicos Reconstrutivos/métodos
Reoperação
Estudos Retrospectivos
Trombectomia
Resultado do Tratamento
Enxerto Vascular
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003917


  7 / 1001 MEDLINE  
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[PMID]:29229120
[Au] Autor:Kirkton RD; Prichard HL; Santiago-Maysonet M; Niklason LE; Lawson JH; Dahl SLM
[Ad] Endereço:Humacyte Inc, Research Triangle Park, North Carolina.
[Ti] Título:Susceptibility of ePTFE vascular grafts and bioengineered human acellular vessels to infection.
[So] Source:J Surg Res;221:143-151, 2018 Jan.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Synthetic expanded polytetrafluorethylene (ePTFE) grafts are routinely used for vascular repair and reconstruction but prone to sustained bacterial infections. Investigational bioengineered human acellular vessels (HAVs) have shown clinical success and may confer lower susceptibility to infection. Here we directly compared the susceptibility of ePTFE grafts and HAV to bacterial contamination in a preclinical model of infection. MATERIALS AND METHODS: Sections (1 cm ) of ePTFE (n = 42) or HAV (n = 42) were inserted within bilateral subcutaneous pockets on the dorsum of rats and inoculated with Staphylococcus aureus (10 CFU/0.25 mL) or Escherichia coli (10 CFU/0.25 mL) before wound closure. Two weeks later, the implant sites were scored for abscess formation and explanted materials were halved for quantification of microbial recovery and histological analyses. RESULTS: The ePTFE implants had significantly higher abscess formation scores for both S. aureus and E. coli inoculations compared to that of HAV. In addition, significantly more bacteria were recovered from explanted ePTFE compared to HAV. Gram staining of explanted tissue sections revealed interstitial bacterial contamination within ePTFE, whereas no bacteria were identified in HAV tissue sections. Numerous CD45 leukocytes, predominantly neutrophils, were found surrounding the ePTFE implants but minimal intact neutrophils were observed within the ePTFE matrix. The host cells surrounding and infiltrating the HAV explants were primarily nonleukocytes (CD45 ). CONCLUSIONS: In an established animal model of infection, HAV was significantly less susceptible to bacterial colonization and abscess formation than ePTFE. The preclinical findings presented in this manuscript, combined with previously published clinical observations, suggest that bioengineered HAV may exhibit low rates of infection.
[Mh] Termos MeSH primário: Prótese Vascular
Infecção/etiologia
Politetrafluoretileno
Infecções Relacionadas à Prótese/etiologia
Enxerto Vascular/efeitos adversos
[Mh] Termos MeSH secundário: Animais
Escherichia coli
Masculino
Ratos Sprague-Dawley
Staphylococcus aureus
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
9002-84-0 (Polytetrafluoroethylene)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


  8 / 1001 MEDLINE  
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[PMID]:29180182
[Au] Autor:Chiang N; Rodda OA; Sleigh J; Vasudevan T
[Ad] Endereço:Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand.
[Ti] Título:Perioperative warming, oxygen, and Ilomedin on oxygenation and healing in infrainguinal bypass surgery.
[So] Source:J Surg Res;220:197-205, 2017 Dec.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Perioperative adjuncts are utilized across surgical specialities with the goal of improving patient outcomes. High-dose oxygen and extended warming are shown to increase wound collagen deposition during abdominal surgery. Prostacyclin is shown to improve limb salvage and patency rate in infrainguinal bypass (IIB) surgery. This study evaluated the impact of these adjuncts on healing and perfusion post IIB surgery. METHODS: This randomized controlled study allocated patients undergoing IIB surgery into three treatment arms (perioperative high-dose oxygen, extended warming, and a synthetic prostacyclin) or a control group. The primary outcome was accumulation of hydroxyproline (OHP, collagen surrogate marker) as collected in polytetrafluoroethylene implants on day 5. Secondary outcomes included levels of growth factors and cytokines, and tissue oxygenation of the wound and foot as measured by hyperspectral technology and ankle-brachial pressure index. Clinical outcomes were observed to day 30, with long-term follow-up of 12 mo. RESULTS: Seventy-one patients completed the study. Comparing treatment groups with the control at day 5, there were no differences in OHP, growth factors or cytokines levels, or improvement in tissue oxygenation at the surgical incision. However, there was more flow to the foot (HT-SUM (%) change) in the Ilomedin group compared to control (0% versus -14.6%, P = 0.045). HT-deoxy was higher at the peripheries in the oxygen and temperature groups, suggesting decreased tissue oxygenation. CONCLUSIONS: The perioperative treatments did not dramatically improve oxygenation or healing of the surgical wound in IIB surgery; however, Ilomedin may result in greater flow to the peripheries.
[Mh] Termos MeSH primário: Temperatura Alta/uso terapêutico
Iloprosta/uso terapêutico
Oxigênio/administração & dosagem
Assistência Perioperatória/métodos
Enxerto Vascular
Cicatrização
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Hidroxiprolina/análise
Perna (Membro)/irrigação sanguínea
Perna (Membro)/cirurgia
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
JED5K35YGL (Iloprost); RMB44WO89X (Hydroxyproline); S88TT14065 (Oxygen)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


  9 / 1001 MEDLINE  
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[PMID]:28958362
[Au] Autor:Teixeira PGR; DuBose J
[Ad] Endereço:Department of Surgery and Perioperative Care, University Medical Center Brackenridge, Dell Medical School, University of Texas at Austin, 1501 Red River Street, Austin, TX 78712, USA.
[Ti] Título:Surgical Management of Vascular Trauma.
[So] Source:Surg Clin North Am;97(5):1133-1155, 2017 Oct.
[Is] ISSN:1558-3171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Vascular injuries remain among the most challenging entities encountered in trauma care. Improvements in diagnostic capabilities, resuscitation approaches, vascular techniques, and prosthetic device options have afforded considerable advancement in the care of these patients. This evolution in care capabilities continues. Despite advances, uncontrolled hemorrhage due to major vascular injury remains one of the most common causes of death after trauma. Successful management of vascular injury requires the timely diagnosis and control of bleeding sources; to facilitate this task, trauma providers must appreciate the capabilities and limitations of diagnostic imaging modalities. Trauma providers must understand when and how to effectively apply these strategies.
[Mh] Termos MeSH primário: Lesões do Sistema Vascular/cirurgia
[Mh] Termos MeSH secundário: Angiografia
Angiografia por Tomografia Computadorizada
Hemorragia/etiologia
Seres Humanos
Ligadura
Ultrassonografia de Intervenção
Enxerto Vascular
Lesões do Sistema Vascular/complicações
Lesões do Sistema Vascular/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170930
[St] Status:MEDLINE


  10 / 1001 MEDLINE  
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[PMID]:28807382
[Au] Autor:Stavroulakis K; Borowski M; Torsello G; Bisdas T; CRITISCH collaborators
[Ad] Endereço:Department of Vascular Surgery, St. Franziskus Hospital GmbH, Muenster, Germany; Department of Vascular Surgery, University Clinic of Muenster, Muenster, Germany. Electronic address: stavroulakis.konstantinos@yahoo.gr.
[Ti] Título:Association between statin therapy and amputation-free survival in patients with critical limb ischemia in the CRITISCH registry.
[So] Source:J Vasc Surg;66(5):1534-1542, 2017 Nov.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity and mortality. Nonetheless, current recommendations are extrapolated from other high-risk populations because of the lack of CLI-dedicated trials. The aim of this explorative study was to evaluate the association of statin therapy with the outcomes of CLI patients. METHODS: The First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) registry is a prospective multicenter registry analyzing the effectiveness of all available treatment strategies in 1200 CLI patients. For the purposes of this analysis, patients were divided into two groups based on statin administration. Treatment crossovers and nonadherent patients were excluded from analysis. The primary composite end point of this study was the amputation-free survival (AFS). Major adverse cardiovascular and cerebral events (MACCEs), time to death, and time to major amputation were also analyzed. RESULTS: Statin therapy was applied in 445 individuals (37%), 371 (31%) patients received no statins, and 384 subjects were excluded from analysis (treatment crossovers). Patients receiving statins were more likely to be younger (P < .001) and to have a history of coronary heart disease (P < .001) or previous intervention at index limb (P < .001). Patients receiving statin therapy had a lower hazard regarding AFS (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.34-0.63; P < .001) and death (HR, 0.40; 95% CI, 0.24-0.66; P < .001) as well as lower odds of MACCE (odds ratio, 0.41; 95% CI, 0.23-0.69; P = .001). However, statin therapy was not associated with reduced amputation rates (HR, 1.02; 95% CI, 0.67-1.56; P = .922). Statin effect on AFS was consistent among diabetics (HR, 0.47; 95% CI, 0.31-0.70; P < .001), patients with chronic kidney disease (HR, 0.53; 95% CI, 0.32-0.87; P = .012), and patients older than 75 years (HR, 0.40; 95% CI, 0.26-0.60; P < .001). Statin administration was also associated with an improved AFS in patients with antiplatelet medication (HR, 0.64; 95% CI, 0.41-0.99; P = .049) and without antiplatelet medication (HR, 0.26; 95% CI, 0.12-0.57; P = .001) and after both endovascular therapy (HR, 0.51; 95% CI, 0.34-0.76; P = .001) and bypass revascularization (HR, 0.38; 95% CI, 0.21-0.68; P = .001). CONCLUSIONS: Statin therapy in CLI patients is associated with an increased AFS and lower rates of mortality and MACCEs without improving, however, the salvage rates of the affected limb.
[Mh] Termos MeSH primário: Amputação
Dislipidemias/tratamento farmacológico
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico
Isquemia/terapia
Doença Arterial Periférica/terapia
Prevenção Secundária/métodos
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Comorbidade
Estado Terminal
Intervalo Livre de Doença
Dislipidemias/sangue
Dislipidemias/diagnóstico
Dislipidemias/mortalidade
Procedimentos Endovasculares
Feminino
Alemanha
Seres Humanos
Isquemia/diagnóstico
Isquemia/mortalidade
Estimativa de Kaplan-Meier
Salvamento de Membro
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/mortalidade
Inibidores da Agregação de Plaquetas/uso terapêutico
Modelos de Riscos Proporcionais
Fatores de Proteção
Sistema de Registros
Medição de Risco
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
Enxerto Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors); 0 (Platelet Aggregation Inhibitors)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE



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