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   Table of Contents - Current issue
January-March 2019
Volume 2 | Issue 1
Page Nos. 1-23

Online since Wednesday, July 24, 2019

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Close association between carotid and coronary atherosclerosis analyzed through SYNTAX score p. 1
P Levantino, G Polizzi, S Evola, G Leone, G Evola, G Novo, S Novo
AIM: This study analyzed the association between carotid and coronary atherosclerosis, particularly in terms of the severity as well as the extension of the disease. MATERIALS AND METHODS: We have recruited a consecutive series of 478 patients (admitted to the Cardiology Unit of University Hospital Paolo Giaccone during 2004–2014). These patients underwent both carotid Doppler ultrasound and coronary angiography. Sex, age, and traditional cardiovascular risk factors were considered. The SYNTAX score was used to grade the complexity of coronary disease. RESULTS: The present study revealed a clear association between carotid atherosclerosis and coronary disease: 68.2% of the examined population showed atherosclerosis in both carotid and coronary arteries. The absence of carotid atherosclerosis was predominantly associated with angiographically normal coronary arteries (37.6%) rather than a single-vessel disease (22.8%), a two-vessel disease (21.8%), or a three-vessel disease (17.8%). When carotid atherosclerosis was present, a normal coronary angiography was uncommon (13.5%), while the detection of a single-vessel disease was more frequent (17.2%), a two-vessel disease was even more frequent (27.6%), and the highest rate described was related to a three-vessel coronary artery disease (CAD) (41.6%). The thickness of the carotid lesion was directly proportional to the number of diseased coronary vessels, and it was also related to the severity of coronary involvement measured by the SYNTAX score. CONCLUSIONS: This study has shown a strong correlation between carotid atherosclerosis and CAD, in terms of extension, and most importantly, severity. It is fundamental to consider a systemic approach to atherosclerosis to obtain an adequate stratification of patients with cardiovascular risk factors and an appropriate therapeutic management and reduce the incidence of adverse events, improving the quality of life and prolonging survival.
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Ultrasound-guided transbrachial arterial access: A safe approach for hemodialysis arteriovenous fistula intervention p. 8
Nwe Ni Aung, Jialing Lim, Julia Xue, Pei Ho
CONTEXT: Endovascular interventions for hemodialysis arteriovenous fistula (AVF) can be performed through transfistula, transradial, and transbrachial artery access (TBA), but many interventionists consider TBA a risky approach and thus avoid using it. AIMS: We conducted a retrospective review to report the safety and applications of TBA for AVF interventions. SETTINGS AND DESIGN: Consecutive endovascular procedures for AVFs with TBA applied during a 2-year period were retrospectively reviewed. SUBJECTS AND METHODS: All brachial artery cannulations were performed under ultrasound guidance, either for fistulogram (20G cannula) only or for both angiogram and therapeutic purposes (4–6 Fr sheath). Demographics, comorbidities, antiplatelet and anticoagulant usage, indications of procedure, lesion sites, treatment outcome, and complication were reported. STATISTICAL ANALYSIS USED: Excel version 2010. RESULTS: One hundred AVF procedures that adopted TBA were performed for 73 patients during the study period (4 diagnostic fistulogram and 96 therapeutic interventions). Indications were dysfunctional AVF (n = 82), acute fistula thrombosis (n = 9), failure-to-mature (n = 8), and steal syndrome (n = 1). In 61 and 5 procedures, the patients were on long-term antiplatelet and anticoagulant agents, respectively. In 69 procedures, more than one lesion were identified in the AVF circuit. Stenosis over the anastomosis, juxta-anastomosis, and cannulation zone was found in 40.6%, 74%, and 67.7% of the AVFs, respectively. Thirty-two procedures had transbrachial 20G cannula inserted and 68 procedures had 4–6 Fr introducer sheath inserted. Technical success of the therapeutic interventions was 98.9%. Two patients developed limited hematoma at TBA site after the procedure and resolved with conservative management. No major complication (hemorrhage, nerve injury, pseudoaneurysm, and dissection) was noted from all the TBA procedures. CONCLUSIONS: TBA is a safe approach for AVF endovascular therapy.
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Retrospective study of hepatic encephalopathy by different transjugular intrahepatic portosystemic shunt ways in portal hypertension p. 15
Xin Huo, Xiao Wen Cui, Min Wang, Chong Jing, Yue Wu, Xin Ming Yu, Hui Zhou, Wen-Peng Li, Xue-Chao Cai, Guan-Zhou Zhou, Yong-Jie Zhang
OBJECTIVE: The objective of the study was to evaluate the effectiveness and safety of the use of different shunting ways in patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: We analyzed the data of 36 patients with liver cirrhosis who received de novo TIPS implantation. Sixteen patients had elective TIPS by shunting the blood to the left downstream veins and 20 to the right ones. All patients were followed up for 2 years. We assessed hepatic encephalopathy (HE), rebleeding, and survival rate in all patients post-TIPS. RESULTS: Under our surgical procedure, more post-TIPS HE was observed in the TIPS-left group, whereas rebleeding was detected in the TIPS-right group (P < 0.05). CONCLUSIONS: The decision regarding TIPS placement way for portal hypertension patients needs individualization to allow its safe use, with concomitant improvement in perioperative morbidity.
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Prevention of recurrent deep-vein thrombosis p. 19
Andrew N Nicolaides
The aim of this review is to outline recent randomized controlled trials and strategies that have tested various methods that aim to reduce the risk of recurrent venous thromboembolism (VTE) after the completion of anticoagulant therapy. Aspirin reduced VTE recurrence by approximately 30% (hazard ratio [HR], 0.68; 95% confidence interval [CI] 0.51–0.90) without any increase in bleeding. Dabigatran was effective in reducing VTE (HR, 0.08; 95% CI, 0.02–0.25) but carried a lower risk of major or nonmajor clinically relevant bleeding than warfarin but a higher risk than placebo: 5.3% in the dabigatran group and 1.8% in the placebo group (HR, 2.92; 95% CI, 1.52–5.60). Rivaroxaban was effective in reducing VTE (HR, 0.18; 95% CI, 0.09–0.39) but carried a higher risk of major or nonmajor clinically relevant bleeding than placebo: 6.0% in the rivaroxaban group and 1.2% in the placebo group (HR, 5.19; 95% CI, 2.3–11.7). Apixaban at either treatment dose (5 mg) or a thromboprophylactic dose (2.5 mg) reduced the risk of recurrent VTE from 8.8% in the placebo group to 1.7% in the apixaban group (Relative risk reduction of 81%) (P < 0.001%) without increasing the rate of major bleeding. Sulodexide reduced the risk of recurrence (HR, 0.49; 95% CI 0.27–0.92), without any increase in bleeding risk. Residual thrombus and elevated D-dimer are markers for increased risk of recurrence. Their presence when combined with other risk factors enables one to stratify patients into high, intermediate, or low risk of recurrence of VTE. Other markers enable one to stratify patients into high, intermediate, and low risk for bleeding. On the basis of the balance of risks for recurrence and bleeding, one can advise patients on the need for secondary prevention and the most suitable medication.
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