ORCID Profile
0000-0001-7781-4748
Current Organisations
Curtin University
,
The Harry Perkins Institute of Medical Research
,
University of Western Australia
,
North Metropolitan Health Service
,
University of Birmingham
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Publications
Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in Coronary Artery Bypass Surgery
Publisher: American Medical Association (AMA)
Date: 09-2021
Should heparin be reversed after carotid endarterectomy? A randomised prospective trial
Publisher: Elsevier BV
Date: 04-1997
DOI: 10.1016/S1078-5884(97)80082-2
Abstract: To investigate whether heparin reversal after carotid endarterectomy reduces the incidence of haemorrhagic complications. A randomised prospective trial. Sixty-four patients randomised to reversal of heparin or no reversal, of whom 31 received protamine titrated to the residual circulating heparin at closure of arteriotomy. Measurements included serial activated clotting times (ACTs), wound drainage, neck swelling using duplex Doppler imaging to measure the depth from skin to carotid bifurcation, and the recording of all complications. Wound drainage volumes were significantly reduced by protamine reversal (68.5 ml compared to 35 ml, p < 0.001), but neck swelling was not (72 mm compared to 70 mm, p = 0.77). Two patients who were not reversed developed neck haematomas requiring evacuation. More importantly, two patients receiving protamine, thrombosed the operated internal carotid artery (ICA) postoperatively and died despite urgent thrombectomy. A further patient who was not randomised in this study but who received protamine also developed ICA thrombosis within the same 3 month period. Reversing heparin with protamine reduces postoperative wound drainage after carotid surgery but may predispose to ICA thrombosis and stroke. This is in keeping with a previous retrospective study published during our trial.
External Carotid Surgery
Publisher: SAGE Publications
Date: 07-2000
DOI: 10.1177/153857440003400404
Abstract: External carotid revascularization has been advocated to correct stenoses and obliterate sources of emboli in symptomatic patients with internal carotid artery (ICA) occlusion. Of more than 450 patients undergoing carotid surgery in an 8-year period, eight patients with amaurosis fugax, hemispheric transient ischemic attacks (TIAs), or global symptoms of cerebral ischemia in the presence of ICA occlusion underwent external carotid artery (ECA) reconstruction. There were five external carotid endarterectomies and three bypasses to the ECA, one from the common carotid artery and two from the subclavian artery. There were no operative deaths, but one minor ipsilateral stroke occurred after subclavian-ECA bypass. There was complete resolution of symptoms in all the other patients. Follow-up ranged from 4 months to 10 years (mean 3.4 years). It is concluded that ECA revascularization may be the best treatment option for relieving or improving late neurologic symptoms secondary to cerebral hypoperfusion and/or embolization through ECA collaterals in the presence of ICA occlusion and ECA stenosis.
Prospective Study of Aspirin and Clopidogrel Resistance in Peripheral Arterial Disease: Exploring Antiplatelet Resistance and Early Post-revascularisation Target Vessel Thrombosis
Publisher: Elsevier BV
Date: 12-2019
Commentary: Computational Modeling of Contemporary Stent-Grafts
Publisher: SAGE Publications
Date: 17-07-2015
Vasculogeriatrics: embracing shared care with our colleagues in geriatric medicine should not be a threat
Publisher: Wiley
Date: 09-2022
DOI: 10.1111/ANS.17785
Acute Global Testicular Infarction Post-EVAR from Cholesterol Embolisation can be Mistaken for Torsion
Publisher: Elsevier BV
Date: 2017
Rivaroxaban and Aspirin in Patients With Symptomatic Lower Extremity Peripheral Artery Disease: A Subanalysis of the COMPASS Randomized Clinical Trial.
Publisher: American Medical Association (AMA)
Date: 30-09-2021
Plaque-penetrating peptide inhibits development of hypoxic atherosclerotic plaque
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.JCONREL.2016.07.020
Abstract: Atherosclerosis treatments are generally aimed at altering systemic lipid metabolism such that atherogenesis, the formation of plaque, is curtailed. The plaques themselves offer some potential therapeutic targets. For ex le, selective depletion of macrophages, which play a key role in atherogenesis, inhibits plaque formation. However, it has not been possible to take advantage of these targets because the drugs that have been tested have not been sufficiently selective. We have developed a peptide, LyP-1, which specifically targets atherosclerotic plaques, penetrates into plaque interior, and accumulates in plaque macrophages. In tumors, LyP-1 can cause apoptosis in cells that take up the peptide. Here we show, using three different atherosclerosis models in ApoE null mice that prolonged systemic treatment with LyP-1 triggers apoptosis of plaque macrophages and reduces plaque in advanced hypoxic plaques, and that it does so without increasing necrotic core of plaques or causing detectable side effects. We also show that LyP-1 recognizes human plaque. These findings suggest that LyP-1 could serve as a lead compound for the development of a new class of anti-atherosclerosis drugs.
Large Iliac Arteries: A High-Risk Group for Endovascular Aortic Aneurysm Repair
Publisher: SAGE Publications
Date: 10-2007
DOI: 10.1177/152660280701400504
Abstract: To examine if the presence of large iliac arteries is a potential risk factor for the development of a type Ib endoleak (iliac sealing zone) or need for iliac artery—related secondary intervention in patients undergoing endovascular abdominal aortic aneurysm repair. The medical notes and all preoperative and postoperative plain abdominal radiographs and computer tomographic scans were reviewed for a consecutive series of 100 patients (89 men mean age 75 years, range 56–91) with large iliac arteries (mean 19.7 mm, range 16–22) who had Zenith endovascular stent-grafts inserted for management of aortoiliac aneurysmal disease from January 1999 until September 2002. Endpoints were all-cause mortality, aneurysm-related death, endoleak, secondary intervention, secondary interventions, and stent-graft migration. Mean follow-up was 30.1±8.3 months at the last follow-up, 30% of patients were dead, 3% were aneurysm-related. Seven (7%) patients developed a type Ib endoleak, with the remainder being type II (29%), type Ia (2%), type III (1%), and type V (endotension, 1%). Eight (27.5%) type II endoleaks persisted, with the remainder closing spontaneously with sac shrinkage. The iliac artery—related secondary intervention rate was 10%, and the overall secondary intervention rate was 16%. Iliac arteries between 16 and 22 mm in diameter may be treated with a cuff to the iliac limb with an expectation of 90% efficacy. Surveillance is required, with a high index of suspicion for type 1b endoleaks. Early secondary iliac intervention with extension to the external iliac artery is recommended if there is an increase in sac size after 6 months.
Optimization of computed tomography pulmonary angiography protocols using 3D printed model with simulation of pulmonary embolism
Publisher: AME Publishing Company
Date: 2019
Carotid sinus nerve blockade during carotid surgery: A randomised controlled trial
Publisher: Elsevier BV
Date: 12-2002
Abstract: we investigated whether carotid sinus nerve infiltration with lignocaine reduced blood pressure lability during the first 24h following carotid endarterectomy (CEA). prospective randomised double-blind controlled trial. eighty patients undergoing CEA for significant symptomatic stenosis of the internal carotid artery. after initial dissection, 5 ml of 1% lignocaine or normal saline placebo according to randomisation was infiltrated around the carotid sinus nerve. Blood pressure was measured by intra-arterial cannula during surgery and for four hours afterwards every 15 min, then manually, hourly for 18 h. patients having excision of the carotid sinus nerve were grouped separately for analysis: 29 patients had lignocaine, 33 placebo and 17 excision (one early death with incomplete data was excluded). Mean systolic, diastolic and pulse pressures did not differ significantly between the three groups before carotid sinus nerve infiltration. After infiltration, those patients who had carotid sinus nerve excision, had significantly higher systolic [mean (SD)=155 (16)mmHg] and diastolic [75 (9)mmHg] pressures than those receiving LA [systolic=136 (15)mmHg, diastolic=65 (10)mmHg] or placebo [systolic=136 (19)mmHg, diastolic=65 (9)mmHg], (p<0.005 ANOVA). Nerve excision also resulted in wider variability of blood pressure as defined by the mean of in idual standard deviations (systolic=25 mmHg, diastolic=13 mmHg) compared to LA (systolic=19 mmHg, diastolic=12 mmHg) or placebo (systolic=18 mmHg, diastolic=10 mmHg) (p<0.05 ANOVA). Normotensive patients had significantly lower mean diastolic pressures (p<0.001 ANOVA) and variability (p<0.05) if they received lignocaine although this did not influence pulse pressure. lignocaine injection of the carotid sinus nerve has no benefit in those patients with existing treated hypertension and only marginal effects in normotensives. It is more important to preserve the carotid sinus nerve if possible.
Fresh frozen cadaver workshops for advanced vascular surgical training
Publisher: Wiley
Date: 16-08-2013
DOI: 10.1111/ANS.12361
Abstract: Reduction in working hours, streamlined training schemes and increasing use of endovascular techniques has meant a reduction in operative experience for newer vascular surgical trainees, especially those exposures which are not routinely performed such as thoracoabdominal, thoracotomy and retroperitoneal aortic, for ex le. This paper describes an Advanced Anatomy of Exposure course which was designed and convened at the Clinical Training & Evaluation Centre in Western Australia and uses fresh frozen cadavers. Feedback was obtained from the participants who attended over three courses by questionnaire. Feedback was strongly positive for the course meeting both its learning outcomes and personal learning objectives, and in addition, making a significant contribution to specialty skills. Most participants thought the fresh frozen cadaveric model significantly improved the learning objectives for training. The fresh frozen cadaver is an excellent teaching model highly representative of the living open surgical scenario where advanced trainees and newly qualified consultants can improve their operative confidence and consequently patient safety in vascular surgery. An efficient fresh frozen cadaver teaching programme can benefit many health professionals simultaneously maximizing the use of donated human tissue.
Optical coherence tomography: a novel imaging approach to visualize and quantify cutaneous microvascular structure and function in patients with diabetes
Publisher: BMJ
Date: 08-2020
DOI: 10.1136/BMJDRC-2020-001479
Abstract: The pathophysiology of microvascular disease is poorly understood, partly due to the lack of tools to directly image microvessels in vivo. In this study, we deployed a novel optical coherence tomography (OCT) technique during local skin heating to assess microvascular structure and function in diabetics with (DFU group, n=13) and without (DNU group, n=10) foot ulceration, and healthy controls (CON group, n=13). OCT images were obtained from the dorsal foot, at baseline (33°C) and 30 min following skin heating. At baseline, microvascular density was higher in DFU compared with CON (21.9%±11.5% vs 14.3%±5.6%, p=0.048). Local heating induced significant increases in diameter, speed, flow rate and density in all groups (all p .001), with smaller changes in diameter for the DFU group (94.3±13.4 µm), compared with CON group (115.5±11.7 µm, p .001) and DNU group (106.7±12.1 µm, p=0.014). Heating-induced flow rate was lower in the DFU group (584.3±217.0 pL/s) compared with the CON group (908.8±228.2 pL/s, p .001) and DNU group (768.8±198.4 pL/s, p=0.014), with changes in density also lower in the DFU group than CON group (44.7%±15.0% vs 56.5%±9.1%, p=0.005). This proof of principle study indicates that it is feasible to directly visualize and quantify microvascular function in people with diabetes and distinguish microvascular disease severity between patients.
Slow to heel: a literature review on the management of diabetic calcaneal ulceration
Publisher: Wiley
Date: 12-02-2018
DOI: 10.1111/IWJ.12839
Stroke Outcomes in the COMPASS Trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-02-2019
DOI: 10.1161/CIRCULATIONAHA.118.035864
Abstract: Strokes were significantly reduced by the combination of rivaroxaban plus aspirin in comparison with aspirin in the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies). We present detailed analyses of stroke by type, predictors, and antithrombotic effects in key subgroups. Participants had stable coronary artery or peripheral artery disease and were randomly assigned to receive aspirin 100 mg once daily (n=9126), rivaroxaban 5 mg twice daily (n=9117), or rivaroxaban 2.5 mg twice daily plus aspirin (n=9152). Patients who required anticoagulation or had a stroke within 1 month, previous lacunar stroke, or intracerebral hemorrhage were excluded. During a mean follow-up of 23 months, fewer patients had strokes in the rivaroxaban plus aspirin group than in the aspirin group (83 [0.9% per year] versus 142 [1.6% per year] hazard ratio [HR], 0.58 95% CI, 0.44–0.76 P .0001). Ischemic/uncertain strokes were reduced by nearly half (68 [0.7% per year] versus 132 [1.4% per year] HR, 0.51 95% CI, 0.38–0.68 P .0001) by the combination in comparison with aspirin. No significant difference was noted in the occurrence of stroke in the rivaroxaban alone group in comparison with aspirin: annualized rate of 0.7% (HR, 0.82 95% CI, 0.65–1.05). The occurrence of fatal and disabling stroke (modified Rankin Scale, 3–6) was decreased by the combination (32 [0.3% per year] versus 55 [0.6% per year] HR, 0.58 95% CI, 0.37–0.89 P =0.01). Independent predictors of stroke were prior stroke, hypertension, systolic blood pressure at baseline, age, diabetes mellitus, and Asian ethnicity. Prior stroke was the strongest predictor of incident stroke (HR, 3.63 95% CI, 2.65–4.97 P .0001) and was associated with a 3.4% per year rate of stroke recurrence on aspirin. The effect of the combination in comparison with aspirin was consistent across subgroups with high stroke risk, including those with prior stroke. Low-dose rivaroxaban plus aspirin is an important new antithrombotic option for primary and secondary stroke prevention in patients with clinical atherosclerosis. URL: www.clinicaltrials.gov . Unique identifier: NCT01776424.
Hemodynamic Comparison of Stent-Grafts for the Treatment of Aortoiliac Occlusive Disease
Publisher: SAGE Publications
Date: 02-06-2021
DOI: 10.1177/15266028211016431
Abstract: To compare the flow patterns and hemodynamics of the AFX stent-graft and the covered endovascular reconstruction of aortic bifurcation (CERAB) configuration using laser particle image velocimetry (PIV) experiments. Two anatomically realistic aortoiliac phantoms were constructed using polydimethylsiloxane polymer. An AFX stent-graft with a transparent cover made with a new method was inserted into one phantom. A CERAB configuration using Atrium’s Avanta V12 with transparent covers made with a previously established method was inserted into the other phantom, both modified stent-grafts were suitable for laser PIV, enabling visualization of the flow fields and quantification of time average wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT). Disturbed flow was observed at the bifurcation region of the AFX, especially at the end systolic velocity (ESV) time-point where recirculation was noticeable due to vortical flow. In contrast, predominantly unidirectional flow was observed at the CERAB bifurcation. These observations were confirmed by the quantified hemodynamic results from PIV analysis where mean TAWSS of 0.078 Pa (range: 0.009–0.242 Pa) was significantly lower in AFX as compared with 0.229 Pa (range: 0.013–0.906 Pa) for CERAB (p .001). Mean OSI of 0.318 (range: 0.123–0.496) in AFX was significantly higher than 0.252 (range: 0.055–0.472) in CERAB (p .001). Likewise, mean RRT of 180 Pa −1 (range: 9–3603 Pa −1 ) in AFX was also significantly higher than 88 Pa −1 (range: 2–840 Pa −1 ) in CERAB (p=0.0086). In this in vitro study, the flow pattern of a modified AFX stent-graft was found to be more disturbed especially at the end systolic phase, its hemodynamic outcomes less desirable than CERAB configuration. While the AFX stent-graft has an advantage over the CERAB configuration in eliminating radial mismatch, and maintaining the anatomical bifurcation for future endovascular intervention, this in vitro study revealed that the associated lower TAWSS, higher OSI and RRT may predispose to thrombosis and are, thus, less desirable as compared to a CERAB configuration. Further investigation is warranted to confirm whether these findings translate into the clinical setting.
The prescription of best medical therapy following infrainguinal bypass grafting in Australia and New Zealand: a multicentre Australasian audit.
Publisher: Wiley
Date: 2021
DOI: 10.1111/ANS.16469
Stress distribution in the walls of major arteries: implications for atherogenesis
Publisher: AME Publishing Company
Date: 08-2021
DOI: 10.21037/QIMS-20-614
Retrograde Fenestration of Endoluminal Grafts From Target Vessels: Feasibility, Technique, and Potential Usage
Publisher: International Society of Endovascular Specialists
Date: 10-2003
Fibromuscular dysplasia presenting with a deep vein thrombosis
Publisher: BMJ
Date: 02-2020
Abstract: A 41-year-old male patient presented with isolated right lower limb swelling. An ultrasound scan showed right external iliac and femoral vein deep vein thrombosis due to extrinsic compression by an aneurysm of the right common iliac artery. Investigations including imaging and a tissue biopsy of right and left femoral arteries confirmed a rare clinical presentation of fibromuscular dysplasia involving iliac, coeliac, renal and pulmonary vessels. The common iliac artery aneurysm was successfully treated with endovascular repair. Six months later, he developed coronary artery involvement with spontaneous dissection of left anterior descending artery diagnosed on coronary angiogram which was managed conservatively. At 6-year follow-up, he remains clinically asymptomatic and continues with regular surveillance imaging. Iliac arterial fibromuscular dysplasia is uncommon and clinical presentation with a complication such as a deep vein thrombosis is atypical.
Surgery for asymptomatic carotid disease
Publisher: Springer Science and Business Media LLC
Date: 10-2004
DOI: 10.1007/BF02914546
Connecting the Dots: How Injury in the Arterial Wall Contributes to Atherosclerotic Disease
Publisher: Elsevier BV
Date: 10-2023
Anti-thrombotic options for secondary prevention in patients with chronic atherosclerotic vascular disease: what does COMPASS add?
Publisher: Oxford University Press (OUP)
Date: 25-06-2018
Rivaroxaban Plus Aspirin in Patients With Vascular Disease and Renal Dysfunction
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JACC.2019.02.048
Abstract: Chronic kidney disease is associated with an increased risk of both bleeding and ischemic cardiovascular events. The purpose of this study was to determine the balance of risks and benefits from the dual pathway antithrombotic regimen (rivaroxaban 2.5 mg twice daily [bd] plus aspirin, compared with aspirin) in vascular patients with or without moderate renal dysfunction. This was a secondary analysis of the COMPASS (Cardiovascular OutcoMes for People using Anticoagulation StrategieS) trial involving 27,395 patients with chronic coronary or peripheral artery disease. In COMPASS, 21,111 patients had an estimated glomerular filtration rate (GFR) at baseline of ≥60 ml/min, 6,276 had a GRF of <60 ml/min. Both the primary efficacy outcome (cardiovascular death, myocardial infarction, or stroke) and major bleeding were more frequent in those with renal dysfunction, and the frequency of these outcome events was inversely related to GFR. However, the primary outcome was consistently reduced with rivaroxaban 2.5 mg bd plus aspirin, irrespective of GFR category (GFR ≥60 ml/min, 3.5% rivaroxaban plus aspirin, 4.5% aspirin alone, hazard ratio [HR]: 0.76, 95% confidence interval [CI]: 0.64 to 0.90 GFR <60 ml/min, 6.4% rivaroxaban plus aspirin, 8.4% aspirin alone, HR: 0.75 95% CI: 0.60 to 0.94). Major bleeding was more frequent with rivaroxaban 2.5 mg plus aspirin versus aspirin alone in those with GFR ≥60 ml/min (2.9% rivaroxaban plus aspirin, 1.6% aspirin alone, HR: 1.81 95% CI: 1.44 to 2.28) and similarly in those with GFR <60 ml/min (3.9% rivaroxaban plus aspirin, 2.7% aspirin alone, HR: 1.47, 95% CI: 1.05 to 2.07). The benefits of the dual pathway COMPASS regimen (rivaroxaban 2.5 mg bd plus aspirin), versus aspirin alone, are preserved in patients with moderate renal dysfunction without evidence of an excess hazard of bleeding.
The COMPASS Trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-07-2020
DOI: 10.1161/CIRCULATIONAHA.120.046048
Abstract: Rivaroxaban 2.5 mg twice daily plus acetylsalicylic acid (aspirin ASA) 100 mg reduced the risk of cardiovascular events as compared with ASA monotherapy in the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) but increased the risk of major bleedings. Analysis of net clinical benefit (NCB) is of key clinical relevance and represents an integrated measure of overall patient outcome. The current prespecified analysis was performed to assess the NCB of adding rivaroxaban 2.5 mg twice daily to ASA monotherapy in patients with chronic vascular disease in the COMPASS study cohort (intention-to-treat study population), with a specific focus on high-risk subgroups. The predefined NCB outcome was the composite of cardiovascular death, stroke, myocardial infarction, fatal bleeding, or symptomatic bleeding into a critical organ. A lower number of NCB adverse outcomes was observed with rivaroxaban 2.5 mg twice daily plus ASA versus ASA alone (hazard ratio, 0.80 [95% CI, 0.70–0.91], P =0.0005), which became increasingly favorable with longer treatment duration. The main drivers of NCB outcomes were “efficacy” events, in particular stroke (0.5%/y versus 0.8%/y hazard ratio, 0.58 [95% CI, 0.44–0.76], P .0001) and cardiovascular death (0.9%/y versus 1.2%/y hazard ratio, 0.78 [95% CI, 0.64–0.96], P =0.02), whereas the bleeding components of the NCB, in particular fatal bleeding (0.09%/y versus 0.06%/y hazard ratio, 1.49 [95% CI 0.67–3.33], P =0.32), only represented a minority of NCB events. In selected high-risk subgroups, including patients with polyvascular disease (≥2 vascular beds affected with atherosclerosis), impaired renal function, heart failure, and/or diabetes mellitus, a larger absolute risk reduction for experiencing a NCB event was observed. Compared with ASA monotherapy, the combination of rivaroxaban 2.5 mg twice daily plus ASA resulted in fewer NCB events primarily by preventing adverse efficacy events, particularly stroke and cardiovascular mortality, whereas severe bleedings were less frequent and with less clinical impact. The NCB was particularly favorable in high-risk subgroups and those with multiple risk characteristics. URL: www.clinicaltrials.gov Unique identifier: NCT01776424.
Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET)
Publisher: Elsevier BV
Date: 09-2021
Major gaps in human evidence for structure and function of the vasa vasora limit our understanding of the link with atherosclerosis
Publisher: Wiley
Date: 20-10-2020
DOI: 10.1111/JOA.13324
Oral factor Xa inhibitors and risk of subdural hematoma
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-07-2020
DOI: 10.1212/WNL.0000000000009826
Abstract: Subdural hematomas (SDHs) are an uncommon, but important, complication of anticoagulation therapy. We hypothesized that the risks of SDH would be similar during treatment with oral factor Xa inhibitors compared with aspirin. We assessed the frequency and the effects of antithrombotic treatments on SDHs in the recent international Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized trial comparing aspirin 100 mg daily, rivaroxaban 5 mg twice daily, and rivaroxaban 2.5 mg twice daily plus aspirin. A systematic review/meta-analysis of randomized trials comparing oral factor Xa inhibitors vs aspirin on SDH risk was undertaken. Among 27,395 COMPASS participants, 28 patients with SDHs were identified (mean age 72 years). SDH-associated mortality was 7%. Incidence was 0.06 per 100 patient-years (11 SDH/17,492 years observation) during the mean 23-month follow-up among aspirin-assigned patients and did not differ significantly between treatments. Three additional randomized controlled trials including 16,177 participants reported a total of 14 SDHs with an incidence ranging from 0.06 to 0.1 per 100 patient-years. Factor Xa inhibitor use was not associated with an increased risk of SDH compared to aspirin (odds ratio, 0.97 95% confidence interval, 0.52–1.81 I 2 = 0%). The frequency of SDH was similar in all 3 treatment arms of the COMPASS trial. The COMPASS trial results markedly increase the available evidence from randomized comparisons of oral factor Xa inhibitors with aspirin regarding SDH. From available, albeit limited, evidence from 4 randomized trials, therapeutic dosages of factor Xa inhibitors do not appear to increase the risk of SDH compared with aspirin. NCT01776424.
Directional Atherectomy of the Common Femoral Artery
Publisher: Elsevier BV
Date: 07-2020
Review of aspirin and clopidogrel resistance in peripheral arterial disease
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.JVS.2017.07.065
Abstract: Aspirin resistance (AR) and clopidogrel resistance (CR) are terms used to describe a reduction in the medication's efficacy in inhibiting platelet aggregation despite regular dosing. This review gives context to the clinical role and implications of antiplatelet resistance in peripheral arterial disease (PAD). A review of English-language literature on AR and CR in PAD involving human subjects using PubMed and MEDLINE databases was performed in April 2017. A total of 2075 patients in 22 relevant studies were identified. To give this issue context, a review of the larger, more established literature on antiplatelet resistance in coronary disease was undertaken, identifying significant research associating resistance to major adverse cardiovascular events (MACEs). Studies in the coronary arterial disease literature have strongly associated antiplatelet resistance with increased MACE. Prevalence of AR or CR in coronary disease appears to be >55% for each in some studies. Meta-analyses of >50 studies revealed that AR and CR are significantly associated with MACE (relative risk of 2.09 and 2.8, respectively). This adds further weight to the literature reporting antiplatelet resistance as an independent predictor of and a threefold risk factor for major adverse cardiovascular events. The prevalence of resistance in PAD in this review was comparable to that in the coronary disease literature, with AR and CR prevalence up to 60% and 65%, respectively. There is evidence that the adverse effects of antiplatelet resistance are significant in PAD. In fact, research directly studying stent thrombosis populations with either coronary arterial disease or PAD revealed more significantly impaired platelet responsiveness to clopidogrel and aspirin in PAD compared with similar in iduals with coronary disease. AR in PAD was found in studies to be a significant risk factor for iliofemoral stent reocclusion (P = .0093) and stroke in patients with symptomatic carotid disease (P = .018). CR was found to be a significant, independent risk factor in predicting ischemic outcomes in several recent PAD studies (P < .0001). Loss-of-function carriers of enzyme CYP2C19, important in clopidogrel metabolism, have a 30% greater risk of ischemic events (P < .001). Importantly, less antiplatelet drug resistance may be encountered with newer antiplatelet agents, including ticagrelor and prasugrel, because of reduced enzymatic polymorphisms. The limited research addressing AR and CR in PAD suggests that further research is required to clarify the role of platelet assays and potential for in idualized antiplatelet therapy.
Optimization of computed tomography pulmonary angiography protocols using 3D printed model with simulation of pulmonary embolism
Publisher: AME Publishing Company
Date: 2019
The Use of Extracorporeal Circulation to Facilitate the Resection of a Large Retroperitoneal Sarcoma With Major Vessel Involvement: A Single-Center Review of 20 Cases
Publisher: Elsevier BV
Date: 07-2023
A Laparoscopic Endovascular Aortobifemoral Conduit That Can Be Retained as a Long-term Bypass: A Solution for Patients With Inadequate Iliac Access
Publisher: International Society of Endovascular Specialists
Date: 02-2009
DOI: 10.1583/08-2417.1
Abstract: To present a laparoscopic technique for placing a partially stented aortobifemoral (ABF) conduit that can be used for more proximal endovascular manipulations and then be retained as a permanent bypass of occlusive iliac disease. Ethical approval was obtained to use a fresh frozen cadaver. The left common iliac artery, distal aorta, and proximal right common iliac artery were dissected laparoscopically. A curved hollow needle was inserted into the distal aorta, and wire access was obtained. A partially stented bifurcated Dacron bypass graft was deployed under fluoroscopic guidance into the distal aorta. The limbs of the bypass were then used as conduits for endovascular access before being tunneled behind the ureters and anastomosed to the femoral arteries in the usual way, retaining the stented graft as an ABF bypass. This novel technique combines laparoscopic access with endovascular manipulation to place an ABF conduit, which can be retained as a permanent bypass without the need for an abdominal incision. This technique could provide a minimally invasive solution for pelvic occlusive disease that hinders endovascular repairs, as well as a minimally invasive means of securing endoluminal access in patients with iliac arteries of inadequate caliber.
Optimization of Computed Tomography Angiography Protocols for Follow-Up Type B Aortic Dissection Patients by Using 3D Printed Model
Publisher: MDPI AG
Date: 25-07-2021
DOI: 10.3390/APP11156844
Abstract: Thoracic endovascular aortic repair (TEVAR) is a life-saving therapy for type B aortic dissection (TBAD). However, surveillance computed tomography (CT) scans in post-TEVAR patients are associated with high radiation dose, thus resulting in potential risk of radiation-induced malignancy. In this study, we developed a patient-specific three-dimensional (3D) printed phantom with stent grafts in situ, then scanned the phantom with different CT protocols to determine the optimal scanning parameters for post-treatment patients. The CT scans were conducted with different kVp and pitch values (80, 100, 120 kVp and pitch of 1.2, 1.5, 2.0, 2.5), resulting in a total of 12 datasets. Signal-to-noise ratio (SNR) was measured to determine and compare the image quality between different datasets. Results showed no significant differences in SNR between different kVp when the pitch value was 1.2. At low pitch values, a decrease in kVp from 120 to 80 led to a significant effective dose reduction by more than 20%. SNR decreased by 30% when pitch was increased from 1.2 to 2.5 at 80 kVp, and 20% at 120 kVp. In contrast, there was only a 3.9% decrease in SNR when kVp was reduced from 120 to 80 at pitch 1.2, and 15.9% at pitch 2.5. High pitch with 100 kVp can effectively reduce the dose while maintaining image quality.
Mortality Benefit of Rivaroxaban Plus Aspirin in Patients With Chronic Coronary or Peripheral Artery Disease
Publisher: Elsevier BV
Date: 07-2021
Gentamicin-Containing Collagen Implant May Reduce Surgical Site Infections After Open Infrainguinal Arterial Revascularization
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.AVSG.2021.06.036
Abstract: Deep-space surgical site infections carry significant morbidity and mortality. The evidence for gentamicin-containing collagen implants at reducing surgical site infections in open infrainguinal arterial surgery is limited. This study examined whether gentamicin-containing collagen implants reduces 30-day surgical site infections and their severity following open infrainguinal arterial surgery. A retrospective observational cohort study that included all patients undergoing infrainguinal arterial bypass or endarterectomy between November 2015 and March 2019 at a single tertiary vascular unit. Patients with contaminated/infected surgical fields, surgical wounds treated with negative pressure therapy, or the usage of antimicrobial implants and dressings other than Collat G In 159 procedures (mean age 67.7 years, 74.8% male, 33.3% diabetic, 16.4% chronic renal failure, 25.2% anticoagulated postoperatively, 32.7% with prosthetic implants), 55 (34.6%) procedures received gentamicin-containing collagen implants. There were significantly more males (85.5% vs. 69.2% P = 0.025), higher rates of obesity (41.8% vs. 26.0% P = 0.041), and hyperlipidemia (65.5% vs. 49.0% P = 0.048) in the gentamicin-containing collagen implant group. In total, 6 (3.8%) procedures developed deep-space surgical site infections (1 with gentamicin-containing collagen implant, 5 without) and 13 (8.2%) had severe surgical site infections that required re-intervention (1 with gentamicin-containing collagen implant, 12 without). On logistic regression analysis, the absence of gentamicin-containing collagen implants statistically significantly increased the odds of overall surgical site infections (OR = 2.50 95% CI 1.01 - 6.19 P = 0.047). There was no statistically significant difference in the odds of deep-space surgical site infections or the severity and need for reintervention of surgical site infections. This is the first study that examined the effect of gentamicin-containing collagen implants on the severity of surgical site infections in vascular surgery. Gentamicin-containing collagen implants may reduce the odds of overall surgical site infections. It did not reduce the odds of deep-space surgical site infections or the severity and reintervention rate of surgical site infections following infrainguinal arterial revascularization. Larger studies are required to achieve adequate power to assess for these outcomes.
Beyond the Standard Model physics at the HL-LHC and HE-LHC
Publisher: CERN
Date: 2019
Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial
Publisher: Elsevier BV
Date: 2018
Current modifications to totally laparoscopic “apron technique”
Publisher: Elsevier BV
Date: 08-2003
DOI: 10.1016/S0741-5214(03)00230-1
Abstract: Since our original description in 1997 of a totally laparoscopic technique for treatment of aortoiliac disease, this type of minimally invasive procedure has been used both in the United States and abroad. We describe improvements that should make this technique more easily reproducible. This modified procedure was offered to six patients, one of whom received a tube graft for treatment of aneurysm disease.
North of England evidence based guideline development project: guideline on the use of aspirin as secondary prophylaxis for vascular disease in primary care
Publisher: BMJ
Date: 25-04-1998
Risk stratification of cardiovascular complications using CHA2DS2-VASc and CHADS2 scores in chronic atherosclerotic cardiovascular disease
Publisher: Elsevier BV
Date: 08-2021
Protocol for a prospective observational study: the Australia and New Zealand Diabetic and Ischaemic Foot Outcomes Study (ANZ-DIFOS)
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/BMJOPEN-2021-050833
Abstract: Diabetic foot disease is a common condition globally and is over-represented in indigenous populations. The propensity for patients with diabetic foot disease to undergo minor or major limb utation is a concern. Diabetic foot disease and lower limb utation are debilitating for patients and have a substantial financial impact on health services. The purpose of this multicentre study is to prospectively report the presentation, management and outcomes of diabetic foot disease, to validate existing scoring systems and assess long term outcomes for these patients particularly in relation to major limb utation. This is a multisite, international, prospective observational study, being undertaken at Waikato Hospital, New Zealand (NZ) Sir Charles Gairdner Hospital, the Royal Adelaide Hospital and the Queen Elizabeth Hospital, Australia. Consecutive participants with diabetic foot disease that meet inclusion criteria and agree to participate will be recruited from multidisciplinary team diabetic foot clinic, vascular clinic, dialysis and admission to hospital. Follow-up of participants will occur at 1, 3, 6 and 12 months. At recruitment and follow-up reviews, information about service details, demographic and clinical history, wound data and discharge information will be recorded. The primary outcomes are the time to wound healing, major utation, overall mortality and utation-free survival at 12 months. This study started in NZ in August 2020 and will commence in Australian sites in early 2021. New Zealand Central Health and Disability Ethics Committee (20/CEN/122), Waikato DHB Research Department (RDO020044), Quality Improvement HoD Sir Charles Gairdner Hospital (39715) and the Central Adelaide Local Health Network (CALHN) Human Research Ethics Committee (13928). Results will be presented at international conferences and published in peer-reviewed journals. Australian New Zealand Clinical Trials Registry (ACTRN12621000337875).
Abstracts from the Wounds Australia Conference 4 - 6 May 2021
Publisher: Cambridge Media
Date: 06-2021
Prediction of thrombus formation using vortical structures presentation in Stanford type B aortic dissection: A preliminary study using CFD approach
Publisher: Elsevier BV
Date: 02-2016
Near infrared spectroscopy in peripheral artery disease and the diabetic foot: A systematic review
Publisher: Wiley
Date: 17-08-2022
DOI: 10.1002/DMRR.3571
Abstract: With the need for tools that assess microvascular status in diabetic foot disease (DFD) being clear, near infrared spectroscopy (NIRS) is a putative method for noninvasive testing of the diabetic foot. The use of NIRS in patients with peripheral arterial disease (PAD) has extended to its role in studying the pathophysiology of DFD. NIRS generates metrics such as recovery time, deoxygenation, oxygen consumption (VO 2 ), tissue oxygen saturation (StO 2 ), total haemoglobin (HbT), and oxyhaemoglobin area under the curve (O 2 Hb AUC ). NIRS may potentially help the multidisciplinary team stratify limbs as high‐risk, especially in diabetic patients with symptoms masked by peripheral neuropathy. NIRS may be useful for assessing treatment effectiveness and preventing deterioration of patients with PAD.
Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta‐analysis
Publisher: Wiley
Date: 28-06-2021
DOI: 10.1111/NEP.13914
Abstract: There is a lack of clarity and guidance for screening peripheral artery disease (PAD) in persons with chronic kidney disease (CKD) and end stage kidney disease (ESKD) despite this group being at excess risk of cardiovascular disease (CVD). In this current study, we performed a systematic review and meta‐analysis to examine the prevalence and risk factors for PAD in persons with CKD in Australian cohorts. We used the inverse variance heterogeneity meta‐analysis with double arcsine transformation to summarize the prevalence of PAD (with 95% CIs). Nine studies and 18 reports from the Australia and New Zealand dialysis and transplant registry with 36 cohorts were included in the review. We found a substantially higher PAD prevalence in cohorts based on an ankle‐brachial index (ABI) or toe systolic pressure (TBI) than cohorts based on self‐reported history. Higher PAD prevalence was observed in ESKD persons than CKD persons without dialysis (PAD diagnosis based on ABI or TBI: 31% in ESKD persons and 23% in CKD persons, PAD diagnosis based on self‐reported history: 17% in ESKD persons and 10% in CKD persons). Older age, Caucasian race, cerebrovascular disease and haemodialysis were associated with the presence of PAD in ESKD persons. Our findings indicated a considerable proportion of PAD in CKD and ESKD persons particularly in those with ESKD. To develop and provide an adequate plan to clinically manage CKD patients with PAD, evidence of cost‐effectiveness and clinical benefit of early detection of PAD in persons with CKD in Australia is recommended for future studies.
How to Prevent Surgical Site Infection in Vascular Surgery
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.AVSG.2021.06.045
Abstract: This review aims to identify and review the current evidence for preventing postoperative surgical site infections in abdominal aortic aneurysm surgery or infrainguinal arterial surgery. Extended literature review of clinical trials that examined the prevention of postoperative surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. Searches were conducted on Ovid MEDLINE (1950 - 13 March 2020) using key terms for vascular surgery, surgical site infections and specific preventative techniques. Articles were included if they discussed a relationship between a preventative technique and surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. The GRADE guidelines were used to assess the quality of evidence. 21 techniques and 81 studies were included. Prophylactic antibiotics and negative pressure wound therapy have a high quality of evidence for the prevention of surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. A moderate quality evidence base was identified for gentamicin containing collagen implant (confined to high surgical site infection risk centers). Currently, there is a low or very low quality of evidence to suggest a reduction in the surgical site infection rate for combination therapy, glycaemic control, Methicillin-resistant Staphylococcus aureus screening and absorbable suture. Evidence suggests no beneficial effect for nutritional supplementation, chlorhexidine bath, hair removal therapy, Staphylococcus aureus nasal eradication, cyanoacrylate microsealant, silver grafts, rif icin bonded grafts, triclosan coated suture and postoperative wound drains. Endoscopic saphenous vein harvest may reduce surgical site infection rate (very low quality of evidence) but may lower long-term patency. Autologous vein grafts may increase surgical site infections (very low quality of evidence) but may provide better long-term patency rates in above-knee infrainguinal bypass surgery. There was no identified evidence for perioperative normothermia, electrosurgical bipolar vessel sealer or Dermabond and Tegaderm for surgical site infection prevention in vascular surgery. Prophylactic antibiotics and postoperative negative pressure wound therapy are effective in the prevention of postoperative surgical site infection in abdominal aortic aneurysm or infrainguinal arterial surgery. There exists a significant risk of bias in the literature for many preventative techniques and further studies are required to investigate the efficacy of gentamicin containing collagen implant, and specific combination therapies.
Compression bandaging: Identification of factors contributing to non-concordance
Publisher: Cambridge Media
Date: 31-03-2019
Abstract: Aims To elucidate reasons for non-concordance with compression bandaging, subject the identified reasons to thematic analysis and use the resultant themes as the basis for the development of a screening tool to identify those patients at risk of non-concordance with compression bandaging. Method A literature search was undertaken using the terms ‘concordance’, ‘compression bandaging’ and ‘venous leg ulcer’. Articles were included if they discussed reasons for non-concordance with compression bandaging. Forty-one articles were identified which met inclusion criteria. The full texts were read and the reasons for non-concordance tabulated. These were then subjected to thematic analysis. Results Six themes emerged. These were termed knowledge deficit resource deficit psychosocial issues pain/discomfort physical limitations and wound management. These themes were used to develop a screening tool to identify patients who exhibit barriers to concordance with compression bandaging. Discussion Compression bandaging is the recommended treatment for venous leg ulceration1-3. However, the degree of concordance with compression bandaging therapy remains at sub-optimal levels4,5. Consequently patients experience protracted ulceration. The development of a risk screening tool for non-concordance will permit targeted intervention to address barriers to concordance before the patient has a poor experience of compression therapy.
Current Technology Venous–Venous Bypass Improves the Safety of Resection of Sarcoma and Benign Retroperitoneal Tumours Involving the Inferior Vena Cava
Publisher: Elsevier BV
Date: 11-2022
Objective comparison of stapled anopexy and open hemorrhoidectomy: A randomized, controlled trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2002
DOI: 10.1007/S10350-004-6446-Z
Abstract: This trial compares stapled anopexy with open hemorrhoidectomy in patients with prolapsing (Grade 3) hemorrhoids. Particular attention was paid to changes in anorectal physiology, nature of tissue resected, quality-of-life assessments, and cost implications of the treatments studied. An initial pilot study was followed by a randomized, controlled trial in a District General Hospital in the United Kingdom. All patients had Grade 3 hemorrhoids. Nineteen patients were studied in the pilot study, with 99 patients in the randomized, controlled trial. All patients in the pilot study and 59 in the randomized, controlled trial underwent stapled anopexy. Thirty patients in the randomized, controlled trial underwent open hemorrhoidectomy. Of the 59 patients in the stapled group, 32 were treated with the Ethicon PPH stapling device, and 27 received stapling with a reusable Autosuture stapling device. The following variables were measured: demographic details, quality of life (Medical Outcomes Study Short Form 36 and directed questions), anorectal manometry, and histology. There was no difference in the case mix within or between the groups. The stapled anopexy groups showed a significant reduction in operative time (P < 0.001) and blood loss (P < 0.001) compared with open hemorrhoidectomy. Open hemorrhoidectomy resulted in significantly greater usage of protective pads postoperatively (P < 0.001) and longer rehabilitation (P < 0.006). Stapled anopexy is an effective alternative treatment for prolapsing hemorrhoids that allows reduced operative time and shorter rehabilitation. It does not appear to affect continence or overall quality of life.
Follow-Up After Endovascular Aortic Aneurysm Repair: The Plain Radiograph Has an Essential Role in Surveillance
Publisher: International Society of Endovascular Specialists
Date: 10-2003
Low-dose rivaroxaban plus aspirin in patients with polypharmacy and multimorbidity: an analysis from the COMPASS trial
Publisher: Oxford University Press (OUP)
Date: 30-06-2021
Abstract: To analyse whether the benefits and risks of rivaroxaban plus aspirin vary in patients with comorbidities and receiving multiple drugs. In patients with coronary or peripheral artery disease, adding low-dose rivaroxaban to aspirin reduces cardiovascular events and mortality. Polypharmacy and multimorbidity are frequent in such patients. We describe ischaemic events (cardiovascular death, stroke, or myocardial infarction) and major bleeding in participants from the randomized, double-blind COMPASS study by number of cardiovascular medications and concomitant medical conditions. We compared event rates and hazard ratios (HRs) for rivaroxaban plus aspirin vs. aspirin alone by the number of medications and concomitant conditions, and tested for interaction between polypharmacy or multimorbidity and the antithrombotic regimen. The risk of ischaemic events was higher in patients with more concomitant drugs (HR 1.7, 95% confidence interval 1.5–2.1 for & vs. 0–2) and with more comorbidities (HR 2.3, 1.8–2.1 for & vs. 0–1). Multimorbidity, but not polypharmacy, was associated with a higher risk of major bleeding. The relative efficacy, safety, and net clinical benefit of rivaroxaban were not affected by the number of drugs or comorbidities. Patients taking more concomitant medications derived the largest absolute reduction in the net clinical outcome with added rivaroxaban (1.1% vs. 0.4% reduction with & vs. 0–2 cardiovascular drugs, number needed to treat 91 vs. 250). Adding low-dose rivaroxaban to aspirin resulted in benefits irrespective of the number of concomitant drugs or comorbidities. Multiple comorbidities and/or polypharmacy should not dissuade the addition of rivaroxaban to aspirin in otherwise eligible patients.
Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial
Publisher: Elsevier BV
Date: 2018
The contribution of the external carotid artery to cerebral perfusion in carotid disease
Publisher: Elsevier BV
Date: 05-2000
Abstract: In the presence of carotid occlusion, the external carotid artery (ECA) becomes an important source of cerebral blood flow, especially if the circle of Willis is incomplete. The contribution of the ECA to hemispheric blood flow in patients with severe ipsilateral carotid stenosis has never been previously investigated. One hundred eight patients were monitored during sequential cross-cl ing of the external (ECA) and then ipsilateral internal carotid artery (ICA) during carotid endarterectomy using transcranial Doppler sonography (TCD) (Neuroguard CDS, Los Angeles, Calif), to measure middle cerebral artery blood flow velocity, and near-infrared spectroscopy, to measure regional cerebral oxygen saturation (CsO(2)) (Invos 3100A Somanetics, Troy, Mich). On the ipsilateral ECA cross-cl , the median fall in CsO(2) was 3% (interquartile range, 1%-4% P <.0001). On addition of the ICA cross-cl there was a further fall of 3% and a total fall of 6% (3%-9% P <.0001). The median percentage fall in middle cerebral artery blood flow velocity on ECA cl ing was 12% (4%-24% P <.0001) on ICA cl ing it was 48% (25%-74% P <.0001). Falls in TCD on ECA cl ing were greater with increasing severity of ipsilateral ICA stenosis. The correlation between CsO(2) and TCD on external cl ing, although less strong than that on internal cl ing, was statistically significant r = 0.32 P =.01 Spearman rank correlation). The falls in TCD and CsO(2) were of a similar order of magnitude and must therefore reflect a fall in cerebral perfusion. The ipsilateral ECA contributes significantly to intracranial blood flow and oxygen saturation in severe carotid stenosis.
Stellarex drug-coated balloon for treatment of femoropopliteal arterial diseaseThe ILLUMENATE Global Study
Publisher: Wiley
Date: 31-10-2018
DOI: 10.1002/CCD.27348
Functional Near Infrared Spectroscopy in Peripheral Vascular Disease: Comparison with Existing Clinical Methods in Assessment of Foot Perfusion
Publisher: Elsevier BV
Date: 09-2021
Cardiopulmonary bypass reduces pulmonary surfactant activity in infants
Publisher: Elsevier BV
Date: 08-1999
Rivaroxaban Plus Aspirin Versus Aspirin in Relation to Vascular Risk in the COMPASS Trial
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JACC.2019.02.079
Abstract: The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that the combination of low-dose rivaroxaban and aspirin reduced major vascular events in patients with stable vascular disease. The purpose of this study was to identify subsets of patients at higher risk of recurrent vascular events, which may help focus the use of rivaroxaban and aspirin therapy. COMPASS patients with vascular disease were risk stratified using 2 methods: the REACH (REduction of Atherothrombosis for Continued Health) atherothrombosis risk score and CART (Classification and Regression Tree) analysis. The absolute risk differences for rivaroxaban with aspirin were compared to aspirin alone over 30 months for the composite of cardiovascular death, myocardial infarction, stroke, acute limb ischemia, or vascular utation for severe bleeding and for the net clinical benefit. High-risk patients using the REACH score were those with 2 or more vascular beds affected, history of heart failure (HF), or renal insufficiency, and by CART analysis were those with ≥2 vascular beds affected, history of HF, or diabetes. Rivaroxaban and aspirin combination reduced the serious vascular event incidence by 25% (4.48% vs. 5.95%, hazard ratio: 0.75 95% confidence interval: 0.66 to 0.85), equivalent to 23 events prevented per 1,000 patients treated for 30 months, at the cost of a nonsignificant 34% increase in severe bleeding (1.34 95% confidence interval: 0.95 to 1.88), or 2 events caused per 1,000 patients treated. Among patients with ≥1 high-risk feature identified from the CART analysis, rivaroxaban and aspirin prevented 33 serious vascular events, whereas in lower-risk patients, rivaroxaban and aspirin treatment led to the avoidance of 10 events per 1,000 patients treated for 30 months. In patients with vascular disease, further risk stratification can identify higher-risk patients (≥2 vascular beds affected, HF, renal insufficiency, or diabetes). The net clinical benefit remains favorable for most patients treated with rivaroxaban and aspirin compared with aspirin.
Value of Diffusion-weighted MRI During Carotid Angioplasty and Stenting
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.EJVS.2005.12.026
Abstract: The incidence of neurological injury following carotid angioplasty and stenting is of great interest to those advocating it as an alternative to endarterectomy in the management of critical carotid stenosis. A significant inter-observer variation exists in determining the presence or absence of a neurological deficit following the procedure objective imaging would be advantageous. In this study, we sought to assess diffusion weighted MRI as a diagnostic tool in evaluating the incidence of neurological injury following carotid angioplasty and stenting (CAS). The first 110 cases of CAS in our unit were included in this series. The procedure was abandoned in three patients. Patients underwent intracranial and extracranial MR angiography, together with diffusion-weighted MRI (DWI) prior to and following CAS and had a formal neurological assessment in the intensive care unit after the procedure. One hundred and ten Procedures were attempted in 98 patients. Twenty-eight percent were asymptomatic. Following CAS, 7.2% of patients had a positive neurological exam (two major strokes with one fatality) and 21% had positive DWI scans, equating to a sensitivity of 86% and a specificity of 85% for DWI in detecting cerebral infarction following CAS. The positive predictive value of the test was 0.3 and negative predictive value 0.99. The major stroke and death rate was 1.8%. While the use of a cerebral protection device appeared to significantly reduce the incidence of cerebral infarction (5% vs. 25%, p = 0.031) this may be a reflection of the learning curve encountered during the study. The incidence of subclinical DWI detected neurological injury was significantly higher than clinical neurological deficit following CAS. Conventional methods of neurological assessment of patients undergoing CAS may be too crude to detect subtle changes and more sensitive tests of cerebral function are required to establish whether these subclinical lesions are relevant.
Assessing Limb Outcomes in Drug Trials in Peripheral Artery Disease: The Need for a Universal and Pragmatic Definition
Publisher: Elsevier BV
Date: 09-2023
Cerebral embolisation during modern cardiopulmonary bypass
Publisher: Oxford University Press (OUP)
Date: 12-2001
DOI: 10.1016/S1010-7940(01)00981-2
Abstract: Cerebral microembolisation still occurs during cardiopulmonary bypass and may cause both stroke and postoperative cognitive impairment. We investigated the frequency of cerebral embolisation during coronary artery bypass surgery with modern cardiopulmonary bypass and related these to ascending aortic atherosclerosis. Transcranial Doppler monitoring for cerebral embolisation to both middle cerebral arteries was performed in 65 patients undergoing coronary artery surgery with non-pulsatile alpha-stat hypothermic bypass. Epicardial ultrasound imaging of ascending aortic atherosclerosis was performed in 14 patients. Thirty patients (56.9%) had more than 200 emboli entering the middle cerebral artery territories during surgery most at the start of bypass and during defibrillation. Readjustment of aortic cl s and aortic cannulation also caused a large number of emboli which were probably particulate. Aortic disease was mild (mean plaque thickness 1 mm, interquartile range 0.9-1.2 mm) and did not relate to the number of cerebral emboli produced by aortic manipulation. Cerebral embolisation remains common during coronary surgery despite advances in filter and bypass pump technology. Aortic manipulation and cl ing was associated with emboli but epicardial ultrasound imaging was of little help in its prediction.
Fresh frozen cadavers in surgical teaching: a gelatine arterial infusion technique
Publisher: Wiley
Date: 23-12-2010
DOI: 10.1111/J.1445-2197.2010.05596.X
Abstract: Fresh frozen human cadavers have been used at the Clinical Training and Evaluation Centre, The University of Western Australia, Perth, WA for years and are an excellent model for surgical dissection thanks to their representative tissue quality. Differentiation between artery and vein can be difficult as both collapse post mortem. A historical technique was therefore refined to increase arterial rigidity using gelatine prior to freezing. Two fresh human cadavers were selected after ethical approval. Gelatine was infused into the carotid artery in one, and into the common femoral artery in the second at a more dilute concentration. In both cases, infusion continued until the rate slowed spontaneously indicating filling prior to setting. The cadavers were frozen according to our standard policy and thawed for a teaching course. These were observational. Examination by palpation and dissection after freezing and subsequent thawing revealed arterial turgor to have developed at the popliteal and brachial levels in the first cadaver, and to the distal vessels in the second. Arterial/venous discrimination was therefore enhanced and confirmed by participant feedback on subsequent courses. The fresh frozen cadaver is already a superior model for teaching thanks to its near life-like representation of tissue quality and handling. A successful technique for infusion of gelatine into the arterial tree of fresh human cadavers prior to freezing has been refined resulting in enhancement of arterial/venous discrimination during anatomical, interventional and surgical teaching, further optimizing its use in teaching and this now our standard means of preparation.
Effect of Initial Treatment With a Single Pill Containing Quadruple Combination of Quarter Doses of Blood Pressure Medicines Versus Standard Dose Monotherapy in Patients With Hypertension on Ambulator
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-07-2023
Computational biomechanics: a potential new tool for the vascular surgeon in personalized management
Publisher: Wiley
Date: 06-2022
DOI: 10.1111/ANS.17476
Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1053/J.GASTRO.2019.04.041
Abstract: Antiplatelets and anticoagulants are associated with increased upper gastrointestinal bleeding. We evaluated whether proton pump inhibitor therapy could reduce this risk. We performed a 3 × 2 partial factorial double-blind trial of 17,598 participants with stable cardiovascular disease and peripheral artery disease. Participants were randomly assigned to groups given pantoprazole 40 mg daily or placebo, as well as rivaroxaban 2.5 mg twice daily with aspirin 100 mg once daily, rivaroxaban 5 mg twice daily, or aspirin 100 mg alone. The primary outcome was time to first upper gastrointestinal event, defined as a composite of overt bleeding, upper gastrointestinal bleeding from a gastroduodenal lesion or of unknown origin, occult bleeding, symptomatic gastroduodenal ulcer or ≥5 erosions, upper gastrointestinal obstruction, or perforation. There was no significant difference in upper gastrointestinal events between the pantoprazole group (102 of 8791 events) and the placebo group (116 of 8807 events) (hazard ratio, 0.88 95% confidence interval [CI], 0.67-1.15). Pantoprazole significantly reduced bleeding of gastroduodenal lesions (hazard ratio, 0.52 95% confidence interval, 0.28-0.94 P = .03) this reduction was greater when we used a post-hoc definition of bleeding gastroduodenal lesion (hazard ratio, 0.45 95% confidence interval, 0.27-0.74), although the number needed to treat still was high (n = 982 95% confidence interval, 609-2528). In a randomized placebo-controlled trial, we found that routine use of proton pump inhibitors in patients receiving low-dose anticoagulation and/or aspirin for stable cardiovascular disease does not reduce upper gastrointestinal events, but may reduce bleeding from gastroduodenal lesions. ClinicalTrials.gov ID: NCT01776424.
Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment
Publisher: AME Publishing Company
Date: 05-2021
DOI: 10.21037/QIMS-20-814
Rationale, design, and baseline participant characteristics in the MRI and cognitive substudy of the cardiovascular outcomes for people using anticoagulation strategies trial
Publisher: SAGE Publications
Date: 30-07-2018
Abstract: Covert vascular disease of the brain manifests as infarcts, white matter hyperintensities, and microbleeds on MRI. Their cumulative effect is often a decline in cognition, motor impairment, and psychiatric disorders. Preventive therapies for covert brain ischemia have not been established but represent a huge unmet clinical need. The MRI substudy examines the effects of the antithrombotic regimens in COMPASS on incident covert brain infarcts (the primary outcome), white matter hyperintensities, and cognitive and functional status in a s le of consenting COMPASS participants without contraindications to MRI. COMPASS is a randomized superiority trial testing rivaroxaban 2.5 mg bid plus acetylsalicylic acid 100 mg and rivaroxaban 5 mg bid against acetylsalicylic acid 100 mg per day for the combined endpoint of MI, stroke, and cardiovascular death in in iduals with stable coronary artery disease or peripheral artery disease. T1-weighted, T2-weighted, T2*-weighted, and FLAIR images were obtained close to randomization and near the termination of assigned antithrombotic therapy biomarker and genetic s les at randomization and one month, and cognitive and functional assessment at randomization, after two years and at the end of study. Between March 2013 and May 2016, 1905 participants were recruited from 86 centers in 16 countries. Of these participants, 1760 underwent baseline MRI scans that were deemed technically adequate for interpretation. The mean age at entry of participants with interpretable MRI was 71 years and 23.5% were women. Coronary artery disease was present in 90.4% and 28.1% had peripheral artery disease. Brain infarcts were present in 34.8%, 29.3% had cerebral microbleeds, and 93.0% had white matter hyperintensities. The median Montreal Cognitive Assessment score was 26 (interquartile range 23–28). The COMPASS MRI substudy will examine the effect of the antithrombotic interventions on MRI-determined covert brain infarcts and cognition. Demonstration of a therapeutic effect of the antithrombotic regimens on brain infarcts would have implications for prevention of cognitive decline and provide insight into the pathogenesis of vascular cognitive decline.
Low-dose rivaroxaban plus aspirin for the prevention of cardiovascular events: an evaluation of COMPASS
Publisher: Future Medicine Ltd
Date: 11-2018
Abstract: The cardiovascular outcomes for people using anticoagulation strategies (NCT01776424) trial randomized 27,395 patients with stable coronary artery disease or peripheral artery disease (PAD) to receive rivaroxaban 5 mg twice-daily alone, the combination of rivaroxaban 2.5 mg twice-daily and aspirin 100 mg daily, or aspirin 100 mg daily alone. The combination arm resulted in a 24% reduction in the primary end point of cardiovascular death, stroke or myocardial infarction, and an 18% reduction in mortality. Rivaroxaban alone did not produce any additional benefit compared with aspirin. The combination therapy also reduced major adverse limb events, including utation, in patients with PAD. Based on these results, the addition of rivaroxaban to aspirin is expected to substantially reduce morbidity and mortality in patients with stable coronary or PAD.
Carotid Endarterectomy Improves Cognitive Function in Patients with Exhausted Cerebrovascular Reserve
Publisher: Elsevier BV
Date: 11-2003
DOI: 10.1016/S1078-5884(03)00384-8
Abstract: To investigate changes in cognitive function following carotid endarterectomy (CEA). Prospective study with controls. CEA patients (n=159) were compared to a urology surgery control group (n=20). In CEA patients cerebrovascular reserve (CVR) was measured preoperatively. During surgery emboli and blood flow velocity in the middle cerebral artery were measured by transcranial Doppler (TCD) and cerebral oxygen saturation (CsO2) by near infrared spectroscopy. Cognitive function was measured preoperatively and at 5 days and 8 weeks postoperatively using a standardised computer battery of tests. Only 8% of patients had normal CVR bilaterally. The median number of emboli during CEA was 12 (range 0-181). On carotid cl ing, TCD velocity fell a median of 41% and cerebral oxygen saturation by 5%. Attention deteriorated compared to controls 5 days following CEA (p=0.003) and this deterioration was related to the rise in TCD velocity on decl ing (r=-0.3, p=0.002). Median attention reaction times improved significantly by 8 weeks (p=0.001) especially in patients' with severely impaired CVR before surgery (p=0.02). Attention improved at 2 months following CEA in patients with impaired CVR. CEA may offer more than reduced stroke risk to patients with impaired CVR.
Peroneus brevis flap in vascular surgical treatment of diabetic lower limb infection
Publisher: Wiley
Date: 24-02-2021
DOI: 10.1111/ANS.16668
Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature.
Publisher: SAGE Publications
Date: 24-01-2019
Abstract: Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.
Shortening and reimplantation for tortuous internal carotid arteries
Publisher: Elsevier BV
Date: 05-1998
DOI: 10.1016/S0741-5214(98)70275-7
Abstract: The purpose of this study was to assess the outcome after the shortening and reimplantation of tortuous internal carotid arteries to prevent kinking after endarterectomy. Through a review of prospective records, we studied patients who underwent carotid endarterectomy (CEA) (n = 233) between 1993 and 1996 who had symptomatic stenosis of the internal carotid artery (ICA) of more than 70%. An elongated proximal ICA was excised, and the ICA was reimplanted into the bifurcation in 30 (13%) patients, with additional patch angioplasty in 5 patients. Of the remaining 203 patients, 50 (21%) had Dacron patch angioplasty, and the rest had conventional CEA with simple closure. In the reimplanted group, one patient had a minor stroke with complete recovery on discharge. Three patients (10%) had neck hematomas requiring reexploration, but in none of these was the bleeding from the artery. At mean follow-up of 15 months, 93% of the arteries were widely patent. Significant stenosis secondary to neointimal hyperplasia was detected in only two patients, for a restenosis rate of 6.7%, which is in line with other published reports. In the control group, 8 (3.9%) patients had perioperative transient ischemic attacks, 5 (2.5%) had strokes, and 13 (6.4%) had hematomas requiring evacuation. At follow-up, 14 (6.9%) of the arteries had restenosed. In carotid surgery, reconstructive techniques must be tailored to operative findings. Excision of a tortuous elongated proximal ICA with reimplantation is not associated with additional mortality or morbidity rates over those of conventional CEA alone and has the advantage of removing disease at the bifurcation. This procedure was carried out in 13% of our patients and should be a procedure with which the vascular surgeon is familiar.
A Technique of “Chimney Nellix” for the Management of Type 1a Endoleak After EVAR
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JVIR.2017.10.022
Abstract: This report presents 3 procedures with visceral "chimney stenting" in conjunction with an endovascular aneurysm sealing (EVAS) device, known as chEVAS, for treatment of type 1a endoleak. It includes the first published chEVAS in a patient with previous fenestrated endovascular aneurysm repair (FEVAR). Cases include an 80-year-old man 8 years after FEVAR for a juxtarenal abdominal aortic aneurysm (AAA) an 85-year-old woman 9 months after endovascular aneurysm repair (EVAR) for a ruptured infrarenal AAA and an 84-year-old woman 3 months after EVAR for a symptomatic infrarenal AAA. Technical success was achieved in all cases, with 1 postoperative death. The remaining 2 patients had no residual type 1a endoleak at 10 and 14 months respectively.
Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial (Dec, 10.1007/s00270-020-02738-5, 2020)
Publisher: Springer Science and Business Media LLC
Date: 08-04-2021
DOI: 10.1007/S00270-021-02827-Z
Abstract: The original version of this paper did not contain a list of Bio4amb investigators.
Surgical Decision Making in Uncomplicated Type B Aortic Dissection: A Survey of Australian/New Zealand and European Surgeons
Publisher: Elsevier BV
Date: 08-2020
A novel roller pump for physiological flow
Publisher: Wiley
Date: 25-03-2020
DOI: 10.1111/AOR.13670
Hybrid treatment of an isolated immunoglobulin G4-related internal thoracic artery aneurysm
Publisher: Elsevier BV
Date: 12-2018
A Laparoscopic Access Technique for Endovascular Procedures:Surgeon Training in an Animal Model
Publisher: International Society of Endovascular Specialists
Date: 06-2006
DOI: 10.1583/05-1787.1
Abstract: To present a laparoscopic technique for placing a transperitoneal conduit in the common iliac artery (CIA) or distal aorta to circumvent stenosed or occluded iliac systems and to assess the success of this laparoscopic access in a live animal model. A porcine model was used owing to similarities in anatomy and size of the pig aorta to the human common iliac artery (CIA). Ethical approval was obtained, and the technique was developed in 8 animals under general anesthesia. A curved hollow needle, a partially stented Dacron conduit, an airtight laparoscopic port and a sealing sheath and valve were developed specifically for percutaneous access through the abdominal wall. A transperitoneal approach was used to the distal aorta. Cannulation by the curved hollow needle via the new port was under direct vision. The conduit was inserted over a guidewire after needle removal and deployed under fluoroscopy. The distal end of the conduit was secured by the sealing sheath and valve, enabling wire and catheter exchange thereafter. A 2-day educational workshop was held for 12 vascular surgeons with a range of laparoscopic experience. After learning the technique on a simulator model, they worked in pairs, alternating surgeon/assistant roles to insert conduits into 12 animals under general anesthesia. Laparoscopic cannulation in all 12 animals was successful. There was no bleeding around the conduit at the aortic arteriotomy. All animals were euthanized after confirmation of conduit patency by back-bleeding. This novel technique bridges the gap between laparoscopic and endovascular techniques in striving for minimally invasive solutions to the treatment of vascular disease. Adaptation to human beings is currently underway and will mean increasing the applicability of endovascular solutions to those patients in whom it would otherwise be denied. The technique would appear not to require specialist laparoscopic skills.
Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
Publisher: Wiley
Date: 09-08-2021
DOI: 10.1111/ANAE.15560
Abstract: We aimed to determine the impact of pre‐operative isolation on postoperative pulmonary complications after elective surgery during the global SARS‐CoV‐2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre‐defined sub‐group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS‐CoV‐2 infection. Patients who isolated pre‐operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS‐CoV‐2 incidence and high‐income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre‐operative testing use of COVID‐19‐free pathways or community SARS‐CoV‐2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study
Publisher: Wiley
Date: 24-08-2021
DOI: 10.1111/ANAE.15563
Abstract: SARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery) recent (1–6 weeks before surgery) previous (≥7 weeks before surgery) or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS‐CoV‐2 2.2% (50/2317) in patients with peri‐operative SARS‐CoV‐2 1.6% (15/953) in patients with recent SARS‐CoV‐2 and 1.0% (11/1148) in patients with previous SARS‐CoV‐2. After adjustment for confounding factors, patients with peri‐operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS‐CoV‐2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS‐CoV‐2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30‐day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS‐CoV‐2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri‐operative or recent SARS‐CoV‐2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS‐CoV‐2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
Cerebral oximetry: a useful monitor during carotid artery surgery
Publisher: Wiley
Date: 06-1996
DOI: 10.1111/J.1365-2044.1996.TB12599.X
Abstract: Cellulose nanocrystals (CNCs) with silver nanoparticles (AgNPs) are used for applications ranging from chemical catalysis to environmental remediation, and generation of smart electronics and biological medicine such as antibacterial agents. To reduce the synthesis cost of AgNPs and environmental pollution, microwave-assisted generation of AgNPs on the CNC surface (AgNPs@CNC) has been found to be useful, because microwave reaction has the advantages of simple reaction conditions, short reaction time and high reaction efficiency. The silver ions (Ag
Blood flow velocity prediction in aorto-iliac stent grafts using computational fluid dynamics and Taguchi method
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.COMPBIOMED.2017.03.015
Abstract: Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB) is a new technique to treat extensive aortoiliac occlusive disease with covered expandable stent grafts to rebuild the aortoiliac bifurcation. Post stenting Doppler ultrasound (DUS) measurement of maximum peak systolic velocity (PSV
Treatment of anticoagulated patients with negative pressure wound therapy
Publisher: Wiley
Date: 15-03-2017
DOI: 10.1111/IWJ.12737
Near infra‐red spectroscopy
Publisher: Wiley
Date: 08-1996
Invasion syndromes: a systematic approach for predicting biological invasions and facilitating effective management
Publisher: Springer Science and Business Media LLC
Date: 02-03-2020
DOI: 10.1007/S10530-020-02220-W
Abstract: Our ability to predict invasions has been hindered by the seemingly idiosyncratic context-dependency of in idual invasions. However, we argue that robust and useful generalisations in invasion science can be made by considering “invasion syndromes” which we define as “a combination of pathways, alien species traits, and characteristics of the recipient ecosystem which collectively result in predictable dynamics and impacts, and that can be managed effectively using specific policy and management actions”. We describe this approach and outline ex les that highlight its utility, including: cacti with clonal fragmentation in arid ecosystems small aquatic organisms introduced through ballast water in harbours large ranid frogs with frequent secondary transfers piscivorous freshwater fishes in connected aquatic ecosystems plant invasions in high-elevation areas tall-statured grasses and tree-feeding insects in forests with suitable hosts. We propose a systematic method for identifying and delimiting invasion syndromes. We argue that invasion syndromes can account for the context-dependency of biological invasions while incorporating insights from comparative studies. Adopting this approach will help to structure thinking, identify transferrable risk assessment and management lessons, and highlight similarities among events that were previously considered disparate invasion phenomena.
Major Adverse Limb Events and Mortality in Patients With Peripheral Artery Disease
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JACC.2018.03.008
Abstract: Patients with lower extremity peripheral artery disease (PAD) are at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). There is limited information on the prognosis of patients who experience MALE. Among participants with lower extremity PAD, this study investigated: 1) if hospitalizations, MACE, utations, and deaths are higher after the first episode of MALE compared with patients with PAD who do not experience MALE and 2) the impact of treatment with low-dose rivaroxaban and aspirin compared with aspirin alone on the incidence of MALE, peripheral vascular interventions, and all peripheral vascular outcomes over a median follow-up of 21 months. We analyzed outcomes in 6,391 patients with lower extremity PAD who were enrolled in the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial. COMPASS was a randomized, double-blind placebo-controlled study of low-dose rivaroxaban and aspirin combination or rivaroxaban alone compared with aspirin alone. MALE was defined as severe limb ischemia leading to an intervention or major vascular utation. A total of 128 patients experienced an incident of MALE. After MALE, the 1-year cumulative risk of a subsequent hospitalization was 61.5% for vascular utations, it was 20.5% for death, it was 8.3% and for MACE, it was 3.7%. The MALE index event significantly increased the risk of experiencing subsequent hospitalizations (hazard ratio [HR]: 7.21 p < 0.0001), subsequent utations (HR: 197.5 p < 0.0001), and death (HR: 3.23 p < 0.001). Compared with aspirin alone, the combination of rivaroxaban 2.5 mg twice daily and aspirin lowered the incidence of MALE by 43% (p = 0.01), total vascular utations by 58% (p = 0.01), peripheral vascular interventions by 24% (p = 0.03), and all peripheral vascular outcomes by 24% (p = 0.02). Among in iduals with lower extremity PAD, the development of MALE is associated with a poor prognosis, making prevention of this condition of utmost importance. The combination of rivaroxaban 2.5 mg twice daily and aspirin significantly lowered the incidence of MALE and the related complications, and this combination should be considered as an important therapy for patients with PAD. (Cardiovascular Outcomes for People Using Anticoagulation Strategies [COMPASS] NCT01776424).
Personalized 3D printed coronary models in coronary stenting
Publisher: AME Publishing Company
Date: 08-2019
Radial artery as a conduit for diabetic crural bypass
Publisher: Oxford University Press (OUP)
Date: 29-11-2003
DOI: 10.1002/BJS.4021
Abstract: An alternative if saphenous vein is absent
Arterial tissue stress and the geography of atheroma
Publisher: Wiley
Date: 11-2021
DOI: 10.1111/ANS.16965
Comparison of Performance of Micro-Computed Tomography (Micro-CT) and Synchrotron Radiation CT in Assessing Coronary Stenosis Caused by Calcified Plaques in Coronary Artery Phantoms
Publisher: MDPI AG
Date: 09-2023
DOI: 10.3390/JVD2030026
Potential for novel imaging techniques to monitor early disease progression in connective tissue disease vasculopathy
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/IMJ.15476
Abstract: Vasculopathy associated with connective tissue diseases (CTD) has erse clinical presentations and complex underlying pathology. Existing imaging techniques remain inadequate for assessing vasculopathy in CTD, particularly in earlier stages of pathogenesis. Novel imaging techniques, such as optical coherence tomography, near‐infrared spectroscopy and superb microvascular imaging, demonstrate potential in monitoring disease progression at earlier stages prior to systemic complications.
Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies
Publisher: Springer Science and Business Media LLC
Date: 23-12-2021
DOI: 10.1007/S00270-020-02738-5
Abstract: Ambulatory peripheral vascular interventions have been steadily increasing. In ambulatory procedures, 4F devices might be particularly useful having the potential to reduce access-site complications however, further evidence on their safety and efficacy is needed. BIO4AMB is a prospective, non-randomized mulitcentre, non-inferiority trial conducted in 35 centres in Europe and Australia comparing the use of 4F- and 6F-compatible devices. The main exclusion criteria included an American Society of Anaesthesiologists class ≥ 4, coagulation disorders, or social isolation. The primary endpoint was access-site complications within 30 days. The 4F group enrolled 390 patients and the 6F group 404 patients. Baseline characteristics were similar between the groups. Vascular closure devices were used in 7.7% (4F group) and 87.6% (6F group) of patients. Patients with vascular closure device use in the 4F group were subsequently excluded from the primary analysis, resulting in 361 patients in the 4F group. Time to haemostasis was longer for the 4F group, but the total procedure time was shorter (13.2 ± 18.8 vs. 6.4 ± 8.9 min, p 0.0001, and 39.1 ± 25.2 vs. 46.4 ± 27.6 min, p 0.0001). Discharge on the day of the procedure was possible in 95.0% (4F group) and 94.6% (6F group) of patients. Access-site complications were similar between the groups (2.8% and 3.2%) and included predominantly groin haematomas and pseudoaneurysms. Major adverse events through 30 days occurred in 1.7% and 2.0%, respectively. Ambulatory peripheral vascular interventions are feasible and safe. The use of 4F devices resulted in similar outcomes compared to that of 6F devices.
20IS A SCAN PART OF THE PLAN? A STUDY EVALUATING THE USE OF MYOCARDIAL PERFUSION SCANS (MPS) AS A PREOPERATIVE ASSESSMENT TOOL TO ASSESS CARDIOVASCULAR RISK IN PATIENTS WHO UNDERGO ENDOVASCULAR ANEURY
Publisher: Oxford University Press (OUP)
Date: 02-2019
Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study
Publisher: Wiley
Date: 09-03-2021
DOI: 10.1111/ANAE.15458
Abstract: Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
Large Iliac Arteries:A High-Risk Group for Endovascular Aortic Aneurysm Repair
Publisher: International Society of Endovascular Specialists
Date: 10-2007
Visualizing and quantifying cutaneous microvascular reactivity in humans by use of optical coherence tomography: impaired dilator function in diabetes
Publisher: American Physiological Society
Date: 11-2020
DOI: 10.1152/AJPENDO.00233.2020
Abstract: The pathophysiology and time course of impairment in cutaneous microcirculatory function and structure remain poorly understood in people with diabetes, partly due to the lack of investigational tools capable of directly imaging and quantifying the microvasculature in vivo. We applied a new optical coherence tomography (OCT) technique, at rest and during reactive hyperemia (RH), to assess the skin microvasculature in people with diabetes with foot ulcers (DFU, n = 13), those with diabetes without ulcers (DNU, n = 9), and matched healthy controls (CON, n = 13). OCT images were obtained from the dorsal part of the foot at rest and following 5 min of local ischemia induced by inflating a cuff around the thigh at suprasystolic level (220 mmHg). One-way ANOVA was used to compare the OCT-derived parameters (diameter, speed, flow rate, and density) at rest and in response to RH, with repeated-measures two-way ANOVA performed to analyze main and interaction effects between groups. Data are means ± SD. At rest, microvascular diameter in the DFU (84.89 ± 14.84 µm) group was higher than CON (71.25 ± 7.6 µm, P = 0.012) and DNU (71.33 ± 12.04 µm, P = 0.019) group. Speed in DFU (65.56 ± 4.80 µm/s, P = 0.002) and DNU (63.22 ± 4.35 µm/s, P = 0.050) were higher than CON (59.58 ± 3.02 µm/s). Microvascular density in DFU (22.23 ± 13.8%) was higher than in CON (9.83 ± 2.94%, P = 0.008), but not than in the DNU group (14.8 ± 10.98%, P = 0.119). All OCT-derived parameters were significantly increased in response to RH in the CON group (all P 0.01) and DNU group (all P 0.05). Significant increase in the DFU group was observed in speed ( P = 0.031) and density ( P = 0.018). The change in density was lowest in the DFU group (44 ± 34.1%) compared with CON (199.2 ± 117.5%, P = 0.005) and DNU (148.1 ± 98.4, P = 0.054). This study proves that noninvasive OCT microvascular imaging is feasible in people with diabetes, provides powerful new physiological insights, and can distinguish between healthy in iduals and patients with diabetes with distinct disease severity.
Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols
Publisher: AME Publishing Company
Date: 2019
Flow pattern analysis in type B aortic dissection patients after stent-grafting repair: Comparison between complete and incomplete false lumen thrombosis
Publisher: Wiley
Date: 05-03-2018
DOI: 10.1002/CNM.2961
Abstract: Endovascular stent graft repair has become a common treatment for complicated Stanford type B aortic dissection to restore true lumen flow and induce false lumen thrombosis. Using computational fluid dynamics, this study reports the differences in flow patterns and wall shear stress distribution in complicated Stanford type B aortic dissection patients after endovascular stent graft repair. Five patients were included in this study: 2 have more than 80% false lumen thrombosis (group 1), while 3 others had less than 80% false lumen thrombosis (group 2) within 1 year following endovascular repair. Group 1 patients had concentrated re-entry tears around the abdominal branches only, while group 2 patients had re-entry tears that spread along the dissection line. Blood flow inside the false lumen which affected thrombus formation increased with the number of re-entry tears and when only small amounts of blood that entered the false lumen exited through the branches. In those cases where dissection extended below the abdominal branches (group 2), patients with fewer re-entry tears and longer distance between the tears had low wall shear stress contributing to thrombosis. This work provides an insight into predicting the development of complete or incomplete false lumen thrombosis and has implications for patient selection for treatment.
Cerebral injury during cardiopulmonary bypass: Emboli impair memory
Publisher: Elsevier BV
Date: 06-2001
Abstract: Cognitive deficits occur in up to 80% of patients after cardiac surgery. We investigated the influence of cerebral perfusion and embolization during cardiopulmonary bypass on cognitive function and recovery. Cerebrovascular reactivity was measured in 70 patients before coronary operations in which nonpulsatile bypass was used. Throughout the operations, middle cerebral artery flow velocity and embolization were recorded by transcranial Doppler and regional oxygen saturation was recorded by near-infrared spectroscopy. Cognitive function was measured by a computerized battery of tests before the operation and 1 week, 2 months, and 6 months after surgery. Elderly patients undergoing urologic surgery served as controls. Cerebrovascular reactivity was impaired preoperatively in 49 patients. Median (interquartile range) regional cerebral oxygen saturation fell during bypass by 10% (6%-15%), indicating increased oxygen extraction, whereas mean middle cerebral flow velocity increased significantly by a median of 6 cm/s (both P <.0001, Wilcoxon), suggesting increased arterial tone. More than 200 emboli were detected in 40 patients, mainly on aortic cl ing and release, when bypass was initiated, and during defibrillation. Cognitive function deteriorated more in patients having cardiopulmonary bypass than in control patients having urologic operations but recovered in most tests by 2 months. Measures of cerebral perfusion (poor cerebrovascular reactivity, low arterial pressures, and flow velocity in the middle cerebral artery) predicted poor attention at 1 week (r = 0.3, P <.01, Spearman). Emboli were associated with memory loss (r = 0.3, P <.02, Spearman). Cognitive deficits were common after cardiopulmonary bypass. Occult cerebrovascular disease was more severe than expected and predisposed to attention difficulties, whereas emboli caused memory deficits. We believe this to be the first report of differing cognitive effects from emboli and hypoperfusion.
Related Organisations
University Of Birmingham
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Shirley Jansen.