bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary emboli due to venous aneurysm of extremities
Authors: Gabrielli  , Rosati  , Vitale  , Millarelli  , Siani  , Chiappa  , Caselli
Published: February 2013

Venous aneurysms are uncommon but they can have devastating consequences, including pulmonary embolism, other thromboembolic events and death. We report six cases of venous aneurysm of the extremities, in which the first sign of presence was acute pulmonary embolism. Surgical resection is recommended whenever possible. Our experience suggests that prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for extremity deep and superficial venous aneurysms for their potential risk of developing thromboembolic complications despite adequate anticoagulation. Other venous aneurysms should be excised only if they are symptomatic or enlarging.
Redo sternotomy for extra-anatomical correction of aortic coarctation and mitral repair in an adult after failed endovascular treatment
Authors: Ozker  , Saritas  , Vuran  , Yoruker  , Kocyigit  , Turkoz
Published: February 2013

Recently, extra-anatomical bypass surgery has been widely used in complicated adult aortic coarctation cases with concomitant intracardiac repair. Stent implantation has been widely used for primary aortic coarctation as well. The procedure has been shown to be effective with long term follow ups. However, failed stent implantations like stent fracture and dislodgement may complicate the clinical status and subsequent surgical procedure. Extraanatomic bypass can provide effective results and lower morbidity in cases with concomitant intracardiac problems and stent failure. Here we present an adult aortic coarctation patient who had undergone a Bentall operation and two unsuccessful stent implantations for recurrent aortic coarctation. The patient then got an extraanatomic bypass for aortic coarctation and concomitant mitral valve commissurotomy through median sternotomy.
Varicose veins: A critical review of the definition and the therapeutical options
Authors: Jeanneret  , Karatolios
Published: February 2013

This review intends to give an overview of the present therapeutic options for varicose vein disease. The definition of varicose vein disease and its recurrence are made and discussed with new aspects including duplexsonography assessment. All therapeutic approaches have developed and refined their treatment modalities, the open surgical as well as the endovenous techniques. In particular the new endovenous techniques are described with regard to safety and outcome, the published literature in this respect is summarized. The studies comparing the different techniques are listed, the prospective long term studies comparing the new techniques with the so called gold standard (open surgery) shall decide on the fate of the different techniques.
Results of open vascular surgical therapy in chronic peripheral arterial disease
Authors: Balzer  , Weis-Müller
Published: February 2013

Surgery in chronic peripheral arterial disease (PAD) can alleviate symptoms in claudicants and may impede amputation in critical limb ischemia. The current data on different surgical strategies and techniques from the aortoiliac region to the pedal arteries as well as amputation as last resort are described and discussed. Treatment of PAD depends on the condition of the patient and his comorbidities. The question of optimal therapy for each patient cannot always be answered in the operating theatre or the angio-suite.
Diet and the content of selenium and lead in patients with abdominal aortic aneurysm
Authors: Socha  , Borawska  , Gacko  , Guzowski
Published: February 2013

Background: To evaluate the content of selenium (Se) and lead (Pb) and the influence of dietary habits and smoking in patients with abdominal aortic aneurysm (AAA). Patients and methods: Forty-nine patients with AAA prior to surgical procedures aged 42 - 81 years and a control group of 22 healthy volunteers aged 31 - 72 years and 17 aortic wall samples from deceased were included in the study. Food-frequency questionnaires were implemented in AAA patients to collect the dietary data. Se and Pb concentrations in the serum and blood, respectively, and in arterial wall and parietal thrombus samples were determined by the atomic absorption spectrometry method. Results: The mean Se level in serum of patients with AAA (60.37 ± 21.2 microg/L) was significantly (p < 0.008) lower than in healthy volunteers (75.87 ± 22.4 microg/L). We observed a significant correlation (r = 0.69, p < 0.0001) between the content of Se in serum and the parietal thrombus of examined patients. Se concentration in aortic wall was inversely correlated to the concentration of Pb (r = - 0.38, p < 0.02). We observed significantly lower (p < 0.05) concentrations of Se (39.14 ± 37.1 microg/g) and significantly higher (p < 0.05) concentrations of Pb (202.69 ± 180.6 microg/g) in aortic wall samples of smoking patients than in non-smoking patients (77.56 ± 70.0 microg/g, 73.09 ± 49.8 microg/g; respectively). Conclusions: Se serum level is lower in patients with AAA than in healthy volunteers. In aortic wall, Se concentration is inversely correlated with Pb concentration. Dietary habits and smoking have an influence on the Se and Pb status in patients with AAA.
Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication
Authors: Grizzo Cucato  , de Moraes Forjaz  , Kanegusuku  , da Rocha Chehuen  , Riani Costa  , Wolosker  , Kalil Filho  , de Fátima Nunes Marucci  , Mendes Ritti-Dias
Published: February 2013

Background: Exercise training is recommended as the first-line therapy for intermittent claudication patients. However, the effects of exercise therapy on cardiovascular function of these patients have been poorly studied. The aim of this study is to compare the effects of walking and strength training on cardiovascular responses assessed at rest and during exercise in patients with intermittent claudication. Patients and methods: Thirty-four patients with stable symptoms of intermittent claudication were randomized into two groups: strength training (ST) consisting of eight exercises, three sets of 10 repetitions, intensity of 11 - 13 on 15-grade Borg scale, 2-min interval between sets; and walking training (WT) consisting of walking on a treadmill, 15 bouts of 2-min, intensity of 11 - 13 on 15-grade Borg scale, with a 2-min interval between bouts. Before and after 12 weeks, blood pressure, heart rate and rate pressure product were measured at rest and during a progressive treadmill test until maximal claudication pain. Results: Fifteen patients in each group completed the training program. After the training programs, resting systolic blood pressure (ST:-6 ± 13 mmHg and WT:-3 ± 18 mmHg, P = .04), heart rate (ST: -6 ± 10 bpm and WT:-2 ± 9 bpm, P = .03), and rate pressure product (ST:-1485 ± 1442 mmHg*bpm and WT:- 605 ± 2145 mmHg*bpm, P = .01) decreased significantly and similarly in both groups. Submaximal systolic blood pressure (ST: -14 ± 23 mmHg and WT:-6 ± 23 mmHg, P = .02), and rate pressure product (ST:-1579 ± 3444 mmHg*bpm and WT: -1264 ± 3005 mmHg*bpm, P = .04) decreased significantly and similarly in both groups. There were no changes in submaximal heart rate after ST and WT. Maximal systolic blood pressure, heart rate, and rate pressure product did not change in either group, although maximal exercise time increased similarly in the ST and WT groups (+31 ± 19 %, and +31 ± 32 %, respectively, P < .01). Conclusions: Strength and walking trainings promoted similar increases in walking capacity and decreases in resting and submaximal exercise cardiovascular load.
Trends in lower extremity surgical and endovascular revascularization in Germany
Authors: Eickmeyer  , Moysidis  , Nowak  , Fifer  , Santosa  , Luther  , Kröger
Published: February 2013

Background: We analyzed trends in lower extremity endovascular and open surgical procedures in hospitalized patients in Germany. Patients and methods: We used national statistics (DRG statistics) published by the Federal Statistical Office including data from almost all hospitals in Germany to calculate annual procedure rates of lower extremity endovascular and open surgical procedures in the years 2005 to 2008. Detailed lists of the OPS-codes 8 - 836, 5 - 381, 5 - 393 separated by the 6th number of the code were analyzed regarding procedures representing revascularization of peripheral arteries including the aorta. Results: Between 2005 and 2008 the total number of endovascular procedures increased from 73,584 to 98,664 and the number of surgical procedures from 74,789 to 86,172 a year. Age-adjusted incidence rates of endovascular procedures in people >= 65 years increased from 325 to 432 per 100,000 while the incidence rates of all open surgical procedures increased from 315 to 351 per 100.000. Looking only at bypass surgery the incidence remained unchanged with 177 and 176 per 100,000 in the same period. Endovascular procedures other than balloon angioplasty including percutaneous atherectomy, laser recanalization or usage of cutting balloon, account for less than 1 % in Germany. Conclusions: The numbers of endovascular procedures overweigh the numbers of open surgical procedures for treatment of lower extremity PAD in Germany today. In contrast to data from the USA we could not demonstrate a decrease of open surgical procedures in Germany in recent years.
Iatrogenic pseudoaneurysm of the popliteal artery following corrective tibial osteotomy
Authors: Szyber Jr.  , Skóra  , Rybak  , Pupka
Published: February 2013

Due to its anatomical location the popliteal artery is exposed to injury during surgical procedures in the region of the knee joint, in particular during high-level corrective osteotomies of the proximal tibial epiphysis. Nevertheless, posttraumatic (iatrogenic) pseudoaneurysm constitutes a very rare complication of the procedure. Only few reports of such complication have been published and they were usually connected with lateral tibial osteotomy - the accidents after medial osteotomy are seldom. The complication we report was observed in a 52-year-old female patient after corrective osteotomy of the medial portion of the proximal tibial epiphysis. The complication was diagnosed 7 days after surgery on US-examination and subsequently confirmed by emergently performed angio-CT. The patient was referred for urgent reconstructive surgery. No significant complications were observed, neither postoperatively nor during follow-up visits.
Aspirin - resistance? A few critical considerations on definition, terminology, diagnosis, clinical value, natural course of atherosclerotic disease, and therapeutic consequences
Authors: Berent  , Sinzinger
Published: February 2013

Based upon various platelet function tests and the fact that patients experience vascular events despite taking acetylsalicylic acid (ASA or aspirin), it has been suggested that patients may become resistant to the action of this pharmacological compound. However, the term aspirin resistance was created almost two decades ago but is still not defined. Platelet function tests are not standardized, providing conflicting information and cut-off values are arbitrarily set. Intertest comparison reveals low agreement. Even point of care tests have been introduced before appropriate validation. Inflammation may activate platelets, co-medication(s) may interfere significantly with aspirin action on platelets. Platelet function and Cox-inhibition are only some of the effects of aspirin on haemostatic regulation. One single test is not reliable to identify an altered response. Therefore, it may be more appropriate to speak about treatment failure to aspirin therapy than using the term aspirin resistance. There is no evidence based justification from either the laboratory or the clinical point of view for platelet function testing in patients taking aspirin as well as from an economic standpoint. Until evidence based data from controlled studies will be available the term aspirin resistance should not be further used. A more robust monitoring of factors resulting in cardiovascular events such as inflammation is recommended.
Patient specific biomodel of the whole aorta - the importance of calcified plaque removal
Authors: Håkansson  , Rantatalo  , Hansen  , Wanhainen
Published: February 2013

Background: The use of anatomical models produced by 3D printing technique (rapid prototyping, RP) is gaining increased acceptance as a complementary tool for planning complex surgical interventions. This paper describes a method for creating a patient specific replica of the whole aorta. Methods: Computed tomography angiography (CTA) DICOM-data was converted to a three-dimensional computer aided design-model (CAD) of the inner wall of the aorta representing the lumen where the calcified plaque contribution was removed in a multi-step editing-manoeuvre. The edited CAD-model was used for creating a physical plaster model of the true lumen in a 3D-printer. Elastic and transparent silicon was applied onto the plaster model, which was then removed leaving a silicon replica of the aorta. Results: The median (interquartile range) difference between diameters obtained from CTA- and RP plaster-model at 19 predefined locations was 0.5 mm (1 mm) which corresponds to a relative median difference of 4.6% (7.0%). The average wall thickness of the silicone model was 3.5 mm. The elasticity property and performance during intervention was good with an acceptable transparency. Conclusions: The integration of RP-techniques with CAD based reconstruction of 3D-medical imaging data provides the needed tools for making a truly patient specific replica of the whole aorta with high accuracy. Plaque removal postprocessing is necessary to obtain a true inner wall configuration.
The concept of an anatomy related individual arterial access: lowering technical and clinical complications with transradial access in bovine- and type-III aortic arch carotid artery stenting
Authors: Dahm  , van Buuren  , Hansen  , Becker  , Wolpers
Published: February 2013

Background: Carotid artery stenting (CAS) from the femoral approach can be anatomically very difficult and the incidence of complications is higher in patients with anatomical variations of the aortic arch, difficulties related to peripheral vascular disease and/or with access site complications. Because the typical morphology in patients with a bovine- or type-III aortic arch applies for an arterial access from the right upper extremity (e.g. radial, brachial) we evaluated success rates and safety of the right transradial access in a prospective study. Patients and methods: Between June 2009 and October 2010, seventeen patients (mean age 74,4 ± 9 years, 10 male) with a bovine- (n = 4) or type-III aortic arch (n = 12) underwent CAS with a planned transradial- (n = 3) or after problematic transfemoral access (n = 14). In patients with a type-III aortic arch (n = 13), the right target common carotid artery (CCA) was cannulated from the right radial artery with a 5F IMA diagnostic catheter-, in patients with a bovine aortic arch (n = 4), the left CCA was accessed from the right radial artery with a 5F Amplatz- or Judkins left catheter. In all patients a 6F- (n = 14) or 5F- (n = 3) shuttle sheath was inserted via the diagnostic catheter and a 0.035 extra-stiff guidewire. All interventions were carried out with the use of a peripheral embolization protection device (EPD). Primary study endpoints were procedural success and major adverse cardiac and cerebrovascular events (MACCE), secondary endpoints were access site complications and the mean intervention time. Results: Procedural success could be achieved in all patients (100 %), MACCE and access site complications did not occur in any patient. Mean interventional time was 48 ± 18 min. Conclusions: CAS using the right transradial approach for left CAS in bovine-type aortic arch or the right transradial approach in type-III aortic arch for right CAS appears to be safe and technically feasible.
Pseudoaneurysm of the left internal carotid artery following tonsillectomy
Authors: Vávrová  , Slezácek  , Vávra  , Karlová  , Procházka
Published: February 2013

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.
Synchronous celiac axis and superior mesenteric artery embolism
Authors: Rajkovic  , Zelic  , Papes  , Cizmek  , Arslani
Published: February 2013

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patients condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.
Duration of anticoagulation after venous thrombosis
Authors: Eichinger  , Kyrle A.
Published: February 2013

Venous thromboembolism (VTE) is a multicausal disease which tends to recur. Recurrence can be prevented by anticoagulant treatment albeit at the cost of bleeding. Deciding on the optimal duration of anticoagulation is based on balancing the risk of recurrence and of bleeding in case anticoagulation is continued. Patients with VTE provoked by a transient risk factor have a low risk of recurrence and stopping anticoagulation after 3 months is recommended because the risk of bleeding likely outweighs the risk of recurrence. In patients with unprovoked VTE recurrence is high and indefinite anticoagulation should be considered. However, the majority of these patients will not suffer recurrence but thus far safe identification of low or high patients risk is not possible. Despite considerable advances in the identification of new risk factors for (recurrent) VTE, predicting the risk of recurrence in an individual patient remains a challenge. Measuring D-Dimer as a global coagulation markers and the use of prediction models that integrate clinical characteristics and laboratory markers are the most promising approaches to improve risk assessment and to optimize the duration of anticoagulation. New oral anticoagulants have been studied for treatment of patients with VTE. However, more data on the bleeding risk during extended thromboprophylaxis are needed to decide which patients may indeed benefit from these novel agents.
Reduction of small infrarenal abdominal aortic aneurysm expansion rate by statins
Authors: Periard  , Guessous  , Mazzolai  , Haesler  , Monney  , Hayoz
Published: February 2013

Background: To evaluate the effect of statins on the annual expansion rate (ER) of small infrarenal abdominal aortic aneurysms (AAA). Patients and methods: All patients under regular surveillance for small AAA between January 2000 and September 2007, in the Department of Angiology, Lausanne University Hospital, were included. Inclusion criteria were baseline abdominal aortic diameter between 25 and 55 mm, at least two measurements of AAA diameter and a minimum follow up of 6 months. Patients with Marfan disease, infectious or inflammatory AAA, and patients with prior AAA repair were excluded. The influence of statin use and other factors on ER were examined by bivariate and multivariate analysis. Results: Among 589 patients who underwent an abdominal aorta evaluation, 94 patients (89 % men, mean age 69.1 years) were finally included in the analysis. Baseline AAA size was 39.9 ± 7.7 mm (mean±SE) and 48.7 ± 8.4 mm at end of follow-up. Patients had a regular aneurysm size assessment during 38.5 ± 27.7 months. Mean ER was 3.59 mm/y (± 2.81). The 50 patients who were treated with statin during the study period had a lower ER compared to the 44 controls (2.91 vs 4.37 mm/year, p = 0.01). Conclusions: This study confirms the considerable individual variations in the AAA expansion rate, and emphasizes the need for regular aortic diameter assessments. In this study, patients treated with statin demonstrate a significant decrease in the ER compared to controls. This finding need to be evaluated in prospective interventional studies powered to demonstrate the potential benefit of statin treatment.
Erythromelalgia: Incidence and clinical experience in a single centre in Sweden
Authors: Alhadad  , Wollmer  , Svensson  , Eriksson
Published: February 2013

Background: Erythromelalgia (EM) incidence has not been well studied and there are only two studies published on this subject as far as we know. The aims are to study the incidence of this rare condition in the south of Sweden, to report the clinical experience from a single centre including characterisation of comorbidity and to report on prognosis. Patients and methods: Retrospective study of a population-based analysis of data from the southernmost part of Sweden corresponding to the median age of the patients (Statistics Sweden). The diagnosis of EM is based on the medical record reflecting the triad of redness, burning pain and increased temperature of the feet or hands or both. We evaluated the presence or absence of EM triad by recording the history, physical examination, laboratory analysis, cold provocation test and laser Doppler imaging, and by searching for any confounding disease in cases of suspected EM. Results: During a 10.5 year period we clinically identified 27 patients with EM. Median age was 49 [IQR (34 - 68)] years, 19 (70 %) were women. The mean delay from the onset of the symptoms to the time of diagnosis was 4.5 (SD ± 3.9) years. Gender and age adjusted incidence of EM for our region was calculated to be 0.36 per 100 000 persons per year. Three patients developed intraabdominal cancer during the follow up, but there was no mortality directed related to EM. Conclusions: The overall population-based incidence of erythromelalgia was 0.36 per 100 000 which is identical with a previous report in a Scandinavian population.
Mid-term outcome after endovascular therapy in the superficial femoral and popliteal artery using long stents
Authors: Schoenefeld  , Donas P. , Schönefeld  , Osada  , Austermann  , Torsello
Published: February 2013

Background: Peripheral artery disease (PAD) affecting the femoropopliteal artery is treated by endovascular interventions [2, 5, 13] increasingly. Aim of the study was to evaluate mid-term efficacy and patency of long stents in the superficial femoral and popliteal artery. Patients and methods: Between September 2006 and September 2007 103 patients received 128 stents for endovascular treatment of femoropopliteal vascular stenosis or occlusion. Clinical and hemodynamic parameters were collected. Risk factors, popliteal involvement and TASC classification, were documented and evaluated. Results: Immediate outcome was satisfactory with a technical success rate of 100 %. After a mean follow-up period of 21 months, primary patency was 83.6 %. Potential risk factor analysis for restenosis and fracture demonstrated hypertension to have borderline significance (P = 0.06). In normotensive patients no restenosis occurred. Further pre-conditions, e.g. smoking, metabolic syndrome, age, gender and previous intervention did not show any influence on restenosis or stent fracture. TASC C and D lesion had similar patency rates compared to TASC A and B lesions. Most of the restenoses (13 out of 16) were observed within the first six months of follow-up. Six stent fracture were observed (4.7 %). Conclusions: Long stents had convincing results after endovascular treatment of the femoropopliteal PAD. The used stent was an efficacious endovascular tool for long athersclerotic lesions in the superficial femoral and popliteal artery. Fracture rate was low with an incidence of 4.7 %. Most restenoses occurred within the first six months so that careful follow-up would be necessary.
Primary splenic angiosarcoma
Authors: Liu  , Du  , Li  , Wang  , Shen  , Yao  , Zhao
Published: February 2013

Primary angiosarcoma of the spleen is a very rare but very aggressive soft tissue sarcoma due to early dissemination. The outcome of this disease is typically dismal with a mean survival of one to two years. However, our here presented case remained uncommonly symptom-free for nine years after splenectomy alone at the early phase of the disease.
Unusual abdominal aneurysms in a patient after kidney transplantation treated by endovascular technique
Authors: Synowiec  , Checinski  , Micker  , Samolewski  , Glyda  , Ast
Published: February 2013

While abdominal aortic aneurysms are quite common, visceral aneurysms are a seldomly diagnosed vascular pathology. Aneurysms of renal arteries, abdominal aorta and iliac arteries seem to be very rare. We present a patient after renal transplantation with aneurysms of both stumps of the renal arteries, abdominal aortic aneurysm and aneurysms of common iliac arteries. Because of the symptomatic course, the patient required urgent treatment. A successful endovascular procedure was performed. Follow-up imaging did not reveal any complications.
Incidental diagnosis of idiopathic gonadal vein thrombosis
Authors: Tsiouris  , Karam  , Shepard D.
Published: February 2013

Gonadal vein thrombosis is a rare but well recognized entity which predominantly occurs in the post partum period. It is also associated with gynecological malignancies, cesarean deliveries, abortions, hypercoagulability and pelvic inflammatory disease. Prompt diagnosis and treatment is warranted to avoid serious complications. We report the rare case of idiopathic, unprovoked gonadal vein thrombosis.
Health related quality of life in patients with critical limb ischemia
Authors: Lawall  , Zemmrich  , Bramlage  , Amann
Published: February 2013

Critical limb ischemia (CLI) is the terminal stage of peripheral artery disease. Research in recent years has been largely focussed on treatment options such as bypass surgery / endovascular treatment, surgery / primary amputation and additional benefits of supportive pharmacotherapy. Despite this plethora of treatment options, however, patients continue to have a reduced health related quality of life (HRQoL). Aim of the present work was to review the available evidence of improvement of HRQoL with regard to different treatment options. We found that a number of clinical studies have been conducted using HRQoL measures mostly as secondary outcomes in patients with CLI and other less severe forms of peripheral arterial disease. The studies demonstrate a consistent improvement of HRQoL over baseline within the first few months after the intervention. Prostaglandins, but no other pharmacotherapies, appear to be effective in patients without an option for revascularization. Due to a largely differing patient population under investigation and the different degrees of disease progression it appears difficult however to compare different treatment options with respect to their impact on HRQoL. HRQoL improvement as a predefined endpoint of novel therapeutic approach studies should be considered more consequently.
Drug-eluting stents for treatment of focal infrapopliteal lesions
Authors: Rastan  , Noory  , Zeller
Published: February 2013

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.
Claudication, in contrast to angina pectoris, independently predicts mortality risk in the general population
Authors: Kieback G. , Lorbeer  , Wallaschofski  , Ittermann  , Völzke  , Felix  , Dörr
Published: February 2013

Background: The aim of our analyses was to investigate whether claudication and angina pectoris, each defined and based on the answer to a single question, are predictive of future mortality. Probands and methods: The study population consisted of 3995 subjects selected from the population-based Study of Health In Pomerania (SHIP). Kaplan-Meier analysis and multivariable Cox proportional hazards regression analysis were used to analyze the association of angina pectoris and claudication with all-cause and cardiovascular mortality adjusted for major cardiovascular risk factors. Results: At baseline, 417 individuals had symptoms of angina pectoris, and 323 had symptoms of claudication. During a median follow-up of 8.5 years, 277 individuals died. Individuals with claudication had a higher fully-adjusted all-cause mortality rate (Hazard Ratio (HR) 1.79; 95 % CI 1.34, 2.39, p < 0.001) and a higher sex- and age-adjusted cardiovascular mortality rate (HR 1.76; 95 % CI 1.03, 2.99, p = 0.038) compared to subjects without claudication. In contrast, subjects with angina pectoris had neither an elevated fully-adjusted all-cause mortality rate (HR 1.15; 95 % CI 0.82, 1.61, p = 0.413) nor sex- and age-adjusted cardiovascular mortality rate (HR 0.71; 95 % CI 0.34, 1.48, p = 0.363) compared to those without this symptom. Conclusions: Claudication, in contrast to angina pectoris, is a strong, independent predictor of all-cause mortality.
Compression therapy in elderly and overweight patients
Authors: Reich-Schupke  , Murmann  , Altmeyer  , Stücker
Published: February 2013

Background: According to the current demography of the western population, age and weight will have increasing impact on medical therapies. The aim of the analysis was to examine if there are differences in the use of compression therapy depending on age and BMI. Patients and methods: Questioning of 200 consecutive phlebological patients (C2-C6) with a compression therapy time of > 2 weeks. Analysis of 110 returned questionnaires. Sub-analysis according to age (>= 60 years vs. < 60 years) and BMI (<25 kg/m2 vs. >=25 kg/m2) were made. Results: Patients >= 60 years have a leg ulcer significantly more often than patients under 60 (20 % vs. 5.9 %, p = 0.03) and frequently need more help with the compression therapy (70.9 % vs. 47.1 %, p = 0.05). 14.6 % of those > 60 years even need the help of another person to apply compression. Patients >= 25 kg/m2 have an ulcer stocking significantly more often (15 % vs. 4.3 %, p = 0.05) and need the help of family members to put on the compression therapy (11.7 % vs. 2.1 %, p = 0.04). There is a tendency of patients >= 25 kg/m2 to complain more often about a constriction of compression therapy (35 % vs. 19.2 %, p = 0.06). Conclusions: There are special aspects that have to be regarded for compression therapy in elderly and overweight patients. Data should encourage prescribers, sellers and manufacturers of compression therapy to use compression in a very differentiated way for these patients and to consider: Is the recommended compression therapy right for this patient (pressure, material, type)? What advice and adjuvants do the patients need to get along more easily with the compression therapy? Are there any new materials or adjuvants that allow those increasing groups of people to get along with compression therapy alone?
Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation
Authors: Krohn  , Gebauer  , Hübler  , Beck
Published: February 2013

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.
Late peripheral stent thrombosis due to stent fracture, vigorous exercise and hyporesponsiveness to clopidogrel
Authors: Linnemann  , Thalhammer  , Wolf  , Tirneci  , Vogl J. , Lindhoff-Last
Published: February 2013

Late peripheral arterial stent thrombosis usually occurs due to haemodynamically relevant in-stent restenosis. However, late stent thrombosis may be multicausal. We report here the well-documented case of a 69-year-old man with acute thrombosis of the stented superficial femoral artery after a long-distance bicycle tour. Catheter-directed thrombolysis revealed a residual stenosis located at a stent fracture site. In addition, platelet function tests revealed an inadequate platelet response to clopidogrel. In conclusion, stent fracture, strenuous exercise and hyporesponsiveness to clopidogrel may have contributed to the development of late peripheral stent thrombosis.
Microvascular dysfunction and pulse wave reflection characterize different vascular pathologies in patients at cardiovascular risk
Authors: Fischer-Rasokat  , Spyridopoulos  , Walter  , Honold  , Zeiher M. , Fichtlscherer
Published: February 2013

Background: Endothelial function and arterial pulse wave reflections play a crucial role in the pathogenesis of atherosclerosis. While the endothelium-dependent reactive hyperemia index (RHI) of the digital arteries is considered as a marker of microvascular function, an increased augmentation index (AI) may indicate beginning macrovascular damage. In this study we assessed the interrelationships among these noninvasive measures of vascular function. Patients and methods: In 178 all-comer patients with documented cardiovascular risk factors (22 % female; 65 % coronary artery disease, CAD), we measured radial AI (rAI) by radial applanation tonometry and digital AI (dAI) as well as RHI by using fingertip peripheral arterial tonometry. A modified SMART risk score was calculated in all participants based on cardiovascular risk factors and preexisting vascular disease. Results: dAI and rAI demonstrated a significant and robust overall correlation (Pearson rank coefficient r = 0.63, p < 0.01), which was not affected by age, sex, diabetes mellitus and CAD. In contrast, both parameters demonstrated at most a weak correlation (dAI: r = 0.26, p < 0.01 and rAI: r = 0.12, p = 0.10) with microvascular function (RHI). While dAI and rAI were significantly correlated to female sex, age, low body height, low heart rate and the presence of CAD, RHI was associated with the presence of diabetes mellitus and nicotine use. Finally, only microvascular function was associated with the modified SMART risk score, but not augmentation indices. Conclusions: RHI and increased pulse wave reflection appear to represent two distinct vascular pathologies in patients with cardiovascular risk. In contrast, RHI might be useful to identify patients at highest cardiovascular risk once atherosclerotic disease has been diagnosed.
Impact of the postthrombotic syndrome on quality of life after primary upper extremity deep venous thrombosis
Authors: Czihal  , Paul  , Rademacher  , Bernau  , Hoffmann
Published: February 2013

Background: To determine the impact of the postthrombotic syndrome (PTS) on quality of life after primary upper extremity deep venous thrombosis (UEDVT). Patients and methods: Twenty-five patients with a history of primary UEDVT, treated with anticoagulation alone, and twenty healthy controls were retrospectively identified and prospectively assessed for health-related quality of life (SF-36 and VEINES-QOL-questionnaire) and upper extremity functional impairment (DASH-score). Presence of PTS was classified according to the modified Villalta-score. Comparisons between patients and controls and between patients with and without PTS were performed using Fisher`s exact test (categorical variables) and Mann-Whitney-U-test (continuous variables). Results: According to the modified Villalta-score, 32 % of the patients suffered from mild to moderate PTS. None of the patients developed severe PTS. Compared to healthy control subjects, patients with a history of primary UEDVT reported on considerably worse health-related quality of life and significantly stronger upper extremity functional impairment. Within the cohort of patients with UEDVT, subjects with PTS had a significantly reduced quality of life and a more severe functional limitation. Conclusions: Quality of life and functional performance are impaired in patients with a history of conservatively treated primary UEDVT. Impairment is most pronounced in patients with mild to moderate PTS occurring in every third patient.
Predictive value of ankle-brachial index to all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease
Authors: Wang  , Guo  , Li  , Hu  , Zhao  , Ma  , Mou  , Liu  , Xu
Published: February 2013

Background: To investigate the predictive value of ankle-brachial index (ABI) for all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease (CKD). Patients and methods: 1563 CKD patients were enrolled in the cohort and were followed up for about 3 years in China. CKD was defined as an eGFR less than 60 ml/min/1.73m2. 573 participants were diagnosed with PAD using ABI <= 0.90. Their average age was 73.4 ±8.2 years. Results: During a median follow-up of 38 months, there were 1353 CKD patients with complete data. A total of 313 patients (161 with and 152 without PAD) died during follow-up. 184 deaths (99 with and 85 without PAD) were caused by cardiovascular disease (CVD). All-cause and CVD mortality of CKD patients with PAD was increased 2.2-fold and 2.4-fold compared with CKD patients without PAD. The hazard ratio (HR) of PAD for all-cause and CVD mortality was 2.15 (95 % CI: 1.66 - 2.79) and 2.51 (95 % CI: 1.80 - 3.50) respectively. Mortality of CKD patients significantly increased with decreasing ABI. That of CKD patients with ABI <= 0.4 was the highest (42.9 % and 28.6 %, respectively) in different ABI categories. Relative risks of all-cause and CVD mortality of CKD patients with ABI <= 0.4 were increased 3.479-fold (95 % CI: 2.076 - 5.830) and 4.960-fold (95 % CI: 2.644 - 9.302) respectively compared with those of patients with ABI > 1.0 and <= 1.4. Special models to evaluate the predictive value of ABI to mortality of CKD patients suggested that addition of ABI significantly increased the predictive value of the model for 3-year mortality compared with a model including conventional risk factors alone. Conclusions: Low ankle-brachial index can predict increased mortality of chronic kidney disease patients. Addition of ankle-brachial index can significantly improve the prediction of 3-year mortality compared with conventional risk factors alone.
Use of biosynthetic prosthesis (Omniflow II®) to replace infected infrainguinal prosthetic grafts - first results
Authors: Töpel  , Betz  , Uhl  , Wiesner  , Bröckner  , Steinbauer
Published: February 2013

Background: The current treatment standard of infected infrainguinal prosthetic vascular grafts includes total graft explantation and autologous vascular reconstruction. In the absence of appropriate autologous venous graft material prosthetic grafts with increased bacterial resistance can be used, whereas reinfection rates are still higher than after autologous reconstruction. Biosynthetic grafts have shown low postoperative infection rates when used as elective bypass material. Their higher resistance to bacterial infection could make them an alternative to replace infected prosthetic grafts in the absence of autologous material. Patients and methods: Between November 2009 and April 2011, 7 patients with infected infrainguinal prosthetic grafts (Szilagyi 3; 3 supragenicular and 4 infragenicular reconstructions) presented to our institution. There were 4 early (< 3 months after implantation) and 3 late infections (> 3 months after implantation. All grafts were explanted and replaced by biosynthetic grafts (Omniflow II®), because the patient had no suitable peripheral vein for complete autologous replacement. In 2 cases a composite graft with greater saphenous vein was done. In 6 cases microbiological cultures from intraoperatively obtained species were positive. The initial broad spectrum antibiotic therapy was continued according to the antibiogram for 6 to12 weeks. Results: There was no early or late reinfection during follow up (mean 9 months, range 4 - 20 months). During follow up we observed graft occlusions in 3 patients (1 due to kinking of the bypass, 1 due to progressive artheriosclerotic occlusion of the outflow vessels and 1 iatrogenic by external compression with a pressure cuff during arthroscopy). There were no early or late major amputations. One patient died with pneumonia 11 months postoperatively. Conclusions: In the absence of appropriate autologous material biosynthetic grafts seem to be a possible alternative to replace infected infrainguinal grafts. The different mechanical properties of biosynthetic grafts may be of certain disadvantage in infragenicular reconstructions.
A giant aneurysm of the popliteal vein
Authors: van der Voort M. , De Maeseneer R.
Published: February 2013

Popliteal vein aneurysm is a rare diagnosis, associated with a 70 % risk of pulmonary embolism, sometimes even with fatal evolution. Surgery dramatically reduces the risk of pulmonary embolism. We report a case of a 66-year-old man with recurrent pulmonary embolism and a giant popliteal venous aneurysm (9.3 × 4 × 4 cm) presenting at our dermatological clinic.
Mondors disease affecting the superficial dorsal vein of the penis
Authors: Girardi
Published: February 2013

A case of the thrombophlebitis of the superficial dorsal vein of the penis (Mondors disease of the penis) is reported. Two possible causes have been identified: a urogenital infection and a muscular strain (strength training). The first one was probably the underlying cause, the second one triggered the disease.
Sclerotherapy in an undetected pregnancy - a catastrophe?
Authors: Reich-Schupke  , Leiste  , Moritz  , Altmeyer  , Stücker
Published: February 2013

According to the guidelines and the manufacturers information, pregnancy is a contraindication for sclerotherapy with Polidocanol. However, in some cases sclerotherapy has been conducted in a period when the pregnancy is not known by the patient. When pregnancy is diagnosed, patients and gynecologists often ask the phlebologist if there is an indication for the interruption of pregnancy. Up to now, there is only rare information on sclerotherapy, polidocanol and pregnancy. Current knowledge is summed up in this article together with case reports. The existing case reports and mainly retrospective case series on intended or accidentally conducted sclerotherapy with common sclerosants and doses show no increased risk for the mother and the unborn child. However, in view of the limited literature data available and the high probability for spontaneous regression of varicose veins postpartum, sclerotherapy should be avoided in pregnancy, if possible. Conservative measures during pregnancy or an elimination of varicose veins before pregnancy should be preferred. In single cases e.g. painful genitoanal varices, the use of sclerotherapy can be helpful even during pregnancy. Thereby, a very thorough clarification of the mother with a final written consent and an implementation according to the guidelines are especially important. According to the current data, there is no reason for an interruption after a sclerotherapy that has been conducted during undetected pregnancy.
Endovascular abdominal aneurysm repair: trends in Germany
Authors: Santosa  , Moysidis  , Nowak  , Heilmaier  , Berg  , Luther  , Kröger
Published: February 2013

Background: As a minimally invasive technique endovascular aneurysm repair (EVAR) reduces the risk of mortality and should be the preferred technique used in older patients. We analysed trends in endovascular and open surgical procedures in patients hospitalized for abdominal aortic aneurysm (AAA) in Germany. Patients and methods: We used national statistics (DRG statistics) published by the Federal Office of Statistics in Germany to calculate the incidence of patients hospitalised with ruptured (rAAA) and elective (eAAA) AAA. In addition, annual procedure rates of endovascular (EVAR) procedures were calculated. Results: Incidence rates of eAAA per 100,000 males (females) showed a small increase from 2006 to 2007 but remained almost unchanged with 74.8 (8.8) in 2007 and 74.5 (9.8) in 2009. Incidence rates of rAAA per 100 000 males remained unchanged but showed a decreasing trend in females. The rate of people treated by EVAR increased form 2006 to 2009: in males from 24.0 % to 40.3 % and in females from 17.3 % to 31.0 %. In younger males (55 - 60 years) the increase in those who received EVAR was smaller (from 22.1 % to 33.9 %) than in older males (85 - 90 years) (from 20.4 to 41.6 %). Despite a clear increase in the use of EVAR from 2006 to 2009 there is only a small trend in reduction of the death rates which is more pronounced in rAAA. Conclusions: There has been a relevant increase in EVAR procedures for the treatment of AAA in Germany in recent years. Parallel to this increase of EVAR, aneurysm-related in-hospital deaths seem be declining slightly. A causal relationship between these trends remains to be proven.