RESUMEN
INTRODUCTION: Restenosis by myointimal hyperplasia after peripheral arterial angioplasty or stenting often limits long term patency. Drug-eluting balloons (DEBs) which inhibit the proliferation of neo-intimal growth of vascular smooth muscle cells may prevent restenosis. The aim of this paper was to examine the evidence in published literature on the use of DEBs in the treatment of peripheral arterial in-stent restenosis (ISR). EVIDENCE ACQUISITION: A systematic literature review was undertaken of all published literature on the treatment of peripheral ISR with drug eluting balloon using Medline and cross-referenced. All published papers on the use of DEBs in peripheral arterial disease (PAD) were used. Cochrane Central Register of Controlled Trials and electronic databases were also searched for on-going studies. EVIDENCE SYNTHESIS: There were no level 1 or 2 evidence published on this subject. The number of high-quality publications is few, and consequently a sufficient analysis is not possible. Recently data from non-randomized cohort studies showed encouraging results with DEB as treatment modality for ISR, whether used alone or as combined strategies. CONCLUSIONS: Evidence from the published literature suggests that DEBs are safe in preventing peripheral ISR. Despite strong corporate pressure for the use of DEBs, there is only circumstantial evidence that this is a useful modality for ISR. Results from on-going studies may allow further meta-analysis for efficiency and cost-effectiveness.
Asunto(s)
Angioplastia de Balón/instrumentación , Fármacos Cardiovasculares/administración & dosificación , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/terapia , Stents , Dispositivos de Acceso Vascular , Angioplastia de Balón/efectos adversos , Animales , Fármacos Cardiovasculares/efectos adversos , Humanos , Hiperplasia , Neointima , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Recurrencia , Retratamiento , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
BACKGROUND: Hybrid procedures with combined open extra-anatomical supra-aortic bypasses and endovascular surgery are less invasive for patients with complex aortic arch pathology. The aim of this paper is to report patients who developed retrograde type A aortic dissection following initially successful hybrid endovascular treatment. METHODS: Retrospective review of prospectively collected computerized departmental database. All patients with supra-aortic hybrid endovascular surgery and post-procedure retrograde type A dissection were identified. Patient demographics, comorbid conditions, perioperative parameters, procedural details and post-operative complications were collected. RESULTS: From May 2005 to July 2014, 163 patients underwent thoracic aortic endovascular procedures at our institution. From the 46 patients who had supra-aortic hybrid endovascular repair, six patients (6/46, 13% of all supra-aortic hybrid cases, 3 males) developed retrograde type A aortic dissection. All were elective cases, with 3 chronic dissecting aneurysms and 3 atherosclerotic aneurysms. All had one-stage hybrid procedures: 2 patients had carotid-carotid bypass grafts, one had carotid-carotid-left subclavian bypass graft, and 3 had bypass grafts from ascending aorta to innominate artery and left carotid artery. Five patients had Cook Zenith thoracic stent-grafts (Cook Medical, Bloomington, IN, USA), and one had Medtronic Valiant stent-grafts (Medtronic Vascular Inc, Santa Rosa, CA, USA). The retrograde type A dissection occurred with sudden symptoms at day 5, 6, 10, 20, 105 and 128, respectively. There were 3 immediate fatalities and 2 patients treated conservatively deemed unfit for reintervention (one died of pneumonia at 9 months, and one remained alive at 7 months post-complication). One patient underwent successful emergency open surgery and survived. CONCLUSIONS: Supra-aortic hybrid procedures in treating aortic arch pathology may be at risk of developing retrograde type A dissection. This post-operative complication inevitably have poor outcome, even with early diagnosis and prompt treatment.
Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Complicaciones Posoperatorias/etiología , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/mortalidad , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Femenino , Hong Kong , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: The new technology of biodegradable scaffolds has the advantage of "leaving nothing behind", whilst allowing the vessel to restore to normal wall integrity. This new approach attempts to circumvent the chronic local inflammatory reaction due to permanent implantation of a foreign body. The aim of this paper was to examine the published literature on the use of biodegradable stents in the treatment of peripheral arterial diseases (PAD). EVIDENCE ACQUISITION: Systematic review was formulated under the instruction of PRIMSA guideline. Papers published from January 2005 to March 2015 in English language were included. Published studies on biodegradable scaffolds or stents in the treatment of PAD were systematically searched and reviewed through a computerized search of Pubmed and Ovid MEDLINE and cross-referenced. Key words include "biodegradable scaffolds", "biodegradable stents", "femoral", "lower limb", "peripheral arterial disease" and "peripheral vascular disease". All relevant published papers which fulfilled these criteria were reviewed. On-going studies from other electronic databases were also examined. EVIDENCE SYNTHESIS: A total of 75 non-duplicated publications were identified, but only 6 articles were eligible into our qualitative analysis (one animal study, 3 case-cohort studies, and 2 randomized studies). In all, 325 stents were used in 282 patients. Technical success rates were 100%. These studies had a short to medium follow-up period up to 58 months. The primary and secondary patency rates were 60.8% (range 32-77%) and 88.4% (range 79-97%) respectively. There are also four on-going studies internationally. CONCLUSIONS: Contemporary published literature suggests that biodegradable scaffold is safe and effective in the treatment of PAD, but these studies were heterogeneous and were limited by their study design, relatively small sample size, and short follow-up period; and therefore do not produce a high enough level of evidence to show superiority that leads to a change in current treatment guidelines.
Asunto(s)
Implantes Absorbibles , Procedimientos Endovasculares/instrumentación , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/terapia , Stents , Andamios del Tejido , Animales , Procedimientos Endovasculares/efectos adversos , Medicina Basada en la Evidencia , Humanos , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Diseño de Prótesis , Factores de Riesgo , Resultado del TratamientoRESUMEN
This study investigated greenhouse gas (GHG) emissions from three different home waste treatment methods in Brisbane, Australia. Gas samples were taken monthly from 34 backyard composting bins from January to April 2009. Averaged over the study period, the aerobic composting bins released lower amounts of CH(4) (2.2 mg m(- 2) h(-1)) than the anaerobic digestion bins (9.5 mg m(-2) h(-1)) and the vermicomposting bins (4.8 mg m(-2) h( -1)). The vermicomposting bins had lower N(2)O emission rates (1.2 mg m(-2) h(- 1)) than the others (1.5-1.6 mg m(-2) h( -1)). Total GHG emissions including both N(2)O and CH(4) were 463, 504 and 694 mg CO(2)-e m(- 2) h(-1) for vermicomposting, aerobic composting and anaerobic digestion, respectively, with N(2)O contributing >80% in the total budget. The GHG emissions varied substantially with time and were regulated by temperature, moisture content and the waste properties, indicating the potential to mitigate GHG emission through proper management of the composting systems. In comparison with other mainstream municipal waste management options including centralized composting and anaerobic digestion facilities, landfilling and incineration, home composting has the potential to reduce GHG emissions through both lower on-site emissions and the minimal need for transportation and processing. On account of the lower cost, the present results suggest that home composting provides an effective and feasible supplementary waste management method to a centralized facility in particular for cities with lower population density such as the Australian cities.