No abstract

No abstract

This review is intended to help clinicians and patients understand the present state of peripheral artery disease, appreciate the progression and presentation of critical limb ischemia/chronic limb-threatening ischemia, and make informed decisions regarding inflow and outflow endovascular revascularization and surgical treatment options within the context of current debates in the medical community. A controlled literature search was performed to obtain research on outcomes of critical limb ischemia patients undergoing complete leg revascularization for peripheral artery disease inflow and outflow disease. Data for this review were identified by queries of medical and life science databases, expert referral, and references from relevant papers published between 1997 and 2019, resulting in 48 articles. The literature review herein indicates that endovascular revascularization—including ballooning, stenting, and atherectomy—is an effective peripheral artery disease therapy for both above the knee and below the knee disease, and can safely and effectively treat both inflow and outflow disease. As such, it plays a leading role in the therapy of lower extremity artery disease.

No abstract

[Cancer Biology & Therapy 5:12, 1654-1657, December 2006 ABstrACtDendritic cells (DCs) possess the unique abilities to initiate a primary immune response and to present antigens to naïve T lymphocytes. Recently, there has been a rapidly growing interest in the use of DCs in active specific immunotherapy (ASI) for the treatment of patients with cancer. In the present study, we determined the ability of DCs to express Melanoma-Associated Antigens (MAAs) from a polyvalent Melanoma Vaccine (DC-MelVac; Patent #11221/5) developed in our facility. The vaccine consists of a recombinant IL-2 gene-encoded vaccinia melanoma oncolysate (rIL-2VMO) derived from an established human melanoma cell line. Our results show that r-IL2VMO-pulsed DCs express MAAs presented by the Mel-2 melanoma cell line oncolysate used in this study. We believe that these promising results will prove useful as an active specific immunotherapeutic agent for patients with Stage III melanoma.

Aim:The incremental cost of peripheral orbital atherectomy system (OAS) plus balloon angioplasty (BA) versus BA-only for critical limb ischemia was estimated. Materials & methods: A deterministic simulation model used clinical and healthcare utilization data from the CALCIUM 360• trial and current cost data. Incremental cost of OAS + BA versus BA-only included differential utilization during the procedure and adverse-event costs at 3, 6 and 12-months. Results: For every 100 procedures, incremental annual costs to the hospital were US$350,930 lower with OAS + BA compared with BA-only. Despite higher upfront costs, savings were realized due to reduced need for revascularization, amputation and end-of-life care over 6-12-month postoperative period. Conclusion: Atherectomy with OAS prior to BA was associated with cost savings to the hospital. Critical limb ischemia (CLI) is the most serious manifestation of peripheral artery disease (PAD). Considered as the 'end stage' of PAD, it involves a chronic lack of blood supply leading to persistent ischemic rest pain in the feet or toes, nonhealing wounds and ulcers, and gangrene [1]. CLI often results in amputation of the affected limb(s) with roughly 25% of CLI patients receiving at least one lower extremity amputation [2]. The economic burden of CLI-diagnosed Medicare patients exceeds US$3.1 billion annually, with most of this cost reflecting the high incidence of hospitalizations related to limb loss and the need for major amputation [3].Treating CLI patients has remained quite challenging, since the associated calcification requires a unique mechanism of action to treat the lesion without damaging the vessel [4]. Balloon angioplasty (BA) continues to be the first-line of revascularization strategy in patients where procedural success via less invasive, nonsurgical approach is favored despite consistently poor intermediate and long-term patency outcomes [5,6]. The latter has been attributed to the presence of calcified plaque in femoropopliteal lesions, with arterial wall calcium associated with higher rates of procedural complications, and flow-limiting dissections that frequently require stent deployment in order to maintain vessel patency [4][5][6]. Furthermore, restenosis rates as high as 40-60% within 1 year of postprocedure and poor correlation between primary patency and limb preservation have been reported. But the American College of Cardiology/American Heart Association guidelines currently recommend against primary stenting of femoropopliteal lesions with atherectomy and stent devices indicated for 'bailout' purposes following suboptimal BA results [5]. Stenting in calcified segments after a prior failed BA often results in stent under expansion and malapposition [6,7]. These are recognized predictors of long-term stent patency and indicate an increased risk of

Objective: We previously analyzed changes in aortic size over the cardiac cycle for patients with aortic valve stenosis but no aortic disease. In this study, we analyzed patients with descending thoracic aortic aneurysm (DTA) and DeBakey type III aortic dissection (AD).Methods: Electrocardiography-gated cardiac computed tomography scans of DTA and AD patients were analyzed. Standardized measurements were made in systole and diastole to determine radial aortic strain and distensibility for 10 anatomic locations along the aortic arch and longitudinal strain for Ishimaru landing zones 0, 1, and 2.Results: Our previous study found age and body mass index to be significant confounding factors on aortic strain, but patients with DTA (n ¼ 10) and AD (n ¼ 19) were not significantly different in terms of age (71 6 8 vs 68 6 11 years; P ¼ .37) or body mass index (29.8 6 3.6 vs 30.8 6 11.4 kg/m 2 ; P ¼ 0.74). Diastolic aortic diameter was greater in patients with DTA vs AD at the sinotubular junction (40.4 6 6.2 mm vs 34.5 6 7.1 mm; P ¼ .03) and in the mid-ascending aorta (46.8 6 5.6 mm vs 37.9 6 4.5 mm; P < .001) but not significantly different at the other locations along the arch. The length of Ishimaru landing zones 0 to 2 was not significantly different for DTA vs AD (Table ). There were no significant differences between the two groups at any location. Radial distensibility ranged between 2.3 Â 10 À3 mm Hg À1 and 7.7 Â 10 À3 mm Hg À1 for the different locations along the arch in DTA patients vs 1.6 Â 10 À3 mm Hg À1 and 8.3 Â 10 À3 mm Hg À1 in AD patients, with no significant differences at any location.Conclusions: The aortic arch has similar dimensions in DTA and AD patients, except for the ascending aorta, which is wider in DTA patients. DTA patients and AD patients show limited radial strain and distensibility in the aortic arch. Longitudinal strain is significant only in the ascending aorta for both DTA and AD patients. This may have implications for stent graft sizing, especially for thoracic endovascular aortic repair procedures with proximal landing zone 0.

No abstract