Concomitant carotid artery disease and aortic valve disease is common. Whereas carotid stenosis does not appear to have an effect on outcomes of patients undergoing aortic valve replacement, the management of a patient with symptomatic carotid disease and severe aortic stenosis is challenging. The advent of minimally invasive endovascular techniques has provided less invasive and effective treatment options for these respective conditions. In this report, we describe two cases of patients successfully treated with concomitant transcatheter aortic valve replacement and transcarotid artery revascularization.
Chronic limb‐threatening ischemia (CLTI) is associated with significant morbidity, including major limb amputation, and mortality. Healing ischemic wounds is necessary to optimize vascular outcomes and can be facilitated by dedicated appointments at a wound clinic. This study aimed to estimate the association between successful wound care initiation and 6‐month wound healing, with specific attention to differences by race/ethnicity. This retrospective study included 398 patients with CLTI and at least one ischemic wound who scheduled an appointment at our wound clinic between January 2015 and July 2020. The exposure was the completion status of patients' first scheduled wound care appointment (complete/not complete) and the primary outcome was 6‐month wound healing (healed/not healed). The analysis focused on how this association was modified by race/ethnicity. We used Aalen‐Johansen estimators to produce cumulative incidence curves and calculated risk ratios within strata of race/ethnicity. The final adjustment set included age, revascularization, and initial wound size. Patients had a mean age of 67 ± 14 years, were 41% female, 46% non‐White and had 517 total wounds. In the overall cohort, 70% of patients completed their first visit and 34% of wounds healed within 6‐months. There was no significant difference in 6‐month healing based on first visit completion status for White/non‐Hispanic individuals [RR (95% CI) = 1.18 (0.91, 1.45); p‐value = 0.130], while non‐White individuals were roughly 3 times more likely to heal their wounds if they completed their first appointment [RR (95% CI) = 2.89 (2.66, 3.11); p‐value<0.001]. In conclusion, non‐White patients were approximately three times more likely to heal their wound in six months if they completed their first scheduled wound care appointment while White/non‐Hispanic individuals' risk of healing was similar regardless of first visit completion status. Future efforts should focus on providing additional resources to ensure minority groups with wounds have the support they need to access and successfully initiate wound care.This article is protected by copyright. All rights reserved.
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