Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem neurocutaneous genetic condition. It is characterized by TSC-associated neuropsychiatric disorders, epilepsy, tumors, and angiomyolipoma in multiple organs, such as the skin, lungs, and kidneys. TSC is also associated with the development of aneurysms of the medium and large arteries, including the renal arteries. This condition will usually be diagnosed early in life, and active surveillance is required of tumor and aneurysm growth to prevent life-threatening events. We have presented the case of a 41-year-old patient with TSC that had not been previously diagnosed. The patient had presented with retroperitoneal hematoma secondary to the rupture of two left renal artery branch aneurysms that had likely developed within the angiomyolipoma.
to 63.1% in 2018 (P ¼ .02). At 1-year follow-up, 32.7% of patients were maintained on DAPT. Patients discharged on DAPT were younger (73.0 vs 74.9 years, P < .001), more often male (80% vs 74.9%, P ¼ .04), and had a higher prevalence of cardiovascular comorbidities: coronary artery disease (36.7% vs 27.5%, P < .001) and prior coronary artery bypass graft or percutaneous coronary intervention (45.2% vs 34.3%, P < .001). Intraoperatively, the DAPT cohort had the same average number of visceral vessels treated (2.8 vs 2.7, P ¼ .09), but had a higher frequency of SMA involvement (70.4% vs 64.0%, P ¼ .02) with a higher proportion of SMA interventions involving snorkels (10.6% vs 7.0%, P ¼ .01). Immediate postoperative outcomes were similar between the two antiplatelet regimens. At 1-year follow up, the two cohorts did not differ in aneurysm size, disease extent, or overall reintervention rate. The DAPT cohort had similar visceral vessel reintervention to the aspirin cohort (4.2% vs 3.5%, P ¼ .54) (Table I). Snorkel treatment and increased number of visceral vessels treated were associated with discharge on DAPT. Increasing age, American Society of Anesthesiologists class 4 or 5, and discharge on anticoagulation were all associated with the decreased likelihood of discharge on DAPT (Table II).Conclusions: These results show an increase in utilization of DAPT after complex endovascular aortic aneurysm surgery involving visceral vessels. DAPT is used more with the snorkel technique and with increased numbers of visceral vessels treated. One-year outcomes including aneurysm size, need for reintervention, and vessel-specific reintervention do not differ based on antiplatelet regimen at discharge.
Objective: Supervised exercise therapy (SET) is recommended as the primary treatment for intermittent claudication (IC). Despite convincing data supporting the efficacy of SET as an initial treatment, implementation in clinical practice remains challenging. The aim of this study was to determine the primary treatment (SET, endovascular revascularization [ER], and open surgery) in relation to secondary lower limb revascularization and survival in patients with IC.Methods: Retrospective data analysis was performed using the national health insurance claims of all newly diagnosed IC patients in The Netherlands between January 2013 and December 2017. Analysis included Kaplan-Meier method and Cox proportional hazards regression models with adjustment for multiple confounders.Results: The 5-year cohort included 54,504 IC patients (primary SET, n ¼ 39,476; primary ER, n ¼ 11,769; and primary open surgery, n ¼ 3259). SET as primary treatment increased from 63% in 2013 to 87% in 2017. Patients who underwent ER or open surgery as a primary treatment had a higher risk of secondary revascularizations (hazard ratio [
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