• Shear wave elastography (SWE) is a group of novel ultrasound-based technologies. • Meta-analysis was employed to assess relevant studies of SWE of thyroid nodules. • SWE had high sensitivity and specificity in identifying malignant thyroid nodules. • The high negative predictive value of SWE can reduce unnecessary biopsies.
IntroductionWe analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), type A aortic dissection (type A AD) and type B aortic dissection (type B AD) in China.MethodsWe performed a systematic analysis of 935 published series on retrograde endovascular treatment for aortic diseases in China from January 1996 to November 2010. Based on the inclusion criteria, 159 studies, involving a total of 5531 patients, were included.ResultsThere were no significant differences in procedural success among the studies (P>0.05). The rates of overall neurologic complications and stroke were significantly different in all two-group comparisons (P<0.01). The type A AD patients had the highest rates of neurologic complications (both 6.67±0.00%), and the AAA patients had the lowest rates (0.31±0.04% and 0.11±0.02%). Significant differences were noted in the rates of cardiac, renal, pulmonary and visceral complications, which were all higher in the type A AD patients than in the other three groups (P<0.01). The endoleak rate was highest in the TAA patients (19.27±5.74%) and was similar in the type A AD patients (P>0.05). A significant difference was noted between the 30-day mortality rate of the type A AD patients and the AAA or type B AD patients (P<0.05).ConclusionEndovascular stent-graft is a feasible and safe treatment for aortic diseases, with high procedural success and low incidences of post-procedural complications and short-term mortality. Endovascular treatment for AAA and type B AD is more efficient than for type A AD and TAA.
the clinical strength and statistical significance of IMT changes associated with cardiovascular outcomes when compared to more direct atherosclerotic risk factors. It may also be, that atherosclerosis in the carotid artery, is not generally representative of atherosclerosis throughout the body. Atherosclerotic plaques in the carotid artery grow longitudinally at twice the rate that they grow in thickness. Therefore, IMT may be a less sensitive measure of plaque evolution than total plaque burden (Mackinnon AD, et al. Stroke 2004;35:2150-4). The bottom line, however, is that while IMT increase indicates increased cardiovascular risk, changes in IMT induced by drug therapy do not appear to reflect clinical outcome. Outcomes of EndovascularRepair of Ruptured Descending Thoracic Aortic Aneurysms Jonker FH, Verhagen HJ, Lin PH, et al. Circulation 2010;121:2718-23.Conclusions: Endovascular repair of ruptured descending thoracic aortic aneurysms (TAAs) provides encouraging results but is associated with a significant rate of neurologic complications and a relatively high rate of endoleak.Summary: Ruptured TAAs are relatively rare with reported an incidence of only about 5 per 100,000. Mortality is high and is thought to exceed 90% (Johannson G. J Vasc Surg 1995;21:985-8). There is little information on endovascular treatment of ruptured TAAs. Ruptures of true degenerative TAAs are often lumped in other series combining penetrating aortic ulcers, thoracic aortic trauma and complications of type B dissection. The authors accumulated a "pure" series of ruptured descending TAAs by identifying patients treated with endovascular repair for ruptured AA at 7 different centers between July 2002 and July 2009. There were 87 patients in this retrospective study with a mean age of 69.8 Ϯ 12 years and 69.0% were men. At presentation 40.2% were hemodynamically unstable and 21.8% were in hypovolemic shock. Following endovascular repair mortality was 18.4%. Increased 30-day mortality after adjusting for age, was associated with hypovolemic shock (OR, 4.75; 95% CI, 1.37 to 16.5; P ϭ .014) and hemothorax on admission (OR, 6.65; 95% CI, 1.64 to 27.1; P ϭ .008). Ruptured TAA s were successfully excluded during TEVAR in 95.4%. Stroke occurred in 8% (n ϭ 7). Four patients died of stroke. Post operative paraplegia occurred in 8% (n ϭ 7) and was permanent in 2 patients and transient in 5. There was an 18.4% incidence of endoleak during the first 30 days (n ϭ 16) with type 1 of endoleaks occurring in 10 patients, type 2 endoleaks in 5 patients and a type 3 endoleak in one patient. There were 2 late aortic esophageal fistulas that were fatal. Estimated freedom from aneurysm related death or intervention was 54.9% at 4 years.Comment: Short term mortality rates of TEVAR treatment of descending TAA rupture compares favorably with open repair of descending TAA rupture (Schermerhorn ML, et al. J Vasc Surg 2008;48:821-7). Endovascular repair of a descending ruptured TAA does appear to be associated with a high rate of neurologic and procedurally rel...
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