EVAS appears to be associated with reasonable 30-day outcomes despite the necessity of procedural evolution in the early adoption of this technique. EVAS appears to be applicable to patients with challenging aortic morphology and endoleak rates should reduce with procedural experience. The utility of EVAS will be defined by the durability of the device in long-term follow-up, although the absence of Type 2 endoleaks is encouraging.
The aim of this article is to review the extent of the association between established renal failure, foot ulcers, gangrene and amputation in diabetes, and to consider the possible mechanisms and clinical implications. In order to do this we used our personal knowledge of the literature, supplemented by searches of Medline and PubMed using appropriate key words. The available literature confirms the close association between established renal failure, peripheral vascular disease, foot ulcers, gangrene and amputation, and indicates that this association is between three and five times greater in diabetes. Once they occur, foot complications are associated with a high mortality. There are multiple possible mechanisms underlying the association, and these include those leading to accelerated peripheral arterial disease, as well as the anaemia and metabolic features of renal failure. There is also evidence that the process of dialysis is itself associated with worsening tissue hypoxia. The results of lower limb revascularisation in established renal failure are poor. We conclude that there is a need for further detailed studies into the factors leading to this association, as well as into the effectiveness of potential interventions. The place of pre-emptive vascular intervention needs to be established. In the meantime, all those responsible for the management of impending and established renal failure in diabetes should remain aware of the possibility of foot disease and should ensure that a structured programme of preventive foot care is implemented.
Reliable models of aortic aneurysms are required to test endovascular stent-graft technology prior to human use. We describe the creation of a standardized prosthetic aneurysm in an ovine model to assess endovascular technology. In an adult ovine model under general anesthesia, a polyester sphere measuring 6 cm across was sutured onto the infrarenal aorta following aortotomy. Two weeks later an endovascular stent-graft was deployed in the aorta. Exclusion was confirmed on monthly ultrasound duplex and during angiography at three months and under terminal anesthesia at six months. Autopsy along with histology of the specimen were then performed. A total of 10 sheep underwent aneurysm implantation. Nine received a straight tube endovascular stent-graft (Lombard Medical, Abingdon, Oxon, UK) and seven completed the study. Five prosthetic aneurysms shrank during serial imaging with duplex ultrasound and angiography. However, two remained the same size. One of these had a type I endoleak whereas the other had endotension (type I endoleak confirmed at autopsy). This animal model provides a reliable and reproducible method of creating prosthetic aneurysms for assessing endovascular stent-grafts. It was possible to assess aneurysm exclusion non-invasively using duplex ultrasound. Aneurysms effectively excluded from the circulation shrank whereas those with an endoleak did not.
Objectives: Utility is a health state value that is influenced by disease, treatments or policy. The use of the EuroQOL five dimension questionnaire (EQ-5D) has been frequently implemented to measure utility in cardiovascular (CV) disease. The objective of the analysis was to report baseline EQ-5D estimates in high CV risk patients with hypercholesterolemia not optimally treated with maximally tolerated statins ± other lipid-lowering treatments. MethOds: Baseline EQ-5D was calculated via pooled analysis of the ODYSSEY FH I, FH II, HIGH FH, COMBO I, COMBO II and LONG TERM registered clinical trials to assess the efficacy and safety of alirocumab for lowering low-density lipoprotein cholesterol (LDL-C) in high CV risk patients. High CV risk patients included: history of recent acute coronary syndrome (ACS); coronary heart disease (CHD); ischemic stroke (IS); peripheral artery disease (PAD); and heterozygous familial hypercholesterolemia (HeFH). The five EQ-5D item scores were estimated and the UK tariff was applied. Results were calculated for each patient segment and were not mutually exclusive, i.e. patients may have had a history of > 1 of the above-mentioned CV conditions. Results: 4,203 patients with baseline EQ-5D were included. Mean age was 59 years and 63% were male. Results by patient segment were: ACS 0-12 months, age 56 years, utility 0.844; ACS 12-24 months, age 59 years, utility 0.858; CHD, age 61 years, utility 0.851; IS, age 64 years, utility 0.797; PAD, age 63 years, utility 0.771; HeFH, age 53 years, utility 0.905. cOnclusiOns: Unadjusted results suggest that the mean baseline EQ-5D for all high CV risk patients ranges from 0.771 for PAD patients to 0.905 for HeFH patients. These results are important for informing the utilities of high CV risk patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.