TASC II classification for femoropopliteal lesions allows individual interpretations, and the common use of this classification as a basis for decision making and reporting outcomes could therefore be questioned.
Spinal cord ischemia is an uncommon complication of an abdominal aortic aneurysm (AAA). We report the case of a 59-year-old man admitted for an acute ischemic Cauda equina syndrome secondary to a spinal cord embolization from an unknown partially thrombosed aortic aneurysm. The patient being at risk of further embolization, we achieved an emergency EVAR. The vascular post-operative course was uneventful. Neurologically, a post operative lumbar medullar MRI confirmed an ischemic Cauda equina syndrome and six months after the surgery, the patient still had a motor and sensory deficit in both lower limbs.
emerged, using no thermal energy and thus being even less invasive. We made a randomized controlled trial to compare the results of mechanochemical ablation (EVMCA) to endovenous laser ablation (EVLA) and radiofrequency ablation (RF) in terms of both technical success (occlusion of the GSV) and quality of life and report results up to 3-years. Methods-The study population comprised 125 patients with GSV insufficiency and varicose veins in one leg, with clinical classification of C2-C4. We randomized them to receive either mechanochemical ablation (59 patients), laser ablation (34 patients), or radiofrequency ablation (32 patients). Local phlebectomies were performed at the same operation, if necessary. The clinical status as well as duplex doppler ultrasound examination results were recorded, and the patients filled quality of life questionnaires 3 years after the initial procedure. By the end of March 2018, 59 patients (27 EVMCA, 16 EVLA and 16 RF) had completed 3-year follow-up and all patients will be finished by mid September 2018. Results-At one month, all treated GSV's were occluded in the ultrasound examination. At one year, the most proximal 20 centimetres of the GSV was recanalized either completely or partly in seven of the EVMCA patients, but only 2 of them had reflux in recanalized part ; in EVLA and RF groups, there was no recanalization (P ¼ 0.078). At three years, proximal 20 cm was open in 7 patients in the EVMCA group and now 5 of them had also reflux in the vein. In EVLA and RF groups, there was no recanalization after 3-years. The whole GSV was recanalized either partly or completely at one year in five patients, 3 of them having reflux, in the EVMCA group, with no recanalization in EVLA or RF groups (P ¼ 0.20). The corresponding numbers at 3-years were 5 recanalized veins (all of them having reflux) in EVMCA-group and still no recanalizations in thermoablation groups. At 3-year follow-up visit, 7 patients wanted additional treatment due to their varicose veins: 4 patients in the EVMCAgroup and 3 patients in the RF-group. All these EVMCA-patients had reflux in GSV and recurrent varicose veins. The 3 patients in the RF-group had occluded GSV but open GSV tributaries.There were no statistically significant differences in QoL measures between the groups at one-or three years. Conclusion-There seems to be more recanalizations at 3year follow-up after EVMCA compared with thermoablation of GSV. Despite this difference the need of procedures for recurrent varicose veins at patient's perspective is the same between the groups.
Background: Mortality remains high after emergency open surgery for a ruptured abdominal aortic aneurysm (RAAA). The aim of the present study was to assess, if intravenous (IV) Interferon (IFN) beta-1a improve survival after surgery by up-regulating Cluster of differentiation (CD73). Methods: This is a multi-center phase II double-blind, 2:1 randomized, parallel group comparison of the efficacy and safety of IV IFN beta-1a vs. placebo for the prevention of death after open surgery for an infra-renal RAAA. All study patients presented a confirmed infra-renal RAAA, survived the primary emergency surgery and were treated with IFN beta-1a (10μg) or matching placebo for 6 days after surgery. Major exclusion criteria included irreversible hemorrhagic shock, unconsciousness at arrival, chronic renal replacement therapy, diagnosed liver cirrhosis, severe congestive heart failure, advanced malignant disease, primary attempt of endovascular aortic repair (EVAR), and per-operative suprarenal clamping over 30 minutes. Main outcome measure was all-cause mortality at day 30 (D30) from initial emergency aortic reconstruction. Results: Out of 40 randomized patients 38 were included in the outcome analyses (27 active arm and 11 placebo). Treatment groups were comparable by baseline characteristics. D30 all-cause mortality was 22.2% (6/27) in the active arm and 18.2% (2/11) in the placebo arm (OR 1.30; 95% CI, 0.21 – 8.19). The most common adverse event relating to the IFN beta-1a was pyrexia (20.7% in the active arm vs. 9.1% in the placebo arm). High level of serum CD73 associated with survival (P = 0.001) whereas the use of glucocorticoids associated with a poor CD73 response and poor survival in the active arm (P = 0.002).Conclusions: IV IFN beta-1a was well tolerated. Survival after open RAAA surgery associated strongly with up-regulation of serum CD73, but the use of glucocorticoids blocked IFN beta-1a from up-regulating CD73. Trial registration: ClinicalTrials.gov NCT03119701Funding/Support: This study was sponsored by Faron Pharmaceuticals Ltd.
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