A 39-year-old female visited our cardiovascular outpatient department with paresthesia and soreness around the right popliteal fossa, where thrill was palpable. There was no history of trauma, apart from her having undergone acupuncture several years previously. An arteriovenous fistula (AVF) was diagnosed by vascular ultrasonography and magnetic resonance imaging. Angiography confirmed the presence of an AVF fed by the medial geniculate artery. Transarterial embolization was performed to close the AVF using coils and tissue adhesive. To the best of our knowledge, acupuncture-induced AVF has not been previously reported. We present a case demonstrating the merits of percutaneous endovascular intervention for treating this rare complication. The additional administration of a tissue adhesive can achieve complete closure of the AVF in the event of an unsatisfactory result following coil embolization. Doctors should be aware of the potential vascular complications of acupuncture, and of the management options.
he use of commercialized statins in the prevention of cardiovascular diseases (CVD) has commonly been accepted based on the informative results of the Cholesterol Treatment Trialists (CTT) reports [1] As an additional effort in the prevention of CVD, professional societies have issued practical recommendations for healthcare providers on the effective use of statins in lowering low-density-lipoprotein cholesterol (LDL-C) [2]. Among these statins, atorvastatin and rosuvastatin are regarded as the most effective as they can reduce more than 30% of LDL-C, even at low doses (i.e. atorvastatin 10 mg; rosuvastatin 5 mg) [2]. The results of the recent HOPE-3 study [3], in which 10 mg rosuvastatin was found to reduce the development of CVD by 24% in intermediate-risk persons, may reinforce the role of rosuvastatin in CVD prevention. However, there are some concerns regarding the use of rosuvastatin.Based on the CTT report [1] and our recent literature review [4], 6 atorvastatin and 4 rosuvastatin studies, characterized by their rigorous double-blind, randomized, placebo-controlled study designs, have been published in the past two decades. A meta-analysis using a random effect model showed that atorvastatin significantly reduced the risk of CVD, with an odds ratio (OR) of 0.82 (95% CI: 0.75-0.90, p <0.001, Figure 1). In contrast, the results of a meta-analysis including the 4 rosuvastatin trials failed to detect a significant reduction in CVD risk, with an OR of 0.86 (0.69-1.07, p = 0.163). Surprisingly, the effect of rosuvastatin in CVD risk prevention remained controversial, even after inclusion of the encouraging HOPE-3 study [3] in the analysis, which then yielded an overall OR of 0.84 (0.70-1
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