Determination of Risk Factors and Establishment of a Prediction Model for Immediate Technical Failure during Endovascular Treatment of Femoropopliteal Occlusive Disease

2018 ◽  
Vol 48 ◽  
pp. 35-44 ◽  
Author(s):  
Yi-Hui Qiu ◽  
Guan-Feng Yu ◽  
Huan-Hao Zhou ◽  
Hu-Wei Xia ◽  
Li Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prediction Model ◽  
Endovascular Treatment ◽  
Occlusive Disease ◽  
Technical Failure

scholarly journals Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease

2019 ◽  
Vol 8 ◽  
pp. 204800401982894 ◽  
Author(s):  
Rafael de Athayde Soares ◽  
Marcelo Fernando Matielo ◽  
Francisco Cardoso Brochado Neto ◽  
Ana Paula Maia Pires ◽  
Rogério Duque de Almeida ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Limb Salvage ◽  
Popliteal Artery ◽  
Cox Regression ◽  
Vessel Diameter ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Small Vessel ◽  
Technical Failure ◽  
Factors Associated

Objectives In this paper, we report the long-term outcomes of the endovascular treatment of femoropopliteal occlusive disease, focusing on the importance of calcification and runoff outflow on limb salvage and patency, and the factors associated with these outcomes at a single center. Methods This retrospective cohort study included consecutive patients with femoropopliteal occlusive who underwent femoropopliteal angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between January 2015 and July 2017. Results In total, 86 femoropopliteal occlusive angioplasties were performed in 86 patients, with an initial technical success rate of 95.34%. The mean ± standard deviation follow-up time was 880 ± 68.84 days. The analysis was performed at 720 days. Technical failure occurred in four patients, who were excluded from the analysis, leaving 82 patients and 82 femoropopliteal occlusive angioplasties. The estimated primary patency, secondary patency, limb salvage, and overall survival rates at 720 days were 60%, 96%, 90%, and 82.5%, respectively. In univariate and multivariate analyses, Cox regression showed worse primary patency rates in patients with one tibial vessel or isolated popliteal artery runoff ( p = 0.005), calcification grade 4 ( p = 0.019), calcification grade > 2 ( p = 0.017), small vessel diameter < 4 mm ( p = 0.03) or primary angioplasty without stenting ( p = 0.021). A univariate analysis showed worse limb salvage in patients with one tibial vessel or isolated popliteal artery runoff ( p = 0.039). Conclusions In this study, the main factors associated with worse outcomes in the endovascular treatment of femoropopliteal occlusive in terms of loss of primary patency were one tibial vessel or isolated popliteal artery runoff, calcification grade 4, or calcification grade > 2, small vessel diameter < 4 mm, and no stents use. One tibial vessel or isolated popliteal artery runoff was also associated with limb loss in a univariate Cox regression analysis.

PREDICTION MODEL OF PROBABILITY ESTIMATE OF FATAL CASES IN INFANTS WITH CONGENITAL MALFORMATIONS IN SURGICAL INTERVENTIONS

2021 ◽  
Vol 8 (2) ◽  
pp. 57-61
Author(s):  
Alexey O. Vlasov ◽  
Iryna A. Holovanova
Keyword(s):  
Risk Factors ◽  
Prediction Model ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Anesthesia Care ◽  
Surgical Interventions ◽  
Different Types ◽  
Combined Anesthesia ◽  
Simple Logistic

Aim: To evaluate different types of combined anesthesia in surgical correction of congenital malformations in infants and to develop a prediction model of the association of risk factors and fatal cases in chosen methods of anesthesia care. Material and methods: The retrospective study included newborns and infants with congenital malformations, who received and continued phased surgical treatment. Determination of risk factors was performed by the method of simple logistic regression with the calculation of the odds ratio (OR), 95% confidence interval (95% CI). Results: A total of 150 children were included in the study. The risk factors for deaths in the surgical correction of congenital malformations in children have been established, a prognostic model has been created. Conclusions: To prevent fatal cases in various types of surgery and options for anesthesia care of newborns and infants with CM, it is advisable to more closely monitor the cerebral, peripheral oximetry at all stages of treatment and timely correct the impaired condition of the child.

Malignant infarction after endovascular treatment: Incidence and prediction

2021 ◽  
pp. 174749302110062
Author(s):  
Marie Louise E Bernsen ◽  
Frans Kauw ◽  
Jasper M Martens ◽  
Aad van der Lugt ◽  
Lonneke SF Yo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prediction Model ◽  
Endovascular Treatment ◽  
Characteristic Curve ◽  
Binary Logistic Regression Model ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Model Combining ◽  
Malignant Infarction ◽  
Lemeshow Test

Background Early prediction of malignant infarction may guide treatment decisions. For patients who received endovascular treatment, the risk of malignant infarction is unknown and risk factors are unrevealed. Aims The objective of this study is to estimate the incidence of malignant infarction after endovascular treatment in patients with an occlusion of the anterior circulation, to identify independent risk factors, and to establish a model for prediction. Methods We analyzed patients who received endovascular treatment for a large vessel occlusion in the anterior circulation within 6.5 h after symptom onset, included in the Dutch MR CLEAN Registry between March 2014 and June 2016. We compared patients with and without malignant infarction. Candidate predictors were incorporated in a multivariable binary logistic regression model. The final prediction model was established using backward elimination. Discrimination and calibration were evaluated with the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test. Results Of 1445 patients, 82 (6%) developed malignant infarction. Independent predictors were lower age, higher National Institutes of Health Stroke Scale (NIHSS), lower alberta stroke program early CT score (ASPECTS), internal carotid artery occlusion, lower collateral score, longer times from onset to groin puncture, and unsuccessful reperfusion. The AUROC of a prediction model combining these features was 0.83 (95% confidence interval (CI): 0.79–0.88) and the Hosmer-Lemeshow test indicated appropriate calibration (P = 0.937). Conclusion The risk of malignant infarction after endovascular treatment started within 6.5 h of stroke onset is approximately 6%. Successful reperfusion decreases the risk. A prediction model combining easily retrievable measures of age, ASPECTS, collateral status, and reperfusion shows good discrimination between patients who will develop malignant infarction and those who will not.

Determination of the prevalence of helicobacter pylori oral infection in smoking patients with chronic generalized periodontitis on the background of chronic hyperacidal gastritis during treatment

2020 ◽  
Vol 40 (4) ◽  
pp. 50-54
Author(s):  
O. L. Zolotukhina ◽  
◽  
Ju. G. Romanova ◽  
O. V. Maslov ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Oral Cavity ◽  
Urease Activity ◽  
Rapid Test ◽  
Oral Infection ◽  
Helicobacter Pylori Infection ◽  
Natural Origin ◽  
Periodontal Tissues

Diseases of periodontal tissues occupy one of the leading positions among modern dental problems, namely the multifactorial nature of these diseases. In modern dental science, the issue of the development of periodontal pathology against the background of somatic pathology and risk factors remains relevant. Pathology of periodontal tissues in 68–90 % of cases is accompanied by chronic diseases of the gastrointestinal tract. Today, there is no doubt that Helicobacter pylori infection can be present in the biotopes of the oral cavity and can affect the course of periodontal pathology. As you know, smoking is one of the important risk factors for the development of inflammatory-dystrophic diseases of periodontal tissues, which can aggravate the course of the latter. The purpose of the work is to determine the prevalence of oral Helicobacter pylori infection in tobacco-dependent patients with chronic generalized periodontitis on the background of chronic hyperacid gastritis during treatment. Patients who received the proposed therapeutic and prophylactic complex (ultraphonophoresis procedures with the created gel «Apisan», and probiotic drug BioGaia ProDentis and angioprotective drug of natural origin — Detralex) showed a gradual decrease in the level of total urease activity and, as a consequence, a decrease the prevalence of Helicobacter pylori infection in the oral cavity according to the results of a urease rapid test with material from the oral cavity, both in the presence of a risk factor — smoking, and in its absence. The use of the proposed therapeutic and prophylactic complex proved to be effective in reducing the prevalence of oral Helicobacter pylori infection in smoking patients and patients who do not smoke, with chronic generalized periodontitis against the background of chronic hyperacidal gastritis associated with Helicobacter pylori.

scholarly journals Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Luca Giannella ◽  
Lillo Bruno Cerami ◽  
Tiziano Setti ◽  
Ezio Bergamini ◽  
Fausto Boselli
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Prediction Model ◽  
Endometrial Hyperplasia ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Stepwise Logistic Regression ◽  
Simultaneous Presence ◽  
Endometrial Pathology

Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.

Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110232
Author(s):  
Peixian Gao ◽  
Changliang Li ◽  
Xuejun Wu ◽  
Gang Li ◽  
Dianning Dong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Occlusive Disease ◽  
Metal Stents ◽  
Infrarenal Aorta ◽  
Bare Metal ◽  
Stent Grafts ◽  
Aortoiliac Occlusive Disease

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

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