Incidence Of Vascular Complications Research Articles

Role of Prophylactic Intra-Aortic Balloon Pump in High-Risk Patients Undergoing Percutaneous Coronary Intervention

Intra-aortic balloon pump (IABP) has been shown to support patients who are at high risk for percutaneous coronary interventions (PCIs) or becoming hemodynamically unstable during PCI, but the longer term outcomes of these strategies are unknown. This study investigated the outcomes of high-risk patients who received a prophylactic IABP (P-IABP) versus patients who required rescue IABP (R-IABP) because of intraprocedural complications. Clinical outcomes of 68 consecutive patients (69 procedures) who underwent high-risk PCI with P-IABP support were compared with those of 46 patients who required R-IABP. Patients who presented with cardiogenic shock or acute ST-segment elevation myocardial infarction, and those who were on mechanical ventilators were excluded. Clinical baseline characteristics were similar between groups except for more diabetics and patients with hypercholesterolemia in the P-IABP group. The procedural success was higher in the P-IABP group, with lower in-hospital mortality and major complications, than in the R-IABP group. At 6 months, the mortality and major adverse cardiac event rates were lower in the P-IABP group (8% vs 29%, p < 0.01, and 12% vs 32%, p = 0.02, respectively). Multivariate analysis showed that prophylactic insertion of an IABP is the only independent predictor of survival at 6 months. The incidence of vascular complications was low and comparable except for more major bleeding (15% vs 3%, p = 0.03) in the R-IABP group. In conclusion, patients who undergo high-risk PCI and then receive P-IABP support have favorable outcomes compared with those who require R-IABP for intraprocedural complications. Therefore, in high-risk patients undergoing PCI, liberal use of a P-IABP should be considered.

Outcomes of split versus reduced‐size grafts in pediatric liver transplantation

Split-liver transplantation, where two grafts are created from a single donor organ, is a means of overcoming donor organ scarcity. There are few data comparing outcomes of split with reduced-size liver grafts, which is the most common type of cadaveric graft in pediatric liver transplantation. The aims of the present paper were to compare survival and complication rates between split and reduced-size cadaveric grafts in pediatric patients receiving a liver transplant in Brisbane. Review of the Queensland Liver Transplant Service database was undertaken. All pediatric patients who received either a cadaveric split or reduced-size graft between 1985 and 2000 were examined. The incidence of patient and graft survival, vascular complications and biliary complications were identified. A total of 251 liver transplants were performed of which 138 were reduced-size grafts and 30 were split grafts. There were no differences in etiology of liver disease, mean age, weight, and urgency of transplant between the two groups. One-year patient and graft survivals were comparable at 73% and 67%, respectively, in both groups. There was no difference in the incidence of vascular complications between groups. Biliary complications were significantly more common after split grafts when compared with reduced-size grafts (21%vs 4%, P < 0.0001) but did not affect patient or graft survival. Survival and vascular complications after split-liver grafts were comparable to outcomes after reduced-size grafts. Biliary complications occur more commonly with split-liver grafts but did not affect patient or graft survival. It is recommended that every pediatric recipient be considered for a split-liver graft.

Effects of Three Groin Compression Methods on Patient Discomfort, Distress, and Vascular Complications Following a Percutaneous Coronary Intervention Procedure

Incidence of vascular complications (VCs) after sheath removal following a percutaneous coronary intervention procedure (PCIP) vary widely by the compression method used to achieve femoral artery hemostasis. To determine if one groin compression method causes the least discomfort and distress for patients and results in fewer VCs. Patients (n = 306, mean age = 62.3 years, 77% male, 96.4% Caucasian) undergoing PCIPs at a tertiary care center in the urban Midwest participated in this three-group experimental design study. They were randomly assigned to Femostop, C-clamp, or manual compression and rated level of groin discomfort and distress on a 0-10 Numeric Rating Scale (NRS) prior to, during, and after arterial compression was released. The groin area was assessed for any VCs (oozing, ecchymosis, hematoma) prior to sheath removal, after compression released, and 12 and 24 hr after sheath removal. No significant differences were found by compression method for discomfort, distress, or VCs. Regardless of method, not having a VC prior to femoral sheath removal contributes to less oozing (z = -3.1, p = .0019), hematoma (z = -9.4, p < .0001), and ecchymosis(z = -10.1, p < .0001). C-clamp contributes to less oozing when hemostasis time is < 30 min (z = -2.2, p = .03), and Femostop is superior when time to hemostasis is >30 min (z = -2.3, p = .02). Not receiving eptifibatide (Integrilin) contributes to less ecchymosis (z = -2.9, p = .004). Nurses need to be vigilant when caring for patients who have a VC prior to femoral sheath removal and have received antiplatelet medications. Further research is needed to identify patient characteristics that may contribute to VCs.

Cerebrovascular disease in highly active antiretroviral therapy–treated individuals: Incidence and risk factors

The occurrence of cerebrovascular events in patients infected by human immunodeficiency virus (HIV) has been traditionally associated with opportunistic infections and tumors, and/or advanced stages of immunosuppression. The current use in the clinical practice of antiretroviral treatment (ART) has been associated with a dramatic reduction of HIV-related mortality. Due to the increase of median age of HIV-infected subjects and to the ART-induced lipid abnormalities, an increasing incidence of vascular complications has been reported in this population. The potential contribution of these novel mechanisms should be considered and added to the classic vascular risk factors in the HIV-infected population and the cardiac abnormalities frequently observed in these patients. Large-scale epidemiological studies are needed to better define the incidence of cerebrovascular events in HIV-infected patients and the factors associated with their occurrence.

Management and Outcome of Living Kidney Grafts with Multiple Arteries

Kidney allografts with multiple renal arteries (MRAs) have been used with increasing frequency since the advent of laparoscopic live donor nephrectomy. To determine if MRA grafts affect the short- and long-term outcomes of grafts and patients, we analyzed 340 grafts procured by open nephrectomy. We divided the graft recipients into five groups according to the methods used for vascular reconstruction. We compared patient and graft survival, serum creatinine levels, total (rewarm) ischemic times (TIT), incidence of acute tubular necrosis (ATN), need for antihypertensive drugs, incidence of acute rejection episodes, and vascular and urologic complications, between the MRA group and a control group of patients with single-artery renal grafts. In patients who underwent multiple anastomoses in situ, prolonged TIT resulted in an increased incidence of ATN, but there was no significant difference between the MRA groups and the control group (P = 0.45). The incidence of vascular complications was higher in the MRA groups (P < 0.01), but there were no significant differences in the other variables among the groups. Multiple renal artery grafts procured by open nephrectomy can be transplanted as successfully as those with single arteries, by using meticulous suturing techniques.

Use of Extended Right Grafts From In Situ Split Livers in Adult Liver Transplantation: A Comparison With Whole-Liver Transplants

Introduction We report our experience of in situ split-liver transplantation (SLT) for adult patients and compare the results with those achieved with whole-liver transplantation (WLT). Method From November 1997 to December 2003, 109 liver transplantation were performed in 104 adult patients including 90 WLT (83%) and 19 SLT (17%) grafts. Fifteen extended right grafts (ERG, segments I + IV to VIII) were obtained with in situ split-liver procedures, generating also left lateral segment grafts, which were transplanted at our institution or elsewhere. Four left lobe (LL, segments I to IV) and right lobe (segments V to VIII) grafts were obtained by a modified in situ procedure for adult recipients. UNOS status, percentage of primary or secondary transplantation, and underlying liver disease were similar among patients receiving whole versus split grafts. Donors were older in whole than ERG cohorts (53 vs 26 years, P < .001). Procurement parameters and intraoperative profiles of transplant procedure were comparable among the groups. Results Median follow-up was 18 months (range: 1 to 73). Four patients with whole (4%) and no patient with ERG underwent retransplantation ( P = NS). One- and 3-year patient survivals were 86% and 79% with WLT versus 93% and 93% with ERG ( P = NS). One- and 3-year graft survivals were 84% and 75% with WLT versus 93%, and 93% with ERG ( P = NS). Incidence of vascular complications was 8% with WLT, 13% with ERG ( P = NS). The incidence of biliary complications was 13% in WLT, 27% in ERG ( P = NS). Conclusions The use of ERG from in situ split livers for adult transplantation allowed us to obtain results comparable or even better than those obtained with WLT. Split-liver transplantation is an effective, safe mechanism to expand the cadaveric donor pool.

Skin Ulcers in Lower Extremities: The Epidemiology and Management in China

Chronic skin ulcers are characterized by different etiological factors and may occur all over the body; the prevention and management of chronic skin ulcers in lower extremities continue to be severe problems in China. Wound healing in these injured tissues is a major health care problem with considerable socioeconomic impact. 1 According to data from epidemiological studies, the incidence of chronic ulcers in surgical hospitalized patients in China is 1.5% to 3.0% 2 ; the site distribution of these wounds varies with etiology. Of the 580 wounded areas in 489 patients, 366 were ulcerated on the lower extremities (63.10%), another 214 wounded sites (36.9%) were ulcerated in some other anatomic area, such as the upper extremities (17.93%), thoracic and abdominal regions (7.76%), the back (4.83%), and the head (6.38%). The principal cause of chronic ulcers is trauma, or traumatic wounds compounded by infections (67.48%). Diabetic ulcers, venous ulcers, and pressure ulcers account for 4.91%, 6.54%, and 9.20%, respectively, of ulcers. 2 The results from relative analysis of etiology, population, and ulcer anatomic distribution further confirmed the high incidence of these chronic skin ulcers in farmers and workers. It is considered that such workers engaged in manual labor are more susceptible to injury than others in the population. These results are quite different from the epidemiological results from Western societies, in that the main causes of wounds to the lower extremities in these countries are diabetes and age-induced diseases. 3,4 Another recent large-scale survey focused on diabetes and its complications revealed that the incidence of vascular complications in extremities in diabetes is 2.6% (type I diabetes) and 5.2% (type II diabetes), and 5.0% in all of diabetes. In all of these cases, 0.7% had dry gangrene, 1.9% had humid or wet gangrene, and 0.4% needed amputation. 5 The results are alarming and serve to warn us about the importance of prevention and management of lower extremity ulcers in the Chinese population. The biological processes of wound healing in chronic skin ulcers are quite different from those in acute skin wounds. In acute skin wounds, the woundhealing processes can be divided into 3 identifiable but overlapping phases, that is, inflammatory phase, proliferative phase, and maturation phase. In contrast, chronic skin ulcers are characterized by defective remodeling of the extracellular matrix, failure of reepithelization, and prolonged inflammation. For deep chronic wounds, such as pressure sores and diabetic foot ulcers, healing necessitates angiogenesis, deposition of the extracellular matrix, contraction, and epithelization. With the presence of such comorbidities as diabetes, infection, venous diseases, and malnutrition in patients who have previously undergone chemotherapy or radiotherapy, the chronic, nonhealing wounds will give both prolonged suffering to patients and frustration to attending physicians. 1,2 Thus, the wound-healing process for chronic wounds is more complicated as compared with the healing of acute wounds. The management of lower extremity ulcers is a ther

Platelet Hyperfunction as Risk Factor for Chronic and Acute Coronary Events

Indians have a very high incidence of vascular complications, such as hypertension, atherosclerosis, coronary artery disease (CAD), and stroke, compared to any other ethnic group in the world. They also have a very high incidence of multiple metabolic diseases, including type 2 diabetes. Elevated levels of known risk factors in this population for CAD does not explain adequately the significant increase in the vascular disease burden in this population. There is some speculation that genetic predisposal of this population may account for this increased incidence in vascular diseases. Environmental toxicants may also contribute significantly to the acceleration of these complex risk promoters.Functional and structural changes in the arterial wall precede the development of clinical complications such as endothelial dysfunction, hypertension, atherosclerosis, hyperfunction of platelets, and coagulation cascade. Vascular dysfunction, therefore, is the major contributor for the pathogenesis of hypertension, atherogenesis, thrombosis, and stroke. Alterations in the balance between platelet-associated vasoconstrictors and endothelial-derived vasodilators result in the vascular dysfunction. Blood platelets play a very important role in the pathogenesis of hypertension, atherogenesis, thrombosis, and stroke. These cells interact with a variety of agonists. Such interactions stimulate specific receptors and lead to the activation of intracellular effector enzymes. Ionized calcium is the primary bioregulator and a variety of signaling mechanisms modulate the cellular physiology and functions. Activated platelets promote the formation of thrombin and initiate coagulation cascade. They also interact with other circulating blood cells and facilitate inflammatory response.Little is known about the effect of environmental toxicants on vascular physiology and pathology. This is true also on their effect on the circulating blood cells. There is some evidence that oxidative stress as well as proinflammatory compounds play a role in vascular biology. In this presentation an attempt will be made to briefly review the known risk factors for CAD; the role of toxicants, eicosanoids, and inflammatory mediators on vascular biology specifically; and the role of platelets and platelet-derived biomolecules on hypertension, atherogenesis, thrombosis, and intercellular communications. Alterations in signaling pathways by environmental toxicants may increase the risk for hypertension, atherosclerosis, thrombosis, and stroke.

Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS study)

This prospective multicenter study was conducted to compare the incidence of significant vascular complications delaying hospital discharge after coronary angiography and percutaneous coronary intervention (PCI) between the radial approach (n = 192) and the femoral approach (n = 185) in octogenarians, a rapidly growing population with numerous risk factors for complications. By intention-to-treat analysis, the incidence of vascular complications was found to be significantly less in the radial group (1.6% vs 6.5%, p = 0.03), without any decrease in the efficacy of PCI and only a slight increase in procedure duration for coronary angiography. All vascular complications, except for 1, occurred in patients treated with the transfemoral approach.

Vascular injury during anterior lumbar surgery

Background context With the number of anterior lumbar procedures expected to increase significantly over the next few years, it is important for spine surgeons to have a good understanding about the incidence of vascular complications during these operations. Purpose To determine the incidence of vascular injury in 1,315 consecutive cases undergoing anterior lumbar surgery at various levels from L2 to S1. Study design/setting Patients undergoing anterior lumbar surgery were studied. Patient sample A total of 1,310 consecutive patients undergoing 1,315 anterior lumbar procedures between August 1997 and December 2002 were included in the study. Outcome measures All patients were evaluated for incidence of vascular injury during and immediately after surgery. Method A concurrent database was maintained on all these cases. All the patients had distal pulse evaluation preoperatively. Patients with venous injuries were further analyzed to determine location and extent of injury, amount of blood loss, completion of the procedure and postoperative sequelae. Patients with pulse deficits or evidence of ischemia during or immediately after surgery were further analyzed in particular in relation to demographic, preoperative variables and management. Results Six patients were identified as having left iliac artery thrombosis (0.45%), and 19 had major vein lacerations (1.4%). Conclusion This study shows that the incidence of vascular injury is relatively low (25 in 1,315 or 1.9%). Because only five of these patients experienced significant sequelae from the approach, it appears that anterior lumbar surgery is quite safe, although it must be carried out with utmost respect for the vessels to avoid possible catastrophic outcomes.

Split-liver transplantation: coming of age.

Objective To identify predictors of graft and recipient survival from a single-institution series of in situ split-liver transplantations and compare outcomes to living donor and whole organs for adults and children. Summary Background Data Split-liver transplantation is a surgical technique that creates 2 allografts from a single cadaver donor. We have applied split-liver transplantation to all indications and categories of medical urgency for initial as well as retransplantation to expand the current donor pool and decrease reliance upon living donation. Methods A retrospective analysis was conducted of 100 consecutive in situ split-liver transplantations yielding a left lateral segment and right trisegment graft that were performed at the University of California Los Angeles between 9/91 and 02/03. These 100 transplantations generated 190 allografts for transplantation into 105 children and 60 adults, with the sharing of 25 allografts among transplant centers across the United States. Outcomes and incidence of complications were compared with living donor and whole organ recipients receiving liver transplantation during the same time period with independent predictors of split-liver graft and recipient survival identified by multivariate analysis. Results The incidence of biliary and vascular complications observed in recipients of left lateral segment grafts created by split-liver transplantation was not statistically different from recipients of left lateral segment grafts created from living donation or children receiving whole-organ grafts from pediatric donors. Kaplan-Meier survival estimations of left lateral segment graft and recipient survival also demonstrated no statistical difference among split-liver, living donor, and whole-organ recipients. Right trisegment grafts from split-liver transplantation demonstrated a 10% incidence of biliary and 7% incidence of vascular complications. Long-term graft function was excellent with patient and graft survival equal to 1086 recipients of cadaver whole-organ grafts from donors ages 10–40 years who underwent transplant operations during the same time period. Predictors of split-liver transplantation graft and recipient survival included United Network for Organ Sharing status at transplantation, indication, occurrence of a complication, donor creatinine, and donor length of hospitalization. Conclusions Split-liver transplantation is an effective mechanism for immediate expansion of the cadaver donor pool that can reduce dependence upon living donation in adults and children. (Ann Surg 2003;238:496–507).

One hundred in situ split-liver transplantations: a single-center experience.

To identify predictors of graft and recipient survival from a single-institution series of in situ split-liver transplantations and compare outcomes to living donor and whole organs for adults and children. Split-liver transplantation is a surgical technique that creates 2 allografts from a single cadaver donor. We have applied split-liver transplantation to all indications and categories of medical urgency for initial as well as retransplantation to expand the current donor pool and decrease reliance upon living donation. A retrospective analysis was conducted of 100 consecutive in situ split-liver transplantations yielding a left lateral segment and right trisegment graft that were performed at the University of California Los Angeles between 9/91 and 02/03. These 100 transplantations generated 190 allografts for transplantation into 105 children and 60 adults, with the sharing of 25 allografts among transplant centers across the United States. Outcomes and incidence of complications were compared with living donor and whole organ recipients receiving liver transplantation during the same time period with independent predictors of split-liver graft and recipient survival identified by multivariate analysis. The incidence of biliary and vascular complications observed in recipients of left lateral segment grafts created by split-liver transplantation was not statistically different from recipients of left lateral segment grafts created from living donation or children receiving whole-organ grafts from pediatric donors. Kaplan-Meier survival estimations of left lateral segment graft and recipient survival also demonstrated no statistical difference among split-liver, living donor, and whole-organ recipients. Right trisegment grafts from split-liver transplantation demonstrated a 10% incidence of biliary and 7% incidence of vascular complications. Long-term graft function was excellent with patient and graft survival equal to 1086 recipients of cadaver whole-organ grafts from donors ages 10-40 years who underwent transplant operations during the same time period. Predictors of split-liver transplantation graft and recipient survival included United Network for Organ Sharing status at transplantation, indication, occurrence of a complication, donor creatinine, and donor length of hospitalization. Split-liver transplantation is an effective mechanism for immediate expansion of the cadaver donor pool that can reduce dependence upon living donation in adults and children.

Outcome of access site in patients treated with platelet glycoprotein IIb/IIIa inhibitors in the era of closure devices.

The most consistent procedural predictor of vascular access site complications thus far has been the intensity and duration of anticoagulant therapy during and after percutaneous coronary interventions (PCI). Several devices have been developed to aid in the closure of the femoral arteriotomy. This report describes the clinical outcome of unsuccessful deployment of femoral closure devices in a cohort of 285 consecutive patients who underwent PCI and were treated with platelet glycoprotein (GP) IIb/IIIa inhibitors. Manual femoral artery compression was used in 123 patients, Perclose in 123 patients, and AngioSeal in 39 patients. Successful homeostasis was achieved in 98.4% of patients who received manual compression, in 91.9% of the Perclose-sealed arteriotomy, and in 84.6% of patients who received the AngioSeal closure device (P = 0.004). The incidence of vascular complications after successful deployment was 9%. Patients not achieving hemostasis with closure device or 1 degrees manual compression developed complications in the majority of cases (> 80%; P < 0.05). By multivariate analysis (with adjustment for baseline differences), the use of AngioSeal closure device was found to be an independent risk factors leading to primary deployment failure and all access site complications (OR 2.97; 95% CI 1.5-6.0; P = 0.006). In summary, failed hemostasis by artery closure devices in patients undergoing PCI who are treated with GP IIb/IIIa inhibitors is associated with significant vascular complications. AngioSeal may be associated with a higher failure rate, while manual compression and Perclose seem to be more effective with a lower complication rate.

Prevalence of retinopathy differs with age at onset of diabetes in a population of patients with Type 1 diabetes.

The VISS study (Vascular complications in South-east Sweden) investigates prevalence and incidence of vascular complications in a population with Type 1 diabetes, from a well-defined geographical area and followed from diagnosis with HbA1c measurement. The study population comprised all 440 patients with Type 1 diabetes onset before the age of 36 years, onset during 1983-1987, and at the time of onset living within the counties of Jönköping, Kalmar or Ostergötland. Retinopathy was examined with fundus photography 1994-1995, and classified according to a modified Airlie House protocol. Fundus photographs from 390 patients were evaluated. In 277 (71%) patients no retinopathy was seen. The prevalence of retinopathy increased from 11% among patients < 5 years old at diabetes onset, to 48% among those 15-19 years old at diabetes onset, and then decreased to 30% for patients 30-35 years old at diabetes onset (P for chi2 for linear trend for all ages 0.017, for age at onset 0-19 years P = 0.0003), without corresponding differences in duration or HbA1c between patients with different onset age. Patients with HbA1c in the highest quartile (> 8.3% HbA1c) had a relative risk of 2.4 (95% confidence interval (CI) 1.7-3.2) of having any retinopathy compared with patients with lower HbA1c, and a relative risk of 7.1 (95% CI 3.0-16.7) of having other forms of retinopathy than microaneurysms. In patients with diabetes duration of 6-13 years, the prevalence of retinopathy is clearly related to glycaemic control. Furthermore, the risk of retinopathy varies with different age at onset, independently of differences in duration or glycaemic control.

Vascular complications of prolonged intra-aortic balloon counterpulsation in cardiac surgical patients

Background. Use of intra-aortic balloon pump (IABP) is associated with certain vascular complications, which are likely to develop more frequently in patients where IABP is used for prolonged period. The present study was undertaken to analyze vascular complications after prolonged IABP use in patients undergoing various cardiac surgical procedures. Methods. Between January 1995 and February 2001, a total of 1130 patients (7.4% of all adult patients undergoing cardiac procedures) required IABP counterpulsation, out of which 220 patients required IABP for more than 4 days. The vascular complications in these patients were studied. The IABP was inserted by percutaneous technique in 211 (95.5%) patients. The mean age of the patients was 57.5±9.5 years and 15% patients were female. The prevalence of peripheral vascular disease was 11.8%. Results. The duration of IABP therapy ranged from 5 days to 21 days with mean duration of 9.71±4.29 days. A total of 41 complications developed in 38 (17.3%) patients. Acute lower limb ischemia, requiring urgent surgical intervention, was the commonest major complication, which developed in 17 patients. This required thromboembolectomy in 11 patients and femoro-femoral bypass in 3 patients. One patient developed gangrene of the leg, requiring below knee amputation. On multivariate analysis, peripheral vascular disease, preoperative serum creatinine, surgery for LV aneurysm and unstable angina and hemodynamic instability (as the indications for IABP) were found as the predictors of vascular complications. Conclusions. Prolonged use of IABP counterpulsation is associated with significant incidence of vascular complications. Proper assessment of peripheral circulation before IABP insertion and appropriate management of ischemic complications are important to avoid limb loss to the patient.

A randomised comparison of the use of 4 and 6 French diagnostic catheters: the limits of downsizing

Background: The use of small catheters for coronary angiography can reduce the risk of vascular complications and allow early ambulation, but excessive downsizing may lead to poor quality imaging. The aim of this study was to assess the feasibility of performing coronary angiography using 4 French (4 F) femoral catheters. Methods: In total, 400 consecutive elective patients were randomised to undergo coronary angiography with 4 F or 6 F catheters. The puncture site was manually compressed and inspected before and after ambulation, and 24 h later. The handling difficulty of the catheters was semi-quantitatively evaluated using a three grade scoring system; angiogram quality was evaluated by two independent physicians. Results: No major procedure-related complications were observed. Coronary arteriography with 4 F catheters was possible in all of the attempted cases. There were no statistical differences between the two groups in terms of procedural or fluoroscopy time, the amount of contrast medium used, or the incidence of vascular complications, while compression time was significantly shorter in the patients studied using the smaller catheter (3.4 vs. 9.9 min; P<0.0001). Catheter stability was similar in the two groups, whereas catheter torque and the quality of the coronary angiograms were statistically better in the patients studied using six French catheters. Conclusions: Coronary angiography with 4 F catheters is technically feasible and permits early ambulation after the procedure. Although the radiological resolution of the images obtained using 4 F catheters was always adequate for clinical decision-making, the angiogram quality and catheter handling were significantly better using the 6 F system.

The Effect of Age, Gender, Risk Level and Glycosylated Hemoglobin in Predicting Foot Amputation in HMO Patients with Diabetes

To determine if age, gender, risk level and glucosylated hemoglobin could predict foot amputations in HMO patients with diabetes. A retrospective chart review of a non-random sample of 27 patients with amputation and 110 randomly selected patients without amputation during the same time period. Chi-square, t-tests and logistic regression were used to analyze the data. There was no significant difference between the group with amputation and those without amputation in age or gender. However, there was a significant difference between the two groups in the risk stratification (p = .005) and glycosylated hemoglobin levels (p = .058). Nurse practitioners can effectively screen for amputation risk factors and closely monitor glycosylated hemoglobin levels of diabetic patients to reduce the incidence of vascular complications and related lower extremity amputation.

Early vascular complications after pediatric liver transplantation

Vascular complications have a detrimental effect on the outcome after liver transplantation. Most studies focus exclusively on hepatic artery thrombosis (HAT). The current study analyzed the incidence, consequences, and risk factors for HAT, portal vein thrombosis (PVT), and venous outflow tract obstruction (VOTO) in a consecutive series of 157 pediatric liver transplantations. The overall incidence of vascular complications was 21%. The incidences of HAT, PVT, and VOTO were 10%, 4%, and 6%, respectively. Patient survival after PVT and VOTO and graft survival after HAT and PVT were less compared with survival of grafts without vascular complications. To identify risk factors for vascular complications, factors related to recipient, donor, and surgical techniques were analyzed. A low donor-recipient (D/R) age ratio, long surgical time, and use of the proper hepatic artery of the recipient for arterial reconstruction were risk factors for HAT Young age, low weight, segmental grafts, and piggyback technique were risk factors for PVT. Fulminant hepatic failure, high D/R age and weight ratios, and use of segmental grafts were related to VOTO. Vascular complications, which occurred in 21% of the pediatric liver transplantations, had a significant impact on patient and graft survival. Size disparity between donor and recipient was an important risk factor for vascular complications, especially in the case of transplantation of segmental grafts. Patient and graft survival might improve by avoiding the identified risk factors.

The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes.

The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes.

Management of arterial puncture site after catheterization procedures: evaluating a suture-mediated closure device

To overcome the challenge associated with achievement in hemostasis after a catheterization procedure, a suture-based closure device was compared with manual compression in a 600-patient randomized trial. The major study end points included the incidence of vascular complications and the time to ambulation after the procedure. The study included diagnostic or interventional procedures. The suture-mediated closure was performed immediately after the procedure independent of the anticoagulation level, whereas manual compression was performed per hospital protocol with sheath removal relying on normalization of patient’s anticoagulation status. A significant reduction in time to achieve hemostasis (7.8 ± 4.8 vs 19.6 ± 13.2 minutes, p <0001) and time to ambulation (4.5 ± 6.5 vs 17.8 ± 5 hours, p <0001) was associated with use of the suture-mediated closure device. The incidence of vascular complications was similar in the overall population (5.7% for suturing device vs 11.3% for compression) or in the interventional patient subset (8.4% for suturing device vs 9.6% for compression). There was a significant reduction in the incidence of vascular complications in the diagnostic procedure subset (4.4% for suturing device vs 12.1% for compression, p <0.05). Thus, the use of a suture-mediated closure device represents a safe alternative to manual compression. Hemostasis and ambulation can be achieved faster with the suturing device than with manual compression, with a potential reduction in access site complications.