Follow-up Modalities Research Articles

Clinical Usage of Different Guidelines in Routine Management, Therapy and Follow-Up of Patients with Renal Cell Cancer in Germany

Objectives: To evaluate the usage of different guidelines and to estimate the impact of changed recommendation in routine management, therapy and follow-up of patients with renal cell cancer (RCC). Methods: An anonymous questionnaire was sent to 600 urologists in Germany. Twenty-seven percent of them were included in the analysis. The questions were about the practice setting, surgical and medical treatment of RCC, follow-up modalities, knowledge and usage of RCC guidelines. Results were correlated with the recommendations of the EAU-guideline. Results: Sixty-eight percent of the urologists were office based. Sixty percent were located in bigger cities. Ninety-eight percent of the colleagues reported to be knowledgeable about the EAU-guidelines, 62% reported to know the American Urological Association, 59% DGU/AWMF, 19% National Comprehensive Cancer Network, 19% European Society for Medical Oncology, 13% Onkopedia, and 3% British Association of Urological Surgeons-guidelines. Eighty-seven percent reported that partial nephrectomy (Nx) was performed in tumours with diameter <4 cm. Forty-one percent performed a radical Nx for tumours that were 4-7 cm. Follow-up of RCC was done in 99%. Fifty-nine percent underwent an abdominal CT scan after 6 months. Thirty-nine percent got a chest X-ray done. Among those with metastatic RCC, only 84% were offered systemic therapy. First-line therapy was predominantly advocated using sunitinib. Conclusion: Almost all urologists know and use the EAU-guidelines. Other guidelines are rarely used. Follow-up is performed in discordance with the EAU-recommendations. Interestingly, only 84% with metastatic disease are introduced to systemic therapy.

Contribution of magnetic resonance imaging in lung cancer imaging

Lung cancer is the leading cause of cancer death worldwide. Prognosis and treatment outcomes are known to be related to the disease stage at the time of diagnosis. Therefore, an accurate assessment of the extent of disease is critical to determine the most appropriate therapy. Currently available imaging modalities for diagnosis and follow-up consist of morphological and functional imaging. Morphological investigations are mainly performed with CT-scan and in some cases with MRI. In this review, we describe the contribution of MRI in lung cancer staging focusing on solid pulmonary nodule characterization and TNM staging assessment using chest and whole-body MRI examinations, detailing in each chapter current recommendations and future developments.

Computed Tomography Perfusion, Magnetic Resonance Imaging, and Histopathological Findings After Laparoscopic Renal Cryoablation: An In Vivo Pig Model

The present study investigates how computed tomography perfusion scans and magnetic resonance imaging correlates with the histopathological alterations in renal tissue after cryoablation. A total of 15 pigs were subjected to laparoscopic-assisted cryoablation on both kidneys. After intervention, each animal was randomized to a postoperative follow-up period of 1, 2, or 4 weeks, after which computed tomography perfusion and magnetic resonance imaging scans were performed. Immediately after imaging, open bilateral nephrectomy was performed allowing for histopathological examination of the cryolesions. On computed tomography perfusion and magnetic resonance imaging examinations, rim enhancement was observed in the transition zone of the cryolesion 1week after laparoscopic-assisted cryoablation. This rim enhancement was found to subside after 2 and 4 weeks of follow-up, which was consistent with the microscopic examinations revealing of fibrotic scar tissue formation in the peripheral zone of the cryolesion. On T2 magnetic resonance imaging sequences, a thin hypointense rim surrounded the cryolesion, separating it from the adjacent renal parenchyma. Microscopic examinations revealed hemorrhage and later hemosiderin located in the peripheral zone. No nodular or diffuse contrast enhancement was found in the central zone of the cryolesions at any follow-up stage on neither computed tomography perfusion nor magnetic resonance imaging. On microscopic examinations, the central zone was found to consist of coagulative necrosis 1 week after laparoscopic-assisted cryoablation, which was partially replaced by fibrotic scar tissue 4 weeks following laparoscopic-assisted cryoablation. Both computed tomography perfusion and magnetic resonance imaging found the renal collecting system to be involved at all 3 stages of follow-up, but on microscopic examination, the urothelium was found to be intact in all cases. In conclusion, cryoablation effectively destroyed renal parenchyma, leaving the urothelium intact. Both computed tomography perfusion and magnetic resonance imaging reflect the microscopic findings but with some differences, especially regarding the peripheral zone. Magnetic resonance imaging seems an attractive modality for early postoperative follow-up.

Young smoker "ABCD" vascular assessment: a four-step ultrasound examination for detecting peripheral, extra and intra-cranial early arterial damage.

BackgroundCigarette smoking is known as a major risk factor in the pathogenic mechanisms of stroke, coronary and peripheral artery disease (CAD and PAD), even in young subjects. The aim of this study is the creation of a four-step ultrasound examination to evaluate and monitor the peripheral, the extra and the intra-cranial assessment of the arterial early damage in smokers. The evaluations of A, the Ankle-brachial index, ABI, B, the Breath holding index, BHI, C, the Carotid intima media thickness, CIMT, and D, the Diameter of the abdominal aorta represent the “ABCD” assessment.MethodsThirty-eight healthy smokers and 43 controls underwent A, calculated for each leg. B was calculated after determination of subjects’ flow velocity of middle cerebral artery (MCA) by trans-cranial colour Doppler (TCCD) before and after 30 s of apnoea at baseline and just after smoking a cigarette, to simulate the chronic and acute effects of smoking. Finally, C and D evaluation were assessed using a high-resolution B-mode ultrasound.ResultsSmokers presented higher values of CIMT (mean and maximal), and lower BHI both at baseline and just after smoking (p < 0.01), though in the normal range. No significant differences were found for A and D between smokers and non- smokers.ConclusionsOur results underline the importance of the assessment of B and C, that, though in the normal range, present significant differences between smokers and non-smokers. These data could drive the screening between smokers in age-related manner. Moreover, the “ABCD” examination could represent a valid method to detect and then monitor smokers’ vascular damage. Although it is far to be considered a screening and routine tool, it should be contemplated in a wider context of possible not-invasive practical screening and follow-up modalities. This would be designed to implement preventive strategies and tools aimed at discouraging tobacco addiction and monitoring cardiovascular risk patients.

Early nontumorous CT findings after irreversible electroporation of locally advanced pancreatic cancer.

The use of irreversible electroporation (IRE) has been a relatively recent development in the palliative treatment of locally advanced pancreatic cancer. With CT as a key modality in patient follow-up, recognition of nontumorous imaging findings is paramount after IRE. A retrospective review of patients having undergone IRE for locally advanced pancreatic adenocarcinoma was performed. A total of 36 patients met inclusion criteria and their imaging studies were reviewed by two radiologists. Nontumorous abnormalities identified in the peri-electroporation bed on Computed Tomography (CT) during the early postoperative period (within 30 days) were characterized and classified into categories. Our results indicate that the most common nontumorous findings in the peri-electroporation bed were vascular, followed by changes involving the gastrointestinal tract, peritoneal cavity, and, infrequently, the biliary tree. Interpretation of CT imaging of the postoperative peri-electroporation bed is challenging. This review of CT findings allows the radiologist to recognize and anticipate significant nontumorous findings in the peri-electroporation bed during early follow-up after IRE.

Work up of incidental adrenal mass: state of the art.

Due to the increasing use of radiological investigations, the detection of incidental adrenal masses has become even more frequent. Therefore, it is crucial to identify the nature of the adrenal mass in order to decide the type of treatment that should be undertaken. Toward this goal, biochemical tests are useful in order to assess catecholamines levels for the presence of a pheochromocytoma or cortisol excess in case of Cushing's syndrome. Furthermore, the dexamethasone suppression test and late-night salivary cortisol may be useful in measuring plasma cortisol, respectively, in the blood and urine. Hyperaldosteronism could be suspected in the presence of arterial hypertension. With regard to imaging modalities, the contrast washout and Hounsfield units estimation might play a role as indicators on computed tomography. In terms of treatment, a surgical approach is most suitable for a hyperfunctioning adrenal mass irrespective of size, and for nonfunctioning masses >4 cm. For indeterminate smaller lesions, with washout >50%, <10 Hounsfield Unit, nonfunctioning, benign-appearing, undergoing a follow-up in regular intervals is more appropriate in order to estimate mass growth. This paper summarizes recent findings on the management of incidental adrenal masses, with a special focus on the use of imaging, surgical management and follow-up modalities in improving patient outcomes.

Techniques and standards in intraoperative graft verification by transit time flow measurement after coronary artery bypass graft surgery: a critical review

Transit time flow measurement (TTFM) is a quality control tool for intraoperative graft evaluation in coronary artery bypass graft (CABG) surgery. A critical review of the literature available using TTFM in CABG surgery is the focus of this article. The main objectives will be to detail precise parameters for flow evaluation, to show limitations of TTFM and to prove its predictive impact on postoperative graft failure rate. Publications listed in the PubMed database were reviewed, searching for intraoperative graft verification in coronary surgery by TTFM, with postoperative imaging follow-up (FU) modality and with a special focus on publications released after European guidelines from 2010. Nine included publications revealed an overall graft failure rate of ∼12%. Mean graft flow had a positive predictive value in the largest study, and cut-offs, of at least 20 ml/min for internal mammary artery (IMA) grafts, therein partially confirming guidelines, and 30-40 ml/min for saphenous venous grafts (SVGs) were proposed. An explicit correlation between graft flow, patency rate and severity of coronary stenosis, by indicating the fractional flow reserve, was found for IMA grafts. Increased pulsatility index and increased systolic reverse flow probably predict worse outcome and may help identifying competitive flow. Diastolic filling, rarely indicated, could not be confirmed as the predictive marker. No significant correlation of TTFM and graft failure rate for radial and other arterial grafts could be found, partially due to the small number of these types of grafts analysed. Larger target vessels and lower postoperative CK-MB levels may predict better graft patency rates. Low sensitivity for TTFM to reliably detect graft failure is certainly a major issue, as found in randomized analyses. However, methodical limitations and varying threshold values for TTFM render a general consensus difficult. Influence of quantity (vessel territory distribution) and quality (myocardial scar) of the graft perfusion area, on TTFM and FU outcome, was not included by anyone and should be part of future research. TTFM is probably not the tool of choice to detect progressive late graft failure of SVG. Peroperative TTFM values should be correlated with one type of conduit, differentiating between early and late graft failure (by applying a uniform, appropriated definition), to precise and confirm threshold values.

PHA-Induced Peripheral Blood Cytogenetics and Molecular Analysis: a Valid Diagnostic and Follow-up Modality for Acute Promyelocytic Leukemia Patients Treated with ATRA and/or Arsenic Tri-oxide.

Acute promyelocytic leukemia (APML) is characterized by the reciprocal translocation t(15;17) (q22;q12) resulting in the PML-RARα fusion gene. A dual diagnostic and follow up approach was applied including cytogenetic demonstration of the t(15;17) translocation and detection of PML-RARα chimeric transcripts by molecular means. Conventional cytogenetics involving bone marrow is beset with high probability of poor metaphase index and was substituted with phytohemagglutinin (PHA)-induced peripheral blood culture based cytogenetic analysis as a diagnostic and follow up modality in APML patients of Kashmir (North India). Both qualitative (RT-PCR) and quantitative (Q-PCR) tests were simultaneously carried out to authenticate the modified cytogenetics. Patient samples were subjected to the said techniques to establish their baseline as well as follow-up status. Initial cytogenetics revealed 30 patients (81%) positive for t(15;17) whereas 7 (19%) had either cryptic translocation or were negative for t(15;17). Two cases had chromosome 16q deletion and no hallmark translocation t(15;17). Q-PCR status for PML-RARα was found to be positive for all patients. All the APML patients were reassessed at the end of consolidation phase and during maintenance phase of chemotherapy where 6 patients had molecular relapse, wherein 4 also demonstrated cytogenetic relapse. It was found that PHA-induced peripheral blood cytogenetics along with molecular analysis could prove a reliable modality in the diagnosis and assessment of follow up response of APML patients.

Incidence of Atrial Fibrillation AfterAtrialFlutter Ablation.

This study was conceived to perform a comprehensive systematic review and meta-analysis of the available evidence to compute the incidence of atrial fibrillation (AF) after successful atrial flutter (AFL) catheter ablation, defined by targeting for bidirectional block, using different types of follow-up modalities and durations. Cavotricuspid-isthmus dependent AFL is usually initiated by short bursts of AF. The incidence of AF after AFL ablation is variable. We evaluated the variation in the reported incidence of AF depending on the type and duration of follow-up, and AF incidence in patients with prior AF versus no prior AF. A systematic review and meta-analysis of published studies between January 1996 and April 2015 and abstracts in the last 2 years describing patients who underwent AFL ablation and the subsequent incidence of AF was performed. Forty-eight studies were included (n = 8,257, ablation success rate: 96%, 79% male). Incidence of new-onset AF correlated with follow-up duration (29% for a weighted mean follow-up duration of 30 months). New-onset AF incidence with<2 years follow-up was 12.4% among group 1 (electrocardiogram and symptoms-driven evaluation, n=759), 19% for group 2 (outpatient Holter monitoring for 1 day to 7 days/year, n= 315), and 45% for group 3 (>7days/year Holter monitoring or by implanted cardiac devices, n= 178). Mean follow-up duration was 15.3 months, 18.5 months, and 16.3 months, respectively. In patients with and without prior AF, the incidence for AF after AFL ablation was 35.3% during mean follow-up duration of 29.7 months. In studies with<2 years follow-up duration, AF incidence was 54% in patients with prior AF versus 13.9% without prior AF (odds ratio: 7.43, 95% confidence interval: 4.96 to 11.11; p< 0.00001). In studies with >2 years follow-up duration, AF incidence was 51.3% in patients with prior AF versus 26.2% without prior AF (odds ratio: 2.93, 95% confidence interval: 2.42 to 3.56; p< 0.00001). The incidence of AF after AFL ablation is high especially in patients with prior AF when compared to those without prior AF. The detection of AF in patients without prior AF significantly increases with more frequent monitoring and/or longer follow-up duration.

Monitoring and management of lung cancer patients following curative-intent treatment: clinical utility of 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography.

A large number of studies have demonstrated that 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) is superior to conventional modalities for the diagnosis of lung cancer and the evaluation of the extent of the disease. However, the efficacy of PET/CT in a follow-up surveillance setting following curative-intent treatments for lung cancer has not yet been established. We reviewed previous papers and evaluated the potential efficacy of PET-CT in the setting of follow-up surveillance. The following are our findings: 1) PET/CT is considered to be superior or equivalent to conventional modalities for the detection of local recurrence. However, inflammatory changes and fibrosis after treatments in local areas often result in false-positive findings; 2) the detection of asymptomatic distant metastasis is considered to be an advantage of PET/CT in a follow-up setting. However, it should be noted that detection of brain metastasis with PET/CT has some limitation, similar to its use in pretreatment staging; 3) additional radiation exposure and higher medical cost arising from the use of PET/CT should be taken into consideration, particularly in patients who might not have cancer after curative-intent treatment and are expected to have a long lifespan. The absence of any data regarding survival benefits and/or improvements in quality of life is another critical issue. In summary, PET/CT is considered to be more accurate and sensitive than conventional modalities for the detection of asymptomatic recurrence after curative-intent treatments. These advantages could modify subsequent management in patients with suspected recurrence and might contribute to the selection of appropriate treatments for recurrence. Therefore, PET/CT may be an alternative to conventional follow-up modalities. However, several important issues remain to be solved. PET/CT in a follow-up surveillance setting is generally not recommended in clinical practice at the moment.

P161. Ultrasound as a primary imaging modality for follow-up of Crohn’s disease in pregnant women: initial results

P161. Ultrasound as a primary imaging modality for follow-up of Crohn’s disease in pregnant women: initial results

Abstract WP329: Video Conferencing is the Preferred Method for Follow-up Communication for Post-hospital Stroke Patients

Introduction: Close communication with a stroke patient after discharge from a comprehensive stroke center has been shown to be crucial for medication compliance, follow up care and improving patient satisfaction. We aimed to improve post-hospitalization compliance and patient satisfaction by assessing if a video call as a routine follow-up communication modality would be the preferred method of communication. Methods: Admitted stroke patients were asked for their preference in post-hospitalization communications with their attending physician. Results: A total of 52 stroke patients were interviewed, 30 (57.7%) requested a video call, 22 (42.3%) requested a phone call. 100% (14/14) ages 55 and younger requested a video call. 70.3% (19/27) of patients 65 years old and younger requested a video call. Conclusion: There is evidently a strong demand for video conferencing as a method of follow-up communication among the post hospitalized stroke population. Although age appears to influence the demand, the majority of patients expressed greater enthusiasm with the concept of video conferencing. Follow-up video communication could improve patient medication, treatment compliance, risk factor reduction and ultimately improve patient care and satisfaction. Video calls will also provide additional visual information that a routine phone call would miss, potentially reducing readmissions. Therefore, with advancing technology and the strong desire for video conferencing, one should begin to think of ways to provide this service.

Retarding CKD Progression: Readily Available through Comprehensive Nutritional Management?

This manuscript is aimed at summarising the evidences raised by the 2nd International conference of the European Renal Nutrition (ERN) working group at the ERA-EDTA “Retarding CKD progression: readily available through comprehensive nutritional management?” This project is focused on everyday nutritional issues related to non-dialysis-dependent chronic kidney disease (CKD) condition. A non-dialysis CKD clinical case of common presentation in the daily clinical practice will be reported and thereafter several key aspects of the comprehensive nutritional management which nephrologists face daily in clinics will be addressed; definitely, baseline nutritional assessment, basic nutritional concerns, major nutritional targets, nutritional strategies to improve renal outcomes, and modalities of nutritional follow-up will be discussed in relation to follow-up of the case report.

The Effect of Scaphoid Fracture Site on Scaphoid Instability Patterns.

Background Scaphoid fractures are common carpal fractures that are often misdiagnosed as wrist sprains and may go on to nonunion. The location of the fracture site may influence the stability of scaphoid nonunions. Purpose To determine whether the stability of a scaphoid nonunion depends upon the fracture's location, we tested the hypothesis that a simulated fracture distal to the apex of the scaphoid dorsal ridge will have greater interfragmentary motion than proximal. Methods Eleven cadaver wrists were moved through three wrist motions using a wrist simulator. In six wrists, a fracture was created distal to the scaphoid apex, and in five a fracture was created proximal to the apex. Sensors attached to the distal and proximal parts of each scaphoid measured the interfragmentary motion during wrist motion. Results In those wrists in which the scaphoid was sectioned distal to the apex, the distal fragment became significantly more unstable relative to the proximal fragment. It flexed, ulnarly deviated, and pronated. These motion changes were less when the scaphoid was sectioned proximally. Discussion Scaphoid fractures distal to the scaphoid apex will have greater interfragmentary motion. The mobility of the fragments at the fracture site is possibly a more important contributory factor of nonunion in scaphoid waist fractures than for proximal scaphoid fractures. Clinical Relevance Understanding the effect that the location of a scaphoid fracture has on the potential for nonunion may influence the modalities of treatment and follow-up.

The Role of Cardiac Computed Tomography in Tetralogy of Fallot and Pulmonary Atresia

Congenital heart disease (CHD) occurs in about 6 to 8 of 1000 live births with the increasing prevalence can be attributed to major improvements in diagnosis and treatment. Imaging has an important role in diagnosis of CHD. It outlines anatomy and physiology, helps to refine management, evaluates the consequences of interventions and helps guide prognosis. However, no single available imaging modality fulfills these roles for all patients and diseases. Therefore, assessment for CHD must involve multimodalities that can be used in a complementary fashion, and that together are sensitive, accurate, reproducible, and cost effective, whilst minimizing harm.In previous years, the diagnosis and the treatment of congenital malformations have often depended on cardiac catheterization. In many institutions, cardiac catheterization still remains the gold standard against which other modalities are measured. In the past decade, however, imaging methodologies have increasingly shifted toward the use of less invasive and noninvasive techniques. Although echocardiography is the most commonly used imaging modality for diagnosis and follow-up of subjects with CHD, the evolution of cardiovascular magnetic resonance (MR) imaging and increasingly computed tomography (CT) does offer new ways to visualize the heart and the great vessels.

Feasibility of self-performed urine pregnancy testing for follow-up after medical abortion

ObjectivesMedical termination of pregnancy (MToP) follow-up can be simplified by combining a clinical assessment with blood and urine human chorionic gonadotropin (hCG) measurements, the later using a low sensitivity urinary pregnancy (LSUP) testing. This study aimed to describe follow-up modalities of MToP in real-life conditions, and assess the benefit of a self-performed urine semiquantitative test in the follow-up of MToP and its feasibility, acceptability and user-friendliness as well as the women capacity to interpret it correctly. Concordance between qualitative results from LSUP test and quantitative values from the blood hCG measurement was also assessed. Study designFrom May to November 2013, we conducted a national, prospective, observational study with 17 centres offering MToP. Pregnant women with at least 63 days of amenorrhea (DA) requesting MToP were recruited during a consultation visit for medical abortion. ResultsA total of 322 women were included (mean age: 28.1±6.4 years). The mean term of pregnancy at the time of MToP was 44.1±6.2 DA. Two regimens were mostly used: 200 and 600mg mifepristone followed by 800μg of misoprostol (51.5 and 33.3% of patients, respectively). 82.0% of women attended the follow-up visit (N=264), 5.0% were reached by phone and 13.0% were lost to follow-up. 86.2% of women performed blood and urine measurements, as requested, on the same day (±one day). The MToP success rate was 93.6% of women. There were two ongoing pregnancies (0.7%) and 16 retained products of conception (5.7%). The overall concordance between urine and blood hCG levels was estimated at 94.5% CI95% [90.2%; 97.4%]. According to the physician's opinion, a majority of women (89.6%) read the urine test correctly. Self-performing the LSUP test at home was found reassuring for 39.9% of women, and satisfactory for 25.8% of them, but 2.8% considered it to be alarming and 11.8% unsettling. ConclusionIn our study, a self-performed LSUP test showed good concordance with blood test and appeared to be relevant, efficient and safe for women to monitor MToP success.

Incidence and Spectrum of Renal Complications and Extrarenal Diseases and Syndromes in 380 Children and Young Adults With Horseshoe Kidney.

The objective of our study was to evaluate the incidence and spectrum of renal complications and of extrarenal diseases and syndromes in children with horseshoe kidney (HSK). The clinical data and imaging studies of 380 subjects (median age, 2.8 years) diagnosed with HSK over a 24-year period were reviewed: 366 children and young adults and 14 fetuses, one of whom died in utero. All renal complications and extrarenal diseases and syndromes were documented. Patient age, initial imaging modality, follow-up imaging modalities, and imaging modality at diagnosis were recorded. One hundred seventy-five patients (46.1%) had renal complications. Pelvocaliectasis without an identifiable cause was the most common complication (n = 83, 21.8%) followed by vesicoureteral reflux (n = 37, 9.7%). Less common renal complications included duplex kidney, multicystic dysplastic kidney, renal stones, asymmetric renal size, ureteropelvic junction obstruction, ureteral stones, acute pyelonephritis, trauma, and renal rhabdomyosarcoma. One hundred ninety patients (50%) had extrarenal diseases or syndromes. Gastrointestinal tract (n = 62) and vertebral (n = 54) anomalies were the most common. Forty-nine patients had syndromes. Turner syndrome was the most common (n = 16) followed by caudal regression syndrome (n = 9). HSK was missed on initial imaging in 42 of 364 postnatal renal examinations and was diagnosed later. The patient groups with renal complications and with extrarenal diseases or syndromes and a missed diagnosis of HSK were significantly younger than the groups without them (p < 0.05, Wilcoxon rank sum test). Half of children with HSK have renal complications or extrarenal diseases or syndromes. The incidence is higher in younger children, and the spectrum of complications, diseases, and syndromes differs from those reported in previous studies of adults with HSK. Children with HSK, especially young children, therefore require follow-up renal examinations and extensive extrarenal workup.

Contrast-enhanced ultrasound after endovascular aortic repair-current status and future perspectives.

An increasing number of patients with abdominal aortic aneurysms (AAAs) are undergoing endovascular aortic repair (EVAR) instead of open surgery. These patients require lifelong surveillance, and the follow-up imaging modality of choice has been traditionally computed tomography angiography (CTA). Repetitive CTA imaging is associated with cumulative radiation exposure and requires the administration of multiple doses of nephrotoxic contrast agents. Contrast-enhanced ultrasound (CEUS) has emerged as an alternative strategy in the follow-up of patients with EVAR and demonstrates high sensitivity and specificity for detection of endoleaks. In fact, a series of studies have shown that CEUS is at least performing equal to computed tomography for the detection and classification of endoleaks. This article summarizes current evidence of CEUS after EVAR and demonstrates its usefulness via various patient cases.

A Systematic Review of Economic Evaluations of Pacemaker Telemonitoring Systems

Introduction and objectivesOver the last decade, telemedicine applied to pacemaker monitoring has undergone extraordinary growth. It is not known if telemonitoring is more or less efficient than conventional monitoring. The aim of this study was to carry out a systematic review analyzing the available evidence on resource use and health outcomes in both follow-up modalities. MethodsWe searched 11 databases and included studies published up until November 2014. The inclusion criteria were: a) experimental or observational design; b) studies based on complete economic evaluations; c) patients with pacemakers, and d) telemonitoring compared with conventional hospital monitoring. ResultsSeven studies met the inclusion criteria, providing information on 2852 patients, with a mean age of 81 years. The main indication for device implantation was atrioventricular block. With telemonitoring, cardiovascular events were detected and treated 2 months earlier than with conventional monitoring, thus reducing length of hospital stay by 34% and reducing routine and emergency hospital visits as well. There were no significant intergroup differences in perceived quality of life or number of adverse events. The cost of telemonitoring was 60% lower than that of conventional hospital monitoring. ConclusionsCompared with conventional monitoring, cardiovascular events were detected earlier and the number or hospitalizations and hospital visits was reduced with pacemaker telemonitoring. In addition, the costs associated with follow-up were lower with telemonitoring.

Revisión sistemática de evaluaciones económicas de los sistemas de telemonitorización en los marcapasos

Introduction and objectivesOver the last decade, telemedicine applied to pacemaker monitoring has undergone extraordinary growth. It is not known if telemonitoring is more or less efficient than conventional monitoring. The aim of this study was to carry out a systematic review analyzing the available evidence on resource use and health outcomes in both follow-up modalities. MethodsWe searched 11 databases and included studies published up until November 2014. The inclusion criteria were: a) experimental or observational design; b) studies based on complete economic evaluations; c) patients with pacemakers, and d) telemonitoring compared with conventional hospital monitoring. ResultsSeven studies met the inclusion criteria, providing information on 2852 patients, with a mean age of 81 years. The main indication for device implantation was atrioventricular block. With telemonitoring, cardiovascular events were detected and treated 2 months earlier than with conventional monitoring, thus reducing length of hospital stay by 34% and reducing routine and emergency hospital visits as well. There were no significant intergroup differences in perceived quality of life or number of adverse events. The cost of telemonitoring was 60% lower than that of conventional hospital monitoring. ConclusionsCompared with conventional monitoring, cardiovascular events were detected earlier and the number or hospitalizations and hospital visits was reduced with pacemaker telemonitoring. In addition, the costs associated with follow-up were lower with telemonitoring.Full English text available from:www.revespcardiol.org/en