Resolution Of Symptoms In Majority Research Articles

Symptom relief in patients undergoing endovascular management of chronic mesenteric ischemia.

Chronic mesenteric ischemia (CMI) is a rare, but potentially fatal condition, which is becoming increasingly prevalent in elderly patients. This study investigated the impact of endovascular intervention on patient symptomology and the influence of extent of mesenteric disease on patient morbidity and mortality. All patients who underwent primary angioplasty (±stenting) to the mesenteric vessels for CMI between July 2008 to July 2017 were retrospectively identified. Patient data relating to comorbidities, clinical presentation, disease burden, procedural details, symptomatology, reintervention and mortality were collected. Mortality was assessed using regression analysis, which was adjusted for age and gender. Overall, 38 patients were included in the study. The median age was 73.5 years (interquartile range, 70.0-77.8). Abdominal pain (N.=36), postprandial pain (N.=32) and weight loss (N.=32) were the most common symptoms reported at presentation. Technical success was achieved in 37 patients. Thirty-two patients were symptom free at 6 weeks and 29 patients were symptom free at 2 years. Overall 5 patients required reintervention. At 30 days and 2 years one and seven patients were deceased, respectively. Significant association was observed between three vessel intervention and overall mortality (adjusted odds ratio 14.5, 95% confidence interval: 1.28-165.86, P=0.031). Majority of patients died of a cause unrelated to their CMI. Endovascular intervention for CMI is safe and provides satisfactory short-term and intermediate term symptom resolution in majority of patients. This study supports the routine use of endovascular intervention in the management of this complex disease.

Sapheno-femoral crossover venous bypass in a case of deep vein thrombosis: an uncommonly done procedure for a very common disease

Vascular bypass procedures using saphenous vein graft are commonly done in cases of peripheral vascular disease, however in cases of venous disease the use of vascular bypass is limited , even though reports in literature show good results with resolution of symptoms in majority of patients. A review of the results of deep vein reconstruction for obstructive disease reveals the clear ability to perform these procedures with the minimum of risk, and the results in the successful cases demonstrate the improvement that follows correction of the physiologic abnormalities of obstruction [1]. Management of venous obstruction seems to be a bit neglected as far as surgical management is concerned with anticoagulants playing the major role. The procedures used in management of unilateral iliofemoral thrombosis are Palma’s procedure (cross-over femoro-femoral venous bypass using saphenous vein from contralateral thigh), use of prosthetic conduits and endovascular interventions. Deep Vein Thrombosis (DVT) is a very common disease with acute presentation of sudden onset edema, difficulty in walking and severe pain in the leg. Initial management is usually with anticoagulants and thrombolysis, with very few patients undergoing embolectomy. Medical management in the acute phase mostly leads to partial recannalization. After resolution of symptoms partially, the chronic phase sets in where patients continue to have edema, develop pigmentation, varicose veins and decreased work performance. Virchow’s triad of stasis, hypercoagulability and injury to vessel wall are important in the pathogenesis and management of the disease. Cross-over femoral venous bypass is suitable for persistent isolated unilateral iliac or common femoral vein occlusions in young and middle aged patients with severe chronic deep venous insufficiency unresponsive to conservative measures [2]. This case is reported to highlight the benefit and good results of vascular bypass in venous obstructions where facility for endovascular procedures is not available.

Determinants of immediate and long‐term results of subclavian and innominate artery angioplasty

Percutaneous angioplasty (PTA) is widely used in the treatment of subclavian/innominate artery obstruction, but factors of long-term PTA outcome are poorly understood. Our aim was to evaluate the efficiency of PTA on symptom resolution and identify determinants of long-term outcome. Seventy-six lesions were treated in 75 patients (58.7% men) aged 60 +/- 8.5 years. PTA was successful in 70 (93.3%) patients, including 58/58 (100%) stenotic lesions and 13/18 (72.2%) occlusions. The mean stenosis grade (QCA) was reduced from 78.9% +/- 16.6% to 13.5% +/- 10.7% (P < 0.01). A great majority of lesions (87.1%) were stented. In 5 (7.1%) high-risk lesions a proximal or distal neuroprotection system was used. There were no strokes or embolic events. Minor complications occurred in 7 (9.3%) cases. Fifty-seven (89%) of 64 symptomatic patients had complete symptom resolution. The mean follow-up was 24.4 +/- 15.5 months (up to 66 months). Ten restenoses (15.6%), including 9 (13.8%) in-stent restenoses and 1 (16.7%) restenosis after balloon angioplasty, were diagnosed in 64 patients and followed up for at least 6 months. Nine symptomatic restenoses were successfully treated with repeated angioplasty. Cox multivariable analysis revealed the following independent predictors of restenosis: implantation of more than one stent (P = 0.005), low stent diameter (P = 0.088), and postprocedural systolic blood pressure difference between upper extremities (P = 0.044). PTA is a safe and effective method for the treatment of the subclavian/innominate artery obstruction and leads to symptom resolution in majority of patients. Restenosis is not frequent and it can be effectively treated with repeat angioplasty. Low stent diameter, implantation of two stents, and upper limb systolic blood pressure difference are independent predictors of restenosis.