Vascular Department Research Articles

A Combined Treatment Effect of Cilostazol and Pentoxifylline in the Treatment of Peripheral Vascular Disease

Background: (50 mg BD) and pentoxifylline (400 mg TDS) therapy in patients with PVD. Additionally, the adverse effects and economic burden of the combination was taken in to account.
 Methodology: An Observational antegrade study was done among 100 patients. A Patient with PVD visited to OPD of the vascular department was enrolled in the study. Data was collected as per the Case Record Form.
 Results: The mean age was found to be 58.4 ± 11.3 years of total 100 patients. An improvement in a Doppler testing (follow-up at the time interval after 1 month, 3 months and 6 months) and increased in peak systolic velocity in distal vessels as well as collaterals were observed in all patients. The PVD was prevalent in 50 to 60 years of age groups and hypertension and smoking were the most common risk factors present in PVD patients. There was more than 70% increase in walking distance after 24 weeks of treatment. Headache 24 (36.4%) and Dizziness 9 (13.6%) were observed as common side effect of therapy. The total cost of the combination therapy was affordable with improved quality of life.
 Conclusion: The combination treatment showed symptomatic improvement in peripheral vascular disease in the study. The peak systolic velocity gradually increased in the distal vessel and the combination was found to be cost-effective.

EP-625 An audit looking at whether consent has been gathered to upload patient details to the National Vascular Registry in Countess of Chester Hospital

Abstract Aims The National Vascular Registry (NVR) forms part of The Vascular Society and aims to improve the quality of care for patients with vascular disease by measuring the quality and outcomes of care for patients who undergo major vascular surgery. Within the vascular department at Countess of Chester Hospital, patients had not consented for their information to be uploaded to the NVR but were still being uploaded post procedure. Methods A retrospective audit collected data from all vascular procedures performed in September 2021 in the Countess of Chester Hospital. For each procedure, we checked whether the data was uploaded to the NVR and where consent had been gathered from the patient to upload their data to the NVR. Results Of 57 procedures performed in September 2021: Conclusion Of 57 procedures, data was uploaded to the NVR 42.3% of the time and of these, consent from the patients was only gained 43.5% of the time. With these results there is room for improvement within the department, firstly to consent patients to allow their data to be uploaded to the NVR and then to upload the data following procedures.

Ankle Hemodynamic Index to Assess the Severity of Peripheral Arterial Disease Compared to Ankle Brachial Index

Aims: The goal of this study is to assess the diagnostic efficacy of the “ankle-brachial index, ankle hemodynamic index (Tanno et al, 2016) correlated with the Rutherford grading of lower limb ischemia” in patients with angiographically proven peripheral artery disease as assessed by either CT or contrast angiography of the lower extremities as imaging modalities. Methods: This observational cross-sectional study included 100 participants with proven peripheral artery disease who were referred to Nasr city health insurance hospital's vascular department and outpatient clinic. Results: Study participants ranged in age from 35-86. The mean age of the participants was 63.6 ± 10.5 years. They were 70 males (70%) and 30 females (30%). The ankle-brachial index value ranged from 0.6 up to 1.3 for all of the participants that were evaluated, with a mean of 1 and a standard deviation of 0.2. Ankle hemodynamic index ranged from 17 to 73, with 17 being the lowest possible value and 73 being the highest possible value. The mean ankle hemodynamic index was 41.2 ± 13.4. Ankle hemodynamic index and Rutherford grade have an extremely statistically significant positive correlation. Conclusion: In conclusion, the AHI was shown to be substantially positively connected with the severity of PAD as assessed by Rutherford grading, but the ABI was found to be non-significantly associated with Rutherford grading. We also discovered that Rutherford grade was linked to HbA1C, Hb, CRP, and ankle DBP. Keywords: Peripheral artery disease, ankle hemodynamic index, Rutherford grading, ankle-brachial index.

Efficacy of polarized light therapy versus monochromatic infrared energy in the treatment of venous leg ulcer

Purpose: To evaluate the effects of polarized light therapy versus monochromatic infrared energy in the treatment of venous leg ulcers. Methods of evaluation: - (Measurement of the ulcer surface area (USA) and the ulcer volume measurement (UVM). Methods: Forty patients suffering from stage 2 lower limb venous ulcers were selected randomly from the vascular and general surgeries departments of Kasr-El-Aini Hospital. These patients were divided randomly into two equal groups in number: One was treated with the polarized light therapy (BLT) besides the regular ulcer care (topical and general medications as well as the intermittent surgical curettage) for three months, while the other was treated with the monochromatic infrared energy (MIRE) therapy, medical treatment and the and the regular ulcer care (topical and general medications as well as the intermittent surgical curettage) for three months or till healing, their ages were ranged from 50 to 65 years. Results: Results showed that both the BLT and MIRE were effective in enhancing the healing of the lower limb venous ulcers as manifested by the highly significant decreases in ulcer surface area (USA) and ulcer volume measurement (UVM).

Telemedicine and Vascular Surgery: Expanding Access and Providing Care Through the COVID-19 Pandemic.

IntroductionAccess to surgical service is limited by provider availability and geographic barriers. Telemedicine ensures that patients can access medical care.ObjectiveThe objective is to describe our use of telemedicine in delivering vascular surgery services to remote locations before and during the COVID-19 pandemic.MethodsWe conducted a retrospective chart review analyzing care delivered at six vascular surgery telemedicine clinics over a 22-month period. We examined vascular diagnoses, recommended interventions, referrals placed, and emergency department visits within 30 days of evaluation. We calculated travel distance saved for patients between their local clinic and our main hospital.ResultsWe identified 94 patients and 144 telemedicine visits, with an average of 1.5 visits per patient (SD = 0.73). The most common referrals were for peripheral artery disease (20.2%) and abdominal aortic aneurysm (14.9%). Three patients were immediately referred to the emergency department due to concern for acute limb ischemia (2) or questionable symptomatic AAA (1). Telemedicine visit recommendations were distributed between no intervention (n = 30, 31.9%), medical management (n = 41, 43.6%), and surgical intervention (n = 23, 24.5%).The surgical intervention cohort was most commonly referred to arterial revascularization (n = 4), venous ablation (n = 4), and arteriovenous fistula procedures (n = 4). Fourteen patients came to our main hospital for surgery and four to local providers. Average travel distance saved per telemedicine visit was 104 miles (SD = 43.7).ConclusionsTelemedicine provided safe, efficient care during the COVID-19 pandemic and saved patients an average of 104 travel miles per visit.

Prognostic Impact of Blood Pressure Change Patterns on Patients With Aortic Dissection After Admission.

ObjectivesHypertension is a predominant risk factor for aortic dissection (AD), and blood pressure (BP) control plays a vital role in the management of AD. However, the correlation between BP change and the prognosis for AD remains unclear. This study aims to demonstrate the impact of BP change patterns on AD prognosis.MethodsThis retrospective study included AD patients at two institutions (Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine and the Vascular Department of the First Affiliated Hospital of Anhui Medical University) between 2004 and 2018. The systolic BP (SBP) change patterns of these patients were analyzed by functional data analysis (FDA). The relationship between BP change patterns and the risk of adverse events (AEs) was assessed using survival analysis.ResultsA total of 458 patients with AD were eligible for analysis. The logistic regression analysis indicated that compared with that in patients with low SBP variation (SBPV), the incidence of AEs in patients with high SBPV was significantly higher (35.84 vs. 20.35%, OR 2.19, P < 0.001). The patients were divided into four categories (accelerating rise, accelerating drop, decelerating rise, and decelerating drop) based on their SBP patterns after FDA fitting. The results of Kaplan–Meier analysis showed that at the 15- and 20-min time points, the incidence of AEs in the decelerating-drop group was significantly lower than that in the accelerating-rise group (OR 0.19, P = 0.031 and OR 0.23, P = 0.050). However, at the 25- and 30-min time points, the difference between these four groups was not significant (OR 0.26, P = 0.08 and OR 0.29, P = 0.10).ConclusionsThis study classified AD patients into four groups according to the SBP change patterns the first 30 min following admission, of which those with accelerating rises in SBP are at the highest risk of AEs, while those with decelerating drops have the best prognosis in the first 24 h after admission. Clinical practitioners may benefit from analyzing patterns of in-hospital SBP.

Correlation between Age and Defect Size with Increased Pulmonary Arterial Pressure in Adult Atrial Septal Defect (ASD) Patients at Cardiology and Vascular Medicine Department dr. Seotomo Public Hospital Surabaya 2019-2021

Abstract: Atrial Septal Defect (ASD) is one of the three most common types of congenital heart disease in the world. Pulmonary arterial hypertension (PAH) is a complication that can be found in patients with secundum type of ASD. There is no research that shows the relationship between patient’s age and defect size with increased pulmonary artery pressure in secundum type of ASD patients in Indonesia, so further research needs to be done. Material and Methods: This study is a retrospective study using an observational analytical research design with cross sectionalapproach. The data from this study were taken from the medical records of ASD patients at the Cardiology and Vascular Department of Dr. Soetomo Public Hospital Surabaya. Results: Sex distribution of patients with secundum ASD was dominated by female patients with a total of 53 people (81.5%), the age distribution of patients was dominated by patients in the age group of 20-24 years as many as 18 people (27.7%). The most common comorbidities in adult secundum ASD patients were hypertension (3.08%) and minor CAD (3.08%). The mean diameter of the secundum ASD defect was 28.03±9.57 mm, and the data for the smallest defect diameter was 4 mm and the largest was 48 mm. Complications of increased PA pressure were dominated by 20 patients with mild PH (30.8%) and the mean mPAP pressure was 39.87±19.03. There were no patients with Eisenmenger syndrome.Conclusion: There was no correlation between patient age and inter-atrial septal diameter with mPAP pressure.

Thrombotic burden, D-dimer levels and complete compression ultrasound for diagnosis of acute symptomatic deep vein thrombosis of the lower limbs

BackgroundDiagnostic algorithms for deep vein thrombosis (DVT) include D-dimer for its high negative predictive value, thus reducing the need for imaging. Small thrombi may be associated with low D-dimer levels, increasing false negatives. AimTo assess the sensitivity and thus the false negative rates of standard and age-adjusted D-dimer cut offs for isolated distal DVT (IDDVT) in outpatients. Materials and methodsWe enrolled consecutive outpatients with suspected DVT of the lower limbs referring to our vascular emergency department from 2009 to 2018. Patients underwent D-dimer testing (STA, Stago, cut-off: 500 μg/L), pretest clinical probability (PTP) evaluation and complete compression ultrasonography. Follow-up was 3 months. ResultsAmong 3948 patients (M:1554–39%, median age 69), 486 proximal DVTs (12.3%) and 348 IDDVTs (8.8%) were diagnosed. Median D-dimer was higher in proximal than IDDVT (3960 vs 1400 μgr/L; p = 0.001). The false negative rate of the standard D-dimer cut-off was 2% (95%CI: 0.8–3.2%) for proximal DVT and 14.7% (95% CI: 11–81%) for IDDVT. The false negative rate of the age-adjusted cut-off was 4.9% (3–7%) for proximal DVT and 19.5% (95% CI: 15.4–24.7%) for IDDVT. Conclusions: Small calf thrombi are associated with low D-dimer levels, and age-adjusted D-dimer may be below the cut-off more frequently in subjects with IDDVT than standard cut-off D-dimer, although such D-dimer levels might exclude IDDVT that require treatment.

145 Best Medical Therapy for Patients with Peripheral Arterial Disease: A Quality Improvement Project in Vascular Surgery, Aberdeen Royal Infirmary

Abstract Introduction Peripheral arterial disease (PAD) is the leading cause of limb amputation and cardiovascular morbidity. The National Institute for Health and Care Excellence (NICE) advocates best medical therapy (BMT) with high-dose statin (atorvastatin 80mg) and antiplatelets (clopidogrel or aspirin) for secondary prevention in patients with PAD. We assessed compliance to BMT prescribing in our vascular department. Method Retrospective data were collected for all patients admitted with symptomatic PAD in our vascular department over a 2-week period. Criteria for BMT were as per NICE guidelines with a standard set to 100%. Following cycle 1, a new admission document prompting antiplatelet and statin review was designed and departmental teaching on BMT delivered. Standard compliance was re-audited after 3 months. Results Twenty-five patients were admitted with PAD during cycle 1 with 28% of patients (n = 7) on BMT on admission. This increased to 40% (n = 10) on discharge with 100% (n = 25) on an antiplatelet and 28% (n = 7) on high-dose statin. Overall, there were twenty patients in cycle 2 with 25% of patients (n = 5) on BMT on admission. This increased to 80% (n = 16) on discharge with 100% (n = 20) on an antiplatelet and 80% (n = 16) on high-dose statin. Conclusions Our data demonstrated poor implementation of BMT for patients with PAD managed in primary care suggesting a need for primary care education. Adaption of our admission proforma to prompt BMT prescribing as well as departmental teaching was associated with drastic improvement of BMT prescription on discharge and standard adherence.

Transient perivascular inflammation of the carotid artery (TIPIC) syndrome.

Background: The Transient Perivascular Inflammation of the Carotid artery (TIPIC) syndrome is presumably a very rare disease characterized by a local transient inflammation of the tissue around the carotid artery. Its pathophysiology remains unknown. We performed an updated study of TIPIC syndrome cases in the setting of a multinational collaborative study. Methods: This study was conducted as an observational multinational retrospective individual patient level cohort study. Information from all known cases diagnosed with TIPIC syndrome in the literature (2005-2020) was collected after a semi-structured literature search of PubMed and Web of Science. We also collected unpublished information of patients from French, Swiss, and Italian vascular medicine or radiology departments. Results: A total of 72 patients were included and served for data analysis: 42 (58.3%) were women; the mean age was 47.9 (SD=11.4) years. Symptoms were unilateral in 92% of patients and 81.4% required pain killers. At baseline, irrespective of the imaging method used, the median thickness of the carotid lesions was 5 (Q1-Q3: 4-7; range: 2-11) mm and the median length of the lesion was 20 (Q1-Q3: 10-30; range: 3-50) mm. We found a positive linear correlation between thickness and length. At follow-up, the thickness of the carotid lesions decreased to a median of 2 (Q1-Q3: 1-3; range: 0-6) mm; the length decreased to a median 10 (Q1-Q3: 5-15; range: 0-41) mm. A linear correlation between baseline and follow-up values was observed for both thickness and length measurements. Symptoms disappeared after a median of 14 (Q1-Q3: 10-15) days. Thirteen patients experienced a recurrence after a median follow-up of 6 (Q1-Q3: 2-12) months. Conclusions: The present analysis elucidates clinical and sonographic characteristics of TIPIC syndrome, indicating the benign nature of this condition. A future international registry will study the long-term course of the disease.

Women Specific Characteristics and 1-Year Outcome Among Patients Hospitalized for Peripheral Artery Disease: A Monocentric Cohort Analysis in a Tertiary Center.

Although women have lower age-standardized cardiovascular disease incidence, prevalence, and death-related rates than men, there are also reports indicating that women with cardiovascular disease receive less care, fewer investigations, and have poorer outcomes after a coronary event. The aims of this study were to compare the characteristics of men and women hospitalized for peripheral artery disease (PAD), their cardiovascular and limb outcomes, and their 1-year mortality. The study is a prospective registry collecting data about all consecutive patients hospitalized for PAD within the vascular department of the tertiary center Georges-Pompidou European Hospital (Paris, France). Patients were required to have one of three inclusion criteria: previous revascularization of the lower limb or any lower limb artery occlusion due to an atherosclerotic vascular disease or hemodynamic evidence of PAD. Exclusion criteria were patients with lower extremity arterial occlusion due to another cause. All patients were followed-up for at least 12 months after the initial hospitalization. Among the 235 patients included, there were 61 women (26%), older than men with a median age of 75.6 and 68.3 years, respectively. Main cardiovascular risk factors and comorbidities were similar for men and women except more former or current smokers [145 (83.4%) vs. 33 (54.1%)] and more history of coronary heart disease [42 (24.1%) vs. 7 (11.5%)] in men. Most patients [138 (58.8%)] had critical limb ischemia and 97 (41.3%) had claudication, with no difference for sex. After discharge, 218 patients received an antithrombotic therapy (93.2%), 195 a lipid-lowering drug (83.3%), 185 an angiotensin converting enzyme inhibitor or angiotensin-receptor blocker (78.9%), similarly between sex. At 1-year, overall mortality, major adverse cardiovascular events, major adverse limb events did not differ with 23 (13.2%), 11 (6.3%) and 32 (18.4%) in men, and 8 (13.1%), 3 (4.9%), 15 (24.6%) in women, respectively, despite the difference in age. Overall mortality, cardiovascular outcomes, limb revascularization or amputation did not differ between men and women, 1-year after hospitalization for PAD although the latter were older, less smoker and had less coronary artery disease. Due to the small size of this cohort, larger studies and future research are needed to better understand sex-specific mechanisms in the pathophysiology and natural history of PAD.

Incident cardiovascular events and early mortality in patients with revascularized critical limb ischemia.

Patients with critical limb ischemia (CLI) present a high risk of cardiovascular events and death. This study aimed to investigate the incidence of major adverse cardiovascular events (MACE) and one-year mortality in patients undergoing percutaneous revascularization procedure for CLI. This investigation is a retrospective analysis of an ongoing cohort study in patients with CLI undergoing endovascular revascularization, hospitalized in the vascular medicine department from November 2013 to December 2018. Major cardiovascular events were collected during the first year after revascularization procedure and were defined as heart failure, acute coronary syndrome, ischemic stroke and sudden death. Mortality and major limb amputations, defined as above-the-ankle amputation, were determined during the one-year follow-up period. Multivariate logistic regression analyses were performed to identify factors independently associated with the occurrence of MACE and one-year mortality after revascularization procedure. A P≤0.05 was considered as statistically significant. The study included 285 consecutive patients, 157 men (55%) and 128 women (45%), with a mean age of 77.8±12 years. Treated hypertension was present in 222 (78%) patients; diabetes was present in 137 (48%) patients; 112 (39%) patients had known coronary heart disease and 20 (7%) patients were dialysis dependent. During the one-year follow-up after revascularization procedure, 75 (26.3%) patients presented an incident cardiovascular event, of whom 19 (6.7%) patients in the perioperative period. Cumulative mortality rate was 26.7% (76 patients) mostly from cardiovascular causes. Twenty-five patients (8.8%) experienced major amputation. In multivariate analysis, the occurrence of MACE was associated with an increased mortality risk (HR 6.96 (2.99-16.94), P<0.001). Other variables associated with an increased mortality were living in a nursing home and malnutrition. Decompensated heart failure and coronary heart disease were both associated with incident MACE in multivariate analysis, independently of confounders. In the present study population, incident MACE were prevalent in the year following endovascular revascularization procedure in patients with CLI and were associated with an increased risk of mortality. Coronary heart disease and decompensated heart failure are important contributors for the occurrence of MACE. In this elderly patient population with CLI, these results should be taken into account during the multidisciplinary team meeting before consideration of revascularization procedure.

Embolism to the main limb arteries in patients with atrial fibrillation

Introduction. Acute limb ischemia due to embolism in patients with atrial fibrillation remains poorly studied. Objective – to study the clinical significance and role of atrial fibrillation (AF) in the development of embolism to the bifurcation of the aorta and the main arteries of the limbs. Materials and methods. Treatment results of 1816 patients with acute ischemia of the extremities due to embolism treated at a specialized vascular surgical department for the past 30 years were analyzed. 1611 (88.7 %) of them had AF. The distribution into studied groups was according to the period time factor. Group 1 (n = 744) consisted of patients admitted in the period from 1991 to 2000; in group 2 (n = 568) – admitted in the period from 2001 to 2010, in group 3 (n = 299) – from 2011 to 2020. Methods included clinical examination, electrocardiography, Doppler-ultrasound, echocardiography. Results. The role of rheumatic heart disease as a cause of AF has decreased over the past decades by almost 10 times (from 19.5 % in group 1 to 2.0 % in group 3). Currently, the main background diseases for the development of AF are arterial hypertension and various forms of coronary artery disease. Embolism in patients with AF may develop in the arteries of all vascular areas of the systemic circulation, but in the practice of a vascular surgeon more often in the main arteries of minor caliber – the brachial (24.5 %) and popliteal (13.0 %). Multiple embolisms to various vascular areas were found in 2.8 % of patients. Urgent surgical revascularization of the limb by open embolectomy was performed in 1481 (91.9 %) patients that allowed 1348 (83.7 %) to be discharged with limb-sparing. Conclusion. In patients with acute limb ischemia of embologenic ethiology, comorbid AF has 88.7 % of them. Urgent embolectomy allows 83.7 % of patients to be discharged without limb amputation. Hospital mortality in the period 1991–2000 was 15.6 %, the last decade has been reduced to 7.4 %.

Elucidation of Histological Features of Pericardium in Cases Clinically Presented as Constrictive Pericarditis: A Retrospective Observational Study

Introduction: Constrictive Pericarditis (CP) is an uncommon but important disease characterised by impaired diastolic ventricular filling and impaired ventricular ejection as a result of thickened, fibrosed and often calcified pericardium. Aim: To analyse histomorphological features of pericardial biopsy removed in patients with clinical and radiological features of constriction. Materials and Methods: The present study was a retrospective observational study conducted at LPS Institute of Cardiology and Cardiothoracic Vascular Surgery and Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India. A total of 108 patients with CP were studied between a time period of January 2008 to June 2019. Clinical, demographic, laboratory and operative data of patients were retrieved from record section of mentioned departments and analysed. On histology the following parameter, if present, were recorded: inflammation and its type, granulation tissue, fibrosis, extracellular collagen deposition, granuloma, haemosiderin deposition, mesothelial hyperplasia, capillary proliferation, and calcification. Data was analysed using Microsoft Office Excel spread sheet. Results: Out of 108 cases, 98 cases (90.7%) had increased pericardial thickness and 10 cases (9.2%) had normal pericardial thickness, despite clinical and echocardiographic features of restriction. In majority of cases (96 cases, 88.9%), inflammation was of chronic type and only in 8 cases (7.4%), it was of acute nature. Tubercular pericarditis was the major cause in 46 cases (42.6%) followed by chronic non specific idiopathic in 39 cases (36.1%). Conclusion: The current study evaluated the histological features of CP in a semiquantitative grade manner thus helping clinician and pathologists to guide for other ancillary testing and thus guide toward accurate diagnosis. The current study evaluated the histological features of CP in a semiquantitative grade manner thus helping pathologists to guide for other ancillary testing and thus guide toward accurate diagnosis.

Rehabilitation potential of patients with ischemic stroke: the possibility of predicting the course of the disease and the results of rehabilitation treatment

To develop a method for assessing RP in patients in the acute period of IS and to evaluate its role in predicting the effectiveness of therapeutic measures in the early recovery period. The study consisted of two parts. In the first part, using mathematical modeling methods, a method was created for assessing the RP of patients with acute IS. For this, we analyzed the discharge records of 102 patients (training sample) with IS aged 42 to 80 years (mean age 64.0±2.6 years). In the second part of the study, the results of rehabilitation measures were analyzed in these patients, who were transferred from the primary vascular department to the neurological department of Angara Clinical Resort. At the end of stage II of rehabilitation, a multidisciplinary team assessed the effectiveness of treatment of patients using integral indicators characterizing the clinical condition of a patient who had a stroke. In the first part of the study, devoted to the development of a mathematical model for assessing the RP of patients with IS, a methodology algorithm was created: a formalized patient card was created, the evidence base is represented by 85 indicators; certain indicators were assigned the values of the coefficients of linear classification functions, depending on which the patient fell into one of 4 groups: group 1 - satisfactory RP with limitations in rehabilitation measures; group 2 - satisfactory RP; group 3 - low RP; 4th group - high RP. The second part of the study was devoted to determining the value of RP for predicting the effectiveness of therapeutic measures in the early recovery period (stage II of medical rehabilitation). When testing patients at the end of treatment at the resort, it was found that the greatest effect was observed in patients of the 4th group with a high RP. A lesser effect was noted in patients of the 2nd group. The worst results were registered in the 1st and especially in the 3rd groups. The use of the method for assessing the RP of patients who have undergone IS, based on mathematical modeling, makes it possible to predict the results of medical rehabilitation of patients with IS at the II stage of rehabilitation in a resort.

Electrocardiographic predictors of the poor outcome of hemorrhagic stroke

To analyze the relationship between electrocardiogram (ECG) parameters in the acute period of hemorrhagic stroke and its poor outcome within 90 days. ECG data of 133 patients with hemorrhagic stroke recorded upon admission to the primary vascular department were analyzed. Eighteen percent out of 133 patients died within 90 days. The only ECG-predictor of the poor outcome of hemorrhagic stroke was the prolongation of corrected QT interval (QTc). The length of QTc should be taken into account while assessing patients with hemorrhagic stroke. The patients with the abnormal QTc are at higher risk of the development of cardiac complications and death.

The structure of stroke and the effect of somatic and addiction diseases on its appearance and course in patients with HIV infection

To study the contribution of somatic and addiction diseases to the formation and course of acute cerebrovascular accidents in people with HIV infection. The study included 123 patients with HIV infection, aged 27 to 86 years, who were treated in the primary vascular departments of hospitals in the Tyumen region in the period from 2013 to 2019. The patients were divided into two groups corresponding to the typology of stroke. All patients underwent a comprehensive neurological examination, laboratory and instrumental studies, including neuroimaging methods. In the group of patients with ischemic stroke, arterial hypertension was observed in 91.1% of cases, and with intracranial hemorrhages - in 66.7%. This risk factor was associated with a fatal outcome in 59.0% of patients with hemorrhages. Among those who died from cerebral infarction, 8.0% of patients suffered from hypertension, and 67.0% of them were men. Concomitant bronchopulmonary pathology in the vast majority of cases increased the risk of ischemic stroke in patients (93.0% of cases), and the presence of pneumonia in the acute period of a stroke significantly increases the risk of death. In addition, 45.5% of patients had comorbid viral hepatitis C (HCV). In this group of patients, 64.0% had an ischemic type of stroke, and 36% had hemorrhage. There were no deaths in patients with ischemic stroke, HIV and HCV, and among patients with hemorrhages and the same viral diseases, the mortality rate was 50.0%. The study showed a greater effect of hypertension on the risk of ischemic stroke than on the risk of intracranial hemorrhage in the study group of patients, which is an inverse relationship than the effect of this factor on the risk of stroke in HIV-negative patients. The presence of hepatitis C in an HIV-infected patient with a stroke increases the likelihood of death from intracranial hemorrhage.

Анализ клинических параметров пациентов с фибрилляцией предсердий и кардиоэмболическим инсультом

Th e aim of the research. To assess baseline clinical parameters of patients with atrial fi brillation and to analyse the whole variety of drugs they receive at the time of the development of cardioembolic stroke from the standpoint of evidence-based cardiology. Material and methods. Th e study was conducted at the premises of the neurological department for patients with acute cerebrovascular accidents of the Samara Regional Clinical Hospital named aft er V.D. Seredavin within the period from 2016 to 2019. In total, 139 patients were enrolled, of which 59 were male. Th e average age of the patients was 72.25±6.33. Results. Patients with atrial fi brillation admitted to the primary vascular department due to cardioembolic stroke were characterised by polymorbidity, namely: arterial hypertension was detected in 99.28 %, chronic kidney disease in 53.96 %, coronary heart disease in 30.94 %, diabetes mellitus in 19.42 % of the cases. Subjects with chronic atrial fi brillation prevailed among the studied patients (62.6 % of the cases). Th e risk of thromboembolic complications according to the CHA2DS2-VASc scale before admission to the hospital averaged at 4.37±1.2 points, while 97.84 % of the patients had indications for anticoagulant therapy. However, in real clinical practice, the prevention of thromboembolic complications was only carried out in 13.67 % of the cases and its quality was in compliancy with modern requirements in 3.60 % of the cases only. Conclusion. Th e data obtained attest to cardioembolic stroke developing in polymorbid patients with atrial fi brillation against the background of low quality management of patients with atrial fi brillation at the outpatient-polyclinic stage. Th is may indicate incomplete awareness of doctors about the possible risks of developing a feasibility study in patients with atrial fi brillation, as well as low patient adherence to treatment.

Vascular Graft Infections With Candida: A Factor for Increased Mortality in in-situ Reconstructions

The empiric antibiotic regimen started after deep cultures and explantation of the graft mostly do not cover antifungals. We retrospectively studied the outcome of candida compared to non-candida VGI and assessed whether these results could justify the addition of antifungals to the empiric antibiotics in the early postoperative period. All patients treated for infected aorto(ilio)femoral graft with excision and reconstruction at the vascular department of University Hospitals Leuven between January 2010 and 2017 (n=56) were studied retrospectively. Patients were allocated to the candida group (n=10) or non-candida group (n=46) according to the presence of Candida in deep culture isolates. All-cause mortality was significantly higher in the candida group compared to the non-candida group. All-cause 30-day mortality was 40% and 13% for both groups respectively (P=0.066). At 5 years this was 90% and 46% respectively (P=0.014). In the candida group 6 patients (60%) had to be revised in the operating room due to bleeding, compared to 5 patients (11%) in the non-candida group (P=0.002). Two patients (20%) and 5 patients (11%) had to be readmitted to the ICU, respectively. Survival of candida related VGI is significantly worse, especially in the first 5 postoperative months. This could justify the addition of an antifungal to the early empiric postoperative antibiotic cocktail, especially in patients with an aorto-enteric fistula. A cost-benefit analysis could be useful to evaluate the yield.

Expert consensus on Tongsaimai Tablets/Capsules in treatment of peripheral vascular diseases in clinical practice

Tongsaimai Tablets/Capsules are composed of Lonicerae Japonicae Flos, Angelicae Sinensis Radix, Achyranthis Bidentatae Radix, Codonopsis Radix, Dendrobii Caulis, Astragali Radix, Scrophulariae Radix, and Glycyrrhizae Radix et Rhizoma, and are effective in promoting blood circulation, removing blood stasis, supplementing Qi, and nourishing Yin. It is widely used in the treatment of peripheral vascular diseases. With 40 years of clinical application, it has accumulated substantial research data and application experience. Its good clinical efficacy and pharmacoeconomic benefits in improving the clinical symptoms of peripheral vascular diseases have been confirmed by relevant research. Meanwhile, this drug has also been recommended by many expert consensus, guidelines, and teaching materials, serving as one of the most commonly used Chinese patent medicines in clinical practice. To further improve the understanding of the drug among clinicians and properly guide its clinical medication, the China Association of Chinese Medicine took the lead and organized experts to jointly formulate this expert consensus. Based on the questionnaire survey of clinicians and the systematic review of research literature on Tongsaimai Tablets/Capsules with clinical problems in the PICO framework, the consensus, combined with expert experience, concludes recommendations or consensus suggestions by GRADE system with the optimal evidence available through the nominal group technique. This consensus defines the indications, usage, dosage, course of treatment, medication time, combined medication, and precautions of Tongsaimai Tablets/Capsules in the treatment of peripheral vascular diseases, and explains the safety of its clinical application. It is recommended for clinicians and pharmacists in the peripheral vascular department(vascular surgery), traditional Chinese medicine surgery(general surgery), and endocrinology department of hospitals at all levels in China.