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1.
How to Prevent Surgical Site Infection in Vascular Surgery: A Review of the Evidence.
Zhao, AH, Kwok, CHR, Jansen, SJ
Annals of vascular surgery. 2022;:336-361
Abstract
BACKGROUND This review aims to identify and review the current evidence for preventing postoperative surgical site infections in abdominal aortic aneurysm surgery or infrainguinal arterial surgery. METHODS Extended literature review of clinical trials that examined the prevention of postoperative surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. Searches were conducted on Ovid MEDLINE (1950 - 13 March 2020) using key terms for vascular surgery, surgical site infections and specific preventative techniques. Articles were included if they discussed a relationship between a preventative technique and surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. The GRADE guidelines were used to assess the quality of evidence. RESULTS 21 techniques and 81 studies were included. Prophylactic antibiotics and negative pressure wound therapy have a high quality of evidence for the prevention of surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. A moderate quality evidence base was identified for gentamicin containing collagen implant (confined to high surgical site infection risk centers). Currently, there is a low or very low quality of evidence to suggest a reduction in the surgical site infection rate for combination therapy, glycaemic control, Methicillin-resistant Staphylococcus aureus screening and absorbable suture. Evidence suggests no beneficial effect for nutritional supplementation, chlorhexidine bath, hair removal therapy, Staphylococcus aureus nasal eradication, cyanoacrylate microsealant, silver grafts, rifampicin bonded grafts, triclosan coated suture and postoperative wound drains. Endoscopic saphenous vein harvest may reduce surgical site infection rate (very low quality of evidence) but may lower long-term patency. Autologous vein grafts may increase surgical site infections (very low quality of evidence) but may provide better long-term patency rates in above-knee infrainguinal bypass surgery. There was no identified evidence for perioperative normothermia, electrosurgical bipolar vessel sealer or Dermabond and Tegaderm for surgical site infection prevention in vascular surgery. CONCLUSIONS Prophylactic antibiotics and postoperative negative pressure wound therapy are effective in the prevention of postoperative surgical site infection in abdominal aortic aneurysm or infrainguinal arterial surgery. There exists a significant risk of bias in the literature for many preventative techniques and further studies are required to investigate the efficacy of gentamicin containing collagen implant, and specific combination therapies.
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2.
Vascular Lesion-Specific Drug Delivery Systems: JACC State-of-the-Art Review.
Marlevi, D, Edelman, ER
Journal of the American College of Cardiology. 2021;(19):2413-2431
Abstract
Drug delivery is central to modern cardiovascular care, where drug-eluting stents, bioresorbable scaffolds, and drug-coated balloons all aim to restore perfusion while inhibiting exuberant healing. The promise and enthusiasm of these devices has in some cases exceeded demonstration of efficacy and even understanding of driving mechanisms. The authors review the means of drug delivery in each device, outlining how the technologies affect vascular behavior. They focus on how drug retention and response are governed by lesion morphology: lipid displacing drug-specific binding sites, calcium inhibiting diffusion, blocking thrombi or promoting luminal washout, and vascular healing steering hyperplastic developments. In this regard, the authors outline the fundamental impact of vascular structure on drug delivery and review the development of contemporary and future devices for coronary and peripheral intervention. They look toward a future where incorporating information on lesion distribution is central to therapeutic success and envision a transition toward lesion-specific treatment for improved interventional outcomes.
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3.
Paclitaxel-related balloons and stents for the treatment of peripheral artery disease: Insights from the Food and Drug Administration 2019 Circulatory System Devices Panel Meeting on late mortality.
Dan, K, Shlofmitz, E, Khalid, N, Hideo-Kajita, A, Wermers, JP, Torguson, R, Kolm, P, Garcia-Garcia, HM, Waksman, R
American heart journal. 2020;:112-120
Abstract
Following the December 2018 publication of a meta-analysis by Katsanos et al reporting higher rates of long-term mortality with the utilization of paclitaxel-related devices (balloons and stents) when compared to control in femoropopliteal arteries, the US Food and Drug Administration (FDA) issued a safety alert in January 2019 and further detailed the implications for future clinical use of these devices in March 2019. The FDA convened a public meeting of the Circulatory System Devices Panel of the Medical Devices Advisory Committee in June 2019. This report summarizes the proceedings of this meeting and the panel's response to the 12 questions posed by the FDA related to the potentially increased late mortality of drug-coated balloons and drug-eluting stents with paclitaxel in patients with peripheral arterial disease.
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4.
Impaired dermal microvascular reactivity and implications for diabetic wound formation and healing: an evidence review.
O'Brien, TD
Journal of wound care. 2020;(Sup9):S21-S28
Abstract
Diabetic foot ulcers (DFUs) are among the most consequential and costly complications faced by patients with diabetes and the global healthcare system. Acknowledged risk factors for DFUs include diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), microtrauma and foot deformities. Research on additional risk factors for DFUs has recently focused on dysregulated, autonomic vasomotor control in the skin of patients with DPN. In particular, impaired dermal microvascular reactivity (IDMR) with its attendant reduction in nutritive capillary blood flow has been identified as an emerging risk factor. This especially relates to refractory wounds noted in patients without overt PAD signs. In this paper, evidence will be reviewed supporting the evolving understanding of IDMR and its impact on DFU formation and healing. Advances in diagnostic instrumentation driving this research along with the most promising potential therapies aimed at improving microvascular function in the diabetic foot will be discussed in brief.
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5.
Anti-hypertensive treatment in peripheral artery disease.
Tsioufis, C, Andrikou, I, Siasos, G, Filis, K, Tousoulis, D
Current opinion in pharmacology. 2018;:35-42
Abstract
Peripheral artery disease (PAD) affects more than 200 million people worldwide. Hypertension has been related to increased risk of PAD. The treatment of elevated blood pressure (BP) in these patients is indicated to lower the cardiovascular risk with a BP goal of less than 130/80mmHg. Although there is no evidence that one class of antihypertensive medication or strategy is superior for BP lowering in PAD, the use of renin-angiotensin-system (RAS) inhibitors can be effective to reduce the cardiovascular risk. Beta-blockers (BBs) are not contraindicated. In the presence of carotid atherosclerosis, calcium-channel blockers (CCBs) and angiotensin-converting-enzyme inhibitors are recommended. In fibromuscular dysplasia the treatment of choice is percutaneous renal angioplasty. In renal artery disease optimal medical therapy includes RAS inhibitors, CCBs, BBs and diuretics.
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6.
[Anti-Thrombotic Treatment of Patients with Peripheral Artery Disease (PAD)].
Espinola-Klein, C
Deutsche medizinische Wochenschrift (1946). 2018;(15):1060-1064
Abstract
Patients with peripheral artery disease are at high-risk for cardiovascular events. Anti-thrombotic treatment is very important for secondary prevention. In symptomatic patients single antiplatelet therapy with clopidogrel or Aspirin is recommended. After peripheral revascularisation transient dual antiplatelet therapy is widely used although there is only little evidence. Following peripheral bypass surgery most patients are treated with single antiplatelet therapy, in some cases (prostetic bypass grafts) dual antiplated therapy can be useful and selected patients with complex venous grafts might profit from anticoagulation with vitamin K antagonists.The recent publication of the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) study showed relevant reduction of MACE (Major Adverse Cariac Events) and MALE (Major Adverse Limb Events) for the combined therapy of rivaroxaban 2 × 2,5 mg compared to Aspirin 100 mg with increased risk for gastrointestinal bleeding. In the current VOYAGER PAD (Vascular Outcomes Study of Aspirin along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) study this concept is tested after peripheral revascularisation.
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7.
Effects of Limb Revascularization Procedures on Oxidative Stress.
Ismaeel, A, Lavado, R, Smith, RS, Eidson, JL, Sawicki, I, Kirk, JS, Bohannon, WT, Koutakis, P
The Journal of surgical research. 2018;:503-509
Abstract
Revascularization procedures to treat patients with peripheral artery disease are among the most common operations performed by vascular surgeons. However, there are major limitations to revascularizations, readmission rates due to procedural complications are high, and greater risks of cardiovascular and limb adverse outcomes have been reported for patients with peripheral artery disease undergoing limb revascularization. Specifically, surgical revascularization may be associated with increased generation of reactive oxygen species based on the ischemia reperfusion injury theory, as restored blood flow and reoxygenation of ischemic areas may be accompanied by increased oxidative stress. In this review, we present the current evidence regarding the effects of revascularization procedures on oxidative stress. We also discuss potential therapeutic interventions to prevent ischemia reperfusion injury-mediated tissue damage.
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8.
LDL apheresis in Japan.
Makino, H, Tamanaha, T, Harada-Shiba, M
Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2017;(5):677-681
Abstract
LDL apheresis has been developed as the treatment for refractory familial hypercholesterolemia (FH). Currently, plasma exchange, double membrane filtration, and selective LDL adsorption are available in Japan, and selective LDL adsorption is most common method. LDL apheresis can prevent atherosclerosis progression even in homozygous (HoFH). However, in our observational study, HoFH who started LDL apheresis from adulthood had poor prognosis compared with patients who started from childhood. Therefore, as far as possible, HoFH patients need to start LDL apheresis from childhood. Although indication of LDL apheresis in heterozygous FH (HeFH) has been decreasing with the advent of strong statin, our observational study showed that HeFH patients who were discontinued LDL apheresis therapy had poor prognosis compared with patients who were continued apheresis therapy. These results suggest that high risk HeFH need to be treated by LDL apheresis even if their LDLC is controlled by lipid-lowering agents. However, by launching new class of lipid lowering agents, that is, PCSK-9 antibody and MTP inhibitor, indication of LDL-apheresis in FH may be changed near the future. LDL-apheresis can provide symptom relief of peripheral artery disease (PAD). Therefore, PAD patients who have insufficient effect by other therapeutic approach including revascularization are also treated by LDL apheresis. Thus, LDL apheresis is still one of good therapeutic options for severe atherosclerotic diseases in Japan.
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9.
Pharmacological secondary prevention in patients with mesenterial artery atherosclerosis and arterial embolism.
Gottsäter, A
Best practice & research. Clinical gastroenterology. 2017;(1):105-109
Abstract
Visceral arteries such as the coeliac (CA), superior mesenteric (SMA), and the inferior mesenteric artery (IMA) might be affected by atherosclerotic occlusive lesions with or without thrombosis or embolization causing ischaemic symptoms from the gastrointestinal tract. After treatment of an acute event, these patients should be offered both non-pharmacological and pharmacological secondary prevention to reduce risk for future ischaemic arterial manifestations. Patients with mesenteric ischaemia caused by atherosclerosis should be evaluated concerning platelet antiaggregation with low dose aspirin or clopidogrel, and those with cardioembolic disease should be recommended anticoagulant treatment with either warfarin or one of the direct oral anticoagulants (DOAC; apixaban, dabigatran, edoxaban, or rivaroxaban). In all patients, blood pressure should be lowered to <140/90 mmHg with ACE-inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, or thiazide diuretics, and LDL-cholesterol should be kept at <1.8 mmol/l, preferably with statins. If present, diabetes should be treated aiming at good metabolic control, and all smokers should be recommended cessation.
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10.
Peripheral artery disease: Drug-coated balloon superior to standard balloon angioplasty.
Huynh, K
Nature reviews. Cardiology. 2017;(7):383