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  • ISSN: 2378-9344
    Volume 3, Issue 4
    Research Article
    Haydar Yasa*, Muhammet Akyuz, Mehmet Bademci, Barcin Ozcem, Nihan Karakas, Tayfun Goktogan, and Ali Gurbuz
    Abstract:
    Background: The operative procedures for carotid stenosis differ in that the eversion technique requires an oblique circumferential incision of the internal carotid artery (ICA) at the carotid bulb and transection of the carotid sinus nerve fibers. In this study, the incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (E-CEA) was compared with conventional carotid endarterectomy (C-CEA) in the short- and mid-term follow-up periods.
    Methods: Baseline blood pressures were recorded in all patients during presurgery testing 1 to 2 weeks before the CEA. Systolic blood pressure value was = 140 mmHg and the value of those under 90 mm Hg diastolic blood pressure was evaluated to have normal blood pressure. Postoperative follow-up of patients with hypertension in the first, sixth, and twelfth months were recorded by outpatient visits, phone calls, and home visits. A total of 164 patients were included in the study without hypertension in the preoperative period (E-CEA=76, C-CEA=88).
    Results: In the postoperative period at one month, patients in the E-CEA group had significantly (P < .005) higher mean peak systolic, diastolic, and mean blood pressures when compared to the C-CEA group. In the sixth and twelfth month follow-up, there was no significant difference between the two groups in terms of hypertension (P=.078). In the E-CEA group, antihypertensive agents continued to be administered to 4 (5.2%) patients and 3(3.4%) in the C-CEA group. Normalization of arterial blood pressure was achieved in the other patients. No significant postoperative neurological, surgical, or cardiac complications developed in any patient in either group.
    Conclusion: As a result, no significant difference between the two groups in terms of postoperative hypertension.
    Jonathan M. Powell, Emanuel M. Ebin, and Francisco O. Nascimento*
    Abstract:
    Background: Atherosclerotic renovascular disease is an increasingly prevalent condition associated with other macrovascular diseases. To date, randomized controlled trials have demonstrated limited mortality benefit of revascularization with stenting when compared to medical therapy.
    Methods: Trials were identified from the PubMed and Cochrane databases. Primary endpoints were overall mortality as well as mortality from cardiovascular and renal causes. Secondary endpoints included occurrence rates of major cardiovascular and renal events as well as change in systolic blood pressure over time. Intention to treat analysis was performed.
    Results: Two large RCTs met inclusion criteria. The pooled data provided 1737 patients of which 862 were in the stented group and 875 received medical therapy alone. Overall mortality was slightly lower in the revascularized group, (RR= 0.93; 95% CI, 0.77-1.12, P= 0.67) however, the benefit was not statistically significant. The mortality benefit from cardiovascular and renal specific causes was not statistically significant. Additionally, the occurrence rate of major cardiovascular and renal events did not differ significantly between the revascularized and medical therapy groups. There was however, a modest decrease in systolic blood pressure over time in the revascularized patients compared to the patients receiving medical therapy alone (mean difference= -1.9mmHg; 95% CI, -3.80 to -0.06; P= 0.04).
    Conclusions: In this meta-analysis of contemporary randomized controlled trials, successful renal artery angioplasty with stenting will provide a modest decrease in systolic blood pressure. However, this meta-analysis did not reach statistical significance to prove benefit of revascularization vs medical therapy alone with regards to mortality. We propose that effects of revascularization may not have equal effect on all patient subgroups. Perhaps if patients are restratified based on baseline chronic kidney disease staging, statistically significant mortality benefit will be elucidated.
    Knut Kroger, Klaus Amendt, Peter Waldhausen, Frank Grieger, Dirk Teuwen, Luis Möckel*, and Olaf Randerath
    Abstract:
    Background: Cilostazol was launched in Germany in 2007 for the treatment of patients with peripheral arterial occlusive disease (PAOD) stage II (intermittent claudication). It is indicated for second-line use when lifestyle modification or other interventions do not result in a decrease of PAOD symptoms.
    Materials and methods: The objective of this non-interventional study was to gain insight regarding the effectiveness and safety of cilostazol, used under “real-life” conditions. Efficacy was evaluated after 12 and 24 weeks of treatment by the following patient-relevant endpoints: overall health status rating by the treating medical practitioner, evaluation of the patients’ quality of life by the SF-36 health survey, and pain-free walking distance (PFWD). Safety was assessed by monitoring of adverse events (AEs).
    Results: A total of 1,311 patients were enrolled in the study and received at least one dose of cilostazol during an observational period of 24 weeks. Mean (standard deviation [SD]) duration of cilostazol treatment was 165 days (SD 47). After 24 weeks of treatment, the overall health status of 79.5% of patients was rated by the medical practitioner as satisfactory, good or very good, and the patients’ quality of life, assessed by the SF-36, had improved compared to baseline. An increase in mean PFWD from baseline measured either on flat floor or on treadmill, was observed (mean PFWD improvement: +191m or relative 203%). A total of 356 patients (27.2%) reported AEs, of whom 66 (5.0%) reported serious AEs. Cardiac AEs were among the more frequently reported, with 55 patients (4.2%) reporting heart racing, palpitations, pulse increased and/or tachycardia.
    Conclusions: The results illustrate that, under “real-life” conditions, treatment with cilostazol improved quality of life and increased mean PFWD in patients with POAD stage II. The safety profile of cilostazol observed in this study was comparable with that observed in the clinical development program.
    Roberto Zarrabeitia1-3*, Blanca Señaris1,4, Julio Rodríguez-Iglesias2,5, Roberto Megía2,5, Carmelo Morales2,5, Sol Elarien6, María Concepcion Farinas-Alvarez, and Jose Antonio Parra
    Objective: To describe the natural history of epistaxis in a cohort of Spanish patients with hereditary hemorrhagic telangiectasia
    Patients and methods: Between 1st january 2002 and 31st december 2013, 353 HHT patients were studied registering epidemiological variables of sex, age and genetics (type of HHT) and crossed with data relating epistaxis frequency, age of onset, type of lesions, severity of symptoms, presence of anemia and transfusion requirements.
    Results: No significant differences were observed regarding epistaxis frequency considering sex and genetics with 96.88% of patients affected. HHT2 patients have a later onset of epistaxis than HHT1 ones. Male, aged patients and those with HHT2 required a higher number of hospitalizations. Male required more transfusions than women (p=0.036) while hemoglobin levels decreased with age in both sexes and were lower in HHT2 patients. Considering the Bergler-Sadick scale, elderly ages conditioned more severity both for quantity and frequency of epistaxis (p<0.0001) while men presented more severity than women considering quantity (p=0.029). Nasal telangiectases were more complex in women and elderly patients.
    Conclusions: Absence of epistaxis in HHT patients is uncommon. HHT2 patients normally start with symptoms later than HHT1 ones and HHT2 patients together with males and elderly population show more severity.
    Case Series
    Nathan A. Dahl, Kathryn C. Chatfield, Annie M. Kulungowski, Roger Harned, and Taizo A. Nakano*
    Abstract:
    Hereditary hemorrhagic telangiectasia (HHT) is a disorder of vascular dysplasia characterized by multiple mucocutaneous and visceral arteriovenous malformations (AVMs). The clinical sensitivity of consensus diagnostic criteria has not been well established within the pediatric population. Furthermore, the age-dependent penetrance of the disorder can make timely diagnosis in children challenging. We present three cases of HHT that demonstrate the spectrum of disease presentation within children and adolescents. Early recognition of the manifestations of HHT in pediatric patients can facilitate timely diagnosis and ensure that recommended screenings and interventions are provided to affected children.
    Review Article
    Rahul Singh, Brandon Lucke-Wold, Kymberly Gyure, and Sohyun Boo*
    Patients with spinal vascular lesions present with unique symptoms and have important anatomical and physiologic changes that must be considered prior to treatment. In this mini-review, we provide an overview of normal spinal vascular anatomy and discuss several key spinal vascular lesions. We provide an overview of cavernous malformations, intradural arteriovenous malformations, perimedullary arteriovenous fistulas, and dural arteriovenous fistulas. Important considerations are addressed in terms of pathologic characterization, specific imaging findings, and treatment approaches.
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