Fate of target vessels after failed infrainguinal angioplasty, by Mohammed Elkassaby
From St James Dublin
Commentary on the opinions of endo first vs bypass first in terms of negating outflow daamage
Ojbective: to look at outflow vesel damaage
Surgeon performed angioplasties
Single centre
POBA, stenting, atherectomy all used
Failed procedure defined as a technical failures as well as reocclusion in 30 days
Divided segments up as follows:
SFA
AK pop
BK pop
Upper tibials
Lower tibial and foot.
Primary and secondary end points
724 procedures Infra inguinal
97 failed cases
Primary success 87%
FU range 26 median , 0 to 40
Most done elective
only 32% done for IC
70% were SFA angio attempts
90% were SIA
Any damanage at all was 22%
16% only to 1 segment and another 6% to more than 1 segment (out of the 5 ‘segment’ areas classified above)
Reinterventions
37% had redo angio with a 65% success
Bypass was only done in 12% cases and success rate 92%
All casuse mortality 8% over 2 years
22% failed angio ended up with major amputation.
82% of the major amputations were in those with no damage
Question from Joseph, surgeon at DGH in Scotland
Says his practice is very similar to what was presented now
Answers to my questions:
they use 18 and 14 wires for tibial, not 0035
And they use ACT to ensure optimum heparin on board.
Meta-analysis of anti-thrombotic options after open revascularisation for PAD, by Luke Davies.
Meta-analysis of anti-thrombotic options after open revascularisation for PAD.
Luke Davies
Medical student
From Bristol
Lists Hinchclifee and Graeme Ambler
PAD affects 230 mi wordlwide
5 yr mortlality of CLTI Rx is 50%
1 yr reintervention rate after bypass stated as 18%
Mentions BEST CLI trial - the study did not specify post revasc Rx BMT
Outcomes of study
primary efficacy outcome: MACE and MALE
primary safety outcome: major haemorrhage
PRISMA
from inception to date
CENTRAL (?)
MEDLINE
EMBASE
Filtered 5000 results
Bayesian network meta analysis
Presented as forest plots
Vit K antagonists significantly reduce risk of MACE but with significant increased risk of bleed.
This study seemed to be saying that the aspirin - rivaroxaban (presumably 2.5 BD) did not improve patency / MACE MALE
Paediatric iatrogenic ALI in an ITU setting; 10 year review by Jess Duguid
Paeds ALI in ITU setting
Jess Duguid
Not Steve Tang
Leeds is regional unit for York Humber
ALI on PICU usually Iatrogenic injury
Intention: to assess frequency of iatrogenic paeds ALI to PICU
Seeking causes, Rx and outcomes
cross sectional study retrospective analysis from 2012 to 2022
They excluded ALI not due to iatrogenic injury
Found 14 cases in total
8 males
median age 2.8
mostly LL and one brachial
Mostly due to femoral lines
Rx: mostly heparin. Others used wre milrinone and GTN patch.
2 cases had operative management
Survival to discharge in 8 out of 14
No amputations
Meta-analysis of BMT after endo Rx of PAD, by ALEX MURIGU
10.01 V21(152). Meta-analysis of BMT after end Rx PAD. ALEX MURIGU
5000 results
20 filtered for analysis into the SR and 18 into the meta-analysis
Aspirin - Cilostazol and Aspirin - Rivaroxaban combinations were more effective in terms of the primary effectiveness outcome of MACE MALE
Some of the Confidence intervals on Haemorrhage outcome are quite wide. Many trials reported no bleeding events.
Conclusion - Significant increase of bleeding with both the addition of Cilostazol or Rivaroxaban to Aspirin, accompanying the improved effectiveness primary outcome of MALE MACE