Predictors of 2-year mortality after EVT or BSX in CLI patients included age >75 years, nonambulatory status, regular dialysis, and ejection fraction <50%. The BEACH score derived from these predictors allows risk stratification of CLI patients undergoing revascularization.
Aims:
This study aimed to investigate the long-term impact of guideline-directed medical therapy (GDMT) on 10-year mortality in patients with chronic limb-threatening ischaemia (CLTI) after revascularization.
Methods:
We performed a retrospective multicentre study enrolle 459 patients with CLTI who underwent revascularization (396 endovascular therapy [EVT] and 63 bypass surgery [BSX] cases) between January 2007 and December 2011. The primary outcome measure was all-cause mortality. We additionally explored the predictors for all-cause mortality using Cox regression hazard models; the influence of GDMT, defined as prescription of antiplatelet agents, statins, and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in aggregate, on all-cause mortality, and the association between baseline characteristics using interaction effects.
Results:
During the 10-year follow-up after revascularization, 234 patients died. In Kaplan-Meier analysis, 10-year mortality was significantly lower in patients who received statins (
p
<.001) and ACE inhibitors or ARBs (
p
=.010) than those who did not. However, there were no differences in 10-year mortality between patients who received anti-platelet agents and those who did not (
p
=.62). Interaction analysis revealed that GDMT had a significantly different hazard ratio in patients who were and were not on hemodialysis and in those treated with EVT or BSX (
p
for interaction =.002 and .044, respectively). In the multivariate analysis, age >75 years, non-ambulatory status, hemodialysis, congestive heart failure, left ventricular ejection fraction <50%, and GDMT were significantly associated with all-cause mortality.
Conclusions:
Appropriate GDMT use was independently associated with 10-year mortality in patients with CLTI after revascularization.
Pancreatic surgery concomitant with abdominal aortic repair is rarely chosen due to concerns about prosthetic infection following pancreatic leakage and the poor prognosis of pancreatic neoplasms. We herein report a successfully treated case of infrarenal abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas treated by a one-stage operation. A 75-year-old male with a history of cerebral infarction and chronic subdural hematoma was referred to our department with a pulsatile abdominal mass. A 70-mm infrarenal abdominal aortic aneurysm with severe proximal neck angulation and a 28-mm multilocular cystic tumor with mural nodules in the pancreas body were detected. Abdominal aortic repair with a prosthetic graft and distal pancreatectomy were performed simultaneously. The postoperative course was mostly uneventful, and he was discharged to a rehabilitation facility.
We evaluated thrombogenesis in laser thermal angioplasty in experimental model. Study I) : Metal tip probe was introduced through the carotid artery and ,laser ablation was performed on the inner surface of the femoral artery of theadult mongrel dogs. Laser ablation was carried out with the energy of 16J, 20J, 24J, 30J which is same energy of clinically used to the
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