With the remarkable drop in tobacco use across the world, also dropped mortality associated to abdominal aorta aneurysm rupture (AAA). All AAA screening programs have been designed decades ago, when the risk was higher. This is why we might need to rethink these programs, or at least design new randomized controlled studies to pave the…
Renal Impairment: How Does It Affect Angioplasty and Surgery?
Courtesy of Dr. Carlos Fava. The incidence of kidney disease is increasing. In its final stage, this pathology is related with coronary disease and increased mortality. Furthermore, we know that, in many occasions, it is associated with diabetes. Nowadays, the evidence comparing the progress of patients with impaired kidney function who have undergone left main…
New Tools to Define Intervention in Asymptomatic Carotid Disease
This meta-analysis included 14 studies and compared the uptake of fluorodeoxyglucose (18F-FDG) according to positron emission tomography (PET)/computed tomography (CT) in symptomatic versus asymptomatic patients, demonstrating a significantly higher uptake in patients with symptomatic lesions. While PET/CT imaging of atheroma is a tool under investigation, with limited applicability in clinical practice, in a relatively close future,…
EuroPCR 2018 | RADIANCE-HTN SOLO: Renal Denervation Guided Through Intravascular Ultrasound
Patients eligible for this study suffered from hypertension, had been treated with up to 2 drugs, and presented a daytime ambulatory blood pressure ≥135/85 mmHg and <170/105 mmHg after a 4-week washout period. The study enrolled 146 patients who were randomized 1:1 to denervation treatment or a sham procedure. The reduction in daytime ambulatory systolic blood pressure was greater…
EuroPCR 2018 | SPYRAL HTN-ON MED: Renal Denervation Comes Back to Life
After several trials with neutral outcomes, renal denervation had been demoted for some time. However, this new study presented at EuroPCR 2018 and simultaneously published in the LANCET brings back the technique with improved devices that seem to yield improved outcomes. The study included patients with uncontrolled arterial hypertension under medical treatment. Eligible patients…
Antithrombotics after Venous Stenting: Rather Different from Coronary Artery Stenting
Should the Antithrombotic/antiplatelet therapy following 10.0 by 60 mm stent implantation to the subclavian vein of a chronic kidney patient be the same as one following a 3.0 by 18 mm stent implantation to the second segment of the left anterior descending artery of this same patient? The daily practice of many interventional cardiologists performing…
Post EVAR Contrast Enhanced Ultrasound Based Follow Up Reduces CT by 90%. Is It Safe Though?
This four-year retrospective analyzis has shown that contrast enhanced ultrasound based follow up protocol post endovascular aortic repair is safe and effective. Aneurysm related mortality, reintervention rate, sac retraction and endoleak detection resulted similar to that of CT based follow up protocols. In this study, doppler and enhanced contrast ultrasound were the main follow up…
Risk of Colonic Ischemia after Abdominal Aortic Aneurysm Repair
This is the largest and most recent analyzis to show colonic ischemia is more frequent after open abdominal aortic aneurysm repair (2.1% a 3.6%), compared against endovascular repair (0.5% a 1%), especially in elective patients. Most cases presented within the first 7 days. The evidence is not enough to determine the cause behind the different…
Significant Association Between Suprarenal Fixation of Endoprostheses and Renal Dysfunction
According to this meta-analysis, soon to be published in Eur. J. Vasc. Endovasc. Surg., endovascular abdominal aortic aneurysm repair prostheses with suprarenal fixation do not alter significantly the glomerular filtration rate at one year from device implantation. However, we should acknowledge that long-term outcomes are still unknown. The literature is inconsistent as regards the definition…
Contrast Induced Kidney Injury, Infamous Problem with No Magical Solutions
In patients at high risk of developing kidney complications undergoing angiography, we did not observe benefits when administering intravenous sodium bicarbonate vs. saline, or oral N-acetylcysteine vs. placebo, as to the prevention of death, dialysis or persistent deterioration of kidney function at 90 days, or the prevention of contrast induced kidney failure. Many small studies…
What’s New in the European Guidelines on Peripheral Arterial Disease
Since the last version of the European guidelines on the diagnosis and treatment of peripheral arterial disease in 2011, there have been many trials and registries that warrant guideline adjustments in many aspects. The first novelty is the teamwork that gave way to these guidelines, which were written in collaboration with the European Society of…
