Multidisciplinary Management of Chronic Limb Threatening Ischemia.

Patients with chronic limb threatening ischemia are at high risk for cardiovascular events, mortality, and adverse limb events. A 62-year-old man with diabetes and peripheral artery disease presented with a new foot ulcer with suspicion of infection. Leveraging evidence-based practices, a multidisciplinary team conducted a prompt and thorough evaluation.

Challenging chest pain: salmonella myopericarditis.

infections have been associated with cardiovascular complications, including myocarditis and myopericarditis. This presentation of myopericarditis highlights key clinical features to aid in diagnosis and the importance of prompt treatment with antibiotics, colchicine and non-steroidal anti-inflammatory drugs (NSAIDs).

Medical Therapy for Peripheral Artery Disease.

Purpose Of Review: Patients with lower extremity peripheral artery disease (PAD) are at high risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). This manuscript will review the current evidence for medical therapy in patients with PAD according to different clinical features and the overall cardiovascular (CV) risk.

Recent Findings: The management of PAD encompasses non-pharmacologic strategies, including lifestyle modification such as smoking cessation, supervised exercise, Mediterranean diet and weight loss as well as pharmacologic interventions, particularly for high risk patients.

Call for Formalized Pathways in Vascular Medicine Training: JACC Review Topic of the Week.

The burden of vascular diseases and complexity of their management have been growing. Vascular medicine specialists may help to bridge gaps in care, especially as part of multidisciplinary teams. However, there is a limited number of vascular medicine specialists because of constraints in training.

Acute Aortic Syndromes.

Acute aortic syndromes, classified into aortic dissection, intramural hematoma, and penetrating aortic ulcer, are associated with high early mortality for which early diagnosis and management are crucial to optimize outcomes. Patients often present with nonspecific clinical symptoms and signs; therefore, it is important for providers to maintain a high index of suspicion for acute aortic syndromes. Electrocardiogram-gated computed tomographic angiography of the chest, abdomen, and pelvis is currently the most practical imaging modality for diagnosis and identification of complications.

Total Ischemic Event Reduction With Rivaroxaban After Peripheral Arterial Revascularization in the VOYAGER PAD Trial.

Background: Patients with peripheral artery disease (PAD) undergoing lower extremity revascularization (LER) are at high risk of major adverse limb and cardiovascular events. The VOYAGER PAD (Efficacy and Safety of Rivaroxaban in Reducing the Risk of Major Thrombotic Vascular Events in Subjects With Symptomatic Peripheral Artery Disease Undergoing Peripheral Revascularization Procedures of the Lower Extremities) trial demonstrated that rivaroxaban 2.5 mg twice daily reduced first events by 15%.

Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention: From the National Cardiovascular Data Registry.

Objectives: The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI.

Background: AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI).

The utilization of intravascular lithotripsy to facilitate transcarotid artery revascularization.

Carotid artery disease and stroke account for the second cause of mortality in worldwide. Recently, transcarotid artery stenting (TCAR) has emerged as a treatment modality that carries a very low stroke rate. However, there are limitations to TCAR, such as heavily calcified plaques that might preclude optimal stent expansion.

Assessment of foot perfusion: Overview of modalities, review of evidence, and identification of evidence gaps.

Patients with critical limb ischemia have nonhealing wounds and/or ischemic rest pain and are at high risk for amputation and mortality. Accurate evaluation of foot perfusion should help avoid unnecessary amputation, guide revascularization strategies, and offer efficient surveillance for patency. Our aim is to review current modalities of assessing foot perfusion in the context of the practical clinical management of patients with critical limb ischemia.

Differential Bioaccumulation of Mercury and Selenium in Stomach Contents and Tissues of Three Colorado, USA, Cutthroat Trout Populations.

Total mercury (THg) and selenium (TSe) levels were measured in stomach contents (SC) and twelve tissues of cutthroat trout (Oncorhynchus clarkii) occurring in three high-elevation lakes of Colorado, USA, inhabiting watersheds absent past and current mining activities. For 32 of 36 tissues, including muscle, mean THg wet weight (ww) concentrations were greater than in the diet (SC) for all sites, indicating biomagnification. Ranges of THg (µg/kg ww) for SC and stomach tissue (ST) were 1.

Recent Trends in Clinical Setting and Provider Specialty for Endovascular Peripheral Artery Disease Interventions for the Medicare Population.

Purpose: To describe national trends in peripheral endovascular interventions by physician specialty, anatomic segment of disease, and clinical location of service.

Materials And Methods: Current Procedural Terminology codes were used to identify claims for peripheral vascular interventions (PVIs) in 2011-2017 Physician Supplier Procedure Summary master files, which contain 100% Part B Medicare billing. Market share was defined as enrollment-adjusted proportion of billed PVI services for each specialty.

Long-Term Outcomes and Associations With Major Adverse Limb Events After Peripheral Artery Revascularization.

Background: Long-term cardiovascular and limb outcomes after revascularization for peripheral artery disease and, in particular, prognosis after post-procedure major adverse limb events (MALE) are not well-studied.

Objectives: This study sought to describe outcomes after peripheral revascularization and assess relationships between post-procedure MALE hospitalization and subsequent events.

Methods: Patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2015, in the Premier Healthcare Database were examined for the co-primary outcomes of interest, composite myocardial infarction (MI) or stroke and composite major amputation or peripheral revascularization.

Finding Common Ground between Adaptive Management and Evidence-Based Approaches to Biodiversity Conservation.

Adaptive management (AM) and evidence-based conservation (EBC) have emerged as major decision-making frameworks for conservation management. AM deals with complexity and the importance of local context in making conservation decisions under conditions of high variability, uncertainty, and rapid environmental and social change. EBC seeks for generality from empirical data and aims to develop and enhance best practice.

Long-term outcomes of carotid artery stenting in patients with a contralateral carotid artery occlusion.

Objectives: To examine the association between a contralateral carotid artery occlusion (CCO) and the rates of subsequent target-lesion restenosis and revascularization after carotid artery stenting (CAS).

Background: Patients with carotid artery disease undergoing revascularization often have a CCO. The association of a CCO with long-term outcomes after CAS is uncertain.

Major Adverse Limb Events and 1-Year Outcomes After Peripheral Artery Revascularization.

Background: Revascularization is important for symptom treatment and limb salvage in peripheral artery disease, yet little data exist on the incidence of post-procedure major adverse limb events (MALE) and longer-term outcomes.

Objectives: This study sought to characterize hospitalizations and outpatient endovascular revascularizations after peripheral artery revascularization, assess temporal trends for outcomes, and identify factors associated with subsequent MALE hospitalization.

Methods: Patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2014, in the Premier Healthcare Database were examined for the primary outcome of 1-year MALE hospitalization.

Ticagrelor in Peripheral Artery Disease Endovascular Revascularization (TI-PAD): Challenges in clinical trial execution.

There is limited evidence to guide clinical decision-making for antiplatelet therapy in peripheral artery disease (PAD) in the setting of lower extremity endovascular treatment. The Ticagrelor in Peripheral Artery Disease Endovascular Revascularization Study (TI-PAD) evaluated the role of ticagrelor versus aspirin as monotherapy in the management of patients following lower extremity endovascular revascularization. The trial failed to recruit the targeted number of patients, likely due to aspects of the design including the lack of option for dual antiplatelet therapy, and inability to identify suitable patients at study sites.

Long-term outcomes after carotid artery stenting of patients with prior neck irradiation or surgery.

Background: Carotid artery stenting (CAS) is often performed in patients with carotid artery stenosis who have relative contraindications to carotid endarterectomy (CEA), including hostile neck anatomy (e.g., history of neck irradiation or prior surgery).

Comparison of Primary Care Physician Reimbursement Rates in the United States.

With a growing shortage of physicians, particularly primary care physicians, the issue of adequate pay in Hawai'i is increasingly important. Anecdotal reports of low pay in Hawai'i have rarely been substantiated. Data from FAIR Health, a company that tracks private insurance reimbursement rates, is compared across the United States (US) for the CPT code 99213.

Seasonal and temperature-related movement of Colorado River cutthroat trout in a low-elevation, Rocky Mountain stream.

Mobile species will migrate considerable distances to find habitats suitable for meeting life history requirements, and stream-dwelling salmonids are no exception. In April-October 2014, we used radio-telemetry to examine habitat use and movement of 36 Colorado River cutthroat trout (CRCT) in a 14.9-km fragment of Milk Creek, a relatively low-elevation stream in the Rocky Mountains (Colorado).

Accurate group velocity estimation for unmanned aerial vehicle-based acoustic atmospheric tomography.

Acoustic atmospheric tomography calculates temperature and wind velocity fields in a slice or volume of atmosphere based on travel time estimates between strategically located sources and receivers. The technique discussed in this paper uses the natural acoustic signature of an unmanned aerial vehicle as it overflies an array of microphones on the ground. The sound emitted by the aircraft is recorded on-board and by the ground microphones.