Publications by authors named "Lucas Busch"
: The safety and efficacy of electrophysiological (EP) procedures using ultrasound (US) guidance are being increasingly studied. We investigated if a systematic workflow with ultrasound guidance (the US4ABL), comprising four steps (transesophageal echocardiography (TEE) for left atrial thrombus exclusion, US of the groin vessels to guide femoral access, TEE-aided transseptal puncture, and transthoracic echocardiography (TTE) for exclusion of pericardial tamponade after the procedure), reduces the number of complications and fluoroscopy duration and dose. : A total of 212 consecutive patients underwent left-sided ablations using the US4ABL workflow and were compared to a group of 299 patients who underwent the same type of ablations using post-procedural TTE to exclude tamponade (standard group: venous and/or arterial access by palpation and fluoroscopy, and pressure guided transseptal puncture).
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- A study called PEERLESS compared two catheter methods, large-bore mechanical thrombectomy (LBMT) and catheter-directed thrombolysis (CDT), for treating intermediate-risk pulmonary embolism (PE) in 550 patients, focusing on various health outcomes.
- The results showed that LBMT led to fewer complications and less need for intensive care compared to CDT, including lower rates of clinical deterioration and ICU admissions.
- Although LBMT had better short-term outcomes, there were no significant differences in mortality or major bleeding between the two treatment methods after 30 days.
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- The study evaluated three-year outcomes of endovascular treatment (EVT) for peripheral arterial disease (PAD) in patients with severe calcified lesions in the common femoral artery (CFA), using data from the Duesseldorf PTA Registry.
- A total of 150 patients were analyzed, with 66 undergoing rotational excisional atherectomy (REA) followed by drug-coated balloon (DCB) angioplasty, and 84 receiving DCB alone; the procedural success rate was high at 97%.
- Findings indicated that EVT is safe and effective, showing high primary and secondary patency rates, low major adverse limb events (MALEs), and major adverse cardiovascular events (MACEs) after three years, suggesting that RE
Background: Timely and economic provision of revascularisation procedures is a major healthcare need. We aimed to examine the safety and efficacy of daycase-based lower extremity endovascular revascularisation procedures in patients with peripheral artery disease.
Methods: In this systematic review and meta-analysis, we searched MEDLINE and Embase for studies from Jan 01, 2000 through Apr 01, 2024 reporting complications of lower limb endovascular revascularisation procedures with same-day discharge.
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- * Thirty patients with symptomatic peripheral artery disease underwent assessments before, immediately after, and four months after EVT or control angiography to evaluate changes in peripheral hemodynamics and aortic function.
- * Results indicated significant improvements in peripheral blood flow, aortic function, and left ventricular diastolic function following EVT, suggesting it may be an effective intervention for these patients.
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- Managing chronic limb-threatening ischemia (CLTI) is tough because it’s hard to gauge oxygen levels in ulcers; this study explored how near-infrared spectroscopy (NIRS) could help.
- The research involved 43 CLTI patients where 27 received endovascular treatment (EVT) and 16 were treated conservatively; results showed significant increases in tissue oxygen saturation (StO) after EVT, unlike in the control group.
- The study concluded that improvements in NIRS-measured StO corresponded to a decrease in wound size and severity, suggesting NIRS could be a beneficial tool for monitoring CLTI outcomes alongside traditional methods like the ankle-brachial index (ABI).
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- Bifemoral arterial access is often used in transcatheter aortic valve implantation (TAVI), and pseudoaneurysms (PSA) can occur as a complication, with a 2.2% incidence found in a study of 2,063 patients.
- Patients with PSA had different health profiles, including lower platelet counts, more heart failure symptoms, and varying treatments (like (N)OACs and aspirin) compared to those without PSA.
- While PSA is linked to increased access site bleeding and longer hospital stays, it does not impact one-year mortality rates, and treatment outcomes for PSA are generally positive.
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- The study investigates how transcatheter aortic valve implantation (TAVI) affects peripheral microvascular tissue saturation (StO2) in patients with severe aortic stenosis.
- Patients were assessed before and after TAVI, measuring cardiac output, blood pressure, arterial stiffness, and StO2 levels using near-infrared spectroscopy.
- Results showed that while cardiac output increased after TAVI, StO2 levels temporarily decreased and then returned to baseline, with changes in StO2 linked to renal function.
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- Macrophages are crucial in vascular inflammation and predicting cardiovascular issues; this study used Fluorine-19 MRI to visualize and quantify macrophage activity in pigs after carotid artery angioplasty.
- Eight minipigs underwent mild and severe vascular injuries, followed by the injection of a perfluorocarbon agent three days later to track inflammatory responses using imaging techniques.
- Results showed successful angioplasty in all subjects, with notable macrophage infiltration and no serious adverse effects; imaging was particularly effective in detecting responses from severe injuries, correlating F MRI signals with macrophage density.
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- The case discusses the importance of ECG interpretation in acute coronary syndrome, particularly when ST-elevation myocardial infarction is not present.
- A patient showing acute chest pain along with biphasic or deeply inverted T-waves in leads V2-V3 indicates a high risk for myocardial infarction.
- Immediate evaluation by a cardiologist and coronary angiography are essential for proper diagnosis and treatment.
Endovascular snare retrieval of an Angio-Seal causing acute limb ischemia.
Clin Case Rep
December 2021
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- Vascular complications (VCs) are a significant risk following artery catheterization, potentially leading to serious health issues.
- Vascular closure devices, while commonly used, can sometimes lead to vessel blockages that necessitate surgical intervention.
- This case report illustrates the successful endovascular retrieval of an obstructed Angio-Seal device, demonstrating an effective approach to manage complications in patients with existing health conditions.
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- DAPT (dual antiplatelet therapy) with aspirin and clopidogrel is common for PAD patients post-angioplasty, but HTPR (high on treatment platelet reactivity) is frequent and linked to MALE (major adverse limb events).
- In a study of 71 CLI (critical limb ischemia) patients, HTPR was found in 64.8% of cases, but there was no difference in MALE or MACCE (major adverse cardiac and cerebrovascular events) between HTPR and non-HTPR patients.
- Notably, bleeding complications were higher in patients with effective responses to DAPT, suggesting that CLI patients may need different antithrombotic strategies.
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- Angioplasty for peripheral artery disease (PAD) significantly lowers both aortic and brachial blood pressure, particularly after treating iliac and femoropopliteal arteries.
- A study on 30 patients showed notable reductions in systolic and diastolic aortic blood pressure following angioplasty, while a larger cohort of 381 patients confirmed similar findings for brachial blood pressure.
- The results suggest that endovascular treatment can effectively manage blood pressure in PAD patients, especially for those with higher baseline levels.
Lipid-lowering therapy is one major cornerstone of medical treatment of cardiovascular disease in order to modulate atherosclerosis. Statins, ezetimibe and novel PCSK9-inhibitors are already recommended in current guidelines and were shown to improve lipid profiles and have positive effects on the rate of ischemic events and cardiovascular mortality. Recent studies suggest that the concept of "The lower the better" might be valid at least regarding low density lipoproteins.
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- High on-treatment platelet reactivity (HTPR) to dual antiplatelet therapy (DAPT) is common in patients with peripheral artery disease (PAD) and may increase the risk of major adverse limb events (MALE) after angioplasty.
- In a study of 102 PAD patients, 36% experienced HTPR to clopidogrel, 11% to aspirin, and another 11% to both medications.
- Patients with dual HTPR had a significantly higher rate of MALE at six months compared to those with sufficient platelet inhibition, suggesting the need for better antithrombotic strategies in these patients.
Purpose: To report the effectiveness of left renal artery (LRA) occlusion using Amplatzer Vascular Plug (AVP) II as treatment for a high-flow renal arteriovenous fistula (RAVF) with multiple renal vein aneurysms (RVA) to prevent aneurysm rupture and cardiac decompensation.
Case Report: A 59-year-old female suffering from a post-traumatic RAVF presented with tachycardia and increased cardiac output (CO). Doppler ultrasonography and computed tomography (CT) scan revealed a high-flow RAVF with multiple RVAs and unilateral critically reduced kidney function.
The updated ESC guidelines on PAD were developed, for the first time, as a collaboration between cardiologists and vascular surgeons and unveiled at the European Society of Cardiology (ESC) 2017 congress. Although awareness has improved, PAD is still associated with significant morbidity, mortality, and quality of life impairment. Primarily, the guidelines emphasize the need for a multidisciplinary management of these patients and propose "a vascular team".
View Article and Find Full Text PDFBackground: Vascular access site-related complications are frequent in the context of transfemoral transcatheter aortic valve replacement (TAVR). The implantation of a covered stent graft is an effective treatment option for bleeding control. However, the external iliac and common femoral arteries are exposed to flexion of the hip joint.
View Article and Find Full Text PDFAfter cardiac catheterization procedures, arterial closure can be achieved by manual compression (MC), using external mechanical compression devices, or by applying vascular closure devices (VCDs) with comparable vascular access site-related complication rates. The aim of the present study was to assess vascular access site-related complications during the implementation of structured sheath removal and MC by paramedics after catheterization procedures. After an observational phase of 3 months to assess the baseline complication rate, a structured 4-level training program was implemented to train assistant personnel, in this case paramedics, in the management of sheath removal by MC.
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