Concomitant mitral regurgitation in patients with low-gradient aortic stenosis: an analysis from the German Aortic Valve Registry.

Background: Patients with severe aortic stenosis (AS) frequently presented mitral regurgitation (MR), which may interfere with the standard echocardiographic measurements of mean pressure gradient (MPG), flow velocity, and aortic valve area (AVA).

Aims: Herein we investigated the prevalence and severity of MR in patients with severe AS and its role on the accuracy of the standard echocardiographic parameters of AS quantification.

Methods: Of all patients with severe AS undergoing transcatheter or surgical aortic valve replacement enrolled in the German Aortic Registry from 2011 to 2017, 119,641 were included in this study.

The 1-year clinical impact of rotational aspiration atherectomy of infrainguinal lesions.

The present study was carried out to provide information about outcome of the Jetstream atherectomy device for treatment of infrainguinal arteries. From February 2006 to February 2007, 172 patients with Rutherford class 1 to 5 lower limb ischemia were enrolled at 9 study sites. The endpoints were evaluation of quality of life according to the walking impairment questionnaire (WIQ) besides technical parameters.

One-year outcome after percutaneous rotational and aspiration atherectomy in infrainguinal arteries in patient with and without type 2 diabetes mellitus.

Background: To compare the safety and efficacy of a rotational aspiration atherectomy system (Jetstream) for the treatment of infrainguinal arteries in diabetic versus nondiabetic patients.

Methods: A total of 172 patients with Rutherford stage 1-5 lower limb ischemia were treated with rotational aspiration atherectomy between February 2006 and February 2007. Of these, 80 patients with type 2 diabetes mellitus (DM: 46.

Effects of aspirin and desmopressin on platelet reactivity in patients undergoing cardiac surgery with extracorporeal circulation.

The effect of desmopressin on platelet function in patients with continued antiplatelet therapy undergoing cardiac surgery is discussed controversially. We assessed platelet reactivity in 86 patients undergoing elective coronary artery bypass grafting (CABG) under extracorporeal circulation. Twenty-nine of these patients were without preoperative antiplatelet therapy (group A), while 57 were treated with acetylsalicylic acid (ASA) 100 mg qd up to the day of surgery.

Acute and long-term outcome of Silverhawk assisted atherectomy for femoro-popliteal lesions according the TASC II classification: a single-center experience.

Background: Directional atherectomy (DA) has become popular in some centers to remove atherosclerotic plaques in femoro-popliteal lesions. Although immediate and also short - term outcome data are promising, solid long-term data are warranted to justify the widespread use in daily practice.

Patients And Methods: In this prospective study de novo and restenotic lesions of the femoro-popliteal segments were treated with the Silverhawk device.

Debulking procedures: potential device specific indications.

During the past decade, the endovascular treatment of peripheral arterial disease has become more widespread due to the impressive extension of the endovascular toolbox to include different atherectomy technologies. The promise of atherectomy is to avoid the "barotraumas" defined as complications of traditional angioplasty such as dissection, elastic recoil, and disruption of the internal elastic lamina resulting in overwhelming neointima and smooth muscle cell proliferation. The oldest atherectomy technologies are the excimer laser and the Rotablator.

One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: the multicenter pathway PVD trial.

Purpose: To report a safety and efficacy study of a novel rotational atherectomy system with aspiration capabilities for the treatment of infrainguinal arterial lesions.

Methods: From February 2006 to January 2007, 172 patients (88 women; mean age 72 years, range 51-93; 47% diabetics) with Rutherford class 1-5 lower limb ischemia were enrolled at 9 study sites. Inclusion criteria were atherosclerotic stenoses >70% and up to 10 cm long in the femoropopliteal segment or up to 3 cm long in the infrapopliteal vessels (reference vessel diameter 3.

Methemoglobinemia in critically ill patients during extended hemodialysis and simultaneous disinfection of the hospital water supply.

Introduction: To evaluate the cause of methemoglobinemia in patients undergoing extended daily hemodialysis/hemodiafiltration we analyzed the relationship between methemoglobinemia and the water disinfection schedule of the hospital.

Methods: We reviewed all arterial blood gas analyses, obtained over a one-year period, in patients undergoing extended hemodialysis/hemodiafiltration, and compared the methemoglobin concentrations obtained on the days when the water supply was disinfected, using a hydrogen peroxide/silver ion preparation, with data measured on disinfection-free days.

Results: The evaluation of 706 measurements revealed a maximum methemoglobin fraction of 1.

Safety and efficacy of the StarClose vascular closure system using 7-F and 8-F sheath sizes: a consecutive single-center analysis.

Purpose: To assess the safety and efficacy of the StarClose device following peripheral vascular interventions employing 7-F and 8-F femoral sheaths.

Methods: From May 2006 to December 2007, 226 consecutive patients (143 men; mean age 69 years, range 36-92) underwent 231 groin punctures (150 with a 7-F sheath and 81 with an 8-F sheath) that were sealed with the StarClose Vascular Closure System. All the patients underwent duplex control of the puncture site 24 hours after deployment of the device to determine the presence of vascular complications (hematoma, pseudoaneurysm, arteriovenous fistula, and arterial/venous thrombosis or stenosis).

Critical review of indications for renal artery stenting: do randomized trials give the answer?

Significant renal artery stenosis (RAS) is a well accepted cause of deterioration of arterial hypertension and of renal insufficiency. Just recently, more interest has been focused on the impact of RAS on structural heart disease and patient survival. Technical improvements of diagnostic and interventional endovascular tools have lead to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy during the past 2 decades.

Percutaneous iliac vein recanalization 17 years after thrombotic occlusion.

Persistent venous outflow obstruction of the iliac veins is one of the mechanisms that seem to portend the greatest risk for late development of severe complications. We report the case of a 42-year-old male with postthrombotic occlusion of the left external iliac artery since the age of 25. We managed to recanalize the obstructed vessel and establish a good flow into the inferior vena cava by venous stenting.

Lumbar artery aneurysm.

The purpose of this report is to present a rare case of lumbar artery aneurysm. We report the case of a 54-years-old male patient who was misdiagnosed over years having a chronic infrarenal aortic aneurysm. A 64-slice CT at our institution revealed a large lumbar artery aneurysm.

Improved renal function and blood pressure control following renal artery angioplasty: the renal artery angioplasty in patients with renal insufficiency and hypertension using a dedicated renal stent device study (PRECISION).

Aims: To evaluate the technical performance of a dedicated renal stent device and the clinical outcome.

Methods And Results: Fifty patients with 55 renal artery stenoses (RAS) >70% (66 +/- 12 years, 58% male) were included in this non-randomised, prospective, multicentre registry. Primary endpoint was the primary patency rate at one year defined as > or =70% as determined by duplex ultrasound.

Acute and long-term outcome of endovascular therapy for aortoiliac occlusive lesions stratified according to the TASC classification: a single-center experience.

Purpose: To compare acute and long-term outcomes of endovascular therapy for TASC (TransAtlantic Inter-Society Consensus) A and B lesions versus TASC C and D lesions.

Methods: Based on a prospectively maintained database, a retrospective analysis was conducted of 375 symptomatic patients (335 men; mean age 63+/-8 years) who underwent 438 interventions for aortoiliac arterial obstructions. Lesions were stratified according to the TASC II classification: 259 (59%) procedures involved TASC A/B lesions, while 113 (26%) were for TASC C and 66 (15%) for TASC D lesions.

Long term outcome after balloon angioplasty and stenting of subclavian artery obstruction: a single centre experience.

Introduction: Percutaneous transluminal angioplasty is an accepted and successful treatment strategy in obstructive disease of the subclavian artery. The purpose of this study was to evaluate the technical and clinical long-term outcome following endovascular therapy.

Patients And Methods: We retrospectively analyzed 99 patients (mean age of 65 +/- 10 years) with 100 interventions of the subclavian arteries and the brachiocephalic trunk with different aetiologies [atherosclerosis (90%); Takayasu's arteritis (5%); thromboembolism (2%); external compression (1%); iatrogenic dissection (1%) and occlusion after graft implantation in type B dissection (1%)].

Color-coded duplex ultrasound for diagnosis of renal artery stenosis and as follow-up examination after revascularization.

Currently, angiography is still considered to be the gold standard for the diagnosis of a renal artery stenosis (RAS). However, angiography is invasive and carries the potential risk of haematoma, pseudoaneurysm, contrast agent induced nephropathy, and athermanous embolization. Color-coded duplex ultrasound is a noninvasive frequently repeatable bed-side examination and is currently the only diagnostic method to reliably differentiate between a hemodynamically relevant or irrelevant stenosis using the side-to-side difference of the intrarenal resistance index (RI).

Cardiac output determination by thermodilution and arterial pulse waveform analysis in patients undergoing aortic valve replacement.

Purpose: To compare the accuracy of cardiac output (CO) measurement by arterial pulse waveform analysis (CO(PW)) to thermodilution assessments in patients with aortic stenosis, a high-risk patient group who may benefit from extended hemodynamic monitoring.

Methods: In 30 patients with aortic stenosis, CO was assessed in triplicate by thermodilution via pulmonary artery catheterization (CO(PAC)), and by arterial pulse waveform analysis (CO(PW)), before and after valve replacement. The techniques were compared by assessing the repeatability coefficient of each method and by calculating the percentage error, bias, and the limits of agreement between methods.

Percutaneous rotational and aspiration atherectomy in infrainguinal peripheral arterial occlusive disease: a multicenter pilot study.

Purpose: To report a safety and efficacy study of the first rotational aspiration atherectomy system (Pathway PV) for the treatment of arterial lesions below the femoral bifurcation.

Methods: From December 2005 to February 2006, 15 patients (9 men; mean age 71+/-9 years) with Rutherford stage 2 to 5 lower limb ischemia were enrolled at 3 study sites. Target lesions were in the superficial femoral (n = 7, 47%), popliteal (n = 7, 47%), and posterior tibial (n = 1, 6%) arteries.

Initial experience with directed laser atherectomy using the CLiRpath photoablation atherectomy system and bias sheath in superficial femoral artery lesions.

Purpose: To report a safety and efficacy study of directed excimer laser atherectomy with the Bias Sheath guiding catheter to create larger lumens in the superficial femoral artery (SFA).

Methods: Fourteen patients (9 men; mean age 66+/-9 years, range 46-76) with chronic lower limb ischemia (Rutherford class 2 to 5) referable to SFA stenoses were treated with the 8-F-compatible Bias Sheath and a 1.7- or 2.

Coil embolisation of an internal iliac artery aneurysm after surgical repair of an infrarenal aortic aneurysm.

We report a case of an 86-year-old asymptomatic patient, who underwent a repair of the infrarenal abdominal aortic aneurysm 13 years ago. He presented with a left internal iliac artery (IIA) aneurysm with a short neck of 3 mm, and a partially thrombosed lumen with a cross sectional diameter of 5.6 cm and a length of 8.

Changes in pulse pressure variability during cardiac resynchronization therapy in mechanically ventilated patients.

Introduction: The respiratory variation in pulse pressure (PP) has been established as a dynamic variable of cardiac preload which indicates fluid responsiveness in mechanically ventilated patients. The impact of acute changes in cardiac performance on respiratory fluctuations in PP has not been evaluated until now. We used cardiac resynchronization therapy as a model to assess the acute effects of changes in left ventricular performance on respiratory PP variability without the need of pharmacological intervention.

Restenosis after stenting of atherosclerotic renal artery stenosis: is there a rationale for the use of drug-eluting stents?

Percutaneous stent-angioplasty has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis (RAS) because of higher acute and long-term success rates compared with balloon angioplasty alone. Restenosis rates after successful renal stent placement vary from 6 to 20% and depend mainly on the definition of restenosis and the vessel diameter of the renal artery or stent. We recommend that restenosis should be defined as >70%.