TY  - JOUR
AB  - OBJECTIVE: Peripheral arterial disease (PAD) has been associated with suboptimal treatment, high mortality, and high amputation rates. It is unclear how the COVID-19 (coronavirus disease 2019) pandemic affected this development in a long term context. METHODS: This was a register based, retrospective, nationwide cohort study including patients hospitalised with PAD as a main or secondary diagnosis and amputation surgery between 2012 - 2021 in Germany. Primary endpoints were population wide major and minor amputation rates, in hospital mortality, and in hospital mortality rates. Secondary endpoints were same admission revascularisations and in hospital mortality in case of complications, i.e., failure to rescue (FTR). Pre-pandemic and pandemic trends, focusing on lockdown periods, were analysed. RESULTS: A total of 365 926 patient records with PAD and amputation surgery were analysed. Median patient age was 75 years and 28.8% were female. Overall population wide amputation and in hospital mortality rates (monthly decrease -0.002/100 000, p < .001, and -0.001/100 000, p < .001, respectively) and in hospital mortality rate (8.0% for 2012 - 2014 vs. 6.5% for 2020 - 2021; p < .001) declined between 2012 and 2020. Concurrently, same admission revascularisations increased (41.0% for 2012 - 2014 vs. 47.0% for 2020 - 2021; p < .001), while FTR decreased in a subset of complications (acute ischaemia, major bleeding, compartment syndrome, and mesenterial ischaemia). In the first pandemic lockdown, there was a temporary trend change to higher major amputations rates (0.02/100 000; p < .001) and higher in hospital mortality rates (+0.007/100 000; p < .001), which changed to a decrease as of the second lockdown (-0.03/100 000, p = .034, and -0.010/100 000, p < .001, respectively) in an interrupted time series analysis. There was no statistically significant change in observed amputation rates during lockdowns, while observed in hospital mortality rates decreased by 12.0% in the first lockdown (0.22/100 000 vs. 0.25/100 000; p = .005) compared with reference periods of the two previous years. CONCLUSION: Between 2012 and 2021, pre-pandemic trends toward decreasing population wide overall amputation rates, fewer major amputations, more amputation related revascularisation procedures, and lower in hospital mortality were maintained despite a temporary trend to increased major amputations and in hospital mortality during the first COVID-19-related lockdown in Germany.
AU  - Uttinger, K.L.*
AU  - Medicke, P.*
AU  - Aldmour, S.*
AU  - Wiegering, A.*
AU  - Steiner, S.
AU  - Schmidt, A.*
AU  - Branzan, D.
C1  - 71323
C2  - 56076
CY  - 32 Jamestown Rd, London Nw1 7by, England
SP  - 641-651
TI  - Ten year time trends of amputation surgery in peripheral arterial disease in Germany: Before and during the COVID-19 pandemic.
JO  - Eur. J. Vasc. Endovasc. Surg.
VL  - 68
IS  - 5
PB  - W B Saunders Co Ltd
PY  - 2024
SN  - 1078-5884
ER  - 

TY  - JOUR
AB  - OBJECTIVES: Data on PCB for below the knee (BTK) angioplasty exhibited conflicting efficacy results and previous meta-analyses suggested an increased mortality and amputation risk highlighting the need for further research. The aim of this study was to investigate safety and efficacy of Paclitaxel coated balloons (PCB) for BTK interventions in a real-world cohort. METHODS: Within a single-center cohort study 552 consecutive patients were included undergoing BTK interventions with and without PCB use. Two-year safety and efficacy results were compared in unadjusted and propensity score matched (PSM) analysis. RESULTS: BTK interventions were performed in 157 patients with PCB angioplasty (100% Lutonix 0.014" drug coated balloon; Bard Lutonix, New Hope, Minnesota, USA) and 395 patients with plain old balloon angioplasty (POBA). The majority of interventions (>70%) were performed for chronic limb threatening ischemia (CLTI). Mean lesion length was 20.8±12.6cm. 61.2% in the PCB and 66.7% in the POBA group were occlusions. In the PCB group, more procedures were performed for restenotic lesions compared to POBA (28.5 vs. 17.2%). In PSM analysis (128 matched pairs), the primary efficacy endpoint was freedom from clinically-driven target lesion revascularization (CD TLR), which occurred in 70.1% in the PCB and 73.1% in the POBA group at 1 year (p=.85; McNemar Test). Survival analysis suggested lower rates of major amputations in the PCB group in unadjusted (94.4%±2.1 vs. 89.2%±1.9 in the POBA group) and PSM analyses (97.2%±1.6 vs. 89.3%±3.5) through 2 years, while no differences were seen for CD TRL and all-cause mortality between the groups. CONCLUSION: In this all-comer analysis, PCB was found to be safe for BTK interventions with a signal towards lower amputation rates but no benefit was seen for repeat revascularization.
AU  - Wittig, T.
AU  - Schmidt, A.*
AU  - Kabelitz, M.*
AU  - Hukauf, M.*
AU  - Pflug, T.*
AU  - Scheinert, D.*
AU  - Steiner, S.
C1  - 66011
C2  - 53038
CY  - 32 Jamestown Rd, London Nw1 7by, England
SP  - 516-525
TI  - Safety and efficacy of all-comers treated with paclitaxel-coated balloon for below the knee intervention.
JO  - Eur. J. Vasc. Endovasc. Surg.
VL  - 64
IS  - 5
PB  - W B Saunders Co Ltd
PY  - 2022
SN  - 1078-5884
ER  - 

TY  - JOUR
AB  - OBJECTIVE/BACKGROUND: Expression patterns and association with cell specific gene expression signatures of the epigenetic regulator histone deacetylase 9 (HDAC9) and matrix metalloproteinase 12 (MMP12) in human plaque are not known. METHODS: This was a prospective cohort study. Genome wide expression analysis was performed in carotid, femoral, aortic plaques (n = 68) and left internal thoracic (LITA) controls (n = 28) and plaque histological severity assessed. Correlation and hierarchical cluster analysis was utilised. RESULTS: HDAC9 was associated with MMP12 expression in carotid plaques (r = .46, p = .012) and controls (r = -.44, p = .034). HDAC9 and MMP12 clustered with inflammatory macrophage markers but not with smooth muscle cell (SMC) rich markers. In plaques from all arterial sites, MMP12 but not HDAC9 showed positive correlation (p < .05) with M2 and M4 polarized macrophage markers, and negative correlation with SMC rich signatures. In the carotid plaques, all M4 macrophage markers associated with MMP12 and HDAC9. The negative association of MMP12 with SMC rich signatures was pronounced in the carotid plaques. Neither HDAC9 nor MMP12 associated consistently with plaque stabilisation or thrombosis related genes. Immunohistochemistry further supported the association between HDAC9 and MMP12 in atherosclerotic plaques. CONCLUSION: M4 macrophages are a possible source for HDAC9 and MMP12 expression in advanced human plaques.
AU  - Oksala, N.K.J.*
AU  - Seppälä, I.*
AU  - Rahikainen, R.*
AU  - Mäkelä, K.M.*
AU  - Raitoharju, E.*
AU  - Illig, T.
AU  - Klopp, N.
AU  - Kholova, I.*
AU  - Laaksonen, R.*
AU  - Karhunen, P.J.*
AU  - Hytönen, V.P.*
AU  - Lehtimäki, T.*
C1  - 50798
C2  - 42886
SP  - 632-640
TI  - Synergistic expression of histone deacetylase 9 and matrix metalloproteinase 12 in M4 macrophages in advanced carotid plaques.
JO  - Eur. J. Vasc. Endovasc. Surg.
VL  - 53
IS  - 5
PY  - 2017
SN  - 1078-5884
ER  - 

TY  - JOUR
AB  - The objective of this article is to assess the availability and validity of economic evaluations of carotid artery stenosis (CS) diagnosis and treatment. DESIGN: Systematic review of economic evaluations of the diagnosis and treatment of CS. METHODS: Systematic review of full economic evaluations published in Medline and Google Scholar up until 28 February 2012. Based on economic checklists (Evers and Philips), the identified studies were classified as high, medium, or low quality. RESULTS: Twenty-three evaluations were identified. The study quality ranged from 26% to 84% of all achievable points (Evers). Seven studies were of high, eight of medium and eight of low quality. No comparison was made between carotid angioplasty and stenting (CAS) and best medical treatment (BMT). For subjects with severe stenosis, comparisons of carotid endarterectomy (CEA) and BMT were also missing. Three of five studies dealing with pre-operative imaging found that duplex Doppler ultrasound (US) was cost-effective compared with carotid angiogram (AG). CONCLUSIONS: There is a huge lack of high-quality studies and of studies that confirm published results. Also, for a given study quality, the most cost-effective treatment strategy is still unknown in some cases ('CAS' vs. 'BMT', 'US combined with magnetic resonance angiography supplemented with AG' vs. 'US combined with computer tomography angiography').
AU  - Shenoy, A.U.
AU  - Aljutaili, M.
AU  - Stollenwerk, B.
C1  - 10688
C2  - 30323
SP  - 505-513
TI  - Limited economic evidence of carotid artery stenosis diagnosis and treatment: A systematic review.
JO  - Eur. J. Vasc. Endovasc. Surg.
VL  - 44
IS  - 5
PB  - Elsevier
PY  - 2012
SN  - 1078-5884
ER  -