Journal of vascular surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease.
To compare late patency after direct and crossover bypass in good-risk patients with unilateral iliac occlusive disease not amenable to angioplasty. ⋯ This study showed that late patency was higher after direct bypass than crossover bypass in good-risk patients with unilateral iliac occlusive disease not amenable to angioplasty. Crossover bypass should be reserved for high-risk patients with unilateral iliac occlusion not amenable to percutaneous recanalization.
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Comparative Study
Duplex ultrasound velocity criteria for the stented carotid artery.
Ultrasound velocity criteria for the diagnosis of in-stent restenosis in patients undergoing carotid artery stenting (CAS) are not well established. In the present study, we test whether ultrasound velocity measurements correlate with increasing degrees of in-stent restenosis in patients undergoing CAS and develop customized velocity criteria to identify residual stenosis > or =20%, in-stent restenosis > or =50%, and high-grade in-stent restenosis > or =80%. ⋯ Progressively increasing PSV and ICA/CCA ratios correlate with evolving restenosis within the stented carotid artery. Ultrasound velocity criteria developed for native arteries overestimate the degree of in-stent restenosis encountered. These changes persist during long-term follow-up and across all grades of in-stent restenosis after CAS. The proposed new velocity criteria accurately define residual stenosis >or =20%, in-stent restenosis >or =50%, and high-grade in-stent restenosis > or =80% in the stented carotid artery.
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Thoracic aneurysms are the main cardiovascular complication of Marfan syndrome (MFS) resulting in premature death. MFS has been associated with mutations of the gene encoding fibrillin-1 (FBN1), a major constituent of the elastic fibers. Matrix metalloproteinases (MMPs) are important in the pathogenesis of abdominal aortic aneurysms but their precise role in MFS is not clear. Doxycycline is a nonspecific MMP inhibitor. The objective of the study was to determine whether docycycline can attenuate matrix degradation and prolong the survival of mice with MFS. ⋯ This study demonstrates that doxycycline significantly delays aneurysm rupture in MFS-like mice by inhibiting expression of tissue MMP-2 and MMP-9 and thus, degradation of the elastic matrix. The results suggest that MMPs contribute to the progression of thoracic aneurysm in MFS and that doxycycline has the potential to significantly alter the course of the disease.
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Randomized Controlled Trial Comparative Study
Cardiopulmonary responses to treadmill and cycle ergometry exercise in patients with peripheral vascular disease.
Peripheral arterial disease (PAD) presenting as intermittent claudication (IC) is routinely assessed as the distance or time walked to the onset of pain, which often occurs before significant cardiopulmonary stress and is subject to confounding factors such as increased body mass and altered gait. Thus, where exercise-induced cardiovascular stress is desirable, such as in cardiac stress testing or clinical trials, an alternative modality of exercise is required. Cycling will circumvent several of the associated problems of treadmill walking and may provide an alternative preferable method of exercise, although there is limited information on the physiologic response of patients with PAD to cycling. This study compared the peak cardiorespiratory responses and the repeatability of cycling and treadmill exercise in patients with PAD. ⋯ These results demonstrate that exercise testing using cycling offers an alternative method of cardiopulmonary testing for patients with IC that is equally reliable and reproducible to treadmill walking. Cycling may be preferable to treadmill exercise because it induces greater cardiopulmonary and metabolic responses and is better tolerated by patients.