Zeitschrift für Kardiologie
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Review Comparative Study
[Homocysteine, endothelial dysfunction and cardiovascular risk: pathomechanisms and therapeutic options].
Elevated homocyst(e)ine plasma concentrations are an independent risk factor for cardiovascular disease. Hyperhomocyst(e)inaemia is common in patients with peripheral arterial occlusive disease, coronary heart disease, cerebrovascular disease, carotid artery stenosis and venous thromboembolism. Endothelial dysfunction may be one underlying cause leading to proatherogenic effects associated with hyperhomocyst(e)inaemia. ⋯ No clinical studies are available to date to prove whether reducing homocyst(e)ine levels to the normal range by supplementary B vitamins will also beneficially affect vascular function or cardiovascular risk. Furthermore it is unknown whether moderately elevated homocyst(e)ine concentrations per se may predispose to development of vascular disease, or whether homocyst(e)ine is an indirect marker of cardiovascular disease. Further investigations will be necessary to elucidate the causal relationship between elevated homocyst(e)ine plasma concentrations and the incidence of cardiovascular events, especially since the therapeutic strategies in hyperhomocyst(e)inaemia would differ depending on the underlying pathophysiological mechanisms.
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Review Comparative Study
[Endovascular stent-graft prosthesis in aortic aneurysm].
Descending thoracic and abdominal aortic aneurysms represent a potential life-threatening situation. Resection and graft replacement of the pathologically altered aorta used to be the preferred method of treatment. ⋯ Postoperative complications, such as paraplegia, renal and pulmonary disease, contribute to prolonged hospital stay and higher medical cost. In this review we report on a promising alternative approach to the surgical treatment of thoracic and abdominal aortic aneurysms, namely the currently emerging utilization of the endovascular stent-graft prosthesis in both thoracic and abdominal aneurysm.