• Keywords
• Evropská kardiologická společnost, DAPA-HF, ISAR-REACT 5, COMPLETE, THEMIS, STICH, dapagliflozin,
• MeSH
• Sodium-Glucose Transporter 2 Inhibitors therapeutic use   MeSH
• Cardiology * trends   MeSH
• Clinical Studies as Topic MeSH
• Humans MeSH
• Heart Diseases drug therapy   prevention & control   therapy   MeSH
• Tissue Survival MeSH
• Practice Guidelines as Topic MeSH
• Ticagrelor administration & dosage   MeSH
• Vascular Grafting statistics & numerical data   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Geographicals
• Europe MeSH

• MeSH
• Anticoagulants therapeutic use   MeSH
• Aspirin therapeutic use   MeSH
• Diabetic Foot diagnosis   complications   MeSH
• Diagnostic Techniques and Procedures MeSH
• Platelet Aggregation Inhibitors therapeutic use   MeSH
• Drug Therapy, Combination MeSH
• Humans MeSH
• Peripheral Arterial Disease * diagnosis   MeSH
• Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use   MeSH
• Vascular Grafting * methods   rehabilitation   statistics & numerical data   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH

Cíl: Endovaskulární léčba aortoiliakálních aneurysmat vyžaduje kotvení stentgraftu do zevní iliakální tepny a tím překrytí odstupu vnitřní iliakální tepny. Nutnost překrýt obě vnitřní iliakální tepny je spojena s vyšším rizikem ischemie tračníku a hýžďových klaudikací. Cílem sdělení je zhodnotit výsledky léčby aortoiliakálních aneurysmat nebo izolovaných aneurysmat pánevních tepen se současnou revaskularizací povodí vnitřní iliakální tepny a srovnat se skupinou nemocných, u kterých revaskularizace provedena nebyla. Metodika: K implantaci iliakálního větveného stentgraftu z důvodu revaskularizace povodí vnitřní iliakální tepny, ať již izolovaně, nebo společně s bifurkačním stentgraftem, bylo indikováno na našem pracovišti v období od března 2010 do ledna 2018 celkem 27 nemocných. Jednalo se o 24 muže a tři ženy ve věku od 54 do 84 let. U 27 nemocných bylo implantováno 28 větvených iliakálních stentgraftů. U 26 nemocných tedy byla revaskularizována pouze jedna vnitřní iliakální tepna, u jednoho nemocného byly revaskularizovány obě vnitřní iliakální tepny. Výsledky: Výkon byl technicky úspěšný u všech nemocných. Perioperační letalita byla v našem souboru 0 % a perioperační morbidita dosáhla 3,7 %. Medián doby sledování nemocných v našem souboru byl 31 měsíců, v rozmezí od 2 do 97 měsíců. Primární průchodnost větví pro vnitřní iliakální tepnu dosáhla v našem souboru 96,42 %. Sekundární endoleak jsme zaznamenali u šesti nemocných (lx endoleak typu 1a, 1x endoleak Ib, 4x endoleak II). U jednoho nemocného jsme zaznamenali zánětlivou komplikaci. Při srovnání ischemických komplikací skupiny nemocných s revaskularizací povodí vnitřní iliakální tepny se skupinou nemocných, u kterých revaskularizace provedena nebyla, se za měsíc po výkonu obě skupiny signifikantně lišily v počtu hýždbvých klaudikací (p = 0,024) a v celkovém počtu ischemických komplikací (p = 0,006). Rok po výkonu se skupiny ve výskytu ischemických komplikací signifikantně nelišily. Závěr: Implantace větvené iliakální komponenty umožňuje efektivní léčbu aortoiliakálních či iliakálních aneurysmat se současnou revaskularizací povodí vnitřní iliakální tepny. Ve srovnání s léčbou aortoiliakálních aneurysmat bez revaskularizace pánevního řečiště takto provedená léčba snižuje výskyt časných ischemických komplikací.

Aim: Endovascular treatment of aortoiliac aneurysms requires anchoring of stent graft into the external iliac artery with covering of internal iliac artery origin. The covering of internal iliac artery of both sides is associated with higher risk of large bowel ischemia and buttock claudication. The aim of article is to evaluate our results of endovascular treatment of aortoiliac aneurysms or isolated iliac aneurysms with revascularization of internal iliac artery territory and to compare results with the group of patients without its revascularization. Methods: From March 2010 to January 2018 27 patients (24 men, 3 women) with median age of 72 years (range 54-84 years) were indicated for the treatment of aortoiliac aneurysms or isolated iliac aneurysms with revascularization of internal iliac artery territory. Twenty eight iliac branched devices were implanted in 27 patients. Internal iliac artery of one side was revascularized in 26 patients, both internal iliac arteries were revascularized in one patient only. Results: Primary technical success was achieved in all patients. Perioperative mortality rate was 0%, perioperative morbidity 3.7%. The median of duration of follow-up was 31 months (range 2-97 months). Primary internal iliac branch patency rate was 96.42%. Secondary endoleak was found at follow-up CT in 6 patients (1 endoleak type la, 1 endoleak type Ib, 4 endoleaks type II). In one patient inflammatory complication was seen. Significantly lower rate of buttock claudications (p = 0.024) and the total number of ischemic complications (p = 0.006) were found one month after procedure in the group of patients with revascularisation of internal iliac artery territory in comparison with the group of patients without revascularization and bilateral internal iliac artery occlusion. No difference of ischemic complications was found between these two groups one year after the procedure. Conclusion: The implantation of abranched iliac component allows effective treatment of aortoiliac or iliac aneurysms with simultaneous revascularization of the internal iliac artery. Compared with treatment of aortoiliac or iliac aneurysms without revascularization of internal iliac artery teritory of both sides the simultaneous revascularization of the internal iliac artery teritory by branched iliac component reduces the incidence of early ischemic complications.

• MeSH
• Aortic Aneurysm, Abdominal * diagnostic imaging   surgery   MeSH
• Iliac Aneurysm diagnostic imaging   surgery   MeSH
• Blood Vessel Prosthesis MeSH
• Endovascular Procedures methods   instrumentation   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Vascular Grafting methods   instrumentation   statistics & numerical data   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with prior myocardial infarction (MI). OBJECTIVES: This study evaluated the efficacy and safety of ticagrelor on major cardiovascular (CV) events and major adverse limb events in patients with PAD and a prior MI. METHODS: PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) randomized 21,162 patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose aspirin. History of PAD was obtained at baseline. Occurrences of major adverse cardiovascular events (MACE) (defined as CV death, MI, or stroke) and major adverse limb events (MALE) (defined as acute limb ischemia or peripheral revascularization for ischemia) were recorded in follow-up. RESULTS: A total of 1,143 patients (5%) had known PAD. In the placebo arm, those with PAD (n = 404) had higher rates of MACE at 3 years than those without (n = 6,663; 19.3% vs. 8.4%; p < 0.001), which persisted after adjusting for baseline differences (adjusted hazard ratio: 1.60; 95% confidence interval: 1.20 to 2.13; p = 0.0013), and higher rates of acute limb ischemia (1.0% vs. 0.1%) and peripheral revascularization procedures (9.15% vs. 0.46%). Whereas the relative risk reduction in MACE with ticagrelor was consistent, regardless of PAD, patients with PAD had a greater absolute risk reduction of 4.1% (number needed to treat: 25) due to their higher absolute risk. The absolute excess of TIMI major bleeding was 0.12% (number needed to harm: 834). The 60-mg dose had particularly favorable outcomes for CV and all-cause mortality. Ticagrelor (pooled doses) reduced the risk of MALE (hazard ratio: 0.65; 95% confidence interval: 0.44 to 0.95; p = 0.026). CONCLUSIONS: Among stable patients with prior MI, those with concomitant PAD have heightened ischemic risk. In these patients, ticagrelor reduced MACE, with a large absolute risk reduction, and MALE. (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS-TIMI 54]; NCT01225562).

• MeSH
• Adenosine administration & dosage   adverse effects   analogs & derivatives   MeSH
• Purinergic P2Y Receptor Antagonists administration & dosage   adverse effects   MeSH
• Aspirin administration & dosage   MeSH
• Stroke epidemiology   prevention & control   MeSH
• Lower Extremity blood supply   surgery   MeSH
• Myocardial Infarction epidemiology   prevention & control   MeSH
• Platelet Aggregation Inhibitors administration & dosage   MeSH
• Ischemia epidemiology   prevention & control   surgery   MeSH
• Drug Therapy, Combination MeSH
• Hemorrhage chemically induced   epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Peripheral Arterial Disease epidemiology   MeSH
• Secondary Prevention MeSH
• Aged MeSH
• Vascular Grafting statistics & numerical data   MeSH
• Dose-Response Relationship, Drug MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH