All patients received unfractionated heparin. Management of primary aortic thrombus required stentgraft in seven patients, aortic thrombectomy in one, and anticoagulation
therapy alone in five. Indications for intervention were recurrent embolism (n = 4), occurrence of embolism under heparin (n = 1), or BYL719 persistent thrombus (n = 2). Endovascular exclusion of AMT was successful in all cases, with no complications or deaths at 30 days and no recurrence at midterm. Analysis of the morphological features of the thrombus identified solely the high degree mobility as associated with adverse outcome (p = .048).
Conclusion: In our experience, stentgraft exclusion of AMT is an effective approach. Systematic evaluation of thrombus mobility by a real-time imaging study can be helpful to better define the indications for radical treatment of the aortic lesion. (C) 2013 European Society for
Vascular Surgery. Published by Elsevier Ltd. All rights reserved.”
“Hypothesis/Introduction: We investigated whether diabetes modified the effectiveness of renin-angiotensin-aldosterone system (RAAS) inhibition on left ventricular hypertrophy selleck (LVH) regression in hypertensive patients in the Aliskiren in Left Ventricular Hypertrophy (ALLAY) trial.
Materials and methods: Participants (n=465) with LVH and a BMI > 25 kg/m(2) were randomized to aliskiren 300mg, CBL0137 losartan 100mg or both daily for 36 weeks, and LVH regression was assessed by cardiac magnetic resonance imaging. Renin concentration, plasma renin activity and aldosterone were assessed in a subset of patients.
Results: Patients with diabetes mellitus (DM) (n=111, 24%) were older (61+/-9 vs. 58+/-11 years, p=0.03), had higher BMI (32.2+/-4.2 vs.
30.7 +/- 4 kg/m(2), p=0.004), higher systolic blood pressure (148+/-14 vs. 145+/-14mmHg, p=0.03) and lower eGFR (79+/-16 vs. 84+/-16ml/min, p=0.03) at baseline. Combination therapy with aliskiren plus losartan was associated with greater LVH reduction than losartan alone in patients with DM (p=0.01), but not in patients without DM (p=0.91; unadjusted interaction p=0.06; adjusted p = 0.038). In a subset of 138 participants, plasma aldosterone was reduced to a greater extent in patients with DM (p-interaction = 0.004).
Conclusions: Patients with DM and LVH may derive differential benefit with dual RAAS inhibition with a combination of aliskiren and losartan compared with losartan alone with respect to LVH reduction. Whether these findings will result in improved outcomes will be further explored in larger studies.”
“P>Sedation for radiological imaging studies encompasses the majority of all sedation-related procedures outside of the intensive care unit.