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The aim of the study was to assess the feasibility and safety of hybrid angiography consisting of carbon dioxide (CO2) angiography supplemented by small doses of iodinated contrast medium (ICM) in the endovascular treatment of chronic limb threatening ischemia (CLTI) patients with pre-existing chronic kidney disease (CKD).
This prospective study comprised all non–dialysis-dependent CKD patients presenting for endovascular management of CLTI. All endovascular interventions were done using CO2 as a contrast medium whether alone or supplemented by ICM (hybrid angiography) to treat unilateral arterial steno-occlusive lesions of iliac, femoropopliteal, or BTK arteries. Study outcomes included feasibility of the device, technical success, and freedom from contrast-induced acute kidney injury (CI-AKI), renal replacement therapy, and CO2 angiography-related complications.
A total of 206 CKD patients underwent endovascular intervention using CO2 only as a contrast medium (159 patients, 77.2%), or hybrid CO2-ICM angiography (47 patients, 22.8%). The overall technical success was 95.6%. Patients were followed up for a mean period of 17.9 ± 4.6 months. The mean volumes of CO2, and ICM consumption were 200.7 ± 95.1 mL, and 11.8 ± 4.4 mL, respectively. The mean procedural, and fluoroscopy times were 95.6 ± 12.5 and 49.5 ± 10.8 minutes, respectively. BTK lesions were significantly associated with the need for hybrid angiography (P = <.0001). The mean pre- and postoperative serum creatinine levels were comparable (P = .08). Two patients (4.3%) showed transient manifestations of CI-AKI, but neither required renal replacement therapy. No statistically significant differences were encountered between the two study groups regarding procedure outcomes.
Hybrid CO2-ICM angiography is safe, feasible, effective, and a fairly simple alternative during endovascular interventions to treat chronic lower extremity ischemia. Using supplemental small volumes of ICM to overcome the suboptimal images generated by CO2 alone does not jeopardize the renal functions in CKD patients.
To examine the relationship between the Global Limb Anatomic Staging System (GLASS) and midterm limb and survival related outcomes of retrograde tibiopedal access, after failed recanalisation of infrainguinal chronic total occlusions (CTOs) using the antegrade approach, in patients with chronic limb threatening ischaemia (CLTI).
This prospective, observational study was conducted between January 2017 and April 2019, and included 213 patients (29 GLASS I, 53 GLASS II, and 131 GLASS III lesions) with infrainguinal CTO in whom a percutaneous tibiopedal access was attempted following failed recanalisation using an antegrade approach. Multivariable Cox proportional hazard regression was performed to assess possible predictors of midterm clinical outcomes. Kaplan–Meier survival curves were used to estimate limb based patency (LBP), limb salvage, amputation free survival (AFS), and overall survival.
The study reported access, crossing, and treatment success of 92.5%, 89.2%, and 89.2% of all tibiopedal access attempts, respectively. In comparison with GLASS I, GLASS stage III was associated with statistically significantly worse midterm LBP (p = .005), overall survival (p = .037), limb salvage (p = .021), and AFS (p < .001).
Retrograde tibiopedal access for recanalisation of infrainguinal CTOs in patients with CLTI is associated with high access, crossing, and treatment success, and low complication rates. The study suggests that GLASS stage may be a useful predictor of midterm limb and survival related outcomes of this approach. In comparison with GLASS I, GLASS III anatomy is associated with a statistically significantly worse LBP, limb salvage, AFS, and overall survival.
ABSTRACT
Organophosphorus pesticides are one of the most extensively used forms of pesticides that could adversely impact fertility in both animals and humans. The current research aimed to investigate the potential effects of long-time malathion administration on testosterone in serum, oxidative stress biomarkers in testicular tissue and sperm characteristics of rats as an experimental model. Twenty adult male Wistar rats were split into two groups: the control group (n = 10) and the malathion-treated group (n = 10) based on the medication received orally by gavage (3 times/week for 60 days). Long-time administration of malathion negatively affected testosterone level, sperm count, sperm viability, and sperm morphology when compared to the control group. Lipid peroxidation increased significantly in the malathion-treated group when compared to the control group. On the other hand, Malathion administration caused a significant reduction in testosterone level, activities of glutathione peroxidase, reduced glutathione, and superoxide dismutase enzymes in the testicular tissue of male rats. In conclusion, long-term with space interval administration of malathion had deleterious effects on testosterone level and testicular oxidative status as well as semen quality in male rats. Consequently, it is essential to monitor surveys of organophosphorus pesticide residues in plants to protect consumer health.