Clinical Highlights

Temple Wins 2016 AHA Philadelphia Heart Science Forum Innovation Challenge

temple_wins_2Temple’s Riyaz Bashir, MD, FACC, RVT won first prize at the American Heart Association’s 2016 Philadelphia Heart Science Forum at WHYY on April 15, 2016, for the invention of a novel device for the treatment of acute pulmonary embolism.

Changing Practice Patterns in Care of Patients with Aortic Dissection

Aortic dissection has historically been treated by cardiothoracic surgeons in open procedures. However, a study led by Temple researchers found that other specialists are becoming increasingly involved thanks to new, minimally invasive endovascular interventions. The researchers, who presented their results at the 2015 Society of Thoracic Surgeons Annual Meeting, reviewed papers published between 1998 and 2013 pertaining to aortic dissection and correlated authors’ specialty affiliations with the use of endovascular technologies.

Stent graft repair is increasingly used for high-risk patients with certain types of aortic tears. Because vascular surgeons have long incorporated endovascular skills into their practice, they are taking on a larger role in the treatment of aortic dissection, especially Type B dissections.

According to Larry R. Kaiser, MD, FACS, Dean of the Lewis Katz School of Medicine at Temple University and a co-author on the study, these findings should encourage cardiothoracic surgeons to continue to incorporate endovascular skills into their training programs so they can offer the latest minimally invasive aortic therapies to their patients.

Challenging the Standard in Dialysis Access

A recently submitted paper from Temple’s Ravi Dhanisetty, MD, and colleagues, now awaiting review, complicates the established wisdom on kidney dialysis access methods.

In recent years, nationwide efforts have promoted using arteriovenous fistulas for dialysis access. Compared with artificial grafts, AV fistulas, created from a patient’s own veins, tend to be more durable and result in fewer infections once in operation, and are thought to be more effective. However, they also require the placement of an arteriovenous catheter for dialysis until the modified vein is healed and ready for use; often this takes several months, during which time the patient is susceptible to infection from the catheter.

An arteriovenous graft.

In some populations, especially underserved communities where patients may have less access to support from caregivers, it can be more difficult to keep the site of the catheter sterile. In Temple’s service area of North Philadelphia, catheter-originated infection is a serious concern. We have also found the patency of artificial grafts placed by Temple surgeons to be equal to that of AV fistulas. Therefore, Temple’s priority is to provide the patient with a dialysis access solution that is ready for use as quickly as possible, reducing the amount of time a patient must spend with the AV catheter implanted. “We feel we should try to prevent infections by putting in a graft or vein shunt as soon as possible,” says Dr. Dhanisetty. “This is a bit of a paradigm shift, but it doesn’t apply to every community.” Dr. Dhanisetty’s paper suggests physicians consider average clinical outcomes among their own patient populations when weighing the pros and cons of grafting vs. AV fistula access.

High-volume Centers Have Improved Outcomes for Catheter-based Blood Clot Removal in Patients with Deep Vein Thrombosis

More patients with lower-extremity proximal deep vein thrombosis are undergoing catheter-directed thrombolysis (CDT), as recent research suggests that CDT reduces the risk of lifestyle-limiting post-thrombotic syndrome compared with anticoagulant therapy alone. A study led by Temple researcher Riyaz Bashir, MD, FACC, RVT, and published in the journal Circulation, found that institutions with a higher annual volume of CDT procedures showed better outcomes. Specifically, centers that performed 6 or more procedures per year had lower in-hospital mortality and lower intracranial hemorrhage rates associated with CDT. “This does not mean that low-volume centers should not perform CDT for patients with lower-extremity DVT,” says Dr. Bashir. “It means that we should focus on standardizing CDT protocols to improve patient selection as well as peri-procedural patient monitoring. Establishment of centers of excellence in treating venous thromboembolic disease may provide the necessary framework within which bleeding risk to the patient can be minimized.”

Prone angiogram showing left common iliac vein stenosis from a venous spur (left), and same vein after stenting (right).
Prone angiogram showing left common iliac vein stenosis from a venous spur (left), and same vein after stenting (right).

Compression Stockings Might Not Prevent Post-Thrombotic Syndrome

Approximately half of people diagnosed with deep vein thrombosis will develop post-thrombotic syndrome—a condition traditionally treated with elastic compression stockings worn on the affected leg. Yet recent studies have cast doubt on the effectiveness of these stockings. A meta-analysis by Temple physician Riyaz Bashir, MD, FACC, RVT, and colleagues adds to this doubt.

Dr. Bashir and colleagues analyzed more than 600 past reports and studies involving elastic compression stockings, including the recent SOX trial that looked specifically at this issue. The results of their findings were published May 5 in The Lancet Haematology.

“Our analysis shows that use of elastic compression stockings does not significantly reduce the development of post-thrombotic syndrome,” says Dr. Bashir. “Many questions remain, such as whether certain groups of patients, like females or elderly patients, benefit from this treatment, or whether the timing of the intervention would make a difference. We believe it’s too early to recommend that physicians stop using compression stockings. This study also highlights that there is a real need for new and more effective therapies for the treatment and prevention of post-thrombotic syndrome.”