Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)
01 Jan 2017-European Journal of Vascular and Endovascular Surgery (W.B. Saunders Ltd)-Vol. 53, Iss: 1, pp 4-52
TL;DR: The management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) as mentioned in this paper is a guideline for the management of thoracic aorta diseases.
About: This article is published in European Journal of Vascular and Endovascular Surgery.The article was published on 2017-01-01 and is currently open access. It has received 697 citations till now. The article focuses on the topics: Thoracic aorta & Vascular surgery.
Citations
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TL;DR: Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.
1,493 citations
University of Tübingen1, University of Pavia2, Charité3, University of Leicester4, University of Barcelona5, University of Graz6, Istanbul University7, Paris Diderot University8, University of Birmingham9, Norfolk and Norwich University Hospital10, Instituto de Medicina Molecular11, Peking Union Medical College Hospital12, University of Iceland13, University of East Anglia14, University of Oxford15
TL;DR: The recommendations for the management of LVV have been updated to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.
Abstract: BACKGROUND
Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations.
METHODS
Using EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations.
RESULTS
Three overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40-60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons.
CONCLUSIONS
We have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.
564 citations
TL;DR: Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortIC arch: an expert consensus document of the European Association for Cardio-Thoracic surgery and the European Society for Vascular Surgery.
Abstract: Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS) Martin Czerny (EACTS Chairperson)* and Jürg Schmidli (ESVS Chairperson) Writing Committee: Sabine Adler, Jos C. van den Berg, Luca Bertoglio, Thierry Carrel, Roberto Chiesa, Rachel E. Clough, Balthasar Eberle, Christian Etz, Martin Grabenwöger, Stephan Haulon, Heinz Jakob, Fabian A. Kari, Carlos A. Mestres, Davide Pacini, Timothy Resch, Bartosz Rylski, Florian Schoenhoff, Malakh Shrestha, Hendrik von Tengg-Kobligk, Konstantinos Tsagakis and Thomas R. Wyss
357 citations
TL;DR: These guidelines are dedicated to Paola De Rango, University of Perugia, Italy, who participated very actively in the process of developing these guidelines, in particular the important chapters on chronic arterial and venous mesenteric ischaemia.
329 citations
Uppsala University1, Gloucestershire Hospitals NHS Foundation Trust2, Nova Southeastern University3, University of Hamburg4, University of Amsterdam5, University of Pécs6, Catholic University of the Sacred Heart7, University of Bern8, Utrecht University9, Houston Methodist Hospital10, University of Patras11, University of Southern Denmark12, Ghent University13, Cambridge University Hospitals NHS Foundation Trust14, Asahikawa Medical University15, Medical University of Graz16, University of Adelaide17, University Health Network18, Imperial College London19, National University of Colombia20
TL;DR: Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia.
227 citations
References
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University of Kansas1, Wellesley College2, University of Illinois at Urbana–Champaign3, Oregon Health & Science University4, Boston University5, McMaster University6, University of Connecticut7, University of North Dakota8, Toronto Western Hospital9, University of Texas Health Science Center at San Antonio10
TL;DR: Criteria for the classification of fibromyalgia are widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites, and no exclusions are made for the presence of concomitant radiographic or laboratory abnormalities.
Abstract: To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
9,289 citations
TL;DR: The data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection and suggest a high clinical index of suspicion is necessary.
Abstract: ContextAcute aortic dissection is a life-threatening medical emergency associated
with high rates of morbidity and mortality. Data are limited regarding the
effect of recent imaging and therapeutic advances on patient care and outcomes
in this setting.ObjectiveTo assess the presentation, management, and outcomes of acute aortic
dissection.DesignCase series with patients enrolled between January 1996 and December
1998. Data were collected at presentation and by physician review of hospital
records.SettingThe International Registry of Acute Aortic Dissection, consisting of
12 international referral centers.ParticipantsA total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom
had type A dissection.Main Outcome MeasuresPresenting history, physical findings, management, and mortality, as
assessed by history and physician review of hospital records.ResultsWhile sudden onset of severe sharp pain was the single most common presenting
complaint, the clinical presentation was diverse. Classic physical findings
such as aortic regurgitation and pulse deficit were noted in only 31.6% and
15.1% of patients, respectively, and initial chest radiograph and electrocardiogram
were frequently not helpful (no abnormalities were noted in 12.4% and 31.3%
of patients, respectively). Computed tomography was the initial imaging modality
used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients
with type A dissection managed surgically was 26%; among those not receiving
surgery (typically because of advanced age and comorbidity), mortality was
58%. Mortality of patients with type B dissection treated medically was 10.7%.
Surgery was performed in 20% of patients with type B dissection; mortality
in this group was 31.4%.ConclusionsAcute aortic dissection presents with a wide range of manifestations,
and classic findings are often absent. A high clinical index of suspicion
is necessary. Despite recent advances, in-hospital mortality rates remain
high. Our data support the need for continued improvement in prevention, diagnosis,
and management of acute aortic dissection.
3,110 citations
American College of Rheumatology1, Mayo Clinic2, Stanford University3, Johns Hopkins University4, University of Colorado Hospital5, Cleveland Clinic6, University of Calgary7, National Institutes of Health8, University of Kentucky9, University of Illinois at Chicago10, Harvard University11, SUNY Downstate Medical Center12, University of California, San Diego13
TL;DR: Criteria for the classification of giant cell (temporal) arteritis were developed by comparing 214 patients who had this disease with 593 patients with other forms of vasculitis, and 2 other variables were included: scalp tenderness and claudication of the jaw or tongue or on deglutition.
Abstract: Criteria for the classification of giant cell (temporal) arteritis were developed by comparing 214 patients who had this disease with 593 patients with other forms of vasculitis. For the traditional format classification, 5 criteria were selected: age greater than or equal to 50 years at disease onset, new onset of localized headache, temporal artery tenderness or decreased temporal artery pulse, elevated erythrocyte sedimentation rate (Westergren) greater than or equal to 50 mm/hour, and biopsy sample including an artery, showing necrotizing arteritis, characterized by a predominance of mononuclear cell infiltrates or a granulomatous process with multinucleated giant cells. The presence of 3 or more of these 5 criteria was associated with a sensitivity of 93.5% and a specificity of 91.2%. A classification tree was also constructed using 6 criteria. These criteria were the same as for the traditional format, except that elevated erythrocyte sedimentation rate was excluded, and 2 other variables were included: scalp tenderness and claudication of the jaw or tongue or on deglutition. The classification tree was associated with a sensitivity of 95.3% and specificity of 90.7%.
2,204 citations
TL;DR: Criteria for the classification of Takayasu arteritis were developed by comparing 63 patients who had this disease with 744 control patients with other forms of vasculitis, and the presence of 3 or more of these 6 criteria demonstrated a sensitivity of 90.5% and a specificity of 97.0%.
Abstract: Criteria for the classification of Takayasu arteritis were developed by comparing 63 patients who had this disease with 744 control patients with other forms of vasculitis. Six criteria were selected for the traditional format classification: onset at age less than or equal to 40 years, claudication of an extremity, decreased brachial artery pulse, greater than 10 mm Hg difference in systolic blood pressure between arms, a bruit over the subclavian arteries or the aorta, and arteriographic evidence of narrowing or occlusion of the entire aorta, its primary branches, or large arteries in the proximal upper or lower extremities. The presence of 3 or more of these 6 criteria demonstrated a sensitivity of 90.5% and a specificity of 97.8%. A classification tree also was constructed with 5 of these 6 criteria, omitting claudication of an extremity. The classification tree demonstrated a sensitivity of 92.1% and a specificity of 97.0%.
1,888 citations
1,797 citations