Z GEFÄSSMED 2012; 9 (2) 13 getesteten Personen hatten rezidivierend positive Cardiolipin-Ak und weitere 3 Patienten hatten rezidivierend positive Beta-2-GP-1Ak im Plasma. Ergebnisse Patienten mit einmalig erhöhtem Lupusantikoagulans hatten einen signifikant höheren BMI (p = 0,0001) und auch ein höheres Körpergewicht (p = 0,02) im Vergleich zu Patienten ohne positivem Lupus-Inhibitor. Bei den Patienten mit mehrmals positiv getestetem Lupus-Inhibitor fand sich keine statistische Signifikanz im Vergleich zu Patienten ohne positiven Lupus-Inhibitor (BMI p = 0,4, Körpergewicht p = 0,7). Das Patientenkollektiv für die Testung von Cardiolipin-Ak und Beta-2-GP-1-Ak bei erhöhtem BMI war zu klein, um statistisch signifikante Ergebnisse zu erzielen. Schlussfolgerung Der Grund, warum Patienten mit einmalig getestetem positivem Lupus-Inhibitor einen statistisch signifikant höheren BMI und höheres Körpergewicht hatten und Patienten mit mehrmals getestetem positivem Lupus-Inhibitor nicht, könnte darin liegen, dass nach einmalig getesteter AntiphospholipidantikörperPositivität eine Therapie mit oralen Antikoagulantien eingeleitet wird. Eine Bestimmung des Lupus-Inhibitors ist unter oraler Antikoagulation nicht möglich. Die Antikoagulation wird in der Regel nicht mehr abgesetzt, um erneut auf APA-Positivität zu testen. Deswegen war auch die Anzahl der Personen mit mehrmals positiv getestetem Lupusantikoagulans sehr niedrig (n = 20). Massive Pulmonary Embolism Caused by Internal Iliac Vein Thrombosis with Free Floating Thrombus Formation in the Inferior Vena Cava M. Brodmann1, T. Gary1, F. Hafner1, K. Tiesenhausen2, H. Deutschmann3, E. Pilger1 1Division of Angiology; 2Division of Vascular Surgery; 3Division of Vascular and Interventional Radiology, Medical University Graz Nowadays compression ultrasound (CUS) is the golden standard for the routine diagnosis of deep venous thrombosis (DVT). The drawback of CUS is the low sensitivity concerning the diagnosis of isolated pelvic vein thrombosis, especially referring to isolated internal iliac vein and ovarian vein thromboses. Therefore MR venography has become a valuable alternative. We present a 45 year old female patient with a massive pulmonary embolism (PE) with the indication for thrombolytic therapy due to severe right ventricular overload. We were not able to detect a DVT in this patient in the lower limbs with CUS. However, further DVTwork up by MR venography showed a free floating thrombus formation originating from the right internal iliac veins into the inferior vena cava. Due to the fact that this thrombus was free floating surgical removement of the thrombus was scheduled and performed successfully. In some patients it might be important to look for so called rare causes of PE, even then when CUS of the lower limbs does not reveal any deep venous thromboses. The diagnostic procedure of choice for these patients seems to be MR phlebography, as with this procedure iliac and pelvic veins can be evaluated without radiation exposure. Percutaneous Transluminal Angioplasty versus Primary Stenting in Infrapopliteal Arteries in Critical limb Ischemia M. Brodmann1, H. Froehlich1, A. Dorr1, T. Gary1, F. Hafner1, H. Deutschmann2, R. H. Portugaller2, E. Pilger1 1Division of Angiology; 2Division of Interventional Radiology, Medical University Graz Purpose In endovascular recanalisation of infrapopliteal arteries, studies have already pointed out the value of balloon angioplasty but for stent implantation very few randomized controlled data exist so far. We conducted a randomized prospective trial in patients with CLI comparing the effect of PTA versus primary stenting in infrapopliteal arteries, concerning 1-year clinical benefit and reobstruction rate. Results 54 patients were either randomized for primary stening (balloon expandable stent) or PTA alone 33 patients were assigned to the PTA group, 21 patients to the Stent group. The whole follow up period of 12 months was completed by 46 patients. Improvement by at least one Rutherford classification was reached by a total of 33 (75.0%) of patients at month 12, 22 (81.5%) in the PTA group and 11 (64.7 %) in the Stent group. A complete ulcer healing at month 12 showed 21 (63.6%) of all patients, with a significantly higher percentage in patients treated with PTA alone (16 [80.0%] vs 5 [38.5%]). 50.0% of all patients showed significant re-obstruction over the follow-up period, 39.4% of the PTA and 66.7% of the stent group. At month 3 loss of primary patency was nearly equal in both groups (23.3% PTA vs 25.0% stent), but drifted apart with the duration of the follow-up period to the disadvantage of primary stenting (month 12 51.9% vs 64.7%). As for secondary patency rate at month 12 the stent group showed a worse secondary patency rate then the PTA group (52.9% vs 70.4%,) Conclusion From our own data we draw the conclusion that PTA alone with the application of modern hydrophilic balloon catheters is superior to primary stenting with balloon expandable stents in infrapopliteal arteries. Safety and Efficacy of Periprocedural Anticoagulation with Enoxaparin in Patients Undergoing Peripheral Endovascular Revascularisation M. Brodmann1, A Dorr1, F Hafner1, T Gary1, H. Froehlich1, E. Kvas2, H. Deutschmann3, E. Pilger1 1Division of Angiology; 2Indepent Biostatistics; 3Division of Interventional Radiology, Medical University Graz Background Anticoagulation is used in endovascular procedures to prevent acute re-occlusion of the target vessel. Consecutive bleeding events are feared complications. Material and Methods We performed a prospective, single center, open label phase III study comparing two different regimes of enoxaparin periinterventional to peripheral EVR stratified into a low and a high risk group according to the reocclusion-risk due to their vessel morphology. Results 184 patients were analyzed, 44 patients in the low risk group and 140 in the high risk group. Concerning the primary safety endpoint a total of 25 (13,59%) bleedings occurred until day 30, 5 of them in the low risk (11.36%) and 20 (14.29%) in the high risk group (p = 0.809 for low vs high risk). Concerning primary efficacy none of the patients showed an acute reocclusion until day 30. Concerning the second endpoint of prevention of chronic re-obstruction, at day 180 ABI has decreased in the low risk group from mean 0.94 at day 30 to mean 0.89 and from 1,28 at day 30 to 0.85 after 6 months in the high risk group. No significant reobstruction was found in the low risk group, whereas 5 significant reobstruction events were objectified in the high risk group. Conclusion We conclude that LMWH either in a low dose or high dose regime during a peripheral EVR is safe concerning bleeding complications and acute reobstructions. The longterm follow up showed no significant difference between our high and our low risk group concerning reobstruction.

Background: Periprocedural anticoagulation is primarily used in endovascular procedures to prevent acute reocclusion of the target vessel, but periprocedural anticoagulation might also have an impact on long-term outcome. Consecutive bleeding events are feared complications. Despite changes in peripheral endovascular revascularizations (EVRs), the periprocedural management has remained unchanged for years. Unfractionated heparin is still the treatment of choice during and immediately after EVR. Materials and Methods: We performed a prospective, single-center, open-label phase III study comparing 2 different regimes of enoxaparin peri-interventional to peripheral EVR stratified into low- and high-risk groups according to the acute and long-term reocclusion risk due to their vessel morphology. In both groups, 0.5 mg/kg of enoxaparin as a bolus was administered intravenously 10 to 15 minutes before the start of the procedure. In the low-risk group, 40 mg of enoxaparin were administered once daily for 7 days; whereas in the high-risk group, 1 mg/kg of enoxaparin was administered subcutaneously (sc) 2 times a day for 48 hours after the procedure and afterward 40 mg of enoxaparin was administered sc once daily for 5 days. Results: For the analysis of the per protocol population, 44 patients remained in the low-risk group and 140 in the high-risk group. Concerning the primary safety end point, a total of 25 (13.59%) bleeding events occurred until day 30; 5 (11.36%) of them in the low-risk group and 20 (14.29%) in the high-risk group (P = .809 for low vs high risk). None of the bleeding events observed were major according to Thrombolysis In Myocardial Infarction criteria. Concerning our primary efficacy end point, none of the patients showed an acute reocclusion classified as a significant decrease in ankle–brachial index (ABI) or elevated peak systolic velocity ratio confirmed by duplex sonography until day 30. Concerning the second end point of prevention of chronic reobstruction, at day 180 ABI has decreased in the low-risk group from mean 0.94 at day 30 to mean 0.89 and from 1.28 at day 30 to 0.85 after 6 months in the high-risk group. No significant reobstruction was found in the low-risk group, whereas 5 significant reobstruction events were objectified in the high-risk group, all of them in the femoropopliteal arterial segment at day 180. Conclusion: We conclude that low-molecular-weight heparin either in a low-dose or high-dose regime during a peripheral EVR is safe concerning bleeding complications and acute reobstructions. The long-term follow-up showed no significant difference between our high- and low-risk groups concerning reobstruction. The periprocedural anticoagulation seems to have no influence on the long-term patency rate after peripheral EVR.

43. Jahrestagung der Österreichischen Gesellschaft für Innere Medizin 559 Ö G IM 1 3 Safety and efficacy of periprocedural anticoagulation with enoxaparin in patients undergoing peripheral endovascular revascularisation M. Brodmann1, A. Dorr1, F. Hafner1, T. Gary1, H. Fröhlich1, E. Kvas2, H. Deutschmann3, G. Seinost1, E. Pilger1 1 Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria 2 Independent biostatistician, Graz, Austria 3 Division of Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria Background: Anticoagulation is used in endovascular procedures to prevent acute re-occlusion of the target vessel. Consecutive bleeding events are feared complications. Despite changes in peripheral endovascular revascularisations (EVR) the periprocedural management has remained unchanged for years. Unfractionated heparin is still the treatment of choice during and immediately after EVR. Methods: We performed a prospective, single center, open label phase III study comparing two different regimes of enoxaparin periinterventional to peripheral EVR stratified into a low and a high risk group according to the reocclusion-risk due to their vessel morphology. In both groups enoxaparin 0.5 mg/kg intravenously (i.v) as a bolus was administered 10–15 min before the start of the procedure. In the low risk group 40 mg enoxaparin once daily were administered for 7 days, whereas in the high risk group enoxaparin 1 mg/kg subcutaneously (s.c) two times a day were applied for 48 h after the procedure and afterwards enoxaparin 40 mg sc once daily was applied for 5 days. Results: For the analysis of the per protocol population (PP) 44 patients remained in the low risk group and 140 in the high risk group. Concerning the primary safety endpoint a total of 25 (13.59 %) bleedings occurred until day 30, 5 of them in the low risk (11.36 %) and 20 (14.29 %) in the high risk group (p = 0.809 for low vs. high risk). None of the bleeding events observed were major bleeding events according to TIMI criteria. Concerning our primary efficacy endpoint none of the patients showed an acute reocclusion classified as a significant decrease of ABI or elevated peak systolic velocity ratio confirmed by duplex sonography until day 30. Concerning the second endpoint of prevention of chronic re-obstruction, at day 180 ABI has decreased in the low risk group from mean 0.94 at day 30 to mean 0.89 and from 1,28 at day 30 to 0.85 after 6 months in the high risk group. No significant reobstruction was found in the low risk group, whereas 5 significant reobstruction events were objectified in the high risk group, all of them in the femoropopliteal arterial segment at day 180. Conclusion: We conclude that LMWH either in a low dose or high dose regime during a peripheral EVR is safe concerning bleeding complications and acute reobstructions. The longterm follow up showed no significant difference between our high and our low risk group concerning reobstruction. The periprocedural anticoagulation seems to have no influence on longterm patency rate after peripheral EVR. Asymptomatic venous thrombotic events in ambulatory cancer patients: impact on survival T. Gary1, K. Belaj1, F. Eisner2, M. Pichler2, M. Brodmann1 1 Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria 2 Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria Background: Asymptomatic venous thrombotic events (VTEs) are possible findings in ambulatory cancer patients. Data regarding the incidence and clinical impact of asymptomatic VTEs are conflicting. We therefore conducted a study to evaluate the occurrence of asymptomatic VTEs of the lower limbs in ambulatory cancer patients. To further evaluate the association of these asymptomatic VTEs on survival during a 9 months follow up period. Methods: In our prospective cohort, we included 150 consecutive ambulatory cancer patients who were free of any clinical symptoms for VTEs. Compression ultrasound to detect deep vein thrombosis (DVT) and superficial venous thrombosis (SVT) of the lower limbs was performed by a vascular specialist. In case of pathological findings the patients were treated with low molecular weight heparin (LMWH) due to current established guidelines. The occurrence of death was investigated during a 9 months follow-up period. Results: A total of 27 (18 %) patients with VTEs were detected, which included 13 patients (8.7 %) with a SVT and 16 patients (10.7 %) showing a DVT. During the 9 months follow-up period the occurrence of a VTE at baseline was associated with a 3.2 fold increased risk for death (HR 3.2 (1.4–7.4); P = 0.01). Conclusion: Asymptomatic VTEs of the lower limbs in ambulatory cancer patients are frequently occurring concomitant features and are associated with poor survival during a 9 months follow-up period despite anticoagulation with LMWH. Silverhawk atherectomy versus primary old balloon angioplasty (POBA) in femorpopliteal stent reobstructionsa randomized controlled pilot trial M. Brodmann1, H. Fröhlich1, P. Rief1, A. Dorr1, F. Hafner1, T. Gary1, P. Eller1, G. Seinost1, H. Deutschmann2, E. Pilger1 1 Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria 2 Division of Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria Background: Due to intimal hyperplasia instent reobstruction in the femoropoliteal arterial segment is still an unsolved problem, even despite application of dual antiplatelet therapy in most patients for at least 3 months postprocedural. Different techniques have been discussed in case of reintervention to Abstracts

Giant cell arteritis (GCA) is the most common systemic vasculitis affecting people over the age of 50 years, especially in the western world. Nevertheless, the initial diagnosis can be tricky, as some of the patients present at first time with a real unusual initial manifestation. One of these can be tongue necrosis, which is according to the literature in accordance with scalp necrosis, the rarest initial manifestation form of GCA. We describe two patients who presented with tongue necrosis as initial symptom of GCA. The diagnosis was made by the American College of Rheumatology criteria, biopsy and duplex sonography of their temporal arteries. A typical halo was seen as a sign of intimal edema. The patients were put on corticosteroids immediately after diagnosis was proven and their symptoms improved quickly.