International Angiology最新文献

Background: The 1064 nm Nd:YAG transdermal laser is commonly used in the ambulatory treatment of lower limb reticular veins and telangiectasias. However, optimal laser parameters, particularly fluence and pulse duration, remain a subject of debate. In this prospective cohort pilot study, we evaluated the histopathological effects of different Nd:YAG 1064 nm laser settings on reticular veins to identify the parameter combinations most associated with vein wall damage.

Methods: Patients scheduled for ambulatory phlebectomy received transdermal laser therapy 24 hours prior to surgery, using different combinations of fluence and pulse duration. A total of 15 vein segments were collected during phlebectomy, 12 treated with the laser and 3 untreated controls. All samples were stained with hematoxylin and eosin and independently analyzed by two blinded pathologists for neutrophilic infiltration, luminal thrombosis, and wall fibrosis.

Results: Laser parameters of 70 J/cm² with pulse durations of 15 ms and 30 ms were significantly associated with the presence of inflammatory infiltrates (P<0.05). No statistically significant differences were found when comparing fixed fluence with variable pulse durations or fixed pulse duration with variable fluences (P>0.05).

Conclusions: Nd:YAG 1064 nm transdermal laser induces histopathological inflammation in reticular veins, particularly when using fluence of 70 J/cm² combined with pulse durations of 15-30 ms.

Introduction: Vascular calcification (VC) comprises intimal arterial calcification (IAC) and medial arterial calcification (MAC). To date, limited data exist on the prevalence of these calcification types in infrainguinal peripheral arterial disease (PAD).

Evidence acquisition: We conducted a systematic review according to PRISMA 2020 guidelines for studies investigating the prevalence of IAC and MAC in PAD.

Evidence synthesis: Three CT-based and six histological studies, encompassing 545 patients and 1161 arteries, were included. The pooled prevalence of VC was 96.99% (95% CI: 84.21-99.49) for CT, and 85.75% (95% CI: 74.65-92.48) for histological studies. CT-based assessment displayed IAC predominance over MAC in the femoropopliteal region, OR 6.63 (95% CI: 4.02-10.94), an outcome replicated by histological studies upon sensitivity analysis, OR 4.86 (95% CI: 1.49-15.91). Conversely, pooling of histological studies identified MAC dominance over IAC in the infra-popliteal arteries, OR 0.10 (95% CI: 0.03-0.30). Meta-regression displayed positive associations between male sex and infra-popliteal IAC, type II diabetes mellitus and femoropopliteal IAC, and chronic limb threatening ischemia (CLTI) and infra-popliteal MAC. The pooled prevalence of bone was 14.62% (95% CI: 8.25-24.58), significantly associated with CLTI, chronic kidney disease, and female sex.

Conclusions: PAD is characterized by a high prevalence of VC, predominantly IAC in the femoropopliteal arteries and MAC within the infra-popliteal region. The association of IAC, MAC and bone formation with distinct patient characteristics further underscores the clinical relevance and biological complexity of VC. Interpretation of these results should, however, be tempered by the absence of segment-matched CT-histology validation.

Introduction: To compare the effect of smoking cessation in abdominal aortic aneurysm growth compared to active smokers and non-smokers.

Evidence acquisition: A systematic review and Network Meta-Analysis was performed following the PRISMA guidelines using a registered protocol (CRD42021295315). We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey databases from inception to January 2022 for comparative studies reporting on abdominal aortic aneurysm growth according to smoking habits. AAA was defined as an infra-renal aortic diameter >3 cm. The main outcome was to estimate the mean difference of abdominal aortic aneurysms growth between smokers, former smokers, and nonsmokers. The estimates were pooled through a random-effects model network meta-analysis and heterogeneity assessed through the I² statistic.

Evidence synthesis: After 567 abstracts reviewed and 17 full text studies, six studies were included in the review and meta-analysis. Studies reported data from 1987-2017, encompassing a population of 2960 people with diagnosis of AAA, which 972 were active smokers, 1254 were former smokers and 679 were nonsmokers. Based on the network estimates, we did not find a statistically significant difference between AAA growth rate differences between former smokers and non-smokers (MD 0.05, 95% CI: -0.36 to 0.47). However, we found statistically significant differences between former smokers and active smokers (MD -0.45, 95% CI: -0.83 to -0.06) and active smokers versus non-smokers (MD 0.50, 95% CI: 0.16 to 0.85).

Conclusions: Smoking cessation seems to reduce the growth rate of AAA to rates similar to non-smokers, being a potential therapeutic target. These findings should lead to a higher awareness of the importance of smoking eviction in AAA patients and to future studies on this matter.

Background: The impact of carotid endarterectomy (CEA) on symptomatic patients with mild high-risk carotid stenosis has not been really investigated and it is not well-defined. This multicenter retrospective study aims to assess the safety and effectiveness of CEA in patients with 50% or less stenosis with symptoms despite best medical therapy.

Methods: Between January 2018 and December 2024, all consecutive patients presenting with carotid-related neurological symptoms and a ≤50% high risk carotid stenosis submitted to CEA in eight high-volume vascular centers were included in the present study. All patients underwent duplex ultrasonography and computed tomography angiography to identify plaque morphological features. All patients were checked for alternative possible source of brain embolism.

Results: Twenty-nine patients with high-risk embolic plaques determining ≤50% stenosis and carotid-related neurological symptoms underwent CEA. The majority of plaques were Gray-Weale 1 or 2 (79.3%) and with ulcerated cap (79.3%). Symptoms reported at onset and during hospitalization up to CEA were 8 (27.5%) TIA, 8 (27.5%) crescendo TIA, 10 (34.4%) minor strokes, 3 (34.4%) strokes in evolution. Ischemic brain lesions of less of 25 mm were detected in 12 patients (41.3%). No perioperative stroke, death, myocardial infarction or cerebral hemorrhage occurred in this series. Only one TIA was detected due to a surgical defect that was promptly corrected. No patient experienced recurrent neurologic events related to the revascularized hemisphere during follow-up (mean 35.6 months).

Conclusions: Despite the limited number of patients included in the study, CEA has been shown to be safe and effective in preventing recurrent neurological ischemic events in highly selected patients with mild carotid high-embolic-risk plaque stenosis treated at high-volume institutions. Further studies are required to identify the most appropriate diagnostic tools and the precise carotid plaque features associated with high-embolic risk.

Background: The aim of this study was to evaluate the feasibility, safety, and radiographic outcomes of vascular plug embolization for high-flow type I endoleaks after endovascular repair of abdominal aortic aneurysms.

Methods: This single-center retrospective case series included 10 patients who underwent endovascular repair of abdominal aortic aneurysms. These patients were subsequently diagnosed with high-flow type I endoleaks, either during the index endovascular repair of abdominal aortic aneurysms at completion angiography or during a staged procedure prompted by the evidence of a persistent type I endoleak on follow-up contrast-enhanced computed tomography. Each patient received endovascular embolization using vascular plugs. The collected data comprised patient demographics, clinical characteristics, complications, device number and size, and procedural details. Contrast-enhanced computed tomography was scheduled at 1, 3, 6, and 12 months and annually thereafter for up to 5 years.

Results: Seven patients (70.0%) had type Ia endoleaks and three (30.0%) had type Ib endoleaks. Twelve vascular plugs were implanted with 100% technical success and complete occlusion of all type I endoleaks. Imaging follow-up was available in eight patients; during 6-52 months of observation, no recurrent type I endoleak was detected on contrast-enhanced computed tomography.

Conclusions: Vascular plug embolization of high-flow type I endoleaks after endovascular repair of abdominal aortic aneurysm is feasible and safe. The technical success rate is high with durable radiographic exclusion on early to mid-term follow-up.

Introduction: Chronic venous disease (CVD) is a widespread disease characterized by various clinical manifestations. This manuscript is Part II of a systematic literature review and meta-analysis assessing the effects of micronized purified flavonoid fraction (MPFF) on lower limb symptoms and signs in patients with CVD at all stages of the disease. Part I examined symptoms and Part II presented herein focused on signs.

Evidence acquisition: A systematic literature review was conducted in November 2023 to identify studies investigating the efficacy of MPFF oral treatment (1000 mg daily for at least 1 month) on venous symptoms and signs in patients with CVD at all stages (C0s-C6). Databases searched included Medline, Embase, and Cochrane. Eligible studies included randomized controlled trials (RCTs) and non-RCTs (non-randomized comparative, single-arm, and observational studies) evaluating venous signs: edema, redness, ulcer healing and disease severity assessed by venous clinical severity score (VCSS). A single-group random-effects meta-analysis was used to estimate the mean change in sign intensity and the proportion of sign improvement or complete resolution from baseline to the final assessment.

Evidence synthesis: Out of 387 identified articles, 56 studies were included in the analysis, among which 33 reported CVD signs in 24,617 MPFF-treated patients. Included participants were mainly females (84.1%) with a mean age (±SD) of 48.6 (±8.8) years, and overweight with a mean BMI of 26.3 (±4.5) kg/m². Significant reductions were observed in mean [95% confidence interval] ankle and calf circumferences (-7.6 mm [-9.1 to -6.2] and -8.0 mm [-11.2 to -4.8], respectively, P<0.001). Venous ulcers were healed in 48.9% [30.3% to 67.8%] or regressed in 73.4% [63.3% to 82.3%] of the patients (P<0.001). Significant improvements were also shown in redness and VCSS score (P<0.001). Twelve studies had a high risk of bias, while sensitivity analyses did not change the study results. Heterogeneity level was frequently high among studies.

Conclusions: This comprehensive meta-analysis provides additional evidence supporting the effectiveness of MPFF in improving clinical signs of CVD across all stages of the disease.

Background: Recently, day case peripheral endovascular interventions have gained momentum due to constantly optimizing results, based on technological and pharmacological advancements. Despite this, some hospitals, especially in rural areas with limited access to the emergency services, have not fully adopted this model. We evaluate the safety and feasibility of same-day discharge after endovascular procedures in north wales hospitals.

Methods: A study was conducted of patients who underwent day-case peripheral arterial endovascular interventions during two distinct 12-month periods: April 2019 to March 2020 and April 2021 to March 2022. Data were sourced from a prospectively maintained interventional radiology database. We defined procedural technical success as the successful distal arterial access and crossing of the target lesion. The primary endpoint was safe same-day discharge, and the secondary endpoint was any adverse event related to the intervention. Patient's demographics, clinical information (including indication: claudication versus critical limb ischemia), primary procedure details, technical success, procedural complications, and unplanned admissions were recorded. Patient's records were evaluated at a minimum of 12 months post procedure.

Results: Over 24-month period, 221 patients underwent 237 peripheral arterial interventions as day case. The mean age was 70 years with male female ratio of 2:1. The indications for intervention were claudication (55%) and critical limb ischemia (45%). The mean distance to hospital from home address was 23.6 kilometers. The most common artery undergoing treatment was the superficial femoral artery (51%). The procedure technical success rate was 90%. There were 12 (5%) complications with three (1.3%) patients requiring open surgery. The unplanned hospital admissions rate was 7.2%. The primary endpoint of safe same-day discharge was achieved in 92.8% of cases.

Conclusions: Same day discharge following peripheral endovascular interventions is safe and feasible even in a rural setting. With a low rate of complications and unplanned admissions this model of care can be adopted universally.

Background: Endovenous ablation techniques (EVA) have become increasingly common and have taken the place of surgical treatment for truncal vein incompetence. We set out to investigate and identify outcome, complications, and incidence of recurrence, and possible causes of truncal recurrence in patients treated with Endovenous Laser Ablation (EVLA).

Methods: A cohort study of 307 consecutive patients (119M/188F) with varicose veins and great saphenous vein incompetence, (C3-C6), were treated with EVLA. Clinical and duplex ultrasound assessment was performed for all patients. Post-procedure patients were placed in compression stockings for 2 weeks, and given enoxaparin for DVT prophylaxis. Patients were also assessed for deep venous thrombosis (DVT), and successful obliteration.

Results: Median initial vein diameter was 6.9 (range 3.7-12.6) mm, and the median ablation energy was 57.8 (range 44.3 to 83.1) J/cm in all 307 patients. Complete truncal occlusion was noted in 301 patients. Truncal occlusion was demonstrated in all patients at initial and 2-week scan, however six patients with were noted to have developed truncal recurrence observed at 6-weeks to 3-months. The median energy delivered was 40.9 (range 35.6 to 41.7) J/cm, significantly less compared to non-recurrent GSV (P=0.02). We observed multiple tiny arteriovenous fistulae with arterialized signals within the lasered vein that became confluent, resulting in truncal recurrence.

Conclusions: Venous re-canalization after EVLA occurs as a result of neovascularization. This takes the form of multiple tiny AV fistulae, that eventually join and becomes a confluent reflux. The triggers for this phenomenon are unclear, but probably related to linear endovenous energy density.

Introduction: Chronic venous disease (CVD) significantly impacts patients' quality of life through leg symptoms and signs. This systematic literature review and meta-analysis, published in two separate articles, evaluated the effects of micronized purified flavonoid fraction (MPFF), a venoactive drug, on CVD symptoms and signs by analyzing data from a wide spectrum of clinical studies in patients with CVD at all stages of the disease. Part I presented herein, focused on symptoms, and Part II on signs.

Evidence acquisition: A systematic review was conducted in November 2023 using PRISMA guidelines. Medline, Embase, and Cochrane databases were searched. Eligible studies included prospective randomized controlled trials (RCTs) and non-RCTs investigating the effects of oral MPFF treatment (1000 mg, daily for at least 1 month) on venous leg symptoms and signs in patients with CVD at all stages (C0s-C6). In the present analysis, primary outcomes were the main venous symptoms including pain, heaviness, discomfort, cramps, feeling of swelling, and burning sensation. Secondary outcomes were pruritus, paresthesia, fatigue, and global symptoms. Patient level of satisfaction with treatment was also assessed. A single-group random-effects meta-analysis was used to estimate the mean change in symptom intensity and the proportion of complete symptom resolution from baseline to the last post-baseline value.

Evidence synthesis: Out of 387 articles, 56 studies were included in the analysis, among which 51 studies involving 39,878 MPFF-treated patients, reported CVD symptoms. Significant reductions in symptom intensity scores were observed for all outcomes (P<0.001), except for fatigue. Improvement of symptoms was further supported by the resolution of pain, heaviness, cramps, discomfort, and burning sensation observed in pooled estimated proportion of patients (76.2%, 61.5%, 80.5%, 69.8%, and 67.2%, respectively; all P<0.001). The overall level of patient satisfaction was estimated to be more than 90%. Twenty studies had high risk of bias, while sensitivity analyses did not change the study results. Heterogeneity level was frequently high among studies.

Conclusions: This systematic review and meta-analysis provide strong evidence of consistent and clinically significant improvements in venous leg symptoms associated with the use of the venoactive drug MPFF, across all stages of CVD.