International Journal of Vascular Medicine最新文献

Background: The study was aimed at evaluating the efficacy, safety, and outcomes of endovascular intervention (EVT) among patients with acute inferior deep vein thrombosis (DVT), as well as revealing the risk factors associated with postthrombotic syndrome (PTS) in these patients.

Methods: This retrospective study was conducted at the Department of Vascular Surgery, C.R. Hospital, Vietnam. The study enrolled all the patients diagnosed with acute lower limb DVT and underwent EVT (thromboaspiration, thrombolysis, balloon angioplasty, and stent placement) between January 2017 and December 2022. All the patients were recorded with treatment outcomes, postinterventional complications, and factors relating to PTS on the follow-up at 1 week and at 1 month after intervention.

Results: A total of 37 patients met the inclusion criteria. Baseline characteristics included a mean age of 55.8 ± 13.3 years, female sex (75.5%), body mass index (BMI) ≥ 23 kg/m² (63.2%), and inferior DVT on the left side (91.9%). Location of thrombus was noted at the iliac vein (97.3%), the femoral vein (70.3%), and the popliteal vein (97.3%). Postoperative length of stay was 5.5 ± 2.7 days, and clinical symptoms reduced in 2.5 ± 0.9 days. There were two cases of bleeding at the interventional site and two cases of death. Partial stenosis at 1 week and 1 month regarding the iliac vein, the femoral vein, and the popliteal vein was 71.4% and 54.3%, 14.3% and 37.1%, and 20.0% and 40.0%, respectively. None of the cases were observed with complete stenosis. In addition, 62.9% of cases reported no PTS. 37.1% of cases were noted with mild PTS. Advanced age, high BMI, duration time of thrombolysis, and underlying diseases were all associated factors relating to PTS. Noticeably, comorbidities and overweight/obesity increased 18.7- and 17.33-fold risk of PTS (p < 0.05), respectively.

Conclusions: EVT is an acceptable alternative method in the treatment of acute inferior DVT. A decision-making of EVTs for acute lower limb DVT should be implemented after assessment of risk factors in large centers with professional conditions and facilities.

Background: Complex decongestive therapy is recognized as the primary treatment of lymphedema. While the influence of weight on the lymphedema appearance and evolution is well known, the relationship between weight and complex decongestive therapy outcome remains underexplored.

Purpose: The purpose of this research is to evaluate the impact of body mass index on the effectiveness of intensive complex decongestive therapy in patients with primary and secondary lower limb lymphedema.

Methods: We conducted a prospective study on 159 patients who underwent 551 complex decongestive therapy programs at the CHU UCL Lymphedema Reference Center from April 1, 2018, to March 19, 2021. Patients were categorized by body mass index ranges (18.5-24.9, 25-29.9, 30-34.9, 35-39.9, and 40-55 kg/m²). Before and after treatment, limb volumes were calculated using the truncated cone formula and functional impairments using the Lymph-ICF-Lower-Limb questionnaire. Linear regression models were used to evaluate the association between weight categories and treatment outcomes and were adjusted for relevant confounding factors.

Results: Higher body mass index was associated with larger initial lymphedema volumes and lower functional status. Complex decongestive therapy reduced the relative lymphedema volume of 7% and improved functional status irrespective of body mass index groups.

Conclusion: Although weight is correlated with an initial greater lymphedema volume and a lower functional status, it does not influence the ability of complex decongestive therapy to reduce limb volume and improve function. Complex decongestive therapy is recommended regardless of a patient's body weight.

Background: Heparin-induced thrombocytopenia (HIT), often accompanied by thrombotic events and collectively referred to as heparin-induced thrombocytopenia and thrombosis (HITT), is worthy of attention. Herein, we analyzed the features of HITT in patients with or without a thrombophilia background present prior to heparin exposure, aiming to identify and customize treatment.

Methods: We searched PubMed and EMBASE to identify studies published up to November 2024, via the keywords "heparin," "thrombocytopenia," "thrombosis," and "thrombophilia." Case series and reports with confirmed HITT were included.

Results: A total of 602 patients (277 males and 325 females with a mean age of 57.00 ± 17.20 years), reported in 481 papers, were carefully analyzed. The median time of thrombocytopenia and thrombosis onset postheparin exposure was Day 9 (5-12) and Day 9 (6-12), respectively. The abnormal platelet counts recovered by Day 5 (3-7) after the cessation of heparin. A more pronounced platelet count reduction was shown in patients with a thrombophilia background than those without this entity (p = 0.004). In this HITT cohort, patients with a thrombophilia background were more likely to develop newly formed venous thrombosis, whereas those without thrombophilia were more prone to arterial thrombosis after heparin use. Anti-platelet factor 4 (PF4)/heparin antibody assay was the mainstream diagnostic method for HITT.

Conclusions: HITT typically presents as newly formed venous thrombosis in patients with a thrombophilia background and as arterial thrombosis in those without thrombophilia. Whereby, screening for thrombophilia in patients with HITT is suggested, as well as considering prolonged alternative anticoagulation therapy in patients with a thrombophilia background.

Background: Endovenous laser ablation (EVLA) is a widely accepted treatment for varicose veins, offering effective results with minimal invasiveness. However, postoperative complications remain a concern. This study examines risk factors associated with adverse outcomes and evaluates long-term clinical efficacy over 48 months.

Methods: This retrospective, single-center study was conducted from January 2020 to January 2024 and included 500 patients with symptomatic varicose veins due to saphenous vein incompetence. All underwent preoperative clinical and duplex ultrasound evaluation; Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification; and Venous Clinical Severity Score (VCSS) scoring. Patients with postthrombotic syndrome, congenital malformations, or active DVT were excluded. EVLA using a 1470-nm laser was performed by an experienced vascular surgeon. Follow-up visits were scheduled periodically over 48 months. Primary outcomes included postoperative complications, while secondary outcomes focused on VCSS trends and patient satisfaction.

Results: The cohort had a mean age of 38 years and was 56.8% female. Most were CEAP C4 or C5 with Grade 3 venous reflux. Minor complications included hematoma (6.4%), swelling (7.2%), infection (4%), and nerve injury (3.6%). Deep vein thrombosis occurred in 2% of patients; no pulmonary embolism or major cardiac events were reported. Endothermal heat-induced thrombosis occurred in 9%, with only 0.8% reaching Grade 3. Hypertension, diabetes, and obesity were associated with higher complication rates. By 48 months, all patients showed clinical improvement with VCSSs below 5.

Conclusions: EVLA is a safe, effective treatment for varicose veins, even in advanced CEAP stages. Identifying patient-specific risk factors may help reduce complications and improve outcomes.

Introduction: Arteriovenous fistulas (AVFs) are the best choice for providing vascular access for hemodialysis patients. AVF maturation is essential for successful hemodialysis. However, up to 60% of AVFs fail to mature due to multiple risk factors. Thus, this study is aimed at investigating the association of anatomical location and preoperative blood parameters with AVF maturity. Methods: This is a retrospective cohort study of 206 patients who underwent their first AVF creation at the Hasheminejad Kidney Center, Tehran, Iran, from January 2016 to January 2019. Demographic and clinical characteristics and blood biomarkers were recorded for all patients preoperatively. Results: The total maturation rate was 67.2%. The primary failure rate of AVFs was 5.8%. Regarding AVF location, wrist fistulas had a higher rate of maturation than antecubital fistulas (73.2% vs. 55.9%, p = 0.013, OR = 2.15). The WBC (p = 0.03), RBC (p = 0.008), and hemoglobin (p = 0.009) levels were lower in the matured AVFs than in the nonmatured groups. Most kidney function biomarkers were not significantly related to AVF maturation. However, the mature wrist AVFs had lower levels of albumin and calcium-phosphorus index. The wrist AVF in patients with calcium levels under 8.5 mg/dL worked more efficiently than antecubital group (76.4% vs. 52.9%, p = 0.015, OR = 2.87). Conclusion: This study supports the evidence that wrist AVF could be a preferred AVF choice in the patients who met its clinical criteria.

Objective: Diagnosis of Takayasu arteritis (TA) is based on a combination of demographic, clinical, biological, and imaging data, but the diagnostic value of each clinical sign remains undetermined. The objective of this rapid review and meta-analyses was to estimate the diagnostic accuracy of these clinical signs. Methods: Eligible studies compared the initial clinical presentation of TA with appropriate controls. The diagnostic reference standard had to be specified. We searched PubMed, Embase, and Google Scholar until May 17, 2024. We assessed bias using the QUADAS-2 tool. We performed meta-analyses using a bivariate random effects model for sensitivity and specificity and a sampling-based approach for positive and negative likelihood ratios (PLR, NLR). Results: Of 15 studies included, 13 were case-control. All studies had a high risk of bias. Overall, 1980 patients with TA were compared to 3129 controls, with the majority having another vasculitis, mostly giant cell arteritis (GCA). Among 29 signs, the most suggestive of TA were vascular signs: blood pressure asymmetry (PLR 9.53, 95% CI 3.43-21.9), vascular bruits (9.0, 2.94-22.4), decrease or absent pulse (8.15, 2.35-22.2), and carotid artery with decreased pulse or tenderness (7.23, 3.64-12.5). Compared to GCA only, several signs reduced the likelihood of TA: headache (0.51, 0.25-0.86), jaw claudication (0.15, 0.05-0.35), polymyalgia rheumatica (0.07, 0.01-0.48), and scalp tenderness (0.04, 0.01-0.30). Conclusion: This review highlights the most useful signs for suspecting the disease when compared to other vasculitis and mimics. This will assist clinicians in estimating the likelihood of TA and guiding investigations.

Objectives: This review assessed the burden of catheter-related infections (CRI), existing gaps in catheter care, and prevention recommendations for catheter-related bloodstream infections (CRBSIs). The review further discusses how the emergence of coronavirus disease (COVID-19) influenced CRBSI rates and prevention strategies in the post-COVID-19 era. Methods: A targeted literature search was conducted of Embase, Ovid MEDLINE, and EBM Reviews. Where applicable, supplemental hand searches were performed to identify evidence for gaps in the targeted search results. The authors reviewed each study and selected those for inclusion based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria. Relevant studies were assessed for inclusion in the present review. Results: Both "active" methods (scrubbing, flushing, and locking) and "passive" methods (disinfection caps) have consistently been shown to reduce CRBSI risk when assessed individually. These practices have markedly improved CRBSI rates over the past two decades, although there are ongoing gaps in catheter care and adherence to best practices. COVID-19 reversed the trend towards improving CRBSI rates, and persistent challenges for nurse staffing and training have resulted in a failure to return to pre-COVID-19 CRBSI rates in the current post-COVID-19 era. These challenges are further compounded by limited rigorous comparative evidence assessing the relative efficacy of individual CRBSI prevention methods. Conclusions: Improving adherence to hub disinfection, along with catheter care and maintenance protocols, is essential for the prevention of CRIs. Further, innovative approaches for simplifying protocols and "forcing function" may increase compliance with CRBSI prevention strategies. In our practice, we routinely use disinfection caps in addition to standard scrubbing and flushing, alongside increased training and monitoring procedures. Additional studies are needed to assess which individual or combination prevention strategies are most efficacious and feasible in the post-COVID-19 era.

Background: Heart failure (HF) is a growing clinical syndrome with high morbidity and mortality. Galectin-3, a key player in cardiac fibrosis and inflammation, has emerged as an important biomarker for HF. This bibliometric analysis is aimed at exploring global scientific output and research trends on the relationship between galectin-3 and HF. Methods: A bibliometric literature search was conducted on the Web of Science in September 2024. Microsoft Excel and VOSviewer were used for scientometric analysis and to visualize scientific achievements, including publication counts, key authors, countries, organizations, journals, and research hotspots in the field. Results: A total of 705 publications met the inclusion criteria after screening. Research on galectin-3 and HF is currently experiencing rapid growth. The United States, China, and the Netherlands produced the most articles, contributing approximately 55% (388/705) of all papers. Most institutions and authors were from the United States and the Netherlands, with the University of Groningen (Netherlands) being the top publishing institution. Key authors include De Boer RA, Januzzi JI, and Van Veldhuisen DJ. The European Journal of Heart Failure was the most cited journal and had the highest number of publications. Key research topics include the relationship between galectin-3 and HF prognosis, fibrosis, mortality, and conditions leading to HF. Conclusion: This is the first bibliometric analysis of publications on the association between galectin-3 and HF. This study provides researchers with valuable insights into the most influential articles on this biomarker and its role in HF. Key research areas focus on galectin-3 role in the diagnosis, pathology, and prognosis of various HF types, causes, and outcomes. Further research should explore how galectin-3 can facilitate earlier diagnosis of HF or fibrosis, with increased international collaboration among researchers.

Objective: This study is aimed at evaluating the predictive value of high-sensitive cardiac troponin T (hs-TnT), and N-terminal probrain natriuretic peptide (NT-proBNP), for cardiovascular events and/or survival in stable adult congenital heart disease (ACHD) patients. Methods: A systematic review along with a meta-analysis was done on studies from 2014 to 2024 that examined hs-TnT, NT-proBNP, and their association with cardiac events and/or mortality in adult patients with congenital heart disease. A comprehensive search was conducted across major databases, and studies reporting biomarker levels and relevant outcomes were included. Data on study characteristics and hazard ratios (HRs) were extracted, and pooled estimates were calculated using random-effects meta-analysis, with heterogeneity assessed through the I ² statistic. STATA software was used for data analysis. Results: A total of five studies, consisting of 1294 adult congenital heart disease (ACHD) patients, were included in this meta-analysis. Elevated NT-proBNP levels were significantly associated with an increased risk of mortality or cardiac events (HR: 2.13; 95% CI: 1.84-2.42), which remained significant after adjustment for confounding factors (adjusted HR: 2.34; 95% CI: 1.55-3.13). Elevated hs-TnT levels were also associated with a higher risk of adverse outcomes (HR: 1.57; 95% CI: 1.36-1.78), with the association remaining significant after adjustment (adjusted HR: 2.65; 95% CI: 1.22-5.76). Sensitivity analysis excluding a study with a lower hs-TnT cut-off further strengthened the association (adjusted HR: 3.03; 95% CI: 0.86-5.21) and reduced heterogeneity. Conclusion: In conclusion, this meta-analysis shows the prognostic value of both NT-proBNP and hs-TnT in adults with congenital heart disease. Each of these markers offered a distinct but complementary clinical insight. Although methodological differences of the included studies limit direct comparison, our systematic review supports the potential value of incorporating both biomarkers into routine risk assessment.

Introduction: Varicose veins are a common condition affecting millions worldwide. Cyanoacrylate closure (CAC) and radiofrequency ablation (RFA) are widely used minimally invasive treatments. CAC offers advantages such as eliminating tumescent local anesthesia (TLA) and reducing nerve injury risk. However, there are few reports comparing CAC and RFA outcomes in Japan. This study is aimed at evaluating the efficacy and safety of CAC and RFA for treating great saphenous vein (GSV) and small saphenous vein (SSV) varicose veins. Materials and Methods: A retrospective, single-center study was conducted with 157 patients (178 limbs) who underwent either CAC (n = 96) or RFA (n = 82) from January 2020 to October 2023. Postoperative occlusion rates, complications, and risk factors for phlebitis were analyzed. Follow-up ultrasound examinations were conducted at up to 3 months postoperatively. Statistical analyses included t-tests, Mann-Whitney U tests, and multivariate logistic regression. Results: Both CAC and RFA achieved a 100% occlusion rate at 3 months. In the CAC group, significantly longer vein segments were treated compared to those in the RFA group (46 ± 14 cm vs. 35 ± 13 cm, p < 0.05). However, phlebitis occurred in 15% of the CAC group, whereas none were reported in the RFA group (p < 0.05). Multivariate analysis identified preoperative swelling (OR: 5.60, 95% CI: 1.33-23.6, p < 0.05) and treated vein length as independent risk factors for phlebitis. All phlebitis cases resolved with conservative treatment. One patient in the RFA group experienced transient paresthesia. Conclusion: CAC is a viable alternative to RFA, demonstrated equivalent occlusion rates, though CAC exhibited a higher incidence of phlebitis. Careful patient selection and perioperative management may help mitigate risks. Further studies with larger cohorts and longer follow-up are needed to optimize treatment protocols and long-term outcomes.