International Journal of Vascular Medicine最新文献

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.

Purpose: Our study is aimed at exploring the association between peripheral artery disease (PAD) and metabolic syndrome (MetS) across different age and gender groups among patients with Type 2 diabetes mellitus (T2DM). Patients and Methods: A total of 3638 patients with T2DM were enrolled in the study, including 281 patients with PAD and 3357 patients without PAD. Demographic data and anthropometric measurements, such as height, weight, and waist circumference, were collected. Laboratory tests and ankle-brachial index (ABI) assessment were also conducted. Multiple logistic regression was used to evaluate the relationship between PAD and the number of MetS components across different age and gender groups. Results: After adjusting for potential confounding factors, our results indicated that the ORs for the presence of PAD increased progressively with the number of MetS components. Stratified analysis showed that this effect was particularly pronounced in younger patients (aged < 40 years) and older patients (aged ≥ 60 years), where the risk of PAD rose with an increasing number of MetS components. Furthermore, the positive association between the number of MetS components and PAD presence was significantly stronger in females. Conclusions: In summary, our findings suggest that the risk of PAD is positively correlated with the number of MetS components in patients with T2DM, especially among younger patients and older patients. Additionally, the positive association between the number of MetS components and the presence of PAD was significantly more evident in female patients.

Background: One of the main challenges in managing lymphedema and lipedema is the lack of valid and reliable objective measures for diagnosis and follow-up. This study was aimed at gathering evidence regarding the objective measures of cardiorespiratory fitness (CRF) among these populations. Methods: Scopus, PubMed, and Embase were searched for observational studies investigating the objective measures of CRF among individuals with lipedema and lymphedema. Both primary and secondary lymphedema were included. Different CRF measures reported by the included articles were determined, and the main outcomes regarding these measurements were extracted. The meta-analysis was performed to compare the pooled mean 6-min walk test (6MWT) between individuals with lower limb lymphedema and lipedema using STATA software (Version 17.0). Results: Eight articles were included, and the majority of participants were female. Four distinct objective measures of CRF were reported among the included articles, including hemodynamic indices, spirometry indices, VO₂ peak, and 6MWT. The mean VO₂ peak was significantly lower among women with breast cancer-related lymphedema; however, there was no correlation between affected limb volumes and the VO₂ peak. The meta-analysis revealed a lower mean 6MWT among individuals with lipedema compared to lymphedema (pooled difference: 37.71 [confidence interval (CI): 5.19-70.22], p value: 0.02, I ²: 0%). Also, there was a significant relationship between 6MWT and subjective measures of CRF, such as the Short Form 36 (SF-36) physical function score, in one included article. Conclusion: While limited evidence exists on the objective measures of CRF among individuals with lymphedema and lipedema, there might be a significant difference in 6MWT between these two groups.