Vasa-european Journal of Vascular Medicine最新文献

The new guidelines for the management of peripheral arterial and aortic diseases (PAAD) from the European Society of Cardiology and endorsed by the European Society of Vascular Medicine (ESVM), emphasize on a comprehensive and multidisciplinary approach focusing on prevention, diagnosis, treatment, and follow-up of patients with a wide range of PAAD, including lower extremity peripheral arterial disease (PAD). The aim of this summary, focusing on PAD and coordinated by the Young Academy of ESVM, is to provide young angiologists with the fundamental principles of these guidelines and to assist them in navigating their everyday clinical practice. PAD diagnosis relies on objective evaluation of flow/oxygen reduction at rest, with arterial ultrasound as the first imaging modality to confirm the presence of arterial lesions. The main goals of PAD management are not only to improve functioning and prevent the occurrence of adverse events at the lower limb level, but also to reduce the overall atherosclerotic burden and achieve the general well-being of patients. To this end, traditional and nontraditional cardiovascular risk factors need to be properly addressed through lifestyle changes and tailored drug therapies. For patients with exertional limb symptoms, supervised exercise training is recommended. Interventional treatment is indicated for limb salvage in patients with chronic limb threatening ischemia and may also be discussed in a multidisciplinary setting in less severe patients with persisting symptoms and reduced quality of life after a minimum period of optimal medical treatment including exercise therapy. For trainees or young specialists in Angiology/Vascular Medicine, these guidelines provide essential elements to improve patient management, encourage interdisciplinary collaboration, and ensure an integrated approach to vascular diseases.

Background: Acute abdominal aortic occlusion is a rare vascular emergency associated with high morbidity and mortality. To date, the topic has hardly been addressed scientifically. Most case series are afflicted with small cohort numbers. The aim of this study was to identify risk factors after invasive treatment of acute abdominal aortic occlusion and changes over time. Patients and methods: Using case-based nationwide hospital statistics (diagnosis-related group [DRG] statistics) from 2009 to 2020, all cases with ICD-10 codes for embolism and thrombosis of the abdominal aorta in conjunction with acute limb ischaemia and consecutive invasive treatment (endovascular or open surgery) were included. The analysis included patient characteristics, treatment, mortality, amputation, and complications. The primary outcome was in-hospital death. A multivariable regression model was applied to detect risk factors. Results: A total of 1160 cases (66% male) with acute abdominal aortic occlusion were identified (941 open; 219 endovascular). Between 2009 and 2020, the rate of endovascular treatments (2010: 6%; 2020: 29%; p<.001) increased significantly over the years. Older patients (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.64-0.9, p=.002) and women (OR 0.65; 95% CI 0.48-0.88, p=.006) were more likely to receive endovascular care. In-hospital mortality was 13% after open surgery and 14% after endovascular treatment, with no significant change in open surgery, but high variability in endovascular treatment during the observation period (2009-2011: open 14%; endovascular 25%; 2018-2020: 10%; 11%). In-hospital mortality increased significantly with higher age (OR 2.19 per 10-year increase; 95% CI 1.79-2.7, p<.001) and comorbidities (OR 1.1 per Elixhauser point; 95% 1.07-1.11, p<.001). Conclusions: Acute aortic occlusion remains a rare but life-threatening emergency. Use of endovascular revascularization techniques is increasing, while in-hospital mortality rates remain high, specifically for older and morbid patients.

Background: The use of questionnaires in vascular rehabilitation has increased. The Walking Impairment Questionnaire (WIQ) can identify functional risk due to peripheral arterial disease (PAD). This study aimed to assess the accuracy of the WIQ for identifying individuals with PAD and intermittent claudication with low functional capacity. Patients and methods: A cross-sectional diagnostic test accuracy study was conducted. The Incremental Shuttle Walk Test (ISWT) assessed the distance walked, and the WIQ, the index test, evaluated the perception of functional capacity. Three reference values in the ISWT were defined: 380 m, 210 m (25th percentile), and 100 m. The accuracy, sensitivity, and specificity of the WIQ were tested using the Receiver Operating Characteristic curve and an alpha of 5% defined statistical significance. Results: One hundred and twenty-one volunteers participated in the study (64 ± 9.7 years, 65% men). The average distance in the ISWT was 270.6 ± 100.2 m. The WIQ scores were: mean 29.7 (14.0-50.2), distance (19; 6.3-47.8), walking speed (25; 13.0-43.5), and stairs (41.7; 12.5-75.0). The WIQ cut-off point for the ISWT references was 1) 37 for 380 m, with a sensitivity of 0.75 and specificity of 0.62 (AUC: 0.73, p=0.003; 95% CI 0.61 to 0.86); 2) 23 for 25th percentile (210 m), with a sensitivity of 0.75 and specificity of 0.70 (AUC: 0.77, p<.0001; 95% CI 0.68 to 0.86) and 3) 14 for 100 m, with a sensitivity of 0.78 and specificity of 0.83 (AUC: 0.77, p=.0001; 95% CI 0.64 to 0.91). Conclusions: The WIQ is helpful as a screening tool in research and clinical practice of PAD. The WIQ score with the best accuracy to identify individuals with low functional capacity was 14.

Background: Carotid endarterectomy (CEA) is a widely accepted treatment to mitigate stroke risk in patients with severe carotid stenosis. The timing of CEA, especially in cases of acute neurological symptoms like crescendo transient ischemic attack (TIA) and stroke-in-evolution, remains contentious. This study evaluates the effectiveness of urgent CEA (UCEA) within 6 hours of crescendo TIA onset compared to elective CEA (ECEA) performed within 2 weeks in preventing recurrent stroke. Patients and methods: This retrospective study analyzed 87 patients with crescendo TIA treated with UCEA and compared them with a matched control group of 174 patients who underwent ECEA for symptomatic carotid disease. All patients underwent preoperative multidetector computed tomography angiography. Primary outcomes included mortality, stroke, TIA, and major adverse cardiac events within 30 days and up to 6 months postoperatively. Results: The UCEA group demonstrated no postoperative strokes or TIAs, with a low complication rate. UCEA resulted in one stroke within 6 months, with complete recovery. The ECEA group experienced one stroke and one death. There were no significant differences in early postoperative complications between the groups. However, the UCEA group exhibited a higher overall mortality rate (4.6% vs. 0.6%; p = 0.044), predominantly due to myocardial infarction. Both groups demonstrated comparable outcomes regarding postoperative complications and carotid restenosis at follow-up. Conclusions: UCEA performed within six hours of crescendo TIA shows comparable perioperative outcomes to ECEA in preventing recurrent strokes. While these findings suggest early intervention with UCEA may be a viable approach for patients with crescendo TIA, significant methodological limitations preclude definitive conclusions about safety and efficacy.

Objective: Abdominal aortic aneurysm (AAA) is a permanent local dilation of the abdominal aorta developed by chronic local inflammation and elastin degradation. Trigonella foenum-graecum (fenugreek) has been reported to have anti-inflammatory properties. We hypothesized that fenugreek supplementation can inhibit AAA growth. Materials and methods: AAA was induced in male Sprague-Dawley rats by intraluminal porcine pancreatic elastase infusion. The treatment by oral gavage was initiated post-operatively on day 1 and was administered daily (750 mg/kg/daily or 1500 mg/kg/daily or distilled water) for 27 days. AAA expansion was monitored weekly by ultrasound measurements in a blinded-to-treatment fashion; rats were euthanized 28 days after surgery. AAA cross-sections were examined histologically, where treatment allocation were blinded. Results: AAA developed in all three groups, yet there was no measured difference (p=0.104) in the maximal inner anterior-posterior abdominal aortic diameter on day 28 post-surgery between the control group (110% ± 70%, n=11), the low-dose fenugreek treatment group (LDF, 105% ± 68%, n=11), and the high-dose fenugreek treatment group (HDF, 153% ± 96%, n=13). Additionally, assessments of elastin structure in the AAA wall using Miller's stain revealed disorganized and ruptured fibers, but no significant differences in the severity of damage or elastin content among the groups were noted. No significant differences were observed in the presence of infiltrating neutrophils (as indicated by myeloperoxidase-positive cells), macrophage infiltration (% CD68-positive area), or area of vascular smooth muscle cells (a-SMA stained cells), or media thickness across control low-dose, and high-dose treatment groups. Conclusions: Daily fenugreek administrations did not halt AAA progression in either low-dose (750 mg/kg/daily) or high-dose (1500 mg/kg/daily) groups when compared to controls. These results did not show any beneficial effects of fenugreek supplementation in the aneurysm wall, and therefore, we can not recommend fenugreek supplementation as a treatment for patients with growing AAAs.

Background: Intermittent negative pressure is an emerging treatment for lower limb vascular disease but the specific physiological effects, particularly upon large artery haemodynamics are unclear. This study examined the influence of intermittent negative pressure upon popliteal artery shear rate during both supine and sitting postures. Participants and methods: Eleven healthy participants (5 female; age: 28.3 ± 5.8 y; weight: 69.6 ± 9.8 kg, height: 1.75 ± 0.07 m) received intermittent negative pressure (-37 mmHg; 9.5-sec on, 7.5-sec off), upon the lower leg during both supine and sitting postures. Popliteal artery blood flow and shear rate were recorded (duplex ultrasound), accompanied by heart rate (3-lead ECG) and blood pressure (volume clamp method). Results: Compared to sitting, a supine posture led to greater mean shear rate during baseline (supine: 21[9]; sitting: 17[13] sec^-1; all median [IQR]) and negative pressure phases (supine: 24[15]; sitting: 17[14] sec^-1; both p<0.05). While supine, negative pressure raised mean shear rate above baseline levels (p<0.05) and reduced it upon return to atmospheric pressure (p < 0.05). In sitting, mean shear rate only differed from baseline at the points of peak and minimum shear (peak:18[17]; minimum: 10[9] sec^-1; both p<0.05). Shear pattern (oscillatory shear index) showed changes from baseline during both postures (p<0.05), but was not different between postures. Conclusions: Intermittent negative pressure influenced lower limb popliteal artery shear rate during both the supine and sitting postures, the effect was greater while supine. Fluctuation in shear pattern seen during both positions may account for positive clinical effects observed following intermittent negative pressure treatment. These findings are framed against previous work investigating clinical populations. Future work should investigate any differences in lower limb haemodynamics and markers of endothelial function among patients with vascular disease.

Background: Due to a lack of validated methodologies, this study aimed to evaluate the quality of life (QoL) among individuals affected by lymphedema and to compare them with the general population and common diseases. Patients and methods: Patients were recruited from October 2023 till March 2024. The SF-36 and LYMQOL questionnaires were administered. The Robert Koch Institute provided data from the survey for secondary evaluations of the DEGS1 study. Descriptive analysis of the patient's data was conducted, followed by an analysis of risk factors, a comparison with common diseases and a pairs matched analyses with the general population based on the parameters sex, age and Body Mass Index (BMI). A p-value below 0.05 was considered significant. Results: Among the 273 patients, 18 had primary lymphedema and 255 had secondary lymphedema due to cancer history. Staging revealed 28 patients in stage I, 137 in stage II, and 75 in stage III. The majority of patients (83%) were female and mostly the lower extremity was affected. Age, International Society of Lymphology (ISL)-stage, and BMI were significantly correlated with reduced QoL in seven, six, and eleven out of thirteen subscales of the respective scores. The LYMQOL analysis revealed, that patients with upper limb lymphedema (ULL) demonstrated higher QoL compared to those with lower limb lymphedema (LLL). When compared to the general population, individuals with ULL exhibited reduced QoL in five out of eight SF-36 domains (p<0.05). Conversely, LLL patients showed decreased QoL across all eight SF-36 subscales (p<0.01). In comparison to diseases like myocardial infarction or malignant diseases, patients with lymphedema experience a significant, diminished QoL. Conclusions: By 2024, lymphedema patients continue to experience significantly lower QoL compared to the general population or common diseases in Germany. LLL patients exhibit a reduced QoL compared to individuals with ULL.

Background: This study examined the link between the Life's Essential 8 (LE8) metric and peripheral artery disease (PAD) prevalence in the U.S. Patients and methods: This population-based prospective cohort study analyzed data from 6,076 participants aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004. LE8 scores were categorized into low, moderate, and high cardiovascular health (CVH) levels. Multivariable weighted logistic regression and subgroup analyses were performed to examine the relationship between CVH and PAD, adjusting for demographic and clinical variables. Results: In final analysis, a total of 6,076 individuals were included, with a mean age of 59.41±12.80 years and 51.3% (n=3,115) being male. The prevalence of PAD was 6.9% (n=418). After adjusting for confounding factors, compared to participants with low CVH, those with moderate CVH had a 34% lower risk of PAD (OR: 0.66, 95% CI: 0.53-0.82), and those with high CVH had a 62% lower risk of PAD (OR: 0.38, 95% CI: 0.25-0.58). Conclusions: In conclusion, we report that lower CVH scores are associated with higher PAD risk among U.S. adults. These findings may contribute to the prevention strategies for PAD.

Today, flow-mediated dilation (FMD) is a standardized test for the non-invasive assessment of vascular endothelial function in humans. The test is often used to assess the influence of various living conditions on the vascular system. Many factors have a short-term effect on FMD and reduce it. However, not every short-term FMD-reducing effect also signals long-term vascular damage with repeated exposure. The comparison between coffee consumption and smoking will be used to discuss that although both stimulants lead to comparable acute changes in vascular function, they differ in their long-term effects on the vascular system. Therefore, acute FMD effects cannot always be equated with long-term damaging effects.