Vasa-european Journal of Vascular Medicine最新文献

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.

Background: Transcatheter aortic valve implantation (TAVI) via transfemoral (TF) access is increasingly integral to aortic valve disease treatment, expanding beyond high-risk patients. Despite technical advancements, access-related vascular complications, occurring in approximately 10% of TAVI procedures, remain a substantial challenge. Objective: This study investigated the clinical and morphological characteristics of percutaneous TF-TAVI patients experiencing occlusive (OC) and hemorrhagic (HC) complications managed with surgical or endovascular reintervention. Methods: The cohort included patients from a Dutch and a German tertiary referral hospital, managed with TF-TAVI procedures between 2017 and 2021 that required reintervention for OC or HC. Demographics, comorbidities, procedural details, and preoperative imaging data were collected and compared between groups. Results: Among 109 TF-TAVI patients, 32 with OC and 77 with HC required reintervention. The OC group presented significantly smaller access arterial diameters (common femoral artery: OC 6.7 mm vs. HC 8.9 mm, p<.001; external iliac artery: OC 7.2 mm vs. HC 8.3 mm, p<.001; common iliac artery: OC 9.4 mm vs. HC 10.5 mm, p=.012) while the HC group presented higher tortuosity index (TI) (OC 1.24 vs. HC 1.30; p=.017). No differences were observed regarding baseline characteristics, vessel calcification or vascular closure device use. Conclusions: In patients requiring reintervention following TF-TAVI, smaller arterial diameters were associated with OC, while higher TI was linked to HC. These findings emphasize the importance of preoperative imaging in developing individualized prevention strategies.

Background: Our aim was to evaluate the prognostic value of detectable high-sensitivity cardiac troponin I (hs-cTnI) and ischaemia-modified albumin (IMA) in predicting all-cause death or non-fatal ischaemic events in patients with PAD after endovascular revascularisation of the lower limbs. Patients and methods: Patients who underwent successful endovascular revascularisation for chronic limb-threatening ischaemia (CLTI) or disabling intermittent claudication (IC) were prospectively included. Pre-procedural levels of hs-cTnI and IMA were measured, and patients were followed for one year for the occurrence of the composite outcome of all-cause death, non-fatal myocardial infarction, new-onset angina, non-fatal ischaemic stroke, transient ischaemic attack, or progression of PAD. Outcomes were evaluated using survival analyses. Results: A total of 487 patients concluded the study, of whom 175 (35.9%) experienced the composite outcome. When considering only the clinical presentation of PAD and biomarker values, in patients with CLTI, hs-cTnI above the limit of detection (LoD) conferred an increased risk of the composite outcome compared to hs-cTnI below the LoD (p=0.004), while for IMA we found no significant difference. Outcomes of patients with CLTI and hs-cTnI or IMA below the LoD did not differ from those of patients with IC (p=0.07 and p=0.462, respectively). When adjusting for clinical characteristics and common cardiovascular risk factors in multivariate Cox survival analysis, neither biomarker improved prognostic performance, however IMA emerged as an independent predictor of the composite outcome in patients with CLTI. Conclusions: In patients with PAD who underwent successful endovascular procedure, neither IMA nor hs-cTnI improved risk stratification beyond clinical determinants. However, detection of IMA was an independent predictor of major cardiovascular events or death in patients with CLTI.

Background: Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are inflammatory diseases. These two entities often co-exist, but little is known about the prevalence of this phenomenon in patients with PAD. The objectives of this prospective cross-sectional study were to determine the prevalence of COPD in patients with PAD and to assess the frequency of COPD underdiagnosis in this group of patients. Patients and methods: Consecutive patients admitted to angiology department were evaluated. Measurements of ankle-brachial and toe-brachial index as well as peripheral arteriography were performed in all participants to confirm PAD. In tobacco smokers with PAD spirometry was performed to identified patients with COPD. Clinical information was obtained from the patients on the basis of questionnaires. Results: Eighty-eight out of 300 consecutive patients were included and assessed. COPD was diagnosed in 33 (37.5%) hospitalized smokers with PAD. COPD has not previously been diagnosed in 28 (84.8%) patients who met the criteria of the disease. Conclusions: There was high prevalence of COPD among tobacco smokers hospitalized in the angiology department. Most of them had never had spirometry performed before. The underdiagnosis rate is relatively high; therefore, all patients with PAD who smoke tobacco should have a spirometry performed, as a screening for COPD.

Background: Dual-pathway inhibition (DPI) with aspirin and rivaroxaban exhibited a net clinical benefit for patients with cardiovascular disease in the randomized COMPASS trial. The non-observational, international XATOA registry showed that the COMPASS results can be reproduced in clinical practice in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). Here we report patient characteristics and clinical outcomes for the subgroup of German PAD patients of the XATOA registry and compare them to COMPASS PAD patients. Patients and methods: XATOA was an international prospective registry of patients receiving DPI with a mean follow-up period of 15 months. The subgroup of German patients with PAD in XATOA comprised 1,819 patients, of which 925 patients (50.9%) had only PAD and 894 patients (49.1%) had both CAD and PAD. Patient characteristics such as prior medical history and prior medications as well as clinical outcomes such as incidences of major adverse limb events (MALE), major adverse cardiovascular events (MACE) and major bleeding events were assessed. Results: DPI was well-tolerated in clinical practice. Patient characteristics and clinical outcomes especially for patients with only PAD differed from characteristics and outcomes of the overall German XATOA population as well as the PAD subgroup of COMPASS. Patients with only PAD were markedly less supplied with lipid-lowering agents and betablockers. Incidences of MALE were high in German PAD patients of XATOA (9.0%) and markedly higher than in the PAD subgroup of COMPASS (1.2%). Incidences of MACE and major bleeding events were lower in German PAD patients of XATOA (MACE: 2.9%, major bleeding: 1.4%) than in PAD patients of COMPASS (MACE: 5.1%, major bleeding: 3.1%). Conclusions: DPI with rivaroxaban and aspirin is well-tolerated by PAD patients in German clinical practice. PAD patients in Germany exhibit different characteristics and show a different clinical outcome profile than PAD patients in COMPASS.