Pub Date : 2024-09-01Epub Date: 2024-08-14DOI: 10.1024/0301-1526/a001141
Hakan Guven
Chronic venous disease is a vascular disorder characterized by impaired venous return and a progressive dysfunction of the venous system. Pathological reflux can occur due to abnormal dilation and weakening of the vein wall. The circulatory system is a natural structure in which physical laws, such as the law of closed containers and gravity, operate. The malfunctions in the system also adhere to these laws of nature. This article explains how the principles of fluid dynamics apply to the flow of blood in the veins of the legs. I am discussing the principles of Pascal's law, Torricelli's law, Bernoulli's law, and Poiseuille's law, and how they are relating to the anatomy and physiology of the venous system.
{"title":"Fluid dynamics and venous hemodynamics in the lower extremities.","authors":"Hakan Guven","doi":"10.1024/0301-1526/a001141","DOIUrl":"10.1024/0301-1526/a001141","url":null,"abstract":"<p><p><b></b> Chronic venous disease is a vascular disorder characterized by impaired venous return and a progressive dysfunction of the venous system. Pathological reflux can occur due to abnormal dilation and weakening of the vein wall. The circulatory system is a natural structure in which physical laws, such as the law of closed containers and gravity, operate. The malfunctions in the system also adhere to these laws of nature. This article explains how the principles of fluid dynamics apply to the flow of blood in the veins of the legs. I am discussing the principles of Pascal's law, Torricelli's law, Bernoulli's law, and Poiseuille's law, and how they are relating to the anatomy and physiology of the venous system.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1024/0301-1526/a001144
Michele Dalla Vestra, Marta Zanon, Elisabetta Grolla, Andrea Tavernese, Giuliana Autiero, Marco Barbierato, Federico Ronco, Fabio Presotto
{"title":"Inferior vena cava filter implantation according to strength of clinical indication.","authors":"Michele Dalla Vestra, Marta Zanon, Elisabetta Grolla, Andrea Tavernese, Giuliana Autiero, Marco Barbierato, Federico Ronco, Fabio Presotto","doi":"10.1024/0301-1526/a001144","DOIUrl":"https://doi.org/10.1024/0301-1526/a001144","url":null,"abstract":"","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-09DOI: 10.1024/0301-1526/a001131
Kangbo Li, Mengjun Dai, Mesud Sacirovic, Nikolaos Pagonas, Oliver Ritter, Janine Kah, Martin A Lauxmann, Peter Bramlage, Anja Bondke Persson, Ivo Buschmann, Philipp Hillmeister
Background: The current study aims to investigate the association between endothelial function and lower extremity perfusion in patients with peripheral artery disease (PAD). Patients and methods: In total 229 patients with PAD (Rutherford stage 0-3) were enrolled in the current study. Endothelial function was assessed by measuring flow-mediated dilation (FMD) and endothelial cell proliferation capacity (ECPC). Lower extremity perfusion was assessed by measuring oscillometry-based ankle brachial index (oABI) and pulse wave index (PWI). In addition, carotid intima-media-thickness (cIMT) was also measured as a surrogate marker for atherosclerosis. Correlations between FMD, ECPC, oABI, PWI, and cIMT were analysed using Pearson correlation coefficient. The relationship between the above variables and the severity of PAD was investigated using ordinal logistic regression analysis. Results: Correlation analysis showed that FMD negatively associated with PWI (r = -0.183, p = 0.005), ECPC positively associated with oABI (r = 0.162, p = 0.014), and oABI negatively associated with PWI (r = -0.264, p < 0.001). Ordinal logistic regression analysis showed that ECPC (β = -0.009, p = 0.048), oABI (β = -5.290, p < 0.001), and age (β = -0.058, p = 0.002) negatively associated with the PAD Rutherford stages. In addition, PWI (β = 0.006, p < 0.001), cIMT (β = 18.363, p = 0.043) positively associated with the PAD Rutherford stages. Conclusions: Endothelial function significantly associates with lower extremity perfusion in patients with PAD, and both are related to the severity of PAD.
研究背景本研究旨在探讨外周动脉疾病(PAD)患者的内皮功能与下肢血流灌注之间的关系。患者和方法共有 229 名 PAD 患者(卢瑟福 0-3 期)参加了本次研究。通过测量血流介导的扩张(FMD)和内皮细胞增殖能力(ECPC)来评估内皮功能。下肢血流灌注通过测量基于示波法的踝肱指数(oABI)和脉搏波指数(PWI)进行评估。此外,还测量了颈动脉内膜厚度(cIMT),作为动脉粥样硬化的替代指标。使用皮尔逊相关系数分析了 FMD、ECPC、oABI、PWI 和 cIMT 之间的相关性。使用序数逻辑回归分析研究了上述变量与 PAD 严重程度之间的关系。结果显示相关性分析表明,FMD 与脉搏波速度呈负相关(r = -0.183,p = 0.005),ECPC 与 oABI 呈正相关(r = 0.162,p = 0.014),oABI 与脉搏波速度呈负相关(r = -0.264,p < 0.001)。顺序逻辑回归分析显示,ECPC(β = -0.009,p = 0.048)、oABI(β = -5.290,p <0.001)和年龄(β = -0.058,p = 0.002)与 PAD Rutherford 分期呈负相关。此外,脉搏波速度指数(β = 0.006,p < 0.001)、cIMT(β = 18.363,p = 0.043)与 PAD Rutherford 分期呈正相关。结论内皮功能与 PAD 患者的下肢血流灌注密切相关,两者都与 PAD 的严重程度有关。
{"title":"Association of endothelial function and lower extremity perfusion in peripheral artery disease.","authors":"Kangbo Li, Mengjun Dai, Mesud Sacirovic, Nikolaos Pagonas, Oliver Ritter, Janine Kah, Martin A Lauxmann, Peter Bramlage, Anja Bondke Persson, Ivo Buschmann, Philipp Hillmeister","doi":"10.1024/0301-1526/a001131","DOIUrl":"10.1024/0301-1526/a001131","url":null,"abstract":"<p><p><b></b> <i>Background:</i> The current study aims to investigate the association between endothelial function and lower extremity perfusion in patients with peripheral artery disease (PAD). <i>Patients and methods</i>: In total 229 patients with PAD (Rutherford stage 0-3) were enrolled in the current study. Endothelial function was assessed by measuring flow-mediated dilation (FMD) and endothelial cell proliferation capacity (ECPC). Lower extremity perfusion was assessed by measuring oscillometry-based ankle brachial index (oABI) and pulse wave index (PWI). In addition, carotid intima-media-thickness (cIMT) was also measured as a surrogate marker for atherosclerosis. Correlations between FMD, ECPC, oABI, PWI, and cIMT were analysed using Pearson correlation coefficient. The relationship between the above variables and the severity of PAD was investigated using ordinal logistic regression analysis. <i>Results</i>: Correlation analysis showed that FMD negatively associated with PWI (r = -0.183, <i>p</i> = 0.005), ECPC positively associated with oABI (r = 0.162, <i>p</i> = 0.014), and oABI negatively associated with PWI (r = -0.264, <i>p</i> < 0.001). Ordinal logistic regression analysis showed that ECPC (<i>β</i> = -0.009, <i>p =</i> 0.048), oABI (<i>β</i> = -5.290, <i>p</i> < 0.001), and age (<i>β</i> = -0.058, <i>p</i> = 0.002) negatively associated with the PAD Rutherford stages. In addition, PWI (<i>β</i> = 0.006, p < 0.001), cIMT (<i>β</i> = 18.363, <i>p =</i> 0.043) positively associated with the PAD Rutherford stages. <i>Conclusions</i>: Endothelial function significantly associates with lower extremity perfusion in patients with PAD, and both are related to the severity of PAD.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1024/0301-1526/a001140
Anne Kolouschek, Max Jonathan Stumpf
{"title":"Optimised CT Pulmonary angiography in pregnant women - first line or last resort?","authors":"Anne Kolouschek, Max Jonathan Stumpf","doi":"10.1024/0301-1526/a001140","DOIUrl":"https://doi.org/10.1024/0301-1526/a001140","url":null,"abstract":"","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1024/0301-1526/a001143
Lakna Harindi Alawattegama, Mariam Gaddah, Linda Kimani, George A Antoniou
Studies have shown that diabetes mellitus is associated with a reduced prevalence and growth of abdominal aortic aneurysms (AAA). Establishing the factors that influence AAA growth will enable us to risk stratify patients and potentially optimise management. We aimed to provide an updated systematic review and meta-analysis that would inform more targeted screening practices based on patient demographics. MEDLINE, EMBASE, and DARE were searched using the Ovid interface and PubMed search engine. Studies were deemed eligible if they compared the growth rate of AAA between diabetic and non-diabetic populations. The mean difference (MD) and 95% confidence internal (CI) was used for data synthesis. Twenty-four studies from 20 articles with a total of 10,121 participants were included in our meta-analysis. An overall negative effect was shown between AAA growth and diabetes, with an annual mean effect of -0.25 mm/year (95% CI -0.35, -0.15; I2 = 73%). Our meta-analysis, which is larger and scientifically more robust compared to previous analyses, has confirmed that diabetes reduces the growth of AAA by approximately 0.25 mm a year compared to non-diabetic populations. This could have significant implications for AAA screening practices.
{"title":"The effect of diabetes on abdominal aortic aneurysm growth - updated systematic review and meta-analysis.","authors":"Lakna Harindi Alawattegama, Mariam Gaddah, Linda Kimani, George A Antoniou","doi":"10.1024/0301-1526/a001143","DOIUrl":"https://doi.org/10.1024/0301-1526/a001143","url":null,"abstract":"<p><p><b></b> Studies have shown that diabetes mellitus is associated with a reduced prevalence and growth of abdominal aortic aneurysms (AAA). Establishing the factors that influence AAA growth will enable us to risk stratify patients and potentially optimise management. We aimed to provide an updated systematic review and meta-analysis that would inform more targeted screening practices based on patient demographics. MEDLINE, EMBASE, and DARE were searched using the Ovid interface and PubMed search engine. Studies were deemed eligible if they compared the growth rate of AAA between diabetic and non-diabetic populations. The mean difference (MD) and 95% confidence internal (CI) was used for data synthesis. Twenty-four studies from 20 articles with a total of 10,121 participants were included in our meta-analysis. An overall negative effect was shown between AAA growth and diabetes, with an annual mean effect of -0.25 mm/year (95% CI -0.35, -0.15; I<sup>2</sup> = 73%). Our meta-analysis, which is larger and scientifically more robust compared to previous analyses, has confirmed that diabetes reduces the growth of AAA by approximately 0.25 mm a year compared to non-diabetic populations. This could have significant implications for AAA screening practices.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1024/0301-1526/a001146
Panagiotis Kanavaros, Georgios Karatzias, Alexandra Papoudou-Bai, Alexandra Barbouti, Theodoros Troupis
The anatomical variability of the thoracic duct and the right lymphatic duct predisposes them to inadvertent damage following head and neck surgery thereby leading to chyle leak which is an uncommon complication with potentially significant associated morbidity. Although chyle leak is predominately associated with left-sided neck surgery, it also occurs as a complication of the right-sided neck dissection. Variable figures concerning chyle leakage after right-sided neck dissections were reported, ranging from 0 per cent to higher prevalences such as 14%, 24%, 33% and 60% of total cases of chyle leakages associated with neck surgery. The right-sided complications may implicate the right lymphatic duct and right-sided terminations of the thoracic duct into the venous system which occur in about 1-6% of humans. Other clinically relevant conditions involving the right-sided major lymphatic vessels include chyle leaks following right anterior cervical spine surgery, cysts of the right lymphatic duct and dilatation of the right lymphatic duct in the setting of recurrent cervical swelling. This article presents a review of the literature concerning the basic anatomy and the clinical relevance of the right lymphatic duct and the right-sided terminations of the thoracic duct into the venous circulation.
{"title":"The right lymphatic duct: basic anatomy and clinical relevance.","authors":"Panagiotis Kanavaros, Georgios Karatzias, Alexandra Papoudou-Bai, Alexandra Barbouti, Theodoros Troupis","doi":"10.1024/0301-1526/a001146","DOIUrl":"https://doi.org/10.1024/0301-1526/a001146","url":null,"abstract":"<p><p><b></b> The anatomical variability of the thoracic duct and the right lymphatic duct predisposes them to inadvertent damage following head and neck surgery thereby leading to chyle leak which is an uncommon complication with potentially significant associated morbidity. Although chyle leak is predominately associated with left-sided neck surgery, it also occurs as a complication of the right-sided neck dissection. Variable figures concerning chyle leakage after right-sided neck dissections were reported, ranging from 0 per cent to higher prevalences such as 14%, 24%, 33% and 60% of total cases of chyle leakages associated with neck surgery. The right-sided complications may implicate the right lymphatic duct and right-sided terminations of the thoracic duct into the venous system which occur in about 1-6% of humans. Other clinically relevant conditions involving the right-sided major lymphatic vessels include chyle leaks following right anterior cervical spine surgery, cysts of the right lymphatic duct and dilatation of the right lymphatic duct in the setting of recurrent cervical swelling. This article presents a review of the literature concerning the basic anatomy and the clinical relevance of the right lymphatic duct and the right-sided terminations of the thoracic duct into the venous circulation.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The COVID-19 pandemic has led to significant disruptions in chronic disease care and forced people to stay at home. The effects of such issues on outpatients with lower extremity peripheral artery disease (PAD) remain unknown. Patients and methods: Single-centre, retrospective-prospective study conducted in a Swiss University Hospital. Patients with PAD were included between May 1 and July 31, 2020, with a follow-up visit at 12 months. Upon both visits, the Leriche-Fontaine PAD stage was recorded, and study participants underwent ankle-brachial index (ABI) calculation to assess limb perfusion. Functional capacities were assessed through the 6-minute walking and treadmill tests. Major adverse cardiovascular (MACE) and limb events (MALE) were recorded. Data collected during the pandemic were compared with the pre-pandemic period (January 1, 2019-April 30, 2020). Results: Overall, 259 patients were included. Mean age was 69 years and male sex was prevalent (69.1%). Odds of experiencing a degradation in PAD stage were lower during the pandemic than before (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.21-0.87; p = 0.018). No significant difference was found between periods in terms of ABI trends. Both pain-free walking time at treadmill test (p = 0.003) and maximal pain intensity at 6-minute walking test (p = 0.001) significantly improved during the pandemic. Compared with the pre-pandemic period, during the pandemic patients were hospitalized less frequently (p = 0.028) and were less likely to undergo elective limb revascularization (p<0.001). No significant difference was found between periods in terms of MALE (p = 0.311), whereas non-fatal strokes were less frequently reported during the pandemic (p = 0.043). Conclusion: In a cohort of outpatients with PAD, we found no evidence of clinical deterioration during the pandemic compared with the pre-pandemic period, though rates of adverse events were nonnegligible in both periods. In case of future pandemics, patients with PAD should be encouraged to maintain an active lifestyle while being closely monitored to avoid clinical worsening.
{"title":"Clinical evolution of patients with lower extremity peripheral artery disease during the COVID-19 pandemic (the COVID-PAD study).","authors":"Giacomo Buso, Stefano Lanzi, André Berchtold, Sébastien Deglise, Adriano Alatri, Luca Calanca, Lucia Mazzolai","doi":"10.1024/0301-1526/a001139","DOIUrl":"https://doi.org/10.1024/0301-1526/a001139","url":null,"abstract":"<p><p><b></b> <i>Background:</i> The COVID-19 pandemic has led to significant disruptions in chronic disease care and forced people to stay at home. The effects of such issues on outpatients with lower extremity peripheral artery disease (PAD) remain unknown. <i>Patients and methods:</i> Single-centre, retrospective-prospective study conducted in a Swiss University Hospital. Patients with PAD were included between May 1 and July 31, 2020, with a follow-up visit at 12 months. Upon both visits, the Leriche-Fontaine PAD stage was recorded, and study participants underwent ankle-brachial index (ABI) calculation to assess limb perfusion. Functional capacities were assessed through the 6-minute walking and treadmill tests. Major adverse cardiovascular (MACE) and limb events (MALE) were recorded. Data collected during the pandemic were compared with the pre-pandemic period (January 1, 2019-April 30, 2020). <i>Results:</i> Overall, 259 patients were included. Mean age was 69 years and male sex was prevalent (69.1%). Odds of experiencing a degradation in PAD stage were lower during the pandemic than before (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.21-0.87; p = 0.018). No significant difference was found between periods in terms of ABI trends. Both pain-free walking time at treadmill test (p = 0.003) and maximal pain intensity at 6-minute walking test (p = 0.001) significantly improved during the pandemic. Compared with the pre-pandemic period, during the pandemic patients were hospitalized less frequently (p = 0.028) and were less likely to undergo elective limb revascularization (p<0.001). No significant difference was found between periods in terms of MALE (p = 0.311), whereas non-fatal strokes were less frequently reported during the pandemic (p = 0.043). <i>Conclusion:</i> In a cohort of outpatients with PAD, we found no evidence of clinical deterioration during the pandemic compared with the pre-pandemic period, though rates of adverse events were nonnegligible in both periods. In case of future pandemics, patients with PAD should be encouraged to maintain an active lifestyle while being closely monitored to avoid clinical worsening.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1024/0301-1526/a001137
Matija Kozak, Pavel Poredoš, Aleš Blinc, Mateja Kaja Ježovnik, Peter Poredoš
Peripheral arterial disease (PAD) represents one of the most frequent manifestations of atherosclerosis in men and women. In both sexes, PAD is related to classical risk factors of atherosclerosis, which are similarly distributed, but some additional factors determine differences between men and women. More frequent asymptomatic disease in women than in men and less frequent screening in women may result in a false underestimation of the prevalence of PAD in women. All these factors may cause delayed diagnosis and treatment of PAD in women. Estrogen hormones have vasoprotective properties that lower the prevalence of atherosclerosis in women of younger age. However, estrogen probably does not have a protective role against the development of cardiovascular disease in women of an older age. Hormone replacement therapy (HRT) of less than one year does not appear to reduce the odds of developing PAD in postmenopausal women. It may even increase the risk of morbidity from vascular interventions. However, some studies indicated that HRT for more than one year significantly decreases the risk of PAD if administered early after the last menstruation. Also, treatment of PAD in women differs to some extent from men.
外周动脉疾病(PAD)是男性和女性动脉粥样硬化最常见的表现之一。在男女两性中,PAD 都与动脉粥样硬化的传统风险因素有关,这些因素的分布情况相似,但一些额外的因素决定了男女之间的差异。与男性相比,女性无症状疾病的发生率更高,女性筛查的频率更低,这些都可能导致女性 PAD 患病率被错误低估。所有这些因素都可能导致女性 PAD 诊断和治疗的延误。雌激素荷尔蒙具有血管保护作用,可降低年轻女性动脉粥样硬化的发病率。但是,雌激素对老年妇女心血管疾病的发生可能没有保护作用。少于一年的激素替代疗法(HRT)似乎不会降低绝经后妇女罹患 PAD 的几率。它甚至可能增加血管介入治疗的发病风险。然而,一些研究表明,如果在末次月经后尽早进行一年以上的人工流产治疗,则可显著降低 PAD 的风险。此外,女性 PAD 的治疗在一定程度上也与男性不同。
{"title":"Peripheral arterial disease in women.","authors":"Matija Kozak, Pavel Poredoš, Aleš Blinc, Mateja Kaja Ježovnik, Peter Poredoš","doi":"10.1024/0301-1526/a001137","DOIUrl":"https://doi.org/10.1024/0301-1526/a001137","url":null,"abstract":"<p><p><b></b> Peripheral arterial disease (PAD) represents one of the most frequent manifestations of atherosclerosis in men and women. In both sexes, PAD is related to classical risk factors of atherosclerosis, which are similarly distributed, but some additional factors determine differences between men and women. More frequent asymptomatic disease in women than in men and less frequent screening in women may result in a false underestimation of the prevalence of PAD in women. All these factors may cause delayed diagnosis and treatment of PAD in women. Estrogen hormones have vasoprotective properties that lower the prevalence of atherosclerosis in women of younger age. However, estrogen probably does not have a protective role against the development of cardiovascular disease in women of an older age. Hormone replacement therapy (HRT) of less than one year does not appear to reduce the odds of developing PAD in postmenopausal women. It may even increase the risk of morbidity from vascular interventions. However, some studies indicated that HRT for more than one year significantly decreases the risk of PAD if administered early after the last menstruation. Also, treatment of PAD in women differs to some extent from men.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1024/0301-1526/a001135
Patricia Wischmann, Manuel Stern, Sven Baasen, Miriam Schillings, Johanna Schremmer, Marc Oliver Stern, Kathrin Klein, Christian Jung, Tobias Zeus, Christian Heiss, Malte Kelm, Lucas Busch
Background: Bifemoral arterial access is common in patients undergoing transcatheter aortic valve implantation (TAVI), with a primary treatment access (TAVI access) and a secondary non-TAVI access. Pseudoaneurysm (PSA) is an important complication of femoral arterial puncture. Major vascular complications after TAVI are well described, but little is known about PSA. Patients and methods: A total of 2063 patients underwent transfemoral TAVI between January 2014 and January 2020. Vascular ultrasound of the common femoral artery was assessed before and after TAVI. We compared patient characteristics, periprocedural risk scores, procedural characteristics, and access site bleeding events according to Valve Academic Research Consortium 3 (VARC-3) criteria, length of stay (LOS), and all-cause mortality at one year between patients with (46) and without (2017) PSA. Results: The incidence of PSA after TAVI was 2.2% (46/2063). All PSA were successfully treated with ultrasound-guided manual compression (UGMC) or thrombin injection (UGTI) without complications. Patients with PSA had lower platelet counts (210×1000/μl vs. 234×1000/μl; p<0.05), more heart failure symptoms on admission (91% vs. 25%; p<0.05), were more often treated with (N)OACs for atrial fibrillation (AF; 54% vs. 38%; p <0.05), and were less often treated with aspirin (35% vs. 51%; p<0.03). Multivariate analysis identified secondary access site (odds ratio [OR] 8.11; p<0.001) and (N)OAC therapy (OR 1.31; p = 0.037) as risk factors for PSA development. PSA is associated with VARC-3 type 1-3 access site bleeding and longer LOS (15.2 ± 11.3 d vs. 11.6 ± 8.9 d; p<0.01), but this did not affect one year mortality (17% vs. 14%; p = 0.53). Conclusions: Pseudoaneurysms are an important complication after TAVI and are associated with access site bleeding and prolonged hospital stay. (N)OAC therapy and secondary access are important risk factors. Pseudoaneurysms can be safely and effectively treated with thrombin injection and do not affect one-year mortality.
{"title":"Importance of pseudoaneurysms after TAVI - a retrospective analysis of 2063 patients.","authors":"Patricia Wischmann, Manuel Stern, Sven Baasen, Miriam Schillings, Johanna Schremmer, Marc Oliver Stern, Kathrin Klein, Christian Jung, Tobias Zeus, Christian Heiss, Malte Kelm, Lucas Busch","doi":"10.1024/0301-1526/a001135","DOIUrl":"https://doi.org/10.1024/0301-1526/a001135","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Bifemoral arterial access is common in patients undergoing transcatheter aortic valve implantation (TAVI), with a primary treatment access (TAVI access) and a secondary non-TAVI access. Pseudoaneurysm (PSA) is an important complication of femoral arterial puncture. Major vascular complications after TAVI are well described, but little is known about PSA. <i>Patients and methods:</i> A total of 2063 patients underwent transfemoral TAVI between January 2014 and January 2020. Vascular ultrasound of the common femoral artery was assessed before and after TAVI. We compared patient characteristics, periprocedural risk scores, procedural characteristics, and access site bleeding events according to Valve Academic Research Consortium 3 (VARC-3) criteria, length of stay (LOS), and all-cause mortality at one year between patients with (46) and without (2017) PSA. <i>Results:</i> The incidence of PSA after TAVI was 2.2% (46/2063). All PSA were successfully treated with ultrasound-guided manual compression (UGMC) or thrombin injection (UGTI) without complications. Patients with PSA had lower platelet counts (210×1000/μl vs. 234×1000/μl; p<0.05), more heart failure symptoms on admission (91% vs. 25%; p<0.05), were more often treated with (N)OACs for atrial fibrillation (AF; 54% vs. 38%; p <0.05), and were less often treated with aspirin (35% vs. 51%; p<0.03). Multivariate analysis identified secondary access site (odds ratio [OR] 8.11; p<0.001) and (N)OAC therapy (OR 1.31; p = 0.037) as risk factors for PSA development. PSA is associated with VARC-3 type 1-3 access site bleeding and longer LOS (15.2 ± 11.3 d vs. 11.6 ± 8.9 d; p<0.01), but this did not affect one year mortality (17% vs. 14%; p = 0.53). <i>Conclusions:</i> Pseudoaneurysms are an important complication after TAVI and are associated with access site bleeding and prolonged hospital stay. (N)OAC therapy and secondary access are important risk factors. Pseudoaneurysms can be safely and effectively treated with thrombin injection and do not affect one-year mortality.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-13DOI: 10.1024/0301-1526/a001130
Stefania Di Gangi, Carole Guillet, Florian Anzengruber, Stefan Zechmann, Thomas O Meier
Background: The risk of developing deep vein thrombosis (DVT) after endovenous ablation of varicose veins varies in the literature. Little is known about the characteristics of this complication and associated factors. This study aimed: 1) to study the occurrence of DVT after ultrasound-guided foam sclerotherapy (UGFS) alone or combined with endovenous laser ablation (EVLA) for lower-limb varicose veins; 2) to identify factors associated with DVT. Patients and methods: The study included all outpatients aged 18 years or older who underwent UGFS and EVLA or UGFS alone at the University Hospital of Zurich between 2011 and 2015. Data were extracted from the hospital electronic medical record. Patients were surveyed about their level of pain after the procedure and their level of satisfaction with the procedure. Duplex ultrasound was used to assess the deep venous system 7-10 days and 6-8 months after the procedure. Regression analysis was used to examine the association of patient and procedure characteristics with the development of DVT. Results: A total of 334 patients (561 procedures performed in 393 different sessions) were included: 73% of the patients underwent combined UGFS and EVLA and 27% underwent UGFS alone. DVT occurred in 24 (7.2%) patients, of whom 88% underwent combined procedures and 17% underwent interventions involving both the great and small saphenous veins on the same session. DVT occurred in 8.2% of patients receiving thromboprophylaxis and in 9.5% of patients not receiving thromboprophylaxis. DVT occurred in 5.2% of women and 11.9% of men. No factors associated with a diagnosis of DVT after intervention were identified. Pain and satisfaction levels did not differ between patients with and without DVT. Conclusions: This study adds to the knowledge of the risk of DVT following UGFS alone or combined with EVLA. Further studies are needed to revise thromboprophylaxis.
{"title":"Deep vein thrombosis after sclerotherapy and endovenous laser ablation of varicose veins - an observational study.","authors":"Stefania Di Gangi, Carole Guillet, Florian Anzengruber, Stefan Zechmann, Thomas O Meier","doi":"10.1024/0301-1526/a001130","DOIUrl":"10.1024/0301-1526/a001130","url":null,"abstract":"<p><p><b></b> <i>Background:</i> The risk of developing deep vein thrombosis (DVT) after endovenous ablation of varicose veins varies in the literature. Little is known about the characteristics of this complication and associated factors. This study aimed: 1) to study the occurrence of DVT after ultrasound-guided foam sclerotherapy (UGFS) alone or combined with endovenous laser ablation (EVLA) for lower-limb varicose veins; 2) to identify factors associated with DVT. <i>Patients and methods:</i> The study included all outpatients aged 18 years or older who underwent UGFS and EVLA or UGFS alone at the University Hospital of Zurich between 2011 and 2015. Data were extracted from the hospital electronic medical record. Patients were surveyed about their level of pain after the procedure and their level of satisfaction with the procedure. Duplex ultrasound was used to assess the deep venous system 7-10 days and 6-8 months after the procedure. Regression analysis was used to examine the association of patient and procedure characteristics with the development of DVT. <i>Results:</i> A total of 334 patients (561 procedures performed in 393 different sessions) were included: 73% of the patients underwent combined UGFS and EVLA and 27% underwent UGFS alone. DVT occurred in 24 (7.2%) patients, of whom 88% underwent combined procedures and 17% underwent interventions involving both the great and small saphenous veins on the same session. DVT occurred in 8.2% of patients receiving thromboprophylaxis and in 9.5% of patients not receiving thromboprophylaxis. DVT occurred in 5.2% of women and 11.9% of men. No factors associated with a diagnosis of DVT after intervention were identified. Pain and satisfaction levels did not differ between patients with and without DVT. <i>Conclusions:</i> This study adds to the knowledge of the risk of DVT following UGFS alone or combined with EVLA. Further studies are needed to revise thromboprophylaxis.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}