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A call for interdisciplinary and guideline-recommended PAD treatment. 呼吁进行跨学科和指南推荐的 PAD 治疗。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-03-01 Epub Date: 2024-11-20 DOI: 10.1024/0301-1526/a001161
Grigorios Korosoglou, Christos Rammos, Eric Secemsky
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引用次数: 0
Prognostic value of biomarkers of ischaemia in patients with peripheral arterial disease following endovascular revascularisation. 外周动脉疾病患者血管内重建术后缺血生物标志物的预后价值
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-03-01 Epub Date: 2025-01-10 DOI: 10.1024/0301-1526/a001170
Nika Dobrilovič, Nuša Gerbec, Kevin Pelicon, Klemen Petek, Aleš Blinc, Vinko Boc, Borut Jug, Mojca Božič Mijovski, Joško Osredkar, Nataša Kejžar, Anja Boc

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.

背景:我们的目的是评估可检测的高敏心肌肌钙蛋白I (hs-cTnI)和缺血修饰白蛋白(IMA)在预测下肢血管内重建后PAD患者全因死亡或非致死性缺血事件中的预后价值。患者和方法:前瞻性纳入因慢性肢体威胁性缺血(CLTI)或致残性间歇性跛行(IC)成功行血管内血管重建术的患者。测量术前hs-cTnI和IMA水平,并随访患者一年,观察全因死亡、非致死性心肌梗死、新发心绞痛、非致死性缺血性卒中、短暂性缺血性发作或PAD进展等复合结局的发生情况。使用生存分析评估结果。结果:共纳入487例患者,其中175例(35.9%)出现复合结局。当仅考虑PAD的临床表现和生物标志物值时,在CLTI患者中,高于检测限(LoD)的hs-cTnI与低于LoD的hs-cTnI相比,复合结局的风险增加(p=0.004),而对于IMA,我们没有发现显着差异。CLTI和hs-cTnI或IMA低于LoD的患者的结局与IC患者没有差异(p=0.07和p=0.462)。当在多变量Cox生存分析中调整临床特征和常见心血管危险因素时,两种生物标志物都不能改善预后,然而IMA成为CLTI患者复合结局的独立预测因子。结论:在接受血管内手术成功的PAD患者中,IMA和hs-cTnI都没有改善超出临床决定因素的风险分层。然而,IMA检测是CLTI患者主要心血管事件或死亡的独立预测因子。
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引用次数: 0
Comparison of patients with occlusive or hemorrhagic access site complications requiring reintervention after percutaneous transfemoral transcatheter aortic valve implantation. 经皮经动脉导管主动脉瓣植入术后出现闭塞性或出血性入路部位并发症而需要再次介入治疗的患者比较。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-03-01 Epub Date: 2024-10-30 DOI: 10.1024/0301-1526/a001154
Moritz Wegner, Reinier R Smeets, Leo F Veenstra, Wael Ahmad, Amelie L Behrens, Florian Kursch, Hendrik Wienemann, Bernhard Dorweiler, Stephan Baldus, Matti Adam, Barend M E Mees, Max M Meertens

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.

背景:通过经股动脉(TF)入路进行经导管主动脉瓣植入术(TAVI)越来越成为主动脉瓣疾病治疗中不可或缺的一部分,其范围已超出高风险患者。尽管技术不断进步,但与入路相关的血管并发症仍是一个巨大的挑战,约有 10% 的 TAVI 手术会出现血管并发症。研究目的本研究调查了发生闭塞(OC)和出血(HC)并发症并接受手术或血管内再介入治疗的经皮 TF-TAVI 患者的临床和形态特征。方法:研究对象包括一家荷兰和一家德国三级转诊医院的患者,这些患者在2017年至2021年间接受了TF-TAVI手术,并因OC或HC而需要再次介入治疗。收集人口统计学、合并症、手术细节和术前影像学数据,并进行组间比较。结果:在109例TF-TAVI患者中,32例OC患者和77例HC患者需要再次介入治疗。OC组的入路动脉直径明显较小(股总动脉:OC 6.7 mm vs. HC 8.9 mm,ppp=.012),而HC组的迂曲指数(TI)较高(OC 1.24 vs. HC 1.30;pp=.017)。在基线特征、血管钙化或使用血管闭合装置方面未观察到差异。结论在TF-TAVI术后需要再次介入的患者中,较小的动脉直径与OC相关,而较高的TI与HC相关。这些发现强调了术前成像在制定个体化预防策略中的重要性。
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引用次数: 0
Dual pathway inhibition in patients with peripheral artery disease in Germany. 德国外周动脉疾病患者的双途径抑制
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-03-01 Epub Date: 2025-01-10 DOI: 10.1024/0301-1526/a001174
Joerg Herold, Nikolaos Dagkonakis, E Sebastian Debus, Ursula Rauch-Kröhnert, Uwe Zeymer, Rupert M Bauersachs

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.

背景:在随机COMPASS试验中,阿司匹林和利伐沙班双途径抑制(DPI)对心血管疾病患者显示出净临床获益。非观察性的国际XATOA登记显示,COMPASS结果可以在冠状动脉疾病(CAD)和外周动脉疾病(PAD)患者的临床实践中重现。在这里,我们报告了XATOA注册的德国PAD患者亚组的患者特征和临床结果,并将其与COMPASS PAD患者进行比较。患者和方法:XATOA是一项接受DPI患者的国际前瞻性注册研究,平均随访时间为15个月。XATOA德国PAD患者亚组包括1819例患者,其中925例(50.9%)患者仅患有PAD, 894例(49.1%)患者同时患有CAD和PAD。评估患者既往病史、既往用药等特征以及主要肢体不良事件(MALE)、主要心血管不良事件(MACE)和主要出血事件发生率等临床结果。结果:DPI临床耐受良好。患者的特征和临床结果,特别是仅PAD患者的特征和临床结果与德国XATOA总体人群以及COMPASS的PAD亚组的特征和结果不同。只有PAD的患者使用的降脂剂和β受体阻滞剂明显减少。男性在XATOA的德系PAD患者中的发病率较高(9.0%),明显高于COMPASS的PAD亚组(1.2%)。德国PAD XATOA患者的MACE和大出血事件发生率(MACE: 2.9%,大出血:1.4%)低于COMPASS PAD患者(MACE: 5.1%,大出血:3.1%)。结论:在德国临床实践中,PAD患者对利伐沙班和阿司匹林联合DPI耐受良好。德国的PAD患者与COMPASS的PAD患者表现出不同的特征和不同的临床结果。
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引用次数: 0
The prevalence of chronic obstructive pulmonary disease in hospitalized tobacco smokers with peripheral artery disease. 伴有外周动脉疾病的住院吸烟者慢性阻塞性肺疾病的患病率。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-03-01 Epub Date: 2025-01-20 DOI: 10.1024/0301-1526/a001168
Marek Kaszuba, Jolanta Kościelniak, Agnieszka Śliwka, Rafał Piliński, Grażyna Bochenek, Paweł Maga, Roman Nowobilski

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.

背景:外周动脉疾病(PAD)和慢性阻塞性肺疾病(COPD)都是炎症性疾病。这两种情况经常共存,但对这种现象在PAD患者中的普遍程度知之甚少。这项前瞻性横断面研究的目的是确定PAD患者中COPD的患病率,并评估该组患者中COPD未被诊断的频率。患者和方法:对连续入住血管内科的患者进行评估。测量踝肱指数和脚趾肱指数以及外周动脉造影对所有参与者进行确认PAD。对患有PAD的吸烟者进行肺量测定,以确定COPD患者。通过问卷调查获得患者的临床信息。结果:连续300例患者中有88例被纳入并评估。在33例(37.5%)患有PAD的住院吸烟者中诊断为COPD。28例(84.8%)符合COPD标准的患者以前没有诊断过COPD。结论:在血管内科住院的吸烟人群中COPD患病率较高。大多数患者以前从未做过肺活量测定。漏诊率较高;因此,所有吸烟的PAD患者都应该进行肺活量测定,作为COPD的筛查。
{"title":"The prevalence of chronic obstructive pulmonary disease in hospitalized tobacco smokers with peripheral artery disease.","authors":"Marek Kaszuba, Jolanta Kościelniak, Agnieszka Śliwka, Rafał Piliński, Grażyna Bochenek, Paweł Maga, Roman Nowobilski","doi":"10.1024/0301-1526/a001168","DOIUrl":"10.1024/0301-1526/a001168","url":null,"abstract":"<p><p><b></b> <i>Background:</i> 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. <i>Patients and methods:</i> 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. <i>Results:</i> 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. <i>Conclusions:</i> 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.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"91-98"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011308","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}
引用次数: 0
Angioplastycombined with intravascular ultrasound vs angioplasty alone in the treatment of peripheral arterial disease. 血管成形术结合血管内超声与单纯血管成形术治疗外周动脉疾病的对比。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-28 DOI: 10.1024/0301-1526/a001187
Mohamed Hosny Sayed, Mustafa Majeed, Avilash Mishrah, Prakash Saha, Narayanan Thulasidasan, Hany Zayed Md

Background: Digital Subtraction Angiography (DSA) is the conventional imaging method for peripheral arterial disease (PAD) assessment but poses limitations for the estimation of the true vessel diameter, especially in diffuse disease. Intravascular ultrasound (IVUS) is used in coronary interventions, offering detailed insights. While IVUS is proven beneficial in coronary interventions, its role in peripheral arterial interventions is less well established. This meta-analysis aims to compare outcomes of peripheral percutaneous transluminal angioplasty (PTA) using angiography only (AO-PTA) versus angiography with IVUS (IVUS-PTA) in PAD. Materials and methods: A systematic review of PubMed, EMBASE, Cochrane, Scopus, and Web of Science databases from January 1996 to August 2024 was conducted. 13 studies met inclusion criteria, including RCTs, observational, and propensity-matched studies. Data extraction, quality assessment, and analyses were performed following PRISMA guidelines. Primary endpoint: freedom from target lesion reintervention (F-TLR) at 12 months. Secondary endpoints: bailout stenting, technical success, and freedom from major amputation (F-MA). Results: A total of 246,418 patients from 13 studies were included. F-TLR at 12-month follow-up was reported in 51,850 procedures. F-MA was reported in 155,933 procedures. IVUS-PTA showed significantly better F-MA and higher bailout stenting, but inferior F-TLR compared to AO-PTA. Technical success was reported in 555 procedures across 5 studies (0.2%). It trended higher with IVUS-PTA but with no statistical significance. Conclusions: IVUS-PTA is associated with superior F-MA and bailout stenting, but inferior F-TLR compared to AO-PTA. Further well-designed RCTs are needed to better support the use of IVUS's role PAD.

{"title":"Angioplastycombined with intravascular ultrasound vs angioplasty alone in the treatment of peripheral arterial disease.","authors":"Mohamed Hosny Sayed, Mustafa Majeed, Avilash Mishrah, Prakash Saha, Narayanan Thulasidasan, Hany Zayed Md","doi":"10.1024/0301-1526/a001187","DOIUrl":"https://doi.org/10.1024/0301-1526/a001187","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Digital Subtraction Angiography (DSA) is the conventional imaging method for peripheral arterial disease (PAD) assessment but poses limitations for the estimation of the true vessel diameter, especially in diffuse disease. Intravascular ultrasound (IVUS) is used in coronary interventions, offering detailed insights. While IVUS is proven beneficial in coronary interventions, its role in peripheral arterial interventions is less well established. This meta-analysis aims to compare outcomes of peripheral percutaneous transluminal angioplasty (PTA) using angiography only (AO-PTA) versus angiography with IVUS (IVUS-PTA) in PAD. <i>Materials and methods:</i> A systematic review of PubMed, EMBASE, Cochrane, Scopus, and Web of Science databases from January 1996 to August 2024 was conducted. 13 studies met inclusion criteria, including RCTs, observational, and propensity-matched studies. Data extraction, quality assessment, and analyses were performed following PRISMA guidelines. Primary endpoint: freedom from target lesion reintervention (F-TLR) at 12 months. Secondary endpoints: bailout stenting, technical success, and freedom from major amputation (F-MA). <i>Results:</i> A total of 246,418 patients from 13 studies were included. F-TLR at 12-month follow-up was reported in 51,850 procedures. F-MA was reported in 155,933 procedures. IVUS-PTA showed significantly better F-MA and higher bailout stenting, but inferior F-TLR compared to AO-PTA. Technical success was reported in 555 procedures across 5 studies (0.2%). It trended higher with IVUS-PTA but with no statistical significance. <i>Conclusions:</i> IVUS-PTA is associated with superior F-MA and bailout stenting, but inferior F-TLR compared to AO-PTA. Further well-designed RCTs are needed to better support the use of IVUS's role PAD.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524548","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}
引用次数: 0
The role of Bromelain and Liposomal Vitamin C in the treatment of chronic venous disease.
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-19 DOI: 10.1024/0301-1526/a001184
Giacomo Buso, Paolo Santini, Francesca Ghirardini, Francesca Cannavacciuolo, Adriana Visonà, Beniamino Zalunardo, Roberto Pola, Romeo Martini

Chronic venous disease (CVD) is a prevalent condition leading to significant morbidity and affecting quality of life. Among conservative treatment strategies, venoactive drugs are often recommended by major guidelines for the management of CVD. Bromelain and vitamin C are now emerging as promising options in the management of several chronic diseases owing to their anti-inflammatory, immunoregulatory, and antioxidant properties, though evidence remains scarce in this setting. This systematic review of the literature, endorsed by the Italian Society of Angiology and Vascular Medicine (Societa Italiana di Angiologia e Patologia Vascolare, SIAPAV), aims to evaluate the efficacy and safety of these compounds in the treatment of CVD. A comprehensive search yielded nine studies, two on bromelain and seven on vitamin C. No studies have evaluated the effects of bromelain and vitamin C alone or in combination, whereas both molecules were administered in combination with other nutritional supplements. Overall, CVD-related symptoms and edema seem to improve with dietary supplement containing these two compounds, with no major safety issues reported. Bromelain and vitamin C may thus represent attractive options in the management of patients with symptomatic CVD and/or presence of venous edema, provided optimal conservative treatment is in place. Dedicated clinical studies are needed to clarify the efficacy and safety of a combination of these molecules in CVD management.

{"title":"The role of Bromelain and Liposomal Vitamin C in the treatment of chronic venous disease.","authors":"Giacomo Buso, Paolo Santini, Francesca Ghirardini, Francesca Cannavacciuolo, Adriana Visonà, Beniamino Zalunardo, Roberto Pola, Romeo Martini","doi":"10.1024/0301-1526/a001184","DOIUrl":"https://doi.org/10.1024/0301-1526/a001184","url":null,"abstract":"<p><p><b></b> Chronic venous disease (CVD) is a prevalent condition leading to significant morbidity and affecting quality of life. Among conservative treatment strategies, venoactive drugs are often recommended by major guidelines for the management of CVD. Bromelain and vitamin C are now emerging as promising options in the management of several chronic diseases owing to their anti-inflammatory, immunoregulatory, and antioxidant properties, though evidence remains scarce in this setting. This systematic review of the literature, endorsed by the Italian Society of Angiology and Vascular Medicine (<i>Societa Italiana di Angiologia e Patologia Vascolare</i>, SIAPAV), aims to evaluate the efficacy and safety of these compounds in the treatment of CVD. A comprehensive search yielded nine studies, two on bromelain and seven on vitamin C. No studies have evaluated the effects of bromelain and vitamin C alone or in combination, whereas both molecules were administered in combination with other nutritional supplements. Overall, CVD-related symptoms and edema seem to improve with dietary supplement containing these two compounds, with no major safety issues reported. Bromelain and vitamin C may thus represent attractive options in the management of patients with symptomatic CVD and/or presence of venous edema, provided optimal conservative treatment is in place. Dedicated clinical studies are needed to clarify the efficacy and safety of a combination of these molecules in CVD management.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450274","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}
引用次数: 0
Hospital frailty risk and CHA2DS2-VA scores in the mortality assessment of older patients with peripheral artery disease.
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-17 DOI: 10.1024/0301-1526/a001183
Sven M Piepenburg, Mariya Maslarska, Christian Weber, Klaus Kaier, Constantin von Zur Mühlen, Dirk Westermann, Christoph Hehrlein

Background: Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. Patients and methods: This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHA2DS2-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHA2DS2-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86-0.87) but had the worst calibration for high-risk patients. The CHA2DS2-VA Score had the lowest AUC 0.69 (95% CI: 0.68-0.70) but was the most consistent prediction model regarding calibration. Conclusions: HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHA2DS2-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHA2DS2-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.

{"title":"Hospital frailty risk and CHA2DS2-VA scores in the mortality assessment of older patients with peripheral artery disease.","authors":"Sven M Piepenburg, Mariya Maslarska, Christian Weber, Klaus Kaier, Constantin von Zur Mühlen, Dirk Westermann, Christoph Hehrlein","doi":"10.1024/0301-1526/a001183","DOIUrl":"https://doi.org/10.1024/0301-1526/a001183","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. <i>Patients and methods:</i> This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHA<sub>2</sub>DS<sub>2</sub>-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHA<sub>2</sub>DS<sub>2</sub>-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86-0.87) but had the worst calibration for high-risk patients. The CHA<sub>2</sub>DS<sub>2</sub>-VA Score had the lowest AUC 0.69 (95% CI: 0.68-0.70) but was the most consistent prediction model regarding calibration. <i>Conclusions:</i> HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHA<sub>2</sub>DS<sub>2</sub>-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHA<sub>2</sub>DS<sub>2</sub>-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433682","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}
引用次数: 0
Prospective study of the duo-hybrid venous stent for treatment of iliac vein obstruction.
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-07 DOI: 10.1024/0301-1526/a001179
Michael Lichtenberg, Stefan Stahlhoff, Simone Mueller, Konstantinos Stavroulakis

Background: This prospective, single center, exploratory study assessed primary patency, clinical performance, and adverse events associated with the DUO-HYBRID Venous Stent used to treat iliac vein obstruction. Materials and methods: Twenty-one patients with symptomatic obstructions were treated with the self-expanding stent designed with varying zones of fatigue and crush resistance to adapt to the challenging iliac vein anatomy. The primary outcome measure was 12-month primary patency, defined as ≤ 50% residual stenosis, the absence of re-thrombosis or reintervention, and the absence of major adverse events from treatment to discharge. Secondary clinical measures included the Villalta score to assess the symptoms of post-thrombotic syndrome (PTS), and the revised Venous Clinical Severity Score (rVCSS) and Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) score, both used to measure the severity of venous disease. Finally, the number of device- or procedure-related adverse events were recorded. Results: Primary patency was 92.9% at 12 months: one patient exhibited restenosis greater than 50% at 12 months. CEAP scores at baseline were predominantly C3 - C5 (78.9%) while at 12 months, 78.6% of scores were C1 - C2 and 14.3% were C0. The mean rVCSS score was 5.5 ± 2.7 at baseline and 1.1 ± 1.0 at 12 months, an 80% reduction in the mean score from baseline. Pre-procedure, 14.3% of patients had a Villalta score of 0-4 while at 12 months, 100% had scores of 0-4 (i.e., no clinically meaningful signs of post-thrombotic syndrome). Two adverse events were reported as possibly related to the device but neither case required revascularization. Conclusions: Observations from this exploratory study demonstrated a primary patency rate of 92.9%, improvements in rVCSS, CEAP, and Villalta scores from baseline, and no cases of target lesion or vessel revascularization at 12 months. The DUO-HYBRID Venous Stent performed appropriately when used for its intended indication.

{"title":"Prospective study of the duo-hybrid venous stent for treatment of iliac vein obstruction.","authors":"Michael Lichtenberg, Stefan Stahlhoff, Simone Mueller, Konstantinos Stavroulakis","doi":"10.1024/0301-1526/a001179","DOIUrl":"https://doi.org/10.1024/0301-1526/a001179","url":null,"abstract":"<p><p><b></b> <i>Background:</i> This prospective, single center, exploratory study assessed primary patency, clinical performance, and adverse events associated with the DUO-HYBRID Venous Stent used to treat iliac vein obstruction. <i>Materials and methods:</i> Twenty-one patients with symptomatic obstructions were treated with the self-expanding stent designed with varying zones of fatigue and crush resistance to adapt to the challenging iliac vein anatomy. The primary outcome measure was 12-month primary patency, defined as ≤ 50% residual stenosis, the absence of re-thrombosis or reintervention, and the absence of major adverse events from treatment to discharge. Secondary clinical measures included the Villalta score to assess the symptoms of post-thrombotic syndrome (PTS), and the revised Venous Clinical Severity Score (rVCSS) and Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) score, both used to measure the severity of venous disease. Finally, the number of device- or procedure-related adverse events were recorded. <i>Results:</i> Primary patency was 92.9% at 12 months: one patient exhibited restenosis greater than 50% at 12 months. CEAP scores at baseline were predominantly C3 - C5 (78.9%) while at 12 months, 78.6% of scores were C1 - C2 and 14.3% were C0. The mean rVCSS score was 5.5 ± 2.7 at baseline and 1.1 ± 1.0 at 12 months, an 80% reduction in the mean score from baseline. Pre-procedure, 14.3% of patients had a Villalta score of 0-4 while at 12 months, 100% had scores of 0-4 (i.e., no clinically meaningful signs of post-thrombotic syndrome). Two adverse events were reported as possibly related to the device but neither case required revascularization. <i>Conclusions:</i> Observations from this exploratory study demonstrated a primary patency rate of 92.9%, improvements in rVCSS, CEAP, and Villalta scores from baseline, and no cases of target lesion or vessel revascularization at 12 months. The DUO-HYBRID Venous Stent performed appropriately when used for its intended indication.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366087","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}
引用次数: 0
S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit. 关于外周动脉闭塞症的诊断、治疗和善后护理的 S3 指南。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-01 DOI: 10.1024/0301-1526/a001171
{"title":"S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit.","authors":"","doi":"10.1024/0301-1526/a001171","DOIUrl":"https://doi.org/10.1024/0301-1526/a001171","url":null,"abstract":"","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":"54 S113","pages":"1-119"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493788","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}
引用次数: 0
期刊
Vasa-european Journal of Vascular Medicine
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