Vasa-european Journal of Vascular Medicine最新文献

Post thrombotic syndrome (PTS) is a frequent complication occurring in patients with deep venous thrombosis (DVT). This chronic condition is associated with a negative impact on quality of life and substantial economic costs. Despite current treatment with anticoagulants and compression therapy, a significant proportion of DVT patients develop PTS. Optimising the diagnosis and identification of high-risk patients is important to provide more appropriate individualised treatment. In addition, a better understanding of the pathogenesis is leading to the necessary improvement of both current treatment strategies and the development of new treatment modalities. Treatments aimed at prevention as well as those aimed at reducing the symptoms of already manifested PTS should be further investigated. Research is currently taking place on promising therapeutical targets including pharmacological (anti-inflammatory and venoactive drugs), and interventional approaches (e.g. mechanical thrombectomy) in patients at different stages of PTS. Progress in all these areas is needed to solve the complex problem of PTS.

Background: Aim of this study was to analyze the effect of medical compression stockings (MCS) class I (according to the German classification "RAL-GZ 387"; 18-21 mmHg) on symptoms in patients with uncomplicated varicose veins (C2s-C4a). Patients and methods: We conducted a randomized (1:1), controlled, clinical trial enrolling patients with uncomplicated varicose veins (CEAP: C2s-C4a). The study consisted of a one-week baseline period and a four-week follow-up period with MCS treatment (compression class I, 18-21 mmHg) in the intervention group and non-treatment in the control group. The frequency and severity of symptoms on the leg including heaviness, pain, swelling, throbbing and itching were measured every evening using an app-based measuring tool. The primary endpoint was the reduction of symptoms during compression therapy, measured by a symptom sum score over a period of 5 weeks ranging from 0 (no symptoms during the day) to 25 (symptoms all day). Results: Patients treated with MCS (n = 25) showed a significant improvement in the overall symptom sum score from 8.90 ± 4.26 at baseline to 6.37 ± 3.55 at follow-up (p = 0.004) whereas for patients in the control group without MCS (n = 25) the overall score remained unchanged (baseline: 7.46 ± 3.71; follow-up: 7.67 ± 4.74; p = 0.293). The intervention group reported significant improvements in symptom frequency scores for pain, leg swelling and feeling of leg heaviness (p ≤ 0.002). In the control group the score for pain significantly increased during the follow-up period. Leg itching was numerically more frequent in patients with MCS. Conclusion: This study indicates that medical compression stockings class I (according to the German classification "RAL-GZ 387"; 18-21 mmHg) significantly improve the frequency and severity of symptoms in patients with uncomplicated varicose veins (CEAP: C2s-C4a).

Background: Growing body of evidence suggests that the atherogenic dyslipidemia phenotype is a precursor to Peripheral Arterial Disease (PAD). Nonetheless, there is limited research regarding the association between Atherogenic Index of Plasma (AIP) and PAD which utilized a community population-based database in the United States. We sought to fill this knowledge gap. Methods: A total of 3,517 participants from the National Health and Nutrition Examination Survey 1999-2004 cycles were enrolled in our study. AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). Logistic regression models were adopted to reveal the relationship of AIP and PAD. Additionally, stratified and interaction analyses were also undertaken to see if the relationship was stable in different subgroups. Results: Participants in the higher tertile of AIP tended to have higher prevalence of PAD. A positive correlation was identified between AIP increase and PAD after fully multivariate adjustment (OR=1.30, 95% CI: 1.06-1.59). The multivariable-adjusted OR and 95% CI of the highest AIP tertile compared with the lowest tertile was 1.50 (1.07-2.1). Subgroup analysis demonstrated that the positive association between AIP and PAD was persistent across population subgroups. Conclusions: Our findings demonstrate a positive association between AIP and the incidence of PAD among adults in American adults. Specifically, 1 unit increase in AIP led to a 30% greater risk of PAD.

Background: The objective of the study was to analyze mid-term results of unselected patients treated with the TREO (Terumo Aortic, Florida, USA) device at six German hospital sites. Methods: A multicenter, retrospective analysis of patients treated within and outside instructions for use (IFU) from January 2017 to November 2020 was performed. Primary outcomes were technical success, mortality and endograft related complications according to IFU status. Secondary outcomes were aneurysm/procedure related re-interventions. Results: 150 patients (92% male, mean age 73 ±8 years) were treated (within IFU 84% vs. outside IFU 16%) with the TREO device for abdominal aortic aneurysms (n=127 intact, n=17 symptomatic and n=6 ruptured; p=0.30). Technical success was achieved in 147/150 (within IFU 99% vs. outside IFU 92%, p=0.08). 30-day mortality was 2%, one year and overall mortality was 3% and 5%. During a mean follow-up of 28.4 months (range: 1-67.4 months), 35 (25%; within IFU 23% vs. outside IFU 35%, p=0.23) patients suffered from endoleaks. The majority were endoleaks type II (n=33), the remaining type Ia (n=5) and type Ib (n=3). No endoleaks type III-V, migrations or aneurysm ruptures occurred. Overall, 19 patients (13%; within IFU 13% vs. 15% outside IFU, p=0.70) received a secondary intervention: nine endoleak related endovascular procedures, three open conversions, two endograft limb related interventions, four surgical revisions of the femoral access sites and two bowl ischemia related procedures, respectively. Conclusions: This non industry-sponsored, multicenter trial indicates that using the TREO device in a real-world setting (both within and outside IFU) seems feasible in the treatment of patients suffering from AAA. While the rate of complications and secondary interventions is in line with previously published data, the findings highlight the fact that standard EVAR is associated with serious adverse events.

Purpose: Technical aspects are crucial for the planning and performing of the atherectomy to treat peripheral arterial disease. This report illustrates the use of a novel atherectomy device and investigates the feasibility, efficacy, and safety procedures involved in performing the atherectomy on 28 patients.

Materials and methods: We performed a prospective analysis of patients who underwent an atherectomy with the BYCROSS^TM Atherectomy device between August 2022 and September 2023 at a tertiary referral centre. Patients with a lesion below the aortic bifurcation (vessel diameter ≥ 3mm) having a de novo or restenotic (stent-included) present were recruited. Major adverse events (MAE) are defined as amputation, death, myocardial infarction, or angiographic distal embolization that require a separate intervention.

Results: Of the 28 patients treated with the BYCROSS device, 23 were men with a mean age of 65.6 ± 9,6 years and a mean BMI of 24,6 ± 3.9 kg/m². Most patients had a typical atherogenic risk profile as well as multiple preexisting comorbidities. In all patients, a symptomatic peripheral arterial disease (PAD) was the main reason for an intervention. The most common Rutherford category was 5 (12/28). The most common lesion region was the femoropopliteal segment (25/28) with 23 de novo stenosis. Mean lesion length was 218,0 ± 93,7 mm. The mean PACCS Score was 3,0 ± 1,0. Stenosis grade was by mean 99,3 ± 3,7%. Ankle Brachial Index (ABI) increased significantly after BYCROSS atherectomy (pre- 0,44 ± 0,43 vs. post-procedure 0,84 ± 0,30 P<0,001. Target lesion/vessel revascularization (TLR/TVR) within the first 30 days was 3,6% (1/28). 30-day MAE rate was 14,3% (vessel perforation in 3/28 patients, embolism in 1/28). There were no deaths, index limb amputations, or myocardial infarctions.

Conclusion: The BYCROSS^TM atherectomy system is a new device with numerous advantages in treating high-grade, calcifying stenosis and occlusion processes in PAD. Based on the above findings, the BYCROSS^TM Atherectomy device represents a feasible, safe, and effective method for endovascular treatment of peripheral arterial disease.

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.

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.