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The routine use of Rivaroxaban as thromboprophylaxis following endovenous thermal ablation.
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-31 DOI: 10.1024/0301-1526/a001182
Alkis Bontinis, Vangelis Bontinis, Argirios Giannopoulos, Ioannis Kontes, Vasiliki Manaki, Apostolos G Pitoulias, Angeliki Chorti, Kiriakos Ktenidis

Background: We investigated the safety and efficacy of rivaroxaban as routine thromboprophylaxis after endovenous thermal ablation (EVTA). Patients and methods: Adhering to the PRISMA 2020 guidelines, we conducted a systematic review for studies published up to April 2024. Primary endpoints included endovenous heat-induced thrombosis (EHIT) class ≥ II, deep vein thrombosis (DVT), major and minor bleeding and the composite endpoint of major thromboembolic complications including any incidents of EHIT ≥ III, DVT or pulmonary embolism (PE). Results: Eight retrospective case series, encompassing 1666 patients, and 2049 truncal veins were included. The pooled EHIT ≥ II, DVT, and major thromboembolic complications estimates were 0.73% (95% CI: 0.37-1.42), 0.51% (95% CI: 0.22-1.17) and 0.71% (95% CI: 0.27-1.89). The crude and pooled major and minor bleeding estimates were 0% (0/885) and 2.60% (95% CI: 1.05-6.33). The pooled early truncal and great saphenous vein (GSV) occlusion outcomes were 99.03% (95% CI: 96.88-99.70) and 98.74% (95% CI: 92.07-99.81). The pooled and crude superficial thrombophlebitis and PE estimates were 2.86% (95% CI: 0.88-8.89) and 0% (0/579). While the comparative analysis between rivaroxaban and low molecular weight heparins (LMWH)/fondaparinux displayed improved outcomes favouring rivaroxaban in terms of DVT, risk ratio (RR), 0.60 (95% CI: 0.12-3.07) and truncal occlusion, odds ratio (OR), 1.43 (95% CI: 0.31-6.55) outcomes did not reach statistical significance. Meta-regression analysis including rivaroxaban treatment durations spanning from three to ten days displayed a negative association between duration of treatment and both truncal, (β = -0.4740, p<0.01) and GSV, (β = -0.4583, p<0.01) occlusion in the early pos-operative period. Conclusions: The results of this review underscore the potential safety of rivaroxaban as thromboprophylaxis in the context of endovenous thermal ablation. The observed inverse relationship between anticoagulation duration and occlusion outcomes should be interpreted with caution, highlighting the need for further research.

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引用次数: 0
Comparison of the risk scoring systems in long term restenosis due to percutaneous interventions to the superficial femoral artery.
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-30 DOI: 10.1024/0301-1526/a001178
Muammer Karakayalı, Inanç Artac, Doğan Ilis, Timor Omar, Ayca Arslan, Ezgi Guzel, Yavuz Karabag, Ibrahim Rencuzogullari

Background: Percutaneous superficial femoral interventions remain the preferred method of treatment for superficial femoral artery (SFA) disease. Nevertheless, long term restenosis continues to be a major limitation of percutaneous interventions. In this context, the objective of this study is to compare the efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting long-term (5 years) restenosis due to percutaneous interventions to the superficial femoral artery. Patients and methods: The sample of this retrospective study consisted of 545 peripheral artery disease (PAD) patients with a percutaneous intervention to the SFA. Of these patients, 362 and 183 were included in the group of PAD patients without long-term (5 years) SFA restenosis (Group 1) and in the group of PAD patients with long-term SFA restenosis (Group 2). The efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting the development of long-term SFA restenosis were comparatively analyzed. Results: CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scores all increased with long-term SFA restenosis. The receiver operating characteristic (ROC) curve analysis revealed that all five risk scoring systems successfully predicted long-term SFA restenosis, whereas the paired ROC curve analysis revealed that CHA2DS2-VASc-HS scores of >4 had the best prognostic power in predicting long term SFA restenosis. Conclusions: The study findings indicated that the CHA2DS2-VASc-HS score was an independent predictor of the development of SFA restenosis. The CHA2DS2-VASc-HS risk scoring system, which is the modified version of CHA2DS2-VASc, outperformed the CHA2DS2-VASc, HATCH, ATRIA, and ATRIA-HSV, the modified version of ATRIA, risk scoring systems in predicting long-term (5 years) SFA restenosis.

背景:经皮股浅动脉介入治疗仍是治疗股浅动脉(SFA)疾病的首选方法。然而,长期再狭窄仍然是经皮介入治疗的主要局限性。在这种情况下,本研究旨在比较 CHA2DS2-VASc、CHA2DS2-VASc-HS、ATRIA、ATRIA-HSV 和 HATCH 风险评分系统在预测股浅动脉经皮介入治疗引起的长期(5 年)再狭窄方面的效果。患者和方法这项回顾性研究的样本包括545名经皮介入股浅动脉的外周动脉疾病(PAD)患者。其中,362 名患者和 183 名患者分别被纳入无长期(5 年)SFA 再狭窄的 PAD 患者组(第 1 组)和有长期 SFA 再狭窄的 PAD 患者组(第 2 组)。比较分析了 CHA2DS2-VASc、CHA2DS2-VASc-HS、ATRIA、ATRIA-HSV 和 HATCH 风险评分系统预测长期 SFA 再狭窄发生的效果。结果CHA2DS2-VASc、CHA2DS2-VASc-HS、ATRIA、ATRIA-HSV和HATCH风险评分均随长期SFA再狭窄的发生而增加。接受者操作特征(ROC)曲线分析表明,所有五种风险评分系统都能成功预测长期SFA再狭窄,而配对ROC曲线分析表明,CHA2DS2-VASc-HS评分>4在预测长期SFA再狭窄方面预后能力最强。结论:研究结果表明,CHA2DS2-VASc-HS 评分是预测 SFA 再狭窄发生的独立指标。CHA2DS2-VASc-HS风险评分系统是CHA2DS2-VASc的改良版,在预测长期(5年)SFA再狭窄方面优于CHA2DS2-VASc、HATCH、ATRIA和ATRIA的改良版ATRIA-HSV风险评分系统。
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引用次数: 0
Comparison of ultrasound-assisted thrombolysis and mechanical thrombectomy in intermediate-high-risk pulmonary embolism.
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-30 DOI: 10.1024/0301-1526/a001180
David Pinsdorf, Daniel Messiha, Ramtin Knuschke, Olga Petrikhovich, Julia Lortz, Rolf Alexander Jánosi, Tienush Rassaf, Christos Rammos

Background: Pulmonary embolism (PE) can result in high mortality. Early risk stratification and treatment are critical for individualized management. In patients with intermediate-high-risk (IHR) PE, guidelines recommend to consider a percutaneous catheter-directed treatment (CDT). While different techniques are available, comparisons between treatments regarding right ventricular (RV) function and outcome are still scarce. This study aimed to compare changes in RV function as well as outcomes in patients with IHR PE after CDT with ultrasound-assisted thrombolysis (USAT) as compared to large-bore mechanical thrombectomy (MT). Patients and methods: This is a retrospective, single-center study in IHR PE, diagnosed in accordance with the ESC Guidelines. All patients underwent a CDT either with USAT (EKOS, Boston Scientific) or MT (FlowTriever System, Inari). Right heart function (RV/LV ratio, TAPSE) was assessed via transthoracic echocardiography before and after CDT as well as interventional characteristics and postinterventional hospital stay were compared. Results: From June 2022 to April 2024, 26 patients (35% female; aged 61.2±15.2 years) were diagnosed with IHR PE and underwent CDT. 14 patients (53.8%) were treated with USAT and 12 patients (46.2%) with MT. The mean procedural time was 40.4±19.8 minutes for USAT and 104±32.2 minutes for MT. RV/LV ratio was improved in both groups (change from baseline USAT -0.48±0.25; MT -0.36±0.13). TAPSE increased by 6.95±3.7 mm in USAT and by 9.8±4.6 mm in MT. Major bleeding (defined as BARC ≥ 3a) occurred only in three patients of the USAT group. The 90-day mortality rate was 0% in both groups. Conclusions: In patients with IHR PE both USAT and MT lead to an improved RV function without mortality within 90 days. Further randomized data have to discriminate the differential impact of novel tools for the treatment of IHR PE.

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引用次数: 0
Large-bore rotational thrombectomy and balloon angioplasty for thrombus fragmentation and removal from occluded iliofemoral or inferior vena cava stents. 大口径旋转血栓切除术和球囊血管成形术用于栓塞的髂股静脉或下腔静脉支架的血栓碎裂和移除。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-20 DOI: 10.1024/0301-1526/a001176
Gabor Forgo, Riccardo Fumagalli, Silvia Cardi, Stefano Barco, Nils Kucher, Tim Sebastian

Background: Although venous stent placement is an established treatment for patients with deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS), stent patency rate may be as low as 80% at 12 months. Treatment of stent occlusion requires the removal of a large amount of fresh or organized thrombus from stents with a diameter of 12-20 mm. The feasibility of large-bore rotational thrombectomy in combination with angioplasty to treat thrombosed venous iliofemoral or inferior vena cava stents has not been investigated yet. Patients and methods: Between May 2023 and June 2024, 12 patients (15 limbs) with symptomatic venous stent occlusions were treated at our institution with the 10-French Rotarex™ thrombectomy device and completed 3-month follow-up by Duplex ultrasound. The primary outcome was primary patency at 90 days after thrombectomy of stent occlusion. Safety outcomes included device-related complications, bleeding, and death. Results: Median age was 41 years, 75% were women. At the index procedure, 10 (83%) patients presented with PTS and two (17%) with acute DVT. Median time from index procedure to re-intervention was 1125 (Q1-Q3: 897-2297) days and from symptom onset to re-intervention 39 (Q1-Q3: 8-186) days. Technical success of re-intervention was achieved in all cases, and bail-out stent-in-stent placement was not required in 5 (33%) limbs. The primary patency rate at 90 days was 86.7% (95% CI: 71.0-100.0). Two (17%) patients experienced recurrent stent thrombosis and were managed conservatively. Peri-interventional minor bleeding occurred in two (17%) patients. There were no device-related complications, major bleeding, or deaths. Conclusions: Large-bore rotational thrombectomy appears to be a feasible strategy to treat iliofemoral and inferior vena cava stent thrombosis, achieving acceptable short-term patency without major adverse events.

背景:虽然静脉支架放置是深静脉血栓形成(DVT)和血栓后综合征(PTS)患者的既定治疗方法,但支架在12个月时的通畅率可能低至80%。支架闭塞的治疗需要从直径为12- 20mm的支架中去除大量新鲜或有组织的血栓。大口径旋转取栓联合血管成形术治疗血栓形成的髂股静脉支架或下腔静脉支架的可行性尚未研究。患者和方法:2023年5月至2024年6月,我院采用10-French Rotarex™取栓装置治疗症状性静脉支架闭塞患者12例(15条肢体),双工超声随访3个月。主要结果是支架闭塞取栓后90天的初步通畅。安全性结果包括器械相关并发症、出血和死亡。结果:中位年龄41岁,75%为女性。在指数手术中,10例(83%)患者出现PTS, 2例(17%)出现急性DVT。从指数检查到再次干预的中位时间为1125天(Q1-Q3: 897-2297),从症状出现到再次干预的中位时间为39天(Q1-Q3: 8-186)。所有病例再次介入手术均取得技术上的成功,5例(33%)肢体不需要置入术。90天原发性通畅率为86.7% (95% CI: 71.0-100.0)。2例(17%)患者复发支架血栓形成,采用保守治疗。2例(17%)患者发生介入性轻度出血。没有器械相关并发症、大出血或死亡。结论:大口径旋转取栓似乎是治疗髂股静脉和下腔静脉支架血栓形成的可行策略,可获得可接受的短期通畅,无重大不良事件。
{"title":"Large-bore rotational thrombectomy and balloon angioplasty for thrombus fragmentation and removal from occluded iliofemoral or inferior vena cava stents.","authors":"Gabor Forgo, Riccardo Fumagalli, Silvia Cardi, Stefano Barco, Nils Kucher, Tim Sebastian","doi":"10.1024/0301-1526/a001176","DOIUrl":"https://doi.org/10.1024/0301-1526/a001176","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Although venous stent placement is an established treatment for patients with deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS), stent patency rate may be as low as 80% at 12 months. Treatment of stent occlusion requires the removal of a large amount of fresh or organized thrombus from stents with a diameter of 12-20 mm. The feasibility of large-bore rotational thrombectomy in combination with angioplasty to treat thrombosed venous iliofemoral or inferior vena cava stents has not been investigated yet. <i>Patients and methods:</i> Between May 2023 and June 2024, 12 patients (15 limbs) with symptomatic venous stent occlusions were treated at our institution with the 10-French Rotarex™ thrombectomy device and completed 3-month follow-up by Duplex ultrasound. The primary outcome was primary patency at 90 days after thrombectomy of stent occlusion. Safety outcomes included device-related complications, bleeding, and death. <i>Results:</i> Median age was 41 years, 75% were women. At the index procedure, 10 (83%) patients presented with PTS and two (17%) with acute DVT. Median time from index procedure to re-intervention was 1125 (Q1-Q3: 897-2297) days and from symptom onset to re-intervention 39 (Q1-Q3: 8-186) days. Technical success of re-intervention was achieved in all cases, and bail-out stent-in-stent placement was not required in 5 (33%) limbs. The primary patency rate at 90 days was 86.7% (95% CI: 71.0-100.0). Two (17%) patients experienced recurrent stent thrombosis and were managed conservatively. Peri-interventional minor bleeding occurred in two (17%) patients. There were no device-related complications, major bleeding, or deaths. <i>Conclusions:</i> Large-bore rotational thrombectomy appears to be a feasible strategy to treat iliofemoral and inferior vena cava stent thrombosis, achieving acceptable short-term patency without major adverse events.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012663","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
Antithrombotic therapy impact on patency and bleeding complications of arteriovenous graft placement in dialysis patients. 抗血栓治疗对透析患者动静脉移植物置放通畅及出血并发症的影响。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-13 DOI: 10.1024/0301-1526/a001177
Konstantinos Dakis, Petroula Nana, Konstantinos Spanos, George Apostolidis, Christos Karathanos, Athanasios Giannoukas, Christian-Alexander Behrendt, Miltiadis Matsagkas, George Kouvelos

Background: Arteriovenous grafts (AVG) can be the only bailout solution for patients who require kidney replacement therapy but are unsuitable for arteriovenous fistula (AVF) creation. Currently, high-level evidence on the effectiveness and safety of antithrombotic therapy in AVG patients is scarce. Materials and methods: Following the PICO (patient; intervention; comparator; outcome) model and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a data search of the English literature in PubMed, SCOPUS, Central Cochrane was conducted, until March 1st, 2023 (PROSPERO Protocol Number: CRD42023401785). Studies on humans with an AVG receiving any kind of antithrombotic medication, reporting on primary and secondary patency rates, and bleeding complications were included. Due to data heterogeneity, a descriptive report of the outcomes was undertaken. Results: Twelve studies, including 22,436 patients with end-stage renal disease (ESRD) and AVG were included, with patient recruitment spanning over a 41-year time-period (1982-2023). Antithrombotic factors included acetylsalicylic acid (ASA), clopidogrel, dipyridamole, warfarin, unfractioned heparin (UFH), and direct oral anticoagulants (DOACs). Ten studies reported on primary patency rates, and two on secondary patency rates. Primary and secondary patency rates (PPR, SPR) were reported better in four studies, similar in three and worse in one study, regarding patients receiving any kind of antiplatelet therapy. Anticoagulation therapy was not associated with increased PPR or SPR, except for one study on apixaban. Patients receiving single or combined antiplatelets versus patients receiving no treatment presented higher bleeding risk in two studies and similar bleeding risk in three studies. Anticoagulation therapy, excluding apixaban, was associated with higher bleeding risk in three studies, when compared to no anticoagulation. Conclusions: Data derived from the current literature were equivocal regarding the use of antiplatelet treatment in patients with AVG. Studies on anticoagulation therapy are confined. Randomized trials with confounder stratification remain crucial for robust long-term data.

背景:对于需要肾脏替代治疗但不适合制造动静脉瘘的患者,动静脉移植(AVG)可能是唯一的救助方案。目前,关于AVG患者抗血栓治疗的有效性和安全性的高水平证据很少。材料和方法:PICO(患者;干预;比较器;在PubMed, SCOPUS, Central Cochrane的英文文献中进行数据检索,直到2023年3月1日(PROSPERO协议号:CRD42023401785)。包括对接受抗血栓药物治疗的房颤患者的研究,报告原发性和继发性通畅率,以及出血并发症。由于数据异质性,对结果进行了描述性报告。结果:纳入了12项研究,包括22,436例终末期肾病(ESRD)和AVG患者,患者招募时间跨度为41年(1982-2023)。抗血栓因子包括乙酰水杨酸(ASA)、氯吡格雷、双嘧达莫、华法林、未分离肝素(UFH)和直接口服抗凝剂(DOACs)。10项研究报道了原发性通畅率,2项研究报道了继发性通畅率。在接受任何抗血小板治疗的患者中,有4项研究报告原发性和继发性通畅率(PPR, SPR)较好,3项研究报告相似,1项研究报告较差。除了一项关于阿哌沙班的研究外,抗凝治疗与PPR或SPR的增加无关。在两项研究中,接受单一或联合抗血小板药物治疗的患者与未接受治疗的患者相比,出血风险更高,在三项研究中,出血风险相似。在三项研究中,抗凝治疗(不包括阿哌沙班)与不进行抗凝治疗相比,出血风险更高。结论:目前文献中关于AVG患者使用抗血小板治疗的数据是模棱两可的,关于抗凝治疗的研究是有限的。混杂因素分层的随机试验对于获得可靠的长期数据仍然至关重要。
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引用次数: 0
Large language models in rare disease: accuracy in addressing fibromuscular dysplasia questions. 罕见疾病中的大型语言模型:解决纤维肌肉发育不良问题的准确性。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-09 DOI: 10.1024/0301-1526/a001175
Leben Tefera, Akiva Rosenzveig, Judah Rajendran, Bhairavi Rajasekar, Joseph Kassab, Deborah Hornacek, Meghann McCarthy, Teresa Wu, Natalia Fedrikova Mahlay, Pulkit Chaudhury
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引用次数: 0
Comparison of endovascular infrapopliteal revascularisation strategies based on the angiosome model in diabetics with CLTI. 基于血管小体模型的糖尿病 CLTI 患者血管内皮下血运重建策略的比较。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-01 Epub Date: 2024-10-23 DOI: 10.1024/0301-1526/a001153
Hans-Ulrich Kreider-Stempfle, Thomas Remp, Sibylle Puntscher, Uwe Siebert, Norah Kreider

Background: Infrapopliteal endovascular interventions (EVT) strategies in diabetic patients are still in debate because the lesions are more likely to be diffuse with a different pattern of collateral arteries ranging from reduced to normal caliber. The aim of this all-comers study was to analyse the outcome of two different infrapopliteal EVT strategies (Group I: angiosome-based direct revascularization - DR vs. Group II: complete (direct + indirect) revascularization strategy - CR) in diabetic patients with chronic limb-threatening ischemia (CLTI) in 2 time-periods. Furthermore we analysed the outcome if DR or CR failed and only indirect revascularization (IR) or no revascularization was possible. Both groups were differentiated in patients with collaterals, defined as an intact pedal arch (immediate or after pedal PTA). Patients and methods: The database includes 91 consecutive EVT with two intrapopliteal interventional strategies performed in 68 diabetic patients (pts. 24 female, 44 male, mean age 73±10 years) between 2013-2016 and 2017-2022. Positive clinical outcome was defined as wound healing with or w/o minor amputation, combined with a symptom improvement to Rutherford category 0 or 1 after 6 months. The clinical outcome proportions were compared using the Fisher's exact test. Results: Successful DR (59%) and successful CR (47%) strategy demonstrated a similar positive clinical outcome (92.6% vs. 90.5%; p=0.594). Indirect revascularization (Group I: 26%; Group II: 44%) showed a significantly lower positive outcome in comparison to a successful DR as well as CR strategy (33.3% vs. 92.6%, p=0.0003; 40% vs 90.5%, p=0.001). IR outcome improved by the presence of collaterals (66.7% vs. 30.8%). Conclusions: In case of successful intervention, both strategies (DR and CR) yielded a similarly high proportion of positive clinical outcome. The role of collaterals and the pedal arch on the clinical outcome are important in patients in whom only IR was possible.

背景:糖尿病患者的髂腹下血管内介入治疗(EVT)策略仍存在争议,因为病变更有可能是弥漫性的,侧支动脉的形态也不尽相同,有的直径缩小,有的直径正常。本研究的目的是分析两种不同的腘窝下EVT策略(第一组:基于血管造影剂的直接血管再通--DR与第二组:完全(直接+间接)血管再通策略--CR)在两个时间段内对患有慢性肢体缺血(CLTI)的糖尿病患者的治疗效果。此外,我们还分析了如果 DR 或 CR 失败,只能进行间接血管再通(IR)或无法进行血管再通的结果。两组患者均有肢体侧支,即完整的足弓(立即或在足弓 PTA 后)。患者和方法:数据库包括2013-2016年和2017-2022年期间为68名糖尿病患者(患者24名女性,44名男性,平均年龄(73±10)岁)实施的91例连续EVT,采用两种髂内介入策略。阳性临床结果定义为伤口愈合,伴有或不伴有轻微截肢,6个月后症状改善至卢瑟福0类或1类。临床结果比例的比较采用费雪精确检验。结果如下DR成功率(59%)和CR成功率(47%)显示出相似的积极临床结果(92.6% vs. 90.5%;P=0.594)。与成功的 DR 和 CR 策略相比,间接血运重建(第一组:26%;第二组:44%)的阳性结果明显较低(33.3% vs. 92.6%,p=0.0003;40% vs. 90.5%,p=0.001)。红外预后因存在侧支而有所改善(66.7% 对 30.8%)。结论在干预成功的情况下,两种策略(DR 和 CR)都能产生类似高比例的积极临床结果。对于只能进行 IR 治疗的患者,瓣膜和足弓对临床结果的影响非常重要。
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引用次数: 0
Impact of polypharmacy on patients undergoing revascularisation for peripheral arterial disease. 多药治疗对接受外周动脉疾病血管重建术患者的影响。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-01 Epub Date: 2024-11-25 DOI: 10.1024/0301-1526/a001164
Philipp Franke, Emmanuel Katsogridakis, Theodosios Bisdas, Athanasios Saratzis, Giovanni Torsello, Nikolaos Tsilimparis, Konstantinos Stavroulakis

Background: To evaluate the impact of polypharmacy, defined as the concurrent use of five or more medications, on the clinical outcomes of patients undergoing revascularisation for symptomatic peripheral arterial disease (PAD). Patients and methods: This is a retrospective analysis of consecutive PAD patients treated by surgical, endovascular or hybrid therapy in a tertiary center between January 2017 and December 2017. The composite of amputation and/or death (amputation-free survival; AFS) was the primary endpoint. Mortality, major limb amputation, risk for Major Cardio-Cerobro-vascular Events (MACCE) and re-intervention during follow-up were additionally analyzed. Results: A total of 560 patients (369 male, 66%) were included. Mean age was 72.43 ± 38.67, while the main indication for treatment was lifestyle limiting claudication (330 patients, 59%). Most patients (434, 78%) were treated with endovascular means, and the commonest anatomical site of intervention was the femoropopliteal arterial segment (449 patients, 80%). A total of 409 (73%) met the criteria for polypharmacy. Cox regression analysis showed that polypharmacy was an independent predictor of death (exp: 4.72, p=0.008), MACCE (exp: 2.82, p=0.001), re-intervention (exp 1.51, p=0.0016) and of the composite outcome of AFS (exp: 3.46, p=0.021) but not of major amputation (exp: 1.26, p=0.686). Propensity-score matching analysis showed that even when controlling for comorbidity and procedural characteristics, polypharmacy is associated with a higher risk of cardiovascular death (p<0.001), MACCE (p<0.001), and re-intervention (p=0.001). Conclusions: In this study, polypharmacy was associated with unfavourable clinical outcomes for patients undergoing revascularisation for symptomatic PAD, without influencing the risk for major limb amputation.

背景:目的:评估多重用药(即同时使用五种或五种以上药物)对因无症状外周动脉疾病(PAD)而接受血管重建手术的患者临床预后的影响。患者和方法:这是一项回顾性分析,对象是2017年1月至2017年12月期间在一家三级中心接受手术、血管内或混合疗法治疗的连续PAD患者。截肢和/或死亡的复合死亡率(无截肢生存率;AFS)是主要终点。此外,还分析了死亡率、主要肢体截肢、主要心脑血管事件(MACCE)风险和随访期间的再干预情况。研究结果共纳入 560 名患者(369 名男性,66%)。平均年龄为(72.43 ± 38.67)岁,主要治疗指征为生活方式限制性跛行(330 名患者,占 59%)。大多数患者(434 人,78%)接受了血管内治疗,最常见的介入部位是股动脉段(449 人,80%)。共有 409 名患者(73%)符合多药治疗标准。Cox回归分析显示,多药是死亡(指数:4.72,P=0.008)、MACCE(指数:2.82,P=0.001)、再次介入(指数:1.51,P=0.0016)和AFS综合结果(指数:3.46,P=0.021)的独立预测因素,但不是大截肢(指数:1.26,P=0.686)的独立预测因素。倾向得分匹配分析表明,即使控制了合并症和手术特征,多药治疗仍与较高的心血管死亡风险相关(p结论:在这项研究中,多药治疗与因症状性 PAD 而接受血管重建术的患者的不利临床结果有关,但不会影响主要肢体截肢的风险。
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引用次数: 0
Fantastic Plastic? 梦幻塑胶?
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-01 DOI: 10.1024/0301-1526/a001165
Mirko Vogler, Max Jonathan Stumpf, Norbert Weiss
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引用次数: 0
Distinct patient characteristics are associated with clinical presentation and prognosis in thromboangiitis obliterans. 血栓闭塞性脉管炎的不同患者特征与临床表现和预后相关。
IF 2.1 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-01 Epub Date: 2024-11-29 DOI: 10.1024/0301-1526/a001158
Andrea Gawaz, Jessica Kristin Henes, Simon Schlegel, Tatsiana Castor, Karin Müller, Meinrad Gawaz, Dominik Rath

Background: Thromboangiitis obliterans (TAO) is a rare but threatening disease associated with significant morbidity and mortality. The pathophysiology is poorly understood, the diagnosis is often obscure and causal treatment options are limited. In the current study, we aimed to identify distinct TAO patient clusters that differed in clinical presentation and prognosis. Patients and methods: We retrospectively analysed a cohort of 48 patients with the working diagnosis TAO who were assessed for clinical presentation at hospital admission. We applied hierarchical clustering to divide patients into clinically meaningful subgroups. Results: Patients were followed-up for a median of 95 months. We found that cluster analyses including a variety of demographic and diagnostic parameters were valuable to identify patient subgroups with similar clinical presentation, but with different clinical course of the disease, including the individual risk for mortality and major amputation. Patients treated with statins showed a significantly better survival, which may allow us to hypothesize that a conventional secondary prevention strategy, which is recommended for atherosclerotic artery diseases, may be of benefit also in patients that present with TAO. Conclusions: The current data may help to develop strategies to identify high-risk TAO patients. Furthermore, statins may serve as a readily available therapeutic option to this rare but serious disease.

背景:血栓闭塞性脉管炎(TAO)是一种罕见但危险的疾病,发病率和死亡率都很高。病理生理学知之甚少,诊断往往模糊不清,因果治疗的选择是有限的。在目前的研究中,我们旨在确定临床表现和预后不同的不同TAO患者群。患者和方法:我们回顾性分析了48例工作诊断为TAO的患者,他们在入院时进行了临床表现评估。我们采用分层聚类将患者分为有临床意义的亚组。结果:患者随访时间中位数为95个月。我们发现,包括各种人口统计学和诊断参数的聚类分析对于确定具有相似临床表现但具有不同临床病程的患者亚组(包括个体死亡和主要截肢风险)是有价值的。接受他汀类药物治疗的患者表现出明显更好的生存率,这可能使我们假设传统的二级预防策略,推荐用于动脉粥样硬化性动脉疾病,也可能对TAO患者有益。结论:目前的数据可能有助于制定识别高危TAO患者的策略。此外,对于这种罕见但严重的疾病,他汀类药物可能是一种现成的治疗选择。
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Vasa-european Journal of Vascular Medicine
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