Vasa-european Journal of Vascular Medicine最新文献

Peripheral Artery Disease (PAD) is a significant global health concern, leading to morbidity through progressive stenosis and eventually occlusion of the lower extremity arterial vasculature. Advanced imaging modalities play a major role in diagnosing PAD, in planning endovascular as well as surgical interventions, and in monitoring post-treatment outcomes. This review highlights the current major imaging techniques, including duplex ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA). It provides insights into their applications, advantages, limitations and the importance of individualized imaging strategies for optimizing patient outcomes.

Background: Peripheral artery disease (PAD) remains under-recognised. Low awareness among the public, patients and healthcare professionals (HCPs) contributes to delayed diagnosis and poorer outcomes. This rapid review applied the Model of Pathways to Treatment (MPT) to synthesise behavioural and system-level factors shaping the diagnostic pathway and identifies evidence gaps to inform intervention and service redesign. Patients and methods: Databases (CINAHL, PubMed, PsycINFO) were searched (January 2001-July 2024) for qualitative, quantitative or mixed-methods studies exploring PAD diagnosis from the perspective of patients, at-risk public or HCPs. Eligible studies examined events, behaviours or timings linked to PAD diagnosis. Quality was assessed using the Mixed Methods Appraisal Tool and findings synthesised using the MPT. Results: Twenty-one studies (13 quantitative, 7 qualitative, 1 mixed method) were included. Mapping to the MPT revealed modifiable, multifactorial barriers across the diagnostic pathway from symptom appraisal to pre-treatment. At the patient level, symptom misattribution, normalisation, competing priorities, fear and financial concerns delayed help-seeking. At the provider level, HCPs often lacked training, confidence or incentives to assess PAD, with underuse of tools including the ankle-brachial index. At the system level, referral delays were linked to unclear pathways and limited feedback from vascular services. Only one study explored variations in diagnosis timeline by population or setting. Conclusions: Although PAD is under diagnosed and associated with poor outcomes, few studies have examined the behavioural and structural factors delaying diagnosis. This review identifies missed opportunities along the diagnostic pathway and highlights targets for future research and intervention across patient, HCP and system levels.

Background: Atherectomy-assisted endovascular revascularization has emerged as a promising treatment tool with high technical success rates in complex and calcified peripheral artery disease (PAD). Our aim was to evaluate sex-specific differences in patients undergoing atherectomy-assisted endovascular revascularization. Patients and methods: Consecutive patients with symptomatic PAD, undergoing rotational atherectomy were included in a prospective single-centre registry. Demographic and clinical data and lesion localization were recorded in men and women. The primary safety endpoint was vessel perforation and peripheral embolization. Secondary endpoints were clinically driven target lesion revascularization (CD-TLR) and mortality rates during follow-up. Results: Overall, 632 patients (847 lesions, median length = 18.0 cm) were analysed (244 women and 388 men). Median age was 78.0 (69.0-84.0) years. Women were older than men (p<.001), while CLTI, diabetes and BTK lesions were more common in men (65.4% versus 58.2%, p<.05, 53.1% versus 38.5%, p=.004, and 35.9% vs. 21.6%, p<.0001, respectively). Lesion length and complexity by TASC were similar in men and women, while men showed higher calcification by PACSS (p=.03). High procedural success rates (99.5%) and low complications rates were observed. Women received less stents than men in the femoropopliteal segment (p=.03). Complication rates were similar between men and women (1.3% versus 2.5%, p=.28 for perforation and 1.5% versus 2.9%, p=.25 for embolization). CD-TLR and mortality rates were similar in men and women. Conclusions: Our study confirms the safety and effectiveness of front cutting rotational atherectomy in men and women presenting with complex and symptomatic PAD. Patient safety was present in men and women, whereas CD-TLR rates were relatively low in both sexes.

Background: Bridging Stent Grafts (BSG) are an essential element of fenestrated and branched endovascular aortic repair (FEVAR and BEVAR respectively). Until CE marking of a dedicated stent in late 2024, a variety of BSG were used. The aim of this study was to evaluate the outcomes of the iCover stent graft in this application. Patients and methods: We retrospectively analysed 22 consecutive patients treated at our institution with FEVAR and BEVAR between 05/2023 and 09/2024. The primary endpoint is a composite of target vessel (TV) technical success and freedom from target vessel instability (TVI) in the early and short-/mid-term phase. Secondary endpoints consisted of early, short- and mid-term clinical outcomes. Results: Ninety-seven iCover stent grafts were used to bridge 90 target vessels: 23 for the coeliac arteries (CA), 23 for the superior mesenteric artery (SMA) and 50 for the renal arteries (RA); one iCover stent could not be implanted. The underlying aortic pathology was juxtarenal and pararenal aneurysm (12/22; 54,5%), penetrating aortic ulcer (PAU) (2/22; 9%), type Ia endoleak following infrarenal EVAR (3/22; 13,6%), chronic type B aortic dissection with aneurysmal degeneration (1/22; 4,5%), Safi type IV (3/22; 13.6%) and Safi type V (1/22; 4.5%) thoraco-abdominal aortic aneurysm (TAAA). The mean aneurysm diameter was 60,5 mm (+/- 10,6 mm). Four (18,2%) patients underwent urgent procedures. The median follow-up was 291,5 days (IQR 63-425,2). 3 patients (13,6%) died from non-aneurysm-related causes. Assisted primary TV technical success was 98,88% (89/90). One non-iCover related loss of TV was excluded from mid-term analysis. The TV patency was 98,88% (89/90) in the early phase and 98,87% (88/89) at mid-term follow-up. Cumulative freedom from TVI was 92,13% (82/89). Conclusions: The iCover is effective and safe to use as a BSG in fenestrated endovascular aortic repair. Our results align with the available literature, but further studies are needed to validate iCover as BGS, especially in BEVAR.

Peripheral artery disease (PAD) affects up to 10% of people older than 50 years in Western Europe and North America, of which the worst clinical spectrum being chronic limb-threatening ischemia (CLTI). It is estimated that up to 20% of patients with CLTI are deemed un-reconstructable cases due to the absence of a suitable distal target vessel or conduit. Recently, percutaneous deep vein arterialization (pDVA) of the foot has been described to treat these patients. Technically arterialization of the deep foot veins is achieved by creating a communication between one of the tibial arteries with the deep veins in the foot. The Limflow system (Inari Medical TM) is the only CE-approved device for this technique. The PROMISE I, II, and UK provided the evidence to back the use of the Limflow system. Because of the limited availability and high cost of the LimFlow System, several studies have reported various off-the-shelf techniques described by authors attempting to achieve pDVA using alternative devices. In this review, we looked at some technical aspects of off-the-shelf pDVA and examine the outcomes in terms of technical success rates, wound healing rates, amputation free survival rates and re-interventions in comparison to those reported after the use of the Limflow system.

Background: Atherectomy emerged recently as an interventional modality for vessel preparation with high rates of mid-term primary patency. However, data regarding the comparison of rotational atherectomy for long calcified lesions with bypass surgery above-the-knee are lacking. Aim to investigate early and mid-term outcomes of this endovascular treatment compared to bypass surgery. Patients and methods: In this retrospective analysis, patients with de novo occlusive TASC D lesions of the superficial femoral artery (SFA) were included. A synthetic above-knee femoropopliteal bypass was preferred as the initial treatment approach for patients with absence of a patent origin/stump of the SFA (group A). On the other hand, in case of patent stump of the SFA of at least 1 cm or more, an endovascular approach with rotational atherectomy and DCB angioplasty with bail-out stenting was preferred (group B). Results: Thirty-eight patients formed group A, and thirty-nine group B. Technical success/stent free technical success was met in 37/38 patients in group A and in 29/39 patients in group B respectively (p<.001). Primary patency was 89.5% in group A compared to 94.7% in group B (log rank test: p=.468), while the secondary patency was 94.9% versus 94.7% (log rank test: p=.068). In group B, two patients required re-intervention 24 months after the initial procedure. In group A, two patients suffered from bypass occlusion occurring 8 months after the initial procedure and unterwent a re-intervention. Conclusions: Endovascular atherectomy-assisted revascularisation and prosthetic bypass exhibit good patency. The time of occurrence of re-interventions differ between the 2 groups unterlining the need for meticulous follow up.

Background: Vascular medicine/angiology plays a crucial role in managing vascular diseases, yet its recognition, training, and practice vary across Europe. To understand these disparities, the European Society for Vascular Medicine (ESVM) conducted a survey among young trainees to assess their attitudes and perception towards vascular medicine training. Methods: A cross-sectional survey was distributed among trainees and young specialists from European countries, including nations with and without vascular medicine as a recognized specialty. The survey was published on the ESVM website and shared through national vascular medicine societies. Participants provided insights into their training experiences, opinions of the specialty, and priorities for improvement. Statistical analysis compared responses based on specialty recognition. Findings: Among 210 respondents, 36.2% (n=76) were from countries without formal specialty recognition. Training was more structured in countries with a recognized specialty (p<.001). Multidisciplinary team meetings were deemed critical by 98.1% but were more common in countries with a recognized specialty (p=.003). Overall, 80.5% (n=169) expressed interest in training abroad. Core vascular domains were well-covered, while areas like lymphatic and microvascular diseases lacked sufficient training both in countries where the specialty was recognized and where it was not. Respondents from countries with a recognized specialty rated their training significantly higher (p=.001). Despite challenges, 85.2% (n=179) would choose the specialty again, and 90.4% (n=190) supported a unified European certification. Interpretation: These findings highlight the need for a harmonized training framework in Europe ensuring a shared foundational curriculum in vascular medicine while enhancing professional mobility and improving patient care across the whole spectrum of vascular diseases.

Background: Supervised exercise therapy (SET) is a first-line treatment for patients with symptomatic peripheral artery disease (PAD). However, its impact on inflammation, as well as the relationship between inflammation and functional improvements, remain poorly understood. Patients and methods: In this prospective, single-arm study, 51 patients with symptomatic PAD underwent a 12-week multimodal SET program. Limb perfusion, walking ability, and estimated muscle power were assessed before and after SET. Inflammatory gene expression in peripheral blood mononuclear cells was evaluated by real-time quantitative PCR. Response to SET was defined as an improvement of >46 m in the six-minute walking distance (6MWD). Results: Following SET, mRNA expression levels significantly decreased for polymorphonuclear (PMN)-elastase (-48%; p=.003) and myeloperoxidase (MPO) (-39%; p=.002). Trends toward reduction were also observed for matrix metalloproteinase-9 (MMP-9) (-42%; p=.070), neutrophil gelatinase-associated lipocalin (NGAL) (-37%; p=.069), and protein-arginine deiminase type 4 (PAD4) (-29%; p=.052). Linear mixed models indicated similar changes between responders and non-responders. After adjusting the model for baseline gene expression levels and clinically relevant covariates, a significant post-SET reduction was observed in both responders and non-responders for PMN-elastase (p=.027 and p<.001, respectively), MMP-9 (both p=.003), and MPO (p=.016 and p=.003, respectively). PAD4 expression significantly decreased only in non-responders (p=.045). Regression analyses revealed no associations between inflammatory gene expression and perfusion, walking ability, or muscle power. Conclusions: SET may reduce the expression of several inflammatory markers in patients with symptomatic PAD, independently of functional gains. Further studies are needed to confirm these findings and to explore whether reducing systemic inflammation translates into improved cardiovascular outcomes in this population.

Background: Endovascular therapy has emerged as an effective minimally invasive approach for treating peripheral artery disease (PAD). Postprocedural dual antiplatelet therapy (DAPT) is commonly used to prevent adverse events, but optimal management remains uncertain. Patients and methods: This international, multicentre retrospective study synthesized data from three studies on covered stents (VIABAHN^® Endoprosthesis) in 437 PAD patients (2001-2015). A dimension index (total stent length/smallest diameter) was developed and externally validated in a second cohort (n=148). Results: Among 321 patients with DAPT, univariate analysis showed no association between the initiation of DAPT and reduced major adverse limb events (MALE). Longer total covered length (aHR: 1.02) and smoking (aHR: 1.43) were associated with increased MALE, while stent diameters of 7-8mm showed a protective effect (aHR: 0.30). Cox proportional hazards models repeatedly showed that both the duration of DAPT and the dimension index (total covered length/smallest stent-graft diameter) were significantly associated with MALE after adjusting for other confounders. However, in a sensitivity analyses, no significant impact of DAPT on MALE was observed in patients with a high dimension index. Conclusions: These findings suggest while longer DAPT strategies might be protective towards MALE, stent-graft properties might be at least as relevant if not more determining regarding impaired outcomes after femoropopliteal interventions. Individualizing DAPT duration based on stent proportions might offer further opportunities for optimized protocols by personalized pharmacological therapies.

Background: Thoracic endovascular aortic repair (TEVAR) involving the left subclavian artery (Ishimaru zone 2) presents technical challenges. This multicentre study evaluates the Ankura thoracic stent graft with in-situ fenestration using a dedicated needle system (Lifetech, Shenzhen, China) for various thoracic aortic pathologies. Patients and methods: Between January 2020 and December 2025, 59 patients from three tertiary centres underwent in-situ fenestration TEVAR (if-TEVAR) for thoracoabdominal aortic pathologies. Clinical and imaging data were analysed, focusing on technical success, complications, and mid-term outcomes. Results: Demographics and comorbidities were comparable across pathologies. The SVS/AAVS age score was higher in TAAA and PAU patients (p=.005). Dissection cases required more grafts (p=.027), larger proximal diameters (p=.022), and showed less distal oversizing in TAAA (p=.031). Differences were noted in fenestration time (p=.049), stent type (p=.032), and adjunctive procedures (p<.001). Technical success was 93.2% (55/59), with no significant variation among groups. One patient died within 30 days (2% mortality). ICU/hospital stays and complications were similar. Conclusions: if-TEVAR with the Ankura graft in zone 2 is feasible with acceptable outcomes. Larger studies with extended follow-up are needed to confirm durability.