Background: Endovascular aortic aneurysm repair (EVAR) has evolved into a widely established alternative to traditional open surgical repair. For EVAR procedures, both mobile (standard operating room (SOR)) and fixed C-arm (hybrid operating room (HOR) systems are available. The aim of our study was to evaluate the advantages of implementing a HOR for endovascular aortic aneurysm repair at a new vascular surgery centre. Materials and methods: Between April 2020 and December 2024, data of 140 patients who treated endovascularly for aortic aneurysms (AAs) were retrospectively evaluated. In detail, between April 2020 and March 2023, in 43 consecutive cases a mobile C-arm device was used, compared to the second period from April 2023 up to December 2024 when 97 consecutive patients with AAs were treated in a HOR. Primary endpoints of the study were procedural duration, radiation exposure time, and radiation dose. Results: Radiation exposure was significantly lower in the HOR group, with median radiation time of 15.3 vs. 23.1 minutes and median dose of 7.9 vs. 13.5 Gy·cm2 (p<.001). The EVAR radiation time (14.1 vs. 20.6 minutes) and dose (6.6 vs. 11.4 Gy·cm2) remained significantly lower in the HOR group (p<.001). The implementation of the HOR was associated with a 125% increase of treated cases, resulting in a nearly four-fold rise of the total monthly case volume compared to the first period with the mobile C-arm. Discussion: The results of our study highlight the advantages of the HOR, such as reduced radiation, improved workflow efficiency and greater procedural capacity. Conclusions: Newly founded vascular centres should consider incorporating a HOR at the earliest opportunity.
Background: Endovascular endothelial cell biopsy (ECBx) allows direct sampling of endothelial cells (ECs) and subsequent assessment of EC function in patients. Our systematic review aims to summarise the current literature describing protocols to obtain and analyse EC and obtain pooled estimates of success rate and EC numbers obtained with different techniques in different populations. Materials and methods: Studies were identified on Medline using the terms 'endothelial cell' AND 'biopsy' AND 'humans'. All primary research involving EC biopsy was included, while animal studies or non-primary research studies were excluded from the review. The data was integrated into a narrative review and the study was registered with PROSPERO (CRD42022278551). Results: Of all journal articles identified (n=784), 51 articles were included in this review. Most studies (n=46) used a J wire for EC sampling from blood vessels in the arm (superficial arm veins [n=30], brachial artery [n=3], radial artery [n=4]). The pooled success rate was 91±15%. The average yield was 1,058±893 cells per biopsy, with variability depending on procedural factors such as wire placement, depth and technique. No significant complications were reported. Several analytical techniques were used to evaluate the isolated ECs with the most common technique being immunofluorescence (n=36). Risk of bias assessment and statistical analysis not performed due to heterogeneity of data and variability in reporting. Conclusions: Endothelial cells can be obtained with a variety of techniques with a high success rate and minimal complications. This review highlights novel research opportunities provided by ECBx.
More than 60 years after withdrawal of ConterganR (thalidomide) from the market, the issue is more relevant than ever for physicians specialised in vascular medicine and cardiology due to the age-related increased use of appropriate health services by those affected. We describe cardiovascular abnormalities of thalidomide embryopathy and point out clinically relevant features that may have a profound influence on the disease management. We also describe and discuss whether arteriosclerotic diseases and complications occur more frequently in those affected by thalidomide embryopathy than in the general population.
Background: Several studies have demonstrated the participation of by-products of the NF-kB pathway in thromboangiitis obliterans, however, the involvement of microRNAs 21, 126 and 181b that are related to this pathway in TAO activation is unknown. Patients and methods: We analyzed the serum levels of miR-21, miR-126 and miR-181b in TAO patients at two times separated by 6 months (TAO-1 and TAO-2 groups) and compared them with three healthy control groups with smokers (SC), former smokers (FSC) and never smokers (NSC). Results: Three patients activated the disease between periods TAO-1 and TAO-2, with elevation of the studied microRNAs. We identified an overexpression of miR-21 in TAO-2 compared to NSC (CI 5.37-21.45; p<0.01); FSC (CI 1.46-18.14; p=0.02) and SC (CI 0.97-16.13; p=0.03). MiR-126 showed overexpression in TAO-2 relative to NSC (CI 3.36-30.95. p=0.02). MiR-181b showed overexpression relative to NSC (CI 0.27-14.18. p=0.04). The groups with a history of smoking had higher means of the microRNAs studied, but without statistical difference. Conclusions: Serum levels of microRNAs 21, 126 and 181b appears to be upregulated in TAO patients and to correlate with periods of greater disease activity, but further studies with a larger number of patients are needed to validate an eventual process of using them as biomarkers of disease activity.
Background: Lower limb peripheral artery disease (PAD) is a common manifestation of atherosclerosis, ranging from subclinical to severe stages including critical ischemia and amputation. Data on epidemiology of PAD in Africa are scarce. This study aimed to determine the prevalence of PAD and identify associated cardiovascular risk factors in Gabon's general population. Patients and methods: Our cross-sectional study utilized quota sampling in three municipalities of the Estuaire province in Gabon. We selected 1502 urban residents aged 18 years and older. Sociodemographic and behavioural data were collected using a questionnaire, along with the Edinburgh Claudication Questionnaire. Ankle-brachial index (ABI) was measured using Doppler examination. PAD was defined as an ABI ≤ 0.90. Results: The average age of the population was 45.2±16.23 years, with 55.7% being females. Among participants, 299 (25.7%) had PAD (95% CI: 23.2-28.3). The prevalence of PAD was 26.2% (95% CI: 22.3-30.2) among men and 25.3% (95% CI: 22.0-28.7) among women. Among the PAD cases, 35 subjects (11.7%) were symptomatic. In the multivariate analysis, factors significantly associated with PAD were sedentary lifestyle (OR = 1.4; 95% CI: 1.0-1.8), hypertension (OR=1.3; 1.0-1.7) and being overweight (OR = 1.8; 95% CI: 1.1-3.1), grade 1 obesity (OR = 1.7; 95% CI: 1.0-2.9), and grade 2 obesity (OR = 1.9; 95% CI: 1.1-3.2) Conclusions: The prevalence of lower limb PAD in Gabon's urban population is important. This highlights the need for greater awareness among those with high cardiovascular risk and mandatory screening in health facilities.
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.
Background: Endovascular treatment is the standard practice for the management of acute limb ischemia (ALI). The risk factors affecting the clinical outcomes of endovascular intervention during mid-term follow-up remain unclear. Patients and methods: 139 patients who presented with ALI, Rutherford I - IIb, undergoing endovascular treatment from October 2016 to December 2021 were retrospectively enrolled. Baseline data, and clinical outcomes were obtained by chart reviews. Major adverse limb events (MALEs) were defined as the occurrence of all-cause mortality, any amputation, and any re-occlusion at the affected limb. All patients were monitored until the time of their death, loss of contact, the incidence of MALEs, or the end of June, 2022. Results: At median follow-up of 17 months, the prevalence of MALEs, all-cause mortality, all amputations, and all re-occlusions were 33.1%, 9.4%, 5.0%, and 24.5%. The technical success rate between catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) groups were comparable (91.9% vs. 95.1%; p=.50). Compared with the CDT group, the PMT group exhibited a higher proportion of extensive thrombus distribution (62.7% vs. 35.1%, p<.01), while required less total urokinase dosage (x 106 units) [1.20 (0.84;1.65) vs. 1.90 (1.40;2.70), p<.01] to achieve a comparable technical success rate (95.1% vs. 91.9%, p=.5). Multivariate Cox-proportional hazards analysis revealed that PMT (hazard ratio [HR] : 0.48, 95% confidence interval [CI] : 0.25-0.92; P=.03), ≧2 patent calf arteries after intervention (HR: 0.30, 95% CI: 0.10-0.97; P=.045) and Rutherford stage IIb, compared with Rutherford I and IIa, (HR: 3.51, 95% CI: 1.02-13.29; P=.047) were independently associated with MALEs. Conclusions: PMT and ≧2 patent calf arteries post-intervention are associated with lower occurrence of MALEs, while Rutherford IIb at presentation is associated with a higher risk of MALEs.
Background: BYCROSS™ atherectomy allows minimally invasive plaque removal in patients with peripheral arterial disease (PAD). Previously published reports with this device provided promising results. However, data on atherectomy combined with intravascular ultrasound (IVUS) are limited. The aim of this study was to assess luminal gain in patients treated with the BYCROSS™ device in femoropopliteal lesions using IVUS. Patients and methods: Consecutive patients with symptomatic PAD due to symptomatic femoropopliteal lesions or occlusions underwent BYCROSS™ atherectomy-assisted endovascular revascularization. Safety in terms of perforation and embolization were evaluated, while area of stenosis (%) and minimal luminal area were measured by IVUS at baseline, after atherectomy and after adjunctive therapy. Results: 21 patients (68.2±8.8 years, 16 male and 11 with chronic limb-threatening ischemia) were included. Mean lesion length was 139.8±68.8 mm and 15 (71.4%) of the lesions were chronic total occlusions (CTO). Most lesions (52.4%) exhibited moderate-to-severe calcification. Median minimal lumen diameter (MLA) was 0.0 mm² (IQR=0.0-2.55 mm²) before treatment, increased to 8.0 mm² (IQR=6.6-11.2 mm²) after atherectomy (p<0.0001 vs. baseline) and further increased to 17.6 mm² (IQR=11.6-22.3 mmm²) after further treatment with angioplasty and if required stenting (p=0.0001 vs. after atherectomy). No perforations were noted, while peripheral embolization was noted in 3 (14.3%) cases, which all could be treated by catheter aspiration. Conclusion: The BYCROSSTM atherectomy system can provide effective lumen gain in femoropopliteal lesions without barotrauma, which can be quantitatively assessed using IVUS. Further studies are now warranted to investigate the impact of luminal gain on long-term patency and limb-related outcomes.
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