Vasa-european Journal of Vascular Medicine最新文献

Background: Kidney transplantation (KT) has been shown to enhance the quality of life, be more cost-effective, and reduce mortality in dialysis patients. We aimed to study the impact of pre-existing diabetes mellitus (DM) and peripheral arterial disease (PAD) on cardiovascular outcomes and mortality after kidney transplantation (KT). Materials and methods: A secondary USRDS (United States Renal Data System) analysis was performed from 2006 to 2017 in adult patients who underwent KT. The primary outcome was 3-year all-cause mortality, and secondary outcomes were myocardial infarction (MI), cerebrovascular accident, gangrene/limb ischemia, and graft failure. Adjusted hazard ratios were computed, and multivariate analysis was conducted. All p-values were 2-sided, and a value of <0.05 was deemed to be statistically significant. Statistical analyses were performed using the SAS 9.4 software. Results: A total of 51,009 patients with kidney transplants met the study inclusion/ exclusion criterion. Patients with both DM and PAD had the highest risk of mortality (15.3%, aHR 1.8, 1.6-2.0), followed by patients with PAD without DM (14.1%, aHR 1.6, 1.4-1.9), DM without PAD (9.9%, aHR 1.4, 1.3-2.6), and those without either DM or PAD (5.5%). MI was also higher in patients with DM and PAD (7.3%, aHR 1.8, 1.5-2.2), followed by DM alone (4.6%, aHR 1.58, 1.4-1.7), PAD alone (4.3%, aHR 1.14, 0.8-1.6), and no diabetes nor PAD (2.2%). Conclusions: In patients undergoing KT, those with pre-existing DM and/ or PAD have a significantly higher all-cause mortality and risk of MI.

Background: Peripheral arterial disease (PAD) increases cardiovascular (CV) morbidity and mortality, but remains underdiagnosed and undertreated. Several trials support low-dose direct oral anticoagulant (DOAC) use in PAD treatment, although this has yet to be widely adopted in clinical practice. Patients and methods: We conducted a retrospective study of patients who underwent ankle-brachial index testing (ABI) from 1996 - 2020 at Mayo Clinic. We included patients with PAD defined by abnormal ABI (<1.0 or >/=1.4). Primary outcomes evaluated were myocardial infarcts (MI), ischemic strokes (IS), critical limb ischemia (CLI)/amputation, bleeding events and all-cause mortality. DOAC and warfarin use were each compared to no anticoagulant use for the outcomes using univariate analysis and multivariate analysis. Results: 22,162 patients had abnormal ABI readings; 1,266 were on warfarin and 269 were on DOAC for any indication. Both the DOAC and warfarin groups showed significant a decrease in all-cause mortality. The DOAC group showed superior mortality outcomes with HR 0.50 [95% CI 0.40-0.63], p-value <0.001 compared to warfarin with HR 0.88 [95% CI 0.81-0.96], p-value <0.004. There appeared to be a similar trend for MI and CLI/amputation however this was not statistically significant. IS was similar with only warfarin being statistically significant. The DOAC group had improved bleeding outcomes compared to the warfarin group, HR 0.53 (95% CI 0.24-0.85), p-value 0.007. Notably, the addition of ASA for both AC groups resulted in significant HR >1. Conclusions: Our study shows that anticoagulation use, particularly DOACs, is associated with decreased all-cause mortality in patients with PAD. There appears to be a favorable trend for DOACs in MI, IS and CLI/amputation. Lastly, DOACs were found to have superior outcomes with bleeding events.

The new guidelines for the management of peripheral arterial and aortic diseases (PAAD) from the European Society of Cardiology and endorsed by the European Society of Vascular Medicine (ESVM), emphasize on a comprehensive and multidisciplinary approach focusing on prevention, diagnosis, treatment, and follow-up of patients with a wide range of PAAD, including lower extremity peripheral arterial disease (PAD). The aim of this summary, focusing on PAD and coordinated by the Young Academy of ESVM, is to provide young angiologists with the fundamental principles of these guidelines and to assist them in navigating their everyday clinical practice. PAD diagnosis relies on objective evaluation of flow/oxygen reduction at rest, with arterial ultrasound as the first imaging modality to confirm the presence of arterial lesions. The main goals of PAD management are not only to improve functioning and prevent the occurrence of adverse events at the lower limb level, but also to reduce the overall atherosclerotic burden and achieve the general well-being of patients. To this end, traditional and nontraditional cardiovascular risk factors need to be properly addressed through lifestyle changes and tailored drug therapies. For patients with exertional limb symptoms, supervised exercise training is recommended. Interventional treatment is indicated for limb salvage in patients with chronic limb threatening ischemia and may also be discussed in a multidisciplinary setting in less severe patients with persisting symptoms and reduced quality of life after a minimum period of optimal medical treatment including exercise therapy. For trainees or young specialists in Angiology/Vascular Medicine, these guidelines provide essential elements to improve patient management, encourage interdisciplinary collaboration, and ensure an integrated approach to vascular diseases.

Background: Carotid endarterectomy (CEA) is a widely accepted treatment to mitigate stroke risk in patients with severe carotid stenosis. The timing of CEA, especially in cases of acute neurological symptoms like crescendo transient ischemic attack (TIA) and stroke-in-evolution, remains contentious. This study evaluates the effectiveness of urgent CEA (UCEA) within 6 hours of crescendo TIA onset compared to elective CEA (ECEA) performed within 2 weeks in preventing recurrent stroke. Patients and methods: This retrospective study analyzed 87 patients with crescendo TIA treated with UCEA and compared them with a matched control group of 174 patients who underwent ECEA for symptomatic carotid disease. All patients underwent preoperative multidetector computed tomography angiography. Primary outcomes included mortality, stroke, TIA, and major adverse cardiac events within 30 days and up to 6 months postoperatively. Results: The UCEA group demonstrated no postoperative strokes or TIAs, with a low complication rate. UCEA resulted in one stroke within 6 months, with complete recovery. The ECEA group experienced one stroke and one death. There were no significant differences in early postoperative complications between the groups. However, the UCEA group exhibited a higher overall mortality rate (4.6% vs. 0.6%; p = 0.044), predominantly due to myocardial infarction. Both groups demonstrated comparable outcomes regarding postoperative complications and carotid restenosis at follow-up. Conclusions: UCEA performed within six hours of crescendo TIA shows comparable perioperative outcomes to ECEA in preventing recurrent strokes. While these findings suggest early intervention with UCEA may be a viable approach for patients with crescendo TIA, significant methodological limitations preclude definitive conclusions about safety and efficacy.

Background: This study aimed to assess the safety of the third-generation ClosureFast catheter for radiofrequency ablation (RFA) in the treatment of great saphenous vein (GSV) reflux in patients presenting to a dedicated vein center. Materials and methods: All consecutive patients with incompetent GSV who underwent RFA between December 2023 and May 2024 were retrospectively analyzed. The primary study endpoints were technical success and postoperative complication rate at 30 days. Secondary study endpoints were freedom from GSV recanalization and recurrent varicose vein (RVV) rate over the follow-up. The improvement in symptoms (measured by the Venous Clinical Severity Score [VCSS]) was evaluated. Results: During the study period, 50 limbs were treated in 50 consecutive patients (mean age 55.8±13.4 years; 56% women; CEAP 2-4; VCSS >5). The technical success rate was achieved in 100% of cases. There was no significant incidence of 30-day complications. There were no instances of deep venous thrombosis or puncture site thermal injury. One patient (2%) had hyperpigmentation; two patients (4%) had ecchymosis; 4 patients (8%) had pain. At a mean follow-up of 2.9±1.4 months, GSV occlusion and freedom from reintervention rates were both 100% within 1 week and 30 days respectively. No patients had RVV over the follow-up. The VCSS score had decreased a median of 3.5 (IQR: 2.4-5) points from baseline (p<0.01). The mean CEAP class had decreased to 1.59 points from baseline, reflecting a shift towards milder disease categories (C0-C2). Conclusions: The third generation of RFA is safe and effective to ablate the GSV with a low complication rate in the perioperative period. However, durability over the follow-up and further studies with larger cohorts of patients are still needed to confirm these outcomes.

Background: The use of questionnaires in vascular rehabilitation has increased. The Walking Impairment Questionnaire (WIQ) can identify functional risk due to peripheral arterial disease (PAD). This study aimed to assess the accuracy of the WIQ for identifying individuals with PAD and intermittent claudication with low functional capacity. Patients and methods: A cross-sectional diagnostic test accuracy study was conducted. The Incremental Shuttle Walk Test (ISWT) assessed the distance walked, and the WIQ, the index test, evaluated the perception of functional capacity. Three reference values in the ISWT were defined: 380 m, 210 m (25th percentile), and 100 m. The accuracy, sensitivity, and specificity of the WIQ were tested using the Receiver Operating Characteristic curve and an alpha of 5% defined statistical significance. Results: One hundred and twenty-one volunteers participated in the study (64 ± 9.7 years, 65% men). The average distance in the ISWT was 270.6 ± 100.2 m. The WIQ scores were: mean 29.7 (14.0-50.2), distance (19; 6.3-47.8), walking speed (25; 13.0-43.5), and stairs (41.7; 12.5-75.0). The WIQ cut-off point for the ISWT references was 1) 37 for 380 m, with a sensitivity of 0.75 and specificity of 0.62 (AUC: 0.73, p=0.003; 95% CI 0.61 to 0.86); 2) 23 for 25th percentile (210 m), with a sensitivity of 0.75 and specificity of 0.70 (AUC: 0.77, p<.0001; 95% CI 0.68 to 0.86) and 3) 14 for 100 m, with a sensitivity of 0.78 and specificity of 0.83 (AUC: 0.77, p=.0001; 95% CI 0.64 to 0.91). Conclusions: The WIQ is helpful as a screening tool in research and clinical practice of PAD. The WIQ score with the best accuracy to identify individuals with low functional capacity was 14.

Background: To investigate the efficacy of Chocolate balloon use as an adjunct to drug-coated balloon (DCB) angioplasty for the treatment of femoropopliteal lesions. Patients and methods: This retrospective study was performed with a 12-month follow-up period. The rate of flow-limiting dissection, primary patency, rate and length of bailout stenting, and freedom from major adverse limb events (MALEs) were compared between femoropopliteal lesions treated with plain balloons (PBs) and those treated with Chocolate balloons combined with DCB angioplasty. Results: In total, 192 patients (197 de-novo lesions) were included: 137 patients (141 lesions) in the PB group and 55 patients (56 lesions) in the Chocolate balloon group. The mean total lesion lengths were 126.84±71.57 and 138.39±65.35 mm (P=0.297), more than half of patients had chronic total occlusion (53.2% and 51.8%, P=0.859), the rates of flow-limiting dissection were 15.6% and 12.5% (P=0.579). Rates of primary patency were 88.1% and 92.6%, respectively. Chocolate balloon use reduced the mean total bailout stenting length (135.17±68.85 vs. 98.24±36.78 mm, P=0.022), including in complex lesions (180±70.43 vs. 102.50±44.64 mm, P=0.011), and the absolute bailout stenting length (total bailout stenting/lesion length ratio; 0.74±0.24 vs. 0.48±0.19, P=0.017). Conclusions: Relative to PB, Chocolate balloon use combined with DCB angioplasty did not show a significant advantage. It did, however, reduce the absolute total bailout stenting length in complex lesions.

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.