Vasa-european Journal of Vascular Medicine最新文献

Chronic venous disease (CVD) is a prevalent condition leading to significant morbidity and affecting quality of life. Among conservative treatment strategies, venoactive drugs are often recommended by major guidelines for the management of CVD. Bromelain and vitamin C are now emerging as promising options in the management of several chronic diseases owing to their anti-inflammatory, immunoregulatory, and antioxidant properties, though evidence remains scarce in this setting. This systematic review of the literature, endorsed by the Italian Society of Angiology and Vascular Medicine (Societa Italiana di Angiologia e Patologia Vascolare, SIAPAV), aims to evaluate the efficacy and safety of these compounds in the treatment of CVD. A comprehensive search yielded nine studies, two on bromelain and seven on vitamin C. No studies have evaluated the effects of bromelain and vitamin C alone or in combination, whereas both molecules were administered in combination with other nutritional supplements. Overall, CVD-related symptoms and edema seem to improve with dietary supplement containing these two compounds, with no major safety issues reported. Bromelain and vitamin C may thus represent attractive options in the management of patients with symptomatic CVD and/or presence of venous edema, provided optimal conservative treatment is in place. Dedicated clinical studies are needed to clarify the efficacy and safety of a combination of these molecules in CVD management.

Background: This prospective, single center, exploratory study assessed primary patency, clinical performance, and adverse events associated with the DUO-HYBRID Venous Stent used to treat iliac vein obstruction. Materials and methods: Twenty-one patients with symptomatic obstructions were treated with the self-expanding stent designed with varying zones of fatigue and crush resistance to adapt to the challenging iliac vein anatomy. The primary outcome measure was 12-month primary patency, defined as ≤ 50% residual stenosis, the absence of re-thrombosis or reintervention, and the absence of major adverse events from treatment to discharge. Secondary clinical measures included the Villalta score to assess the symptoms of post-thrombotic syndrome (PTS), and the revised Venous Clinical Severity Score (rVCSS) and Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) score, both used to measure the severity of venous disease. Finally, the number of device- or procedure-related adverse events were recorded. Results: Primary patency was 92.9% at 12 months: one patient exhibited restenosis greater than 50% at 12 months. CEAP scores at baseline were predominantly C3 - C5 (78.9%) while at 12 months, 78.6% of scores were C1 - C2 and 14.3% were C0. The mean rVCSS score was 5.5 ± 2.7 at baseline and 1.1 ± 1.0 at 12 months, an 80% reduction in the mean score from baseline. Pre-procedure, 14.3% of patients had a Villalta score of 0-4 while at 12 months, 100% had scores of 0-4 (i.e., no clinically meaningful signs of post-thrombotic syndrome). Two adverse events were reported as possibly related to the device but neither case required revascularization. Conclusions: Observations from this exploratory study demonstrated a primary patency rate of 92.9%, improvements in rVCSS, CEAP, and Villalta scores from baseline, and no cases of target lesion or vessel revascularization at 12 months. The DUO-HYBRID Venous Stent performed appropriately when used for its intended indication.

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.

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.

Objective: Abdominal aortic aneurysm (AAA) is a permanent local dilation of the abdominal aorta developed by chronic local inflammation and elastin degradation. Trigonella foenum-graecum (fenugreek) has been reported to have anti-inflammatory properties. We hypothesized that fenugreek supplementation can inhibit AAA growth. Materials and methods: AAA was induced in male Sprague-Dawley rats by intraluminal porcine pancreatic elastase infusion. The treatment by oral gavage was initiated post-operatively on day 1 and was administered daily (750 mg/kg/daily or 1500 mg/kg/daily or distilled water) for 27 days. AAA expansion was monitored weekly by ultrasound measurements in a blinded-to-treatment fashion; rats were euthanized 28 days after surgery. AAA cross-sections were examined histologically, where treatment allocation were blinded. Results: AAA developed in all three groups, yet there was no measured difference (p=0.104) in the maximal inner anterior-posterior abdominal aortic diameter on day 28 post-surgery between the control group (110% ± 70%, n=11), the low-dose fenugreek treatment group (LDF, 105% ± 68%, n=11), and the high-dose fenugreek treatment group (HDF, 153% ± 96%, n=13). Additionally, assessments of elastin structure in the AAA wall using Miller's stain revealed disorganized and ruptured fibers, but no significant differences in the severity of damage or elastin content among the groups were noted. No significant differences were observed in the presence of infiltrating neutrophils (as indicated by myeloperoxidase-positive cells), macrophage infiltration (% CD68-positive area), or area of vascular smooth muscle cells (a-SMA stained cells), or media thickness across control low-dose, and high-dose treatment groups. Conclusions: Daily fenugreek administrations did not halt AAA progression in either low-dose (750 mg/kg/daily) or high-dose (1500 mg/kg/daily) groups when compared to controls. These results did not show any beneficial effects of fenugreek supplementation in the aneurysm wall, and therefore, we can not recommend fenugreek supplementation as a treatment for patients with growing AAAs.

Background: Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. Patients and methods: This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHA₂DS₂-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHA₂DS₂-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86-0.87) but had the worst calibration for high-risk patients. The CHA₂DS₂-VA Score had the lowest AUC 0.69 (95% CI: 0.68-0.70) but was the most consistent prediction model regarding calibration. Conclusions: HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHA₂DS₂-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHA₂DS₂-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.

Background: Acute abdominal aortic occlusion is a rare vascular emergency associated with high morbidity and mortality. To date, the topic has hardly been addressed scientifically. Most case series are afflicted with small cohort numbers. The aim of this study was to identify risk factors after invasive treatment of acute abdominal aortic occlusion and changes over time. Patients and methods: Using case-based nationwide hospital statistics (diagnosis-related group [DRG] statistics) from 2009 to 2020, all cases with ICD-10 codes for embolism and thrombosis of the abdominal aorta in conjunction with acute limb ischaemia and consecutive invasive treatment (endovascular or open surgery) were included. The analysis included patient characteristics, treatment, mortality, amputation, and complications. The primary outcome was in-hospital death. A multivariable regression model was applied to detect risk factors. Results: A total of 1160 cases (66% male) with acute abdominal aortic occlusion were identified (941 open; 219 endovascular). Between 2009 and 2020, the rate of endovascular treatments (2010: 6%; 2020: 29%; p<.001) increased significantly over the years. Older patients (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.64-0.9, p=.002) and women (OR 0.65; 95% CI 0.48-0.88, p=.006) were more likely to receive endovascular care. In-hospital mortality was 13% after open surgery and 14% after endovascular treatment, with no significant change in open surgery, but high variability in endovascular treatment during the observation period (2009-2011: open 14%; endovascular 25%; 2018-2020: 10%; 11%). In-hospital mortality increased significantly with higher age (OR 2.19 per 10-year increase; 95% CI 1.79-2.7, p<.001) and comorbidities (OR 1.1 per Elixhauser point; 95% 1.07-1.11, p<.001). Conclusions: Acute aortic occlusion remains a rare but life-threatening emergency. Use of endovascular revascularization techniques is increasing, while in-hospital mortality rates remain high, specifically for older and morbid patients.

Background: Intermittent negative pressure is an emerging treatment for lower limb vascular disease but the specific physiological effects, particularly upon large artery haemodynamics are unclear. This study examined the influence of intermittent negative pressure upon popliteal artery shear rate during both supine and sitting postures. Participants and methods: Eleven healthy participants (5 female; age: 28.3 ± 5.8 y; weight: 69.6 ± 9.8 kg, height: 1.75 ± 0.07 m) received intermittent negative pressure (-37 mmHg; 9.5-sec on, 7.5-sec off), upon the lower leg during both supine and sitting postures. Popliteal artery blood flow and shear rate were recorded (duplex ultrasound), accompanied by heart rate (3-lead ECG) and blood pressure (volume clamp method). Results: Compared to sitting, a supine posture led to greater mean shear rate during baseline (supine: 21[9]; sitting: 17[13] sec^-1; all median [IQR]) and negative pressure phases (supine: 24[15]; sitting: 17[14] sec^-1; both p<0.05). While supine, negative pressure raised mean shear rate above baseline levels (p<0.05) and reduced it upon return to atmospheric pressure (p < 0.05). In sitting, mean shear rate only differed from baseline at the points of peak and minimum shear (peak:18[17]; minimum: 10[9] sec^-1; both p<0.05). Shear pattern (oscillatory shear index) showed changes from baseline during both postures (p<0.05), but was not different between postures. Conclusions: Intermittent negative pressure influenced lower limb popliteal artery shear rate during both the supine and sitting postures, the effect was greater while supine. Fluctuation in shear pattern seen during both positions may account for positive clinical effects observed following intermittent negative pressure treatment. These findings are framed against previous work investigating clinical populations. Future work should investigate any differences in lower limb haemodynamics and markers of endothelial function among patients with vascular disease.