Vascular Medicine最新文献

Superficial venous incompetence (SVI) is the most common manifestation of chronic venous disease and represents a significant global health burden. Ultrasound has long been the diagnostic modality of choice in the evaluation of SVI, offering excellent anatomical information of venous reflux. However, the most widely used and currently recommended ultrasound parameter, reflux time, has shown a limited correlation with clinical severity and should primarily be considered a qualitative measure used to determine the presence or absence of venous reflux. In this context, quantitative assessments of venous reflux may provide a more nuanced and clinically informative evaluation of the severity and character of SVI. This review aims to summarize and critically assess the current evidence, as well as existing knowledge gaps, concerning quantitative ultrasound-based evaluation of SVI.

Background: Sclerotherapy is the treatment of choice for telangiectasias and reticular veins of the lower limbs, but long-term follow-up raises concerns about recurrence. This study aimed to evaluate the long-term outcomes of sclerotherapy for lower-limb telangiectasias and reticular veins over 3 years, focusing on disease control, pigmentation, and matting.

Methods: A prospective, blinded cohort study followed patients treated with a single sclerotherapy session for telangiectasias (Study 1) or reticular veins (Study 2). Two groups were compae2-1358red: Group 1 received 0.2% polidocanol in 70% hypertonic glucose (PDHG) and Group 2 received 75% hypertonic glucose (HG) alone. Data were collected at 60 days and 3 years posttreatment. Analyses included recurrence, pigmentation, and matting. Photographic measurements were performed using ImageJ™ software.

Results: A total of 43 patients were included in Study 1 and 35 in Study 2, with a mean follow-up of 36 months in both. The groups were epidemiologically similar. Recurrence occurred in both studies. In Study 1, almost all the patients had recurrence of telangiectasias, with no significant difference between treatments. In Study 2, recurrence was minimal and favored PDHG (p = 0.016). Pigmentation resolved mainly over time, with no significant intergroup or interstudy differences. Matting was more persistent in telangiectasias but nearly disappeared in reticular veins, with no significant group differences.

Conclusions: Telangiectasia recurrence was common after 3 years, regardless of treatment. In contrast, reticular veins showed minimal recurrence, particularly with PDHG. Pigmentation generally resolved spontaneously. Matting was more persistent in telangiectasias than in reticular veins. These findings support the long-term viability of both approaches in clinical practice.

Background: Patients with diabetes mellitus (DM) and established cardiovascular disease (CVD) face a markedly increased risk of future major adverse cardiovascular events (MACE). This study aimed to assess the clinical characteristics and outcomes of patients with DM with CVD initiating dual pathway inhibition (DPI) with rivaroxaban 2.5 mg twice daily plus aspirin in clinical practice.

Methods: The prospective XATOA (Xarelto plus Acetylsalicylic acid: Treatment patterns and Outcomes in patients with Atherosclerosis) registry enrolled patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD). Baseline characteristics, cardiovascular outcomes, and bleeding rates were analyzed according to diabetes status. Among patients with DM, outcomes were also compared by vascular territory (CAD, PAD, or both), and findings were benchmarked against the randomized COMPASS trial.

Results: Among 5532 patients included in XATOA, 2130 (38.5%) had diabetes, predominantly type 2 (96.1%). Patients with DM with PAD alone were less likely to receive optimal preventive therapies than those with CAD or CAD + PAD. Compared to patients without diabetes, patients with DM had a 59% higher risk of major adverse vascular events (MAVE), including MACE and major adverse limb events (MALE) (p < 0.001). Event rates (per 100 patient-years) in patients with DM were 2.1 for CAD, 10.1 for CAD + PAD, and 14.2 for PAD alone. Major bleeding rates were similar across diabetes status (4.3/100 patient-years) and vascular territories. The composite rate of MACE and major bleeding in patients with DM aligned closely with results from the COMPASS trial.

Conclusion: Patients with DM with CVD are at significantly high cardiovascular risk, and those with PAD appear to be undertreated. Real-world outcomes observed in the XATOA registry are consistent with randomized trial data, supporting the benefit of DPI in this high-risk population.

Abdominal aortic aneurysm (AAA) affects over 35 million individuals and poses a potentially fatal risk. Risk stratification and surveillance strategies are well established, but their impact on patient-reported outcomes (PROs) remains diffuse and may vary by clinical and biopsychosocial profiles. It is also unclear whether individuals with this often 'silent' condition experience thriving or growth concepts referred to as 'flourishing.' To address these gaps, we systematically reviewed PRO studies in AAA to answer three questions: (1) Are there instruments tailored to AAA phenotypes (rupture, elective repair, surveillance, screening), and what patient-centered dimensions are measured? (2) What mental health assessments are commonly used? (3) Do existing PROs capture elements of flourishing? We included 16 studies. Generic PRO tools were frequently used but limited in scope. Five AAA-specific instruments were identified, focusing on physical symptoms, treatment satisfaction, and disease burden. Most were developed using Classical Test Theory, with item burden ranging from 11 to 70 items, and primarily targeted surveillance or elective surgery populations. Mental health assessment was minimal - typically single items embedded in health status instruments addressing anxiety and depression. Flourishing was indirectly assessed through measures of social connection and emotional well-being. Current PRO approaches fail to capture the heterogeneous, patient-centered experience of living with AAA. We propose a growth-based framework for PRO evaluation using adaptive testing to accommodate clinical complexity while minimizing response burden, supporting integrative, value-based, patient-centered care.

Introduction: This study compared the risks and incidences of major bleeding between patients undergoing revascularization for peripheral (PAD) and coronary artery disease (CAD).

Methods: A subanalysis of the ASPARAGUS study (ASsessment of Prognosis in PAtients with CoRonary or Peripheral Artery Disease UnderGoing PercUtaneouS or Surgical Intervention) was conducted to compare the incidence of bleeding complications between patients with PAD and CAD. Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were applied in 4343 patients with PAD and 6238 with CAD, respectively. The primary study endpoint was the cumulative incidence of major bleeding, defined as Bleeding Academic Research Consortium types 3 and 5.

Results: At least one major bleeding criterion and one minor bleeding criterion were found in 61.5% and 79.3% of patients with PAD, compared with 32.0% and 65.9% of patients with CAD, respectively. During a median follow-up of 27.4 months, 385 incidences of major bleeding were recorded. In the PAD group, the crude incidence rate of major bleeding was 19.1 per 1000 person-years, which was higher than the 10.7 per 1000 person-years in the CAD group. Multivariable Poisson regression analysis demonstrated that PAD versus CAD was not significantly associated with incident major bleeding after adjusting for ARC-HBR major and minor criteria (adjusted incidence risk ratio = 1.14, 95% CI, 0.93-1.40; p = 0.22).

Conclusion: Patients with PAD had higher ARC-HBR scores and a higher incidence rate of major bleeding than those with CAD. Their higher risk of major bleeding was driven by their higher prevalence of ARC-HBR-defined risk factors.

Introduction: The study aimed to evaluate the efficacy and safety of laparotomy combined with mechanical thrombectomy in patients with acute, critical, noncirrhotic porto-mesenteric vein thrombosis (NC-PMVT).

Methods: Between January 2018 and January 2025, 20 patients diagnosed with acute, critical NC-PMVT, who underwent laparotomy with mechanical thrombectomy, were included in this study. Baseline characteristics, clinical presentation, and perioperative data were collected. Safety and efficacy were evaluated based on symptom relief, recanalization rate, technical success, and procedure-related complications. Recurrence and long-term complications were assessed over a 12-month follow-up.

Results: The technical success rate was 100%. Intestinal resection was performed in eight patients, with a mean resected bowel length of 61.75 ± 9.75 cm. Abdominal pain was alleviated in 60% of patients by postoperative day 5. The mean length of hospital stay was 10 ± 3.91 days. At discharge, 12 (60%) patients achieved complete recanalization (CR) and eight (40%) demonstrated partial recanalization (PR). At follow-up, CR was observed in 16 (80%) patients, PR persisted in three (15%), and one died from an unrelated condition. All surviving patients achieved complete symptom resolution. No procedure-related complications or recurrences were reported during follow-up.

Conclusion: Laparotomy with mechanical thrombectomy is demonstrated to be a safe and effective treatment for acute, critical NC-PMVT.

Post-pulmonary embolism syndrome (PPES) encompasses a diverse spectrum of long-term complications that are associated with persistent dyspnea, exercise intolerance, and a decrease in quality of life. The PPES constellation ranges from life-threatening conditions such as chronic thromboembolic pulmonary hypertension (CTEPH) to nonlife-threatening but still debilitating conditions such as chronic thromboembolic pulmonary disease (CTED) or post-PE deconditioning. The safety and efficacy of exercise and cardiopulmonary rehabilitation programs to prevent and manage these symptoms in PPES has not been well established. Herein, we review contributors to PPES and synthesize the evidence for exercise training after PE to treat and prevent PPES.