Vascular Medicine最新文献

Introduction: Peripheral artery disease (PAD) is a common manifestation of atherosclerosis. Despite the effectiveness of endovascular therapy (EVT), patients with PAD often face poor prognoses. This study investigates the relationship between specific inflammatory indices and wound healing in patients with Fontaine stage 4 chronic limb-threatening ischemia (CLTI).

Methods: From June 2021 to January 2024, 168 patients with Fontaine stage 4 CLTI, totaling 185 affected extremities, who underwent successful EVT, were assessed retrospectively. Patients were categorized based on wound healing post-EVT. The Naples prognostic score (NPS), pan-immune inflammation value (PIV), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated. Discrimination and decision curve analyses were used to explore the link between inflammation and wound healing.

Results: Wound healing was observed in 142 (76.8%) patients post-EVT. Nonhealing patients exhibited higher indices of NPS, PIV, SII, and SIRI. NPS (aOR = 0.381, 95% CI 0.215-0.675, p = 0.001), PIV (aOR = 0.997, 95% CI 0.996-0.999, p < 0.001), SII (aOR = 0.997, 95% CI 0.996-0.997, p < 0.001), and SIRI (aOR = 0.443, 95% CI 0.313-0.625, p < 0.001) were independently predictive of wound healing. SIRI (AUC = 0.840, 95% CI 0.777-0.904) demonstrated superior predictive ability compared to PIV (AUC = 0.799, 95% CI 0.722-0.876, pdif < 0.001), SII (AUC = 0.788, 95% CI 0.712-0.865, pdif < 0.001), and NPS (AUC = 0.760, 95% CI 0.681-0.838, pdif < 0.001). SIRI also showed higher net reclassification improvement over PIV (68.4%, pdif < 0.001), SII (38.5%, pdif = 0.024), and NPS (29.8%, pdif = 0.079). All inflammatory indices, especially SIRI, provided prognostic value in determining wound healing at high treatment thresholds (> 40%).

Conclusion: In patients with CLTI undergoing EVT, SIRI, SII, PIV, and NPS may help predict the potential for wound healing during in-hospital follow up, with SIRI being the strongest predictor.

Background: Although bleeding is a common procedure-related adverse event following endovascular therapy (EVT), limited data exist regarding the procedural and anatomical factors associated with its complications in patients with lower-extremity artery disease (LEAD) undergoing EVT. Methods: Data were extracted from a nationwide Japanese EVT registry of 73,990 patients who underwent EVT for symptomatic LEAD between January 2021 and December 2022. The primary outcome measure was in-hospital bleeding complications, including access site bleeding, nonaccess site bleeding, and hemorrhagic stroke. Results: The mean age of the patients was 75 ± 9 years, and 69% were men. In-hospital bleeding complications were observed in 613 (0.8%) patients. Logistic regression analysis demonstrated significant associations between bleeding complications and the following procedural, anatomical, and pharmacological variables: emergent revascularization (odds ratio [OR]: 1.90, 95% CI: 1.29-2.79), multiple approach sites (OR: 2.46, 95% CI: 2.00-3.01), bilateral arterial calcification (OR: 1.46, 95% CI: 1.19-1.79), chronic occlusion (OR: 1.53, 95% CI: 1.28-1.83), dual antiplatelet therapy (OR: 1.70, 95% CI: 1.27-2.28), and oral anticoagulant (OR: 1.63, 95% CI: 1.31-2.03). The adjusted incidence of in-hospital bleeding was 0.59% (95% CI: 0.51-0.68%) in patients with one of the identified procedural and anatomical risk factors, 0.96% (95% CI: 0.82-1.13%) in patients with two factors, and 2.40% (95% CI: 1.88-3.05%) in patients with three or four factors. Conclusions: Procedural and anatomical factors as well as antithrombotic strategies were significantly associated with an increased risk of in-hospital bleeding in patients with LEAD who underwent EVT.

Introduction: Reintervention following peripheral vascular intervention (PVI) for peripheral artery disease (PAD) is common. Guideline-directed medical therapy (GDMT) is recommended post-PVI, yet its association with reintervention outcomes remains unclear.

Methods: We analyzed Vascular Quality Initiative registry data linked with Medicare outcome for patients undergoing PVI for PAD (2017-2018). GDMT was defined as the receipt of statin, antiplatelet, and angiotensin-converting enzyme or angiotensin receptor blocker (ACE/ARB) therapy if hypertensive at discharge. Competing risk analyses and conditional risk models assessed the reintervention outcome, and the recurrent reintervention outcomes within 2 years, by GDMT receipt, compliance with each GDMT element, the number of elements received, and GDMT rate across sites and operators in a 1:1 propensity score-matched cohort.

Results: We included 13,244 patients (mean age 72.0 ± 9.9, women 41.0%). The reintervention outcome did not differ by GDMT receipt (cumulative incidence: 43.0% [95% CI 41.0-44.9%] in no GDMT vs 41.2% [95% CI 39.4- 43.0%] in GDMT; subhazard ratio (sHR): 1.03 [95% CI 0.97-1.10]), compliance with GDMT elements, the number of elements received, or site and operator GDMT rates (sHR per 10% increase: 1.00 [95% CI 0.98-1.03] and 1.00 [95% CI 0.98-1.02]) (all p > 0.05). However, a higher operator GDMT rate reduced the recurrent reintervention risk (HR: 0.98 [95% CI 0.97-1.00], p = 0.026).

Conclusion: Around 40% of patients undergoing a PVI experience reintervention within 2 years, but the outcome was not reduced with GDMT receipt, and higher GDMT rates by site and operators were not associated with reintervention risk. Future studies should focus on medication adherence, refills, and more granular GDMT data for PAD care surveillance postrevascularization.

Introduction: Exercise transcutaneous oximetry (Ex-TcpO2) is used to support the vascular origin of lower-limb pain, or to assess walking impairment. The aim of this study was to describe the association between Ex-TcpO2 measurement and the perioperative clinical and morphological outcomes after revascularization in patients with intermittent claudication (IC). Methods: From January to December 2022, a single-center prospective observational study was conducted among patients with IC. Patients were referred by vascular surgeons for Ex-TcpO2 for doubtful arterial origin. Perioperative clinical and morphological outcomes were assessed by the Rutherford-Becker classification and duplex ultrasound examination. The primary patency rate and primary sustained clinical improvement were evaluated at 1 month after revascularization. Results: Eighty-two patients (64% men) underwent Ex-TcpO2 and were enrolled in the study, of whom 65% were category III of the Rutherford classification. Indications for Ex-TcpO2 were to assess the origin of the IC symptoms in 65%. Sixty-seven (81%) patients had positive Ex-TcpO2, and 15 (18%) had negative Ex-TcpO2. Patients with positive Ex-TcpO2 were older (65 ± 13 vs 58 ± 20, p = 0.43), and had a significantly lower ankle-brachial index (ABI) compared to the negative group (0.65 ± 0.22 vs 0.92 ± 0.22, p < 0.001) as well as a lower maximum walking distance (MWD) (200 m [150, 300] vs 525 m [500, 872], p < 0.001). Forty-two patients underwent revascularization (Ex-TcpO2 positive [n = 35/67]; Ex-TcpO2 negative [n = 7/15]). Revascularization technical success and primary patency rate were 100% in both groups. Clinical improvement was significantly greater in the Ex-TcpO2 positive group (97% [n = 34/35] vs 0% [n = 0/7], p < 0.001). Multivariate analysis shows a positive association between pain at the buttock and the decrease from rest of oxygen pressure (DROP) ≤ -15 mmHg at the level of the buttock with the presence of iliac lesions. Conclusion: On a routine basis, Ex-TcpO2 is a tool of interest to assess patients with claudication for doubtful arterial origin or walking distance, especially in proximal IC, and to predict favorable clinical outcomes after revascularization.

Background: The calf muscle pump is an understudied contributor to venous return from the lower extremity. This study aimed to determine if calf pump function (CPF) is independently associated with the severity of chronic venous disease classified by CEAP (Clinical-Etiology-Anatomy-Pathophysiology).

Methods: The Mayo Clinic Vascular Laboratory database was analyzed from January 2015 through September 2023. Ambulatory adults who underwent venous air plethysmography were included. Venous plethysmography assessed the severity of venous incompetence, and CPF was measured as ejection fraction (EF) per leg. The clinical component (C0 through C6) of the CEAP score was evaluated for each extremity at the time of the study.

Results: A total of 7760 limbs from 3733 patients were analyzed. The mean age was 62 years, with 62% women. Venous obstruction was detected in 3.2% of limbs. Venous incompetence severity was categorized as normal (44%), mild (26%), moderate (19%), and severe (10%). A significant trend of reduced CPF was observed with higher CEAP scores (p < 0.001). Multivariable logistic regression, adjusted for age, sex, degree of venous incompetence, and obstruction showed reduced CPF was a significant predictor (odds ratio 1.84, CI: 1.5-2.2) of active/prior ulcer (C5 or C6). In contrast to more severely reduced CPF, mildly reduced CPF (EF 40-49%) was not associated with active/prior ulcers.

Conclusion: This large contemporary study demonstrates that decreased CPF is associated with worse chronic venous disease. Importantly, we demonstrate for the first time that CPF is independently associated with active/prior venous ulcers after accounting for other venous physiologic parameters and demographics.

The rupture of an abdominal aortic aneurysm (AAA) poses a significant threat, with a high mortality rate, and the mechanical stability of the arterial wall determines both its growth and potential for rupture. Owing to extracellular matrix (ECM) degradation, wall-resident cells are subjected to an aberrant mechanical stress environment. In response to stress, the cellular mechanical signaling pathway is activated, initiating the remodeling of the arterial wall to restore stability. A decline in mechanical signal responsiveness, coupled with inadequate remodeling, significantly contributes to the AAA's progressive expansion and eventual rupture. In this review, we summarize the main stresses experienced by the arterial wall, emphasizing the critical role of the ECM in withstanding stress and the importance of stress-exposed cells in maintaining mechanical stability. Furthermore, we will discuss the application of biomechanical analyses as a predictive tool for assessing AAA stability.

Introduction: We aimed to investigate deep femoral artery (DFA) status during endovascular treatment (EVT) and the patency of the femoropopliteal (FP) artery and DFA using current stent devices for ostial FP lesions.

Methods: A multicenter, retrospective study analyzed data from 457 patients who underwent EVT with stent deployment for de novo ostial FP lesions between April 2018 and December 2021 at eight centers in Japan. Propensity score-matched analysis was performed to compare the clinical impacts of DFA coverage for ostial FP lesions with stent deployment. The prognostic value was analyzed based on DFA status during EVT, primary patency of the FP artery, clinically driven-target lesion revascularization (CD-TLR) of the FP artery, and incidence of DFA occlusion/major amputation/acute limb ischemia (ALI) at 3 years.

Results: A total of 132 matched pairs of patients was analyzed using propensity score matching. The percentage of DFA occlusion and stenosis was significantly higher in the DFA coverage group. However, there were no significant differences in terms of primary patency of the FP artery, CD-TLR, DFA occlusion, major amputation, or ALI after 3 years.

Conclusions: Stent deployment in DFA coverage significantly led to the DFA stenotic events of EVT during the procedure, but patency of the FP artery and DFA, major amputation, and ALI up to 3 years did not differ according to stent deployment for ostial FP lesions.