Vascular Medicine最新文献

Introduction: The long-term effects of supervised exercise training (SET) on functional performance and health-related quality of life (HRQoL) in symptomatic peripheral artery disease (PAD) are poorly investigated, especially in women. This study investigated these outcomes 1 year after SET in both women and men.

Methods: In this single-arm, prospective, nonrandomized study, patients with symptomatic PAD participating in the 3-month SET program were investigated. Functional performance (6-minute walking distance [6MWD], the stair-climbing test [SCT], and the short physical performance battery [SPPB]), and HRQoL (physical component summary [PCS] score of the Short Form-36 questionnaire) were assessed before and following SET, as well as at 6 and 12 months after SET completion.

Results: Ninety patients (women: n = 30; men: n = 60) with chronic symptomatic PAD (ankle-brachial index 0.78 ± 0.22; mean age 65.4 ± 10.2 years) were included in the study. The 6MWD (women: before: 387.2 ± 88.6 m; after: 472.4 ± 57.0 m; 12 months: 469.9 ± 57.8 m; men: before: 431.7 ± 94.0 m; after: 477.5 ± 88.6 m; 12 months: 467.2 ± 73.4 m), SPPB score (women: before: 9.6 ± 2.4; after: 11.3 ± 1.0; 12 months: 11.2 ± 0.5; men: before: 10.6 ± 1.4; after: 11.5 ± 0.9; 12 months: 11.3 ± 0.8), and SCT (women: before: 8.6 ± 4.4 s; after: 5.6 ± 1.6 s; 12 months: 5.8 ± 1.2 s; men: before: 6.2 ± 2.3 s; after: 5.0 ± 1.9 s; 12 months: 5.3 ± 1.6 s) significantly improved over time (p ≤ 0.001), with no significant differences between women and men. The PCS score (women: before: 30.3 ± 8.0; after: 38.8 ± 8.4; 12 months: 35.7 ± 7.4; men: before: 32.4 ± 10.5; after: 35.7 ± 9.5; 12 months: 35.4 ± 7.6) significantly improved in women only (p = 0.020).

Conclusion: One year after SET, both women and men with PAD exhibit similar functional benefits, whereas HRQoL improvements were observed exclusively in women.

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.

Background: Coronary calcification is a well-known predictor of coronary events, yet the impact of carotid artery calcification on systemic vascular events (e.g., cerebral ischemic, coronary, and peripheral artery events) remains unclear. The aim of this study was to determine whether carotid calcification can be used to predict systemic vascular events.

Methods: This single-center, retrospective cohort study included 194 patients who had a history of vascular disease, including carotid stenosis or occlusion, coronary artery disease, valvular heart disease, ischemic stroke, or transient ischemic attack. We collected data pertaining to risk factors and laboratory parameters. Calcification of the carotid arteries was assessed via whole-body computed tomography, and the modified carotid Agatston calcium score (CCS) was determined. Participants were divided into two CCS groups according to the cut-off value determined via receiver operating characteristic curve analysis; high CCS ≥ 126 and low CCS < 126. Coronary, ischemic cerebrovascular, and peripheral vascular events were recorded over a 5-year follow-up period, and their incidence was compared between the groups using Cox proportional hazards regression analysis.

Results: Older age, hypertension, and chronic kidney disease had a significant positive impact on the CCS. Systemic vascular events (hazard ratio [HR]: 2.70, CI: 1.07-6.79, p = 0.022), coronary events (HR: 4.29, CI: 0.87-21.1, p = 0.045), and peripheral vascular events (p = 0.032) were significantly more frequent in the high versus low CCS group.

Conclusion: The CCS may be a useful tool for predicting future systemic vascular events, including those related to coronary and peripheral artery diseases.

Introduction: Sedentary behavior, specifically an acute bout of prolonged uninterrupted sitting, is associated with heightened cardiovascular disease (CVD) risk, with increased arterial stiffness (AS) being implicated as a principal pathophysiological mechanism. The current systematic review, with meta-analysis, aimed to consolidate the AS response to (1) prolonged uninterrupted sitting and (2) interrupted sitting, as assessed by central and peripheral pulse wave velocity (PWV).

Methods: In total, 326 articles were identified, of which 11 and seven met the inclusion criteria for objectives (1) and (2), respectively. Mean differences (MD) and 95% CI were calculated for all trials using a three-level random-effects model, with restricted maximum likelihood (REML) estimation. The amount of heterogeneity was estimated using Cochran's Q and Higgins's I² tests.

Results: (1) Prolonged uninterrupted sitting resulted in a significant increase in carotid-femoral (cf) PWV (MD = 0.184 m/s, 95% CI = 0.098 to 0.270, p < 0.0003). (2) Interrupting bouts of prolonged sitting resulted in a significant increase in cf-PWV (MD = 0.127 m/s, 95% CI = 0.044 to 0.209, p < 0.0026) that was lower compared to the uninterrupted sitting.

Conclusion: An acute bout of uninterrupted sitting appears to increase cf-PWV; although interrupting prolonged sitting with brief physical activity is beneficial, it does not fully mitigate the response.

Background: Though anticoagulation is a well-established treatment for stroke prevention in cervical artery dissection, antiplatelet agents could offer comparable effectiveness and lower bleeding risk. This meta-analysis assesses the incidence of stroke and hemorrhagic events following various antithrombotic treatments.

Methods: A systematic search was conducted using PubMed, Scopus, and Cochrane Library databases, including comparative studies involving patients with cervical artery dissection treated with anticoagulants and antiplatelet agents, and was registered in the PROSPERO database. The primary outcomes were stroke and hemorrhagic events. Prespecified random effects subgroup analysis was conducted to examine the impact of different types of anticoagulants and various antiplatelet treatment schemes, indicating the antiplatelet group as the reference for the odds ratio (OR).

Results: A total of 22 studies reporting on 5180 patients treated with antiplatelets, vitamin K antagonists (VKAs), and direct oral anticoagulants (DOACs) for prevention of stroke fulfilled the inclusion criteria. The incidence of stroke (OR: 0.86, 95% CI: 0.62-1.20, p = 0.38), intracranial hemorrhage (OR: 0.66, 95% CI: 0.30-1.44, p = 0.30), and extracranial hemorrhage (OR: 0.74, 95% CI: 0.23-2.41, p = 0.62) was not statistically significantly different between the anticoagulant and antiplatelet groups. The comparison of antiplatelets to VKAs (OR: 1.46, 95% CI: 0.79-2.72, p = 0.23) and exclusively aspirin to VKAs (OR: 1.26, 95% CI: 0.48-3.29, p = 0.64) shows nonsignificant differences in terms of stroke. Overall, hemorrhagic events were less frequent in the antiplatelet compared to VKA groups (OR: 0.40, 95% CI: 0.17-0.91, p = 0.03).

Conclusions: Anticoagulation demonstrates a comparable incidence of stroke events, intra- and extracranial hemorrhage, and mortality with antiplatelet therapy. (PROSPERO Registration No.: CRD42024535906).

Background: Paclitaxel-coated balloons (PCBs) are widely used for femoropopliteal artery (FPA) diseases. However, data on recurrence and recurrence patterns after PCB angioplasty are limited. This study investigated the association between recurrence patterns, baseline characteristics, and clinical outcomes in the cases following PCB angioplasty.

Methods: This multicenter, retrospective study included 1159 limbs in 1031 patients treated for de novo FPA lesions using PCBs. Patients were classified into three groups (patency, restenosis, and reocclusion) according to patency or recurrence patterns within 2 years after the index PCB angioplasty. The primary outcome was the incidence of target lesion revascularization (TLR), and the secondary outcome was the pattern of re-recurrence within 2 years following TLR using PCBs.

Results: When comparing the three groups, reocclusive cases were characterized by more complex lesions, including chronic total occlusion, at baseline. Following the index PCB angioplasty, approximately 70% of recurrent cases underwent TLR, which was performed more frequently in reocclusive than in restenotic cases (82.1% vs 63.7%). Conversely, a higher percentage of restenotic cases did not require TLR compared to reocclusive cases (10.3% vs 27.8%). In cases where TLR was performed using PCBs, the rate of re-recurrence with occlusive morphology was significantly higher in reocclusive than in restenotic cases (52.3% vs 24.3%).

Conclusions: After PCB angioplasty for FPA lesions, symptomatic recurrence and requirement for TLR were more frequent in reocclusive cases. Even after TLR using PCBs, reocclusive cases tend to recur with occlusion.