Vascular Medicine最新文献

Background: Osteoporosis has been suggested to be associated with abdominal aortic aneurysms, yet its impact on endovascular aneurysm repair (EVAR) outcomes remains unclear. This study evaluated the impact of osteoporosis on long-term outcomes and aneurysm sac remodeling in patients undergoing EVAR.

Methods: This single-center retrospective study included 119 patients who underwent EVAR between 2014 and 2018. Osteoporosis was defined as morphological vertebral compression fractures or an L1 vertebral trabecular attenuation (⩽ 110 Hounsfield units [HU]) on preoperative computed tomography. Patients were stratified into osteoporosis (O; n = 74) and nonosteoporosis (NO; n = 45) groups to compare clinical outcomes and aneurysm sac behavior. Multivariable analyses were performed to identify predictors of mortality and sac changes.

Results: The O group had a significantly higher all-cause mortality (39.2% vs 18.1%, p = 0.012) and lower 10-year survival (40.8% vs 79.5%, p < 0.05). Sac shrinkage was more frequent in the NO group (1.6 ± 8.6 vs -7.6 ± 10.3 mm, p < 0.001). Lower L1 HU was significantly associated with sac expansion. Pharmacologic treatment yielded greater sac reduction than nontreatment (-4.3 ± 2.6 vs 2.6 ± 1.0 mm, p = 0.015). Multivariable analysis identified osteoporosis, older age, and type II endoleaks as independent predictors of sac enlargement, whereas osteoporosis treatment was independently associated with sac shrinkage.

Conclusions: Osteoporosis is associated with reduced survival and impaired aneurysm sac remodeling following EVAR. Pharmacological treatment may promote sac remodeling and improve clinical outcomes. Routine evaluation and management of osteoporosis may be important post-EVAR care strategies.

Background: Despite improving abdominal aortic aneurysm (AAA) outcomes in the United States, significant disparities exist. Smaller studies found that women experienced worse outcomes after endovascular aortic aneurysm repair (EVAR), yet few larger analyses have confirmed this. This study aimed to characterize sex-related differences in outcomes among patients who underwent infrarenal EVAR.

Methods: Medicare fee-for-service beneficiaries ⩾ 66 years old who underwent infrarenal EVAR for intact AAA between January 1, 2011 and December 31, 2019 were included in this retrospective cohort study. The primary outcome was a composite of late aneurysm rupture, aortic reintervention, conversion to open repair, or all-cause mortality. Cox regression and Fine-Gray models were used.

Results: Among 111,381 patients, the mean age was 76.63 ± 6.60 years, 92.88% were White, and 21.19% were women. The maximum follow-up was 3283 days. The hazard of the primary outcome was higher in women in the adjusted model (p = 0.013). When mortality was excluded, the association with sex persisted (p < 0.0010 [adjusted subdistribution model]; p < 0.0010 [adjusted cause-specific model]). Women experienced a lower frequency of postprocedural office visits, but a higher frequency of emergency department visits and hospital readmissions.

Conclusion: Women undergoing EVAR had a greater risk of adverse outcomes and unexpected healthcare utilization. Further investigation is warranted to determine the drivers of these outcomes.

Background: Intraplaque hemorrhage (IPH) and lipid-rich necrotic core (LRNC) are key markers of carotid plaque vulnerability and stroke risk. Though magnetic resonance imaging (MRI) can detect both, duplex ultrasound is more accessible and may identify echolucent plaque areas that correlate with IPH or LRNC. This study investigated whether quantitative ultrasound can predict the presence of IPH or LRNC in atherosclerotic carotid artery stenosis (CS).

Methods: In this prospective single-center study, patients with moderate to severe asymptomatic or symptomatic CS underwent MR plaque imaging and quantitative ultrasound with color mapping. Echolucency was measured in various plaque areas using several gray-scale thresholds. IPH was defined as part of the LRNC. Receiver operating characteristic (ROC) curve analysis assessed the predictive value of ultrasound for MRI-detected IPH or LRNC.

Results: Among 113 enrolled patients, 75 patients (mean age 75 years; 69% men; 40% with symptomatic CS) were included in the analysis. On MRI, 43 patients (57%) had LRNC, and 32 patients (43%) showed IPH in the index artery. In the group without IPH, LRNC status could not be scored for 19 index arteries. Echolucency of the plaque surface with a gray-scale value < 20 showed the strongest association with IPH, with an area under the ROC curve (AUC) of 0.58 (95% CI 0.43, 0.71) and a negative predictive value of 0.64 (95% CI 0.50, 0.69) for the presence of IPH (sensitivity 0.50, specificity 0.65). For LRNC without IPH, several thresholds yielded the best-performing AUC of 0.48 (95% CI 0.23, 0.73/0.74)Conclusion:Quantitative ultrasound does not reliably predict the presence of IPH or LRNC, as detected by MRI, in patients with atherosclerotic internal CS.

Background: Adequate distal perfusion assessment is crucial for managing chronic limb-threatening ischemia (CLTI). Skin perfusion pressure (SPP) and transcutaneous oxygen pressure (TcPO₂) are commonly used to evaluate perfusion and predict wound healing. The main objective of this study was to compare the effectiveness of SPP and TcPO₂ in predicting early wound healing following endovascular therapy (EVT) for CLTI.

Methods: We retrospectively reviewed 99 limbs from 87 patients with Rutherford category 5 or 6 CLTI enrolled in the K-VIS ELLA registry (ClinicalTrials.gov Identifier: NCT02748226). SPP and TcPO₂ were measured before and within 48 hours after EVT. Clinical outcomes included early wound healing (defined as complete epithelialization without major amputation within 3 months), major amputation, repeat revascularization, major adverse limb events (MALE), and all-cause death.

Results: A high post-EVT SPP (⩾ 48 mmHg) significantly predicted early wound healing and was associated with a higher proportion of wound healing and a lower risk of repeat revascularization at 6 months. TcPO₂ did not significantly predict early wound healing; however, a high post-EVT TcPO₂ (⩾ 27 mmHg) correlated with lower proportions of repeat revascularization and MALE at 6 months. Neither SPP nor TcPO₂ was associated with mortality or major amputation.

Conclusion: High SPP within 48 hours post-EVT was a significant predictor of early wound healing in CLTI. Although TcPO₂ was not predictive of early wound healing, it was linked to other favorable limb outcomes. Further studies are required to validate our findings and define the complementary roles of SPP and TcPO₂ in managing CLTI.

Introduction: Endothelial dysfunction is a hallmark of sepsis pathophysiology, driven by inflammation, oxidative stress, and endoplasmic reticulum (ER) stress, leading to vascular abnormalities and organ failure. Niban, a multifunctional cellular stress response protein, regulates endothelial homeostasis, with its phosphorylation playing a critical role in mitigating ER stress. We hypothesized that sepsis-induced endothelial dysfunction in the aorta is driven by reduced Niban phosphorylation, which increases ER stress, but can be restored by NiPp, a cell-permeant phosphopeptide mimetic designed to replicate phosphorylated Niban.

Methods: Rats were subjected to a cecal slurry model of polymicrobial sepsis. Molecular markers of ER stress and Niban phosphorylation were analyzed using Western blot, and the vascular reactivity of septic aortae was assessed in muscle baths. Ex vivo NiPp treatment on septic aortic dysfunction was also evaluated. The effects of ER stressors or circulating sepsis mediators, including lipopolysaccharides, interleukin-1β, and cell-free hemoglobin, on endothelial function in healthy aortic rings were tested with or without NiPp.

Results: Septic aortas exhibited reduced Niban and endothelial nitric oxide synthase phosphorylation, as well as increased glucose-regulated protein 78 levels. Ex vivo treatment with NiPp improved endothelial dysfunction in septic rat aortas. Moreover, NiPp improved endothelium-dependent relaxation in aortic rings exposed to the ER stressor or any of the circulating sepsis mediators ex vivo.

Conclusion: Together, these findings highlight reduced Niban phosphorylation as an important driver of vascular endothelial dysfunction during sepsis, and suggest a mechanistic link between sepsis, reduced Niban phosphorylation, and heightened ER stress.

Introduction: This study aims to determine whether quantitative Doppler waveform parameters-specifically waveform frequency and acceleration time-are associated with central venous hypertension (CVH) and can be used to identify CVH noninvasively during routine venous duplex ultrasound.

Methods: This retrospective case-control study included 199 patients who underwent venous duplex ultrasound. Cases (n = 63) had a clinical diagnosis of CVH, and age- and sex-matched controls (n = 136) had no evidence of CVH. Doppler waveforms from the common femoral vein (CFV) and femoral vein (FV) were analyzed for frequency, peak systolic velocity, acceleration time, and volume flow rate. Multivariable regression and receiver operating characteristic analyses were used to assess diagnostic performance.

Results: Patients with CVH had significantly higher waveform frequency and shorter acceleration time compared to controls (all p < 0.001). Receiver operating characteristic analysis showed that FV waveform frequency ⩾ 60 cycles/minute had excellent diagnostic accuracy for CVH (AUC = 0.95), and CFV acceleration time < 400 ms was moderately predictive (AUC = 0.67). The combination of FV frequency ⩾ 60 cycles/minute and CFV acceleration time < 400 ms yielded the highest diagnostic performance. Peak systolic velocity and volume flow rate were not associated with CVH.

Conclusions: Quantitative spectral Doppler criteria-specifically, increased FV waveform frequency and decreased CFV acceleration time-are strongly associated with CVH. These objective, reproducible parameters may enhance the diagnostic value of routine venous duplex ultrasound and support earlier recognition of occult cardiovascular disease in patients evaluated for chronic venous symptoms.