Vascular Medicine最新文献

Introduction: The manifestations of the central lymphatic vessels in primary lower-extremity lymphedema (LEL) remain incompletely understood. Advanced magnetic resonance imaging (MRI) techniques offer the potential to noninvasively evaluate central lymphatic vessels and their relationship with disease severity. Our objective was to investigate the differences in imaging performance of central lymphatics and inguinal lymph nodes in primary LEL of different clinical stages, and to assess the ability of MRI to grade primary LEL. Methods: Patients were staged according to the International Society of Lymphology (ISL), with 92 cases in stage I, 134 in stage II, and 53 in stage III. All patients underwent lower-extremity MRI, pelvic MRI, and magnetic resonance thoracic ductography (MRTD). Chi-squared tests and Fisher's exact tests were used to compare the relationship between the central lymphatic vessels and inguinal lymph nodes with clinical staging. LEL was graded based on MRI images, and a partial correlation coefficient was employed to assess the correlation between MRI grading and clinical staging. Results: A significant correlation was observed between clinical staging and MRI grading (R = 0.728, p < 0.001). The incidence of abnormalities in the terminal thoracic duct and the lumbar and iliac lymphatic vessels differed significantly across clinical stages (p ⩽ 0.001). Additionally, the frequency of enlarged inguinal lymph nodes on both the affected and the unaffected sides showed statistically significant differences (p = 0.001). Conclusion: MRI grading demonstrates a high correlation with clinical staging. Changes in central lymphatic vessels and inguinal lymph nodes, as identified through MRTD, provide valuable insights for the clinical staging of primary LEL.

Background: The association between ectopic fat and vascular stiffness is poorly studied and has never been systematically reviewed. We conducted a systematic review and meta-analysis aimed to systematize current literature and investigate the association of perivascular adipose tissue (PVAT) and the indices of vascular wall remodeling and arterial stiffness, such as pulse wave velocity (PWV), augmentation index (AI), cardio-ankle vascular index (CAVI), endothelium-dependent vasodilation (EDV), and intima-media thickness (IMT).

Methods: A systematic literature review was performed according to PRISMA guidelines via searching PubMed, Scopus, and Web of Science databases using specific keywords. Data were extracted from eight studies with 1244 participants that fit the criteria and analyzed using a random-effects model.

Results: Our pooled analysis revealed stronger correlations between carotid-femoral pulse wave velocity (cfPWV), AI, and the density of thoracic periaortic adipose tissue (r = 0.56, p < 0.05, n = 14); carotid extra-media thickness (EMT) and average daily PWV in the aorta (r = 0.56, p < 0.05, n = 84); and thoracic periaortic fat volume and CAVI (r = 0.49, p < 0.05, n = 318).

Conclusion: Our results demonstrate the association between PVAT and vascular wall remodeling, emphasizing the need for early detection of dysfunctional PVAT as the contributor to higher cardiovascular risk, not only in patients with risk factors and cardiovascular diseases, but also in healthy individuals. (PROSPERO Registration No.: CRD42023443139).

Rare vascular diseases are a diverse group of life-threatening conditions defined by their low prevalence but profound impact on patient morbidity and quality of life. Diagnosing these disorders remains a significant clinical challenge due to their genetic heterogeneity, overlapping phenotypes, and limited patient populations. As such, the development of robust and human-relevant disease models is critical for elucidating pathogenic mechanisms and guiding therapeutic discovery. The advent of human induced pluripotent stem cell (iPSC) technology has opened new avenues for modeling rare vascular diseases by enabling the generation of patient-specific vascular cell types, including endothelial cells, smooth muscle cells, and fibroblasts, and the creation of both two-dimensional cultures and three-dimensional vascular organoids. Together with genome editing and next-generation multiomics, these platforms represent new approach methodologies (NAMs) that allow for detailed investigation of disease biology, facilitate the correction of pathogenic mutations, and enable high-throughput drug screening in a personalized context. In this review, we highlight the advancements in iPSC-derived vascular modeling, discuss the integration of gene editing and multiomics technologies, and explore their transformative potential for uncovering mechanisms and developing precision therapies for rare vascular diseases.

Background: Peripheral vascular interventions (PVI) in chronic limb-threatening ischemia (CLTI) are used to prevent amputation. However, imaging practices following PVI and their correlation with amputation outcomes remain unclear. Methods: Using Medicare-linked Vascular Quality Initiative data (2017-2019), we identified imaging tests (ankle-brachial index [ABI], duplex ultrasound, magnetic resonance angiography, computed tomography angiography) ordered within 1 year post-PVI for CLTI. Site variability was assessed using median odds ratio (MOR) and intraclass correlation coefficient (ICC). The association between post-PVI imaging and 1-year major amputation was examined using competing risk analyses in a propensity-matched cohort. Results: We included 10,006 patients (mean age: 72.1 ± 11.0 years); 25.5% received no imaging. Over 50% of imaging tests were ABI and 83.1% were ordered within 3 months. Significant site variability was noted (none vs ⩾ 1: MOR 1.64, 95% CI 1.50-1.78; ICC 7.6%, 95% CI 5.2-9.9%; per one-unit increase in monthly volume: MOR 1.06, 95% CI 1.05-1.07; ICC 9.4%, 95% CI 7.0-11.8%). Having none versus ⩾ 1 imaging tests post-PVI occurred more in patients with lower 1-year major amputation rates (5.7%, 95% CI 5.0-6.6% vs 8.8%, 95% CI 7.9-9.9%, p < 0.001; subdistribution hazard ratio [SHR] 0.63, 95% CI 0.53-0.76, p < 0.001). More imaging ordered was correlated with a higher rate of major amputation (SHR 1.83, 95% CI 1.52-2.20, p < 0.001). Conclusions: Imaging practices post-PVI for CLTI are highly variable. Imaging tests are more often ordered in patients with higher amputation rates, but causality cannot be inferred. Additional information about symptom status and access to care are necessary. Standardized follow-up imaging protocols need to be developed and studied for improved clinical outcomes.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM), but their effect on the risk of cardiovascular events and amputation in patients with chronic limb-threatening ischemia (CLTI) remains underexplored. This retrospective cohort study evaluated the association between GLP-1RA use and the 5-year risk of major amputation, all-cause mortality, and cardiovascular events in diabetic patients with CLTI.

Methods: The TriNetX real-world clinical data platform was used to identify patients with T2DM and CLTI, categorized by GLP-1RA prescription records. Propensity score matching was applied based on demographics, comorbidities, concurrent medications, and laboratory values. Cox proportional hazards, Kaplan-Meier curves, and the log-rank test were used for analysis.

Results: Among 139,173 patients with T2DM and CLTI, 17,306 patients were GLP-1RA users and 121,867 were non-GLP-1RA users. Following propensity score matching, 15,743 patients remained in each group (91% match rate). The mean age was 65.4 ± 11 years and 58.9% were men. The mean follow-up duration was 753.7 days. GLP-1RA users had a significantly lower rate of major amputation (hazard ratio [HR]: 0.745; 95% CI: 0.679-0.816; log-rank p < 0.001), all-cause mortality (HR: 0.7; 95% CI: 0.663-0.738; log-rank p < 0.001), and myocardial infarction (MI) (HR: 0.838; 95% CI: 0.792-0.886; log-rank p < 0.001). There was no difference in the risk of ischemic stroke (HR: 0.969; 95% CI: 0.906-1.036; log-rank p = 0.353).

Conclusion: The use of GLP-1RA medications is associated with a significant decrease in the 5-year risk of major amputations, all-cause mortality, and MI in diabetic patients with CLTI.

Introduction: The transition to an outpatient setting for endovascular treatment of lower-limb peripheral artery disease (PAD) remains slow, and obstacles persist. The aim of this study was to identify the obstacles to its development, according to vascular interventionalists.

Methods: Between September 2022 and October 2023, all French vascular interventionalists, who were members of the participating societies, were asked to answer an online questionnaire on their outpatient setting practice for PAD endovascular treatment. The questionnaire explored patient selection criteria (medical and social), treatments, follow up, and potential obstacles.

Results: Of the 279 respondents (43%), 228 (82%) were currently performing endovascular treatment of PAD on an outpatient basis. Most interventionalists (n = 179, 79%) declared that an outpatient setting practice did not alter their technical approach. Age, obesity, chronic limb-threatening ischemia (CLTI), and chronic renal failure were not considered exclusion criteria for an outpatient setting by more than half of the respondents. Long iliac and femoropopliteal thrombosis were considered exclusion criteria by 48 (21%) and 75 (33%) of them, respectively. Interventionalists estimated the rate of potentially eligible patients at 58.3 ± 22.5%. Social isolation (lack of comprehension, communication means, or company) was considered the main exclusion criterion for more than 90% of the respondents. Medico-legal risks were identified as the main obstacle for 39% of interventionalists not practicing outpatient care.

Conclusion: This prospective study identifies, from the perspective of vascular interventionalists, medico-legal risks, social isolation, and the complexity of lesions as the main obstacles to the transition to an outpatient setting for endovascular treatment of lower-limb PAD.

Background: In-stent occlusion (ISO) remains a significant challenge in postthrombotic syndrome (PTS), with limited histopathologic characterization.

Methods: Between January 2022 and November 2024, 19 patients with PTS (12 men; mean age 44.3 ± 12.4 years) presenting with 20 iliofemoral venous ISO underwent thrombectomy using the RevCore system. Histopathology was performed on retrieved materials from 16 limbs. Technical success, stent patency, and Villalta score were assessed. Kaplan-Meier and Cox regression identified predictors of restenosis/occlusion.

Results: Technical success was 95% (19/20 limbs). In venous stent occlusions < 3 months duration (n = 12), retrieved materials contained more fresh thrombus (40.4%, p = 0.058) and old thrombus (41.3%, p = 0.040) than in occlusions ⩾ 3 months duration (n = 4), where diffuse intimal thickening (DIT) was predominant (73.8%, p = 0.008). Severe restenosis/occlusion occurred in 60% (12/20) of limbs during a median 209.5-day follow up, with median patency of 144.5 days. Villalta scores improved from 14.8 ± 7.1 to 9.4 ± 6.8 at 1 month (p = 0.002) and 9.5 ± 6.8 at the final follow up (p = 0.001). Retrieved materials containing > 50% old thrombus had a higher restenosis/occlusion risk (p = 0.026). Common iliac vein (CIV) residual stenosis ⩾ 30% (hazard ratio (HR) = 4.103; p = 0.037) and a restored common femoral vein (CFV) flow diameter < 8.0 mm (HR = 3.871; p = 0.026) predicted severe restenosis/occlusion.

Conclusion: In PTS-related ISO, DIT predominated in occlusion ⩾ 3 months. Old thrombus, CIV residual stenosis ⩾ 30%, and a CFV flow diameter < 8.0 mm predicted restenosis/occlusion. Integrating histopathologic assessment into postthrombectomy evaluation may help tailor and optimize management strategies for iliofemoral ISO.