Vascular Medicine最新文献

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.

Introduction: Vascular contributions to cognitive impairment and dementia are potentially modifiable. Early detection of reversible arterial injury may improve risk stratification and provide treatment monitoring. We hypothesized that carotid ultrasound grayscale median (GSM), a novel imaging biomarker of early arterial injury, would predict incident all-cause dementia in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: The MESA enrolled adults free of atherosclerotic cardiovascular disease. Common carotid GSM was measured at baseline. Incident all-cause dementia events were identified by hospital and death records. Cox proportional hazards models with natural cubic splines investigated the association of baseline GSM and all-cause dementia.

Results: The 1788 participants were a mean (SD) 63.1 (10.3) years old and 53% were women. Over a median 13.7 years, 157 all-cause dementia events occurred. In fully adjusted models, with additional adjustment for carotid intima-media thickness, lower (worse) GSM independently predicted incident all-cause dementia (hazard ratio, 1st to 3rd tertile, 1.45 [95% CI, 1.11-1.90], p = 0.021).

Conclusions: Lower GSM independently predicts all-cause dementia, beyond traditional arterial injury measures, suggesting it may serve as an early marker of dementia risk.

Background: In patients with chronic limb-threatening ischemia (CLTI), a subset of patients are beneficiaries of welfare assistance. We sought to investigate the clinical features and prognosis of patients with CLTI receiving welfare compared to those not receiving welfare in the Japanese population.

Methods: This is a subanalysis of the multicenter, prospective Wound-directed Angiosome RevasculaRIzation apprOach to patients with cRitical limb iSchemia (WARRIORS) registry. We evaluated 440 patients with CLTI accompanied by tissue loss undergoing infrapopliteal revascularization. The outcome measures included a 24-month wound-healing rate, and overall survival and follow-up continuity. We compared the outcomes between the welfare and nonwelfare groups (n = 48 and 392, respectively) using the Kaplan-Meier method and log-rank tests.

Results: Frequencies of nonambulatory status, diabetes mellitus, hemodialysis, and wound severity stratified by Wound, Ischemia, and foot Infection classification showed no significant inter-group differences. The number of patients treated with bypass surgery was lower in the welfare group than in the nonwelfare group. The 24-month wound healing and follow-up continuity rates were significantly lower in the welfare group compared to the nonwelfare group (37.3% vs 59.6%, p = 0.005 and 47.9% vs 58.0%, p = 0.048, respectively). In contrast, the 24-month overall survival rate did not differ significantly between the groups (63.1% vs 71.7%, p = 0.27).

Conclusions: Patients receiving welfare had significantly worse wound-healing rates and a higher loss to follow up even within the framework of the Japanese universal health insurance system.

Introduction: Chronic venous disease (CVD) is highly prevalent, imposing a significant burden on patients. Treatment options include surgical and nonsurgical modalities. Neuromuscular electrical stimulation (NMES) is an alternative that artificially activates the calf muscle pump, improving blood flow parameters. This systematic review evaluates its effectiveness in relieving CVD symptoms.

Methods: PubMed, Web of Science, and Scopus were sought for experimental and observational studies published between 2000 and March 2025. Included studies assessed NMES for CVD symptoms. Exclusion criteria were electrode application directly to or around ulcers and sample sizes under 10 patients. The primary objective included peripheral edema, quality of life, venous leg ulcer healing, and leg pain. Adverse effects were the secondary outcome. Risk of bias was evaluated using appropriate tools.

Results: Out of 269 records gathered, eight were included (three randomized controlled trials, one nonrandomized controlled trial, and four case series), totaling 311 patients, 214 of whom used NMES. The mean age was 56.7 years (95% CI: 48.0-65.4 years) and 49.9% (95% CI 40.5-59.2%) were women. Devices used were Geko and Veinoplus (three studies each) and Revitive IX (two studies). Six studies evaluated edema, with a decrease in NMES groups in four. Quality of life was evaluated in five studies; pain and ulcer healing were appraised in three each, all showing improvement. Reported adverse effects included mild skin irritation and rash.

Conclusion: NMES shows promising results across all outcomes studied. However, studies may suffer from publication or selection bias, imperfect designs, and other individual factors. (PROSPERO registration No.: CRD42023401762).