Vascular Medicine最新文献

Introduction: Extracoronary vascular abnormalities (EVAs) are common in patients with spontaneous coronary artery dissection (SCAD), and expert consensus statements recommend evaluation with head-to-pelvis cross-sectional imaging. Lack of a universal imaging protocol remains a barrier to consistent implementation of this recommendation. We sought to implement a high-fidelity, single-session, head-to-pelvis computed tomography angiography (CTA) protocol that minimizes radiation and contrast exposure compared to multisession CTA.

Methods: A total of 97 consecutive patients with SCAD were evaluated with a single-session CTA (SS-CTA protocol). The comparison group consisted of 63 consecutive patients who underwent asynchronous CTA of different body segments (MS-CTA). The primary outcome was total radiation dose and contrast volume in each imaging protocol. The secondary outcome was prevalence of EVAs.

Results: There was no difference in baseline characteristics, SCAD presentation, or management between groups. The SS-CTA protocol had a 24% lower radiation dose (1873 ± 676 mGy-cm vs 2452 ± 1099 mGy-cm, p < 0.001) and a 21% lower contrast volume (161.2 ± 48.7 mL vs 203.8 ± 68.4 mL, p < 0.001) compared to the MS-CTA protocol. There was no significant difference in the prevalence of EVAs detected between imaging groups (55.7% vs 57.1%, p = 0.854).

Conclusion: This study demonstrates the effectiveness of a single-acquisition CTA protocol for EVA detection in patients with SCAD. The SS-CTA protocol minimized radiation and contrast exposure for a patient population that may require frequent imaging over the lifespan. Further studies are needed to determine whether expanded availability of this protocol would improve adherence to expert consensus recommendations.

It has been posited that the inflammatory process seen in atherosclerosis is underpinned by gut dysbiosis. Dysbiosis refers to alterations in the function, composition, and diversity of the human gut microbiota, all of which are influenced by endogenous and exogenous stimuli. Currently there is limited literature describing the association between gut microbiota and peripheral artery disease (PAD). This review summarizes the evidence surrounding the role of gut microbiota in the initiation of atherosclerosis (through direct infection of atherosclerotic plaque or systemic immune response to bacterial products and metabolites) and how dysbiosis may influence the various treatment modalities for PAD, including medical therapy (pharmacotherapy, lifestyle changes, and supervised exercise training) and surgery (endovascular and open revascularization). In particular, the role of short chain fatty acids (SCFAs), the effects of exercise on SCFA-producing and lactic acid bacteria (LAB) and, consequently, the lack of targeted research into dietary interventions and supplementation are highlighted in this review. This review highlights the potential for gut microbiota as not only a therapeutic target in patients with PAD, but also as a diagnostic and screening tool. It is imperative that the focus of future research is on the potential for personalized treatment which targets the gut microbiota (such as synbiotics, postbiotics, nicotinamide adenine dinucleotide (NAD) supplementation, selective antibiotics, resistance exercise, senolytics, and fecal microbial transplantation [FMT]) to be utilized as adjuncts to already existing treatment options for PAD. This review also highlights the potential role of biobanks and analysis of atherosclerotic plaques in further advancing knowledge and research in this area.

Background: We aimed to investigate metabolomic alterations in peripheral artery disease (PAD) by analyzing blood from the femoral artery and vein, assessing metabolite release/uptake in chronically ischemic lower limbs (PAD group) and nonischemic limbs (controls), and evaluating the representativeness of upper-limb venous samples.

Methods: In this exploratory case-control study, 24 patients with PAD (Fontaine IIb and III) and 18 control subjects with stable angina were enrolled. Blood was drawn from the femoral artery and vein, and the antecubital fossa. Metabolomic profiling of serum samples was performed using liquid chromatography and tandem mass spectrometry. We analyzed 560 metabolites, including amino acids and derivatives, acylcarnitines, ceramides, phosphatidylcholines, tri- and diglycerides, cholesteryl esters, sphingomyelins, and fatty acids, as well as 52 metabolic ratios/sums across various biochemical classes.

Results: Femoral arteriovenous (AV) concentration differences with in-group significance in at least one group and between-group significance was observed for 47 metabolites and five metabolic sums. Among these, eight metabolic variables in antecubital vein samples were significant. Correlation between AV differences and antecubital vein samples was weak.

Conclusion: Using the femoral AV concentration differences of metabolites, we identified significant local metabolomic shifts in the PAD group. Most of these changes were not revealed using traditional upper-limb venous blood sampling. Further study of AV differences could improve the understanding of the pathophysiology of PAD.

Background: This study aimed to assess the impact of active malignancy on outcomes in patients undergoing revascularization for acute limb ischemia (ALI), focusing on mortality, limb salvage, and patency loss. Methods: We conducted a retrospective analysis of consecutive patients with ALI who underwent lower-limb revascularization over a 7-year period. Patients were stratified into two groups based on the presence of active malignancy at ALI diagnosis. Kaplan-Meier analysis was used to assess survival, limb salvage, and freedom from reocclusion. Cox proportional hazards models were applied to identify independent predictors of mortality, major amputation, and reocclusion. Results: A total of 296 patients were included, with a mean age of 76.2 ± 12.6 years; 62.8% were men. Most occlusions involved the femoropopliteal segment (57.8%). Thirty-eight patients (12.8%) had active malignancy. Baseline characteristics, interventions, and 30-day outcomes were similar between groups. Over a median follow up of 29.8 ± 24.6 months, 140 deaths (47.3%) were recorded. Patients with malignancy had significantly worse survival (p = 0.005), but similar rates of limb salvage and freedom from reocclusion. In multivariable analysis, active malignancy was independently associated with higher mortality (OR 3.321, 95% CI 1.310-8.418, p = 0.01), but not with limb salvage or patency loss. Conclusion: Active malignancy is associated with increased mid- and long-term mortality in patients with ALI, yet limb-related outcomes remain comparable to nononcological patients. Aggressive revascularization strategies should not be withheld solely due to malignancy when clinically appropriate.