Vascular Medicine最新文献

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.

Introduction: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to fewer complications, yet many fail to mature. Although clinical predictors have been studied, results remain inconsistent. Recent guidelines recommend considering functional status when selecting access, but evidence is limited. This study evaluated the impact of functional status on fistula maturation.

Methods: In this retrospective cohort study, we included 315 patients who underwent AVF creation at a university hospital. Data were collected on demographics, comorbidities, and AVF characteristics. Functional status was measured by the Katz Activities of Daily Living (ADL) Index. The primary outcome was overall clinical AVF maturation within 270 days. Secondary outcomes included unassisted maturation and AVF abandonment.

Results: Of the 315 patients analyzed, the mean age was 66 years (SD, 13 years) and 43% were women. Clinical AVF maturation rates at 3, 6, and 9 months were 34%, 60%, and 72%, respectively. Patients with severe disability (Katz ADL score 0-2) had lower maturation rates (23%, 43%, and 47% at 3, 6, and 9 months) compared to those with partial or no disability. In univariable analysis, clinical maturation of AVF at 9 months was associated with age, female sex, unmarried status, cardiovascular disease, larger arterial diameter, and severe disability. In multivariable analysis, severe disability was independently associated with maturation failure (OR 2.439, 95% CI 1.028-5.784, p = 0.043).

Conclusion: Disability, measured by the Katz ADL Index, independently predicts lower AVF maturation rates. Patients with severe disability may require tailored interventions and closer monitoring.

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.

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).