Vascular Medicine最新文献

Background: Although there are reports on angioplasty for inframalleolar (IM) occluded lesions in chronic limb-threatening ischemia (CLTI), the clinical outcomes specific to the IM stenotic lesions remain unclear. This study evaluated the effect of balloon angioplasty for IM stenotic lesions on the clinical outcomes of patients with CLTI.

Methods: This is a multicenter, retrospective, nonrandomized observational study. We retrospectively analyzed 194 patients with CLTI who underwent endovascular therapy for infrapopliteal (IP) lesions with IM stenotic lesions distal to the target IP lesion between November 2017 and August 2022. Angioplasty for IM stenotic lesions was performed in 99 patients. Outcome measures included wound healing rate, amputation-free survival (AFS), and freedom from reintervention. Propensity score matching was conducted to reduce baseline differences.

Results: Propensity score matching extracted 69 pairs with no significant baseline differences. The wound healing rate was not significantly different between the angioplasty and nonangioplasty groups (64.0% vs 59.6%, p = 0.94). Similarly, no significant differences were observed in AFS (82.4% vs 82.2%, p = 0.94) and freedom from reintervention (51.1% vs 46.6%, p = 0.81). However, the lesion morphology at reintervention progressed from stenosis to occlusion more frequently in the angioplasty group than in the nonangioplasty group (39.3% vs 12.9%, p = 0.035). Multivariate analysis identified angioplasty in IM lesions as an independent predictor of lesion morphology progression in IM lesions.

Conclusion: Angioplasty was associated with a higher rate of lesion morphology progression, which should be considered when determining treatment strategies.

Background: The aims were to determine the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in individuals free from ASCVD (a) in the presence of carotid bifurcation plaques (CBP) < 3-mm thick and ⩾ 3 mm in comparison to a normal vessel wall and (b) the risk modulation in the presence or absence of additional common femoral bifurcations with plaques (CFBP) in a cohort study.MethodsA total of 1000 subjects aged 58.4 ± 10.5 years, free from ASCVD, were followed up for 15.2 ± 4.9 years (mean ± SD). The primary endpoint was a composite of first time fatal or nonfatal 10-year ASCVD events.ResultsThe 10-year risk of ASCVD was 6% in the absence of carotid plaques; 10% in the presence of unilateral and 23% in the presence of bilateral < 3-mm plaques (adjusted hazard ratio [HR] 1.65 [95% CI 1.11-2.47] and 2.03 [95% CI 1.32-3.00], respectively); and 29% for unilateral and 63% for bilateral 3-5 mm plaques (adjusted HR 2.40 [95% CI 1.41-4.09] and 3.78 [95% CI 1.77-8.06], respectively). In those with unilateral or bilateral < 3-mm CBP in the presence of two CFBP, the 10-year risk of ASCVD was 26% and 37% (adjusted HR 3.01 [95% CI 1.38-6.58] and 2.52 [95% CI 1.55-4.10], respectively). The 10-year risk was 2% in those without CBP or CFBP and 26% in those with two CFBP only.ConclusionsThe presence of a < 3-mm CBP may be associated with a significant ASCVD risk, especially if bilateral. This risk is better defined by the additional presence or absence of two CFBPs.

Superior vena cava (SVC) syndrome results from stenosis and/or occlusion of the central venous system leading to symptomatology associated with head and neck as well as upper-extremity venous congestion. With the rise in central venous catheter use and increasing cases of malignancy, the incidence of SVC syndrome has steadily increased in recent years. This narrative review explores the clinical presentation of SVC syndrome, alongside its evolving etiologies within modern clinical practice and its pathophysiology. In light of this, advanced imaging modalities and management approaches are discussed based on the extensive institutional experience, detailing the preprocedural imaging techniques, conservative and interventional treatment options, and follow-up imaging protocols.

Arterial calcification is prevalent in peripheral artery disease (PAD), especially among patients with advanced age, diabetes, or renal disease. Peripheral arterial calcium score (PACS) is an emerging tool to quantify calcification in peripheral arteries and predict outcomes such as amputation and mortality. This systematic review evaluates PACS methodologies and its association with these adverse outcomes. In a comprehensive search of Embase, MEDLINE (PubMed), and PubMed Central (PMC) from January 1991 to January 2025, 1092 studies were retrieved, of which 17 met the inclusion criteria. Computed tomography and X-ray imaging were the main imaging modalities used to detect calcification through a variety of PACS. A higher PACS was linked to increased risk of amputation and/or mortality. PACS holds potential for predicting outcomes in PAD, particularly amputation and mortality. Standardization of PACS methods is needed to enhance its clinical utility and integration into practice.

Introduction: This study aimed to evaluate the incidence and risk factors for progression to chronic limb-threatening ischemia (CLTI) in patients with peripheral artery disease (PAD) and de novo claudication who underwent endovascular therapy (EVT), particularly femoropopliteal intervention.

Methods: A total of 338 limbs from consecutive patients with de novo claudication who received their first EVT were evaluated. The primary endpoint was progression to CLTI, assessed using the Kaplan-Meier estimate and hazard ratios (HRs) calculated via Cox regression analysis.

Results: CLTI developed in 21 of 196 femoropopliteal interventions and four of 142 aortoiliac interventions. The median time from initial femoropopliteal intervention to CLTI onset was 2.4 years. Limbs treated with femoropopliteal intervention progressed to CLTI more often than those treated with aortoiliac intervention (estimated 10-year incidence: 15.3% vs 8.6%). Univariate analysis identified chronic kidney disease with or without hemodialysis (HR: 6.43; 95% CI: 2.02-24.1, HR: 3.13; 95% CI: 1.02-11.6), chronic heart failure (HR: 2.71; 95% CI: 1.14-6.55), severe calcification (HR: 2.98; 95% CI: 1.06-7.39), P2-3 segment intervention (HR: 4.72; 95% CI: 1.52-12.4), and poor infrapopliteal runoff (HR: 15.1; 95% CI: 5.06-64.7) as risk factors. Multivariate analysis showed poor infrapopliteal runoff as an independent predictor (HR: 11.2; 95% CI: 3.56-49.3).

Conclusion: Progression to CLTI following femoropopliteal intervention in patients with claudication is influenced by comorbidities, vessel calcification, involvement of the P2-3 segment, and especially poor infrapopliteal runoff, regardless of EVT strategy.