Vascular Medicine最新文献

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.

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.