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.

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.