Vascular Medicine最新文献

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.

Background: The efficacy of venoactive drug (VAD) treatment for pelvic venous disorder (PeVD) has not been fully investigated. This study was aimed at evaluating the efficacy and safety of different diosmin-containing agents in women with PeVD. Methods: VENOTREAT was a single-center, randomized, open-label study included 150 women with symptomatic PeVD, who were allocated for the 2-month therapy a once-daily intake of: (1) micronized purified flavonoid fraction (MPFF) 1000 mg; (2) diosmin 600 mg, or (3) hesperidin and diosmin combination (HDC) 1000 mg. The effects on chronic pelvic pain (CPP), the time to pain relief, as well as adverse events (AEs) were investigated. Results: Patients receiving MPFF reported a CPP reduction, using visual analog scale (VAS) scores, from 5.7 ± 0.8 to 2.8 ± 0.4 (p = 0.001) by day 7 and its elimination by day 28 in all cases. In the diosmin and HDC groups, the CPP reduction became significant by day 14 (VAS scores from 5.3 ± 0.6 to 3.7 ± 0.3 and from 5.1 ± 0.3 to 3.5 ± 0.2, respectively, both p = 0.001), and pain was eliminated after 2 months in 37 and 35, and decreased in the remaining 13 and 15 patients to VAS scores 1.07 ± 0.2 and 1.1 ± 0.07, accordingly. AEs included headache, nausea, gastralgia, and diarrhea and were reported in 7.3% of cases in general and in 6%, 8%, and 8% of patients in the MPFF, diosmin, and HDC groups, respectively. No serious AEs were observed. Conclusion: VAD treatment is effective and safe for eliminating CPP in PeVD. MPFF provides a faster and greater effect on venous CPP of venous origin. ClinicalTrials.gov Identifier: NCT06584799.

Background: The carotid body (CB) detects blood oxygen changes and may play a role in metabolic diseases. Several studies have suggested a link between CB size and cardiovascular conditions. This study aimed to evaluate CB size using computed tomography angiography (CTA) and investigate its associations with cardiovascular and metabolic conditions.

Methods: A retrospective analysis of 279 patients undergoing CTA of the cervical vasculature was conducted. The CB was identified as an enhancing structure at the carotid bifurcation, and its area was measured on axial images. Clinical data, including comorbidities and vascular risk factors, were collected. Statistical analyses included univariate and stepwise multiple linear regression to identify significant predictors of CB size.

Results: The CB was identified in 163 patients (49.1% right, 50.9% left). The mean CB area was 3.183 mm² for the right side and 2.901 mm² for the left. Obstructive sleep apnea (OSA) and internal carotid artery (ICA) stenosis ⩾ 70% were significant predictors of increased CB size. In the final regression model, OSA was associated with a 1.049 mm² increase in CB area (p = 0.027), whereas ICA stenosis ⩾ 70% and renin-angiotensin system inhibitor treatment were associated with increases of 0.528 mm² (p = 0.036) and 0.494 mm² (p = 0.037), respectively. CB hypertrophy was also associated with hypertension, obesity, and smoking in univariate analyses.

Conclusions: This study highlights significant associations between CB hypertrophy and conditions such as OSA and ICA stenosis, suggesting that CB enlargement reflects the interplay between hypoxia, vascular pathology, and metabolic dysregulation. CTA may assess CB size as a cardiovascular biomarker.