Vascular Medicine最新文献

Background: Impaired angiogenic response in peripheral artery disease (PAD) contributes to the progression of tissue ischemia, but methods to evaluate angiogenesis at the tissue level are limited. We describe a novel approach to measure angiogenesis and identify microRNA (miR)-gene pathways utilizing adipose tissue from patients with PAD. Methods: Patients with PAD undergoing infrainguinal bypass surgery or non-PAD control patients undergoing knee replacement surgery were recruited. Subcutaneous adipose tissue was obtained at the time of surgery. In patients with PAD, adipose tissue was taken from both the proximal and the distal ends of the surgical incision. Angiogenic capacity was measured and miR sequencing was performed. Differentially expressed miRs were defined by p < 0.01 and log₂ (fold change) > 1 or < -1. The miRs that correlated with angiogenic capacity and their gene targets were identified. Results: Participants with PAD (n = 10) and control participants (n = 5) were recruited. Capillary sprouting was impaired in distal (p = 0.0014) but not proximal (p = 0.12) PAD adipose tissue. In a subset of samples (controls: n = 4, PAD: n = 6), miR sequencing revealed 56 differentially expressed miRs in distal PAD. Six miRs with a correlation to impaired capillary sprouting and related to angiogenesis using Qiagen Ingenuity Pathway Analysis (IPA) software were identified (miRs 144-3p, 15b-5p, 18b-5p, 20b-5p, 454-3p, and 363-3p). These miRs are predicted to target regulators of angiogenesis including vascular endothelial growth factor A (VEGFA), phosphatase and tensin homologue (PTEN), and cyclin-dependent kinase inhibitor 1A (CDKN1A). Conclusion: Evaluation of ischemic adipose tissue represents a novel approach to gain insight into impaired angiogenesis in PAD. Integration with miR sequencing and target analysis has the potential to identify novel pathways of impaired angiogenesis in PAD.

IntroductionFew tests are validated for ischemia grading in chronic limb-threatening ischemia (CLTI). An additional, easily accessible and validated technique would be beneficial. This study aimed to determine whether transmetatarsal pressure (TMP) is valid in the evaluation of CLTI ischemia grade. We also aimed to assess if values for TMP were meaningful in patients with noncompressible ankle-brachial indices (ABI).MethodsA cohort of patients with peripheral artery disease (PAD) presenting to our vascular center from March 1 to May 1, 2022, underwent TMP measurement concurrent with ABI and toe pressure (TP) measurement. Linear and quadratic regression models were used to assess the relation between TMP and TP or ABI.ResultsA total of 108 patients who were being followed for PAD underwent testing. Half had a history of CLTI (55% of patients with diabetes and 43% of patients without diabetes). The relation between TP and TMP was best described by a quadratic formula with an R² value of 0.41. By combining the existing WIfI ischemia ranges defined by TP and the quadratic formula, new ischemia grades were calculated for TMP. Ischemia grades 0, 1, 2, and 3 corresponded to ranges of TMP pressure (mmHg) of ≥ 75, 45-74, 30-44, and < 30. There were 25 instances where a patient had an abnormally elevated ABI. None of these patients had a noncompressible TP or TMP.ConclusionWe demonstrated that TMP can be integrated into the WIfI classification. We believe that TMP evaluation may increase the reliability, accuracy, and accessibility of CLTI assessment and management.

Background: Symptomatic peripheral artery disease (PAD) is prevalent and guideline-recommended therapies include optimal medical therapy (OMT), supervised exercise therapy (SET), and revascularization (stenting). The Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) trial examined longitudinal patient-reported outcomes to assess response to OMT, SET, and stenting. The predictors of symptomatic improvement have not been fully assessed.

Methods: This is a secondary analysis of the CLEVER trial, which randomized patients with claudication to OMT alone, OMT plus SET, or OMT plus stenting. The primary outcome was a change in the Peripheral Artery Questionnaire (PAQ) summary score by 10 points or more from baseline to 6 and 18 months. Multivariate logistic regression was used to identify predictors of response.

Results: Of the 103 participants (66 men, median age 63 years), 65 (63%) had a response to therapy at 6 months. Of 98 participants who completed the 18-month PAQ, 52 (53%) had a symptomatic response. On binary logistic regression, when compared to OMT, SET (6 months: odds ratio [OR] 4.25, 95% CI: 1.33-13.58; 18 months: OR 3.92, 95% CI: 1.04-14.70) and ST (6 months: OR 5.19, 95% CI: 1.58-17.03; 18 months: OR 11.50, 95% CI: 2.89-45.72) were associated with an increase in PAQ at 6 and 18 months.

Conclusion: Among randomized patients in the CLEVER trial, treatment with either SET or stenting was predictive of clinically meaningful change in the PAQ summary score from baseline to 6 and 18 months. These interventions, with a prioritization of SET, should be more widely available to patients with PAD. This study adds to the findings of the CLEVER trial by denoting that SET and stenting are beneficial in patients with PAD, independent of comorbidities.

Epidemiological studies of transgender women suggest that these individuals experience higher rates of venous thromboembolism than their cisgender peers. Several factors likely increase this risk, including medication use, comorbidities, and social determinants of health. Estrogen-based gender-affirming hormone therapy is critical for helping patients address unwanted secondary sexual characteristics and induce physical changes in accordance with their gender identity. However, the use of estrogen-based gender-affirming hormone therapy may increase the risk of venous thromboembolism. This review article summarizes the current evidence describing venous thromboembolism risk among patients using various forms of estrogen, including transgender and cisgender individuals. The article also discusses strategies for managing venous thromboembolism in patients using estrogen-based gender-affirming hormone therapy and methods to reduce venous thromboembolism risk.

Endovascular renal denervation (RDN) is a catheter-based, procedural therapy for the treatment of hypertension that was approved by the US Food and Drug Administration (FDA) in November 2023. Early studies suggest that endovascular RDN reduces blood pressure (BP) in patients with hypertension. However, BP response to RDN is highly variable, optimal patient selection remains uncertain, and the procedure's high cost remains a significant challenge. The purpose of this review is to comprehensively examine the literature regarding the mechanism by which endovascular RDN reduces BP and the safety and effectiveness of RDN, and to discuss key considerations for selecting appropriate patients for endovascular RDN. Relevant studies in the field were identified from PubMed using search terms including 'renal denervation' and 'renal denervation for hypertension.' In conclusion, clinical trials have demonstrated a statistically significant BP-lowering effect of endovascular RDN, which based on multiple trials with long-term follow-up, appears to persist over several years with low complication rates. More research is needed to understand which patients benefit most from endovascular RDN and to evaluate the long-term outcomes, including the impact of endovascular RDN on cardiovascular events.

Introduction: The long-term effects of supervised exercise training (SET) on functional performance and health-related quality of life (HRQoL) in symptomatic peripheral artery disease (PAD) are poorly investigated, especially in women. This study investigated these outcomes 1 year after SET in both women and men.

Methods: In this single-arm, prospective, nonrandomized study, patients with symptomatic PAD participating in the 3-month SET program were investigated. Functional performance (6-minute walking distance [6MWD], the stair-climbing test [SCT], and the short physical performance battery [SPPB]), and HRQoL (physical component summary [PCS] score of the Short Form-36 questionnaire) were assessed before and following SET, as well as at 6 and 12 months after SET completion.

Results: Ninety patients (women: n = 30; men: n = 60) with chronic symptomatic PAD (ankle-brachial index 0.78 ± 0.22; mean age 65.4 ± 10.2 years) were included in the study. The 6MWD (women: before: 387.2 ± 88.6 m; after: 472.4 ± 57.0 m; 12 months: 469.9 ± 57.8 m; men: before: 431.7 ± 94.0 m; after: 477.5 ± 88.6 m; 12 months: 467.2 ± 73.4 m), SPPB score (women: before: 9.6 ± 2.4; after: 11.3 ± 1.0; 12 months: 11.2 ± 0.5; men: before: 10.6 ± 1.4; after: 11.5 ± 0.9; 12 months: 11.3 ± 0.8), and SCT (women: before: 8.6 ± 4.4 s; after: 5.6 ± 1.6 s; 12 months: 5.8 ± 1.2 s; men: before: 6.2 ± 2.3 s; after: 5.0 ± 1.9 s; 12 months: 5.3 ± 1.6 s) significantly improved over time (p ≤ 0.001), with no significant differences between women and men. The PCS score (women: before: 30.3 ± 8.0; after: 38.8 ± 8.4; 12 months: 35.7 ± 7.4; men: before: 32.4 ± 10.5; after: 35.7 ± 9.5; 12 months: 35.4 ± 7.6) significantly improved in women only (p = 0.020).

Conclusion: One year after SET, both women and men with PAD exhibit similar functional benefits, whereas HRQoL improvements were observed exclusively in women.