Vascular Medicine最新文献

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.

Background: The calf muscle pump is an understudied contributor to venous return from the lower extremity. This study aimed to determine if calf pump function (CPF) is independently associated with the severity of chronic venous disease classified by CEAP (Clinical-Etiology-Anatomy-Pathophysiology).

Methods: The Mayo Clinic Vascular Laboratory database was analyzed from January 2015 through September 2023. Ambulatory adults who underwent venous air plethysmography were included. Venous plethysmography assessed the severity of venous incompetence, and CPF was measured as ejection fraction (EF) per leg. The clinical component (C0 through C6) of the CEAP score was evaluated for each extremity at the time of the study.

Results: A total of 7760 limbs from 3733 patients were analyzed. The mean age was 62 years, with 62% women. Venous obstruction was detected in 3.2% of limbs. Venous incompetence severity was categorized as normal (44%), mild (26%), moderate (19%), and severe (10%). A significant trend of reduced CPF was observed with higher CEAP scores (p < 0.001). Multivariable logistic regression, adjusted for age, sex, degree of venous incompetence, and obstruction showed reduced CPF was a significant predictor (odds ratio 1.84, CI: 1.5-2.2) of active/prior ulcer (C5 or C6). In contrast to more severely reduced CPF, mildly reduced CPF (EF 40-49%) was not associated with active/prior ulcers.

Conclusion: This large contemporary study demonstrates that decreased CPF is associated with worse chronic venous disease. Importantly, we demonstrate for the first time that CPF is independently associated with active/prior venous ulcers after accounting for other venous physiologic parameters and demographics.

Background: Coronary calcification is a well-known predictor of coronary events, yet the impact of carotid artery calcification on systemic vascular events (e.g., cerebral ischemic, coronary, and peripheral artery events) remains unclear. The aim of this study was to determine whether carotid calcification can be used to predict systemic vascular events.

Methods: This single-center, retrospective cohort study included 194 patients who had a history of vascular disease, including carotid stenosis or occlusion, coronary artery disease, valvular heart disease, ischemic stroke, or transient ischemic attack. We collected data pertaining to risk factors and laboratory parameters. Calcification of the carotid arteries was assessed via whole-body computed tomography, and the modified carotid Agatston calcium score (CCS) was determined. Participants were divided into two CCS groups according to the cut-off value determined via receiver operating characteristic curve analysis; high CCS ≥ 126 and low CCS < 126. Coronary, ischemic cerebrovascular, and peripheral vascular events were recorded over a 5-year follow-up period, and their incidence was compared between the groups using Cox proportional hazards regression analysis.

Results: Older age, hypertension, and chronic kidney disease had a significant positive impact on the CCS. Systemic vascular events (hazard ratio [HR]: 2.70, CI: 1.07-6.79, p = 0.022), coronary events (HR: 4.29, CI: 0.87-21.1, p = 0.045), and peripheral vascular events (p = 0.032) were significantly more frequent in the high versus low CCS group.

Conclusion: The CCS may be a useful tool for predicting future systemic vascular events, including those related to coronary and peripheral artery diseases.

Introduction: Sedentary behavior, specifically an acute bout of prolonged uninterrupted sitting, is associated with heightened cardiovascular disease (CVD) risk, with increased arterial stiffness (AS) being implicated as a principal pathophysiological mechanism. The current systematic review, with meta-analysis, aimed to consolidate the AS response to (1) prolonged uninterrupted sitting and (2) interrupted sitting, as assessed by central and peripheral pulse wave velocity (PWV).

Methods: In total, 326 articles were identified, of which 11 and seven met the inclusion criteria for objectives (1) and (2), respectively. Mean differences (MD) and 95% CI were calculated for all trials using a three-level random-effects model, with restricted maximum likelihood (REML) estimation. The amount of heterogeneity was estimated using Cochran's Q and Higgins's I² tests.

Results: (1) Prolonged uninterrupted sitting resulted in a significant increase in carotid-femoral (cf) PWV (MD = 0.184 m/s, 95% CI = 0.098 to 0.270, p < 0.0003). (2) Interrupting bouts of prolonged sitting resulted in a significant increase in cf-PWV (MD = 0.127 m/s, 95% CI = 0.044 to 0.209, p < 0.0026) that was lower compared to the uninterrupted sitting.

Conclusion: An acute bout of uninterrupted sitting appears to increase cf-PWV; although interrupting prolonged sitting with brief physical activity is beneficial, it does not fully mitigate the response.