Vascular Medicine最新文献

Background: Paclitaxel-coated balloons (PCBs) are widely used for femoropopliteal artery (FPA) diseases. However, data on recurrence and recurrence patterns after PCB angioplasty are limited. This study investigated the association between recurrence patterns, baseline characteristics, and clinical outcomes in the cases following PCB angioplasty.

Methods: This multicenter, retrospective study included 1159 limbs in 1031 patients treated for de novo FPA lesions using PCBs. Patients were classified into three groups (patency, restenosis, and reocclusion) according to patency or recurrence patterns within 2 years after the index PCB angioplasty. The primary outcome was the incidence of target lesion revascularization (TLR), and the secondary outcome was the pattern of re-recurrence within 2 years following TLR using PCBs.

Results: When comparing the three groups, reocclusive cases were characterized by more complex lesions, including chronic total occlusion, at baseline. Following the index PCB angioplasty, approximately 70% of recurrent cases underwent TLR, which was performed more frequently in reocclusive than in restenotic cases (82.1% vs 63.7%). Conversely, a higher percentage of restenotic cases did not require TLR compared to reocclusive cases (10.3% vs 27.8%). In cases where TLR was performed using PCBs, the rate of re-recurrence with occlusive morphology was significantly higher in reocclusive than in restenotic cases (52.3% vs 24.3%).

Conclusions: After PCB angioplasty for FPA lesions, symptomatic recurrence and requirement for TLR were more frequent in reocclusive cases. Even after TLR using PCBs, reocclusive cases tend to recur with occlusion.

The present review introduces the term 'infective native visceral artery aneurysm (INVAA)' and provides a systematic review of the literature on this topic. The terms 'mycotic' and 'infected' have been replaced by the term 'infective native' to more accurately describe aneurysms of this type. A systematic search of MEDLINE, Embase, Google Scholar, and Scopus databases was performed to identify articles reporting on INVAAs to April 2024. Inclusion criteria encompassed studies describing 'mycotic' or 'infected' primary visceral aneurysms, excluding patients with concurrent aneurysms in the aorta. The search yielded 356 articles, with 161 meeting the inclusion criteria, covering 175 patients. The median age was 48 years (IQR: 33-60 years), predominantly men (n = 127, 72.6%). INVAA was most frequently reported in the superior mesenteric artery (37.5%, n = 65), followed by the hepatic (22.9%, n = 40) and splenic arteries (14.3%, n = 25). Endocarditis was the predominant etiology in 67.4% (n = 118) of cases. Gram-positive pathogens were identified in 58.8% (n = 103) of cases. Treatment modalities included open surgery (49.7%, n = 87), endovascular interventions (37.7%, n = 66), and medical management (12.0%, n = 21). The overall proportion of patients who died was 13.7% (n = 24). In multivariable modeling, cerebral aneurysms (OR: 4.0, 95% CI 1.17, 12.8; p = 0.02), gastrointestinal bleed (OR: 5.79, 95% CI 1.86, 17.6; p < 0.01), and chronic kidney disease (OR: 16.0, 95% CI 2.3, 136; p < 0.01) were associated with increased odds of death. The optimal treatment for INVAA remains undefined, highlighting the need for standardization of reporting and prospective registries to enhance the understanding and management of this complex disease.

Background: Inflammation and immune dysregulation are thought to drive residual cardiovascular disease risk among persons living with human immunodeficiency virus (HIV) (PLWH) despite effective viral suppression with antiretroviral therapy (ART).

Methods: We investigated differences in carotid inflammation and atherosclerosis in a longitudinal cohort of virally suppressed PLWH (N = 50; on stable ART with CD4 > 250 cells/mm³, viral load < 200 copies/mL for > 6 months) and HIV-uninfected controls (N = 51) matched for age, sex, hypertension, diabetes, smoking, hyperlipidemia, and family history of premature coronary artery disease (CAD). Participants were ≥ 40 years old at enrollment. Measures of carotid vascular inflammation (K^trans), neovascularization (V_p), and wall thickness were assessed at baseline, 1 year, and change over 1 year by dynamic contrast-enhanced magnetic resonance imaging (MRI).

Results: Among 101 participants, 8% were women, 42% had hypertension, 52% had hyperlipidemia, 16% had diabetes, and 48% had a family history of CAD. Both PLWH and control participants demonstrated a reduction in systolic and diastolic blood pressures and total cholesterol over 1 year; however, the difference was not significant by HIV status. PLWH had a significant reduction in triglycerides compared with controls (-48.8 vs 12.8 mg/dL, p = 0.026). HIV was not associated with baseline, follow up, or change in markers of systemic inflammation assessed by plasma cytokines, nor vascular inflammation as assessed by K^trans, V_p, carotid wall thickness, or percent wall volume (a measure of plaque burden).

Conclusion: In contrast to other studies of treated and virally suppressed PLWH, HIV infection was not associated with carotid inflammation or plaque in our hypothesis-generating study.

Adherence to guideline-recommended therapies for peripheral artery disease (PAD), including pharmacotherapy (antiplatelet, lipid-lowering, and antihypertensive agents) and lifestyle modifications (smoking cessation, diet, weight management, and physical activity) remains low. Though single-component interventions targeting smoking cessation, exercise, or medication adherence show some efficacy, comprehensive multicomponent interventions are vital for addressing the complexity of PAD management. This review systematically synthesized multicomponent interventions for patients with PAD. A systematic search was conducted in Embase, MEDLINE, Cochrane Library, APA PsycINFO, CINAHL, Web of Science Core Collection, ProQuest, and Google Scholar to identify primary research describing multicomponent interventions supporting PAD treatment adherence, published between 2007 and 2024. A narrative synthesis was reported using the Template for Intervention Description and Replication (TIDieR) checklist and the behavioral change techniques (BCT) taxonomy. Out of 15 studies (2462 patients, 60.4% men) included in this review, only two addressed all guideline-recommended treatment aspects. Key intervention components included structured exercise (12/15) and education programs (10/15). Most interventions were delivered by multidisciplinary teams in hospital settings over 3 months. Only one study employed behavioral theory in its development, and most interventions (13/15) focused on the BCT 'instructions on how to perform a behavior' rather than diverse BCTs. No interventions significantly increased adherence to all PAD therapies. Few studies measured the intervention's impact on adherence, making it difficult to determine effective intervention characteristics. Most interventions lacked behavioral science approaches and were not designed to address specific adherence determinants. Future interventions should incorporate these elements to effectively address patients' needs. Open Science Framework Registry ID: osf.io/7xqzj.