101
|
Métairie A, Tollenaere Q, Lanéelle D, Le Faucheur A, Le Pabic E, Omarjee L, Mahé G. Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease. Front Cardiovasc Med 2022; 9:941600. [PMID: 36158813 PMCID: PMC9500167 DOI: 10.3389/fcvm.2022.941600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Ankle-brachial index (ABI) is commonly used for screening lower extremity peripheral artery disease (PAD) according to the international guidelines. Arterial Doppler waveform recordings is a tool to diagnose and assess PAD severity. We hypothesized that ABI measurement could be simplified by measuring only the pressure where the best arterial flow is recorded. The aim of this study was to evaluate the concordance between ABI performed according to the American Heart Association guidelines (AHA-ABI) and ABI measured according to best arterial waveform (FLOW-ABI). Design This was a monocentric cross-sectional study. Methods We included patients with exertional limb symptoms suspected of PAD. Arterial Doppler waveforms and ABI were acquired on both lower extremities at the pedis and tibial posterior arteries. Each arterial waveform was classified using the Saint-Bonnet classification. Concordances were analyzed with the kappa coefficient (confidence interval 95%). Exercise PAD study was registered n° NCT03186391. Results In total, one hundred and eighty-eight patients (62+/−12 years and 26.8+/−4.5 kg/m2) with exertional limb symptoms were included from May 2016 to June 2019. On each extremity, FLOW-ABI had excellent concordance for the diagnosis of PAD with the AHA-ABI with a kappa of 0.95 (95% CI: 0.90, 0.99) in the right extremity and 0.91 (95% CI: 0.86, 0.97) in the left extremity. Conclusion There is almost perfect concordance between AHA-ABI and FLOW-ABI. Thus, ABI can be simplified into five pressure measurements instead of seven in patient suspected of PAD with exertional limb symptoms. The question remains in patients with chronic limb ischemia.
Collapse
Affiliation(s)
| | | | | | | | - Estelle Le Pabic
- CHU Rennes, Inserm, Clinical Investigation Center (CIC), Rennes, France
| | | | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- University of Rennes, Rennes, France
- CHU Rennes, Inserm, Clinical Investigation Center (CIC), Rennes, France
- Pôle Imagerie Médicale et Explorations Fonctionnelles, Hôpital Pontchaillou, Rennes, France
- *Correspondence: Guillaume Mahé
| |
Collapse
|
102
|
Kluckner M, Nierlich P, Hitzl W, Aschacher T, Gratl A, Wipper S, Aspalter M, Moussalli H, Linni K, Enzmann FK. Long-Term Results of Endovascular Treatment with Nitinol Stents for Femoropopliteal TASC II C and D Lesions. Medicina (B Aires) 2022; 58:medicina58091225. [PMID: 36143902 PMCID: PMC9500608 DOI: 10.3390/medicina58091225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/21/2022] [Accepted: 09/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives: The feasibility of endovascular treatment (EVT) for Trans-Atlantic Inter-Society Consensus (TASC) II C and D femoropopliteal artery lesions has been described, but no prospective study has performed a long-term follow-up. The aim of this study was to report the long-term results of nitinol stents (NS) for the treatment of long femoropopliteal lesions. Materials and Methods: A single-center prospective, randomized controlled trial (RCT) comparing EVT with NS and vein bypass surgery was previously performed. The EVT group’s follow-up was extended and separately analyzed with primary patency as the primary endpoint. The secondary endpoints were technical success, secondary patency, reinterventions, limb salvage, survival, complications, and clinical improvement. Results: Between 2016 and 2020, 109 limbs in 103 patients were included. A total of 48 TASC II C and 61 TASC II D lesions with a mean lesion length of 264 mm were reported. In 53% of limbs, the indication for treatment was chronic limb-threatening ischemia. The median follow-up was 45 months. Technical success was achieved in 88% of cases, despite 23% of the lesions being longer than 30 cm (retrograde popliteal access in 22%). At four-year follow-up, primary patency, secondary patency, and freedom from target lesion revascularizations were 35%, 48%, and 58%, respectively. Limb salvage and survival were 90% and 80% at 4 years. Clinical improvement of at least one Rutherford category at the end of follow-up was achieved in 83% of limbs. Conclusions: This study reports the longest follow-up of endovascular treatment with nitinol stents in femoropopliteal TASC II C and D lesions. The results emphasize the feasibility of an endovascular-first strategy, even in lesions beyond 30 cm in length, and clarify its acceptable long-term durability and good clinical outcomes. Large multicenter RCTs with mid- and long-term follow-up are needed to investigate the role of different endovascular techniques in long femoropopliteal lesions.
Collapse
Affiliation(s)
- Michaela Kluckner
- Department of Vascular Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria
| | - Patrick Nierlich
- Chirurgie Nierlich, Vienna Private Hospital, A-1090 Vienna, Austria
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, A-5020 Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Thomas Aschacher
- Department of Cardiovascular Surgery, Clinic Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, A-1210 Vienna, Austria
| | - Alexandra Gratl
- Department of Vascular Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria
| | - Sabine Wipper
- Department of Vascular Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria
| | - Manuela Aspalter
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Herve Moussalli
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Klaus Linni
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Florian K. Enzmann
- Department of Vascular Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria
- Correspondence:
| |
Collapse
|
103
|
Mosarla RC, Armstrong E, Bitton-Faiwiszewski Y, Schneider PA, Secemsky EA. State-of-the-Art Endovascular Therapies for the Femoropopliteal Segment: Are We There Yet? JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1. [PMID: 36268042 PMCID: PMC9581461 DOI: 10.1016/j.jscai.2022.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Peripheral arterial disease is an increasingly prevalent condition with significant associated morbidity, mortality, and health care expenditure. Endovascular interventions are appropriate for most patients with either ongoing symptoms of intermittent claudication despite lifestyle and medical optimization or chronic limb-threatening ischemia. The femoropopliteal segment is the most common arterial culprit responsible for claudication and the most commonly revascularized segment. Endovascular approaches to revascularization of the femoropopliteal segment are advancing with an evolving landscape of techniques for arterial access, device-based therapies, vessel preparation, and intraprocedural imaging. These advances have been marked by debate and controversy, notably related to the safety of paclitaxel-based devices and necessity of atherectomy. In this review, we provide a critical overview of the current evidence, practice patterns, emerging evidence, and technological advances for endovascular intervention of the femoropopliteal arterial segment.
Collapse
Affiliation(s)
| | - Ehrin Armstrong
- Adventist Heart and Vascular Institute, St Helena, California
| | | | | | - Eric A. Secemsky
- Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Corresponding author: (E.A. Secemsky)
| |
Collapse
|
104
|
Yazdani SK, Lei B, Cawthon CV, Cooper K, Huett C, Giangrande PH, Miller FJ. Local intraluminal delivery of a smooth muscle-targeted RNA ligand inhibits neointima growth in a porcine model of peripheral vascular disease. MOLECULAR THERAPY - NUCLEIC ACIDS 2022; 29:577-583. [PMID: 36090749 PMCID: PMC9403884 DOI: 10.1016/j.omtn.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
Anti-proliferative agents have been the primary therapeutic drug of choice to inhibit restenosis after endovascular treatment. However, recent safety and efficacy concerns for patients who underwent peripheral artery disease revascularization have demonstrated the need for alternative therapeutics. The aim of this investigation was to investigate the efficacy of a cell-specific RNA aptamer inhibiting vascular smooth muscle cell proliferation and migration. First, the impact of the RNA aptamer (Apt 14) on the wound healing of primary cultured porcine vascular smooth muscle cells (VSMCs) was examined in response to a scratch wound injury. We then evaluated the effect of local luminal delivery of Apt 14 on neointimal formation in a clinically relevant swine iliofemoral injury model. In contrast with a non-selected control aptamer (NSC) that had no impact on VSMC migration, Apt 14 attenuated the wound healing of primary cultured porcine VSMCs to platelet-derived growth factor-BB. Histological analysis of the Apt 14-treated arteries demonstrated a significant reduction in neointimal area percent diameter stenosis compared with arteries treated with saline and NSC controls. The findings of this study suggest that aptamers can function as selective inhibitors and thus provide more fine-tuning to inhibit selective pathways responsible for neointimal hyperplasia.
Collapse
|
105
|
Liu P, Zheng LH, He XQ, Yang Y, Zhang LK, Zhang L, Zhang F. Mid-Term Outcomes of Endovascular Therapy for TASC II D Femoropopliteal Lesions with Critical Limb Ischaemia: A Retrospective Analysis. Ann Vasc Surg 2022; 88:182-190. [PMID: 36007776 DOI: 10.1016/j.avsg.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/17/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study evaluated the mid-term results of endovascular therapy (EVT) for Trans-Atlantic Inter-Society (TASC) II D femoropopliteal lesions in patients with critical limb ischaemia (CLI). METHODS Fifty-seven limbs of 54 patients with CLI due to TASC II D femoropopliteal lesions who underwent EVT at the First Hospital of Hebei Medical University were retrospectively analysed in single-centre, observational study. The patient characteristics, endovascular procedural details, freedom from target lesion revascularisation (TLR), patency rates, ulcer healing rate, and limb salvage rate were accessed. RESULTS The patients' mean age was 68.2 ± 8.2 years. All patients were treated by EVT. The final technical success rate was 98.2% (56/57). There were 23 cases of pain at rest, 18 cases of ulcer, and 15 cases of gangrene. The median length of the treated segment was 286 ± 42 mm (56/56) and the mean number of stents placed per patient was 2.0 ± 0.8 (49/56). The postoperative ankle-brachial index (ABI) was significantly higher than that of the preoperative ABI (P < 0.05). The perioperative complication rate was 10.7% (6/56). The re-stenosis or occlusion rate was 44.6% (25/56). The estimated rates of freedom from TLR at 1 year, 2 years, and 3 years were 86.8%, 67.0%, and 62.5%, respectively. Univariate analysis showed that predictors of freedom from TLR were the number of runoff vessels, length of the lesion, and complexity of the lesion, while predictors for re-stenosis or occlusion were the length and the complexity of the lesion. The ulcer healing rate was 93.8%. The limb salvage rates were 76.4%, 74.4%, and 70.9% at 1, 2, and 3 years after treatment, respectively. CONCLUSIONS The mid-term outcomes of EVT for TASC II D femoropopliteal lesions in patients with CLI indicated that this treatment approach is safe and effective, and is clinically applicable.
Collapse
Affiliation(s)
- Peng Liu
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Li-Hua Zheng
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Xin-Qi He
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Yan Yang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Li-Ke Zhang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Lei Zhang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Feng Zhang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China.
| |
Collapse
|
106
|
Han J, Luo L, Wang Y, Wu S, Kasim V. Therapeutic potential and molecular mechanisms of salidroside in ischemic diseases. Front Pharmacol 2022; 13:974775. [PMID: 36060000 PMCID: PMC9437267 DOI: 10.3389/fphar.2022.974775] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Rhodiola is an ancient wild plant that grows in rock areas in high-altitude mountains with a widespread habitat in Asia, Europe, and America. From empirical belief to research studies, Rhodiola has undergone a long history of discovery, and has been used as traditional medicine in many countries and regions for treating high-altitude sickness, anoxia, resisting stress or fatigue, and for promoting longevity. Salidroside, a phenylpropanoid glycoside, is the main active component found in all species of Rhodiola. Salidroside could enhance cell survival and angiogenesis while suppressing oxidative stress and inflammation, and thereby has been considered a potential compound for treating ischemia and ischemic injury. In this article, we highlight the recent advances in salidroside in treating ischemic diseases, such as cerebral ischemia, ischemic heart disease, liver ischemia, ischemic acute kidney injury and lower limb ischemia. Furthermore, we also discuss the pharmacological functions and underlying molecular mechanisms. To our knowledge, this review is the first one that covers the protective effects of salidroside on different ischemia-related disease.
Collapse
Affiliation(s)
- Jingxuan Han
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
- State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing, China
| | - Lailiu Luo
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
- State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing, China
| | - Yicheng Wang
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
- State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing, China
| | - Shourong Wu
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
- State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing, China
- The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing, China
- *Correspondence: Shourong Wu, ; Vivi Kasim,
| | - Vivi Kasim
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
- State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing, China
- The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing, China
- *Correspondence: Shourong Wu, ; Vivi Kasim,
| |
Collapse
|
107
|
Ichihashi S, Fujimura N, Utsunomiya M, Bolstad F, Nakai T, Iwakoshi S, Tanaka T. Hemodynamic evaluation of lower limbs in patients with chronic limb-threatening ischemia. Cardiovasc Interv Ther 2022; 37:635-640. [PMID: 35941316 DOI: 10.1007/s12928-022-00883-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
Revascularization plays an important role in the treatment of chronic limb-threatening ischemia. Evaluation of hemodynamic compromise in the lower extremity is required to optimize the treatment strategy for each patient. A variety of methods have been reported to detect arterial obstruction or impaired foot perfusion. This article reviews each method, clarifying features and limitations.
Collapse
Affiliation(s)
- Shigeo Ichihashi
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan.
| | - Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Makoto Utsunomiya
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.,TOWN Homecare Clinic, Tokyo, Japan
| | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Nara, Japan
| | - Takahiro Nakai
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan
| | - Shinichi Iwakoshi
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan
| |
Collapse
|
108
|
Bearne LM, Delaney N, Nielsen M, Sheehan KJ. Inequity in exercise-based interventions for adults with intermittent claudication due to peripheral arterial disease: a systematic review. Disabil Rehabil 2022:1-10. [PMID: 35931094 DOI: 10.1080/09638288.2022.2102255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the equity in access to trials of exercise interventions for adults with intermittent claudication due to peripheral arterial disease. METHODS Systematic electronic database searches of MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Clinical Trials, PEDRO, Opengrey, ISRCTN and ClinincalTrials.gov for randomised controlled trials of exercise interventions for adults with intermittent claudication were conducted. Data extraction was informed by Cochrane's PROGRESS-Plus framework. RESULTS Searches identified 6412 records. Following the screening of 262 full texts, 49 trials including 3695 participants were included. All trials excluded potential participants on at least one equity factor. This comprised place of residence, language, sex, personal characteristics (e.g., age and disability), features of relationships (e.g., familial risk factors) and time-dependent factors, (e.g., time since revascularisation). Overall, 1839 of 7567 potential participants (24.3%) were excluded based on equity factors. Disability was the most frequently reported factor for exclusions. CONCLUSION Trialists endeavour to enrol a representative sample in exercise trials whilst preserving the safety profile of the intervention. This review highlights that these efforts can inadvertently lead to inequities in access as all trials excluded potential participants on at least one equity factor. Future exercise trials should optimise participation to maximise generalisability of findings. PROSPERO registration no. CRD42020189965.Implications for rehabilitationEquity factors influence health opportunities and outcomes.All trials of exercise for people with intermittent claudication excluded adults on at least one equity factor.Disability was the predominant factor for exclusions from trials.Trials should optimise participation to maximise generalisability of results as these findings are used to inform treatment and service design.
Collapse
Affiliation(s)
- Lindsay Mary Bearne
- School of Life Course and Population Sciences, King's College London, London, United Kingdom.,Centre for Applied Health and Social Care Research, Kingston University and St George's, University of London, London, United Kingdom
| | - Nancy Delaney
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Mae Nielsen
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Katie Jane Sheehan
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
| |
Collapse
|
109
|
Elliott MB, Matsushita H, Shen J, Yi J, Inoue T, Brady T, Santhanam L, Mao HQ, Hibino N, Gerecht S. Off-the-Shelf, Heparinized Small Diameter Vascular Graft Limits Acute Thrombogenicity in a Porcine Model. Acta Biomater 2022; 151:134-147. [PMID: 35933100 DOI: 10.1016/j.actbio.2022.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
Thrombogenicity poses a challenge to the clinical translation of engineered grafts. Previously, small-diameter vascular grafts (sdVG) composed of fibrin hydrogel microfiber tubes (FMT) with an external poly(ε-caprolactone) (PCL) sheath supported long-term patency in mice. Towards the development of an sdVG with off-the-shelf availability, the FMT's shelf stability, scale-up, and successful conjugation of an antithrombotic drug to the fibrin scaffold are reported here. FMTs maintain mechanical stability and high-water retention after storage for one year in a freezer, in a refrigerator, or at room temperature. Low molecular weight heparin-conjugated fibrin scaffolds enabled local and sustained delivery during two weeks of enzymatic degradation. Upscaled fabrication of sdVGs provides natural biodegradable grafts with size and mechanics suitable for human application. Implantation in a carotid artery interposition porcine model exhibited no rupture with thrombi prevented in all heparinized sdVGs (n=4) over 4-5 weeks. Remodeling of the sdVGs is demonstrated with endothelial cells on the luminal surface and initial formation of the medial layer by 4-5 weeks. However, neointimal hyperplasia at 4-5 weeks led to the stenosis and occlusion of most of the sdVGs, which must be resolved for future long-term in vivo assessments. The off-the-shelf, biodegradable heparinized fibrin sdVG layer limits acute thrombogenicity while mediating extensive neotissue formation as the PCL sheath maintains structural integrity. STATEMENT OF SIGNIFICANCE: : To achieve clinical and commercial utility of small-diameter vascular grafts as arterial conduits, these devices must have off-the-shelf availability for emergency arterial bypass applications and be scaled to a size suitable for human applications. A serious impediment to clinical translation is thrombogenicity. Treatments have focused on long-term systemic drug therapy, which increases the patient's risk of bleeding complications, or coating grafts and stents with anti-coagulants, which minimally improves patient outcomes even when combined with dual anti-platelet therapy. We systematically modified the biomaterial properties to develop anticoagulant embedded, biodegradable grafts that maintain off-the-shelf availability, provide mechanical stability, and prevent clot formation through local drug delivery.
Collapse
Affiliation(s)
- Morgan B Elliott
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205; Department of Chemical and Biomolecular Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD 21218; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218
| | - Hiroshi Matsushita
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago, Chicago, IL 60637
| | - Jessica Shen
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218
| | - Jaeyoon Yi
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD 21218; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218
| | - Takahiro Inoue
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago, Chicago, IL 60637
| | - Travis Brady
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218
| | - Lakshmi Santhanam
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Hai-Quan Mao
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218; Department of Materials Science and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD 21218; Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231
| | - Narutoshi Hibino
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218; Section of Cardiac Surgery, Department of Surgery, The University of Chicago, Chicago, IL 60637
| | - Sharon Gerecht
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205; Department of Chemical and Biomolecular Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD 21218; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218; Department of Materials Science and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD 21218; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205; Department of Biomedical Engineering, Duke University, Durham, NC 27705.
| |
Collapse
|
110
|
Nair V, Singh S, Ashraf MZ, Yanamandra U, Sharma V, Prabhakar A, Ahmad R, Chatterjee T, Behera V, Guleria V, Patrikar S, Gupta S, Vishnoi MG, Rigvardhan, Kalshetty K, Sharma P, Bajaj N, Khaling TD, Wankhede TS, Bhattachar S, Datta R, Ganguli LP. Epidemiology and pathophysiology of vascular thrombosis in acclimatized lowlanders at high altitude: A prospective longitudinal study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 3:100016. [PMID: 37384264 PMCID: PMC10306047 DOI: 10.1016/j.lansea.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Previous literature suggests that thrombosis is more common in lowlanders sojourning at high altitude (HA) compared to near-sea-level. Though the pathophysiology is partly understood, little is known of its epidemiology. To elucidate this, an observational prospective longitudinal study was conducted in healthy soldiers sojourning for months at HA. METHODS A total of 960 healthy male subjects were screened in the plains, of which 750 ascended, to altitudes above 15,000ft (4,472m). Clinical examination, haemogram, coagulogram, markers of inflammation and endothelial dysfunction, were studied at three time points during ascent and descent. The diagnosis of thrombosis was confirmed radiologically in all cases where a thrombotic event was suspected clinically. Subjects developing thrombosis at HA were labelled as Index Cases (ICs) and compared to a nested cohort of the healthy subjects (comparison group,(CG)) matched for altitude of stay. FINDINGS Twelve and three subjects, developed venous (incidence: 5,926/105 person-years) and arterial (incidence: 1,482/105 person-years) thrombosis at HA, respectively. The ICs had enhanced coagulation (FVIIa: p<0.001; FXa: p<0.001) and decreased levels of natural anticoagulants (thrombomodulin, p=0.016; tissue factor pathway inhibitor [TFPI]: p<0.001) and a trend to dampened fibrinolysis (tissue plasminogen activator tPA; p=0.078) compared to CG. ICs also exhibited statistically significant increase in the levels of endothelial dysfunction and inflammation markers (vascular cell adhesion molecule-1[VCAM-1], intercellular adhesion molecule-1 [ICAM-1], vascular endothelial growth factor receptor 3 [VEGFR-3], P-Selectin, CD40 ligand, soluble C-reactive protein and myeloperoxidase: p<0.001). INTERPRETATION The incidence of thrombosis in healthy subjects at HA was higher than that reported in literature at near sea-level. This was associated with inflammation, endothelial dysfunction, a prothrombotic state and dampened fibrinolysis. FUNDING Research grants from the Armed Forces Medical Research Committee, Office of the Director General of Armed Forces Medical Services (DGAFMS) & Defence Research and Development Organization (DRDO), Ministry of Defence, India.
Collapse
Affiliation(s)
- Velu Nair
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Director General Medical Services (Army), India
- Comprehensive Blood & Cancer Center (CBCC), Gandhinagar, Gujarat, India
| | - Surinderpal Singh
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Physiology, Army College of Medical Sciences, New Delhi, India
| | - Mohammad Zahid Ashraf
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Uday Yanamandra
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- 153 General Hospital, Leh, India
| | - Vivek Sharma
- Department of Imaging & Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Radiology, Bharati Vidyapeeth Hospital & Medical College, Pune, Maharashtra, India
| | - Amit Prabhakar
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
- Cardiovascular Research Institute (CVRI), University of California, San Francisco, USA
| | - Rehan Ahmad
- Department of Clinical Haematology and Centre for Stem Cell Therapy and Research, Army Hospital (Research and Referral), New Delhi, India
- Luchkee Health Pvt Ltd Vasant Kunj, New Delhi, India
| | - Tathagata Chatterjee
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (Research & Referral), New Delhi, India
- Department of Haematology and Stem Cell Transplant, ESIC Med College and Hospital, Faridabad, Haryana, India
| | - Vineet Behera
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Internal Medicine, INHS Asvini, Colaba, Mumbai, India
| | - Vivek Guleria
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Cardiology, Army Hospital (Research & Referral), New Delhi, India
| | - Seema Patrikar
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shivi Gupta
- 403 Field Hospital, C/o 56 APO, India
- Indian Field Hospital, UN Mission, Malakal 71111, South Sudan
| | - Madan Gopal Vishnoi
- 403 Field Hospital, C/o 56 APO, India
- Department of Nuclear Medicine, Command Hospital (Eastern Command), Kolkata, India
| | - Rigvardhan
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
| | - Kiran Kalshetty
- Regimental Medical Officer, 20 Grenadiers c/o 56 APO, India
- Department of Anaesthesiology, 305 Field Hospital, C/o 99 APO, India
| | - Prafull Sharma
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Cardiology, Military Hospital, Jalandhar, Punjab, India
| | - Nitin Bajaj
- Department of Internal Medicine, Command Hospital (Western Command), Chandimandir, Haryana, India
- Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Thyelnai D. Khaling
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Physiology, Institute of Aerospace Medicine, Bangalore, Karnataka, India
| | - Tanaji Sitaram Wankhede
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Sports Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Srinivasa Bhattachar
- Department of Physiology, Institute of Aerospace Medicine, Bangalore, Karnataka, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Rajat Datta
- Department of Cardiology, Army Hospital (Research & Referral), New Delhi, India
- Director General Armed Forces Medical Services, New Delhi, India
| | - Late Prosenjit Ganguli
- Department of Clinical Haematology and Centre for Stem Cell Therapy and Research, Army Hospital (Research and Referral), New Delhi, India
- Department of Pathology, Command Hospital (Eastern Command), Kolkata, India
| |
Collapse
|
111
|
Tamura Y, Yasu T. There Are Not Enough Facilities for Outpatient Cardiac Rehabilitation - What Is the Solution? Circ J 2022; 86:2008-2009. [PMID: 35858824 DOI: 10.1253/circj.cj-22-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuma Tamura
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| |
Collapse
|
112
|
Li Q, Birmpili P, Johal AS, Waton S, Pherwani AD, Boyle JR, Cromwell DA. Delays to revascularization for patients with chronic limb-threatening ischaemia. Br J Surg 2022; 109:717-726. [PMID: 35543274 PMCID: PMC10364726 DOI: 10.1093/bjs/znac109] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Vascular services in England are organized into regional hub-and-spoke models, with hubs performing arterial surgery. This study examined time to revascularization for chronic limb-threatening ischaemia (CLTI) within and across different care pathways, and its association with postrevascularization outcomes. METHODS Three inpatient and four outpatient care pathways were identified for patients with CLTI undergoing revascularization between April 2015 and March 2019 using Hospital Episode Statistics data. Differences in times from presentation to revascularization across care pathways were analysed using Cox regression. The relationship between postoperative outcomes and time to revascularization was evaluated by logistic regression. RESULTS Among 16 483 patients with CLTI, 9470 had pathways starting with admission to a hub or spoke hospital, whereas 7013 (42.5 per cent) were first seen at outpatient visits. Among the inpatient pathways, patients admitted to arterial hubs had shorter times to revascularization than those admitted to spoke hospitals (median 5 (i.q.r. 2-10) versus 12 (7-19) days; P < 0.001). Shorter times to revascularization were also observed for patients presenting to outpatient clinics at arterial hubs compared with spoke hospitals (13 (6-25) versus 26 (15-35) days; P < 0.001). Within most care pathways, longer delays to revascularizsation were associated with increased risks of postoperative major amputation and in-hospital death, but the effect of delay differed across pathways. CONCLUSION For patients with CLTI, time to revascularization was influenced by presentation to an arterial hub or spoke hospital. Generally, longer delays to revascularization were associated with worse outcomes, but the impact of delay differed across pathways.
Collapse
Affiliation(s)
- Qiuju Li
- Correspondence to: Qiuju Li, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK (e-mail: )
| | - Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Hull York Medical School, Hull, UK
| | - Amundeep S Johal
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Sam Waton
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arun D Pherwani
- Vascular Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust & Department of Surgery, University of Cambridge, Cambridge, UK
| | - David A Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| |
Collapse
|
113
|
Galanakis N, Maris TG, Kontopodis N, Tsetis K, Kehagias E, Tsetis D. Perfusion imaging techniques in lower extremity peripheral arterial disease. Br J Radiol 2022; 95:20211203. [PMID: 35522774 PMCID: PMC10996332 DOI: 10.1259/bjr.20211203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
Abstract
Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound, CT, MRI and digital subtraction angiography. These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system. However, they can be also used to evaluate limb perfusion, using appropriate techniques and protocols. This information may be valuable for assessment of the severity of ischemia and detection of hypoperfused areas. Moreover, they can be used for planning of revascularization strategy in patients with severe PAD and evaluation of therapeutic outcome. These techniques may also determine prognosis and amputation risk in patients with PAD. This review gives a basic overview of the perfusion techniques for lower limbs provided by imaging modalities such as ultrasound, CT, MRI, digital subtraction angiography and scintigraphy and their clinical applications for evaluation of PAD and revascularization outcome.
Collapse
Affiliation(s)
- Nikolaos Galanakis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and
Vascular Surgery, University Hospital Heraklion, University of Crete
Medical School, Heraklion,
Greece
| | - Konstantinos Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Elias Kehagias
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| |
Collapse
|
114
|
García-Madrid M, García-Álvarez Y, Sanz-Corbalán I, Álvaro-Afonso FJ, López-Moral M, Lázaro-Martínez JL. Predictive value of forefoot plantar pressure to predict reulceration in patients at high risk. Diabetes Res Clin Pract 2022; 189:109976. [PMID: 35772587 DOI: 10.1016/j.diabres.2022.109976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/03/2022]
Abstract
AIMS To analyze a plantar pressure cut-off point for diabetic foot reulceration beneath the metatarsal heads in patients with previous forefoot amputation. METHODS A one-year prospective study was conducted in a total of 105 patients at high risk for foot ulceration. Peak plantar pressure (PPP) and pressure-time integral (PTI) in the entire foot, the forefoot region, and each metatarsal head separately were registered. ROC curves were used to select the optimal diagnostic pressure cut-off points. Patients were follow-up monthly or until the development of an ulcer event. RESULTS A total of 52 (49.5%) patients developed a reulceration. Using ROC analyses for PPP in the full-foot and in the forefoot, did not predict reulceration beneath the metatarsal heads. Analyzing separately each metatarsal head all patients with values greater than or equal to 20.8 N/cm2 at the 1st, 18.62 N/cm2 for the 2nd, 18.85 at the 3rd, 17.88 at the 4th, and 12.2 at the 5th metatarsal heads will suffer a reulceration despite the use of orthopedic treatment with optimum values of sensitivity (from 100 to 87.5) and specificity (from 83.2 to 62.8). CONCLUSION Barefoot pressures beneath the metatarsal heads should be analyzed separately to predict the region at risk of reulceration.
Collapse
Affiliation(s)
- Marta García-Madrid
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain..
| | - Yolanda García-Álvarez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain..
| | - Irene Sanz-Corbalán
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain..
| | - Francisco J Álvaro-Afonso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain..
| | - Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain..
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain..
| |
Collapse
|
115
|
Han J, Luo L, Marcelina O, Kasim V, Wu S. Therapeutic angiogenesis-based strategy for peripheral artery disease. Theranostics 2022; 12:5015-5033. [PMID: 35836800 PMCID: PMC9274744 DOI: 10.7150/thno.74785] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023] Open
Abstract
Peripheral artery disease (PAD) poses a great challenge to society, with a growing prevalence in the upcoming years. Patients in the severe stages of PAD are prone to amputation and death, leading to poor quality of life and a great socioeconomic burden. Furthermore, PAD is one of the major complications of diabetic patients, who have higher risk to develop critical limb ischemia, the most severe manifestation of PAD, and thus have a poor prognosis. Hence, there is an urgent need to develop an effective therapeutic strategy to treat this disease. Therapeutic angiogenesis has raised concerns for more than two decades as a potential strategy for treating PAD, especially in patients without option for surgery-based therapies. Since the discovery of gene-based therapy for therapeutic angiogenesis, several approaches have been developed, including cell-, protein-, and small molecule drug-based therapeutic strategies, some of which have progressed into the clinical trial phase. Despite its promising potential, efforts are still needed to improve the efficacy of this strategy, reduce its cost, and promote its worldwide application. In this review, we highlight the current progress of therapeutic angiogenesis and the issues that need to be overcome prior to its clinical application.
Collapse
Affiliation(s)
- Jingxuan Han
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Lailiu Luo
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Olivia Marcelina
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Vivi Kasim
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China.,The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing 400044, China.,✉ Corresponding authors: Vivi Kasim, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65112672, Fax: +86-23-65111802, ; Shourong Wu, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65111632, Fax: +86-23-65111802,
| | - Shourong Wu
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China.,The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing 400044, China.,✉ Corresponding authors: Vivi Kasim, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65112672, Fax: +86-23-65111802, ; Shourong Wu, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65111632, Fax: +86-23-65111802,
| |
Collapse
|
116
|
Kretzschmar D, Thieme M, Aschenbach R, Schulze PC, Möbius-Winkler S. A Very Rare Cause of Thrombotic Peripheral Occlusion. Int J Angiol 2022; 32:75-80. [PMID: 36727155 PMCID: PMC9886445 DOI: 10.1055/s-0042-1745850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 45-year-old healthy woman presented with claudication of the right leg. The resting ankle-brachial index (ABI) was reduced to 0.6, and a duplex scan revealed an occlusion of the right popliteal artery. Angiography presented a patent superficial femoral artery that ends above the knee joint. Laterally, there was delayed retrograde contrast filling of the popliteal artery. After exploring the internal iliac artery, we crossed a thrombotic occlusion of a persisting sciatic artery (PSA). Local thrombolysis with recombinant tissue plasminogen activator (1 mg/h) was initiated. The Angiography 18 hours later showed a reduction of thrombotic material and relevant stenosis in the proximal part of the vessel. Residual thrombus and the stenosis were covered by two stentgrafts (Gore Viabahn Endoprosthesis) that were stabilized by an interwoven stent (Supera). Final angiography displayed a patent sciatic artery and a three-vessel run off. Postinterventional ABI was normalized to 1.0. The magnetic resonance imaging 6 days after the intervention demonstrated a patent PSA again and a normal blood flow on the left leg. A PSA should be included in the differential diagnosis of lower limb ischemia or suspected aneurysm formation. We demonstrated the feasibility of an interventional approach with an excellent outcome in this case.
Collapse
Affiliation(s)
- Daniel Kretzschmar
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,HUGG-Herz and Gefäßmedizin Goslar, Fleischscharren 4, 38640 Goslar, Germany,Address for correspondence Daniel Kretzschmar, MD HUGG-Herz and Gefäßmedizin GoslarFleischscharren 4, 38640 GoslarGermany
| | - Marcus Thieme
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Rene Aschenbach
- Department of Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| |
Collapse
|
117
|
The Incidence of Chronic Limb-Threatening Ischemia in the Midland Region of New Zealand over a 12-Year Period. J Clin Med 2022; 11:jcm11123303. [PMID: 35743374 PMCID: PMC9225294 DOI: 10.3390/jcm11123303] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022] Open
Abstract
The epidemiology of severe PAD, as characterized by short-distance intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI), remains undefined in New Zealand (NZ). This was a retrospective observational cohort study of the Midland region in NZ, including all lower limb PAD-related surgical and percutaneous interventions between the 1st of January 2010 and the 31st of December 2021. Overall, 2541 patients were included. The mean annual incidence of short-distance IC was 15.8 per 100,000, and of CLTI was 36.2 per 100,000 population. The annual incidence of both conditions was greater in men. Women presented 3 years older with PAD (p < 0.001). Patients with short-distance IC had lower ipsilateral major limb amputation at 30 days compared to CLTI (IC 2, 0.3% vs. CLTI 298, 16.7%, p < 0.001). The 30-day mortality was greater in elderly patients (<65 years 2.7% vs. ≥65 years 4.4%, p = 0.049), but did not differ depending on sex (females 36, 3.7% vs. males 64, 4.1%, p = 0.787). Elderly age was associated with a worse survival for both short-distance IC and CLTI. There was a worse survival for females with CLTI. In conclusion, PAD imposes a significant burden in NZ, and further research is required in order to reduce this disparity.
Collapse
|
118
|
Adams OP, Herbert JR, Unwin N, Howitt C. Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados. Vasc Health Risk Manag 2022; 18:387-395. [PMID: 35668835 PMCID: PMC9166688 DOI: 10.2147/vhrm.s364993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied. Methods Multistage probability sampling was used to select a representative population sample of people ≥25 years of age with known diabetes or fasting blood glucose ≥7 mmol/L or HbA1c ≥6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤0.90 or >0.4; normal 1.00 to 1.40 in both legs; and non-compressible >1.40 in one leg and the other not ≤0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD. Results Of 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤0.90) had normal waveforms in both arteries (Kappa = 0.43). Conclusion Asymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.
Collapse
Affiliation(s)
- O Peter Adams
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St Michael, Barbados
| | - Joseph R Herbert
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St Michael, Barbados
| | - Nigel Unwin
- George Alleyne Chronic Disease Research Centre, University of the West Indies, St. Michael, Barbados.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,European Centre for Environment and Human Health, University of Exeter, Truro, UK
| | - Christina Howitt
- George Alleyne Chronic Disease Research Centre, University of the West Indies, St. Michael, Barbados
| |
Collapse
|
119
|
Characteristics of Plantar Pressure Distribution in Diabetes with or without Diabetic Peripheral Neuropathy and Peripheral Arterial Disease. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2437831. [PMID: 35707567 PMCID: PMC9192305 DOI: 10.1155/2022/2437831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
Background. Excessive plantar pressure leads to increased risk of diabetic foot ulcers. Diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) have been considered to be associated with alterations in gait and plantar pressure in diabetic patients. However, few studies have differentiated the effects with each of them. Objective. To investigate the plantar pressure distribution in diabetic patients, with DPN and PAD as independent or combined factors. Methods. 112 subjects were recruited: 24 diabetic patients with both DPN and PAD (DPN-PAD group), 12 diabetic patients with DPN without PAD (DPN group), 10 diabetic patients with PAD without DPN (PAD group), 23 diabetic patients without DPN or PAD, and 43 nondiabetic healthy controls (HC group). The in-shoe plantar pressure during natural walking was measured. Differences in peak pressure, contact area, proportion of high pressure area (%HP), and anterior/posterior position of centre of pressure (COP) were analysed. Results. Compared with HC group, in DPN-PAD group and DPN group, the peak pressures in all three forefoot regions increased significantly; in PAD group, the peak pressure in lateral forefoot increased significantly. The contact area of midfoot in the DPN-PAD group decreased significantly. PAD group had larger HP% of lateral forefoot, DPN group had larger HP% of inner forefoot, and DPN-PAD group had larger HP% of total plantar area. There was a significant tendency of the anterior displacement of COP in the DPN-PAD group and DPN group. No significant differences were observed between the D group and HC group. Conclusion. DPN or PAD could affect the plantar pressure distribution in diabetic patients independently or synergistically, resulting in increased forefoot pressure and the area at risk of ulcers. DPN has a more pronounced effect on peak pressure than PAD. The synergistic effect of them could significantly reduce the plantar contact area of midfoot.
Collapse
|
120
|
Mochidome T, Takahara M, Miura T, Soga Y, Fujihara M, Kawasaki D, Hirano K, Choi D, Iida O. Vascular Pathology and Impact of Stent Eccentricity for Stent Restenosis in Femoropopliteal Endovascular Therapy. J Vasc Interv Radiol 2022; 33:1089-1096. [PMID: 35671987 DOI: 10.1016/j.jvir.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/18/2022] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To explore the clinical features associated with stent eccentricity and reveal the impact of stent eccentricity on 1-year restenosis risk after femoropopliteal stent implantation for symptomatic atherosclerotic peripheral artery disease (PAD). MATERIALS AND METHODS The effect of stent asymmetry expansion immediately after treatment on long-term patency has not been fully investigated. We used the clinical database of a multicenter prospective study registering 2,018 limbs of 1,766 patients in whom intravascular ultrasound (IVUS)-supported femoropopliteal endovascular therapy (EVT) for symptomatic atherosclerotic PAD was planned from November 2015 to June 2017. We included 1,233 limbs of 1,088 patients implanted with either a bare nitinol stent, drug-eluting stent (DES), or stent graft, and administered two or more antithrombotic drugs. Stent eccentricity was evaluated using IVUS calculated as ((maximum diameter)/(minimum diameter) - 1) at the cross-section segment with the lowest lumen area after stent implantation. RESULTS Chronic total occlusion and bilateral arterial calcification (peripheral artery calcification scoring system grades 3 and 4) were positively associated with stent eccentricity, whereas renal failure on dialysis, DES, and stent graft use were negatively associated with stent eccentricity (all p<0.05). Stent eccentricity was associated with an increased risk of 1-year restenosis (odds ratio (OR) 1.18, 95% confidence interval (CI) 1.01-1.37; p=0.034). However, after adjustment for the lesion severity and implanted stent types, the association was no longer significant (OR 1.07, 95% CI 0.91-1.24; p=0.43). CONCLUSION Stent eccentricity was not significantly associated with 1-year restenosis risk after femoropopliteal EVT.
Collapse
Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Morinomiya Hospital, Osaka, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Keisuke Hirano
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Donghoon Choi
- Department of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| |
Collapse
|
121
|
Monteiro F, Correia MDA, Farah BQ, Christofaro DGD, Oliveira PMLD, Ritti-Dias RM, Cucato GG. Alterações Longitudinais nos Níveis de Atividade Física e Parâmetros de Risco Cardiovascular em Pacientes com Doença Arterial Periférica Sintomática. Arq Bras Cardiol 2022; 119:59-66. [PMID: 35674567 PMCID: PMC9352116 DOI: 10.36660/abc.20210386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022] Open
|
122
|
Gostev AA, Osipova OS, Saaya SB, Bugurov SV, Cheban AV, Rabtsun AA, Ignatenko PV, Karpenko AA. Bypass Versus Interwoven Nitinol Stents for Long Femoro-Popliteal Occlusions: A Propensity Matched Analysis. Cardiovasc Intervent Radiol 2022; 45:929-938. [PMID: 35581472 DOI: 10.1007/s00270-022-03134-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/23/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To compare femoro-popliteal bypass and interwoven nitinol stenting for long occlusions of the femoro-popliteal segment. MATERIALS AND METHODS Single center retrospective propensity matching analysis of the symptomatic patients with long occlusion of the femoro-popliteal segment (> 20 cm), who underwent stenting with interwoven nitinol stent or femoro-popliteal bypass from 2012 to 2020. PRIMARY ENDPOINTS primary patency, primary-assisted patency, secondary patency. Secondary endpoints: major adverse cardiovascular events, major adverse limb events, primary sustained clinical improvement, survival. RESULTS A total of 437 patients were enrolled: 294 in the bypass group and 143 in the endovascular therapy (EVT) group. After propensity score matching, 264 and 113 patients remained in the groups, respectively. A median occlusion length was 250 mm. One-year and two-year primary and secondary patency rates were comparable in both groups (two-year primary patency: 68.5% for bypass vs. 68.9% for EVT, p = 1.00). In the "above the knee" subgroup analysis, two-year secondary patency was higher in the EVT group than in the bypass group (90.9% vs. 77.5%, p = 0.048). In "below-the-knee" subgroup analysis, primary and primary assisted patency were statistically significantly higher in the EVT group than in artificial bypass subgroup (66.7% vs. 42.4%, p = .046 and 76.7% vs. 45.5%, p = .011, respectively). However, compared to autovenous bypass, the EVT group showed lower primary patency rates, although the differences are not significant. CONCLUSION A nonselective endovascular strategy can allow for regular successful treatment of femoro-popliteal lesions longer than 25 cm.
Collapse
Affiliation(s)
- Alexander A Gostev
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055.
| | - Olesya S Osipova
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Shoraan B Saaya
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Savr V Bugurov
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Alexey V Cheban
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Artem A Rabtsun
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Pavel V Ignatenko
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Andrey A Karpenko
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| |
Collapse
|
123
|
The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI). J Cardiovasc Dev Dis 2022; 9:jcdd9050147. [PMID: 35621858 PMCID: PMC9144270 DOI: 10.3390/jcdd9050147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The ankle−brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe−brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011−2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8−1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80−0.89 and 0.90−0.99 had poorer survival compared to ABI categories 1.00−1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80−0.99 vs. 1.00−1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80−0.99 vs. 1.00−1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90−0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00−1.29.
Collapse
|
124
|
Ilyas S, Powell RJ. Management of the no-option foot: Deep vein arterialization. Semin Vasc Surg 2022; 35:210-218. [DOI: 10.1053/j.semvascsurg.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022]
|
125
|
Rossi FH, Giusti JCG, Cury MVM, Beraldo JPN, Brochado Neto FC, Kambara AM. Real-life outcomes of endovascular and bypass infrapopliteal intervention for chronic limb-threatening ischemia in GLASS stages II and III. Eur J Vasc Endovasc Surg 2022; 64:41-48. [DOI: 10.1016/j.ejvs.2022.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
|
126
|
Society for Vascular Surgery Appropriate Use Criteria for Management of Intermittent Claudication. J Vasc Surg 2022; 76:3-22.e1. [PMID: 35470016 DOI: 10.1016/j.jvs.2022.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/09/2022] [Indexed: 12/28/2022]
Abstract
The Society for Vascular Surgery (SVS) Appropriate Use Criteria (AUC) for Management of Intermittent Claudication were created using the RAND appropriateness method (RAM) which is a validated and standardized methodology that combines best-available evidence from medical literature with expert opinion, using a modified-Delphi process. These criteria serve as a framework upon which individualized patient and clinician shared decision-making can grow. These criteria are not absolute. AUC should not be interpreted as a requirement to administer treatments rated as appropriate (benefit outweighs risk). Nor should AUC be interpreted as a prohibition on treatments rated as inappropriate (risk outweighs benefit). There will be clinical situations in which moderating factors, not included in these AUC, will shift the appropriateness level of a treatment for an individual patient. Proper implementation of AUC calls for a description of those moderating patient factors. For scenarios with an indeterminate rating, clinician judgement combined with best available evidence should determine treatment strategy. Importantly, these are scenarios in need of mechanisms to track treatment decisions and outcomes. AUC should be revisited on a periodic basis to ensure that these criteria remain relevant. The panelists rated 2280 unique scenarios for the treatment of intermittent claudication (IC) in the aortoiliac, common femoral and femoropopliteal segment in Round 2 rating. Of these, only 9 (0.4%) had disagreement according to the IPRAS formula, indicating an exceptionally high degree of consensus among the panelists. [Note, post-hoc, the term, "inappropriate," was replaced with the term "R>B" (risk outweighs benefit). The term "appropriate" was also replaced with "B>R" (benefit outweighs risk)]. The key principles for the management of intermittent claudication reflected within these AUC are: (1) Exercise therapy is a preferred initial management strategy for all patients with IC. (2) For patients who have not completed exercise therapy, invasive therapy may provide net benefit in selected patients with IC who are non-smokers, are taking optimal medical therapy, are considered low physiologic and technical risk, and who are experiencing severe lifestyle limitation and/or short walking distance. (3) Considering the long-term durability of currently available technology, invasive interventions for femoropopliteal disease should be reserved for patients with severe lifestyle limitation and short walking distance. (4) In the common femoral segment, open common femoral endarterectomy provides greater net benefit than endovascular intervention for the treatment of IC. (5) In the infrapopliteal segment, invasive intervention for the treatment of intermittent claudication is of unclear benefit and may be harmful.
Collapse
|
127
|
Wang CC, Lu CR, Hsieh LC, Kuo CC, Huang PW, Chang KC, Chang CT, Hsu CH. Comparison of pharmaco-mechanical thrombolysis and catheter-directed thrombolysis for treating thrombotic or embolic arterial occlusion of the lower limb. INT ANGIOL 2022; 41:292-302. [PMID: 35437980 DOI: 10.23736/s0392-9590.22.04809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whether pharmaco-mechanical thrombolysis (PMT) results in superior outcomes to catheter-directed thrombolysis (CDT) in treating thrombotic or embolic arterial occlusion of the lower limbs is unclear. METHODS We enrolled 94 patients with Rutherford class I-IIb due to thrombotic or embolic arterial occlusion in the lower limbs and who received emergency endovascular treatment. Baseline demographics, laboratory data, angiography and clinical outcomes were collected through chart reviews and fluoroscopic imaging. The procedural characteristics (thrombolytic drug dosage, treatment duration, and additional procedures), immediate angiographic outcomes (patency of calf vessels, and complete lysis), complications (major bleeding, and fasciotomy), and primary composite end-points (30-day mortality, amputation, and reocclusion) were compared between patients who received CDT versus PMT. RESULTS Compared with CDT, PMT was independently associated with lower total UK dosage (standardised coefficientβ= - 0.44; p < 0.01) and higher prevalence of complete lysis (odds ratio = 1.78, 95% confidence interval: 1.03 - 3.06; p = 0.04) after adjustments of covariates. The PMT group had significantly shorter treatment duration (23.00 [7.25 - 39.13] vs. 41.00 [27.00 - 52.50]; p < 0.01). No significant intergroup differences were observed for the primary composite end point (10.7% vs. 9.1%; p = 0.81), or prevalence of the major bleeding (9.1% vs. 0.0%; p = 0.10) despite the PMT group comprising patients with more.advanced chronic kidney disease and more diffuse thrombosis. CONCLUSIONS PMT with a Rotarex is a safe and effective strategy for treating thrombotic or embolic lower limb ischemia. It significantly reduced the thrombolytic drug dosage, and resulted in the complete lysis being more likely.
Collapse
Affiliation(s)
- Chun-Cheng Wang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chiung-Ray Lu
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Li-Chuan Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chin-Chi Kuo
- School of Medicine, China Medical University, Thaicung, Taiwan.,Big Data Center, China Medical University Hospital, Thaicung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Wen Huang
- Big Data Center, China Medical University Hospital, Thaicung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Cheng Chang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chiz-Tzung Chang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chung-Ho Hsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan -
| |
Collapse
|
128
|
Zierfuss B, Höbaus C, Herz CT, Koppensteiner R, Stangl H, Schernthaner GH. HDL particle subclasses in statin treated patients with peripheral artery disease predict long-term survival. Thromb Haemost 2022; 122:1804-1813. [PMID: 35436798 DOI: 10.1055/a-1827-7896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Low-density lipoprotein-cholesterol (LDL-C) reduction showed a strong reduction of cardiovascular (CV) event rates in CV disease. However, the residual risk of future CV events remains high, which especially extends to peripheral arterial disease (PAD). Nuclear magnetic resonance (NMR)-spectroscopy offers a novel method for analyses of the lipoprotein spectrum. This study investigates lipoprotein subclasses using NMR-spectroscopy and assesses implications for long-term survival in PAD. NMR-spectroscopy was performed by Nightingale Inc. in 319 patients with stable PAD and well-controlled CV risk factors. Patients were followed-up for ten years. During that period 123 patients (38.5%) died, of those 68 (21.3%) were defined as CV-deaths. Outcome data were analyzed by the Kaplan-Meier method and multivariable Cox regression for lipoprotein particles. Small and medium high-density lipoprotein-particles (S-HDL-P and M-HDL-P) showed a significant inverse association with all-cause mortality in Cox-regression analyses after multivariable adjustment (S-HDL-P hazard ratio 0.71, 95% confidence interval 0.57-0.88; M-HDL-P 0.72, 0.58-0.90) for each increase of 1 standard deviation. In contrast, cholesterol-rich x-large HDL-particles (XL-HDL-P) showed a positive association with all-cause mortality (1.51, 1.20-1.89). Only the association between XL-HDL-P and CV-death sustained multivariable adjustment (1.49, 1.10-2.02), whereas associations for S-HDL-P and M-HDL-P were attenuated (0.76, 0.57-1.01; 0.80, 0.60-1.06). This study shows a novel association for a beneficial role of S-HDL-P and M-HDL-P but a negative association with higher cholesterol-rich XL-HDL-P for long-term outcome in well-treated patients with PAD. Thus, these results provide evidence that NMR-measured HDL particles identify patients at high CV residual risk beyond adequate lipid-lowering therapy.
Collapse
Affiliation(s)
- Bernhard Zierfuss
- Department of Medicine 2, Division of Angiology, Medical University of Vienna, Wien, Austria
| | - Clemens Höbaus
- Department of Medicine 2, Division of Angiology, Medical University of Vienna, Wien, Austria
| | - Carsten Thilo Herz
- Department of Medicine 3, Division of Nephrology and Dialysis, Medical University of Vienna, Wien, Austria
| | - Renate Koppensteiner
- Department of Medicine 2, Division of Angiology, Medical University of Vienna, Wien, Austria
| | - Herbert Stangl
- Center for Pathobiochemistry and Genetics, Institute for Medical Chemistry, Medical University of Vienna, Wien, Austria
| | | |
Collapse
|
129
|
Yamauchi Y, Takahara M, Iida O, Shintani Y, Sugano T, Yamamoto Y, Kawasaki D, Fujihara M, Soga Y, Hirano K, Yamaguchi T, Yokoi H, Miyamoto A, Nakamura M. Independent predictors of major adverse cardiovascular events at 3 years after aortoiliac stent implantation. J Vasc Interv Radiol 2022; 33:826-833.e1. [PMID: 35398480 DOI: 10.1016/j.jvir.2022.03.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To identify risk factors for major adverse cardiovascular events (MACE) in real-world practice for symptomatic peripheral artery disease (PAD) in Japan. MATERIALS AND METHODS Data on Japanese patients (N=880) from the Observational prospective Multicenter registry study on Outcomes of peripheral arTErial disease patieNts treated by AngioplaSty tHerapy for aortoIliac artery (OMOTENASHI) who underwent de novo aortoiliac stent placement. The 3-year risk of incident MACE was investigated. RESULTS The median age of the patients was 72.6 years (range, 34-97 years), and 83.1% were male. Patients had the following conditions: smoking, 35.6%; hypertension, 94.1%; dyslipidemia, 81.7%; diabetes, 48.0%; renal failure on dialysis, 12.6%; myocardial infarction, 12.7%; stroke, 15.8%; and chronic limb-threatening ischemia (CLTI), 7.1%. Femoropopliteal lesions were present in 38.8% of the limbs with aortoiliac lesions. The 3-year rate of freedom from MACE was 89.1%. The baseline characteristics age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions were independently associated with the risk of incident MACE. When the study population was stratified according to these risk factors, the rate of MACE was highest in patients with at least 3 risk factors (32.9% at 3 years). CONCLUSION The 3-year rate of freedom from MACE was reported. The baseline characteristics age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions are independent risk factors for MACE after aortoiliac stent placement.
Collapse
Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | | | - Teruyasu Sugano
- Department of Cardiovascular Medicine, Yokohama City University Hospital, Kanagawa, Japan
| | - Yoshito Yamamoto
- Department of Cardiovascular Medicine, Iwaki Kyoritsu General Hospital, Fukushima, Japan
| | - Daizo Kawasaki
- Department of Internal Medicine, Morinomiya Hospital, Osaka, Japan
| | | | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Keisuke Hirano
- Division of Cardiology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Akira Miyamoto
- Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
| | | |
Collapse
|
130
|
Cardiovascular protection associated with cilostazol, colchicine and target of rapamycin inhibitors. J Cardiovasc Pharmacol 2022; 80:31-43. [PMID: 35384911 DOI: 10.1097/fjc.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/06/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT An alteration in extracellular matrix production by vascular smooth muscle cells is a crucial event in the pathogenesis of vascular diseases such as aging-related, atherosclerosis and allograft vasculopathy. The human target of rapamycin (TOR) is involved in the synthesis of extracellular matrix by vascular smooth muscle cells. TOR inhibitors reduce arterial stiffness, blood pressure, and left ventricle hypertrophy and decrease cardiovascular risk in kidney graft recipients and patients with coronary artery disease and heart allograft vasculopathy. Other drugs that modulate extracellular matrix production such as cilostazol and colchicine have also demonstrated a beneficial cardiovascular effect. Clinical studies have consistently shown that cilostazol confers cardiovascular protection in peripheral vascular disease, coronary artery disease, and cerebrovascular disease. In patients with type 2 diabetes, cilostazol prevents the progression of subclinical coronary atherosclerosis. Colchicine reduces arterial stiffness in patients with Familial Mediterranean Fever and patients with coronary artery disease. Pathophysiological mechanisms underlying the cardioprotective effect of these drugs may be related to interactions between the cytoskeleton, TOR signaling and cyclic AMP synthesis that remain to be fully elucidated. Adult vascular smooth muscle cells exhibit a contractile phenotype and produce little extracellular matrix. Conditions that upregulate extracellular matrix synthesis induce a phenotypic switch toward a synthetic phenotype. TOR inhibition with rapamycin reduces extracellular matrix production by promoting the change to the contractile phenotype. Cilostazol increases the cytosolic level of cyclic AMP, which in turn leads to a reduction in extracellular matrix synthesis. Colchicine is a microtubule-destabilizing agent that may enhance the synthesis of cyclic AMP.
Collapse
|
131
|
Gecoverte endovaskuläre Rekonstruktion der Aortenbifurkation (CERAB). Radiologe 2022; 62:601-606. [DOI: 10.1007/s00117-022-00989-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
|
132
|
Saratzis A, Argyriou A, Davies R, Bisdas T, Chaudhuri A, Torsello G, Stavroulakis K, Zayed H. Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry. Eur J Vasc Endovasc Surg 2022; 63:688-695. [PMID: 35337725 DOI: 10.1016/j.ejvs.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report outcomes following endovascular revascularisation for severe aorto-iliac occlusive disease (AIOD) using covered (CS) or bare metal (BMS) stent(s). METHODS This was a retrospective cohort study including patients who underwent treatment with CS or BMS for AIOD between November 2012 and March 2020 in 12 European centres. Outcome measures included death, freedom from target lesion revascularisation (TLR), major amputation, and major adverse cardiac and cerebrovascular events (MACCE). RESULTS Overall, 252 patients (53% males; mean age 65 ± 10 years) were included (102 with a bare metal and 150 with a covered aortic stent); 122 (48%) presented with chronic limb threatening ischaemia (CLTI). Severe arterial calcification was noted in > 65% of patients, 70% presented with Trans-Atlantic Societies Consensus (TASC) D lesions, 32% and 46% had aortic or iliac chronic total occlusion (CTO), respectively. Median follow up was 17 months (range 6 - 40; none lost to follow up). Median inpatient stay was two days (range two to four). During the first 30 days, two patients died (both with covered aortic stents, because of cardiovascular events), none required TLR, two (1%) patients had a major amputation (all presented with CLTI), and three (1%) had a MACCE. At 17 months, mortality (BMS 14% vs. CS 7%, hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.42 - 2.26, p = .94, log rank test) and TLR (11% vs. 10%, HR 1.98, 95% CI 0.89 - 4.43, p = .095) did not differ statistically significantly between the two groups; only three patients had a major limb amputation during late follow up (all with a covered stent). In a multivariable model, the use of an aortic CS did not influence TLR. In a conditional Cox regression, however, the concomitant use of aortic and iliac CSs was associated with improved freedom from TLR. CONCLUSION Endovascular reconstruction with aortic CSs or BMSs for severe AIOD showed comparable midterm performance. The use of both aortic and iliac CSs seems to be associated with reduced TLR.
Collapse
Affiliation(s)
- Athanasios Saratzis
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Angeliki Argyriou
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany.
| | - Robert Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Theodosios Bisdas
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany; Department of Vascular and Endovascular Surgery, Athens Medical Centre, Greece
| | | | - Giovanni Torsello
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St. Thomas' NHS Foundation Trust, UK
| | | |
Collapse
|
133
|
Danışan G, Ateş ÖF, Taydaş O, Özdemir M, Küpeli A, Erkin A. Retrograde Guidewire-Assisted Remodeling Technique: A Novel Technique for Endovascular Recanalization of Occluded Arterial Origins in Critical Limb Ischemia. J Endovasc Ther 2022; 29:516-524. [PMID: 35293247 DOI: 10.1177/15266028221083463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The main objective of this study is to describe the retrograde guidewire-assisted remodeling technique (REGART), a novel technique, and assess its feasibility, safety, and effectiveness in the recanalization of ostial arterial occlusions without a visible stump in the critical limb ischemia (CLI). MATERIALS AND METHODS A retrospective review of 387 patients who underwent endovascular treatment (EVT) for peripheral artery disease between January 2020 and June 2021 was performed. Among these, 23 patients (14 males [60.8%]) with a mean age of 64.2 (range: 55-72) years who underwent REGART were included. Patient demographics, procedural details, and outcomes were noted. RESULTS The technical success rate was 95.6% (22/23). The angiographic success rate was 86.3% (19/22). The procedure-related complication rate was 21.7% (5/23), with 4 (17.4%) major complications and 1 (4.3%) minor complication. CONCLUSION In the CLI, results of this trial suggest that REGART is feasible, effective, and with acceptable safety in the catheterization of occluded artery origins without a visible stump when conventional anterograde and retrograde techniques fail. Thus, the target occluded artery can be recanalized while preserving other arterial origins by minimizing dissection risk through subintimal balloon angioplasty at the bi-trifurcation level.
Collapse
Affiliation(s)
- Gürkan Danışan
- Department of Radiology, Sakarya University, Sakarya, Turkey
| | - Ömer Faruk Ateş
- Department of Radiology, Sakarya University, Sakarya, Turkey
| | - Onur Taydaş
- Department of Radiology, Sakarya University, Sakarya, Turkey
| | - Mustafa Özdemir
- Department of Radiology, Sakarya University, Sakarya, Turkey
| | - Ali Küpeli
- Department of Radiology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Alper Erkin
- Department of Cardiovascular Surgery, Sakarya University, Sakarya, Turkey
| |
Collapse
|
134
|
Nikaido T, Sekiguchi M, Yonemoto K, Kakuma T, Watanabe K, Kato K, Kobayashi H, Tominaga R, Otani K, Yabuki S, Kikuchi SI, Konno SI. Generalization of a clinical diagnosis support tool for lumbar spinal stenosis: Can the ankle brachial pressure index be replaced by palpation of the posterior tibial artery in the lumbar spinal stenosis diagnostic support tool? (DISTO project). J Orthop Sci 2022; 28:543-546. [PMID: 35305863 DOI: 10.1016/j.jos.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Japanese Society for Spine Surgery and Related Research previously developed a diagnostic support tool for lumbar spinal stenosis (LSS-DST). Using the LSS-DST, general physicians can identify potential cases of LSS. However, in the LSS-DST, measurement of the ankle brachial pressure index (ABI) is required to exclude peripheral artery lesions in the lower limbs. We can expect further application of the LSS-DST if we can identify a simpler and easier method than ABI measurement. Therefore, in this large-scale, multicenter, cross-sectional study, we verified whether palpation of the posterior tibial (PT) artery could be used instead of ABI in the LSS-DST. METHODS This survey was conducted at 2177 hospitals and included 28,883 participants. The sensitivity and specificity of the original LSS-DST method using the ABI and that of the LSS-DST ver2.0 with PT artery palpation were assessed to screen their ability for diagnosing LSS, using the physicians' final diagnosis based on the patients' history, physical examination and radiographic findings as the gold standard. RESULTS The sensitivity and specificity [95%CI] of the LSS-DST were 88.2% [87.5, 88.8] and 83.9% [83.4, 84.5], respectively, whereas the sensitivity and specificity of the LSS-DST ver2.0 were 87.7% [87.0, 88.3] and 78.3% [77.7, 78.9], respectively, indicating that LSS-DST ver2.0 is a useful screening tool for LSS with good sensitivity. CONCLUSION When the item of ABI in the LSS-DST is replaced by palpation of the PT artery (LSS-DST ver2.0), its sensitivity is maintained as a screening tool for LSS. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan.
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Koji Yonemoto
- Biostatistics Center, Kurume University, Japan; Advanced Medicine Research Center, School of Medicine, University of the Ryukyus, Japan; Division of Biostatistics, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Japan
| | | | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Ryoji Tominaga
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Shin-Ichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
| | | |
Collapse
|
135
|
Clinical Effect of Revascularization Strategies and Pharmacologic Treatment on Long-Term Results in Patients with Advanced Peripheral Artery Disease with TASC C and D Femoropopliteal Lesions. J Interv Cardiol 2022; 2022:3741967. [PMID: 35317345 PMCID: PMC8916894 DOI: 10.1155/2022/3741967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background This study was to assess the clinical outcome and associated parameters of endovascular therapy (EVT group) and bypass surgery (bypass group) in patients with long femoropopliteal TransAtlantic Inter-Society Consensus II (TASC II) C and D peripheral artery disease (PAD). Methods 187 patients who underwent successful EVT or bypass surgery were assessed. The endpoints included the events of cardiovascular disease (CVD) and lower-extremity amputation (LEA), 3-year primary patency, and 3-year amputation-free survival (AFS). Results The 3-year primary and secondary patency rates were better in the bypass group (P=0.007 and P=0.039, respectively), while the incidences of LEA, new CVD events, and mortality were comparable between groups. Weighted multivariate Cox analyses showed that cilostazol treatment (hazard ratio (HR): 0.46, 95% confidence interval (CI): 0.3–0.72, P=0.001), statin treatment (HR: 0.54, 95% CI: 0.33–0.9, P=0.014), and direct revascularization (DR) (HR: 0.47, 95% CI: 0.29–0.74, P=0.001) were predictive factors of 3-year primary patency. Kaplan–Meier curve analyses of time-to-primary cumulative AFS showed that nondiabetes mellitus, mild PAD, and cilostazol and statin treatment were correlated with a superior 3-year AFS (log rank test, P=0.001, P < 0.001, P=0.009, and P=0.044, respectively). Conclusions Endovascular stenting based on the angiosome concept and bypass surgery provide comparable benefits for the treatment of long, advanced femoropopliteal lesions after a short follow-up period, whereas cilostazol therapy for more than 3 months, aggressive treatment of dyslipidemia, and surgical revascularization were associated with higher primary patency.
Collapse
|
136
|
Manfredini F, Traina L, Gasbarro V, Straudi S, Caruso L, Fabbian F, Zamboni P, Manfredini R, Lamberti N. Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study. Intern Emerg Med 2022; 17:439-449. [PMID: 34499318 PMCID: PMC8964614 DOI: 10.1007/s11739-021-02827-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
In patients with peripheral artery disease (PAD), supervised exercise at near-moderate pain improves walking ability but not ankle-brachial index (ABI) values. In a retrospective observational study, we determined vascular and functional effects of a 6-month structured pain-free exercise program in patients with claudication and compressible vessels. Four-hundred and fifty-nine consecutive patients were studied. Segmental limb pressures were measured and ABI calculated during circa-monthly hospital visits. The 6-min (6MWD) and the pain-free walking distance (PFWD) during the 6-min walking test were determined. Two daily 8-min sessions of slow-moderate in-home walking at increasing metronome-paced speed were prescribed. After excluding patients with unmeasurable ABI or incompletion of the program, 239 patients were studied. Safe and satisfactory (88%) execution of the prescribed training sessions was reported. During the visits, bilateral ABI improved (+ 0.07; p < 0.001) as well as the segmental pressures in the more impaired limb, with changes already significant after 5 weeks of slow walking. Both systolic and diastolic blood pressure decreased overtime (F = 46.52; p < 0.001; F = 5.52; p < 0.001, respectively). 6MWD and PFWD improved (41[0‒73]m p < 0.001 and 107[42‒190]m p < 0.001, respectively) with associated decrease of walking heart rate (F = 15.91; p < 0.001) and Physiological Cost Index (F = 235.93; p < 0.001). The variations of most parameters at different visits correlated to the training load calculated. In a regression model, the PFWD variations directly correlated with rate sessions completed, training load and ABI change and inversely with the baseline value (R2 = 0.27; p < 0.001). In the PAD population studied, moderate pain-free exercise improved ABI with associated progressive functional and cardiovascular changes occurring regardless of subjects characteristics.
Collapse
Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Sofia Straudi
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, University Hospital of Ferrara, Ferrara, Italy
| | | | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
| |
Collapse
|
137
|
Higashino N, Iida O, Soga Y, Takahara M, Suzuki K, Mori S, Kawasaki D, Haraguchi K, Yamaoka T, Mano T. 10-Year clinical outcomes of hemodialysis patients with peripheral arterial disease due to infrainguinal disease undergoing endovascular therapy. Heart Vessels 2022; 37:1453-1461. [PMID: 35141801 DOI: 10.1007/s00380-022-02032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
Abstract
Although symptomatic peripheral arterial disease (PAD) is common in patients with hemodialysis (HD), few studies have evaluated the long-term clinical outcomes of revascularization in this population. The aim of the current study was to investigate the 10-year clinical outcomes of HD patients with PAD undergoing endovascular therapy (EVT). We retrospectively analyzed 750 limbs from 578 HD patients with symptomatic PAD due to infrainguinal lesions, treated with EVT, between May 2004 and November 2011. The primary outcome was 10-year mortality and the secondary outcome was 10-year freedom from major adverse limb events (MALEs). Predictors for each outcome were evaluated by Cox proportional-hazards model. The 10-year rate of survival and freedom from MALEs was 23.6 ± 3.1% and 76.4 ± 2.9%, respectively. In the multivariate analysis, patients with over 80 years [hazard ratio (HR) 2.10; 95% confidence interval (CI) 1.58-2.80; p < 0.001], non-ambulatory status (HR 1.55; 95% CI 1.19-2.03; p = 0.001), absence of hypertension (HR 1.59; 95% CI 1.19-2.08; p = 0.001), heart failure (HR 1.36; 95% CI 1.02-1.80; p = 0.03), and tissue loss (HR 1.65; 95% CI 1.28-2.12; p < 0.001) were at an increased risk of 10-year mortality. Cerebrovascular diseases (HR 1.60; 95% CI 1.03-2.49; p = 0.038), no cilostazol use (HR 1.69; 95% CI 1.09-2.70; p = 0.021), tissue loss (HR 3.87; 95% CI 2.37-6.34; p < 0.001), and poor below-the-knee (BTK) run-off (HR 1.68; 95% CI 1.04-2.71; p = 0.035) were significantly associated with MALEs. After risk stratification analysis based on risk score assignment according to number of predictors, 10-year survival and freedom from MALE were lower in the higher score groups (10-year survival rates according to number of risk factors: 0, 35.1%; 1, 20.3%; 2-5, 10.8%; respectively, p < 0.001, 10-year freedom from MALE rates in patients with greater number of risk factors: 0-1, 90.2%; 2-3, 65.5%; 4-5, 61.6%; respectively, p < 0.001). The 10-year clinical outcomes after EVT for HD patients with PAD due to infrainguinal disease were clinically suboptimal. Risk stratification based on these predictors before EVT would be useful in estimating future adverse outcome.
Collapse
Affiliation(s)
- Naoko Higashino
- Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shinsuke Mori
- Department of Cardiology, Yokohama-City Tobu Hospital, Yokohama, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | | | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| |
Collapse
|
138
|
Ibeggazene S, Pymer S, Birkett ST, Caldow E, Harwood AE. A systematic review of exercise intervention reporting quality and dose in studies of intermittent claudication. Vascular 2022; 31:477-488. [PMID: 35130092 DOI: 10.1177/17085381211070700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Exercise therapy is an important treatment option for people with intermittent claudication (IC). Appropriate reporting of exercise interventions in populations with IC within randomised controlled trials (RCTs) is important to ensure that research can be translated into clinical practice. Therefore, the purpose of our review is to evaluate the reporting of exercise interventions in RCTs of exercise therapy in patients with IC. METHODS A systematic search was performed to identify relevant trials in patients with IC published until May 2020. Studies including only participants with critical limb ischaemia or asymptomatic peripheral artery disease were excluded. Each trial was scored using the recently developed 'Consensus on Exercise Reporting Template' (CERT) which has a maximum obtainable score of 19. RESULTS Of 1489 unique records identified from the search, 73 trials were included, reporting 107 exercise interventions. Overall, the average CERT score was 10/19. The exercise equipment used, the use of supervision and a description of whether the exercise prescription was tailored or generic were the most frequently reported intervention components. The motivational strategies used, intervention adherence and intervention fidelity were the most underreported CERT components. There was no trend indicating that CERT scores were higher in more recent publications. CONCLUSIONS We have identified that important details about exercise interventions are frequently missing from the published literature. These missing data hinder replication of research findings and limit the translation of evidence into clinical practice.
Collapse
Affiliation(s)
- Saïd Ibeggazene
- College of Health, Wellbeing and Life Sciences, 7314Sheffield Hallam University, Sheffield, UK
| | - Sean Pymer
- Academic Vascular Surgical Unit, 12195Hull York Medical School, Hull, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, 6723University of Central Lancashire, Preston, UK
| | - Edward Caldow
- School of Health and Society, 7046University of Salford, Salford, UK
| | - Amy E Harwood
- Centre for Sports, Exercise and Life Sciences, 120958Coventry University, Coventry, UK
| |
Collapse
|
139
|
Yoshimura G, Kamidani R, Miura T, Oiwa H, Mizuno Y, Yasuda R, Kitagawa Y, Fukuta T, Miyake T, Okamoto H, Kanda N, Doi T, Okada H, Yoshida T, Yoshida S, Ogura S. Leriche syndrome diagnosed due to polytrauma: a case report. Int J Emerg Med 2022; 15:8. [PMID: 35120433 PMCID: PMC8903668 DOI: 10.1186/s12245-022-00411-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/06/2022] [Indexed: 12/29/2022] Open
Abstract
Background Leriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication and numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a case of Leriche syndrome diagnosed incidentally on trauma pan-scan computed tomography (CT). Case presentation A 61-year-old Asian male was driving a passenger car and had a head-on collision with a dump truck that required an emergency call. The patient was transported to our hospital in a doctor’s helicopter. Physical examination revealed the following vital signs: respiratory rate, 23 breaths per min; SpO2, 98% under a 10-L administration mask; pulse rate, 133 beats per min; blood pressure, 142/128 mmHg; Focused Assessment with Sonography for Trauma, positive; Glasgow Coma Scale assessment, E3V5M6; and body temperature, 35.9 °C. Trauma pan-scan CT showed bilateral mandibular fractures, bilateral multiple rib fractures, bilateral pneumothorax, sternal fractures, hematoma around thoracic spine, small bowel perforation, mesenteric injury, right clavicle fracture, right ankle debridement injury, and thrombotic occlusion from just above the abdominal aortic bifurcation to the bilateral common iliac arteries. Although thrombotic occlusion needed to be differentiated from traumatic aortic injury, the presence of collateral blood vessels led to the diagnosis of Leriche syndrome, and conservative treatment was performed. Damage control surgery was required for the small bowel injuries. From the second day of admission, the patient was treated with continuous intravenous heparin and prostaglandin preparations. However, impaired blood flow and reperfusion injury in the right lower extremity progressed. On the fifth day of admission, right thigh amputation was performed. The patient required renal replacement therapy for 2 weeks starting from the third day of admission. Conclusions In this case, conservative therapy was initially chosen for Leriche syndrome. However, the complex factors in the acute phase of trauma led to development of hemorrhagic necrosis, requiring amputation of the lower extremity. Our findings indicate the need to carefully consider the unique factors affecting Leriche syndrome patients when considering treatment indications and choices for trauma.
Collapse
Affiliation(s)
- Genki Yoshimura
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Ryo Kamidani
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Tomotaka Miura
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hideaki Oiwa
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yosuke Mizuno
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Ryu Yasuda
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yuichiro Kitagawa
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tetsuya Fukuta
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takahito Miyake
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Haruka Okamoto
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Norihide Kanda
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tomoaki Doi
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hideshi Okada
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takahiro Yoshida
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shozo Yoshida
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shinji Ogura
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| |
Collapse
|
140
|
Boudreau H, Blakeslee-Carter J, Novak Z, Sutzko DC, Spangler EL, Passman MA, Scali ST, McFarland GE, Pearce BJ, Beck AW. Association of Statin and Antiplatelet Use with Survival in Patients with AAA with and without Concomitant Atherosclerotic Occlusive Disease. Ann Vasc Surg 2022; 83:70-79. [PMID: 35108555 DOI: 10.1016/j.avsg.2022.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Statin therapy has been associated with improved clinical outcomes in patients undergoing treatment for vascular disease. Current guidelines do not address statin therapy in isolated abdominal aortic aneurysm (AAA) in the absence of other atherosclerotic cardiovascular disease (ASCVD). This study aims to elucidate effects of statin therapy, either as monotherapy or combined with antiplatelet agents, on the long-term mortality of patients with and without ASCVD who undergo elective AAA repair. METHODS A retrospective review was performed on all AAA patients treated electively with endovascular (EVAR) and open aortic repair (OAR) in the Society for Vascular Surgery Vascular Quality Initiative from 2003-2020. Long-term mortality was evaluated based on the presence of statin and antiplatelet medication use at discharge stratified by those with and without a history of ASCVD. Unadjusted survival was estimated by Kaplan Meier methodology. Cox proportional hazards modeling was used to determine mortality risk after adjusting for key factors. RESULTS A total of 47,012 AAA repairs were selected for analysis: 80.7% EVAR (N=40,153) and 19.3% OAR (N=6,859). EVAR patients on combined statin/antiplatelet (AP) therapy had significantly better survival irrespective of whether they had known ASCVD. In the presence of ASCVD, EVAR patients on statin alone had improved survival compared to those not on a statin (10.9±0.5 vs 10.5±0.4 years, Log Rank <.001), with survival being even greater among those receiving combined statin/AP therapy (12.2±0.2 vs 10.5±0.4 years, Log Rank <.001). In the absence of ASCVD, EVAR patients on statin alone also had better mean survival compared to patients not on a statin (8.7±0.5 vs 8.4±0.4 years, Log Rank<.001), with higher survival among statin/AP therapy patients (9.4±0.2 years vs 8.7±0.5 years, Log Rank <.001). Comparison of adjusted survival via Cox multivariable regression demonstrated a protective effect of statins (HR=0.737, p=0.04, vs no medication) and combined statin/AP therapy (HR=0.659, p=0.001, vs no medication) in patients with ASCVD history. A similar protective effect (statin: HR 0.826, p=0.05. Combination statin/AP: HR 0.726, p<.001, vs no medication) was identified in patients without ASCVD history. Within the OAR cohort, statin therapy was not associated with improved survival among patients without ASCVD; however, combined statin/AP therapy had a protective effect for patients with a known ASCVD diagnosis. Based on KM analysis, OAR patients with ASCVD on combined statin/AP therapy had significantly higher mean survival compared to isolated statin therapy (12.7±0.2 vs 10.3±0.65 years) and no medical therapy (10.5±0.8 years, Log Rank <.001). In KM analysis, OAR patients without known ASCVD indications (N=3591) had no significant survival differences based on the presence of combined statin/AP therapy (8.4 ± .07 vs. 8.5 ± .11 years, Log Rank=.638). CONCLUSION Isolated statin therapy and combined statin/AP therapy showed significant survival benefit in all EVAR and OAR patients with ASCVD indications, as well as among EVAR patients without a known ASCVD diagnosis. OAR patients without ASCVD did not have a significant survival benefit from statin therapy, but low numbers in this group may have confounded the findings. Combined statin/AP therapy appears to have significant post-repair survival benefits even in isolated AAA without ASCVD, as demonstrated in post-EVAR patients in this study. Expansion of statin use recommendations within aneurysm treatment guidelines may be warranted.
Collapse
Affiliation(s)
- Hunter Boudreau
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Juliet Blakeslee-Carter
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Zdenek Novak
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Danielle C Sutzko
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Emily L Spangler
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Marc A Passman
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Salvatore T Scali
- University of Florida College of Medicine, Division of Vascular Surgery and Endovascular Therapy, Gainesville, FL
| | - Graeme E McFarland
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Benjamin J Pearce
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL
| | - Adam W Beck
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL.
| |
Collapse
|
141
|
Tarabrin AS, Maksimkin DA, Pavkina AA, Khovalkin RG, Zheltov NY, Shugushev ZK. [Endovascular interventions in patients with glass iii infrainguinal arterial disease: 2-year results]. Khirurgiia (Mosk) 2022:70-78. [PMID: 35289552 DOI: 10.17116/hirurgia202203170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the results of endovascular surgery in patients with chronic limb-threatening ischemia (CLTI) with infrainguinal arterial disease GLASS III. MATERIAL AND METHODS Treatment outcomes were analyzed for the period 2017-2018. Inclusion criteria were age over 18 years, CLTI, extended (>20 cm) stenosis de novo and occlusion of femoropopliteal segment (FPS) combined with occlusive lesion of tibial arteries. We analyzed 147 patients divided into 2 groups depending on stenting strategy. FPS-1-TA included 53 patients who underwent angioplasty (± stenting) of femoropopliteal arteries and lower leg arteries resulted at least one patent tibial artery. FPS-2-TA enrolled 94 patients who underwent angioplasty of femoropopliteal arteries and lower leg arteries resulted ≥2 patent tibial arteries. Mean age was 71.0±9.8 years. There were 75 men. Demographics and clinical characteristics of patients were similar. RESULTS Technical success rate was 100%. Mean length of stenting was 203 ± 99 mm. Occlusion of all 3 leg arteries correlated with high incidence of femoropopliteal stenting. In the FPS-1-TA group, stents were implanted in 39 patients, in the FPS-2-TA group - in 71 patients (73.6% and 75.5%, respectively, p=0.8). Braided nitinol stents were used for stenting of the lower third of superficial femoral artery and p1-p3 segments. Mean follow-up period was 22.6±1.1 months. Two-year results were not age-specific in our study. Kaplan-Meier overall survival, freedom from amputation and amputation-free survival for the entire sample were 79.6%, 81.0%, and 66.7%, respectively. We compared these values in both groups using Mantel-Cox log-rank test and obtained significant differences (67.9% vs 86.2%, p=0.004; 64.2% vs 90%, p<0.0001; 47.2% vs 77.7%, p<0.0001, respectively). CONCLUSION Our results are comparable with literature data regarding freedom from amputation and amputation-free survival. We obtained significant differences in overall survival and freedom from amputation depending on endovascular strategy for tibial arteries. Correction of distal vessels with recanalization of at least two tibial arteries is advisable for endovascular treatment of diffuse complex lesions.
Collapse
Affiliation(s)
- A S Tarabrin
- Bauman Moscow City Hospital No. 29, Moscow, Russia
- People' Friendship University of Russia, Moscow, Russia
| | - D A Maksimkin
- People' Friendship University of Russia, Moscow, Russia
| | - A A Pavkina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - N Yu Zheltov
- Bauman Moscow City Hospital No. 29, Moscow, Russia
| | | |
Collapse
|
142
|
ELSHERIF M, ELSHARKAWI M, TAWFICK W, GHONEIM B, HYNES N, SULTAN S. Two decades of peripheral arterial disease intervention in a tertiary vascular referral center. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
143
|
Tsuruoka T, Kodama A, Yamaguchi S, Masutomi T, Koyama A, Murohara T, Komori K, Shibata R. Zinc deficiency impairs ischemia-induced angiogenesis. JVS Vasc Sci 2022; 3:30-40. [PMID: 35128488 PMCID: PMC8792263 DOI: 10.1016/j.jvssci.2021.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022] Open
Abstract
Objective Zinc is an important essential trace metal involved in many physiologic functions, and its deficiency can affect the development of multiple organs, including the vasculature. However, clarity is lacking regarding the effects of zinc deficiency in the regulation of angiogenesis. We investigated the effects of zinc deficiency on the revascularization process through animal experiments and examined the relationship between the circulating zinc levels and tissue blood perfusion in patients with chronic limb-threatening ischemia (CLTI). Methods Zinc-deficient mice and control wild-type mice had undergone surgery to create unilateral hindlimb ischemia. Next, we examined the relationship between the serum zinc levels and skin perfusion pressure (SPP) as an index of tissue blood perfusion in patients with CLTI. A total of 51 patients with CLTI who had been referred for de novo revascularization for CLTI due to arteriosclerosis obliterans at our hospital from May 2012 to March 2016 were enrolled. Results The zinc-deficient mice showed a significant reduction in blood flow recovery rates in the ischemic limb and capillary density in the ischemic adductor muscle fibers compared with the control wild-type mice. The zinc-deficient mice also showed increased reactive oxygen species production after hindlimb ischemia. Nicotinamide adenine dinucleotide phosphate oxidase inhibitors ameliorated the zinc deficient-induced impairment of revascularization. The serum zinc levels were positively associated with the SPP in the CLTI patients. Multivariate regression analysis also revealed that the serum zinc levels were significantly correlated with the SPP in patients with CLTI. Conclusions Zinc deficiency impaired the rate of ischemia-induced revascularization through enhanced oxidative stress rates, suggesting that nutritional management for zinc sufficiency could be useful in CLTI prevention and treatment. In the present study, we investigated the effects of zinc deficiency on angiogenesis. We found that zinc deficiency impaired the rate of ischemia-induced revascularization through enhanced oxidative stress rates in animal model. In addition, the skin perfusion pressures were positively associated with the serum zinc levels in patients with chronic limb-threatening ischemia. Thus, the intake of zinc could be useful for the prevention and/or treatment of ischemic limb disease. Circulating zinc levels could be a useful marker for the assessment of atherosclerosis-based vascular disease such as limb ischemia. Possibly, nutritional improvement by zinc intake could lead to the prevention and treatment of ischemic vascular disease.
Collapse
Affiliation(s)
- Takuya Tsuruoka
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akio Kodama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shukuro Yamaguchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Masutomi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akio Koyama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Correspondence: Kimihiro Komori, MD, PhD, Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumaicho, Showa-ku, Nagoya 466-8550, Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
144
|
Kamoen V, Vander Stichele R, Campens L, De Bacquer D, Van Bortel L, de Backer TL. Propionyl-L-carnitine for intermittent claudication. Cochrane Database Syst Rev 2021; 12:CD010117. [PMID: 34954832 PMCID: PMC8710338 DOI: 10.1002/14651858.cd010117.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis. Intermittent claudication is a symptomatic form of PAD that is characterized by pain in the lower limbs caused by chronic occlusive arterial disease. This pain develops in a limb during exercise and is relieved with rest. Propionyl-L-carnitine (PLC) is a drug that may alleviate the symptoms of PAD through a metabolic pathway, thereby improving exercise performance. OBJECTIVES The objective of this review is to determine whether propionyl-L-carnitine is efficacious compared with placebo, other drugs, or other interventions used for treatment of intermittent claudication (e.g. exercise, endovascular intervention, surgery) in increasing pain-free and maximum walking distance for people with stable intermittent claudication, Fontaine stage II. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and the ClinicalTrials.gov trials register to July 7, 2021. We undertook reference checking and contact with study authors and pharmaceutical companies to identify additional unpublished and ongoing studies. SELECTION CRITERIA Double-blind randomized controlled trials (RCTs) in people with intermittent claudication (Fontaine stage II) receiving PLC compared with placebo or another intervention. Outcomes included pain-free walking performance (initial claudication distance - ICD) and maximal walking performance (absolute claudication distance - ACD), analyzed by standardized treadmill exercise test, as well as ankle brachial index (ABI), quality of life, progression of disease, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and evaluated trials for risk of bias. We contacted study authors for additional information. We resolved any disagreements by consensus. We performed fixed-effect model meta-analyses with mean differences (MDs) and 95% confidence intervals (CIs). We graded the certainty of evidence according to GRADE. MAIN RESULTS We included 12 studies in this review with a total number of 1423 randomized participants. A majority of the included studies assessed PLC versus placebo (11 studies, 1395 participants), and one study assessed PLC versus L-carnitine (1 study, 26 participants). We identified no RCTs that assessed PLC versus any other medication, exercise, endovascular intervention, or surgery. Participants received PLC 1 grams to 2 grams orally (9 studies) or intravenously (3 studies) per day or placebo. For the comparison PLC versus placebo, there was a high level of both clinical and statistical heterogeneity due to study size, participants coming from different countries and centres, the combination of participants with and without diabetes, and use of different treadmill protocols. We found a high proportion of drug company-backed studies. The overall certainty of the evidence was moderate. For PLC compared with placebo, improvement in maximal walking performance (ACD) was greater for PLC than for placebo, with a mean difference in absolute improvement of 50.86 meters (95% CI 50.34 to 51.38; 9 studies, 1121 participants), or a 26% relative improvement (95% CI 23% to 28%). Improvement in pain-free walking distance (ICD) was also greater for PLC than for placebo, with a mean difference in absolute improvement of 32.98 meters (95% CI 32.60 to 33.37; 9 studies, 1151 participants), or a 31% relative improvement (95% CI 28% to 34%). Improvement in ABI was greater for PLC than for placebo, with a mean difference in improvement of 0.09 (95% CI 0.08 to 0.09; 4 studies, 369 participants). Quality of life improvement was greater with PLC (MD 0.06, 95% CI 0.05 to 0.07; 1 study, 126 participants). Progression of disease and adverse events including nausea, gastric intolerance, and flu-like symptoms did not differ greatly between PLC and placebo. For the comparison of PLC with L-carnitine, the certainty of evidence was low because this included a single, very small, cross-over study. Mean improvement in ACD was slightly greater for PLC compared to L-carnitine, with a mean difference in absolute improvement of 20.00 meters (95% CI 0.47 to 39.53; 1 study, 14 participants) or a 16% relative improvement (95% CI 0.4% to 31.6%). We found no evidence of a clear difference in the ICD (absolute improvement 4.00 meters, 95% CI -9.86 to 17.86; 1 study, 14 participants); or a 3% relative improvement (95% CI -7.4% to 13.4%). None of the other outcomes of this review were reported in this study. AUTHORS' CONCLUSIONS When PLC was compared with placebo, improvement in walking distance was mild to moderate and safety profiles were similar, with moderate overall certainty of evidence. Although In clinical practice, PLC might be considered as an alternative or an adjuvant to standard treatment when such therapies are found to be contraindicated or ineffective, we found no RCT evidence comparing PLC with standard treatment to directly support such use.
Collapse
Affiliation(s)
- Victor Kamoen
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Laurence Campens
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Cardiovascular Center, Ghent University Hospital, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Luc Van Bortel
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Tine Lm de Backer
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
- Cardiovascular Center, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
145
|
Paulino Geisel P, Pantuso Monteiro D, de Oliveira Nascimento I, Gomes Pereira DA. Evaluation of functional capacity and muscle metabolism in individuals with peripheral arterial disease with and without diabetes. J Vasc Surg 2021; 75:671-679. [PMID: 34921971 DOI: 10.1016/j.jvs.2021.08.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Peripheral arterial disease (PAD) is characterized by intermittent claudication, which interferes with walking and leads to worsening of functional capacity. This mechanism has not been clearly defined in PAD. Thus, the aim of our study was to identify the muscular metabolism and vascular function variables using near-infrared spectroscopy (NIRS) and their possible associations with functional capacity in individuals with PAD and secondly to verify the differences in these variables between persons with PAD and diabetes mellitus (DM) and those with PAD without DM. METHODS A total of 39 participants with intermittent claudication were enrolled, 14 of whom had DM. They were assessed for functional capacity by the total distance covered in the treadmill test with the speed and grade constant and for muscle function and metabolism using near-infrared spectroscopy at rest and during the treadmill test. The Spearman correlation coefficient was computed to assess the presence of an association between the variables, and multiple linear regression analysis was performed, considering the total test distance as the dependent variable. The assessment between groups was performed using the independent t test or Mann-Whitney U test. RESULTS The near-infrared spectroscopy variables related to tissue oxygen saturation in the test recovery phase were correlated with the functional performance during the treadmill test. Thus, those with a longer or slower recovery time and those with greater tissue deoxygenation had walked a shorter distance. A significant difference (P = .049) was noted between those with PAD stratified by DM in the reoxygenation time required for an occlusion. CONCLUSIONS These findings reinforce the hypothesis that peripheral factors related to vascular function and muscular metabolism can affect the walking capacity of persons with PAD and that microvascular dysfunction is more prevalent among those with PAD and DM.
Collapse
|
146
|
Endovascular interventions in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Peripheral artery diseases are a worldwide medical and social problem. Approximately 30 % of patients with critical limb ischemia will undergo amputations and 25 % will die after 1 year. These patients require reconstructive and angioplastic interventions to preserve the limb.
The aim of the study is to compare the effectiveness of different endovascular surgical technologies in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries.
Materials and methods. Among 243 endovascular interventions, 51 patients were presented with multilevel steno-occlusive lesions of the infrarenal aortic arteries as a result of atherosclerosis obliterans. 42 patients (82.4 %) had two-level lesions and 9 (17.6 %) had three-level lesions.
Results. Among 42 patients with a two-level lesion, 29 (56.9 %) ones had femoral arterial segment affection in combination with tibial artery affection. 13 (25.5 %) patients suffered from the lesion of the iliac segment in combination with the affection of the femoral segment arteries. In 9 (17.6 %) patients the lesions of three or more levels were determined: an iliac segment in combination with femoral and popliteal arteries – in 4 patients, and in 2 patients there were lesions of the femoral, popliteal and tibial segments, in 3 patients there was a lesion of the iliac, femoral, popliteal and tibial-foot segments in different degrees of severity.
7 balloon angioplasties and 13 stenting procedures were performed in two and three-level lesions in which the iliac arterial segment was affected. Only balloon angioplasty was used to revascularize the infraingvinal arterial segments. In the early postoperative period, the complications included thrombosis appeared in 6 patients. It was possible to restore the blood flow and save the limb only in 3 persons. For the other 3 ones, the attempts to restore the patency of the arteries were unsuccessful and resulted in the amputation of the lower extremity. Mortality in the early postoperative period was 3.9 % (2 death due to myocardial infarction).
Conclusions. The persons with multilevel steno-obstructive lesions of the infrarenal aortic arteries are the most difficult category of patients with CLI. The surgical method of choice for patients with multilevel steno-occlusive lesions is the endovascular angioplasty with or without stenting.
Collapse
|
147
|
Yasu T. Comprehensive cardiac rehabilitation program for peripheral arterial diseases. J Cardiol 2021; 80:303-305. [PMID: 34857431 DOI: 10.1016/j.jjcc.2021.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
Peripheral arterial disease (PAD) is a phenotype of atherosclerotic disease often associated with cerebrovascular or coronary artery disease. The incidence of cardiovascular events in patients with PAD is 5.4% per year, which is higher than that of cerebrovascular or coronary artery disease. The most useful screening method for PAD is the ankle brachial pressure index (ABI). The ABI should be measured in (1) all patients with lower limb symptoms such as claudication, (2) all patients aged 65 years and over, and (3) those aged 50 to 65 years who have risk factors such as smoking and diabetes mellitus. PAD is diagnosed if the ABI is <0.9. A comprehensive cardiac rehabilitation program includes complete smoking cessation, blood pressure control with antihypertensive medications and salt reduction for hypertension, glycemic control for diabetes mellitus, and appropriate medications such as antiplatelet agents and statins. A multidisciplinary team approach is effective in comprehensive cardiac rehabilitation for patients with PAD, even those with critical limb ischemia (CLI). Exercise therapy is a crucial and essential treatment for PAD, except in CLI. Exercise therapy is contraindicated in patients with acute arterial occlusion and CLI with infection. PAD is often associated with other atherosclerotic diseases; the patient should be monitored for ischemic heart disease during the initial exercise stress test using the Gardner treadmill protocol. Supervised exercise therapy is highly recommended (Class I, Level of Evidence A). Alternatively, a home-based exercise program is feasible (Class IIa, Level of Evidence A). The exercise type (treadmill, track walking, ergometer), frequency (3 to 5 days per week), intensity (speed and incline), and duration (30 minutes) are determined based on the exercise stress test results for each patient. Exercise should be continued at least 3 times a week for at least 12 weeks. Cilostazol is highly recommended (Class I, Level of Evidence A).
Collapse
Affiliation(s)
- Takanori Yasu
- Department of Cardiovascular Medicine & Nephrology, Dokkyo Medical University.
| |
Collapse
|
148
|
Ursli M, Zierfuss B, Grigassy T, Pesau G, Koppensteiner R, Schernthaner GH, Höbaus C. Galectin-3 is linked to peripheral artery disease severity, and urinary excretion is associated with long-term mortality. Atherosclerosis 2021; 341:7-12. [PMID: 34929561 DOI: 10.1016/j.atherosclerosis.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Galectin-3 (Gal-3) is a biomarker involved in fibrosis and vascular inflammation. Gal-3 has been linked to chronic kidney disease (CKD) and patients with peripheral artery disease (PAD). Conflicting reports exist about the relevance of Gal-3 in PAD. The study aims to elucidate a possible link between serum and urinary Gal-3 and long-term survival in PAD patients without critical limb ischemia and mild to moderate CKD. METHODS Galectin-3 (Gal-3) was measured in serum (n = 311) and urine (n = 266) of PAD patients (age 69 (62-77) years) by bead-based multiplex assay. Urinary Gal-3 concentration was normalized to urine creatinine (cr) levels. Mortality data were retrieved from the Austrian central death registry after a median observation period of 9.2 years. Survival analyses were performed by the Kaplan-Meier method and Cox-regression. RESULTS Serum Gal-3 was higher in patients with claudication symptoms (p = 0.001) and correlated inversely with the patients' ankle-brachial index (R = -0.168, p = 0.009). Serum Gal-3 and urinary Gal-3 (uGal-3/cr) were associated with the estimated glomerular filtration rate (R = -0.359, p < 0.001; R = -0.285, p < 0.001). Serum Gal-3 was not linked to all-cause mortality [HR 1.17 (CI 0.96-1.42)] over 9.2 years. However, uGal-3/cr was associated with all-cause mortality [HR 1.60 (CI 1.31-1.95)]. This association sustained multivariable adjustment for cardiovascular risk factors and renal function [HR 1.71 (CI 1.35-2.17)]. CONCLUSIONS This study is the first to show an association of uGal-3/cr and long-term mortality in patients with PAD. Gal-3 was not predictive of long-term mortality but seems to be a marker of PAD severity in patients without critical limb ischemia.
Collapse
Affiliation(s)
- Martin Ursli
- Department of Internal Medicine I, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, Karl Landsteiner Institute for Nephrology and Hematooncology, St. Poelten, Austria
| | - Bernhard Zierfuss
- Division of Angiology, Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Grigassy
- Division of Angiology, Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gerfried Pesau
- Division of Angiology, Medicine II, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Division of Angiology, Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Clemens Höbaus
- Division of Angiology, Medicine II, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
149
|
Jiang J, Xu W. Predictability and usefulness of intravascular ultrasound-guided angioplasty in patients with femoropopliteal lesions: a systematic review and meta-analysis. INT ANGIOL 2021; 41:74-81. [PMID: 34825800 DOI: 10.23736/s0392-9590.21.04769-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To assess whether intravascular ultrasound (IVUS)-guided angioplasty in femoropopliteal lesions would improve clinical outcomes and predict restenosis. EVIDENCE ACQUISITION Studies in which IVUS-guided angioplasty was used for femoropopliteal lesions were searched from the MEDLINE, Embase, Web of Science, and Cochrane databases; articles with the full text were included. The primary endpoint of this study was primary patency at 12 months, while the secondary endpoints were primary patency at 24 months, freedom from target lesion revascularization (TLR) at 12 months, and correlation of restenosis with the distal external elastic membrane (EEM) area, post-intervention minimum lumen area, lesion length, dissection, and calcification. EVIDENCE SYNTHESIS Altogether, 11 observational studies involving 1521 patients (1703 lesions) were analyzed. The quality of the evidence for 7 main outcomes was assessed as "very low" by The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification. The mean follow-up period was 1.5 years. The pooled rates were: 78% for 12-month primary patency (95% confidence interval [CI], 0.72-0.83), 74.3% for 24-month primary patency (95% CI, 0.71-0.78), and 80% for 12-month freedom from TLR (95% CI, 0.74-0.86). The 12-month primary patency of IVUS use (relative risk [RR], 2.01; 95% CI, 1.48-2.74) was higher compared to non-IVUS use. The minimum lumen (stent) area (standard mean difference (SMD) = -0.30; 95% CI, -0.46 to -0.15) and dissection (OR 1.58; 95% CI, 1.01-2.49, P = 0.047), were associated with midterm patency in terms of restenosis. CONCLUSIONS In IVUS-guided angioplasty in patients with femoropopliteal lesions, the minimum lumen (stent) area and dissection were associated with restenosis. Nevertheless, there is limited and heterogeneous evidence regarding the usefulness and Predictability of IVUS in patients with peripheral arterial disease in the femoropopliteal artery, especially in long-term patency and as a predictor of declining patency. The optimal role of IVUS in such patients should be elucidated in the future.
Collapse
Affiliation(s)
- Junhui Jiang
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, Guangdong, China
| | - Weiguo Xu
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital(Zhuhai hospital affiliated with Jinan University), Zhuhai, Guangdong, China -
| |
Collapse
|
150
|
Li M. Guidelines and standards for comprehensive clinical diagnosis and interventional treatment for diabetic foot in China (Issue 7.0). J Interv Med 2021; 4:117-129. [PMID: 34805959 PMCID: PMC8562298 DOI: 10.1016/j.jimed.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/22/2023] Open
Abstract
Diabetic foot (DF) is one of the most common complications of diabetes and is associated with high morbidity, disability, lethality and low cure-rate. The clinical diagnosis and treatment of DF need to be standardized. The Chinese Diabetic Foot Cell and Interventional Therapy Technology Alliance has released six editions of guidelines and standards for clinical diagnosis and interventional treatment of DF, which filled the gap in the domestic DF treatment standard and played an important role in improving the level of diagnosis and treatment in China. In line with the latest developments in diagnosis and treatment, the Alliance, along with other 89 institutions, developed and issued the new edition based on the sixth edition to help standardize the clinical diagnosis and treatment of DF in China.
Collapse
Affiliation(s)
- Maoquan Li
- China Alliance of Cellular and Interventional Therapy Techniques for Diabetic Foot, China.,Technical Committee on Interventional Medicine and Bioengineering of Chinese Intervention Physicians Branch, China.,National Centre for Clinical Medical Research on Radiation and Treatment, China.,Department of Interventional and Vascular Surgery, Affiliated Tenth People's Hospital of Tongji University, China.,Interventional Vascular Institute of Tongji University, Shanghai 200072, China
| |
Collapse
|