1
|
Brown PA, Brown PD. Extracellular vesicles and atherosclerotic peripheral arterial disease. Cardiovasc Pathol 2023; 63:107510. [PMID: 36460259 DOI: 10.1016/j.carpath.2022.107510] [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: 07/23/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
Atherogenesis involves a complex multifactorial process including chronic inflammation that requires the participation of several cell types and molecules. In addition to their role in vascular homeostasis, extracellular vesicles also appear to play an important role in atherogenesis, including monocyte transmigration and foam cell formation, SMC proliferation and migration, leukocyte transmigration, and thrombosis. Peripheral arterial disease, a major form of peripheral vascular disease, is characterized by structural or functional impairment of peripheral arterial supply, often secondary to atherosclerosis. Elevated levels of extracellular vesicles have been demonstrated in patients with peripheral arterial disease and implicated in the development of atherosclerosis within peripheral vascular beds. However, extracellular vesicles also appear capable of delivering cargo with atheroprotective effects. This capability has been exploited in vesicles engineered to carry content capable of neovascularization, suggesting potential for therapeutic angiogenesis. This dual capacity holds substantial promise for diagnosis and therapy, including possibly limb- and life-saving options for peripheral arterial disease management.
Collapse
Affiliation(s)
- Paul A Brown
- Department of Basic Medical Sciences, University of the West Indies, Mona, Jamaica.
| | - Paul D Brown
- Department of Basic Medical Sciences, University of the West Indies, Mona, Jamaica
| |
Collapse
|
2
|
Chhabra JS, Lu JJ, Simmons JM. Adventitial cystic disease in the external iliac artery of a 29-year-old man. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:516-519. [PMID: 34401615 PMCID: PMC8358282 DOI: 10.1016/j.jvscit.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Adventitial cystic disease (ACD) is an uncommon condition that generally occurs at the popliteal artery but, rarely, can occur in the external iliac artery. To date, only eight cases of ACD occurring in the external iliac artery have been reported. We have reported the case of a 29-year-old man who had presented with new-onset claudication. Despite an extensive imaging workup, ACD was not confirmed until the gross intraoperative examination. We have reported our process of diagnosis and treatment in addition to that reported in previous studies to enhance the historical fund of knowledge for this rare pathology.
Collapse
Affiliation(s)
- Jaineet S Chhabra
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
| | - Joyce J Lu
- Division of Vascular Surgery, Department of Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Justin M Simmons
- Division of Vascular Surgery, Department of Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Mich
| |
Collapse
|
3
|
Plantar Flexion-Induced Entrapment of the Dorsalis Pedis Artery in a Teenaged Cross-Country Runner. Ann Vasc Surg 2020; 70:213-218. [PMID: 32333951 DOI: 10.1016/j.avsg.2020.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Symptomatic peripheral artery disease of the lower extremity rarely affects young adults and, when present, typically has a nonatherosclerotic etiology. Anatomical variants have manifested as symptomatic foot ischemia in four cases in the literature. We describe the case of a 17-year-old girl presenting with foot pain upon plantar flexion due to dynamic dorsalis pedis (DP) artery entrapment by fibrous bands and the extensor hallucis brevis (EHB) tendon. METHODS The patient was a 17-year-old girl who presented with right foot pain upon plantar flexion, which resolved upon returning to the neutral position. The potential site of compression was identified on MRI where the DP artery ran deep to the EHB tendon near the first and second tarsometatarsal joints. On diagnostic arteriogram, there was notching of the dorsalis pedis over the talus bone. The dorsalis pedis Doppler signal was obliterated upon plantar flexion. A longitudinal incision was made over the artery in the area of compression. The flexor retinaculum was incised. Abnormal fibrous bands were identified, which were lysed anterior to the artery. The EHB tendon was released and transferred distally to the extensor hallucis longus tendon. RESULTS A completion angiogram showed a persistently patent dorsalis pedis artery with plantar flexion. She was discharged one day postoperatively without issues. On follow-up, the patient was ambulatory with complete resolution of her pain. Arterial duplex demonstrated normal velocities through the dorsalis pedis in all positions. CONCLUSIONS Symptomatic peripheral artery disease is a rare presentation in young adults and is usually due to nonatherosclerotic pathophysiology. We present a rare case of dorsalis pedis artery entrapment syndrome. Given the mechanical nature of obstruction, surgical correction was an effective treatment.
Collapse
|
4
|
Mowafy KA, Soliman M, Hammoda AM, Soliman RM. Bilateral Lower Limb Disabling Claudication in a Young Man: A Case of Mönckeberg’s Arteriosclerosis. VASCULAR AND ENDOVASCULAR REVIEW 2019. [DOI: 10.15420/ver.2018.20.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Mönckeberg’s arteriosclerosis, also called medial calcific sclerosis or Mönckeberg’s sclerosis, is a form of vessel hardening due to increased calcium deposits in the tunica media layer. There is disagreement over its clinical significance and aetiology and its relation to atherosclerosis and vascular calcification. Its clinical presentations and treatment are still debated. More effort should be directed on attempting to distinguish between atherosclerotic lesions and Mönckeberg’s lesions on the basis of age, location and the pattern of calcifications where there is considerable overlap between intimal or medial and involvement of the internal elastic lamina border between those planes. In-depth research is still needed to create consensus guidelines for the diagnosis and management of this condition. This article includes a review of the literature and a case report of a 22-year-old man with the condition.
Collapse
Affiliation(s)
- Khalid Abdelaziz Mowafy
- Vascular and Endovascular Surgery Department, Mansoura College of Medicine, Mansoura University, Egypt
| | - Mosaad Soliman
- Vascular and Endovascular Surgery Department, Mansoura College of Medicine, Mansoura University, Egypt
| | - Ahmed Magdy Hammoda
- Vascular and Endovascular Surgery Department, Mansoura College of Medicine, Mansoura University, Egypt
| | - Reem Mosaad Soliman
- Vascular and Endovascular Surgery Department, Mansoura College of Medicine, Mansoura University, Egypt
| |
Collapse
|
5
|
Kawarada O, Zen K, Hozawa K, Ayabe S, Huang HL, Choi D, Kim SH, Kim J, Kato T, Tsubakimoto Y, Nakama T, Ichihashi S, Fujimura N, Higashimori A, Fujihara M, Sato T, Yan BPY, Pang SYC, Wongwanit C, Leong YP, Chua B, George RK, Yokoi Y, Motomura H, Obara H. Contemporary critical limb ischemia: Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care. Cardiovasc Interv Ther 2018; 33:297-312. [PMID: 29654408 PMCID: PMC6153892 DOI: 10.1007/s12928-018-0523-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
The burden of peripheral artery disease (PAD) and diabetes in Asia is projected to increase. Asia also has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world. Therefore, most Asian patients with PAD might have diabetic PAD or ESRD-related PAD. Given these pandemic conditions, critical limb ischemia (CLI) with diabetes or ESRD, the most advanced and challenging subset of PAD, is an emerging public health issue in Asian countries. Given that diabetic and ESRD-related CLI have complex pathophysiology that involve arterial insufficiency, bacterial infection, neuropathy, and foot deformity, a coordinated approach that involves endovascular therapy and wound care is vital. Recently, there is increasing interaction among cardiologists, vascular surgeons, radiologists, orthopedic surgeons, and plastic surgeons beyond specialty and country boundaries in Asia. This article is intended to share practical Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care for CLI.
Collapse
Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Japan.
- Department of Cardiovascular Medicine, Ikuwakai Memorial Hospital, Osaka, Japan.
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Shinobu Ayabe
- Department of Plastic Surgery, Yao Tokushukai General Hospital, Yao, Japan
| | - Hsuan-Li Huang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Hong Kim
- Department of Cardiology, Busan Veterans Hospital, Busan, South Korea
| | - Jiyoun Kim
- Department of Orthopedic Surgery, Busan Veterans Hospital, Busan, South Korea
| | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | | | - Tasuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tomoyasu Sato
- Department of Radiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Bryan Ping-Yen Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Skyi Yin-Chun Pang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | | | - Yew Pung Leong
- Department of Vascular Surgery, Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Benjamin Chua
- Department of Vascular Surgery, Vascular and Interventional Centre Singapore, Mount Elizabeth Novena Specialist Centre, The Farrer Park Hospital, Singapore, Singapore
| | - Robbie K George
- Department of Vascular Surgery, Narayana Hrudayalaya and Mazumdar Shaw Medical Centre, Bengaluru, India
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Osaka City University, Osaka, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Gwon JG, Kwon YJ, Han YJ, Cho YP, Kwon TW. Chronic Nonatherosclerotic Occlusive Popliteal Artery Disease. Ann Vasc Surg 2017; 47:128-133. [PMID: 28887249 DOI: 10.1016/j.avsg.2017.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The outcomes of revascularization of nonatherosclerotic occlusive popliteal artery disease are unknown. Therefore, the objective of this study was to analyze the outcomes of recanalization of nonatherosclerotic occlusive popliteal artery disease, the results of which would be useful in creating surgical strategies for such cases. METHODS From January 2000 to December 2015, a total of 22 patients with nonatherosclerotic occlusive popliteal artery disease underwent open surgical repair. We retrospectively analyzed the data of these patients. Thrombectomy with angioplasty on the occluded popliteal artery, graft interposition, and bypass surgery were conducted for revascularization of the affected region. We analyzed the overall primary patency rate, type of graft, and surgical approach. Furthermore, we compared the primary patency rate after surgical treatment. RESULTS Of 22 patients, 3 (13.6%) had cystic adventitial disease, 16 (72.7%) had popliteal artery entrapment syndrome, and 3 (13.6%) were diagnosed as having thromboangiitis obliterans. Five patients (22.7%) underwent thrombectomy with patch angioplasty, 8 (36.3%) underwent bypass surgery, and 9 (40.9%) underwent graft interposition of the popliteal artery. All graft interpositions and thrombectomies with patch angioplasty were performed through a posterior approach, whereas all bypass surgeries were performed through a medial approach except in 1 case. The mean follow-up period was 54.95 ± 42.99 months. The overall primary patency rate at 1, 3, and 10 years was 100%, 86.9%, and 69.5%, respectively. In the bypass group, the primary patency rate at 1, 3, and 10 years was 100%, 66.7%, and 44.4%, respectively. In the other groups, the primary patency rate was 100% during the follow-up period. The difference in primary patency rate was statistically significant (P ≤ 0.05). CONCLUSIONS The result of surgical treatment for nonatherosclerotic occlusive popliteal artery disease was better than that of atherosclerotic popliteal artery disease. Direct popliteal artery reconstruction, such as graft interposition or thrombectomy with patch angioplasty, showed better short- and long-term patency than did bypass surgery.
Collapse
Affiliation(s)
- Jun Gyo Gwon
- Department of Surgery, University of Hanyang College of Medicine and Guri Hospital, Gyeonggi, Republic of Korea
| | - Yong-Jae Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Young Jin Han
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Pil Cho
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Won Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
| |
Collapse
|