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Titan AL, Chang J, Megerle K, Murray P, Hammert W. State of the art review: The management of chronic vascular disorders in the hand and upper limb. J Hand Surg Eur Vol 2023; 48:295-302. [PMID: 36753288 DOI: 10.1177/17531934221145498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This review article summarizes the basic principles of vascular anatomy, physiology, diagnostic work-up and treatment for patients with nontraumatic upper extremity vascular disorders. Vascular disorders can be considered vasospastic or occlusive. The most commonly encountered vasospastic condition is Raynaud's Phenomenon secondary to scleroderma. While historically this has been managed medically with vasodilators, more advanced cases can benefit from surgical treatment to improve blood flow and minimize tissue loss, with compelling evidence that earlier surgical intervention can modify disease process and should be considered. Occlusive disease can present as aneurysm or thrombosis and often requires surgical treatment with resection of the occluded segment with or without vascular reconstruction. In advanced atherosclerotic disease or end stage ischemia, arterialization of the venous system can be considered to avoid more proximal amputations.
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Affiliation(s)
- Ashley L Titan
- Department of Surgery, Division of Plastic Surgery, Stanford University Hospital, Stanford, CA, USA
| | - James Chang
- Department of Surgery, Division of Plastic Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Kai Megerle
- Centre for Hand Surgery, Microsurgery and Plastic Surgery, Schön Clinic, Munich, Germany
| | - Peter Murray
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville Florida, USA
| | - Warren Hammert
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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2
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Tokuda T, Oba Y, Kagase A, Matsuda H, Suzuki Y, Murata A, Ito T, Hirano K. Feasibility and impact of extra-vascular ultrasound-guided endovascular treatment for infrapopliteal artery occlusive disease. Catheter Cardiovasc Interv 2023; 101:870-876. [PMID: 36877810 DOI: 10.1002/ccd.30615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/09/2022] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE This study aimed to examine the feasibility and impact of extra-vascular ultrasound (EVUS)-guided intervention for infrapopliteal (IP) artery occlusive disease. MATERIALS AND METHODS A retrospective analysis was performed using data collected from patients who underwent endovascular treatment (EVT) for IP artery occlusive disease between January 2018 and December 2020 at our institution. A total of 63 consecutive de novoocclusive lesions were compared according to the recanalization method utilized. Propensity score matching analysis was performed to compare the clinical outcomes of the methods utilized. The prognostic value was analyzed based on the technical success rate, distal puncture rate, radiation exposure, amount of contrast media, postprocedural skin perfusion pressure (SPP), and procedural complication rate. RESULTS Eighteen matched pairs of patients were analyzed using propensity score-matched analysis. Radiation exposure was significantly lower in the EVUS-guided group than in the angio-guided group, with 135 and 287 mGy (p = 0.04) exposure on average, respectively. There were no significant differences between the two groups in terms of technical success rate, distal puncture rate, the amount of contrast media, postprocedural SPP, and procedural complication rate. CONCLUSION EVUS-guided EVT for IP occlusive disease achieved a feasible technical success rate and significantly reduced radiation exposure.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiro Oba
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Hiroaki Matsuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yoriyasu Suzuki
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Akira Murata
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Keisuke Hirano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
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3
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de Cort BA, Salemans PB, Fritschy WM, Pierie MEN, Lind RC. Long-Term Outcome for Covered Endovascular Reconstruction of Aortic Bifurcation for Aortoiliac Disease: A Single-Center Experience. J Endovasc Ther 2021; 28:906-913. [PMID: 34190635 DOI: 10.1177/15266028211028210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The gold standard for the treatment of complex (TASC II C and D) atherosclerotic aortoiliac lesions is still open surgical repair. Endovascular techniques have a lower mortality and morbidity rate but this comes at the cost of worse patency rates when compared with open repair. Improved short- and mid-term results have been reported using the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. The aim of this study was to report our initial experience with the CERAB technique and report long-term patency rates. MATERIALS AND METHODS All patients treated with the CERAB technique between 2012 and 2018 were prospectively registered in an institutional database and included in this study. Patient demographics, characteristics, symptoms, procedural, and follow-up details were collected and analyzed retrospectively. Perioperative complications and reinterventions were also identified. The Kaplan-Meier survival method was used to assess cumulative rates of patency. RESULTS A total of 44 patients were treated with the CERAB technique and included in this study. The majority of the treated aortoiliac occlusions were classified as complex: TASC II C (n=7; 15.9%) or TASC II D (n=25; 56.8%). Primary patency rate at 60 months was 83.3%, assisted primary patency was 90.9% and secondary patency 95%. No significant differences were found in patency rates comparing noncomplex (TASC II A and B) and complex (TASC II C and D) aortoiliac lesions. Seven patients (15.9%) required at least one additional procedure to maintain either assisted primary patency or secondary patency during follow-up. The 30-day complication rate in this series was 20.5% (n=9), of which 55.6% (n=5) were minor complications. All major 30-day complications (n=4) occurred during or directly after the CERAB procedure. Thirty-day mortality was 0%. No limb occlusions occurred within 30 days of the procedure. CONCLUSION Good long-term patency rates can be achieved with the CERAB technique to treat aortoiliac stenosis or occlusions while maintaining advantages associated with endovascular interventions. This remains true even when a CERAB is used to treat complex aortoiliac lesions. An endo-first approach to treat complex aortoiliac lesions seems viable.
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Affiliation(s)
- Boris A de Cort
- Department of Vascular Surgery, Isala, Zwolle, The Netherlands
| | - Pieter B Salemans
- Department of Vascular Surgery, Isala, Zwolle, The Netherlands.,Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | | | - Robert C Lind
- Department of Vascular Surgery, Isala, Zwolle, The Netherlands.,Department of Thoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
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4
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De Beaufort LM, Nasr B, Corvec TL, Brisard L, Guyomarc'h B, Fellah I, Postaire B, Chaillou P, Clough RE, Maurel B. Automated Image Fusion Guidance during Endovascular Aorto-Iliac Procedures: A Randomized Controlled Pilot Study. Ann Vasc Surg 2021; 75:86-93. [PMID: 33823257 DOI: 10.1016/j.avsg.2021.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The benefits of imaging guidance using a new fully automated fusion process (CYDAR) have been demonstrated during endovascular aortic aneurysm repair, but little is known about its use during aorto-iliac occlusive disease endovascular revascularization. The aim of this study was to evaluate the influence of CYDAR image fusion guidance during endovascular treatment of symptomatic aorto-iliac occlusive lesions, compared with control patients treated using standard 2D fluoroscopy alone. METHODS This is a single-center randomized controlled pilot study that recruited patients undergoing aorto-iliac endovascular revascularization. RESULTS Between January 2019 and February 2020, 37 patients with symptomatic aorto-iliac lesions were enrolled: 18 were assigned to the fusion group and 19 to the control group. Patients and lesions characteristics were well balanced between both study groups. The technical success of the procedure was 100% in the Fusion group and 94% in the control group. All radiation-related parameters were lower in the fusion compared to the control group, including: median DAP 18.5 Gy.cm2 vs. 21.8 Gy.cm2; Air Kerma 0.10 Gy vs. 0.12 Gy; fluoroscopy dose 4.2 Gy.cm2 vs. 5.1 Gy.cm2; and number of DSA 7.5 vs. 8. The volume of iodinated contrast used was higher in the fusion group: 41 mL vs. 30 mL. The total procedure time was the same in both groups:60 min vs. 60 min. CONCLUSIONS The results of this pilot study suggest the use of fusion imaging in endovascular treatment of aorto-iliac disease results in reduction in radiation-related measured parameters with no change in procedure time and higher doses of iodinated contrast used. These results need to be further investigated in a larger, adequately powered study.
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Affiliation(s)
| | - Bahaa Nasr
- CHU Nantes, l'institut du thorax, service de chirurgie cardio-vasculaire, Nantes, France
| | - Tom Le Corvec
- CHU Nantes, l'institut du thorax, service de chirurgie cardio-vasculaire, Nantes, France
| | - Laurent Brisard
- CHU Nantes, département d'anesthésie réanimation, Nantes, France
| | | | - Imen Fellah
- CHU Nantes, l'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Boris Postaire
- CHU Nantes, l'institut du thorax, service de chirurgie cardio-vasculaire, Nantes, France
| | - Philippe Chaillou
- CHU Nantes, l'institut du thorax, service de chirurgie cardio-vasculaire, Nantes, France
| | - Rachel E Clough
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London
| | - Blandine Maurel
- CHU Nantes, l'institut du thorax, service de chirurgie cardio-vasculaire, Nantes, France; Université de Nantes, Nantes, France.
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Roman S, Mekheal N, Tal S, Michael P. More Than Just an Ulcer: A Case of HIV-Associated Iliac Aneurysms Presenting With a Leg Ulcer. Cureus 2021; 13:e13203. [PMID: 33717743 PMCID: PMC7943397 DOI: 10.7759/cureus.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The incidence of symptomatic vasculitis in human immunodeficiency virus (HIV)-infected patients is approximately 1%, and it commonly presents as arterial occlusive disease or aneurysmal disease. Early diagnosis of vascular complications in those patients is essential; however, it is extremely challenging. Iliac aneurysms are usually silent, and because of their deep location, detection of these aneurysms is typically difficult. Therefore, they always continue to be asymptomatic until rupture unless they are discovered incidentally on a radiological investigation for an irrelative condition. We present the case of a 61-year-old HIV-positive man with bilateral iliac aneurysms and total coronary artery occlusion presenting with a leg ulcer.
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Affiliation(s)
- Sherif Roman
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Nader Mekheal
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Shani Tal
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Patrick Michael
- Internal Medicine, St. Joseph's Univeristy Medical Center, Paterson, USA
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6
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Vishnyakova MV, Pronin IN, Larkov RN, Vishnyakova MV. [Ct-angiography in assessment of critical occlusive carotid artery disease]. Zh Vopr Neirokhir Im N N Burdenko 2021; 85:37-42. [PMID: 34951758 DOI: 10.17116/neiro20218506137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Occlusive carotid artery disease is still one of the major causes of ischemic stroke in the world. Progression of severe carotid stenosis may lead to critical stenosis and vascular occlusion. Nevertheless, there is still no pure definition of the concept of critical occlusive carotid artery disease. OBJECTIVE To define the role of CT-angiography in assessment of critical occlusive carotid artery disease. MATERIAL AND METHODS We analyzed data of 405 patients who underwent preoperative precise assessment of carotid arteries and subsequent surgical treatment for the period from 2016 to 2019. Contrast-enhanced CT-angiography (Philips Ict scanner, 256 slices) was made after previous ultrasound. Contrast agent injection rate was 4-5 ml/sec. CT angiography data were assessed according to a specialized protocol. RESULTS Critical occlusive carotid artery disease was observed in 128 (31.6%) cases including critical stenosis (24.94%), near-occlusion (5.92%) and local occlusion (0.74%). Critical stenosis was characterized by local narrowing ≥90% and normal diameter of distal arterial segment. In case of near-occlusion, local critical stenosis was accompanied by narrowing of distal arterial segment. In case of local occlusion, distal collateral supply of internal carotid artery occurred through atypically originating ascending pharyngeal artery. Patients with near-occlusion and local occlusion of internal carotid artery had no signs of ICA hypoplasia and intracranial stenoses. All elements of circle of Willis were observed in 70% of patients. CONCLUSION State of distal segment of internal carotid artery can be considered as a differential diagnostic criterion for critical occlusive carotid disease variants. CT-angiography provides all necessary data and can be recommended for precise preoperative assessment.
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Affiliation(s)
- M V Vishnyakova
- Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgery Center, Moscow, Russia
| | - R N Larkov
- Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia
| | - M V Vishnyakova
- Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia
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Tokuda T, Mori S, Oba Y, Koshida R, Kagase A, Matsuda H, Suzuki Y, Murata A, Ito T, Hirano K. Comparison of ultrasound-guided versus angiography-guided endovascular treatment for femoropopliteal artery occlusive disease. Catheter Cardiovasc Interv 2020; 97:E518-E524. [PMID: 33314540 DOI: 10.1002/ccd.29437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/19/2020] [Accepted: 11/29/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE This study aimed to compare the efficacy of ultrasound-guided and angiography-guided intraluminal approach for femoropopliteal (FP) artery occlusive disease. METHODS A retrospective analysis was performed using the data collected regarding patients that underwent endovascular treatment (EVT) for FP artery occlusive disease between January 2010 and April 2018 at two centers. A total of 221 consecutive de novo lesions were analyzed according to the method of recanalization. Propensity score-matched analysis was performed to compare the clinical outcomes of recanalization methods for FP occlusive lesions. The prognostic value was analyzed based on the number of guidewires, wire cross time, distal puncture rate, radiation exposure, the amount of contrast media, primary patency, and clinically driven-target lesion revascularization (CD-TLR) at 1 year. RESULTS A total of 44 matched pairs of patients were analyzed after propensity score-matched analysis. The number of guidewires, distal puncture rate, wire passage time, radiation exposure, and the amount of contrast media were significantly lower in the ultrasound-guide group, with 3.4 vs. 4.7, 9.1% vs. 54.5%, 47 min vs. 83 min, 207 mGy vs. 821 mGy, 66 ml vs. 109 ml, respectively (p < .01), but there were no significant differences between the two groups in terms of primary patency and CD-TLR. CONCLUSIONS The ultrasound-guided EVT for FP occlusive disease significantly reduced the number of guidewires, wire cross time, the rate of distal puncture, radiation exposure, and the amount of contrast media used.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern hospital, Yokohama, Kanagawa, Japan
| | - Yasuhiro Oba
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Ryoji Koshida
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Hiroaki Matsuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yoriyasu Suzuki
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Akira Murata
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern hospital, Yokohama, Kanagawa, Japan
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8
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Soares TR, Amorim P, Manuel V, Lopes A, Fernandes E Fernandes R, Martins C, Pedro LM. A single-center experience in the eversion femoral endarterectomy. Vascular 2020; 28:348-354. [PMID: 32041491 DOI: 10.1177/1708538120905440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Endarterectomy is the treatment of choice for arterial occlusive disease of the femoral bifurcation. Longitudinal arteriotomy and prosthetic patch angioplasty is the standard technique but, due to the increasing concerns with prosthetic-related infections and multidrug-resistant pathogens our group adopted an alternative approach. We present our experience with eversion femoral endarterectomy. METHODS All patients submitted to eversion femoral endarterectomy in a single institution during 2016-2019 were retrospectively analyzed. Patient demographics, surgical data, and complications were captured from medical records. RESULTS Nineteen patients, 84.2% male and a median age of 67 years (IQR 62-78) were submitted to eversion femoral endarterectomy with a median follow-up of 180 days (IQR 71-395). Seventeen (89.4%) patients were treated for chronic limb ischemia and the other two were submitted to femoral endarterectomy during endovascular aortic aneurysm repair. Most of the patients had smoking history (84.2%), followed by hypertension (68.4%), dyslipidemia (63.2%), coronary heart disease (29.4%), and diabetes (26.3%). Only 3 patients (15.8%) were submitted exclusively to endarterectomy, 13 (68.4%) were submitted to endarterectomy as an adjuvant for peripheral endovascular treatment, 2 (10.5%) as a concomitant procedure to endovascular repair of aortic aneurysm, and 1 (5.3%) was complemented with thrombectomy of the femoro-popliteal sector. Primary patency rates were 100% and 87.5% (CI (38.7-98.1)) at 6 and 12 months, respectively. Primary-assisted and secondary patency rates were 100%. The 30-day mortality rate was 5.3% (n = 1) and complication rate 10.5% (n = 2). One patient complicated with acute renal disease related to rhabdomyolysis. Another patient developed a wound-related hematoma treated with surgical drainage, but died three days after consequent to ischemia-reperfusion injury. CONCLUSIONS Eversion femoral endarterectomy is a safe and feasible technique, with good patency results and respecting the concept of leaving nothing behind. A careful control of the proximal and distal endpoints is essential for the success of the technique.
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Affiliation(s)
- Tony R Soares
- Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Pedro Amorim
- Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Viviana Manuel
- Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Alice Lopes
- Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Ruy Fernandes E Fernandes
- Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Carlos Martins
- Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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IJpma A, Te Riet L, van de Luijtgaarden KM, van Heijningen PM, Burger J, Majoor-Krakauer D, Rouwet EV, Essers J, Verhagen HJM, van der Pluijm I. Inflammation and TGF-β Signaling Differ between Abdominal Aneurysms and Occlusive Disease. J Cardiovasc Dev Dis 2019; 6:E38. [PMID: 31683995 DOI: 10.3390/jcdd6040038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/17/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
Abdominal aortic aneurysms (AAA), are usually asymptomatic until rupture causes fatal bleeding, posing a major vascular health problem. AAAs are associated with advanced age, male gender, and cardiovascular risk factors (e.g. hypertension and smoking). Strikingly, AAA and AOD (arterial occlusive disease) patients have a similar atherosclerotic burden, yet develop either arterial dilatation or occlusion, respectively. The molecular mechanisms underlying this diversion are yet unknown. As this knowledge could improve AAA treatment strategies, we aimed to identify genes and signaling pathways involved. We compared RNA expression profiles of abdominal aortic AAA and AOD patient samples. Based on differential gene expression profiles, we selected a gene set that could serve as blood biomarker or as pharmacological intervention target for AAA. In this AAA gene list we identified previously AAA-associated genes COL11A1, ADIPOQ, and LPL, thus validating our approach as well as novel genes; CXCL13, SLC7A5, FDC-SP not previously linked to aneurysmal disease. Pathway analysis revealed overrepresentation of significantly altered immune-related pathways between AAA and AOD. Additionally, we found bone morphogenetic protein (BMP) signaling inhibition simultaneous with activation of transforming growth factor β (TGF-β) signaling associated with AAA. Concluding our gene expression profiling approach identifies novel genes and an interplay between BMP and TGF-β signaling regulation specifically for AAA.
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Stavres J, Sica CT, Blaha C, Herr M, Wang J, Pai S, Cauffman A, Vesek J, Yang QX, Sinoway LI. The exercise pressor reflex and active O 2 transport in peripheral arterial disease. Physiol Rep 2019; 7:e14243. [PMID: 31637857 PMCID: PMC6803779 DOI: 10.14814/phy2.14243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022] Open
Abstract
It is unclear if the exaggerated exercise pressor reflex observed in peripheral arterial disease (PAD) patients facilitates Oxygen (O2 ) transport during presymptomatic exercise. Accordingly, this study compared O2 transport between PAD patients and healthy controls during graded presymptomatic work. Seven PAD patients and seven healthy controls performed dynamic plantar flexion in the bore of a 3T MRI scanner. Perfusion, T2 * (an index of relative tissue oxygenation), and SvO2 (a measure of venous oxygen saturation) were collected from the medial gastrocnemius (MG) during the final 10 seconds of each stage. Blood pressure was also collected during the final minute of each stage. As expected, the pressor response to presymptomatic work (4 kg) was exaggerated in PAD patients compared to controls (+14 mmHg ± 4 and +7 mmHg ± 2, P ≤ 0.034). When normalized to changes in free water content (S0 ), T2 * was lower at 2 kg in PAD patients compared to controls (-0.91 Δms/ΔAU ± 0.3 and 0.57 Δms/ΔAU ± 0.3, P ≤ 0.008); followed by a greater increase in perfusion at 4 kg in the PAD group (+18.8 mL/min/100g ± 6.2 vs. -0.21 mL/min/100g ± 3.2 in PAD and controls, P ≤ 0.026). Lastly, SvO2 decreased at 4 kg in both groups (-13% ± 4 and -2% ± 4 in PAD and controls, P ≤ 0.049), suggesting an increase in O2 extraction in the PAD group. Based on these findings, O2 transport appears to be augmented during graded presymptomatic work in PAD patients, and this may be partially mediated by an exaggerated pressor response.
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Affiliation(s)
- Jon Stavres
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Christopher T. Sica
- Department of RadiologyPennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Cheryl Blaha
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Michael Herr
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Jianli Wang
- Department of RadiologyPennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Samuel Pai
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Aimee Cauffman
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Jeffrey Vesek
- Milton S. Hershey Medical Center, Department of Molecular BiologyPennsylvania State University College of MedicineHersheyPennsylvania
| | - Qing X. Yang
- Department of RadiologyPennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
- Department of NeurosurgeryPennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
| | - Lawrence I. Sinoway
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineMilton S. Hershey Medical CenterHersheyPennsylvania
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Fernandez Prendes C, Padrón Encalada C, Zanabili Al-Sibbai AA, Del Castro Madrazo JA, Camblor Santervas LA, Alonso Perez M. The Use Of The Gore® Hybrid Vascular Graft For Treatment Of Complex Iliofemoral Revascularization Procedures. Vasc Endovascular Surg 2018; 52:222-225. [PMID: 29366386 DOI: 10.1177/1538574418754442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the uses and advantages of hybrid vascular grafts (HVGs) for complex iliofemoral revascularization procedures. CASE REPORT We report 3 cases of iliofemoral occlusions repaired with the Gore HVG, used as an alternative technique to standardized common femoral artery (CFA) endarterectomy associated with iliac stenting or open repair. The indication in each of the 3 cases was different: In the first case, there was an absent CFA secondary to a mycotic pseudoaneurysm, in the second case, an iatrogenic lesion of the posterior wall of the CFA during the intervention was performed, and in the third case, the indication was because of thrombosis of a previous iliofemoral revascularization procedure. CONCLUSION Although we only present 3 cases, the Gore HVG can be useful for complex iliofemoral revascularizations, serving as an alternative to standardized CFA endarterectomy plus iliac stenting in cases where there is a damaged or absent CFA, especially in high-surgical risk patients.
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Pillay B. HIV-associated large-vessel vasculopathy: a review of the current and emerging clinicopathological spectrum in vascular surgical practice. Cardiovasc J Afr 2015; 26:70-81. [PMID: 25940120 PMCID: PMC4832607 DOI: 10.5830/cvja-2015-017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
An established relationship exists between human immunodeficiency virus (HIV) and the vascular system, which is characterised by clinical expressions of aneurysmal and occlusive disease that emanate from a common pathological process. The exact pathogenesis is currently unknown; attempts to implicate opportunistic pathogens have been futile. Theories converge on leucocytoclastic vasculitis with the vaso vasora as the vasculopathic epicentre. It is thought that the virus itself or viral proteins trigger the release of inflammatory mediators that cause endothelial dysfunction and smooth muscle proliferation leading to vascular injury and thrombosis. The beneficial effects of highly active anti-retroviral therapy alter the natural history of the disease profile and promote longevity but are negated by cardiovascular complications. Atherosclerosis is an emerging challenge. Presently patients are managed by standard surgical protocols because of non-existent universal surgical interventional guidelines. Clinical response to treatment is variable and often compounded by complications of graft occlusion, sepsis and poor wound healing. The clinical, imaging and pathological observations position HIV-associated large-vessel vasculopathy as a unique entity. This review highlights the spectrum of HIV-associated large-vessel aneurysmal, occlusive and atherosclerotic disease in vascular surgical practice.
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MESH Headings
- Aneurysm/etiology
- Aneurysm/therapy
- Animals
- Atherosclerosis/etiology
- Atherosclerosis/therapy
- Blood Vessels/immunology
- Blood Vessels/virology
- Endothelium, Vascular/immunology
- Endothelium, Vascular/surgery
- Endothelium, Vascular/virology
- HIV Infections/complications
- HIV Infections/therapy
- Humans
- Myocytes, Smooth Muscle/immunology
- Myocytes, Smooth Muscle/pathology
- Myocytes, Smooth Muscle/virology
- Practice Guidelines as Topic
- Thrombosis/etiology
- Thrombosis/therapy
- Vascular Surgical Procedures
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
- Vasculitis, Leukocytoclastic, Cutaneous/therapy
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Affiliation(s)
- Balasoobramanien Pillay
- Department of Vascular/Endovascular Surgery, Nelson R Mandela School of
Medicine, Durban, South Africa
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