Vasa-european Journal of Vascular Medicine最新文献

{"title":"The guidewire crosses but nothing else does - a pictorial review.","authors":"Marta Lobato, August Ysa, Flavio Villani, Emiliano Chisci, Stefano Michelagnoli, Lorenzo Patrone","doi":"10.1024/0301-1526/a001251","DOIUrl":"10.1024/0301-1526/a001251","url":null,"abstract":"<p><p><b></b> When a peripheral arterial stenosis/occlusion can be crossed by a guidewire, but no device can follow over it, to have proficiency in bailout strategies which allow device crossing can be beneficial. Limited information is available on these bailout manoeuvres. This article aims to provide a comprehensive pictorial review of various bailout techniques, equipping operators with an algorithm to apply in specific scenarios, to eventually improve procedural success rates.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"40-48"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrograde direct stent puncture for femoropopliteal lesion crossing is safe and effective - results from a multicenter German registry.","authors":"Nikolaos Konstantinou, Grigorios Korosoglou, Andrej Schmidt, Michael Lichtenberg, Martin Andrassy, Erwin Blessing, Nikolaos Tsilimparis, Giovanni Torsello, Konstantinos Stavroulakis","doi":"10.1024/0301-1526/a001212","DOIUrl":"10.1024/0301-1526/a001212","url":null,"abstract":"<p><p><b></b> <i>Background:</i> To evaluate the safety and efficacy of direct retrograde stent punctures for crossing of chronic total occlusions in patients with symptomatic peripheral arterial disease. <i>Methods:</i> A retrospective registry of consecutive patients treated with retrograde recanalization techniques in five high-volume German centers was performed. Patient cases with attempted retrograde after failed antegrade revascularization were studied. Primary endpoint was technical success. Secondary endpoints were access vessel complications, need for bail-out procedures and major or minor amputation. <i>Results:</i> Of the 1516 retrograde punctures recorded in the registry, 63 (4.2%) were direct stent punctures. Superficial femoral artery stents were punctured in 88.9% (56/63) of the cases, tibial artery stents in 6 patients (9.5%) and a stent in an occluded femoropopliteal bypass in one case (1.6%). Mean lesion length was 322±125 mm. Stent puncture was successful in 62 cases (98.4%) and the procedural success rate was 96.8% (61/63) with one technical failure despite successful puncture. A sheathless approach was performed in 79.4% (50/63) of cases. Drug-coated balloon angioplasty was applied in 63.5% (40/63) and new stenting (bare-metal or drug-eluting) in 55.6% (35/63) of lesions. One minor and no major amputations were recorded in the first 30 days after the procedure. A sheathless retrograde approach was associated with significantly higher procedural technical success (p = .04). <i>Conclusion:</i> Retrograde femoral or tibial direct stent puncture seems to be safe and effective for the recanalization of chronic total occlusions of the femoropopliteal segment in cases where antegrade recanalization is deemed unsuccessful.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"62-66"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation for heparin-induced thrombocytopenia before, during, and after peripheral endovascular procedures.","authors":"Silvia Cardi, Alice Trinchero, Jan-Dirk Studt, Riccardo M Fumagalli, Nils Kucher, Stefano Barco","doi":"10.1024/0301-1526/a001220","DOIUrl":"10.1024/0301-1526/a001220","url":null,"abstract":"<p><p><b></b> Acute heparin-induced thrombocytopenia (HIT) type II requires the immediate discontinuation of heparin and initiation of a non-heparin anticoagulant. Lifelong avoidance of heparin is generally recommended due to the risk of recurrence. Therefore, anticoagulation management in endovascular procedures remains challenging, as heparin is the preferred anticoagulant and evidence on alternative strategies is limited. This narrative review outlines an institutional approach aligned with current guidelines and examines the available data on non-heparin anticoagulants in this setting. Current evidence may support the use of bivalirudin among non-heparin anticoagulants for peripheral endovascular interventions due to indirect evidence of its use during percutaneous coronary intervention in patients with acute HIT. However, bivalirudin is often not available due to drug shortage and not approved for HIT in Europe. This leaves argatroban as the main alternative, particularly in patients with renal impairment. Data on non-heparin anticoagulation for HIT were extrapolated from other types of intervention and from small retrospective studies. In selected cases of patients with remote or subacute HIT B and negative antibodies, intraoperative heparin may be considered if alternative anticoagulants are not practical, particularly in emergency situations, even in this approach is controversial and not discussed in current guidelines regarding peripheral endovascular procedures. In the absence of robust evidence, anticoagulation strategies should be individualized and patients adequately informed. Further studies are necessary to optimize anticoagulant management among patients with HIT undergoing peripheral endovascular interventions.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"18-29"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atherosclerotic plaque stabilization and regression.","authors":"Pavel Poredoš, Ana Spirkoska Mangaroska, Peter Poredoš","doi":"10.1024/0301-1526/a001202","DOIUrl":"10.1024/0301-1526/a001202","url":null,"abstract":"<p><p><b></b> Atherosclerotic plaques represent a typical deterioration of arterial wall in atherosclerotic process and are the source of cardiovascular events. Plaque progression and composition represent a major risk for cardiovascular events. Therefore, recently many studies have assessed changes in plaque characteristics and their response to various treatment modalities. In the last two decades, improvement in plaque imaging modalities that can assess plaque volumes and composition enable to follow plaque characteristics in a non-invasive way. Clinical trials utilizing arterial imaging modalities have shown that reducing LDL cholesterol to low levels can reduce atherosclerotic plaque burden and favourably modify plaque composition. These outcomes have been achieved with statin therapy and newer lipid-lowering strategies such as protein convertase subtilisin/kexin type 9 inhibitors. Also, some anti-inflammatory drugs and other anti-atherosclerotic medications can lead to significant reduction in plaque burden. However, the data assessing association of plaque regression to reduction of cardiovascular events are limited. Therefore, the aim of this narrative review is to elucidate the possibilities and the role of plaque assessment and if it might offer the potential to guide personalized management of patients at risk for cardiovascular events in the future.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"30-39"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid and femoral bifurcation plaques detected by ultrasound as predictors of cardiovascular events.","authors":"Aleš Blinc, Andrew N Nicolaides, Pavel Poredoš, Kosmas I Paraskevas, Christian Heiss, Oliver Müller, Christos Rammos, Agata Stanek, Borut Jug","doi":"10.1024/0301-1526/a001214","DOIUrl":"10.1024/0301-1526/a001214","url":null,"abstract":"<p><p><b></b> Risk factor-based algorithms give a good estimate of cardiovascular (CV) risk at the population level but are often inaccurate at the individual level. Detecting preclinical atherosclerotic plaques in the carotid and common femoral arterial bifurcations by ultrasound is a simple, non-invasive way of detecting atherosclerosis in the individual and thus more accurately estimating his/her risk of future CV events. The presence of plaques in these bifurcations is independently associated with increased risk of CV death and myocardial infarction, even after adjusting for traditional risk factors, while ultrasonographic characteristics of vulnerable plaque are mostly associated with increased risk for ipsilateral ischaemic stroke. The predictive value of carotid and femoral plaques for CV events increases in proportion to plaque burden and especially by plaque progression over time. Assessing the burden of carotid and/or common femoral bifurcation plaques enables reclassification of a significant number of individuals with low risk according risk factor-based algorithms into intermediate or high CV risk and intermediate risk individuals into the low- or high CV risk. Ongoing multimodality imaging studies, supplemented by clinical and genetic data, aided by machine learning/ artificial intelligence analysis are expected to advance our understanding of atherosclerosis progression from the asymptomatic into the symptomatic phase and personalize prevention.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"8-17"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new approach to pain management in Lipedema.","authors":"Erika Mendoza","doi":"10.1024/0301-1526/a001224","DOIUrl":"10.1024/0301-1526/a001224","url":null,"abstract":"","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"67-68"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The year in vascular medicine: Highlights in Vasa - European Journal of Vascular Medicine 2025.","authors":"Giacomo Buso, Tristan Mirault, Oliver Schlager, Christian Heiss, Vinko Boc, Marianne Brodmann, Walter Ageno, Stefano Barco, Juraj Madaric, Jill Belch, Oliver J Müller, Eva Freisinger, Christian-Alexander Behrendt, Grigorios Korosoglou, Michael Czihal, Lucia Mazzolai, Christos Rammos","doi":"10.1024/0301-1526/a001257","DOIUrl":"https://doi.org/10.1024/0301-1526/a001257","url":null,"abstract":"","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":"55 1","pages":"1-5"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infrapopliteal bypass surgery in the endovascular era.","authors":"Selina Dittrich, Briain Haney, Ulrich Rother, Livia Cotta, Ursula Werra, Bernhard Dorweiler, Farzin Adili, Christian-Alexander Behrendt","doi":"10.1024/0301-1526/a001210","DOIUrl":"10.1024/0301-1526/a001210","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Over the past decade the increasing adoption of endovascular-first strategies has significantly altered the landscape in the treatment of peripheral arterial disease (PAD), raising concerns about the continuation and future development of high-quality surgical training, particularly in regard to tibial and pedal bypass procedures. This study aims to assess the current surgical and endovascular experience among the community of German vascular surgery program directors. <i>Materials and methods:</i> This study consisted of a questionnaire-based survey among German vascular surgeons who are licensed to provide further training in vascular surgery (in 2024). The aim was to assess participant's clinical experience, technical approaches to bypass surgery, decision making algorithms to revascularization procedures, and perceived adequacy of training in vascular surgery. <i>Results:</i> A total of 272 (77.7%) of the 350 invited surgeons responded, including 19 females (7.0%). The majority of the participants worked at academic teaching hospitals (79.8%), while 9.2% were in university hospitals and 11.0% worked at non-teaching hospitals. The median number of below-the-knee bypasses performed per career was 524 (IQR 286-1002), including 57 (IQR 20-129) pedal bypasses. Academic teaching hospitals reported the highest number of bypasses (601 vs. 300 in university hospitals) and non-teaching hospitals reported the highest number of endovascular procedures (786 vs. 301). Although the majority reported high confidence levels in performing said procedures, a considerable heterogeneity existed in technical aspects such as intraoperative anticoagulation, clamping technique, and post-surgical quality control. There was no association between institution type and technical aspects. One-third of respondents were over 60 years of age and therefore close to retirement age. <i>Conclusions:</i> This survey provided valuable insights into the delivery of vascular surgery programs in Germany, revealing a high variability in surgical experience, techniques, and training exposure. With an aging workforce and the further evolution of endovascular techniques, structured mentorship programs and standardized training curricula are essential to tackle the challenge of ensuring vascular surgeons remain proficient in tibial and pedal bypass surgery.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"56-61"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preclinical atherosclerosis and the risk of cardiovascular events.","authors":"Pavel Poredoš, Christian Heiss, Borut Jug, Oliver J Müller, Andrew N Nicolaides, Kosmas I Paraskevas, Christos Rammos, Agata Stanek, Aleš Blinc","doi":"10.1024/0301-1526/a001203","DOIUrl":"10.1024/0301-1526/a001203","url":null,"abstract":"","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"6-7"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the on-site availability of treatment options of endarterectomy or stenting and the outcomes after carotid revascularisation.","authors":"Lan Zang, Christoph Knappich, Michael Kallmayer, Bianca Bohmann, Vanessa Lohe, Felix Kirchhoff, Shamsun Naher, Sofie Lückerath, Hans-Henning Eckstein, Andreas Kuehnl","doi":"10.1024/0301-1526/a001244","DOIUrl":"https://doi.org/10.1024/0301-1526/a001244","url":null,"abstract":"<p><p><b></b> <i>Background:</i> The aim of this study was to determine whether the on-site availability of treatment options (carotid endarterectomy CEA, carotid artery stenting CAS) was associated with patient and hospital characteristics, medical management and outcome. <i>Materials and methods:</i> This study is a pre-planned sub study of the Integration and Spatial Analysis of Regional, Site-specific, and patient-level factors for Improving Quality of treatment for carotid artery stenosis (ISAR-IQ) project, which analysed data from the nationwide German statutory quality assurance carotid database. Hospitals were categorized according to on-site availability of: CEA-only, CAS-only, and both CEA and CAS centre. Primary outcome event was any in-hospital perioperative stroke or death. The multivariable regression analysis was adjusted for age, sex, American Society of Anesthesiologists Physical Status (ASA stage), symptomatic status, antiplatelet therapy, ipsilateral and contralateral degree of stenosis, pre- and post-procedural assessment by a specialist in neurology, and hospital volume. <i>Results:</i> A total of 201,330 patients undergoing CAS or CEA for asymptomatic or symptomatic carotid stenosis between 2012 and 2018 were included. 74% were treated in hospitals that offer both methods, 24% in CEA-only centres and 2.5% in CAS-only centres. The median annual number of cases for CEA and CAS was 44 and 7, respectively, in centres that offered both compared to 16 and 6 in centres that performed either CEA or CAS, respectively. The overall stroke and death rate until hospital discharge was 2.1%. In centres providing both CEA and CAS, the stroke and death rates were 2.0% for CEA and 2.4% for CAS. These figures were 2.0% in centres providing CEA-only and 3.0% for CAS-only centres. The multivariable regression analysis showed significant higher perioperative stroke or death rate in the CEA-only group (adjusted Odds Ratio aOR=1.12, 95%-confidence interval (CI) 1.03-1.21) and CAS-only group (aOR=1.26, 95%-CI 1.04-1.52) versus the combined CEA and CAS group. <i>Conclusions:</i> Centres providing both CEA and CAS had a lower risk of perioperative stroke and death than centres performing CEA-only or CAS-only. The minimum volume recommendations of the national guideline were not achieved in the median by CEA-only and CAS-only centres. This could be a starting point for public health measures to increase guideline conformity and treatment quality.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}