Vasa-european Journal of Vascular Medicine最新文献

{"title":"Angioplasty combined with intravascular ultrasound vs angioplasty alone in the treatment of peripheral arterial disease.","authors":"Mohamed Hosny Sayed, Mustafa Majeed, Avilash Mishrah, Prakash Saha, Narayanan Thulasidasan, Hany Zayed","doi":"10.1024/0301-1526/a001187","DOIUrl":"10.1024/0301-1526/a001187","url":null,"abstract":"<p><p><i>Background:</i> Digital Subtraction Angiography (DSA) is the conventional imaging method for peripheral arterial disease (PAD) assessment but poses limitations for the estimation of the true vessel diameter, especially in diffuse disease. Intravascular ultrasound (IVUS) is used in coronary interventions, offering detailed insights. While IVUS is proven beneficial in coronary interventions, its role in peripheral arterial interventions is less well established. This meta-analysis aims to compare outcomes of peripheral percutaneous transluminal angioplasty (PTA) using angiography only (AO-PTA) versus angiography with IVUS (IVUS-PTA) in PAD. <i>Materials and methods:</i> A systematic review of PubMed, EMBASE, Cochrane, Scopus, and Web of Science databases from January 1996 to August 2024 was conducted. 13 studies met inclusion criteria, including RCTs, observational, and propensity-matched studies. Data extraction, quality assessment, and analyses were performed following PRISMA guidelines. Primary endpoint: freedom from target lesion reintervention (F-TLR) at 12 months. Secondary endpoints: bailout stenting, technical success, and freedom from major amputation (F-MA). <i>Results:</i> A total of 246,418 patients from 13 studies were included. F-TLR at 12-month follow-up was reported in 51,850 procedures. F-MA was reported in 155,933 procedures. IVUS-PTA showed significantly better F-MA and higher bailout stenting, but inferior F-TLR compared to AO-PTA. Technical success was reported in 555 procedures across 5 studies (0.2%). It trended higher with IVUS-PTA but with no statistical significance. <i>Conclusions:</i> IVUS-PTA is associated with superior F-MA and bailout stenting, but inferior F-TLR compared to AO-PTA. Further well-designed RCTs are needed to better support the use of IVUS's role PAD.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"291-298"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524548","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":"Intravascular ultrasound evaluation of BYCROSS™ Atherectomy.","authors":"Dominik Liebetrau, Viktoria Peters, Alexander Hyhlik-Duerr, Christian Scheurig-Münkler, Amila Jehn, Christoph Schöfthaler, Grigorios Korosoglou","doi":"10.1024/0301-1526/a001199","DOIUrl":"10.1024/0301-1526/a001199","url":null,"abstract":"<p><p><b></b> <i>Background:</i> BYCROSS™ atherectomy allows minimally invasive plaque removal in patients with peripheral arterial disease (PAD). Previously published reports with this device provided promising results. However, data on atherectomy combined with intravascular ultrasound (IVUS) are limited. The aim of this study was to assess luminal gain in patients treated with the BYCROSS™ device in femoropopliteal lesions using IVUS. <i>Patients and methods:</i> Consecutive patients with symptomatic PAD due to symptomatic femoropopliteal lesions or occlusions underwent BYCROSS™ atherectomy-assisted endovascular revascularization. Safety in terms of perforation and embolization were evaluated, while area of stenosis (%) and minimal luminal area were measured by IVUS at baseline, after atherectomy and after adjunctive therapy. <i>Results:</i> 21 patients (68.2±8.8 years, 16 male and 11 with chronic limb-threatening ischemia) were included. Mean lesion length was 139.8±68.8 mm and 15 (71.4%) of the lesions were chronic total occlusions (CTO). Most lesions (52.4%) exhibited moderate-to-severe calcification. Median minimal lumen diameter (MLA) was 0.0 mm² (IQR=0.0-2.55 mm²) before treatment, increased to 8.0 mm² (IQR=6.6-11.2 mm²) after atherectomy (p<0.0001 vs. baseline) and further increased to 17.6 mm² (IQR=11.6-22.3 mmm²) after further treatment with angioplasty and if required stenting (p=0.0001 vs. after atherectomy). No perforations were noted, while peripheral embolization was noted in 3 (14.3%) cases, which all could be treated by catheter aspiration. <i>Conclusion:</i> The BYCROSS^TM atherectomy system can provide effective lumen gain in femoropopliteal lesions without barotrauma, which can be quantitatively assessed using IVUS. Further studies are now warranted to investigate the impact of luminal gain on long-term patency and limb-related outcomes.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"314-321"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111247","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":"Risk factors of major adverse limb events in patients with acute limb ischemia undergoing endovascular treatment during mid-term follow-up.","authors":"Chun-Cheng Wang, Chiung-Ray Lu, Li-Chuan Hsieh, Kuan-Cheng Chang, Chiz-Tzung Chang, Chung-Ho Hsu","doi":"10.1024/0301-1526/a001209","DOIUrl":"10.1024/0301-1526/a001209","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Endovascular treatment is the standard practice for the management of acute limb ischemia (ALI). The risk factors affecting the clinical outcomes of endovascular intervention during mid-term follow-up remain unclear. <i>Patients and methods:</i> 139 patients who presented with ALI, Rutherford I - IIb, undergoing endovascular treatment from October 2016 to December 2021 were retrospectively enrolled. Baseline data, and clinical outcomes were obtained by chart reviews. Major adverse limb events (MALEs) were defined as the occurrence of all-cause mortality, any amputation, and any re-occlusion at the affected limb. All patients were monitored until the time of their death, loss of contact, the incidence of MALEs, or the end of June, 2022. <i>Results:</i> At median follow-up of 17 months, the prevalence of MALEs, all-cause mortality, all amputations, and all re-occlusions were 33.1%, 9.4%, 5.0%, and 24.5%. The technical success rate between catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) groups were comparable (91.9% vs. 95.1%; p=.50). Compared with the CDT group, the PMT group exhibited a higher proportion of extensive thrombus distribution (62.7% vs. 35.1%, p<.01), while required less total urokinase dosage (x 10⁶ units) [1.20 (0.84;1.65) vs. 1.90 (1.40;2.70), p<.01] to achieve a comparable technical success rate (95.1% vs. 91.9%, p=.5). Multivariate Cox-proportional hazards analysis revealed that PMT (hazard ratio [HR] : 0.48, 95% confidence interval [CI] : 0.25-0.92; P=.03), ≧2 patent calf arteries after intervention (HR: 0.30, 95% CI: 0.10-0.97; P=.045) and Rutherford stage IIb, compared with Rutherford I and IIa, (HR: 3.51, 95% CI: 1.02-13.29; P=.047) were independently associated with MALEs. <i>Conclusions:</i> PMT and ≧2 patent calf arteries post-intervention are associated with lower occurrence of MALEs, while Rutherford IIb at presentation is associated with a higher risk of MALEs.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"337-346"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660317","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":"Endovascular inferior mesenteric artery revascularisation for chronic mesenteric ischaemia in selected clinical scenarios.","authors":"Annette Thurner, Dominik Peter, Sven Flemming, Ralph Kickuth","doi":"10.1024/0301-1526/a001204","DOIUrl":"10.1024/0301-1526/a001204","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Experience on endovascular inferior mesenteric artery (IMA) revascularisation for atherosclerotic chronic mesenteric ischaemia (CMI) is limited and its clinical benefit remains uncertain. <i>Patients and methods:</i> This retrospective single-centre study included 12 patients with CMI who underwent endovascular IMA revascularisation between January 2014 and January 2024. Indications were: (1) IMA stenosis with endoscopically confirmed colonic ischaemia, (2) IMA stenosis with retrograde filling of a proximally occluded superior mesenteric artery ineligible for revascularisation, and (3) overall improvement of collateralisation in critical CMI due to multi-vessel disease. Technical success, clinical success and primary clinical patency were assessed. Procedure-related adverse events, symptom recurrence, mortality and survival rates were also analysed. <i>Results:</i> Seven isolated IMA interventions and five IMA revascularisations as part of a multi-vessel approach were performed. Balloon-expandable stents were used in 11 cases; one patient underwent balloon angioplasty with intravascular lithotripsy. Technical success was 83% (10/12); two cases had >50% residual stenosis due to annular aortic calcification impeding stent expansion. Median final residual stenosis was 27% (IQR 23.5). Four minor procedure-related adverse events occurred. Clinical success was 92% (11/12). Median follow-up was 17 months (IQR 20.7). The all-cause mortality rate was 25% (3/12). The mesenteric ischaemia-related mortality rate was 8% (1/12). The symptom recurrence rate was 33% (4/12). At 6 and 12 months, primary clinical patency rates were 71% and 54%, and survival rates were 83% and 72%. <i>Conclusions:</i> Endovascular IMA revascularisation is a viable treatment for CMI in selected scenarios where other options are inappropriate. Despite the specific calcification pattern at the IMA origin predisposing to residual stenosis, most patients had symptom resolution and acceptable clinical patency with low recurrence and mortality rates. However, 33% of patients had early symptom recurrence requiring treatment. It remains difficult to assess whether IMA revascularisation is curative or a bridge to open revascularisation.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"322-330"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161178","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":"Outcomes of endovascular treatment in nonagenarians with symptomatic peripheral arterial disease.","authors":"Andrius Drobnys, Michael Lichtenberg, Nikolaos Konstantinou, Nikolaos Tsilimparis, Konstantinos Stavroulakis","doi":"10.1024/0301-1526/a001205","DOIUrl":"10.1024/0301-1526/a001205","url":null,"abstract":"<p><p><b></b> <i>Background:</i> To report the clinical outcomes of endovascular therapy in nonagenarians treated for symptomatic peripheral arterial disease (PAD). <i>Patients and methods:</i> This is a retrospective analysis of 81 nonagenarians (mean age 93±2.4 years) treated by endovascular therapy for chronic limb threatening ischemia (CLTI) or claudication between December 2017 and August 2023. The composite of amputation and/or death (amputation-free survival; AFS) was the primary endpoint. Technical success, mortality, major limb amputation, risk for Major Adverse Cardio-Cerebro-vascular Events (MACCE) and re-intervention during follow-up were additionally analysed. <i>Results:</i> Most patients presented with CLTI (n=75, 93%). Popliteal artery interventions were most frequently performed (n=59, 73%), followed by superficial femoral artery (n=57, 70%), tibial (n=49, 61%), aortoiliac (n=11, 14%) and common femoral artery (n=7, 9%) procedures. The technical success rate was 100% and the in-hospital mortality was 1% (n=1). At 24 months the AFS was 23.5%, while the major amputation and mortality rates were 4.9% and 75.3% respectively. In the same period the rate of MACCE was 74.1% and the freedom from re-intervention rate amounted to 85.2% The cox regression analysis revealed a lower AFS among males (HR:1.8, 95% CI: 1.06-3.03, p=0.03) and a higher risk for MACCE in patients on warfarin (HR:3.1, 95% CI:1.26-7.59, p=0.01). <i>Conclusions:</i> Despite the high technical success and the low amputation rates, a very high mortality rate at follow up was observed among nonagenarians undergoing endovascular procedures for PAD. Male gender and Warfarin administration increased the risk for adverse events.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"331-336"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286606","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 medicine doesn't interest me at all.\" Beliefs, health behaviors, and medication adherence in peripheral arterial disease.","authors":"Anette Arbjerg Højen, Sara Jacobsen, Chalotte Winther Nicolajsen, Nikolaj Eldrup, Christian Nikolaj Petersen, Christian-Alexander Behrendt, Marie Dahl, Mette Søgaard","doi":"10.1024/0301-1526/a001223","DOIUrl":"https://doi.org/10.1024/0301-1526/a001223","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Non-adherence to guideline-directed best medical therapies is prevalent in people with lower extremity peripheral arterial disease (PAD), constituting a significant challenge to effective treatment. Underlying drivers for non-adherence remain poorly understood. This study explored patients' health-related beliefs and behaviours regarding antithrombotic and lipid-lowering therapy to identify opportunities for improvement. <i>Patients and methods:</i> Using a qualitative design, we conducted semi-structured interviews with patients with symptomatic PAD based on a purposeful sampling strategy. Patients were recruited from four vascular surgery departments in Denmark between December 2022 and January 2024, excluding those with cognitive impairment or terminal illness. Data were analysed using framework analysis based on the six domains of the Health Belief Model (HBM): perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. <i>Results:</i> Sixteen patients participated (median age: 69 years, 38% women); 68.8% had intermittent claudication, 18.8% had chronic limb-threatening ischemia, and 12.5% had undergone major amputation. Seven patients were adherent, and nine were non-adherent to secondary preventive therapy. Patients expressed low perceived awareness of PAD severity and its cardiovascular implications. Their perception of PAD centred around leg pain and its impact on everyday life, limiting their understanding of the benefits of secondary preventive therapies. Patients lacked knowledge about treatment goals and did not link secondary preventive therapy with PAD. Adherence barriers included inadequate understanding of PAD's chronic progressive nature, concerns about side-effects, prescription confusion, and financial constraints. Internal adherence triggers included fear of recurring pain, complications, and early death. External cues to action included a trusting patient-provider relationship and receiving comprehensive, understandable information. <i>Conclusions:</i> This study highlights the multifaceted challenges hindering adherence to antithrombotic and lipid-lowering therapies. Addressing the limited disease awareness and the expressed need for patient-centred communication delivered in a trusting patient-provider relationship could serve as starting point for future strategies to improve adherence.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970850","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":"Systolic acceleration time as an indicator of hemodynamic severity in peripheral artery disease with medial artery calcification.","authors":"Anne-Kathrin Tolke, Bettina-Maria Taute","doi":"10.1024/0301-1526/a001226","DOIUrl":"https://doi.org/10.1024/0301-1526/a001226","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Ankle-brachial-index (ABI) calculation is the recommended method in diagnosing peripheral artery disease (PAD) but its use is limited due to medial artery calcification (MAC) which leads to incompressibility of lower limb arteries and results in false elevated ABI values. Measurement of systolic acceleration time (AT) by duplex ultrasound is being discussed as an alternative, but whether coexisting MAC influences AT values remains unknown. <i>Patients and methods:</i> In a prospective clinical study healthy subjects, patients with MAC and patients with PAD with and without MAC were examined. In all 238 participants ABI calculation for posterior tibial artery (ATP) and anterior tibial artery (ATA) was performed by continuous wave (CW) Doppler ultrasonography, followed by measurement of AT derived from velocity-time spectra of ATP, ATA, and brachial artery (AB) by colour-coded duplex sonography. We introduced an innovative parameter to quantify PAD severity: the absolute difference value of AT (DAT), calculated as the absolute difference between crural AT and brachial AT. This parameter aims to minimize confounding effects of cardiac conditions on AT measurements. <i>Results:</i> It was found that a coexisting MAC does not have a significant impact on AT values (p>.05). According to the findings of this study PAD is present in patients with AT >95ms (sensitivity (Se): 85%, specificity (Sp): 87%) or in patients with DAT >20ms (Se: 82%, Sp: 84%). <i>Conclusions:</i> Both AT and DAT are suitable quantitative parameters for PAD diagnosis and severity assessment in patients with coexisting MAC, providing valuable alternatives when ABI is unreliable.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970870","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":"Antiplatelets and native arteriovenous fistula dysfunction.","authors":"Ioanna Pouliopoulou, Stefanos Roumeliotis, Konstantinos Leivaditis, Vangelis Bontinis, Alkis Bontinis, Theodora Chatzimpalasi, Vassilios Liakopoulos","doi":"10.1024/0301-1526/a001225","DOIUrl":"10.1024/0301-1526/a001225","url":null,"abstract":"<p><p><b></b> <i>Background:</i> We investigated the safety and efficacy of antiplatelet therapy in preventing native arteriovenous fistula (AVF) dysfunction. <i>Patients and methods:</i> A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Randomized controlled trials (RCTs) evaluating the effects of antiplatelet therapy following native AVF creation were eligible for inclusion. The primary endpoint was AVF primary patency. Secondary endpoints included AVF maturation, abandonment, and overall bleeding. <i>Results:</i> Twelve RCTs, comprising 2,491 patients, were incorporated in the analysis. The included studies assessed aspirin, clopidogrel, ticlopidine, and dypiridamole across various dosing regimens. The postoperative administration of antiplatelets, regardless of the specific drug or dose, was associated with improved AVF primary patency compared to controls or placebo, odds ratio (OR) 2.28 (95% CI: 1.42-3.65). Subgroup analysis showed no significant differences for aspirin 100mg daily or clopidogrel 75mg daily compared to controls/placebo, with ORs of 1.08 (95% CI: 0.76-1.54) and 2.16 (95% CI: 0.95-4.91), respectively. In contrast, ticlopidine 250mg twice daily significantly improved patency, OR 3.48 (95% CI: 1.46-8.26). Additionally non-statistically significant differences were identified between the antiplatelet and control/placebo groups in terms of maturation, OR 1.58 (95% CI: 0.81-3.09), AVF abandonment, risk ratio (RR) 0.93 (95% CI: 0.58-1.50), or overall bleeding RR 1.18 (95% CI: 0.77-1.81). Finally, meta-regression analysis of the antiplatelet groups pooled estimates revealed a negative association between maturation and follow-up duration (β =-0.1235, p<.01), and treatment duration and abandonment outcomes (β =-0.065, p<.01). <i>Conclusions:</i> This review demonstrated the safety and efficacy of antiplatelet therapy in preserving AVF patency, with ticlopidine and clopidogrel emerging as the primary contributors to this outcome. These findings suggest the potentially beneficial role of adenosine diphosphate (ADP) receptor antagonists in maintaining AVF patency.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970905","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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-08","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":"The role of duplex ultrasound surveillance after prosthetic femoropopliteal bypass.","authors":"Michaela Kluckner, Wolfgang Hitzl, David Wippel, Laura Schönherr, Sabine Wipper, Leonhard Gruber, Florian K Enzmann","doi":"10.1024/0301-1526/a001216","DOIUrl":"https://doi.org/10.1024/0301-1526/a001216","url":null,"abstract":"<p><p><b></b> <i>Background:</i> Current guidelines on the follow-up after infrainguinal bypass recommend clinical examination with history, pulse palpation and ankle-brachial-index assessment. Depending on the guideline, duplex ultrasound may or may not be recommended due to the lack of evidence. Data on this topic is sparse, especially after prosthetic bypass. <i>Patients and methods:</i> In a retrospective single-centre analysis, ultrasound surveillance examinations of 181 patients after femoropopliteal prosthetic bypass were analysed. Flow-velocities and flow-patterns of the inflow, anastomoses, the bypass as well as the outflow vessels were evaluated. The primary endpoint was primary patency, while primary-assisted and secondary patency as well as amputation-free survival were secondary endpoints. <i>Results:</i> By applying the Fine-Gray Model five ultrasound criteria were identified to increase the risk of loss of primary patency. A monophasic flow-pattern of the bypass as well as the popliteal artery showed a hazard-ratio of 2.0 (95% CI: 1.26-3.1, p=.003) and 1.7 (95% CI: 1.09-2.64, p=.02), respectively. A peak systolic velocity <60cm/sec of the deep femoral artery was significantly associated with loss of primary patency (p=.025). Decrease of inflow velocity as well as the deep femoral artery during follow-up were also significantly connected to loss of primary patency (p<.001). Primary-assisted and secondary patency as well as amputation-free survival were significantly associated with the waveform in the bypass and the popliteal artery (p<.001, p=.011, p=.031, p=.013). <i>Conclusions:</i> Ultrasound surveillance after femoropopliteal prosthetic bypass can identify factors associated with lower patency rates and amputation-free survival. These findings can help detect patients at higher risk of bypass occlusion and may improve their outcome.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800402","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}