Vascular Medicine最新文献

{"title":"Atherectomy-assisted endovascular therapy versus open repair for atherosclerotic common femoral artery disease: The multicenter ARISTON study.","authors":"Grigorios Korosoglou, Jason T Lee, Martin Andrassy, Drosos Kotelis, Marco V Usai, Mario D'Oria, Raphael Coscas, Nicola Troisi, Bahaa Nasr, Athanasios Saratzis, Solon Antoniades, Konstantinos P Donas","doi":"10.1177/1358863X251323508","DOIUrl":"10.1177/1358863X251323508","url":null,"abstract":"<p><strong>Background: </strong>Endarterectomy (open repair) represents the gold-standard for common femoral atherosclerotic disease (CFAD) treatment. However, with developments like atherectomy, endovascular therapy (endovascular revascularization) may offer an alternative option. The aim of the present study was to evaluate the safety and effectiveness of endovascular versus open therapy for the CFAD.</p><p><strong>Methods: </strong>The ARISTON (AtheRectomy-assIsted endovaScular Therapy versus OpeN) study was an 11-center research collaborative in which data from consecutive patients with symptomatic CFAD were analyzed. Retrospective matching was performed for patient-specific characteristics, including age, cardiovascular risk factors and comorbidities, and lesion-specific variables, including lesion calcification and complexity. Primary endpoints were all-cause mortality and freedom from clinically driven target lesion revascularization (CD-TLR). Amputation-free survival (AFS) was a secondary endpoint.</p><p><strong>Results: </strong>From 2015 to 2022, 826 patients undergoing endovascular (<i>n</i> = 213 [25.8%]) versus open therapy (<i>n</i> = 613 [74.2%]) were analyzed. The total number of procedural complications was higher with open therapy, whereas hospital stay was shorter with endovascular therapy (<i>p</i> < 0.0001 for both). Major adverse cardiac and limb events at 30-day outcomes were, however, not statistically different (<i>p</i> = 0.06). Bail-out stent rates with atherectomy-assisted endovascular therapy were 5.1%. After matching and during 1.72 (0.9-3.3) years of follow up, all-cause mortality, AFS, and CD-TLR were not statistically different in endovascular versus open therapy (HR = 0.68, 95% CI 0.36-1.29; HR = 1.5, 95% CI 0.59-3.77; and HR = 1.46, 95% CI 0.61-3.49, <i>p</i> = NS for all).</p><p><strong>Conclusion: </strong>Endovascular and open therapy exhibit comparable outcomes for the treatment of patients with symptomatic CFAD, including similar CD-TLR in patients with claudication and AFS in patients with chronic limb-threatening ischemia, during short-term follow up. Atherectomy-assisted endovascular therapy may therefore provide a useful alternative for patients who are unfit for surgery.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"170-182"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel swine model of chronic deep vein thrombosis (DVT) suitable for endovascular device assessment.","authors":"Wenzhu Li, Farouc A Jaffer","doi":"10.1177/1358863X251324911","DOIUrl":"10.1177/1358863X251324911","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"136-137"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of the Hospital Frailty Risk Score (HFRS) and outcomes in peripheral artery disease and end-stage kidney disease.","authors":"Monil Majmundar, Chan Wan-Chi, Kunal N Patel, Vidit Majmundar, Rhythm Vasudeva, Kirk A Hance, Adam Ali, George Hajj, Axel Thors, Jinxiang Hu, Kamal Gupta","doi":"10.1177/1358863X251316837","DOIUrl":"10.1177/1358863X251316837","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) and end-stage kidney disease (ESKD) are independent risk factors affecting outcomes like in-hospital mortality. The role of a frailty index in prognosticating outcomes in patients with ESKD and PAD is unknown. We aim to assess the prognostic value of the Hospital Frailty Risk Score (HFRS) and its association with outcomes in these patients.</p><p><strong>Methods: </strong>We identified patients with PAD using data from the United States Renal Data System (USRDS) for the years 2015-2018. These patients were stratified into three categories of frailty risk based on their HFRS, a validated frailty assessment tool using ICD-10 codes: low (< 5), intermediate (5-10), and high risk (> 10) and based on revascularization or not. Primary outcomes included in-hospital mortality and composite of mortality or major amputation. Secondary outcomes encompassed postdischarge mortality and composite of mortality or major amputation at 1 year.</p><p><strong>Results: </strong>Out of 122,649 patients with PAD and ESKD, 4118 underwent revascularization and 118,531 did not. In-hospital outcomes demonstrated a nonlinear relationship and postdischarge outcomes displayed a nearly linear relationship with HFRS, regardless of revascularization status. In both cohorts, the high-risk group was associated with a significantly higher risk of in-hospital mortality/amputation (revascularization: odds ratio [OR] 4.6, 95% CI 3.3-6.2, <i>p</i> < 0.001; no revascularization: OR 3.1, 95% CI 2.8-3.3, <i>p</i> < 0.001) and mortality (revascularization: OR 5.5, 95% CI 3.4-8.7, <i>p</i> < 0.001; no revascularization: OR 5.1, 95% CI 4.6-5.6, <i>p</i> < 0.001) compared with the low-risk group.</p><p><strong>Conclusion: </strong>In patients with ESKD and PAD, the HFRS serves as a valuable predictor of mortality and amputation irrespective of revascularization. This information can support informed decision-making.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"138-146"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous leg ulcers: A review of clinical variability and differential diagnosis.","authors":"Raghu Kolluri, Eri Fukaya, Surith Krishna, Steven Dean","doi":"10.1177/1358863X251319243","DOIUrl":"10.1177/1358863X251319243","url":null,"abstract":"<p><p>Venous hypertension due to anatomical venous insufficiency (superficial or deep venous valvular reflux and venous obstruction) and/or functional venous insufficiency (calf dysfunction, dependent edema, lymphatic dysfunction, elevated central venous pressures, etc.) leads to chronic venous insufficiency (CVI) and its sequelae. The most severe clinical manifestation of CVI is venous leg ulcer (VLU), which leads to substantial morbidity and disability. VLUs can present in both typical and atypical forms. However, several other types of leg ulcers can mimic VLUs. Therefore, vascular and wound care specialists must recognize the variability in VLU presentation and understand the differential diagnoses to deliver an accurate diagnosis and optimal care of atypical VLUs and conditions that resemble VLUs. Herein, we review and discuss the broad differential diagnosis of VLUs, supported by illustrative examples.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"218-237"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of arterial wall remodeling by mechanical stress: Focus on abdominal aortic aneurysm.","authors":"Maolin Qiao, Yaling Li, Sheng Yan, Rui Jing Zhang, Honglin Dong","doi":"10.1177/1358863X241309836","DOIUrl":"10.1177/1358863X241309836","url":null,"abstract":"<p><p>The rupture of an abdominal aortic aneurysm (AAA) poses a significant threat, with a high mortality rate, and the mechanical stability of the arterial wall determines both its growth and potential for rupture. Owing to extracellular matrix (ECM) degradation, wall-resident cells are subjected to an aberrant mechanical stress environment. In response to stress, the cellular mechanical signaling pathway is activated, initiating the remodeling of the arterial wall to restore stability. A decline in mechanical signal responsiveness, coupled with inadequate remodeling, significantly contributes to the AAA's progressive expansion and eventual rupture. In this review, we summarize the main stresses experienced by the arterial wall, emphasizing the critical role of the ECM in withstanding stress and the importance of stress-exposed cells in maintaining mechanical stability. Furthermore, we will discuss the application of biomechanical analyses as a predictive tool for assessing AAA stability.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"238-249"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical improvement after arterial revascularization is associated with exercise oximetry results.","authors":"Mohammad Zagzoog, Ewa Tuleja, Ulrique Michon-Pasturel, Benoît Boura, Romain De Blic, Lucie Derycke, Alexandros Mallios, Maxime Raux, Yann Gouëffic","doi":"10.1177/1358863X251313964","DOIUrl":"10.1177/1358863X251313964","url":null,"abstract":"<p><p><b>Introduction:</b> Exercise transcutaneous oximetry (Ex-TcpO2) is used to support the vascular origin of lower-limb pain, or to assess walking impairment. The aim of this study was to describe the association between Ex-TcpO2 measurement and the perioperative clinical and morphological outcomes after revascularization in patients with intermittent claudication (IC). <b>Methods:</b> From January to December 2022, a single-center prospective observational study was conducted among patients with IC. Patients were referred by vascular surgeons for Ex-TcpO2 for doubtful arterial origin. Perioperative clinical and morphological outcomes were assessed by the Rutherford-Becker classification and duplex ultrasound examination. The primary patency rate and primary sustained clinical improvement were evaluated at 1 month after revascularization. <b>Results:</b> Eighty-two patients (64% men) underwent Ex-TcpO2 and were enrolled in the study, of whom 65% were category III of the Rutherford classification. Indications for Ex-TcpO2 were to assess the origin of the IC symptoms in 65%. Sixty-seven (81%) patients had positive Ex-TcpO2, and 15 (18%) had negative Ex-TcpO2. Patients with positive Ex-TcpO2 were older (65 ± 13 vs 58 ± 20, <i>p</i> = 0.43), and had a significantly lower ankle-brachial index (ABI) compared to the negative group (0.65 ± 0.22 vs 0.92 ± 0.22, <i>p</i> < 0.001) as well as a lower maximum walking distance (MWD) (200 m [150, 300] vs 525 m [500, 872], <i>p</i> < 0.001). Forty-two patients underwent revascularization (Ex-TcpO2 positive [<i>n</i> = 35/67]; Ex-TcpO2 negative [<i>n</i> = 7/15]). Revascularization technical success and primary patency rate were 100% in both groups. Clinical improvement was significantly greater in the Ex-TcpO2 positive group (97% [<i>n</i> = 34/35] vs 0% [<i>n</i> = 0/7], <i>p</i> < 0.001). Multivariate analysis shows a positive association between pain at the buttock and the decrease from rest of oxygen pressure (DROP) ≤ -15 mmHg at the level of the buttock with the presence of iliac lesions. <b>Conclusion:</b> On a routine basis, Ex-TcpO2 is a tool of interest to assess patients with claudication for doubtful arterial origin or walking distance, especially in proximal IC, and to predict favorable clinical outcomes after revascularization.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"147-154"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of contemporary stents with deep femoral artery coverage.","authors":"Takahiro Tokuda, Naoki Yoshioka, Akiko Tanaka, Shunsuke Kojima, Kohei Yamaguchi, Takashi Yanagiuchi, Kenji Ogata, Tatsuro Takei, Tatsuya Nakama","doi":"10.1177/1358863X241311936","DOIUrl":"10.1177/1358863X241311936","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to investigate deep femoral artery (DFA) status during endovascular treatment (EVT) and the patency of the femoropopliteal (FP) artery and DFA using current stent devices for ostial FP lesions.</p><p><strong>Methods: </strong>A multicenter, retrospective study analyzed data from 457 patients who underwent EVT with stent deployment for de novo ostial FP lesions between April 2018 and December 2021 at eight centers in Japan. Propensity score-matched analysis was performed to compare the clinical impacts of DFA coverage for ostial FP lesions with stent deployment. The prognostic value was analyzed based on DFA status during EVT, primary patency of the FP artery, clinically driven-target lesion revascularization (CD-TLR) of the FP artery, and incidence of DFA occlusion/major amputation/acute limb ischemia (ALI) at 3 years.</p><p><strong>Results: </strong>A total of 132 matched pairs of patients was analyzed using propensity score matching. The percentage of DFA occlusion and stenosis was significantly higher in the DFA coverage group. However, there were no significant differences in terms of primary patency of the FP artery, CD-TLR, DFA occlusion, major amputation, or ALI after 3 years.</p><p><strong>Conclusions: </strong>Stent deployment in DFA coverage significantly led to the DFA stenotic events of EVT during the procedure, but patency of the FP artery and DFA, major amputation, and ALI up to 3 years did not differ according to stent deployment for ostial FP lesions.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"162-169"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of the inflammatory indices on wound healing in patients with chronic limb-threatening ischemia revascularized via percutaneous intervention.","authors":"Yeliz Guler, Omer Genc, Furkan Akbas, Abdullah Yildirim, Ilyas Cetin, Aslan Erdogan, Ufuk S Halil, Huseyin Akgun, Berat Erdem, Ahmet Guler, Cevat Kirma","doi":"10.1177/1358863X251320867","DOIUrl":"10.1177/1358863X251320867","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral artery disease (PAD) is a common manifestation of atherosclerosis. Despite the effectiveness of endovascular therapy (EVT), patients with PAD often face poor prognoses. This study investigates the relationship between specific inflammatory indices and wound healing in patients with Fontaine stage 4 chronic limb-threatening ischemia (CLTI).</p><p><strong>Methods: </strong>From June 2021 to January 2024, 168 patients with Fontaine stage 4 CLTI, totaling 185 affected extremities, who underwent successful EVT, were assessed retrospectively. Patients were categorized based on wound healing post-EVT. The Naples prognostic score (NPS), pan-immune inflammation value (PIV), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated. Discrimination and decision curve analyses were used to explore the link between inflammation and wound healing.</p><p><strong>Results: </strong>Wound healing was observed in 142 (76.8%) patients post-EVT. Nonhealing patients exhibited higher indices of NPS, PIV, SII, and SIRI. NPS (aOR = 0.381, 95% CI 0.215-0.675, <i>p</i> = 0.001), PIV (aOR = 0.997, 95% CI 0.996-0.999, <i>p</i> < 0.001), SII (aOR = 0.997, 95% CI 0.996-0.997, <i>p</i> < 0.001), and SIRI (aOR = 0.443, 95% CI 0.313-0.625, <i>p</i> < 0.001) were independently predictive of wound healing. SIRI (AUC = 0.840, 95% CI 0.777-0.904) demonstrated superior predictive ability compared to PIV (AUC = 0.799, 95% CI 0.722-0.876, <i>p</i>dif < 0.001), SII (AUC = 0.788, 95% CI 0.712-0.865, <i>p</i>dif < 0.001), and NPS (AUC = 0.760, 95% CI 0.681-0.838, <i>p</i>dif < 0.001). SIRI also showed higher net reclassification improvement over PIV (68.4%, <i>p</i>dif < 0.001), SII (38.5%, <i>p</i>dif = 0.024), and NPS (29.8%, <i>p</i>dif = 0.079). All inflammatory indices, especially SIRI, provided prognostic value in determining wound healing at high treatment thresholds (> 40%).</p><p><strong>Conclusion: </strong>In patients with CLTI undergoing EVT, SIRI, SII, PIV, and NPS may help predict the potential for wound healing during in-hospital follow up, with SIRI being the strongest predictor.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"186-196"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Masters: How RNA drugs will transform vascular medicine.","authors":"John P Cooke","doi":"10.1177/1358863X251323275","DOIUrl":"10.1177/1358863X251323275","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"120-123"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking common femoral artery disease treatment: When and how to choose endovascular over open surgery?","authors":"Maxime Dubosq-Lebaz, Eric A Secemsky","doi":"10.1177/1358863X251328645","DOIUrl":"10.1177/1358863X251328645","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"183-185"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}