This study examined the link between the Life's Essential 8 (LE8) metric and peripheral artery disease (PAD) prevalence in the U.S. This population-based prospective cohort study analyzed data from 6,076 participants aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004. LE8 scores were categorized into low, moderate, and high cardiovascular health (CVH) levels. Multivariable weighted logistic regression and subgroup analyses were performed to examine the relationship between CVH and PAD, adjusting for demographic and clinical variables. In final analysis, a total of 6,076 individuals were included, with a mean age of 59.41±12.80 years and 51.3% (n=3,115) being male. The prevalence of PAD was 6.9% (n=418). After adjusting for confounding factors, compared to participants with low CVH, those with moderate CVH had a 34% lower risk of PAD (OR: 0.66, 95% CI: 0.53-0.82), and those with high CVH had a 62% lower risk of PAD (OR: 0.38, 95% CI: 0.25-0.58). In conclusion, we report that lower CVH scores are associated with higher PAD risk among U.S. adults. These findings may contribute to the prevention strategies for PAD.

Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are inflammatory diseases. These two entities often co-exist, but little is known about the prevalence of this phenomenon in patients with PAD. The objectives of this prospective cross-sectional study were to determine the prevalence of COPD in patients with PAD and to assess the frequency of COPD underdiagnosis in this group of patients. Consecutive patients admitted to angiology department were evaluated. Measurements of ankle-brachial and toe-brachial index as well as peripheral arteriography were performed in all participants to confirm PAD. In tobacco smokers with PAD spirometry was performed to identified patients with COPD. Clinical information was obtained from the patients on the basis of questionnaires. Eighty-eight out of 300 consecutive patients were included and assessed. COPD was diagnosed in 33 (37.5%) hospitalized smokers with PAD. COPD has not previously been diagnosed in 28 (84.8%) patients who met the criteria of the disease. There was high prevalence of COPD among tobacco smokers hospitalized in the angiology department. Most of them had never had spirometry performed before. The underdiagnosis rate is relatively high; therefore, all patients with PAD who smoke tobacco should have a spirometry performed, as a screening for COPD.

To assess long-term patency rates, clinical outcomes, and device-related adverse events associated with the use of a dedicated woven nitinol venous stent following venoplasty to treat patients with symptomatic iliac and femoral vein obstruction. This single-center, single-arm, observational study consisted of 25 patients with iliofemoral vein obstructions caused by residual thrombosis, non-thrombotic compression, or post-thrombotic stenosis. Lesions were treated with the blueflow Venous Stent, a closed-cell stent made of woven strands of Nitinol wire. Primary outcome measures were primary patency and sustained clinical success at 3 months while secondary clinical measures included the revised Venous Clinical Severity Score (rVCSS), Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification, and the number of device-related adverse events through 60 months. Primary patency was 94.7% and sustained clinical success was 76.5% at 3 months. Primary patency was 95.2% and 70% while sustained clinical success was 76.2% and 70% at 12 and 60 months. The mean rVCSS was 7.4 ± 4.0 at baseline, 5.3 ± 1.8 at 3 months, 4.6 ± 1.4 at 12 months, and 2.6 ± 0.9 at 60 months. CEAP classifications at baseline were predominantly C3 (52%) while 36%, 52%, and 40% of scores were C1-C2 at 3, 12, and 60 months. One device-related adverse event (i.e., in-stent restenosis) was reported resulting in reintervention. There were three patient deaths: two from the progression of metastatic cancer and one from a bicycle accident. This exploratory study demonstrated a primary patency rate of 94.7% and a clinical success rate of 76.2% at 3 months. Patency was 70% with a 65% reduction in the mean rVCSS score from baseline at 5 years (-5.2). The blueflow Venous Stent performed adequately with no safety concerns when used for its intended indication.

Carotid endarterectomy (CEA) is a widely accepted treatment to mitigate stroke risk in patients with severe carotid stenosis. The timing of CEA, especially in cases of acute neurological symptoms like crescendo transient ischemic attack (TIA) and stroke-in-evolution, remains contentious. This study evaluates the effectiveness of urgent CEA (UCEA) within 6 hours of crescendo TIA onset compared to elective CEA (ECEA) performed within 2 weeks in preventing recurrent stroke. This retrospective study analyzed 87 patients with crescendo TIA treated with UCEA and compared them with a matched control group of 174 patients who underwent ECEA for symptomatic carotid disease. All patients underwent preoperative multidetector computed tomography angiography. Primary outcomes included mortality, stroke, TIA, and major adverse cardiac events within 30 days and up to 6 months postoperatively. The UCEA group demonstrated no postoperative strokes or TIAs, with a low complication rate. UCEA resulted in one stroke within 6 months, with complete recovery. The ECEA group experienced one stroke and one death. There were no significant differences in early postoperative complications between the groups. However, the UCEA group exhibited a higher overall mortality rate (4.6% vs. 0.6%; p = 0.044), predominantly due to myocardial infarction. Both groups demonstrated comparable outcomes regarding postoperative complications and carotid restenosis at follow-up. UCEA performed within six hours of crescendo TIA shows comparable perioperative outcomes to ECEA in preventing recurrent strokes. While these findings suggest early intervention with UCEA may be a viable approach for patients with crescendo TIA, significant methodological limitations preclude definitive conclusions about safety and efficacy.

: Abdominal aortic aneurysm (AAA) is a permanent local dilation of the abdominal aorta developed by chronic local inflammation and elastin degradation. Trigonella foenum-graecum (fenugreek) has been reported to have anti-inflammatory properties. We hypothesized that fenugreek supplementation can inhibit AAA growth. : AAA was induced in male Sprague-Dawley rats by intraluminal porcine pancreatic elastase infusion. The treatment by oral gavage was initiated post-operatively on day 1 and was administered daily (750 mg/kg/daily or 1500 mg/kg/daily or distilled water) for 27 days. AAA expansion was monitored weekly by ultrasound measurements in a blinded-to-treatment fashion; rats were euthanized 28 days after surgery. AAA cross-sections were examined histologically, where treatment allocation were blinded. : AAA developed in all three groups, yet there was no measured difference (p=0.104) in the maximal inner anterior-posterior abdominal aortic diameter on day 28 post-surgery between the control group (110% ± 70%, n=11), the low-dose fenugreek treatment group (LDF, 105% ± 68%, n=11), and the high-dose fenugreek treatment group (HDF, 153% ± 96%, n=13). Additionally, assessments of elastin structure in the AAA wall using Miller's stain revealed disorganized and ruptured fibers, but no significant differences in the severity of damage or elastin content among the groups were noted. No significant differences were observed in the presence of infiltrating neutrophils (as indicated by myeloperoxidase-positive cells), macrophage infiltration (% CD68-positive area), or area of vascular smooth muscle cells (a-SMA stained cells), or media thickness across control low-dose, and high-dose treatment groups. : Daily fenugreek administrations did not halt AAA progression in either low-dose (750 mg/kg/daily) or high-dose (1500 mg/kg/daily) groups when compared to controls. These results did not show any beneficial effects of fenugreek supplementation in the aneurysm wall, and therefore, we can not recommend fenugreek supplementation as a treatment for patients with growing AAAs.

The use of questionnaires in vascular rehabilitation has increased. The Walking Impairment Questionnaire (WIQ) can identify functional risk due to peripheral arterial disease (PAD). This study aimed to assess the accuracy of the WIQ for identifying individuals with PAD and intermittent claudication with low functional capacity. A cross-sectional diagnostic test accuracy study was conducted. The Incremental Shuttle Walk Test (ISWT) assessed the distance walked, and the WIQ, the index test, evaluated the perception of functional capacity. Three reference values in the ISWT were defined: 380 m, 210 m (25th percentile), and 100 m. The accuracy, sensitivity, and specificity of the WIQ were tested using the Receiver Operating Characteristic curve and an alpha of 5% defined statistical significance. One hundred and twenty-one volunteers participated in the study (64 ± 9.7 years, 65% men). The average distance in the ISWT was 270.6 ± 100.2 m. The WIQ scores were: mean 29.7 (14.0-50.2), distance (19; 6.3-47.8), walking speed (25; 13.0-43.5), and stairs (41.7; 12.5-75.0). The WIQ cut-off point for the ISWT references was 1) 37 for 380 m, with a sensitivity of 0.75 and specificity of 0.62 (AUC: 0.73, p=0.003; 95% CI 0.61 to 0.86); 2) 23 for 25th percentile (210 m), with a sensitivity of 0.75 and specificity of 0.70 (AUC: 0.77, p<.0001; 95% CI 0.68 to 0.86) and 3) 14 for 100 m, with a sensitivity of 0.78 and specificity of 0.83 (AUC: 0.77, p=.0001; 95% CI 0.64 to 0.91). The WIQ is helpful as a screening tool in research and clinical practice of PAD. The WIQ score with the best accuracy to identify individuals with low functional capacity was 14.

Acute abdominal aortic occlusion is a rare vascular emergency associated with high morbidity and mortality. To date, the topic has hardly been addressed scientifically. Most case series are afflicted with small cohort numbers. The aim of this study was to identify risk factors after invasive treatment of acute abdominal aortic occlusion and changes over time. Using case-based nationwide hospital statistics (diagnosis-related group [DRG] statistics) from 2009 to 2020, all cases with ICD-10 codes for embolism and thrombosis of the abdominal aorta in conjunction with acute limb ischaemia and consecutive invasive treatment (endovascular or open surgery) were included. The analysis included patient characteristics, treatment, mortality, amputation, and complications. The primary outcome was in-hospital death. A multivariable regression model was applied to detect risk factors. A total of 1160 cases (66% male) with acute abdominal aortic occlusion were identified (941 open; 219 endovascular). Between 2009 and 2020, the rate of endovascular treatments (2010: 6%; 2020: 29%; p<.001) increased significantly over the years. Older patients (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.64-0.9, p=.002) and women (OR 0.65; 95% CI 0.48-0.88, p=.006) were more likely to receive endovascular care. In-hospital mortality was 13% after open surgery and 14% after endovascular treatment, with no significant change in open surgery, but high variability in endovascular treatment during the observation period (2009-2011: open 14%; endovascular 25%; 2018-2020: 10%; 11%). In-hospital mortality increased significantly with higher age (OR 2.19 per 10-year increase; 95% CI 1.79-2.7, p<.001) and comorbidities (OR 1.1 per Elixhauser point; 95% 1.07-1.11, p<.001). Acute aortic occlusion remains a rare but life-threatening emergency. Use of endovascular revascularization techniques is increasing, while in-hospital mortality rates remain high, specifically for older and morbid patients.

The new guidelines for the management of peripheral arterial and aortic diseases (PAAD) from the European Society of Cardiology and endorsed by the European Society of Vascular Medicine (ESVM), emphasize on a comprehensive and multidisciplinary approach focusing on prevention, diagnosis, treatment, and follow-up of patients with a wide range of PAAD, including lower extremity peripheral arterial disease (PAD). The aim of this summary, focusing on PAD and coordinated by the Young Academy of ESVM, is to provide young angiologists with the fundamental principles of these guidelines and to assist them in navigating their everyday clinical practice. PAD diagnosis relies on objective evaluation of flow/oxygen reduction at rest, with arterial ultrasound as the first imaging modality to confirm the presence of arterial lesions. The main goals of PAD management are not only to improve functioning and prevent the occurrence of adverse events at the lower limb level, but also to reduce the overall atherosclerotic burden and achieve the general well-being of patients. To this end, traditional and nontraditional cardiovascular risk factors need to be properly addressed through lifestyle changes and tailored drug therapies. For patients with exertional limb symptoms, supervised exercise training is recommended. Interventional treatment is indicated for limb salvage in patients with chronic limb threatening ischemia and may also be discussed in a multidisciplinary setting in less severe patients with persisting symptoms and reduced quality of life after a minimum period of optimal medical treatment including exercise therapy. For trainees or young specialists in Angiology/Vascular Medicine, these guidelines provide essential elements to improve patient management, encourage interdisciplinary collaboration, and ensure an integrated approach to vascular diseases.

Today, flow-mediated dilation (FMD) is a standardized test for the non-invasive assessment of vascular endothelial function in humans. The test is often used to assess the influence of various living conditions on the vascular system. Many factors have a short-term effect on FMD and reduce it. However, not every short-term FMD-reducing effect also signals long-term vascular damage with repeated exposure. The comparison between coffee consumption and smoking will be used to discuss that although both stimulants lead to comparable acute changes in vascular function, they differ in their long-term effects on the vascular system. Therefore, acute FMD effects cannot always be equated with long-term damaging effects.

This study aimed to assess the safety of the third-generation ClosureFast catheter for radiofrequency ablation (RFA) in the treatment of great saphenous vein (GSV) reflux in patients presenting to a dedicated vein center. All consecutive patients with incompetent GSV who underwent RFA between December 2023 and May 2024 were retrospectively analyzed. The primary study endpoints were technical success and postoperative complication rate at 30 days. Secondary study endpoints were freedom from GSV recanalization and recurrent varicose vein (RVV) rate over the follow-up. The improvement in symptoms (measured by the Venous Clinical Severity Score [VCSS]) was evaluated. During the study period, 50 limbs were treated in 50 consecutive patients (mean age 55.8±13.4 years; 56% women; CEAP 2-4; VCSS >5). The technical success rate was achieved in 100% of cases. There was no significant incidence of 30-day complications. There were no instances of deep venous thrombosis or puncture site thermal injury. One patient (2%) had hyperpigmentation; two patients (4%) had ecchymosis; 4 patients (8%) had pain. At a mean follow-up of 2.9±1.4 months, GSV occlusion and freedom from reintervention rates were both 100% within 1 week and 30 days respectively. No patients had RVV over the follow-up. The VCSS score had decreased a median of 3.5 (IQR: 2.4-5) points from baseline (p<0.01). The mean CEAP class had decreased to 1.59 points from baseline, reflecting a shift towards milder disease categories (C0-C2). The third generation of RFA is safe and effective to ablate the GSV with a low complication rate in the perioperative period. However, durability over the follow-up and further studies with larger cohorts of patients are still needed to confirm these outcomes.

This prospective, single center, exploratory study assessed primary patency, clinical performance, and adverse events associated with the DUO-HYBRID Venous Stent used to treat iliac vein obstruction. Twenty-one patients with symptomatic obstructions were treated with the self-expanding stent designed with varying zones of fatigue and crush resistance to adapt to the challenging iliac vein anatomy. The primary outcome measure was 12-month primary patency, defined as ≤ 50% residual stenosis, the absence of re-thrombosis or reintervention, and the absence of major adverse events from treatment to discharge. Secondary clinical measures included the Villalta score to assess the symptoms of post-thrombotic syndrome (PTS), and the revised Venous Clinical Severity Score (rVCSS) and Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) score, both used to measure the severity of venous disease. Finally, the number of device- or procedure-related adverse events were recorded. Primary patency was 92.9% at 12 months: one patient exhibited restenosis greater than 50% at 12 months. CEAP scores at baseline were predominantly C3 - C5 (78.9%) while at 12 months, 78.6% of scores were C1 - C2 and 14.3% were C0. The mean rVCSS score was 5.5 ± 2.7 at baseline and 1.1 ± 1.0 at 12 months, an 80% reduction in the mean score from baseline. Pre-procedure, 14.3% of patients had a Villalta score of 0-4 while at 12 months, 100% had scores of 0-4 (i.e., no clinically meaningful signs of post-thrombotic syndrome). Two adverse events were reported as possibly related to the device but neither case required revascularization. Observations from this exploratory study demonstrated a primary patency rate of 92.9%, improvements in rVCSS, CEAP, and Villalta scores from baseline, and no cases of target lesion or vessel revascularization at 12 months. The DUO-HYBRID Venous Stent performed appropriately when used for its intended indication.

Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHADS-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHADS-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86-0.87) but had the worst calibration for high-risk patients. The CHADS-VA Score had the lowest AUC 0.69 (95% CI: 0.68-0.70) but was the most consistent prediction model regarding calibration. HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHADS-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHADS-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.

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. 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). 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. 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.

Chronic venous disease (CVD) is a prevalent condition leading to significant morbidity and affecting quality of life. Among conservative treatment strategies, venoactive drugs are often recommended by major guidelines for the management of CVD. Bromelain and vitamin C are now emerging as promising options in the management of several chronic diseases owing to their anti-inflammatory, immunoregulatory, and antioxidant properties, though evidence remains scarce in this setting. This systematic review of the literature, endorsed by the Italian Society of Angiology and Vascular Medicine (, SIAPAV), aims to evaluate the efficacy and safety of these compounds in the treatment of CVD. A comprehensive search yielded nine studies, two on bromelain and seven on vitamin C. No studies have evaluated the effects of bromelain and vitamin C alone or in combination, whereas both molecules were administered in combination with other nutritional supplements. Overall, CVD-related symptoms and edema seem to improve with dietary supplement containing these two compounds, with no major safety issues reported. Bromelain and vitamin C may thus represent attractive options in the management of patients with symptomatic CVD and/or presence of venous edema, provided optimal conservative treatment is in place. Dedicated clinical studies are needed to clarify the efficacy and safety of a combination of these molecules in CVD management.

Arteriovenous grafts (AVG) can be the only bailout solution for patients who require kidney replacement therapy but are unsuitable for arteriovenous fistula (AVF) creation. Currently, high-level evidence on the effectiveness and safety of antithrombotic therapy in AVG patients is scarce. Following the PICO (patient; intervention; comparator; outcome) model and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a data search of the English literature in PubMed, SCOPUS, Central Cochrane was conducted, until March 1st, 2023 (PROSPERO Protocol Number: CRD42023401785). Studies on humans with an AVG receiving any kind of antithrombotic medication, reporting on primary and secondary patency rates, and bleeding complications were included. Due to data heterogeneity, a descriptive report of the outcomes was undertaken. Twelve studies, including 22,436 patients with end-stage renal disease (ESRD) and AVG were included, with patient recruitment spanning over a 41-year time-period (1982-2023). Antithrombotic factors included acetylsalicylic acid (ASA), clopidogrel, dipyridamole, warfarin, unfractioned heparin (UFH), and direct oral anticoagulants (DOACs). Ten studies reported on primary patency rates, and two on secondary patency rates. Primary and secondary patency rates (PPR, SPR) were reported better in four studies, similar in three and worse in one study, regarding patients receiving any kind of antiplatelet therapy. Anticoagulation therapy was not associated with increased PPR or SPR, except for one study on apixaban. Patients receiving single or combined antiplatelets versus patients receiving no treatment presented higher bleeding risk in two studies and similar bleeding risk in three studies. Anticoagulation therapy, excluding apixaban, was associated with higher bleeding risk in three studies, when compared to no anticoagulation. Data derived from the current literature were equivocal regarding the use of antiplatelet treatment in patients with AVG. Studies on anticoagulation therapy are confined. Randomized trials with confounder stratification remain crucial for robust long-term data.

We investigated the safety and efficacy of rivaroxaban as routine thromboprophylaxis after endovenous thermal ablation (EVTA). Adhering to the PRISMA 2020 guidelines, we conducted a systematic review for studies published up to April 2024. Primary endpoints included endovenous heat-induced thrombosis (EHIT) class ≥ II, deep vein thrombosis (DVT), major and minor bleeding and the composite endpoint of major thromboembolic complications including any incidents of EHIT ≥ III, DVT or pulmonary embolism (PE). Eight retrospective case series, encompassing 1666 patients, and 2049 truncal veins were included. The pooled EHIT ≥ II, DVT, and major thromboembolic complications estimates were 0.73% (95% CI: 0.37-1.42), 0.51% (95% CI: 0.22-1.17) and 0.71% (95% CI: 0.27-1.89). The crude and pooled major and minor bleeding estimates were 0% (0/885) and 2.60% (95% CI: 1.05-6.33). The pooled early truncal and great saphenous vein (GSV) occlusion outcomes were 99.03% (95% CI: 96.88-99.70) and 98.74% (95% CI: 92.07-99.81). The pooled and crude superficial thrombophlebitis and PE estimates were 2.86% (95% CI: 0.88-8.89) and 0% (0/579). While the comparative analysis between rivaroxaban and low molecular weight heparins (LMWH)/fondaparinux displayed improved outcomes favouring rivaroxaban in terms of DVT, risk ratio (RR), 0.60 (95% CI: 0.12-3.07) and truncal occlusion, odds ratio (OR), 1.43 (95% CI: 0.31-6.55) outcomes did not reach statistical significance. Meta-regression analysis including rivaroxaban treatment durations spanning from three to ten days displayed a negative association between duration of treatment and both truncal, (β = -0.4740, p<0.01) and GSV, (β = -0.4583, p<0.01) occlusion in the early pos-operative period. The results of this review underscore the potential safety of rivaroxaban as thromboprophylaxis in the context of endovenous thermal ablation. The observed inverse relationship between anticoagulation duration and occlusion outcomes should be interpreted with caution, highlighting the need for further research.

Pulmonary embolism (PE) can result in high mortality. Early risk stratification and treatment are critical for individualized management. In patients with intermediate-high-risk (IHR) PE, guidelines recommend to consider a percutaneous catheter-directed treatment (CDT). While different techniques are available, comparisons between treatments regarding right ventricular (RV) function and outcome are still scarce. This study aimed to compare changes in RV function as well as outcomes in patients with IHR PE after CDT with ultrasound-assisted thrombolysis (USAT) as compared to large-bore mechanical thrombectomy (MT). This is a retrospective, single-center study in IHR PE, diagnosed in accordance with the ESC Guidelines. All patients underwent a CDT either with USAT (EKOS, Boston Scientific) or MT (FlowTriever System, Inari). Right heart function (RV/LV ratio, TAPSE) was assessed via transthoracic echocardiography before and after CDT as well as interventional characteristics and postinterventional hospital stay were compared. From June 2022 to April 2024, 26 patients (35% female; aged 61.2±15.2 years) were diagnosed with IHR PE and underwent CDT. 14 patients (53.8%) were treated with USAT and 12 patients (46.2%) with MT. The mean procedural time was 40.4±19.8 minutes for USAT and 104±32.2 minutes for MT. RV/LV ratio was improved in both groups (change from baseline USAT -0.48±0.25; MT -0.36±0.13). TAPSE increased by 6.95±3.7 mm in USAT and by 9.8±4.6 mm in MT. Major bleeding (defined as BARC ≥ 3a) occurred only in three patients of the USAT group. The 90-day mortality rate was 0% in both groups. In patients with IHR PE both USAT and MT lead to an improved RV function without mortality within 90 days. Further randomized data have to discriminate the differential impact of novel tools for the treatment of IHR PE.

Although venous stent placement is an established treatment for patients with deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS), stent patency rate may be as low as 80% at 12 months. Treatment of stent occlusion requires the removal of a large amount of fresh or organized thrombus from stents with a diameter of 12-20 mm. The feasibility of large-bore rotational thrombectomy in combination with angioplasty to treat thrombosed venous iliofemoral or inferior vena cava stents has not been investigated yet. Between May 2023 and June 2024, 12 patients (15 limbs) with symptomatic venous stent occlusions were treated at our institution with the 10-French Rotarex™ thrombectomy device and completed 3-month follow-up by Duplex ultrasound. The primary outcome was primary patency at 90 days after thrombectomy of stent occlusion. Safety outcomes included device-related complications, bleeding, and death. Median age was 41 years, 75% were women. At the index procedure, 10 (83%) patients presented with PTS and two (17%) with acute DVT. Median time from index procedure to re-intervention was 1125 (Q1-Q3: 897-2297) days and from symptom onset to re-intervention 39 (Q1-Q3: 8-186) days. Technical success of re-intervention was achieved in all cases, and bail-out stent-in-stent placement was not required in 5 (33%) limbs. The primary patency rate at 90 days was 86.7% (95% CI: 71.0-100.0). Two (17%) patients experienced recurrent stent thrombosis and were managed conservatively. Peri-interventional minor bleeding occurred in two (17%) patients. There were no device-related complications, major bleeding, or deaths. Large-bore rotational thrombectomy appears to be a feasible strategy to treat iliofemoral and inferior vena cava stent thrombosis, achieving acceptable short-term patency without major adverse events.

Percutaneous superficial femoral interventions remain the preferred method of treatment for superficial femoral artery (SFA) disease. Nevertheless, long term restenosis continues to be a major limitation of percutaneous interventions. In this context, the objective of this study is to compare the efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting long-term (5 years) restenosis due to percutaneous interventions to the superficial femoral artery. The sample of this retrospective study consisted of 545 peripheral artery disease (PAD) patients with a percutaneous intervention to the SFA. Of these patients, 362 and 183 were included in the group of PAD patients without long-term (5 years) SFA restenosis (Group 1) and in the group of PAD patients with long-term SFA restenosis (Group 2). The efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting the development of long-term SFA restenosis were comparatively analyzed. CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scores all increased with long-term SFA restenosis. The receiver operating characteristic (ROC) curve analysis revealed that all five risk scoring systems successfully predicted long-term SFA restenosis, whereas the paired ROC curve analysis revealed that CHA2DS2-VASc-HS scores of >4 had the best prognostic power in predicting long term SFA restenosis. The study findings indicated that the CHA2DS2-VASc-HS score was an independent predictor of the development of SFA restenosis. The CHA2DS2-VASc-HS risk scoring system, which is the modified version of CHA2DS2-VASc, outperformed the CHA2DS2-VASc, HATCH, ATRIA, and ATRIA-HSV, the modified version of ATRIA, risk scoring systems in predicting long-term (5 years) SFA restenosis.