Saphenous vein versus synthetic graft in arteriovenous fistula for hemodialysis in patient with inaccessible veins
An autologous arteriovenous fistula (AVF) provides an optimal and secure way for managing the condition. An optimal blood supply to hemodialysis is linked to decreased incidence of complications and mortality, as well as reduced expenses. The objective of this research was to evaluate the outcome of people with suboptimal superficial venous system quality or who had exhausted all available arteriovenous fistula options, who received either autologous saphenous vein graft or polytetrafluoroethylene (PTFE) interposition graft as an access for effective hemodialysis.
The rheolytic thrombectomy AngioJet™ is a safe and technically feasible method for treating acute and sub-acute occluding lesions in the visceral arteries
The aim of this study is to evaluate the safety and feasibility of the AngioJet™ device in the endovascular treatment of visceral ischemia with stenotic or occlusive lesions.
Characteristics and percutaneous transluminal angioplasty treatment outcomes of superior vena cava obstruction in patients undergoing hemodialysis
This study aimed to investigate the clinical outcomes of percutaneous transluminal angioplasty (PTA) in patients undergoing hemodialysis with different types of superior vena cava obstruction (SVCO) lesions.
Midterm results after FEVAR and open surgery for infrarenal aortic aneurysms with short proximal necks: systematic review with meta-analysis of comparative studies
This systematic review with meta-analysis aimed to compare short and midterm outcomes between fenestrated endovascular aneurysm repair and open surgery in repair of infrarenal abdominal aortic aneurysms with short necks.
Oral rivaroxaban for the treatment of deep vein thrombosis in outpatients: a propensity score-matched comparison with a historical inpatient population
Despite the guidelines' appeal to treat patients with deep vein thrombosis and low-risk pulmonary embolism in outpatient settings, the real-world evidence shows a high prevalence of inpatient therapy leading to unwarranted health resource utilization. The study aimed to assess the efficacy and safety of rivaroxaban in outpatient settings compared to inpatient treatment.
Glycocalyx disruption, endothelial dysfunction and vascular remodeling as underlying mechanisms and treatment targets of chronic venous disease
The glycocalyx is an essential structural and functional component of endothelial cells. Extensive hemodynamic changes cause endothelial glycocalyx disruption and vascular dysfunction, leading to multiple arterial and venous disorders. Chronic venous disease (CVD) is a common disorder of the lower extremities with major health and socio-economic implications, but complex pathophysiology. Genetic aberrations accentuated by environmental factors, behavioral tendencies, and hormonal disturbances promote venous reflux, valve incompetence, and venous blood stasis. Increased venous hydrostatic pressure and changes in shear-stress cause glycocalyx injury, endothelial dysfunction, secretion of adhesion molecules, leukocyte recruitment/activation, and release of cytokines, chemokines, and hypoxia-inducible factor, causing smooth muscle cell switch from contractile to synthetic proliferative phenotype, imbalance in matrix metalloproteinases (MMPs), degradation of collagen and elastin, and venous tissue remodeling, leading to venous dilation and varicose veins. In the advanced stages of CVD, leukocyte infiltration of the vein wall causes progressive inflammation, fibrosis, disruption of junctional proteins, accumulation of tissue metabolites and reactive oxygen and nitrogen species, and iron deposition, leading to skin changes and venous leg ulcer (VLU). CVD management includes compression stockings, venotonics, and surgical intervention. In addition to its antithrombotic and fibrinolytic properties, literature suggests sulodexide benefits in reducing inflammation, promoting VLU healing, improving endothelial function, exhibiting venotonic properties, and inhibiting MMP-9. Understanding the role of glycocalyx, endothelial dysfunction, and vascular remodeling should help delineate the underlying mechanisms and develop improved biomarkers and targeted therapy for CVD and VLU.
Role of single peroneal versus single non-peroneal tibial angioplasty in limb salvage
The peroneal artery is known to give branches to the anterior and posterior tibial arteries. Scattered reports in the literature over the last decade failed to provide solid evidence as to the optimum strategy for below-knee targeted revascularization in limited-option patients with critical limb-treating ischemia (CLTI). We sought to determine the benefit of performing single peroneal tibial artery angioplasty revascularization compared with single non-peroneal angiosome-targeted tibial artery angioplasty revascularization for patients presented with CLTI.
The impact of intraoperative Fogarty balloon dilation on arteriovenous fistula success: clinical and functional outcomes
An effectively functioning arteriovenous fistula (AVF) is vital for end-stage renal disease patients. This study aims to evaluate the effects of Fogarty balloon catheter dilation on creating an effectively functioning AVF.
Current evidence on the effectiveness and safety of oral anticoagulants in superficial venous thrombosis: a systematic review and meta-analysis
Previous studies suggest fondaparinux as an effective regimen for superficial venous thrombosis (SVT), but the inconvenience of prolonged parenteral injections has prompted investigations into oral anticoagulants (OACs). This study aims to evaluate the current evidence on the effectiveness and safety of OACs in the treatment of SVT.
Management of arterial hypertension in patients with peripheral arterial disease
Hypertension is a major risk factor for peripheral arterial atherosclerotic disease (PAD). Hypertension deteriorates arterial wall function and the morphology of all layers of arteries. Endothelial cell injury enhances permeability and promotes migration of cholesterol and monocytes into the vessel wall. Increased blood pressure (BP) through hyperplasia of smooth muscle cells initiates remodeling of the arterial wall that increases peripheral resistance. Further, hypertension, particularly in patients with dyslipidemia, provokes atherosclerosis in different vascular territories, including the lower legs. Guidelines recommend treatment of hypertension in patients with PAD to reach the target BP of <130/80 mmHg. However, systolic BP (SBP) <120 mmHg may worsen oxygen delivery to the diseased leg and is related to a higher rate of cardiovascular (CV) events. Therefore, there is a J-shape relationship between SBP and the rate of primary outcomes. Any class of antihypertensive drugs, including beta-blockers, can be used for the treatment of hypertension in patients with PAD. Angiotensin converting enzyme (ACE) inhibitors may have some additional benefit over other antihypertensive drugs including improvement of perfusion of the diseased leg and are recommended even in patients with critical limb ischemia. In conclusion: hypertensive patients with PAD are at increased risk for CV events and treatment of raised BP is indicated, but SBP <120 mmHg and DBP <70 mmHg may contribute to adverse limb outcomes and other CV events. Consequently, PAD patients may require a different BP target than those without PAD.
Interventions for the treatment of recurrent varicose vein disease arising from the saphenofemoral junction or the great saphenous vein: a systematic review and meta-analysis
We investigated the safety and feasibility of the available interventions in the treatment of recurrent varicose vein disease.
Prescription versus over-the-counter venotonics: HPLC-DAD and static digestive model simulation comparison
Venotonics are a class of therapeutically active molecules that have vaso-protective effects. They are used to alleviate venous diseases and disorders, particularly venous insufficiency. We compared the composition of prescription versus over-the-counter (OTC) venotonics using high-performance liquid chromatography with UV detection (HPLC-DAD) and simulating their digestion using a static digestive model.
Atherosclerotic cardiovascular disease risk based on SCORE algorithms and reclassification based on preclinical atherosclerotic plaques
The aim of this study was to determine the efficacy of the number of carotid and common femoral bifurcations with plaque (NBP) detected by ultrasound in reclassifying atherosclerotic cardiovascular disease (ASCVD) risk obtained from SCORE algorithms. Data from the cohort of 1000 individuals free from ASCVD in the Cyprus Epidemiological Study on Atherosclerosis was used.
Mini-skin longitudinal incision versus traditional longitudinal incision for carotid endarterectomy in patients with carotid artery stenosis: a systematic review and meta-analysis
Carotid endarterectomy (CEA) remains the gold standard intervention for stroke prevention in patients with carotid artery stenosis but the surgical technique continues evolving with research being conducted on minimally invasive alternatives. Mini-skin incision CEA has emerged as a more aesthetically appealing and less painful alternative to the traditional technique with a potential impact on main procedural events. We aimed to provide a review of the literature and to compare the mini-skin incision with the traditional approach.
Organization of angiology in countries with associate societies of International Union of Angiology
Angiology is a multidisciplinary medical discipline, consequently in some countries multidisciplinary vascular centres were organized, which provide comprehensive management of patients with different vascular diseases. However, the organization of the care for vascular patients differs between the countries. Therefore, we aimed to check the organization of angiology (vascular surgery and vascular medicine) in countries-associate members of IUA and to stimulate the development of multidisciplinary vascular centres. The questionnaire was sent to 60 countries- associate members of IUA, and 35 societies from 30 countries responded. The responses showed that in most countries vascular patients are treated by vascular surgeons. Vascular surgeons and radiologists are also main providers of peripheral arterial diagnostics and invasive treatment. In most countries vascular medicine is marginalized. With the exception of some west European countries multidisciplinary vascular centres are rare and facilities for management of vascular patients insufficient. National societies expect from IUA more educational activities and creating consensus documents. Therefore, IUA should promote the foundation of vascular centres and provide systemic education in angiology.
Effects of light compression on chronic venous disease, edema and comfort in women during pregnancy and postpartum period: a prospective randomized study
Lower limb edema associated with venous disorders is an increasingly common problem in pregnant women. The study aimed to assess the use of compression class 1 (ccl1=18-21 mmHg) in lower limb edema and CVD prevention in pregnant and postpartum women.
Effect of hemodynamic suppression on cognitive function in patients after carotid artery stenting
This study examines the impact of carotid artery stenting (CAS) on cognitive function in stroke patients, particularly in relation to hemodynamic depression (HD).
Safety of adjuvant open axillary access during complex thoracoabdominal aortic endovascular procedures
Endovascular treatment of aortic diseases with complex anatomy may require an additional upper extremity arterial access (like axillary access) for support during aortic navigation and allowing the use of larger sheaths for thoracoabdominal antegrade access. The objective of this study is to evaluate the safety of the open axillary approach as adjuvant access in complex thoracoabdominal aortic endovascular interventions.
Automated 3D ultrasound bridges the gap between novices and experts in diameter assessment of abdominal aortic aneurysms
The current management of abdominal aortic aneurysm (AAA) hinges upon assessing diameter using ultrasound (US). Diameter reproducibility with conventional two-dimensional ultrasound (2D-US) is challenging and requires experienced operators. A novel automatic three-dimensional ultrasound (3D-US) system enables on-cart software-assisted diameter estimation (3D-SAUS), potentially facilitating more precise diameter measurements than 2D-US. This study aimed to assess the variance of AAA diameter measurements among US novices and experts by comparing 2D-US with 3D-SAUS in a clinical setting.
Dyslipidemia and lower extremity arterial disease
Dyslipidemia is an established risk factor for cardiovascular diseases. We aimed to review its role in the pathogenesis of lower extremity arterial disease (LEAD), as well as the effect of lipid-lowering treatment on the progression of LEAD.
Diet and exercise in relation to lower extremity artery disease
Adherence to the Mediterranean diet (MeD) has been associated with a reduced incidence of peripheral arterial disease (PAD)/lower extremity arterial disease (LEAD) in observational trials and in a randomized trial. In secondary prevention, a lower hazard ratio for composite major adverse cardiovascular events has been associated with better adherence to MeD in a relatively small, randomized trial. This has not been confirmed in a sub-analysis of a large interventional trial of dual antithrombotic treatment. The effects of vegetarian, vegan or low carbohydrate/ketogenic diets on the incidence and outcomes of PAD/LEAD are not known. While abdominal obesity is associated with diabetes mellitus and PAD/LEAD, the lowest incidence of PAD/LEAD has been found in subjects with a body mass index 25-29.9 kg/m. Malnutrition is a negative prognostic factor for survival of patients with chronic limb threatening ischemia. Physical activity (PA) is an acute stressor, but habitual recreational PA results in beneficial adaptations and improved health. In observational studies, lower levels of exercise and lower physical fitness have been associated with more prevalent PAD/LEAD. In contrast to coronary artery disease, that shows a reverse J-shaped relationship between long-term endurance exercise and coronary atherosclerosis, such a relationship is not known for PAD/LEAD. A general recommendation for maintaining cardiovascular health is performing regular moderate-intensity exercise with some vigorous-intensity aerobic PA, and resistance exercise at least twice a week. Combinations of healthy behaviors are more effective in preventing PAD/LEAD than a single behavioral component. In treatment of PAD/LEAD causing intermittent claudication, supervised walking training is recommended among measures of first-line treatment, while unsupervised walking training should be considered as an alternative.