Artery Diameter Research Articles

#865 Autologous cephalic vein transposition in the placement of forearm arteriovenous fistulas

Abstract Background and Aims The autologous vein transposition was commonly used for hemodialysis vascular access (VA) in selected patient. The saphenous vein was used as a vascular graft; while, the contralateral cephalic vein was used as a bridge. We describe a new technique of autologous cephalic vein transposition to create a native AVF in hemodialysis patients. Method Patients referred to our hospital for a vascular access placement. US vascular mapping of upper extremities revealed small arteries, but adequate forearm veins in all patients. Specifically, the radial artery luminal diameter was < 1.4 mm and < 1.6 mm, respectively at wrist and at middle-arm. While, at bend of the elbow, the ulnar artery diameter (>2.5 mm) in one case, and the brachial artery diameter (>3.5 mm) in two cases, were deemed adequate as feeding arteries of a possible AVFs. Furthermore, the diameter of the forearm cephalic vein ranged from 2.0 to 2.4 mm; in the upper arm the veins were obstructed or stenotic in one of the two arms. The basilic vein was patent in both arms of the patients; the internal diameter varied from 2.5 to 2.7 mm. Due to difficulty to create a traditional fistula, and higher risk of primary failure, it was decided to transpose the cephalic vein, from the forearm not suitable for the AVF, to the contralateral arm chosen for the AVF placement. Results With local anesthesia, an approximately 10-cm stretch of cephalic vein was harvested from the arm contralateral to the site chosen for AVF. Then, the transposed veins, reversed in their cranio-caudal position, were tunneled subcutaneously and anastomosed, in an end-to-end fashion, with cephalic vein at wrist region, and subsequently in a side-artery to end-vein at the elbow crease. The transposed AVFs were created in three patients with ESKD (2M/1F), mean age 47± 3.6 years, (two in the non-dominant arm), without complications. After 4 weeks, all the AVF were patent and the access flow was 660±120 ml/min. All the three AVF was deemed mature and usable for hemodialysis. Conclusion In selected cases, autologous transposition of the cephalic vein can be used to create an AVF, providing a long segment for cannulation. This type of AVF can be an alternative to prosthetic fistula, sparing the central venous catheter.

Correlation and risk factors of peripheral and cervicocephalic arterial atherosclerosis in patients with ischemic cerebrovascular disease

Patients with ischemic cerebrovascular disease (ICVD) frequently develop concomitant peripheral artery disease (PAD) or renal artery stenosis (RAS), and multiterritorial atherosclerotic patients usually have a worse prognosis. We aimed to evaluate the status of peripheral atherosclerosis (AS) and cervicocephalic AS (CAS) in ICVD patients with AS, their correlation, and related risk factors contributing to coexisting cervicocephalic-peripheral AS (CPAS). Based on the severity and extent of AS evaluated by computed tomography angiography and ultrasound, the degree of AS was triple categorized to assess the correlation between CAS and PAD/RAS. CAS and PAD/RAS were defined as the most severe stenosis being ≥ 50% luminal diameter in cervicocephalic or lower limb arteries, and a peak systolic velocity at the turbulent site being ≥ 180 cm/s in the renal artery. Among 403 patients with symptom onset within 30 days, CAS, PAD, and RAS occurrence rates were 68.7%, 25.3%, and 9.9%, respectively. PAD was independently associated with the degree of extracranial and intracranial CAS (p = 0.042, OR = 1.428, 95% CI 1.014–2.012; p = 0.002, OR = 1.680, 95% CI 1.206–2.339), while RAS was independently associated with the degree of extracranial CAS (p = 0.001, OR = 2.880, 95% CI 1.556–5.329). Independent CPAS risk factors included an ischemic stroke history (p = 0.033), increased age (p < 0.01), as well as elevated fibrinogen (p = 0.021) and D-dimer levels (p = 0.019). In conclusion, the occurrence rates of RAS and PAD in ICVD patients with AS is relatively high, and with the severity of RAS or PAD increase, the severity of CAS also increase. Strengthening the evaluation of peripheral AS and controlling elevated fibrinogen might be crucial for preventing and delaying the progression of multiterritorial AS in ICVD patients with AS, thereby improving risk stratification and promoting more effective prevention and treatment strategies.

#2331 Distal arteriovenous fistulas for hemodialysis – too many interventions?

Abstract Background and Aims Distal arteriovenous fistula (dAVF) for haemodialysis (HD) is preferred due to lesser complications, despite greater risk of maturation failure. In HD patients, age and comorbid conditions increased the risk of access failure and number of procedures necessary for fistula patency. Preferred location for AVF poses a challenging decision. Advantages of dAVF must be taken into account although these may lead an unreasonably high number of interventions. Our aim was to determine time to functioning distal AFV in our centre and number of procedures necessary to achieve such status. Method Single centre retrospective analysis was performed on a cohort of patients submitted to distal AFV construction from 2015-2021. Success rate was defined as AFV patency in time for dialysis. Results Of 528 patients submitted to AVF construction from 2015 - 2021, 110 radiocephalic fistulas were seen, 59% male patients, mean age 68.5±12,0 yrs. Comorbidities were prevalent (80.9%, n=89), DM (54.6%) and HF (41.1%). Outcomes at 6 weeks were adequate maturation in 4.5% (n=59), 31.8% (n=35) late maturation (LM) and 14.5%(n=16) primary failure (PF). Causes of LM included inflow and outflow stenosis, 34.3% and 37.1%, respectively. LM (&amp;gt; 6 weeks) requiring no further intervention was seen in 28.6%. PF patients had smaller artery diameters on pre-operative US, with no statistical significance (0.23±0.07; 0.30 ± 0.2; p=0,375). Assisted patency rate was 78.2%. Number of procedures for access permeability was 1, 2 e 3 in 40%, 25.5% and 6.4%, respectively. Mean of 1,5±0,7 interventions per patient. Median time-to-adequate AFV was 2.0 (IQR 2,0 - 6,45) months. Success rate was 72,8%. Conclusion Outcomes at 6 weeks in our cohort were similar to those reported in literature. Timely referencing may increase access patency with resort to vascular intervention. Individualized management is essential, discussing risks and benefits taking into account the treatment burden associated with numerous procedures. Patency rates and outcomes after HD initiation and even cost analysis are essential to guide recommendations.

Total bile acids levels as a stratification tool for screening portopulmonary hypertension in patients with decompensated cirrhosis.

Echocardiography is necessary for portopulmonary hypertension diagnosis, and identifying patients with cirrhosis who require it is challenging. In this study, we aimed to investigate the utility of the total bile acid (TBA) levels as a screening tool for identifying patients with decompensated cirrhosis who should undergo echocardiography for portopulmonary hypertension diagnosis. We evaluated 135 patients with decompensated cirrhosis who underwent liver transplantation. Subsequently, factors contributing to tricuspid regurgitation pressure gradient (TRPG) elevation (≥30mmHg) were analyzed using preoperative data, including the TBA levels. The median age of patients was 58years (61 women), and 45 and 90 patients had Child-Turcotte-Pugh grades of B and C, respectively. The median TRPG level was 21mmHg, and 17 patients (12.6%) showed TRPG elevation. Multiple logistic regression analysis revealed that elevated TBA (odds ratio 4.322; p=0.013) and main pulmonary artery diameter ≥33mm (odds ratio 4.333; p=0.016) were significantly associated with TRPG elevation. The TBA cut-off value (167.7μmol/L) showed a high diagnostic performance, with 70.6% sensitivity and 64.4% specificity. Ursodeoxycholic acid (UDCA) administration increased the TBA levels dose-dependently. Analysis stratified by UDCA use revealed that in patients not taking UDCA (n=59), elevated TBA levels and younger age significantly contributed to TRPG elevation. However, in those taking UDCA (n=76), this contribution disappeared, suggesting that UDCA consumption reduced TBA levels' efficiency in diagnosing TRPG elevation. The TBA levels may be a potential screening tool for TRPG elevation; however, caution is warranted when interpreting cases treated with UDCA.

#806 Predicting arteriovenous fistula success using ferumoxytol-enhanced MRI (Fe-MRI) and computational flow dynamics (CFD)

Abstract Background and Aims Arteriovenous fistula (AVF) failure is common and is invariably associated with preexisting anatomic problems of the inflow and outflow circuit. Ferumoxytol, an iron oxide nanoparticle, provides a safe alternative to gadolinium contrast material for MR angiography in chronic kidney disease (CKD). Computational fluid dynamics (CFD) has been utilised to virtually demonstrate the haemodynamics within AVFs using high-quality vascular mapping obtained with ferumoxytol-enhanced MRI (Fe-MRI). Using Fe-MRI and CFD we aimed to assess AVF haemodynamics and identify flow patterns and geometries associated with AVF success. Method In this pilot study we used Fe-MRI datasets of CKD patients who had vascular mapping 6 weeks after AVF creation. Using CFD methods we performed vessel segmentation to construct three-dimensional (3D) patient-specific geometries from images obtained with Fe-MRI (Fig. 1). We then completed a detailed CFD analysis for each AVF geometry to establish the associations of haemodynamic (mean wall shear stress (WSS), oscillatory shear index (OSI), blood flow velocity, and areas of abnormal flow) and anatomical parameters (anastomosis angle, feeding artery diameter, feeding artery curvature, draining vein diameter, and draining vein curvature) with AVF outcomes. The primary outcome was AVF success defined as AVF use (assisted or unassisted) for dialysis for a minimum of 3 months. ROC analysis was used to assess anatomical predictors of AVF flows of ≥1000 ml/min. Results The study included 17 patients with CKD who had AVF creation between 2018 and 2020. From these, 13 AVFs were successfully used for dialysis and 4 failed to mature or were used for dialysis for &amp;lt;3 months before failure. Compared to failed fistulas, successful AVFs had higher mean WSS and OSI. Failed AVFs were characterised by different haemodynamic patterns including lower flow rates with less helical flows. On ROC analysis the three metrics with the highest area under the curve (AUC) values were the feeding artery curvature (0.82), feeding artery diameter (0.76), and draining vein diameter (0.74) with a combined AUC value of 0.83 (Fig. 2). Conclusion Using Fe-MRI and CFD in the post-surgical juxta-anastomotic environment higher mean WSS and OSI were predictive of AVF success. In addition, the feeding artery curvature, feeing artery and draining vein diameters are strongly correlated with high venous flow rates, one of the key factors of AVF success. Although vessel diameters are routinely measured as part of pre-operative vascular mapping, a greater emphasis should be given on mean WSS, OSI and feeding artery vessel curvature when selecting vessels for AVF creation.

The beneficial effects of monoglucosyl hesperidin and monoglucosyl rutin on vascular flexibility: a randomized, placebo-controlled, double-blind, parallel-group study

Background: There is mounting evidence that the intake of polyphenols can help prevent cardiovascular complications. Furthermore, multiple intakes of different polyphenol compounds are expected to have a synergistic effect. However, few studies have examined the preventive effect of simultaneous polyphenol intake on cardiovascular complications in healthy adults. Objective: The present study aimed to evaluate the efficacy of daily intake of 70 mg of monoglucosyl hesperidin (MH) alone, or in combination with 140 mg of monoglucosyl rutin (MR), in improving vascular flexibility. Methods: This 8-week study was conducted on 66 healthy male and female participants with a relatively high body mass index (BMI) and low vascular flexibility. The participants were randomly assigned to an MH group (MH alone), MHMR group (combination of MH and MR), or placebo group by a computer-generated list (each n = 22). Participants took two tablets per day of either MH, MHMR or placebo during the intervention. Outcomes included vascular function indices, capillary flow, and inflammatory markers. Assessment points were at 4 weeks (4w) and 8 weeks (8w) of the intervention. Results: The primary outcome was flow-mediated dilation. In an analysis including participants whose left brachial-ankle pulse wave velocity (baPWV) was ≥1232.5 cm/s at baseline in the per-protocol set, the MHMR group showed significant improvement compared with the placebo group in flow-mediated dilation, maximum post-avascularization artery diameter, baPWV (each and average of both legs), and E-selectin at 8w. Conclusion: These results indicated that MH, in combination with MR, may act on vascular endothelial cells to improve vascular flexibility in healthy adults with a relatively lowvascular flexibility. (UMIN000046054). Keywords: Monoglucosyl hesperidin; Monoglucosyl rutin; flow-mediated dilation; E-selectin; pulse wave velocity, body mass index, vascular flexibility

Description of the characteristics of the nailfold capillary structure in healthy children: a multi-centric study.

Nailfold videocapillaroscopy (NVC) is the primary diagnostic tool for the assessment of microcirculation in the pediatric population. To define and standardize age-specific normal NVC patterns in healthy children and adolescents. A cross-sectional observational multicentric study was conducted in 564 participants aged 5-17 years. Dino-Lite CapillaryScope 200 Pro Model MEDL4N Pro was performed at 200× magnification. Quantitative and qualitative NVC parameters were analysed separately for each age group and divided into four groups based on age categories. Of the 564 healthy participants, 54.9% were female. A total of 1184 images and 3384 capillaries were analysed. Positive correlations were observed between age and capillary density (P< 0.001, R = 0.450, CI95% 0.398-0.503). There was also a positive correlation between age and arterial/venous, loop diameter and capillary length, whereas there was a weak negative correlation between intercapillary distance. However, no correlation was found between age and capillary width. In addition, capillary density was significantly lower in the 5-7 age group compared with the other patient groups. Arterial limb diameter was lower in the 5-7 age group, while venous limb diameter was significantly wider in the 15-17 age group compared with the other patient groups. Dilated capillaries (8.7%), capillary tortuosity (14.4%), crossed capillaries (43.1%), micro-haemorrhages (2.7%) and avascular area (4.8%) were present in all age groups. Excellent intra- and interobserver ICC values were obtained for all parameters. These findings hold potential significance for future studies, aiding in the analysis and differentiation of children suspected of rheumatological diseases with potential microangiopathy.

The role of the alveolar antral artery in oral and maxillofacial surgery: A comprehensive review

BackgroundThis review aims to explore the role of the alveolar antral artery and to contribute a combined data set pertaining to the artery's prevalence, diameter, and proximity of related structures. MethodsA comprehensive literature review. Five databases were searched, namely: Web of Science, Scopus, MEDLINE-PubMed, EMBASE, CINHAL-Ultimate in September 2023. Collected and analyzed data included the prevalence and diameter of the alveolar antral artery, the diameter of the artery divided into groups of less than 1 mm, 1–2 mm, and more than 2 mm, and the distance between the artery and the alveolar ridge. The AQUA-tool was utilized to assess the quality of each study. The data was extracted and organized into comparison tables. Results50 articles met the inclusion criteria. The studies reported differences between genders regarding the included criteria. The review identified inconsistent nomenclature used to describe the alveolar antral artery, potentially leading to confusion or misinterpretation among researchers and clinicians. The literature discusses a variety of scenarios regarding the artery in surgical operations, including techniques for managing and preserving it. DiscussionThe literature highlights the importance of standardizing anatomical nomenclature for anastomosis and emphasizes the necessity for developing clinical guidelines in the management of the artery.

Application of a supporting catheter in surgery for forearm arteriovenous fistula construction.

This study explored the feasibility of a supporting catheter combined with modified end-to-side anastomosis in the operation of radio-cephalic arteriovenous fistula (RC-AVF) and evaluated the clinical application value of this technique. Sixty patients underwent RC-AVF operations in our hospital from January 2022 to June 2022. All the patients were treated with modified end-to-side AVF anastomosis and divided into the control group or the test group depending on whether a supporting catheter was applied. The clinical data of 60 cases were analysed retrospectively. Intraoperative related indices, the first time the fistula was used, the success rate of first puncture, the blood flow of first dialysis, the maturity condition of fistula, the size of anastomosis, the diameter of radial artery and drainage vein, the blood flow of brachial artery 8 weeks after operation and the incidence of complications within 6 months after operation were compared between the two groups. Compared with that in the control group, the time spent on the vascular anastomosis in the test group was significantly shortened (p<0.05). The blood flow of the first dialysis, the size of the anastomosis, the diameter of the drainage vein, the blood flow of the brachial artery 8 weeks after the operation and the incidence of complications within 6 months after operation were significantly different between the two groups (p<0.05). In the RC-AVF operation, using a supporting catheter can not only increase operation efficiency by reducing surgical injury and difficulty of vascular anastomosis, but also improve postoperative prognosis. RC-AVF is worth promoting in clinical practice.

Ultrasound Guided Measurement of Inferior Vena Cava Diameter, Common Carotid Artery Diameter versus Central Venous Pressure for Estimation of Intravascular Volume Status in Septic Shock Patients

Background: In critically ill patients, the fluid resuscitation is crucial and is the first step in treatment protocol. Invasive CVP measurement was used to guide fluid resuscitation. However, it is time consuming and invasive maneuver. Ultrasound measurement of inferior vena cave and common carotid arteries are suggest to predict the fluid response as well as CVP or even better. The current work designed to compare inferior vena cava diameter and common carotid artery diameter with central venous pressure for estimation of intravascular volume status in septic shock. Patients and Methods: The study included 60 subjects with septic shock who received vasopressor support. CVP and ultrasound were performed before and after fluid challenge test. Values of inferior vena cava and common carotid arteries were documented and compared to CVP values. This was performed after full clinical assessment by detailed clinical examination and laboratory workup. Results: The MAP was significantly increased and HR decreased after than before procedure. In addition, CVP, (inferior vena cava), ICVmax, ICV min and common carotid artery diameter (CCAD) were significantly increased, IVC CI (%) was significantly reduced after procedure than basal values. There was significant decrease of IVCmax, IVCmin and CCAD while there was significant increase of IVC CI% with lower (&lt;8) than higher (&gt; 8) CVP values. CVP was positively and significantly correlated with IVCmax, IVCmin and CCAD, while it was inversely correlated with IVC CI%. The AUC was over 0.75 for IVCmax, IVCmin and CCAD for prediction of CVP while it was lower than 0.7 for IVC CI%. These data reflected the better predictive power of IVCmax, IVCmin and CCAD. The best cutoff value was 1.35, 1.25, 10.45 and 4.15 for IVCmax, IVCmin, IVC CI% and CCAD successively. Conclusion: IVC and CCA diameters measurement by US may replace CVP measurement for estimation of intravascular volume status in septic shock patients.

Novel Noninvasive Index Combining Echocardiography and Computed Tomography for Screening for Pulmonary Hypertension in Patients With Systemic Sclerosis

BackgroundIn patients with systemic sclerosis (SSc), early detection of pulmonary hypertension (PH) improves survival. This study aimed to investigate whether a combination index (cPAT) of the tricuspid regurgitation jet peak gradient and the ratio of pulmonary artery (PA) diameter to aortic diameter measured by computed tomography (CT; PA ratio) can estimate the mean PA pressure (mPAP) and detect PH more accurately than conventional parameters in SSc patients. MethodsA total of 36 SSc patients who underwent PH screening were retrospectively analyzed. All patients were screened for PH between 2013 and 2017 by echocardiography, CT, and right heart catheterization. Patients with mPAP > 20 mm Hg by right heart catheterization were diagnosed as having PH. Additionally, patients with an mPAP > 20 mm Hg, pulmonary vascular resistance > 2 Wood units, and PA wedge pressure ≤ 15 mm Hg, for whom other causes were ruled out, including group 2-5, were defined as having pulmonary atrial hypertension. ResultsOf 36 patients, 29 patients were female (81%), and the average duration of SSc was 7.5 years. The mPAP was significantly correlated with the tricuspid regurgitation jet peak gradient (r = 0.734), the PA ratio (r = 0.584), and the cPAT (r = 0.848). In receiver operating characteristic analysis to identify PH, the cPAT showed the highest area under the curve, 0.906, among the 3 parameters. Additionally, in receiver operating characteristic analysis to identify pulmonary atrial hypertension, the cPAT also showed the highest area under the curve, 0.851, among the 3 parameters. ConclusionsThe cPAT is a new index combining echocardiogram and CT results that provides the most accurate noninvasive assessment of mPAP in SSc patients. The cPAT can also help detect PH early in SSc patients, thereby allowing for earlier treatment.

Analysis of the diameter of the distal radial artery at anatomic snuffbox by ultrasonography in patients scheduled for coronary intervention.

Assessing the size of the distal radial artery (DRA) in anatomic snuffbox (AS) before coronary intervention is extremely important in the selection of suitable patients, improving the success rate of puncture and reducing the complications. To evaluate the diameter of the DRA in AS and its influencing factors in Chinese patients scheduled for coronary intervention. Ultrasound was used to detect the inner diameter of vessels. A total of 1182 patients were involved in the study. In all patients, the mean inner diameters of the DRA, conventional radial artery (CRA) and ulnar artery (UA) were 2.00 ± 0.43 mm, 2.38 ± 0.51 mm and 1.99 ± 0.47 mm, respectively. The proportion of DRA diameter ⩾2.0 mm was 53% (in all patients), 64% (in males), 36% (in females), respectively. The DRA/CRA ratios were 0.85 ± 0.13 in all patients, 0.86 ± 0.13 in males and 0.84 ± 0.13 in females. The diameter of the DRA was strongly positively correlated with the diameter of the CRA (r = 0.750, p < 0.05), and weakly correlated with the body mass index (r = 0.303, p < 0.05) and the diameter of the UA (r = 0.304, p < 0.05). Multivariate regression analysis showed that female sex, age ⩾60 years, body mass index <24 kg/m2, previous CRA/DRA access and history of coronary artery disease were independent predictors of the DRA diameter <2.0 mm. Measurement of the diameter of the DRA by ultrasonography may offer important information prior to coronary catheterization.

NEW ONSET OF PULMONARY HYPERTENSION IN A PATIENT AFFECTED BY RECURRENT LUNG CANCER

Abstract 39 years old non–smoker female patient came to our observation in July 2023 complaining dyspnea on mild exertion. She had a history of lung adenocarcinoma with epidermal growth factor receptor (EGFR) positive for exon 19 deletion treated with left pneumonectomy and ipsilateral hilar mediastinal lymphadenectomy 5 years earlier, and contralateral disease progression currently treated with chemotherapy. Transthoracic echocardiogram showed circumferential prepericardial effusion requiring pericardiocentesis with transient clinical benefit. Indeed, after a month, she presented with worsening dyspnea and echocardiographic evidence of dilated and hypokinetic right ventricle and severe pulmonary hypertension associated with distal right pulmonary artery stenosis secondary to extrinsic compression by the neoplastic mass as shown by the chest CT scan (fig 1). A right heart catheterization confirmed this finding (minimum diameter of right pulmonary artery of 6 mm, maximum systolic pulmonary blood pressure of 99 mmHg) and a palliative stenting of the distal portion of the right pulmonary artery was performed with resolution of the stenosis, reduction of the pulmonary gradient (fig 2 and 3) and resolution of the dyspnea.

Comprehensive Two-Dimensional Pediatric Echocardiographic Nomograms for Coronary Artery Sizes in Caucasian Children and Comparison among Major Nomograms.

Although coronary artery nomograms in children have been published, data on Caucasian children are lacking. The aim of this study is to provide: (i) a full dataset of coronary artery diameters in healthy children and (ii) a comparison among major previous nomograms. We prospectively evaluated 606 healthy subjects (age range, 1 days-<18 years; median age 8.7 years; 62.5% male). Coronary artery measurements in a short-axis view were performed. Age, heart rate, and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. To assess the accuracy of the predictive models of different studies, a Z-score calculator was created using Lopez's nomograms for comparison. The association with BSA was found to be stronger, and was used for normalization of our data. The best-fit models, satisfying the assumption of homoscedasticity and normality of residuals and showing the highest R2 scores, were logarithmic (ln[y] = a + b*ln[x]). Predicted values and Z-score boundaries by BSA are provided. Our ranges of normality are slightly lower than those, diverging from -0.22 to -0.59 Z-scores for the left main coronary artery and from -0.23 to -0.3 Z-scores for the right coronary artery. We report a complete dataset of normal echocardiography coronary artery diameter (including new measures of the proximal origin) values in a large population of healthy children. Our data were statistically like those of north American nomograms.

Infrared thermography for normal endothelial function screening.

Endothelial dysfunction (ED) suspicion will allow to prevent accelerated atherosclerosis and premature death. To establish the usefulness of thermography for endothelial function screening in adults with cardiovascular risk factors. Cross-sectional, analytical diagnostic test. A brachial arterial diameter (BAD) increase < 11% at one-minute post-ischemia meant probable ED and was confirmed if BAD was ≥ 11% post-sublingual nitroglycerin. Thermographic photographs of the palmar region were obtained at one minute. Descriptive statistics, ROC curve, Mann-Whitney's U-test, chi-square test, or Fisher's exact test were used. Thirty-eight subjects with a median age of 50 years, and with 624 thermographic measurements were included. Nine had ED (flow-mediated vasodilation [FMV]: 2.5%). The best cutoff point for normal endothelial function in subjects with cardiovascular risk factors was ≥ 36 °C at one minute of ischemia, with 85% sensitivity, 70% specificity, positive and negative predictive values of 78 and 77%, area under the curve of 0.796, LR+ 2.82, LR- 0.22. An infrared thermography-measured temperature in the palmar region greater than or equal to 36 °C after one minute of ischemia is practical, non-invasive, and inexpensive for normal endothelial function screening in adults with cardiovascular risk factors.

Exposure to occupational air pollution and vascular endothelial dysfunction in workers of the steel industry in Iran.

Air pollution is recognized as a risk factor for cardiovascular diseases; however, the precise underlying mechanisms remain unclear. This study investigated the impact of occupational air pollution exposure on endothelial function in workers within the steel industry. Specifically, we examined male employees in the coke-making division of the Isfahan Steel Company in Iran, as well as those in administrative roles with no known history of cardiovascular risk. Data on age, body mass index, duration of employment, blood pressure, fasting blood sugar, and lipid profile were collected. To assess endothelial function, flow-mediated dilation (FMD) was measured. The baseline brachial artery diameter was greater (mean difference [95% CI] = 0.068mm [0.008 to 0.128]), while the FMD was lower (mean difference [95% CI] = -0.908 % [-1.740 to -0.075]) in the coke-making group than in the control group. After controlling for potential confounding variables, it was observed that working in the coke-making sector of the industry was associated with lower FMD (F = 3.954, p = .049). These findings indicated that occupational air pollution exposure among workers in the steel industry is linked to impaired endothelium-dependent vasodilation.

Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas.

To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure. This study included patients who underwent AVF surgery using an autogenous vein between February 2020 and June 2021 and received staged angioplasty with a full-length balloon catheter. To minimize balloon overlap and the risk of barotrauma to the immature vein, serial-staged upsizing balloon angioplasty with a long balloon catheter covering the entire vein segment was employed approximately 2 weeks apart. Twenty-three patients (mean age, 69.50 years; mean follow-up, 620.62 days) with average diameters of the radial artery and cephalic vein at 2.14 ± 0.5 mm and 2.43 ± 0.5 mm, respectively, were enrolled. In the first procedure, the average AVF diameter and flow were 4.03 ± 0.57 mm and 438.08 ± 220.95 mL/min, respectively, with juxta-anastomotic stenosis (JAS) present in 61.5% of cases. After staged full-length BAM, the average fistula diameter and flow improved to 5.95 ± 0.86 mm and 717.52 ± 305.95 mL/min, respectively. Maturation was achieved in 87% of the cases. No hematomas or ruptures occurred around the arterialized veins. Despite successful maturation and cannulation, 65.2% of the patients required additional percutaneous transluminal angioplasty (PTA) during the follow-up period. The necessity for PTA was determined by the presence of JAS prior to the first staged full-length BAM, with an odds ratio of 11.74 (95% confidence interval: 1.31-104.96, P = 0.03). Staged full-length BAM can be safely used in patients with small veins requiring further maturation. Most patients achieved successful cannulation following maturation without post-procedural complications. Staged full-length BAM is a safe and effective method for enhancing maturation in patients with underdeveloped small veins.

Transfemoral-only transcatheter aortic valve replacement: A single center experience of 400 consecutive patients.

In transcatheter aortic valve replacement (TAVR),transfemoral (TF) access offers several advantages over alternative access routes. Advances in sheaths and valve delivery technology have catalyzed the feasibility of TF-TAVR, even in challenging anatomies. Report procedural characteristics and outcomes of a TAVR program aiming for a 100% TF access rate. Consecutive patients undergoing TAVR were enrolled in a prospective registry. Equipment used to facilitate TF-access in challenging anatomies included low-profile sheaths, dilatators, peripheral balloons, covered and uncovered self-expandingand balloon-expandable stents, and intravascular lithotripsy (IVL). A total of 400 patients with a mean age of 81 ± 6 years (42% female) were analyzed. Minimal iliofemoral artery diameter (MLD) of the main access side was <5 mm in 42 (10.5%), extreme tortuosity was present in 65 (16.3%), and severe calcification in 59 (14.8%). TF-access was successful in 399 (99.8%) patients. A transaxillary access was used in one patient. In multivariable analysis, an MLD < 5 mm was the strongest predictor for vascular complications (11.9% vs. 3.9%, OR: 3.86, 95% CI: 1.38-10.8, p = 0.01). Such patients also had more major/life-threatening bleeding (14.2% vs. 3.1%, p < 0.001) and required more planned and unplanned peripheral interventions to enable TFaccess (35.8% vs. 3.4%, p < 0.001). Our study shows that utilization of dedicated sheaths, peripheral balloons, stents, and IVL enables TAVR via TF access in >99% of patients. However, rates of vascular and bleeding complications in patients with narrow iliofemoral arteries (MLD < 5 mm) were high.

Impact of yoga on the central and peripheral vascular function among desk-based workers: A single-centered trial study

Background The aim of this study was to observe and analyze vascular function in ‘prolonged sitting’, followed by a yoga asana routine and pranayama intervention. Participants in this study include those who work from desks in offices. The study required the participants to attend on three separate days at random, and they had to finish a computerized test on each day. On the first day, participants were required to complete a computer test while sitting still for four hours (with the exception of washroom breaks). The next day, they underwent a computerized test along with a pranayama intervention. Finally, on the last day, they underwent a computerized test along with a yoga asana intervention. At the start of the study and after two and four hours, we measured the diameter and velocity of the common carotid artery (CCA) and superficial femoral artery (SFA). Methods The study was a within-subjects prospective single-center trial conducted in the Department of Radio-Diagnosis and Imaging, Kasturba Medical Hospital, Manipal, India, between September 2022 and January 2023. Participants were asked to do one of the following ‘activities’ over successive weeks: Week 1 – Prolonged sitting; Week 2 – Pranayama intervention; and Week 3 – Yoga asana intervention during prolonged sitting. The baseline and follow-up variables of pulse velocity, endothelial thickness, and shear rate were assessed for normality through a Shapiro-Wilk Test. Results Our sample included 11 participants with moderate physical activity, five with high physical activity and one with low physical activity. Yoga asana intervention comprised participants sitting continuously for four hours, with a yoga asana intervention being provided every hour, lasting for 10 minutes. Conclusions Yoga asana improves vascular functions in prolonged sitting conditions. This routine can promote the concept of interrupted sitting and ways to reduce it with efficient yoga asana practice without changing the work culture and provide better physical relief. Trial registration Clinical Trials Registry – India ( CTRI/2022/09/045628), date of registration: 19/09/2022(CTRI/2022/9/045628)https://ctri.nic.in/Clinicaltrials/main1.php?EncHid=16349.27799,

Determining risk factors for vascular and bleeding complications after TAVR using CT angiography

Abstract Funding Acknowledgements None. Introduction The use of pre-procedural computed tomography angiography (CTA) of the iliofemoral sector in the planning of transaortic valve replacement (TAVR) has demonstrated a reduction in the risk of vascular complications in patients undergoing TAVR. In this study, we aimed to characterise the clinical and radiological factors associated with bleeding and vascular complications after TAVR. Methods Patients undergoing transfemoral TAVR in a tertiary centre between 2017 and 2019 were included in this analysis. All patients underwent iliofemoral CTA before the procedure and classical CTA-derived data as well as iliofemoral calcium volume were collected. Clinical data and outcomes regarding bleeding events, as well as vascular complications according to Valve Academic Research Consortium 2 (VARC-2) criteria, were also collected. 207 patients were included in this analysis, of whom 53% were women. The median age was 82 years (IQR 76-86) and the median STS mortality risk score was 3.9% (IQR 2.59-5.99). In this population, vascular complications according to the VARC-2 criteria occurred in 33% of patients (19% with major complications). Patients with lower body mass index (BMI) were more likely to suffer vascular complications. Vascular access with fluoroscopy was associated with a higher prevalence of complications compared to ultrasound-guided vascular access (62% vs. 38%, p=0.037). When considering radiological criteria, smaller minimum luminal diameter and area of the common femoral and external iliac arteries were associated with a greater risk of vascular complications, as were increased sheath to external iliac artery ratios and luminal attenuation values (p&amp;lt;0.05 for all). Bleeding complications occurred in 20 patients, with a greater prevalence of bleeding events in female patients (77% vs. 23%, p=0.001). Patients with a lower BMI, a history of obstructive pulmonary disease or coronary artery disease, aortic insufficiency and fluoroscopic valvular access were more likely to have bleeding complications. Regarding radiological criteria, decreased maximal luminal diameter of the common femoral artery and smaller minimal luminal diameters and areas of the external iliac artery were associated with bleeding complications. Increased sheath-to-femoral artery ratios and luminal attenuation values were associated with an increased risk of vascular complications (p&amp;lt;0.05 for all). Conclusion Our study underscores the importance of pre-procedural CTA in TAVR planning and identifies separate risk factors for vascular and bleeding complications.