Atherosclerotic Occlusive Disease Research Articles

Polyvascular Disease is Common in Patients Undergoing Carotid Endarterectomy and Lower Extremity Bypass and is Associated With Worse Outcomes

IntroductionPolyvascular disease is strongly associated with increased risk of cardiovascular morbidity and mortality. However, its prevalence in patients undergoing carotid and lower extremity surgical revascularization and its impact on outcomes are unknown. MethodsThe Vascular Quality Initiative was queried for carotid endarterectomy (CEA) or infrainguinal lower extremity bypass (LEB), 2013-2019. Polyvascular disease was defined as presence of atherosclerotic occlusive disease in > 1 arterial bed: carotid, coronary, and infrainguinal. Primary outcomes were: (1) composite perioperative myocardial infarction (MI) or death and (2) 5-year survival. Patient characteristics and perioperative outcomes were evaluated using chi-square test and multivariable logistic regression. Survival was analyzed using Kaplan-Meier method and Cox proportional hazards multivariable models. ResultsPolyvascular disease was identified in 47% of CEA (39% 2 arterial beds, 7.6% 3 arterial beds; n = 93,736) and 47% of LEB (41% 2 arterial beds, 5.7% 3 arterial beds; n=25,223). For both CEA and LEB, patients with polyvascular disease had more comorbidities including hypertension, congestive heart disease, chronic obstructive pulmonary disease, smoking, diabetes mellitus, and end-stage renal disease (P<0.0001). Perioperative MI/death rates increased with increasing number of vascular beds affected following CEA (0.9% 1 bed vs 1.5% 2 beds vs 2.7% 3 beds, P<0.001) and LEB (2.2% 1 bed vs 5.3% 2 beds vs 6.6% 3 beds, P<0.001). Polyvascular disease was independently associated with perioperative MI/death after CEA (OR 1.59 (95% CI 1.40-1.81), P<.0001) and LEB (OR 1.78 (95% CI 1.52-2.08), P<.0001). Five-year survival was decreased in patients with polyvascular disease after CEA (82% 3 beds vs 88% 2 beds vs 92% 1 bed, P<0.01) and LEB (72% 3 beds vs 75% 2 beds vs 84% 1 bed, P<0.01) in a dose-dependent manner, with the lowest 5 year survival observed in those with 3 arterial beds involved. Polyvascular disease was independently associated with five-year mortality following CEA (HR 1.33 (95% CI 1.24-1.40), P=0.0001) and LEB (HR 1.30 (95% CI 1.20-1.41), P=0.0001). ConclusionPolyvascular disease is common in patients undergoing CEA and LEB and is associated with higher risk of perioperative MI/death and decreased long-term survival. Following revascularization, polyvascular disease patients may be considered for more aggressive cardioprotective medications and closer follow up.

Outcomes of Endovascular Intervention for Atherosclerotic Lesions Confined to the Popliteal Artery

Most surgeons employ an endovascular-first approach to the treatment of peripheral arterial disease (PAD), but controversy remains regarding the ideal interventions for the management of isolated popliteal artery disease (IPAD). Indeed, there are a paucity of data that compare outcomes of popliteal stents vs other peripheral vascular interventions (PVIs). The goal of this study was to evaluate outcomes of PVIs in IPAD. The Vascular Study Group of New England database was queried for all IPAD PVIs performed for atherosclerotic occlusive disease from 2010 to 2021. Those with at least 1 year of follow-up data available were included for analysis. The primary endpoint was 1-year freedom from a composite target lesion (TL) treatment failure that included restenosis >50% on duplex, reintervention, or ipsilateral major amputation. We included 689 procedures performed on 634 patients. Of these, 250 (36.3%) were treated with plain balloons (POBA), 215 (31.2%) had stents, 170 (24.7%) had special balloons (drug-coated, cutting, or lithotripsy), and 54 (7.8%) atherectomies were performed. Stent placement was associated with lower freedom from TL treatment failure (72.6%) than special balloon (81.2%; P= .048) and atherectomy (88.9%; P= .012), but not POBA (76.8%; P= .293). On multivariable logistic regression, stents (odds ratio, 0.637; P= .021) and preoperative P2Y12 inhibitor therapy (odds ratio, 0.683; P= .048) were both associated with lower freedom from intervention failure. Popliteal stent placement is associated with a higher rate of TL treatment failure at 1year when compared with other PVIs including special balloon angioplasty and atherectomy, but not POBA, and should therefore be avoided in favor of special balloons or atherectomy whenever feasible.

Incidence, Risk Factor and Prognosis of Carotid Artery Stenosis in Patients with Atherosclerotic Occlusive Disease

Incidence, Risk Factor and Prognosis of Carotid Artery Stenosis in Patients with Atherosclerotic Occlusive Disease

Comparative study of arterial doppler with digital subtraction angiography in lower limb peripheral arterial disease: a protocol

Background One of the serious cardiovascular conditions is peripheral arterial disease; in which distinctive feature is diminished blood supply towards the lower extremities, frequently because of atherosclerotic occlusive disease. Methods We will compare arterial Doppler with digital subtraction angiography in peripheral lower limb occlusive arterial sickness; to determine Peripheral Arterial Disease along with its location and stenosis severity on Duplex Ultra-Sonography and Digital Subtraction Angiography; and to determine the segment-to-segment agreement of the arterial tree within Duplex Ultra-Sonography and Digital Subtraction Angiography. Implications This will encourage the participants for periodic investigation and proper use of medications which will improve hospital/facility outcome. It will be helpful for older individuals how are more susceptible to peripheral artery disease. A fair accurate treatment options will be given to patients. Limitations Findings will only be applicable to our organization because the study will be done at one tertiary care hospital, limiting their external validity and generalizability.

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review PART II-Pharmacological Approach for Management of Elderly Patients with Peripheral Atherosclerotic Lesions outside Coronary Territory.

Aging is a key risk factor for atherosclerosis progression that is associated with increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity, quality of life, and it is associated with reduced life expectancy. As most multicenter randomized trials exclude elderly and very elderly patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home, there is insufficient data on the management of older patients presenting with atherosclerotic lesions outside coronary territory. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment. In addition, due to a variety of severe comorbidities in the elderly, the average daily number of pills taken by octogenarians exceeds nine. Polypharmacy frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and non-adherence. Therefore, we have attempted to gather data on the medical treatment in patients with extra-cardiac atherosclerotic lesions indicating where there is some evidence of the management in elderly patients and where there are gaps in evidence-based medicine. Public PubMed databases were searched to review existing evidence on the effectiveness of lipid-lowering, antithrombotic, and new glucose-lowering medications in patients with extra-cardiac atherosclerotic occlusive disease.

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review: Part I-Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients.

Atherosclerosis is a generalized and progressive disease. Ageing is a key risk factor for atherosclerosis progression that is associated with the increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity and quality of life, and it is associated with reduced life expectancy. Although there is evidence on coronary artery disease management in the elderly, there is insufficient data on the management in older patients presented with atherosclerotic lesions outside the coronary territory. Despite this, trials and observational studies systematically exclude older patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment and referral for endovascular or surgical interventions. Therefore, we attempted to gather data on the prevalence, risk factors, and management strategies in patients with extra-coronary atherosclerotic lesions.

Transcriptomic Analysis of Type 2 Diabetes Mellitus Combined with Lower Extremity Atherosclerotic Occlusive Disease.

The pathological damage mechanism of type 2 diabetes (T2D) and macroangiopathy is extremely complex, and T2D and arteriosclerosis obliterans have different biological behaviors and clinical features. To explore the mechanism of lower extremity arteriosclerosis occlusion (LEAOD) in T2D patients, we utilized RNA-seq to identify unique gene expression signatures of T2D and LEAOD through transcriptomic analysis. We obtained blood samples and performed RNA sequencing from four patients with T2D, five of whom had LEAOD. Another six age- and gender-matched blood samples from healthy volunteers were used for control. By exploring the general and specific differential expression analysis after transcriptome sequencing, specific gene expression patterns of T2D and LEAOD were verified. Transcriptome analysis found differentially expressed genes in T2D, and T2D + LEAOD (vs normal) separately, of which 35/486 (T2D/T2D + LEAOD) were up-regulated and 1290/2970 (T2D/T2D + LEAOD) were down-regulated. A strong overlap of 571 genes across T2D, LEAOD, and coexisting conditions was mainly involved in extracellular exosomes and the transcription process. By exploring the sex difference gene expression features between T2D, T2D + LEAOD, and healthy controls, we noticed that sex chromosome-associated genes do not participate in the sexual dimorphism gene expression profiles of T2D and LEAOD. Protein-Protein Interaction Network analysis and drug target prediction provided the drug candidates to treat T2D and LEAOD. This study provides some evidence at the transcript level to uncover the association of T2D with LEAOD. The screened hub genes and predicted target drugs may be therapeutic targets.

MINIMAL INCISION SURGERY FOR THE AORTOILIAC SEGMENT – RESULTS OF A SINGLE-CENTER STUDY

The purpose of this prospective single-center study was to determine the feasibility of minilaparotomy for aortoiliac segment and its effect on intraoperative and postoperative outcomes. Materials and Methods: From August 2020 to July 2022, the authors used minilaparotomy in 24 patients with aortoiliac atherosclerotic occlusive disease. The comparison group included 27 patients undergoing laparotomy. The age of the patients ranged from 58 to 83 years, among them 37 men and 14 women. In the group with traditional access, 9 aorto-bifurcational and 18 linear operations were performed; in the minimal incision group, there were 7 bifurcational and 17 linear interventions. Results and Discussion: The duration of surgery was 196.5±26.7 minutes for operations with traditional access, and 146.3±16.7 minutes in the group with minimal incision. On average, minimal incision surgeries were shorter by 52.3±14.4 minutes (p≤0.05). For patients from the group with minimal incision, the length of stay in intensive care was 1.27±0.4 days, and with traditional access 2.3±0.3 (p≤0.05). Postoperative bed stay for the group with mini-access was 6.4±0.5 days, for patients with classic access 9.2±1.2 days (p≤0.05). 4 patients in the comparison group had postoperative paresis, and in one of them it was complicated by eventration. In the long-term postoperative period, two patients in the comparison group required surgery for an incisional hernia. Conclusions: Minimal incision access to the aorta can reduce surgical trauma and intervention time, shorten the patient’s stay in the intensive care unit and postoperative bed, and minimize perioperative and postoperative complications. During repeated reconstructive interventions on the aorta, a “high” mini-access to the aorta allows to quickly reach the optimal area of the aorta for anastomosis and minimize organ trauma, as well as prevent adhesions in the abdominal cavity.

Correlation between C-reactive protein to albumin ratio and restenosis after femoral popliteal stenting in patients with lower extremity arteriosclerotic obliterans

Objective: To investigate the study of the correlation between C-reactive protein to albumin ratio (CAR) and restenosis after stenting in patients with lower extremity atherosclerotic occlusive disease(LEASO). Methods: The clinical data of 95 patients with LEASO admitted to the Department of Vascular Surgery of Nanjing Drum Tower Hospital from June 2020 to December 2022 were retrospectively analyzed. There were 67 males and 28 females,aged (73.1±9.4) years (range:51 to 92 years). The patients were classified into the restenosis group (n=61) and the patency group (n=34) according to the CT angiography results. Independent sample t test,Mann-Whitney U test and χ2 test were used to compare the data between two groups. Risk factors for restenosis after femoropopliteal artery stenting in patients with LEASO were analyzed using multivariate Cox regression. The relationship between preoperative CAR level and restenosis after stent placement was analyzed. Subject operating characteristic(ROC) curves of CAR were plotted to assess the predictive value of CAR for restenosis after stenting,and the results were expressed as area under the curve (AUC). Results: The aortoiliac calcification grade,number of stents,length of stents,C-reactive protein and CAR levels in restenosis group were higher than those in the patency group,and the serum albumin level was lower than that in the patency group(all P<0.05). And the results of multifactorial Cox regression analysis showed that higher pre-procedure CAR level and lower ABI value was an independent risk factor for in-stent restenosis. The AUC of the ROC curve for restenosis was 0.737(95%CI:0.617 to 0.856),the AUC of the ROC curve for 12-month restenosis was 0.709(95%CI:0.602 to 0.815), and the AUC of the ROC curve for 24-month restenosis was 0.702(95%CI:0.594 to 0.811). Conclusion: Higher pre-procedural CAR levels in patients with LEASO is risk factor for in-stent restenosis,and CAR has a predictive value for restenosis after lower extremity arterial stent dilatation and angioplasty.

Tips and Tricks to Facilitate the Combined Iliofemoral Endarterectomy With Stenting for Heavily Calcified Common Femoral Artery Atherosclerosis With Involvement of the External Iliac Artery.

Management of a heavily calcified atherosclerotic occlusive disease involving the common femoral artery (CFA) and external iliac artery (EIA), poses a surgical challenge. Though the current guidelines recommend open surgical therapy for such lesions, this approach is neither easy nor represents the current real-life practice. To describe tips and tricks facilitating the hybrid technique for the management of distal iliofemoral atherosclerotic disease, where classic endarterectomy is inadequate or ill-performed. A contralateraly inserted guidewire reaches the distal iliac artery via the crossover technique and is directly retrieved from the femoral arteriotomy immediately after removal of the anterior plaque segment. The retrieved and secured guidewire enables extensive retrograde CFA endarterectomy over the wire with avusion proximally to the inguinal ligement, followed by patch arterioplasty. Externalizing the guidewire from the patch enables traction on it and facilitates advancement of the stent through tortuous or stenosed iliac vessels as well as accurate stent deployment to cover the margin of the EIA residual plaque. Moreover, this manipulation enables ipsilateral placement of a sheath and passage of a second, retrograde guidewire to perform kissing stenting in the common iliac vessels. Chronic thrombotic lesions require covered stents to avoid thrombus propagation and meticulous flushing before completion of the femoral patching. The combined iliofemoral endarterectomy with stenting does not require advanced endovascular skills and prevents complications associated with incomplete femoral endarterectomy. Extensive avulsion endarterectomy proximal to the inguinal ligament is efficiently and safely performed over a retrieved crossover guidewire, enabling precise residual stenting above the flexion site.

Contemporary Medical Management of Peripheral Arterial Disease.

Peripheral arterial disease (PAD) is characterized by atherosclerotic arterial occlusive disease of the lower extremities and is associated with an increased risk of major adverse cardiovascular events (MACE) in addition to disabling clinical sequelae, including intermittent claudication and chronic limb-threatening ischemia (CLTI). Given the growing burden of disease, knowledge of modern practices to prevent MACE and major adverse limb events (MALE) is essential. This review article examines evidence for medical management of PAD and its associated risk factors, as well as wound prevention and care. A thorough review of the literature was performed, with attention to evidence for the management of modifiable atherosclerotic risk factors, claudication symptoms, wound prevention, and wound care. Contemporary management of PAD requires a multi-faceted approach to care, with medical optimization of smoking, hypertension, hyperlipidemia, and diabetes mellitus. The use of supervised exercise therapy for intermittent claudication is highlighted. The anatomic disease patterns of smoking and diabetes mellitus are discussed further, and best practices for diabetic foot ulcer prevention, including offloading footwear, are described. Quality wound care is essential in this patient population and involves strategic use of debridement, wound-healing adjuncts, and skin substitutes, when appropriate. The objective of medical management of PAD is to reduce the risk of MACE and MALE. Atherosclerotic risk factor optimization, appropriate wound care, and management of diabetic foot ulcers, foot infections, gangrene, and chronic, non-healing wounds are critical components of PAD care. Interdisciplinary care is essential to coordinate care, leverage expertise, and improve outcomes.

Endovascular revascularization of isolated internal iliac artery for symptomatic occlusive atherosclerotic disease is a viable and underused option for patients with gluteal muscle claudication

Often confused with pseudoclaudication, gluteal muscle claudication is a difficult condition to diagnose and treat. We present the case of a 67-year-old man with a history of back and buttock claudication. He had undergone lumbosacral decompression with no relief of buttock claudication. Computed tomography angiography of the abdomen and pelvis showed occlusion of the bilateral internal iliac arteries. Exercise transcutaneous oxygen pressure measurements obtained on referral to our institution revealed a significant decrease. He underwent successful recanalization and stenting of the bilateral hypogastric arteries with complete resolution of his symptoms. We also reviewed the reported data to highlight the trend in the management of patients with this condition.

Abstract 546: MicroRNA-1282 As A Cis-Antisense Regulator Of Angiogenesis In Diabetic Critical Limb Ischemia

Introduction: Peripheral artery disease (PAD) is an atherosclerotic occlusive disease that leads to reduced blood flow to the lower extremities and endothelial dysfunction. Some patients develop critical limb ischemia (CLI), a severe manifestation of PAD defined as chronic ischemic rest pain with higher risk of amputation. Major risk factors for both PAD and CLI is type 2 diabetes. However, the pathophysiological contribution of microRNAs (miRNAs), in diabetic CLI progression remains poorly elucidated. Methods: By overlapping plasma miRNA sequencing in PAD patients that develop CLI with a mouse model, miRNAs were identified in the progression of diabetic limb ischemia. In this study, we describe miR-1282, a previously uninvestigated miRNA that was the highest upregulated miRNA in high-risk diabetic CLI human subjects. Results: Preliminary studies uncover a mouse ortholog of human miR-1282, a cis-antisense miRNA, that strongly inhibits the expression of SERF2 (small EDRK-rich factor 2), a protein-coding gene located on the opposite DNA strand in both human and mouse endothelial cells. SERF2 is predicted to affect the formation of aggresomes, the inclusion bodies of misfolded proteins; however, its molecular function is also poorly understood. MiR-1282 expression was decreased by diabetic stimuli such as hypoxia and glucose; and its expression inversely correlated with SERF2 expression in endothelial cells. Our in vitro studies indicate that miR-1282 mimic overexpression or SERF2 siRNA-mediated inhibition reduced a range of endothelial angiogenic assays and inhibits apoptosis. Proteomics by tandem mass-tag mass-spectrometry and transcriptomics by RNA-Seq suggest that miR-1282 likely regulates protein quality control system (SERF2, BAG1, BAG3, and HSPB8) and regulated cell death (CASP3, SLC7A11, and CTH), among others. Intriguingly, intramuscular administration of miR-1282 significantly improved blood flow recovery by laser doppler imaging in the hindlimbs of diabetic db/db mice compared to control injected mice. Conclusion: Taken together, the cis-antisense regulatory network of miR-1282-SERF2 axis reveals novel insights in the progression of diabetic CLI.

Long-term outcomes and quantitative radiologic analysis of extracranial–intracranial bypass for hemodynamically compromised chronic large artery occlusive disease

This study aimed to demonstrate the effectiveness of nonemergent extracranial-to-intracranial bypass (EIB) in symptomatic chronic large artery atherosclerotic stenosis or occlusive disease (LAA) through quantitative analysis of computed tomography perfusion (CTP) parameters using RAPID software. We retrospectively analyzed 86 patients who underwent nonemergent EIB due to symptomatic chronic LAA. CTP data obtained preoperatively, immediately postoperatively (PostOp0), and 6 months postoperatively (PostOp6M) after EIB were quantitatively analyzed through RAPID software, and their association with intraoperative bypass flow (BF) was assessed. The clinical outcomes, including neurologic state, incidence of recurrent infarction and complications, were also analyzed. The time-to-maximum (Tmax) > 8 s, > 6 s and > 4 s volumes decreased significantly at PostOp0 and up through PostOp6M (preoperative, 5, 51, and 223 ml (median), respectively; PostOp0, 0, 20.25, and 143 ml, respectively; PostOp6M, 0, 7.5, and 148.5 ml, respectively; p < 0.001, p < 0.001, and p < 0.001, respectively). The postoperative improvement in the Tmax > 6 s and > 4 s volumes was significantly correlated with the BF at PostOp0 and PostOp6M (PostOp0, r = 0.367 (p = 0.001) and r = 0.275 (p = 0.015), respectively; PostOp6M r = 0.511 (p < 0.001) and r = 0.391 (p = 0.001), respectively). The incidence of recurrent cerebral infarction was 4.7%, and there were no major complications that produced permanent neurological impairment. Nonemergent EIB under strict operation indications can be a feasible treatment for symptomatic, hemodynamically compromised LAA patients.

Medial artery calcification in peripheral artery disease.

Medial artery calcification (MAC) is a distinct, highly regulated process that is often identified in small and mid-sized arteries of the lower extremities. It is associated with advanced age, diabetes, and chronic kidney disease. MAC often occurs in conjunction with atherosclerotic occlusive disease in lower extremity arteries, and when seen together or in isolation, long-term limb outcomes are negatively affected. In patients with peripheral artery disease (PAD), the extent of MAC independently correlates with major amputation and mortality rates, and it predicts poor outcomes after endovascular interventions. It is associated with increased arterial stiffness and decreased pedal perfusion. New endovascular methods aimed at treating calcified lower-extremity lesions may improve our ability to treat patients with limb-threatening ischemia. Although recent developments have increased our understanding of the mechanisms contributing to MAC, further investigations are needed to understand the role of medial calcification in PAD, and to develop strategies aimed at improving patient outcomes.

Predictors of restenosis after popliteal angioplasty in patients with chronic limb threatening ischemia

Purpose: To evaluate factors associated with restenosis after angioplasty of popliteal artery lesions in patients presenting with chronic limb threatening ischemia. Methods: A prospective non-randomized study between from August 2018 to December 2020 conducted on 25 patients presenting with chronic limb threatening ischemia and having popliteal artery atherosclerotic occlusive disease (median age 65.52 (±8.35) years). Plain balloon angioplasty was done and patients were followed for 6 months. The primary outcomes were the primary patency and predictors of restenosis. Results: The primary patency at 6 months was 64%. Restenosis after angioplasty was associated with the presence of multilevel disease (p=0.036), presence of complete total occlusion (p=0.003), and subintimal angioplasty (p=0.005). Other studied variables weren't associated with patency loss. Conclusion: Angioplasty of popliteal atherosclerotic disease is feasible and has accepted short term primary patency rate. The presence of multilevel disease, popliteal complete occlusion, and the use of subintimal angioplasty were associated with lower primary patency after 6 months.

When is revascularization of an anomalous left vertebral artery necessary prior to its coverage?

In the current issue, Potter et al present a series of 17 left vertebral-to-carotid artery transpositions in patients with an anomalous left vertebral artery (aLVA) originating from the arch of the aorta undergoing arch procedures and thoracic endovascular aneurysm repairs that would otherwise require sacrifice or coverage of the aLVA.1 Previously, the largest series of aLVA-to-carotid transpositions performed in the setting of aortic repairs consisted of only six patients.2 Of note, Bergeur’s seminal report of 218 proximal VA transpositions were performed primarily for symptomatic atherosclerotic occlusive disease.

Clinical Application of Serum microRNAs in Atherosclerotic Coronary Artery Disease.

MicroRNAs (miRs) are promising diagnostic, prognostic and therapeutic biomolecules for atherosclerotic cardiovascular disease. Atherosclerotic occlusive disease concerns a large population of patients, carrying the highest incidence of fatal and non-fatal adverse events, such as myocardial infarction, ischemic stroke, and limb ischemia, worldwide. Consistently, miRs are involved in regulation and pathogenesis of atherosclerotic coronary artery disease (CAD), acute coronary syndromes (ACS), both with ST-segment (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI), as well as cardiac remodeling and fibrosis following ACS. However, the genetic and molecular mechanisms underlying adverse outcomes in CAD are multifactorial, and sometimes difficult to interpret for clinicians. Therefore, in the present review paper we have focused on the clinical meaning and the interpretation of various miRs findings, and their potential application in routine clinical practice.

Role of NOS and Inflammatory Markers in the Early Restenosis After the Application of Femoral Arterial Stent.

The objective of this research was to investigate the role of inflammatory markers, including the interleukin-6 (IL-6), matrix metalloprotease 9 (MMP-9), tumor necrotic factor α (TNF-α), endothelin-1 (ET-1) and nitric oxide synthase (NOS) in the early restenosis after the application of femoral arterial stent. According to this, serum samples were collected from the patients who accepted the implantation of arterial stents due to the atherosclerotic occlusive disease in the lower extremities at the following timepoints: 24 h before implantation, 24 h, 1 month, 3 months and 6 months after implantation. With the samples, we detected the levels of IL-6, TNF-α and MMP-9 by using the enzyme-linked immunosorbent assay (ELISA) in serum, levels of ET-1 in plasma by using the non-balanced method of radioimmunity assay and the activity of NOS by using the chemical analysis. Results showed that during the 6-month follow-up, 15 patients (15.31%) reported restenosis; at postoperative 24 h, the level of IL-6 in the restenosis group was much lower than that of the non-restenosis group (P < 0.05), while the level of MMP-9 was higher than that of the non-restenosis group (P < 0.01); besides, at postoperative 24 h, 1, 3, and 6 months after the operation, the average level of ET-1 in the restenosis group was higher than that in the non-restenosis group (P < 0.05 or 0.01). In the restenosis group, the level of NOS in the serum of patients after the implantation of the stent decreased evidently, which was rescued by the treatment of atorvastatin in a dose-dependent manner (P < 0.05). In conclusion, at postoperative 24 h, the levels of IL-6 and MMP-9 increased, while the level of NOS decreased, and the level of ET-1 in the plasma of restenosis patients keeps higher than the baseline.

Risk Factor Analysis and Long-Term Outcomes in Patients with Endovascular Revascularization for Intermittent Claudication or Chronic Limb-Threatening Ischemia

The aim of this study is to review long-term outcome and identify risk factors for patients with peripheral arterial disease (PAD) with percutaneous transluminal angioplasty/stent as a primary treatment strategy for intermittent claudication (IC) or chronic limb-threatening ischemia (CLTI). A retrospective cohort study with data collected prospectively from Clinical Data Analysis and Reporting System, departmental database, and Clinical Management System. All patients who underwent endovascular procedures for PAD between January 2011 and December 2020 were identified. The primary outcomes are overall survival and amputation-free survival. Predictive factors for OS and AFS were determined using Cox Model. A total number of 640 patients with PAD (IC, n=243; CLTI, n=377) underwent endovascular percutaneous transluminal angioplasty/stenting for PAD from January 2011 to December 2020. Patients with CLTI had a significantly higher 30days readmission rate (18.8% vs. 6.5%, P<0.001), emergency reoperation within 30days (3.4% vs. 0%, P=0.002), and death within same admission (2.7% vs. 0%, P=0.008) compared to IC patients. The overall survival and amputation-free survival rates were significantly lower in CLTI patients (P<0.0001 and P<0.0001, respectively). On Cox multivariate analysis, CLTI was strongly predictive of all-cause mortality and amputation (hazard ratio [HR] 2.33 and HR 14.92, respectively). In patients with CLTI, chronic kidney disease was an independent predictor of mortality and amputation (HR 1.66 and HR 2.36, respectively). Smoking and ischemic heart disease were also independent predictors of mortality in this subgroup (HR 2.06 and HR 2.43, respectively). Although patients with IC and CLTI both manifest from atherosclerotic occlusive disease of the lower limb arteries, these patients may have different clinical outcomes with significant mortality occurred in both IC and CLTI groups. In patients with IC, the risk of amputation was less than 1% at 5years following revascularization.