Lower Extremity Arteries Research Articles

Impact of intravascular ultrasound-guided endovascular therapy on periprocedural outcomes in patients with lower-extremity artery disease.

Although technological improvements in intravascular ultrasound (IVUS) may reduce technical failures in endovascular therapy (EVT), perioperative complications (POCs) associated with IVUS use may increase. This study investigated the impact of IVUS on periprocedural outcomes in symptomatic lower-extremity artery disease (LEAD) patients undergoing EVT. This study evaluated 28,088 symptomatic LEAD patients who underwent EVT between January 2021 and December 2021 using a prospective nationwide registry in Japan. Outcome measures included periprocedural outcomes, including technical failure and POCs. To compare outcomes with and without IVUS use, propensity score matching analysis was performed for overall and for each arterial region (aortoiliac [AI], femoropopliteal [FP], and infrapopliteal [IP] arteries) using a binary logistic regression model. IVUS was used in 75%, 72%, and 37% of AI, FP, and IP lesions, respectively. After propensity matching extraction, the IVUS group had a tendency of lower technical failure rate than the non-IVUS group, although not statistically different (3.9% vs. 5.4%, p = 0.054), without an increase in the POC rate (1.8% vs. 1.6%, p = 0.54). Regarding the per-regional analysis, the technical failure rate of FP-EVT was significantly lower in the IVUS group (3.1% vs. 4.2%, p = 0.006), whereas those of AI-EVT (2.2% vs. 3.1%, p = 0.12) and IP-EVT (6.8% vs. 6.1%, p = 0.37) were not significantly different between the two groups. Furthermore, IVUS did not increase the POC rate for any region (AI-EVT: 1.3% vs. 1.3%, p = 1.00; FP-EVT: 1.8% vs. 1.7%, p = 0.75; and IP-EVT: 2.0% vs. 1.7%, p = 0.56). The current study revealed that IVUS did not increase the POCs and technical failure for overall lesions but reduced the incidence of FP-EVT technical failure.

Examination of patients with diabetes mellitus and peripheral arterial disease according to the adapted ischaemic criteria of the WIfI classification

Objective. To combine the determination of ischemia class indicators according to the WIfI classification and simultaneous performance of ultrasound duplex scanning of the arteries of both lower extremities during the initial examination of patients with diabetes mellitus and peripheral arterial disease to predict healing, determine the risk of amputation and the need for revascularisation. Materials and methods. We treated 74 patients with diabetes mellitus and peripheral arterial disease who had signs of infection, ulceration or destruction of deep foot tissues. Patients were divided into two groups: the main group – 43 patients (ischaemia class was determined by the WIfI classification with simultaneous performance of ultrasound duplex scanning of the lower extremity arteries with assessment of lesions by ultrasound criteria) and the control group – 31 patients (ischaemia class according to the WIfI classification was determined only by portable Doppler). Patients in both groups received comprehensive treatment. Results. During the 1–year follow–up, the frequency of re–hospitalisation associated with deterioration of the condition due to limb ischaemia in the main group was statistically significantly (p=0.03) lower than in the control group. Conclusions. The integration of ultrasound duplex scanning at the initial stage of diagnosis allows to determine the degree of ischemia more accurately and to refer the patient for vascular correction in time.

Impact of the Coexisting Coronary Artery Disease on Five-Year Outcomes in Lower Extremity Artery Disease Patients Without Chronic Limb-Threatening Ischemia.

Coronary artery disease (CAD) is often noted in patients with lower-extremity artery disease (LEAD). However, the effects of CAD on patients with LEAD have not been clearly investigated. In this study, to investigate the effect of CAD on patients with LEAD without chronic limb-threatening ischemia (CLTI), we compared the five-year clinical outcomes of patients with and without CAD. Between 2014 and 2017, 246 patients with symptomatic LEAD without CLTI underwent endovascular treatment. Patients with a history of CAD revascularization or CAD defined by CAD studies were divided into CAD groups, and others were non-CAD groups. After excluding ineligible patients, propensity matching produced 40 patients in each group, and clinical outcomes were compared between the groups. Using five years of Kaplan-Meier analysis between the CAD and non-CAD groups, no significant differences were observed in survival (90.0% vs 92.5%, p=0.693), freedom from cardiovascular events (42.5% vs 57.5%, p=0.110), freedom from LEAD revascularization (67.5% vs 67.5%, p=0.940), and freedom from CLTI (100% vs. 95.0%, p=0.148). However, significant differences were observed in freedom from CAD revascularization (67.5% vs 97.5%, p<0.001) and freedom from symptomatic CAD (85.0% vs 97.5%, p=0.048). Our results suggest that in patients with LEAD without CLTI, CAD caused increased CAD revascularization and symptomatic CAD. However, CAD did not affect survival, cardiovascular events, LEAD revascularization, or CLTI in such patients. When CAD was observed in patients with LEAD without CLTI, more frequent follow-up of CAD may improve the long-term clinical outcomes of such patients.

6-PUB: Prevention of Severe Lower Extremity Artery Disease in Patients with Diabetes—Analysis of Factors Using a Large Database

6-PUB: Prevention of Severe Lower Extremity Artery Disease in Patients with Diabetes—Analysis of Factors Using a Large Database

Efficacy and safety of rivaroxaban versus warfarin in the management of unusual site deep vein thrombosis: a retrospective cohort study.

Unusual site deep vein thrombosis (DVT) was defined as venous thromboembolism (VTE) occurring outside the conventional deep veins of the lower extremity or pulmonary arteries. However, the optimal anticoagulation therapy for unusual site DVT remained unclear. This study aims to evaluate the efficacy and safety of rivaroxaban in unusual site DVT. This retrospective cohort study enrolled consecutive patients at Nanjing Drum Tower Hospital between January 2011 and December 2021 who were diagnosed with unusual site DVT. Patients were divided into two groups based on their ultimate medication choice: the warfarin group and the rivaroxaban group. The demographic characteristics were recorded for all enrolled patients. Clinical outcomes included recurrent VTE, bleeding complications and major bleeding. A total of 1,088 patients were divided into warfarin (n = 514) and rivaroxaban (n = 574) groups. After the stabilized inverse probability of treatment weighting, Hazard Ratios for warfarin vs. rivaroxaban of recurrent VTE, bleeding complications and major bleeding were 0.52(95% CI: 0.25-1.08), 0.30(95% CI: 0.14-0.60), and 0.33 (95% CI, 0.13-0.74), respectively. Risk of clinical outcomes in specified subgroups for age, gender, renal function, thrombosis sites and diagnosis were assessed. The interaction of gender and treatment on major bleeding was significant (P for interaction = 0.062). Otherwise, there was no significant interaction between the other subgroups and the treatment group in terms of clinical outcomes. Compared with warfarin, rivaroxaban exhibited comparable efficacy for the anticoagulant treatment of unusual site DVT, associated with a lower risk of bleeding complications and major bleeding.

The phenomenon of drug-coating embolism during lower extremity endovascular interventions with paclitaxel-coated balloon.

There is a risk of distal embolization lower extremity endovascular interventions. Possibly a drug-coating embolism caused by coating detachment from intravascular devices. This review focuses on providing updated information on distal embolism in endovascular revascularization of lower extremity arteries, including the use of drug-coated balloons. Drug-coating embolism is a special case of distal embolization during recanalization of the arteries of the lower extremities. Preclinical studies have demonstrated embolization of drug-coated balloons during angioplasty of lower extremity arteries. However, the clinical role of drug-coating embolism is not completely clear. A 2020 meta-analysis found an increased risk of major lower extremity amputation after drug-coated balloon angioplasty in patients with critical limb ischemia. But long-term research is emerging to support the safety of using these devices. Perhaps a more thorough assessment of the quality of life and the degree of compensation of lower limb ischemia with an intraoperative assessment of the frequency of peripheral embolizations using ultrasound emboli detection, as well as microcirculation with transcutaneous oximetry and laser Doppler flowmetry of the operated lower limb will allow a more detailed study of the phenomenon of drug-coating embolism and its impact on long-term clinical outcomes. According to the results of preclinical studies, the use of paclitaxel-coated balloons leads to an increase in the concentration of paclitaxel in distal skeletal muscles. However, paclitaxel concentration in skeletal muscle was significantly higher in first-generation DCBs. The non-target effects of drug-coating balloon are not fully understood and require further study. Understanding the phenomenon of drug-coating embolism can help physicians to better assess the patient risk and to minimize complications.

Mature neutrophils as a marker of hypoechoic carotid plaques and a predictor of polyvascular disease progression

Aim. To evaluate the diagnostic and prognostic value of circulating mature and aging neutrophils in relation to hypoechoic carotid plaques and short-term progression of carotid and multifocal atherosclerosis.Material and methods. The study included 200 patients (89 males and 111 fe­males), aged 40-64 years. All patients underwent duplex ultrasound of the carotid and lower extremity arteries at the first visit and at a repeat visit after 12-24 months. Ultrasound morphology of carotid plaques was assessed using greyscale median analysis. Phenotyping and differentiation of neutrophil subpopulations was carried out using flow cytometry.Results. The absolute and relative number of mature neutrophils directly correlated with ultrasound indicators of carotid atherosclerosis, while the number of aging neutrophils — with the degree of lower extremity artery stenosis. Patients with hypoechoic carotid plaques were characterized by a significantly higher absolute number of mature neutrophils (p=0,0340). An increase in the number of mature neutrophils over 3023,0 cells/μL made it possible to predict the hypoechoic carotid plaques with a sensitivity of 75,0% and a specificity of 69,5%. Patients with carotid atherosclerosis progression had a higher absolute number of mature neutrophils (p=0,0140), as did patients with progression of multifocal atherosclerosis (p=0,0162). An increase in the number of mature neutrophils more than 3223,0 cells/μL was associated with an increase in the relative risk of polyvascular disease progression by 3,09 times (95% confidence interval, 1,34-7,17; p=0,0082) after adjustment for baseline cardiovascular disease risk.Conclusion. Among patients aged 40-64 years, increased numbers of circulating mature neutrophils are associated with an increased carotid plaque burden and hypoechoic carotid plaques. An increase in the number of mature neutrophils over 3223,0 cells/μL was associated with a 3,09-fold increase in the relative risk of polyvascular disease after adjustment for baseline cardiovascular risk.

Lymphedema in a patient with decompensated cirrhosis

The lymphatic system is critical in body fluid homeostasis. Although lymphatic vascular expansion prevents the development of ascites and oedema in the early stages of liver cirrhosis, compensatory mechanisms cannot achieve this in the advanced stages due to lymphatic dysfunction. A 36-year-old male patient, who had been followed up for cryptogenic cirrhosis for 15 years, had been complaining of excessive swelling in his legs for the last 4 years. Excessive swelling in the legs was accompanied by skin rashes and ulcers, and the leg skin had an orange peel appearance characteristic of lymphedema. Bilateral lower extremity artery and venous system colour Doppler ultrasonography showed that the vascular structures of the right lower extremity arterial and venous system were open, and the flow rate, direction and spectrum were normal. The patient, who could not undergo liver transplantation due to organ limitations, died due to sepsis following lymphedema-induced wound infection. In conclusion, this case suggests that lymphedema should be considered in the presence of oedema in cases of decompensated cirrhosis, and the necessary conservative treatments should be applied.

Abstract 2125: Aneurysmal Disease Among Hospitalized Patients With Fibromuscular Dysplasia - Types And Prevalence: Findings From The National Inpatient Sample

Introduction: Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease that can lead to various arterial abnormalities, including dissection, occlusion, and aneurysm. Only a few studies have examined the common types of aneurysmal disease among patients with FMD. We examine the types and prevalence of aneurysmal disease among hospitalized patients with FMD. Methods: Using the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) diagnosis codes, we queried the National Inpatient Sample 2016 to 2020 for hospitalizations among patients ≥18 years old with a diagnosis of Fibromuscular dysplasia. Aneurysmal disease of the iliac, carotid, upper extremity, lower extremity, renal, vertebral artery, thoracic aorta, and abdominal aorta was further identified in this cohort of patients using ICD-10 codes. We examined prevalence of FMD and further compared the prevalence of aneurysmal disease among hospitalized patients with and without FMD. Results: Our study included 9,315 weighted hospitalizations among patients with fibromuscular dysplasia (mean [SD] age 61.2 [15.5] years). FMD was five times more common in females than males (84.1% vs. 15.9%). Compared to hospitalized patients without FMD, aneurysmal disease was more common among hospitalized patients with FMD. The most common aneurysmal site among patients with and without FMD was the renal artery (1.4%) and abdominal aorta (0.71%) respectively. The prevalence of aneurysmal disease among hospitalized patients with FMD was renal artery aneurysm (1.40%), abdominal aortic aneurysm (1.29%), carotid artery aneurysm (1.23%), thoracic artery aneurysm (1.02%), vertebral artery aneurysm (0.86%), lower extremity artery aneurysm (0.38%), iliac artery aneurysm (0.27%), and upper extremity artery aneurysm (0.16%). Conclusion: Aneurysmal disease is prevalent among hospitalized patients with Fibromuscular dysplasia, with the renal artery identified as the most common site of aneurysm. Further research is needed to understand better the relationship between FMD and other vascular abnormalities.

Caring for patients with lower extremity artery disease: going beyond stents and bypass grafts.

Caring for patients with lower extremity artery disease: going beyond stents and bypass grafts.

Early and Long-Term Results of Simultaneous and Staged Revascularization of Coronary and Carotid Arteries.

Carotid artery disease is prevalent among patients with coronary heart disease. The concomitant severe lesions in the carotid and coronary arteries may necessitate either simultaneous or staged revascularization involving coronary bypass and carotid endarterectomy. However, there is presently a lack of consensus on the optimal choice of surgical treatment tactics for patients with significant stenoses in both carotid and coronary arteries. The aim of the current study was to compare the 30-day and long-term outcomes of coronary and carotid artery revascularization surgery based on the simultaneous or staged surgical tactics. This single-center retrospective study involved 192 patients with concurrent coronary artery disease and carotid artery stenosis ≥ 70%, of whom 106 patients underwent simultaneous intervention (CABG + CEA) and 86 patients underwent staged CABG/CEA. The mean time between stages ranged from 1 to 4 months (mean 1.88 ± 0.9 months). The endpoints included death from any cause, non-fatal stroke, non-fatal myocardial infarction (MI), and major adverse cardiovascular events (MACEs) (death + non-fatal MI + non-fatal stroke) within 30 days after the last intervention and in the long-term follow-up period (median follow-up-6 years). The 30-day all-cause mortality, incidence of postoperative non-fatal MI, non-fatal stroke, and MACEs did not exhibit differences between the groups after single-stage and staged interventions. However, the overall risk of postoperative complications (adjusted for the risk of any complication per patient) (OR 2.214, 95% CI 1.048-4.674, p = 0.035), as well as the duration of ventilatory support (p = 0.004), was elevated in the group after simultaneous interventions compared with the staged intervention group. This difference did not result in an increased incidence of death and MACEs in the group after simultaneous interventions. In the long-term follow-up period, there were no significant differences observed when comparing simultaneous or staged surgical tactics in terms of overall survival (54.9% and 62.6% in Groups 1 and 2, respectively, P log-rank = 0.068), non-fatal stroke-free survival (45.6% and 33.6% in Groups 1 and 2, respectively, P log-rank = 0.364), non-fatal MI-survival (57.6% and 73.5% in Groups 1 and 2, respectively, P log-rank = 0.169), and MACE-free survival (7.1% and 30.2% in Groups 1 and 2, respectively, P log-rank = 0.060). The risk factors associated with an unfavorable outcome included age, smoking, BMI, LV EF, and atherosclerosis of the lower extremity arteries. This study revealed no significant difference in the impact of simultaneous CABG + CEA or staged CABG/CEA on the incidence of death, stroke, MI, and MACEs over a 30-day and long-term follow-up period. Although the immediate results indicated an increased risk of a complicated course (attributable to overall complications) and more prolonged ventilation after simultaneous CABG + CEA compared with staged CABG/CEA, this did not lead to an increase in fatal complications. Therefore, the implementation of either tactic is considered eligible and appropriate following a thorough operative risk assessment.

Body surface area is positively associated with ankle-brachial index.

Ankle-brachial index (ABI) measurement is a widely used diagnostic test for lower extremity artery disease. Previously, a larger body surface area (BSA) has been associated with lower blood pressure and lower 2-h post-load glucose concentrations in the oral glucose tolerance test. Our aim was to evaluate whether BSA has an impact on ABI and the prevalence of lower ABI values. ABI measurements were performed on 972 subjects aged 45 to 70 years at high cardiovascular disease (CVD) risk. Subjects with previously diagnosed kidney disease, CVD, and diabetes were excluded. Their BSA was calculated by the Mosteller formula. Study subjects were divided into five BSA levels corresponding to 12.5th, 25th, 25th, 25th, and 12.5th percentiles of the total distribution. Effect modification by BSA in ABI between sexes was derived from a four-knot restricted cubic splines regression model. After adjustments for age, sex, pulse pressure, glucose regulation, waist circumference, alcohol intake, smoking status, leisure-time physical activity and medication, BSA level had a positive linear relationship with ABI (p for linearity <0.001). When BSA was less than 2.0 m2, there was no difference between the sexes, but when BSA was higher than 2.0 m2, men had higher ABI. BSA shows a positive linear relationship with ABI in CVD risk subjects without manifested CVD. The difference in ABI between men and women is modified by BSA and is appreciable when BSA is larger than 2.0 m2.

The characteristics of arterial risk factors and ankle-brachial index in patients with lower extremity chronic venous diseases: results from the BEST study.

The aim of our study was to explore the characteristics of the arterial risk factors and ankle-brachial index (ABI) in patients with lower extremity chronic venous disease (LECVD). A total of 2642 subjects were employed in our study. The lifestyle and clinical data were collected. The history of vascular diseases contained coronary artery disease, stroke, hypertension, and diabetes. ABI low than 0.9 was considered as lower extremity artery disease (LEAD). A series of blood indicators were measured. Patients with ABI low than 0.9 belonged to the group of LEAD. Age, smoking, drinking, hypertension, diabetes mellitus, lipid-lowering drug, antidiabetic, total protein, total protein, triglyceride, low-density lipoprotein cholesterol, glycosylated hemoglobin and homocysteine were the common risk factors shared by LEAD and LECVD (P<0.05). The prevalence of LEAD in patients with LECVD was higher than those without LECVD (P<0.05). In Pearson correlation analysis, LECVD was related to LEAD (P<0.05). Before and after adjusted shared factors, as the performance of the logistic regression models, LEAD was an independent risk factor for the prevalence of LECVD (OR=2.937, 95% CI: [1.956, 4.411], P<0.001). Our study demonstrated that an ABI lower than 0.9 is an independent risk factor for LECVD.

Hybrid procedures in the treatment of obliterative arteriopathy of the lower limbs

Lower extremity artery disease is defined as a narrowing of the caliber of arteries to the lower limbs, resulting in hemodynamic loss, with or without clinical symptoms, The detection and the diagnosis of peripheral arterial disease is obtained by calculating the ankle brachial index , An adapted treatment reduces the morbi-mortality linked to this disease, the management of LEAD involves controlling risk factors and hygienic-dietary measures, medical management, and finally surgical treatment (conventional surgery, endovascular treatment, or hybrid procedures). The progress in hybrid procedures has expanded the possibilities for revascularization in patients with severe and complex arterial lesions. These techniques provide an excellent alternative for specific indications,

Balloon angioplasty and stenting of lower extremity arteries in patients with critical limb ischemia

Lower extremity peripheral vascular disease is a typical, rapidly progressive, and disabling condition. In most patients, limb ischemia is detected at late stages of the disease. As a result, they are at high risk of limb loss, which makes a complete conventional treatment ineffective. In this situation, balloon angioplasty and stenting of lower extremity ar- teries are considered the optimal modern method of treating patients with critical limb ischemia. This study aims to evaluate the effectiveness of endovascular techniques to improve revascularization during the treatment of critical lower extremity ischemia. The research involved a comprehensive examination and endovascular treatment of 170 patients with occlusive-stenotic lesions of the lower extremity arteries. The patients were operated for critical ischemia between January 2016 and December 2022, and the effectiveness of the measures taken was analyzed. It was found that the pathology under the study requires timely diagnosis and identification of the severity of limb ischemia and circulatory disorders, with the subsequent preparation of an appropriate treatment plan. The authors discussed the main problems accompanying balloon angioplasty and stenting of the lower extremity arteries in patients with critical limb ischemia. Also, the experience of developed countries in the optimization and improvement of the studied tech- nique was studied. It has been proven that the diagnosis of lower extremity vascular disease is related to specific difficulties. However, it can be made on an outpatient basis by analyzing medical examination data and simple labor- atory methods. The authors also examined the feasibility and prospects of balloon angioplasty and stenting of the lower extremity arteries in patients with critical limb ischemia. The re-search findings have a practical value for improving the treatment of patients with occlusive and stenotic lesions of the lower extremities, as well as for improving the effec-tiveness of balloon angioplasty and stenting.

Non-coronary peripheral arterial complications in people with type 2 diabetes: a Swedish retrospective cohort study

BackgroundFew studies have explored long-term trends and risk factors for peripheral arterial complications in type 2 diabetes compared to the general population. Our research focuses on identifying optimal risk factors, their significance, multifactorial control risks, and trends for these complications in diabetic patients versus general controls. MethodsThis study included persons with type 2 diabetes mellitus entered into the Swedish National Diabetes Register 2001-2019 and controls matched for age-, sex- and county of residence. Outcomes comprised of extracranial large artery disease, aortic aneurysm, aortic dissection, lower extremity arterial disease and diabetes foot disease. Standardized incidence rates and Cox regression were used for analyses. FindingsThe study comprises 655,250 persons with type 2 diabetes mellitus; average age 64.2; 43.8% women. Among persons with type 2 diabetes mellitus, the incidence rates per 100,000 person years for each non-coronary peripheral arterial complication event changed between 2001 and 2019 as follows: extracranial large artery disease 170.0 to 84.9; aortic aneurysm 40.6 to 69.2; aortic dissection 9.3 to 5.6; lower extremity artery disease from 338.8 to 190.8; and diabetic foot disease from 309.8 to 226.8. Baseline hemoglobin A1c (HbA1c), systolic blood pressure (SBP), smoking status and lipid levels were independently associated with all outcomes in the type 2 diabetes mellitus cohort. Within the cohort with type 2 diabetes mellitus, the risk for extracranial large artery disease and lower extremity artery disease increased in a stepwise fashion for each risk factor not within target. Excess risk for non-coronary peripheral arterial complications in the entire cohort for persons with type 2 diabetes mellitus, compared to matched controls, were as follows: extracranial large artery disease adjusted hazard ratio (HR) 1.69 (95% confidence interval (CI), 1.65-1.73), aortic aneurysm HR 0.89 (95% CI, 0.87-0.92), aortic dissection HR 0.51 (95% CI, 0.46-0.57) and lower extremity artery disease HR 2.59 (95% CI, 2.55-2.64). InterpretationsThe incidence of non-coronary peripheral arterial complications has declined significantly among persons with type 2 diabetes mellitus, with the exception of aortic aneurysm. HbA1c, smoking and blood pressure demonstrated greatest relative contribution for outcomes and lower levels of cardiometabolic risk factors are associated with reduced relative risk of outcomes.Funding: Swedish governmental and the county support of research and education of doctors, the Swedish Heart and Lung Foundation and Åke-Wibergs grant.

Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous

BackgroundSevere calcification often prevents device passage and balloon expansion in cases of lower extremity artery disease. To address this limitation, we introduced a novel calcium modification technique called Rendezvous-PIERCE (R-PIERCE).MethodsA needle was inserted in a retrograde manner and advanced to touch the tip of an antegrade guidewire within the lesion. Then, the guidewire was advanced into the lumen of the needle to achieve partial guidewire externalization, also known as needle rendezvous. The needle was then introduced over the externalized guidewire under wire tension and repeatedly rotated and advanced across the lesion to modify calcified intimal plaques. Notably, this technique can be applied in the opposite direction.ResultsCase 1 involved a 68-year-old male with a calcified occlusion of the anterior tibial artery. An antegrade guidewire reached the midpoint of the occlusion; however, microcatheters and balloons could not pass through the proximal calcification. Therefore, R-PIERCE was used to modify uncrossable lesions. An antegrade 2.5-mm balloon crossed and dilated the lesion, achieving hemostasis at the needle insertion site. The antegrade guidewire successfully crossed the entire lesion and was dilated by the 2.5-mm balloon. Final angiography demonstrated successful flow. In Case 2, an 80-year-old male had a calcified femoropopliteal occlusion. An antegrade guidewire was advanced into the distal superficial femoral artery (SFA); however, no device could follow it. R-PIERCE was performed to modify the calcification from the distal to the medial SFA. The antegrade balloon successfully crossed and dilated obstructed lesions. Furthermore, the antegrade guidewire crossed the entire lesion, and the antegrade balloon was dilated. Final angiography revealed a successful flow without complications.ConclusionsR-PIERCE is useful for modifying complex calcified lesions during the wiring of occlusive lesions.

Evaluation of cardiac and vascular remodeling in patients with arterial hypertension in combination with atherosclerosis of the lower extremity arteries

Objective: to evaluate the features of cardiac and vascular remodeling in patients with arterial hypertension (AH) and atherosclerosis of the arteries of the lower extremities (LAA) of varying severity. Materials and methods: the study involved 120 patients with hypertension. Depending on the presence of AANC, all patients were divided into 3 groups: group 1 — 46 patients with hypertension and clinically manifested AANC, group 2 — 39 patients with hypertension and asymptomatic AANC, group 3 — 35 patients with hypertension without AANC. The characteristics of cardiac and vascular remodeling were assessed based on the results of 24-hour blood pressure monitoring (ABPM) using Vasotens technology, triplex ultrasound scanning (UTS) of the arteries of the lower extremities (LEA), and echocardiographic examination (EchoCG). Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA) and IBM SPSS Statistica 26.0 (IBM, USA). Results: in the group of patients with severe circulatory disorders of the lower extremities, compared with patients with asymptomatic AANK, significantly lower values of the indicator — reflected wave propagation time (RWTT, ms) (p = 0.006) and significantly higher values of the indicator — augmentation index (AIX) were revealed) and augmentation index in the aorta (AIXao) (p&lt;0.05). A direct statistically significant correlation of moderate strength was revealed between the degree of stenosis (%) of the ANC and the values of the AIX and AIXao indicators (r = 0.345, p = 0.001). Higher values of the dimensions of the walls of the left ventricle (LV) were determined: the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PLW) in patients of the 1st and 2nd groups in comparison with the indicators in patients of the 3rd group (p&lt;0 .05). Patients of all three groups had thickening of the left ventricle and intraventricular septum (&gt;11 mm) and an increase in LVMI. In patients with hypertension and severe AANC, the maximum values of LVMI were determined, which were significantly higher than the corresponding values in patients of the 2nd (p = 0.004) and 3rd (p = 0.0001) groups. LV systolic function in all patients included in the study was assessed as intact. However, the highest ejection fraction (EF) values were recorded in patients with hypertension without AANC, and were significantly higher than those in patients with hypertension and concomitant asymptomatic AANC (p = 0.02), as well as in patients with hypertension and clinically manifested AANC (p =0.001). Conclusions: the progression of AANK was associated with an increase in the stiffness of both peripheral and main arteries, which was accompanied by an increase in the load on the myocardium, which in 97.8% of cases led to more pronounced myocardial remodeling of the concentric hypertrophy type.

A numerical study on the siphonic effect of enhanced external counterpulsation at lower extremities with a coupled 0D-1D closed-loop personalized hemodynamics model

Enhanced external counterpulsation (EECP) is a treatment and rehabilitation approach for ischemic diseases, including coronary artery disease. Its therapeutic benefits are primarily attributed to the improved blood circulation achieved through sequential mechanical compression of the lower extremities. However, despite the crucial role that hemodynamic effects in the lower extremity arteries play in determining the effectiveness of EECP treatment, most studies have focused on the diastole phase and ignored the systolic phase. In the present study, a novel siphon model (SM) was developed to investigate the interdependence of several hemodynamic parameters, including pulse wave velocity, femoral flow rate, the operation pressure of cuffs, and the mean blood flow changes in the femoral artery throughout EECP therapy. To verify the accuracy of the SM, we coupled the predicted afterload in the lower extremity arteries during deflation using SM with the 0D-1D patient-specific model. Finally, the simulation results were compared with clinical measurements obtained during EECP therapy to verify the applicability and accuracy of the SM, as well as the coupling method. The precision and reliability of the previously developed personalized approach were further affirmed in this study. The average waveform similarity coefficient between the simulation results and the clinical measurements during the rest state exceeded 90%. This work has the potential to enhance our understanding of the hemodynamic mechanisms involved in EECP treatment and provide valuable insights for clinical decision-making.

Lack of causal association between cheese intake and risk of peripheral vascular diseases: A two‐sample Mendelian randomization study

AbstractBackgroundPrevious observational studies have yielded inconclusive findings regarding the potential association between cheese intake and peripheral vascular diseases (PVDs). We sought to systematically investigate the causal link between cheese intake and PVDs.MethodsA two‐sample Mendelian randomization (MR) investigation was undertaken to evaluate the causal link between cheese intake and PVDs. This MR analysis relied on summary statistics derived from published genome‐wide associations studies (GWAS). GWAS summary statistics for cheese intake (N = 451,486), peripheral artery disease (PAD) (N = 361,194), PVD (N = 463,010), pulmonary embolism (PE) (N = 463,010), and deep vein thrombosis (DVT) (N = 6795) were derived from the UK Biobank. GWAS summary statistics for peripheral angiopathy (N = 162,394), aortic dissection (N = 218,792), aortic aneurysm (AA) (N = 218,792), other PVDs (N = 218,792), and arterial embolism and thrombosis of lower extremity artery (N = 218,792) were extracted from the FinnGen. Primary analysis was performed using an inverse variance weighted method. Sensitivity analyses included weighted median, MR Egger, and weighted mode analyses. Results are shown as odd ratio (OR) and 95% confidence interval (CI).ResultsGenetically predicted cheese intake was not associated with PAD (OR = 1.00, 95% CI: 1.00–1.00, p = 0.953), PVD (OR = 1.00, 95% CI: 0.99–1.00, p = 0.265), peripheral angiopathy (OR = 0.56, 95% CI: 0.09–3.66, p = 0.566), aortic dissection(OR = 0.69, 95% CI: 0.19–2.55, p = 0.583), AA(OR = 0.92, 95% CI: 0.46–1.82, p = 0.809), other PVDs (OR = 0.99, 95% CI: 0.44–2.21, p = 0.979), PE (OR = 1.00, 95% CI:1.00–1.00, p = 0.635), DVT (OR = 0.83, 95% CI: 0.62–1.12, p = 0.229), and arterial embolism and thrombosis of lower extremity artery (OR = 0.69, 95% CI: 0.21–2.29, p = 0.5413).ConclusionBased on the results of our two‐sample MR analysis, we found no significant association between cheese intake and the risk of PVDs. We firmly believed that these findings had the potential to enhance the efficacy of prevention strategies for PVDs, at both the national and clinical level, by improving our understanding of the risk factors involved in their development. Low‐sugar, low‐salt and low‐fat cheese may be a good choice for people at high risk of PVDs.