Management Of Vascular Disease Research Articles

Effectiveness of osteopathic manipulative treatment in cardiovascular function: a systematic review protocol

The objective of this review is to investigate the short- and long-term effects of osteopathic manipulative treatment on cardiovascular function and its regulators in the nervous and endocrine systems. A variety of pharmacological and lifestyle-based treatments are used to prevent or treat vascular diseases, yet vascular disease underpins the top 2 causes of death worldwide. There is a need for more preventative and therapeutic interventions in the management and prevention of vascular disease that are compatible with existing interventions. Osteopathic manipulative treatment has shown promise as a non-invasive approach to improve cardiovascular function, but it is currently utilized mostly for alleviating musculoskeletal symptoms. A comprehensive summary of the evidence on the effectiveness of osteopathic manipulative treatment in cardiovascular function will assist clinicians and guide future research directions. This review will consider randomized controlled trials, non-randomized controlled trials, and crossover studies. Participants must have received osteopathic manipulative treatment intervention. Comparators will include passive or active controls, including controls for body position, touch, and other potential interventions for vascular disease. Cardiovascular, nervous-system, or endocrine-system outcome variables must be measured at least once after treatment. Adverse events will also be considered. Searches will be conducted in the following sources: MEDLINE, the Journal of Osteopathic Medicine , Embase, Scopus, ProQuest One Academic, MedNar, the International Journal of Osteopathic Medicine , and CINAHL. Studies available in English, without date restrictions, will be considered for inclusion. Relevant studies will be selected by 2 independent reviewers, critically appraised, and extracted using a tool customized for the details of the study. If meta-analysis is possible, evidence will be summarized using standard techniques with subgroup analyses providing more insight into particular osteopathic manipulative treatment techniques, time frame of the treatment, and duration of effects, among others. Certainty of findings will be presented using GRADE. PROSPERO CRD42021225838.

Real-world diffusing capacity simulation data: how well do they fit current European Respiratory Society/American Thoracic Society acceptability criteria?

ERS/ATS D LCO standards recommend acceptability ranges for weekly D LCO simulation testing performed with a 3-L syringe. On some devices, the ERS/ATS limits may exceed or not fit a 3-sd range, in which case, simulation ranges based on 3 sd may be appropriate. https://bit.ly/3Z0YoZL.

Updated research priorities of the Society for Vascular Surgery.

In 2011, the Society for Vascular Surgery (SVS) prepared a set of clinical research priorities through a survey of its membership. These priorities were developed with the goal of enhancing clinical research to improve care for vascular patients. In the subsequent decade, several of these priorities served as the focus of clinical trials and significant research efforts. It was understood from the outset that this list of priorities represented a starting point with the intention that they be reevaluated at suitable intervals. In 2021, the SVS Research Council set out to update the research priorities by surveying the SVS membership and engaged a panel of subject matter experts. This process resulted in an updated set of vascular research priorities that more clearly align with current areas of emphasis. Our priorities remain focused on basic areas including aortic disease, carotid disease, lower extremity arterial disease, venous disease, dialysis access, and medical management of vascular disease, along with the topic of health care disparities. The 10 updated priorities reported herein reflect our increasing awareness of the need to understand vascular disease pathogenesis and prevention in the context of a diverse patient population. Importantly, patient-centered outcomes and personalized vascular care are at the core of these updated priorities. Similar to the aims of the original 2011 clinical research priorities, our hope is that this updated list will help to drive large-scale investigations that will improve how we care for our vascular patients.

Personalized vascular healthcare: insights from a large international survey.

Fragmentation of healthcare systems through limited cross-speciality communication and intermittent, intervention-based care, without insight into follow-up and compliance, results in poor patient experiences and potentially contributes to suboptimal outcomes. Data-driven tools and novel technologies have the capability to address these shortcomings, but insights from all stakeholders in the care continuum remain lacking. A structured online questionnaire was given to respondents (n = 1432) in nine global geographies to investigate attitudes to the use of data and novel technologies in the management of vascular disease. Patients with coronary or peripheral artery disease (n = 961), physicians responsible for their care (n = 345), and administrators/healthcare leaders with responsibility for commissioning/procuring cardiovascular services (n = 126) were included. Narrative themes arising from the survey included patients' desire for more personalized healthcare, shared decision-making, and improved communication. Patients, administrators, and physicians perceived and experienced deficiencies in continuity of care, and all acknowledged the potential for data-driven techniques and novel technologies to address some of these shortcomings. Further, physicians and administrators saw the 'upstream' segment of the care journey-before diagnosis, at point of diagnosis, and when determining treatment-as key to enabling tangible improvements in patient experience and outcomes. Finally, despite acceptance that data sharing is critical to the success of such interventions, there remains persistent issues related to trust and transparency. The current fragmented care continuum could be improved and streamlined through the adoption of advanced data analytics and novel technologies, including diagnostic and monitoring techniques. Such an approach could enable the refocusing of healthcare from intermittent contacts and intervention-only focus to a more holistic patient view.

Response of seed endophytic bacteria for the management of chickpea wilt, Fusarium oxysporum f. sp. ciceris

Vascular wilts are devastating plant diseases that can affect both annual crops as well as woody perennials, hence inducing major food losses and damaging valuable natural ecosystems. Because of ecological and economic reasons, the management of vascular wilt diseases by conventional chemical methods is raising concerns. More environmentally friendly alternatives such as the use of microbial antagonist to control phytopathogens are now of growing interest. The fact that bacterial endophytes are able to colonize an ecological niche similar to that of vascular wilt pathogens favours them as potential biocontrol agents against wilt diseases. Several possible disease suppression mechanisms of beneficial bacteria were proposed, among them induction of systemic resistance, growth promotion and competition. In this view, we studied out the seed endophytic bacteria (SEB) for the management of chickpea wilt Caused by Fusarium oxysporum f. sp. ciceris. Among the treatment of seed entophytic bacterial isolate in SEB-5 was found highest germination percent (92% in JG 11), minimum mortality percent at pre and post–emergence (7.69 and 9.53% in JG 11 and JG 16, respectively). The minimum total mortality percent 17.82 % was found in JG 11 of SEB-5. The other seed entophytic bacterial isolate were found statistically at par with SEB-5. The minimum germination percent (78.5% in JG 62) as well as highest total mortality percent approximate 58% in JG 11 was found in T6 (treated control). Similarly, all the treatments of seed entophytic bacterial had higher root length and shoot length as compared to T6. Among the treatments the SEB-5 was found significantly highest by 23 cm in root length and 48 cm in shoot length as well as highest vigour index (6613) over the T6 in JG 11 variety. Among the varieties grown the JG 11 was perfumed better and found resistant and JG 62 was found susceptible to wilt. The treatment of seed endophytic bacterial isolate SEB-5, SEB-3, SEB-2, SEB-1 and SEB-4 was identified against wilt pathogen in reduce disease incidence, plant mortality and severity as well as promoting plant growth and health.

Cerebral microbleeds is associated with dementia in Parkinson's disease.

Emerging evidence suggests that cerebral small vessel disease (CSVD) may worsen cognitive functions in Parkinson's disease (PD). However, the effect of microbleeds on cognitive function in patients with PD remains unknown. This study explored the association between the presence, number and location of microbleeds with dementia in PD patients. This cross-sectional study included 431 patients with PD from Beijing Tiantan Hospital from May 2016 to August 2019. Cognition assessments (MMSE, MoCA) were performed for these patients. MRI imaging sequences were obtained and reviewed independently by two well-trained readers who were blind to all clinical data. Spearman's correlation analysis and logistic regression model analysis were further used for the assessments. An association between cerebral microbleeds with cognitive ability and dementia in PD patients was revealed. A significance was observed between the total number of microbleeds and two widely used scores of cognitive assessments (Spearman R = - 0.120 to MMSE with a p = 0.016, and - 0.117 to MoCA with a p = 0.020). In detail, infratentorial microbleeds were associated with the level of cognition in PD patients (Spearman R = - 0.099 to MMSE with a p = 0.049, and - 0.116 to MoCA with a p = 0.021). Furthermore, logistic regression analysis results also confirmed such correlations between the number of microbleeds and cognitive ability after adjusting for age, cholesterol level, Hamilton Anxiety Scale, Hamilton Depression Scale, and white matter hyperintensity Fazekas score (OR 3.28, p = 0.035, 95% CI 1.090-9.892). The occurrence of microbleeds, especially in the infratentorial locations, may worsen the cognitive function of PD patients and result in dementia. Management of cerebral vascular disease could be beneficial to patients with PD.

Redox Mechanisms of Platelet Activation in Aging.

Aging is intrinsically linked with physiologic decline and is a major risk factor for a broad range of diseases. The deleterious effects of advancing age on the vascular system are evidenced by the high incidence and prevalence of cardiovascular disease in the elderly. Reactive oxygen species are critical mediators of normal vascular physiology and have been shown to gradually increase in the vasculature with age. There is a growing appreciation for the complexity of oxidant and antioxidant systems at the cellular and molecular levels, and accumulating evidence indicates a causal association between oxidative stress and age-related vascular disease. Herein, we review the current understanding of mechanistic links between oxidative stress and thrombotic vascular disease and the changes that occur with aging. While several vascular cells are key contributors, we focus on oxidative changes that occur in platelets and their mediation in disease progression. Additionally, we discuss the impact of comorbid conditions (i.e., diabetes, atherosclerosis, obesity, cancer, etc.) that have been associated with platelet redox dysregulation and vascular disease pathogenesis. As we continue to unravel the fundamental redox mechanisms of the vascular system, we will be able to develop more targeted therapeutic strategies for the prevention and management of age-associated vascular disease.

An Imidazoline 2 Receptor Ligand Relaxes Mouse Aorta via Off-Target Mechanisms Resistant to Aging.

Imidazoline receptors (IR) are classified into three receptor subtypes (I1R, I2R, and I3R) and previous studies showed that regulation of I2R signaling has neuroprotective potential. In order to know if I2R has a role in modulating vascular tone in health and disease, we evaluated the putative vasoactive effects of two recently synthesized I2R ligands, diethyl (1RS,3aSR,6aSR)-5-(3-chloro-4-fluorophenyl)-4,6-dioxo-1-phenyl-1,3a,4,5,6,6a-hexahydropyrrolo[3,4-c]pyrrole -1-phosphonate (B06) and diethyl [(1-(3-chloro-4-fluorobenzyl)-5,5-dimethyl-4-phenyl-4,5-dihydro-1H-imidazol-4-yl]phosphonate] (MCR5). Thoracic aortas from Oncins France 1 (3- to 4-months-old) and C57BL/6 (3- to 4- and 16- to 17-months-old mice) were mounted in tissue baths to measure isometric tension. In young mice of both strains, MCR5 induced greater relaxations than either B06 or the high-affinity I2R selective ligand 2-(2-benzofuranyl)-2-imidazoline (2-BFI), which evoked marginal responses. MCR5 relaxations were independent of I2R, as IR ligands did not significantly affect them, involved activation of smooth muscle KATP channels and inhibition of L-type voltage-gated Ca2+ channels, and were only slightly modulated by endothelium-derived nitric oxide (negatively) and prostacyclin (positively). Notably, despite the presence of endothelial dysfunction in old mice, MCR5 relaxations were preserved. In conclusion, the present study provides evidence against a functional contribution of I2R in the modulation of vascular tone in the mouse aorta. Moreover, the I2R ligand MCR5 is an endothelium-independent vasodilator that acts largely via I2R-independent pathways and is resistant to aging. We propose MCR5 as a candidate drug for the management of vascular disease in the elderly.

Potential Effects of Natural H2S-Donors in Hypertension Management.

After the discovery of hydrogen sulfide (H2S) in the central nervous system by Abe and Kimura in 1996, the physiopathological role of H2S has been widely investigated in several systems such as the cardiovascular. In particular, H2S plays a pivotal role in the control of vascular tone, exhibiting mechanisms of action able to induce vasodilation: for instance, activation of potassium channels (KATP and Kv7) and inhibition of 5-phosphodiesterase (5-PDE). These findings paved the way for the research of natural and synthetic exogenous H2S-donors (i.e., molecules able to release H2S) in order to have new tools for the management of hypertension. In this scenario, some natural molecules derived from Alliaceae (i.e., garlic) and Brassicaceae (i.e., rocket or broccoli) botanical families show the profile of slow H2S-donors able to mimic the endogenous production of this gasotransmitter and therefore can be viewed as interesting potential tools for management of hypertension or pre-hypertension. In this article, the preclinical and clinical impacts of these natural H2S-donors on hypertension and vascular integrity have been reviewed in order to give a complete panorama of their potential use for the management of hypertension and related vascular diseases.

Statins in prevention of thromboembolic events: from seminal studies to recent advances.

Statins, 3‑hydroxy‑methylglutaryl coenzyme A reductase inhibitors, reduce the rate of cardiovascular events in primary and secondary prevention, and represent a cornerstone in the management of atherosclerotic vascular disease. Statins were also shown to be effective in lowering the risk of venous thromboembolism (VTE) in its primary and secondary prevention, but their use in VTE prophylaxis is still not approved and recommended in current guidelines. Several antithrombotic mechanisms of these cholesterol‑lowering agents, largely independent of the magnitude of low‑ density lipoprotein cholesterol reduction, were demonstrated in a broad spectrum of experimental in vitro and in vivo models. However, these studies yielded inconsistent results, such as substantial differences related to the use of specific statins, their dose or final concentration, and even the clinical setting (patients with cardiovascular disease or VTE vs healthy subjects). Anticoagulant properties of statins, reported for the first time 25 years ago, involve downregulation of tissue factor expression with a subsequent decreased thrombin generation and inhibition of thrombin‑mediated reactions, including factor V and factor XIII activation, and enhanced endothelial thrombomodulin expression resulting in increased protein C activation. Enhanced fibrinolysis was also reported partly as a result of reduced activity of fibrinolysis inhibitors such as plasminogen activator inhibitor‑1 (PAI‑1) and thrombin‑activatable fibrinolysis inhibitor. This review summarizes the findings of the studies from the 1990s until the most recent reports to update our knowledge on the impact of statins on blood coagulation and its potential clinical relevance.

Recommendations for OCT Angiography Reporting in Retinal Vascular Disease: A Delphi Approach by International Experts

Purpose:To develop a consensus nomenclature for reporting OCT angiography (OCTA) findings in retinal vascular disease (e.g., diabetic retinopathy, retinal vein occlusion) by international experts.Design:Delphi-based survey.Subjects, Participants, and/or Controls:Twenty-five retinal vascular disease and OCTA imaging experts.Methods, Intervention, or Testing:A Delphi method of consensus development was used, comprising 2 rounds of online questionnaires, followed by a face-to-face meeting conducted virtually. Twenty-five experts in retinal vascular disease and retinal OCTA imaging were selected to constitute the OCTA Nomenclature in Delphi Study Group for retinal vascular disease. The 4 main areas of consensus were: definition of the parameters of “wide-field (WF)” OCTA, measurement of decreased vascular flow on conventional and WF-OCTA, nomenclature of OCTA findings, and OCTA in retinal vascular disease management and staging. The study end point was defined by the degree of consensus for each question: “strong consensus” was defined as ≥85% agreement, “consensus” as 80% to 84%, and “near consensus” as 70% to 79%.Main Outcome Measures:Consensus and near consensus on OCTA nomenclature in retinal vascular disease.Results:A consensus was reached that a meaningful change in percentage of flow on WF-OCTA imaging should be an increase or decrease ≥30% of the absolute imaged area of flow signal and that a “large area” of WF-OCTA reduced flow signal should also be defined as ≥30% of the absolute imaged area. The presence of new vessels and intraretinal microvascular abnormalities, the foveal avascular zone parameters, the presence and amount of “no-flow areas,” and the assessment of vessel density in various retinal layers should be added for the staging and classification of diabetic retinopathy. Decreased flow ≥30% of the absolute imaged area should define an ischemic central retinal vein occlusion. Several other items did not meet consensus requirements or were rejected in the final discussion round.Conclusions:This study provides international consensus recommendations for reporting OCTA findings in retinal vascular disease, which may help to improve the interpretability and description in clinic and clinical trials. Further validation in these settings is warranted and ongoing. Efforts are continuing to address unresolved questions.

Promote the professional team-building of pulmonary circulation and open an exciting new chapter in the management of pulmonary vascular and right heart diseases in China

肺循环系统不仅包括肺血管（肺动脉、肺静脉等），还包括右心（右心房、室和肺动脉瓣、三尖瓣及其附属结构等）。肺血管和右心疾病不仅影响肺循环功能，还可严重影响呼吸系统和左心系统而危及生命。近年来我国学者在肺循环领域取得了重要进展。本期重点号刊发的内容涉及如何建设我国急性肺栓塞多学科救治团队、高海拔地区肺栓塞患者的临床特征、纤维纵隔炎侵犯肺血管的特征及其介入治疗、经皮肺动脉球囊扩张术治疗慢性血栓栓塞性肺动脉高压以及妊娠肺动脉高压患者长期预后等关键领域。相信本期内容对我国肺循环系统的医教研工作有重要参考价值。.

Use of Suture-Mediated Closure Devices for Closure of Punctures in Prosthetic Patches or Grafts is Associated With High Rates of Technical Success and Low Complication Rates.

Despite the increasing use of endovascular techniques in the management of peripheral vascular disease, there is little data on the safety of percutaneous closure devices in punctures of synthetic vascular material. Our paper sought to address this paucity in the literature by reviewing the incidence of complications occurring in patients in whom the ProGlide device was utilised to achieve haemostasis post-percutaneous puncture of vascular patches and graft materials. A retrospective review of patient records was conducted at a tertiary referral centre. Patients who had undergone percutaneous punctures of prosthetic bypass grafts or patch angioplasties between January 2011 and December 2020 were identified from a prospectively collected database. Medical records and post-procedural imaging were reviewed to assess the occurrence of post-procedural complications such as pseudoaneurysms, puncture site stenosis and further interventions for access complications. A total of 73 punctures of prosthetic material were performed in 42 patients, of which 39 utilised ProGlides. Median age of included patients was 72years. There was male predominance in the cohort (69.8%), and most punctures (87.3%) were through polyurethane patches. Device success rate was 95%, and no patients required open repair. There was a low incidence of complications, with no patients developing pseudoaneurysms, arteriovenous fistulas, ischaemic limbs or > 50% stenosis when either manual pressure or the ProGlide device was used to achieve haemostasis. Furthermore, there were no returns to theatre or further interventions performed for access site complications. The use of the ProGlide closure device has a low incidence of complications and its safety appears to be equivalent to manual compression when used to achieve haemostasis in percutaneous punctures of synthetic vascular material in select patients. To our knowledge, this is the only article to date to assess the safety of the ProGlide in this setting.

In Memoriam: Louis L. Leatherman, Jr., MD (1937–2022)

Louis Levy Leatherman, Jr., MD, died peacefully on 11 January 2022. Born on 17 April 1937, he was the eldest son of Gertrude Leatherman and Louis Levy Leatherman, Sr. His desire to become a physician was motivated by his father's death of heart disease when Louis Jr. was 16 years old.Dr. Leatherman studied at Louisiana College, then earned his medical degree from Louisiana State University Medical School in 1962. His internship was at Martin Army Community Hospital in Fort Benning, Georgia (1962–1963), and his internal medicine residency at Confederate Memorial Medical Center in Shreveport, Louisiana (1965–1967).He moved to Houston in 1968 for his cardiology fellowship, sponsored by Baylor College of Medicine (BCM). During his training at St. Luke's Episcopal Hospital (SLEH) and the Texas Heart Institute (THI), he grew to appreciate his colleagues' aggressive management of heart and vascular disease. Their varied approaches to diseases and problems taught him to think flexibly when he evaluated his own patients. He participated in SLEH's first heart transplant program and considered it “fantastically exciting.”Cardiologists were also seeking alternatives to open heart surgery for treating blockages in coronary arteries. In the late 1970s, a new technique, percutaneous transluminal coronary angioplasty (PTCA), enabled special catheters to be threaded into coronary arteries and inflated to reopen blocked blood vessels. Dr. Leatherman, along with Dr. Paolo Angelini, brought PTCA to THI after studying under Dr. Andreas Gruentzig. In 1979, the National Heart, Lung, and Blood Institute chose THI as a test site, and, by April 1980, THI physicians had performed 100 PTCA procedures.Dr. Leatherman established a private practice at the Medical Clinic of Houston while also serving as attending physician at SLEH and THI, Clinical Associate Professor of Medicine at BCM, consulting staff member at Texas Children's Hospital, and teaching staff member at Ben Taub General Hospital and Jefferson Davis Hospital. He retired in 1995 after a 30-year career.In 1972, Dr. Leatherman purchased a ranch near Bertram, Texas, where he and his family enjoyed escaping the rigors of his medical practice. He loved nature and wildlife. In 1994, he married Mary Gail Swift, and when he retired, they moved to the ranch permanently. The couple traveled monthly to Ruston, Louisiana, to help run a corporate wellness clinic for a good friend.Dr. Leatherman was preceded in death by his parents and by his first wife and mother of his children, Charlotte Wheeler Leatherman. He is survived by his wife Mary Gail Leatherman; daughter Dr. Martha Leatherman (and husband Dr. James Moore); son Mark Leatherman (and wife Peggy); brothers Dr. Edward H. and Malcolm L. Leatherman; grandchildren Jameson, Jonathan, and Rachel Moore, and Ashley and Hunter Leatherman; stepchildren Curt Swift and Shelly Swift Roeder; and step-grandchildren Jackson and Mia Swift, and Levon and Iva Mae Roeder.Dr. Leatherman, a pioneer in advancing the treatment of heart disease, was deeply committed to his patients. They, along with his colleagues and family, will cherish his memory and contributions.

EP.FRI.344 Training in remote and austere emergency surgery - Is it UK relevant or Medical tourism?

Abstract Aims Military surgical trainees from ST4 were deployed to Afghanistan. They gained extensive experience of surgical trauma. The placement no longer exists, and the type of deployment has moved from fully equipped, multi-disciplinary team scenario to small team, remote and austere. With increasing specialisation and advancing technology how do surgeons prepare for remote and austere surgery with resource-limited decision making? One consideration is an out-of-programme experience in a developing nation. This needs to be balanced with the impression of “medical tourism. Methods A charity-funded experienced UK general surgeon was needed in an Eastern Province hospital, Rwanda. This provided opportunity for a registrar to assist. “Give back” was by assisting in the training of Rwandan doctors and establishing a stand-alone surgical service. Results The workload included resource-constrained operative and non-operative management of significant trauma (including head injuries and burns), general surgery, vascular, urology and gynaecology disease in all age groups. 114 operations in 29 working days, Non-operative management decisions were the most challenging, resulting in immersive trauma and emergency surgery experience. The surgery involved unusual operations and creative clinical and technical thinking. There was a significant amount of trauma, most presenting very late, creating management complexities due to infection risk. Conclusions The role of remote and austere surgery is applicable to UK trainees, in particular military trainees, those who wish to work in remote and austere environments and for real life critical thinking exposure that could apply to resource limitation or delay-to-surgery in mass casualty situations.

Medical Management of Vascular Disease

Although surgeons may be able to bypass or open blocked arteries and replace aneurysms with minimally invasive surgery, patients continue to die from the other cardiovascular consequences of vascular disease. Surgeons must become more involved in the nonsurgical treatments of peripheral artery disease (PAD). A good understanding of the role of lipids in atherosclerosis is critical but surgeons must also recognize the threats of diabetes; smoking; hypertension; and hyperlipidemia on PAD. Treatments, including lifestyle modification, diet, exercise, and the influence of lipid-lowering agents is described. Medications that can alter PAD are described in detail and include statins; fibrates; niacin; bile acid sequestrants; ezetimibe; and antiplatelet agents. Side effects and monitoring is also described. Although much of the review covers the general principles of medical management of patients with PAD, components of this overall disease process are also provided and include pharmacological intervention for claudication; stroke; aortic aneurysms; and nonatherosclerotic vascular disease. This review contains 2 figures, 2 tables, and 181 references.

Two-year outcomes in patients undergoing rotational atherectomy and drug coated balloon therapy for chronic total occluded peripheral arterial diseases: A retrospective cohort study

Background/Aim: Atherectomy is a minimally invasive endovascular surgery technique for removing atherosclerotic plaques in stenosed arteries. It seems to increase the success of angioplasty in the treatment of peripheral artery disease. We aimed to evaluate the outcomes of patients who underwent rotational atherectomy and drug-coated balloon therapy. Methods: In this retrospective cohort study, thirty-four patients who underwent rotational atherectomy and drug-coated balloon angioplasty between August 2016 and January 2019 were evaluated. The Rotablator System (Boston Scientific Corporation; Scimed, Plymouth, MN, USA) was used in all cases. Drug-coated balloons were used in the femoropopliteal section in all patients. Results: The mean age of patients was 65.55 (8.36) years. Seventeen had diabetes mellitus, for which 12 were using oral antidiabetic drugs and 5 were using insulin. At the 3rd postprocedural month, 94.1% of patients (n=32) had no clinical symptoms (P<0.01), two patients needed additional procedures such as balloon angioplasty and stenting due to decreased blood flow and severe stenosis of the superficial femoral artery. At the 1-year follow-up, while 2 patients needed surgery, one needed stenting to the superficial femoral artery. Within 2 years, 27 patients (79.4%) were clinically stable without any symptoms and 2 patients had undergone surgery. Conclusion: Atherectomy devices have become a major tool in the management of peripheral vascular disease. Opening the natural lumen of the arteries gives the patient more time before open vascular surgery.

Automated Segmentation of the Human Abdominal Vascular System Using a Hybrid Approach Combining Expert System and Supervised Deep Learning.

Background: Computed tomography angiography (CTA) is one of the most commonly used imaging technique for the management of vascular diseases. Here, we aimed to develop a hybrid method combining a feature-based expert system with a supervised deep learning (DL) algorithm to enable a fully automatic segmentation of the abdominal vascular tree. Methods: We proposed an algorithm based on the hybridization of a data-driven convolutional neural network and a knowledge-based model dedicated to vascular system segmentation. By using two distinct datasets of CTA from patients to evaluate independence to training dataset, the accuracy of the hybrid method for lumen and thrombus segmentation was evaluated compared to the feature-based expert system alone and to the ground truth provided by a human expert. Results: The hybrid approach demonstrated a better accuracy for lumen segmentation compared to the expert system alone (volume similarity: 0.8128 vs. 0.7912, p = 0.0006 and Dice similarity coefficient: 0.8266 vs. 0.7942, p < 0.0001). The accuracy for thrombus segmentation was also enhanced using the hybrid approach (volume similarity: 0.9404 vs. 0.9185, p = 0.0027 and Dice similarity coefficient: 0.8918 vs. 0.8654, p < 0.0001). Conclusions: By enabling a robust and fully automatic segmentation, the method could be used to develop real-time decision support to help in the management of vascular diseases.

Imaging the Retinal Vasculature.

Advances in retinal imaging are enabling researchers and clinicians to make precise noninvasive measurements of the retinal vasculature in vivo. This includes measurements of capillary blood flow, the regulation of blood flow, and the delivery of oxygen, as well as mapping of perfused blood vessels. These advances promise to revolutionize our understanding of vascular regulation, as well as the management of retinal vascular diseases. This review provides an overview of imaging and optical measurements of the function and structure of the ocular vasculature. We include general characteristics of vascular systems with an emphasis on the eye and its unique status. The functions of vascular systems are discussed, along with physical principles governing flow and its regulation. Vascular measurement techniques based on reflectance and absorption are briefly introduced, emphasizing ways of generating contrast. One of the prime ways to enhance contrast within vessels is to use techniques sensitive to the motion of cells, allowing precise measurements of perfusion and blood velocity. Finally, we provide a brief introduction to retinal vascular diseases.

Pulmonary hypertension in interstitial lung disease: screening, diagnosis and treatment.

Pulmonary vascular disease resulting in pulmonary hypertension in the context of interstitial lung disease (PH-ILD) is a common complication that presents many challenges in clinical practice. Despite recent advances, the pathogenetic interplay between parenchymal and vascular disease in ILD is not fully understood. This review provides an overview of the current knowledge and recent advances in the field. Clinical trials employing the phosphodiesterase-5-inhibitor sildenafil delivered negative results whereas riociguat showed harmful effects in the PH-ILD population. More recently, inhaled treprostinil showed positive effects on the primary endpoint (six-min walk-distance) in the largest prospective randomized placebo-controlled trial to date in this patient population. Additionally, a pilot trial of ambulatory inhaled nitric oxide suggests beneficial effects based on the novel endpoint of actigraphy. In view of these novel developments this review provides an overview of the status quo of screening, diagnosis and management of pulmonary vascular disease and PH in patients with ILD.