Obliterative Arteriopathy Research Articles

#2885 Thrombosis complicating the first native arteriovenous fistula: what are the risk factors?

Abstract Background and Aims The native arteriovenous fistula is considered the best vascular access for hemodialysis, whose ultimate complication is thrombosis. The risk factors for this complication are multiple. The aim of our work is to determine the risk factors for thrombosis of the first created native AVF. Method This is a retrospective descriptive study of 65 patients over 18 years of age and hemodialyzed in our department who benefited of the confection of a native arteriovenous fistula at the same hospital. Results Arteriovenous fistula thrombosis occurred in 41.53% of patients with an average age of 49.4 years and a sex ratio M/F=3.5. 59.2% of arteriovenous fistulae were distal versus 40.7% proximal, divided into humerocephalic (29.6%) and humerobasilic (11.1%). AVF thrombosis occurred after a mean duration of 3.19 years after its confection [01 months, 13 years]. 25.9% of arteriovenous fistulae had not yet been punctured. 63% of patients were smokers, 55.6% were diabetics, 74.1% were hypertensive and 66.7% were cardiac with predomination of ischemic etiology in 29.6%. 44.4% of patients had obliterative arteriopathy of the lower limbs, 25.9% of whom were amputees. Patients had been on dialysis for an average of 4.4 years [01 months, 13 years], with diabetic nephropathy predominating at 51.9%. All patients were on antiplatelet therapy and 7.4% on anticoagulation. 11.1% had perdialytic hypotension. Multivariate statistical analysis revealed a significant correlation between anemia, diabetes and the occurrence of thrombosis (respectively p = 0.03; p = 0.024). Conclusion Patients with arteriovenous fistula thrombosis have multiple cardiovascular risk factors. Diabetes and anemia remain the main predictive factors for thrombosis.

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,

Evaluation of Cardiovascular Risk among Carpenter Cabinetmakers in the Dakar Region: Study of Vascular Function and Heart Rate Variability

Background: Contemporary concerns recognize atmospheric air pollution as a significant contributor tocardiovascular diseases. Notably, wood dust, colloquially known as sawdust, emerges as a source of air pollution.Our investigation sought to assess the impact of wood dust on the cardiovascular health of carpenters in the Dakarregion.Methods: This cross-sectional study encompassed one hundred (100) carpenters in the Dakar region. Acomprehensive questionnaire gathered data on socio-demographic features, professional experience, medicalhistory, preventive measures, and lifestyle habits. Vascular function assessment involved determining finger-toepulse wave velocity (ft-PWV) using a popmeter. Additionally, we screened for obliterative arteriopathy of thelower limbs (OALL). Heart rate variability measurement provided insights into the sympatho-vagal balanceof nervous control over cardiac activity.Results: The average age in our population was 38 ±7.2 years, with a body mass index of 22.7 ±2.8 kg/m2. A majority(69%) worked an average of 10.2 hours per day for six days per week. Approximately 73% of the shops were observedto be enclosed. Respiratory and ocular symptoms were prevalent among participants. Analysis using the Pop meterrevealed arterial stiffness (ft-PWV>10 m/s) in 3% of participants, and 11% exhibited arterial hypertension.OALL was present in 8% of participants. Furthermore, a positive correlation (P=0.003; r=0.581) between ft-PWVVand mean arterial pressure was noted. Data on cardiac variability indicated a substantial proportion of participantsdisplaying decreased tone in the cardiac-parasympathetic nervous system in the supine position (94.73% hadRMSSD values above norms). Notably, abnormal activation of the parasympathetic system (HF) and decreasedsympathetic system activity (low values for HF, LF, and LF/HF compared with norms) were observed in theorthostatic position.
 Conclusion: Carpentry work in environments with elevated air pollution, potentially emanating from wooddust, poses inhalation risks for workers. The inhalation of wood dust appears linked to an increased risk andexacerbation of cardiovascular complications.

Evaluation and management of abnormal liver enzymes in the liver transplant recipient: When, why, and what now?

Evaluation and management of abnormal liver enzymes in the liver transplant recipient: When, why, and what now?

Evaluation of the quality of life of 50 type 2 diabetic patients followed in a Medical Center for Non-Communicable Diseases in Rabat: Hay Ennahda II

Diabetes is a progressive and severe chronic metabolic disease. It is a major public health problem, responsible for a high morbidity and mortality rate in the world and in Morocco. Our study involves 50 patients with type 2 diabetes recruited at the Hay Ennahda II Extention III Non-Communicable Disease Medical Center in Rabat. This is a descriptive and analytical observational study, the purpose of which is to assess the quality of life of Moroccan type 2 diabetic patients by means of a generic questionnaire "SF-12" and a specific questionnaire for diabetes "Diabetes-39". The results showed that diabetes negatively affects the quality of life of diabetic patients and established that the factors associated with their quality of life are multiple: factors related to socio-demographic characteristics (gender, ethnicity and marital status), comorbidities (hypertension and dyslipidemia), related to the pathology itself (obesity) and its chronic degenerative complications (diabetic neuropathy and obliterative arteriopathy of the lower limbs). Unlike the literature, some socio-economic characteristics (age, level of education, professional activity), others related to diabetes (age of diabetes and glycemic control) and therapeutic management do not affect quality of life in our study, this can be explained by the size of our sample. This preliminary study is a pilot study that introduces the issue of the quality of life of people with diabetes in Rabat. It will be continued to obtain a larger sample, in order to better study the peculiarities of the Moroccan patients in this field.

American Society of Anesthesiologists-Physical Status Classification As An Independent Risk Factor of Surgical Site Infection After Infra-Inguinal Arterial Bypass.

The present study aimed to assess whether high-risk American Society of Anesthesiologists (ASA)-Physical Status was an independent risk factor for the development of surgical site infection (SSI) after infra-inguinal lower extremity bypass (LEB). The ASA-Physical Status Classification System assesses the overall physical status preoperatively. ASA-Physical Status is associated with postoperative morbidity and mortality. However, limited data are available on how ASA-Physical Status Class affects the development of SSI after infra-inguinal LEB. Patients who had undergone infra-inguinal LEB from January 1, 2015 to December 31, 2018, for obliterative arteriopathy or popliteal aneurysm at our university hospital were included. SSI risk factors were identified using multivariable logistic regression. The length of hospital stay, major limb events (MALE), major adverse cardiovascular events (MACE), and all-cause mortality were compared for patients with SSI versus those without SSI 3 months and 1- year of follow-up after the index surgery. Among the 267 patients included, 30 (11.2%) developed SSI during the 3-month period and 32 (12%) at 1 year. ASA-Physical Status ≥3 [odds ratio (OR): 3.7, 95% confidence interval CI) 1.5-11.1], emergency surgery (OR: 2.7, 95% CI 1.2-6.0), general anesthesia (OR: 2.8, 95% CI 1.3-6.1), and procedure performed by a junior surgeon (OR: 2.7, 95% CI 1.3-6.0) were independently associated with SSI. At 3 months and 1 year, SSI was significantly associated with MALE (including surgical wound debridement, subsequent thrombectomy, major amputation), length of hospital stay, and all-cause mortality. The ASA-Physical Status should be considered in medical management when an infra-inguinal LEB is considered in frail patients, to prevent surgical complications.

Knowledge of Patients and Their Accompanying Persons about Obliterative Arteriopathy of the Lower Limbs at Conakry University Hospital in 2022

Knowledge of Patients and Their Accompanying Persons about Obliterative Arteriopathy of the Lower Limbs at Conakry University Hospital in 2022

The Importance of Arterial Stenosis in Diabetic Patients Case Presentation

Abstract For the adult population the frequency of peripheral arterial disease is 3% - 4%. Cardiovascular and cerebrovascular event rates, both fatal and non-fatal, are increased in patients with PAD and DM relative to nondiabetic patients with PAD. It is the clinical case of a 62-year-old patient, diagnosed with type 2 diabetes with chronic obliterative arteriopathy stage IV of the lower limbs. Postoperative evolution was favorable, as there was no need for amputation of the left hallux or debridement of necrotic tissues, due to the decision to perform the timely iliofemoral bypass that restored arterial flow to the femoral and iliac arteries through the prosthetic graft. Continued treatment to normalize lipid metabolism, hypertension, repeated vasodilator therapy, diet and exercise are absolutely necessary and must be included in the long-term therapeutic plan of patients who have undergone restorative surgery, with timely referral to specialist medical services.

Exploring the pathophysiologic basis of constrictive pericarditis of Kohlmeier Degos disease: A case series and review of the literature

Kohlmeier-Degos Disease is a unique thrombotic microvascular and arteriopathic vasculopathy that is highly selective in the organs it targets. It invariably involves the skin and can be a purely cutaneous process. It affects both the microvasculature and the arterial system ranging from a thrombogenic microangiopathy to a fibrointimal obliterative arteriopathy with an accompanying background of extravascular fibrosis. A potentially lethal complication of Kohlmeier-Degos disease is constrictive pericarditis and pleuritis. We present three male patients, ages 26 years, 46 years and 58 years of age with established cutaneous and gastrointestinal Kohlmeier-Degos disease who developed progressive pericarditis which in two necessitated a pericardiectomy. There are 6 other reported cases, 5 in men, with restrictive symptoms developing on average 6 years following the onset of skin disease and all with gastrointestinal involvement. Half of the patients died within one year following the diagnosis of cardiopulmonary restrictive disease. The restrictive symptoms developed within 12 months, 2 years and 11 years following the initial skin presentation. In one patient this complication developed despite receiving eculizumab, indicative that this extravascular fibrosing reaction was not complement mediated as opposed to the thrombotic microvascular component of the disease which is C5b-9 mediated. Two of the three patients had evidence of right ventricular dysfunction. Two of our patients died within 1 year of developing constrictive pericarditis due to progressive cardiopulmonary failure. A profibrogenic process resembling scleroderma was seen given the degree of smooth muscle actin staining along with a mirror image reduction in CD34 expression within the fibrotic pleura and pericardium. There was significant upregulation in type I interferon signaling in cases tested as revealed by the degree of staining for MXA, the surrogate type I interferon marker. We propose that excessive type I interferon signaling results in the influx of monocyte derived dendritic cells with subsequent transdifferentiation into potent collagen producing myofibroblasts. We believe that targeting and suppressing type I interferon signaling should be a cornerstone of early therapy in patients with Kohlmeier- Degos disease to prevent pleural and pericardial fibrosis.

Caractéristiques clinicopathologiques et résultats postopératoires de l’entérite radio-induite : une étude rétrospective de 41 patients

Surgery is required in patients with symptoms of chronic radiation-induced enteritis (CRE) resistant to medical therapy. The study aimed to correlate histopathologic features of CRE to the clinical presentation and the postoperative recurrence. All patients with small bowel resection performed for CRE between 2006 and 2017 were studied. Histological data were retrospectively correlated to initial clinical data and to postoperative recurrence of CRE (occlusion, need for parenteral nutrition) observed during a median follow-up of 32 months. Forty-one patients were studied (39 women and 2 men, median age 62 yo at time of radiation for pelvic cancer, 80% gynecologic). Median time to surgery after radiation was 3 years. Ileocaecal resections (80% of patients) removed 60cm (median length). Histologically, a diffuse obliterative arteriopathy was present in 24 (59%) patients, highly associated to amyotrophy, villous atrophy and ulceration observed in 66, 63 and 34% of patients respectively (P<.05). Diffuse arteriopathy was uncorrelated with patient's age and vascular risk factor (tobacco, diabetes, hypertension, dyslipidemia). Median time to surgery after radiation was longer in patients presenting with obliterative arteriopathy (13 years vs. 2.6 years, P=0.0002). During follow-up, half of the patients had a recurrence of CRE, uncorrelated to the arteriopathy. Radiation-induced enteritis requiring late surgery after radiation presented histologically with a diffuse obliterative arteriopathy and ischemic features. In our center, half of the patients were cured by surgery. The arterial injury was not a risk factor for postoperative recurrence.

Epidemiological and Prognostic Profile of Patients Operated for Obliterative Arteriopathy of the Lower Limbs (OALL) at the General Hospital of Yaoundé – Cameroon

Introduction: Obliterative Arteriopathy of the Lower Limbs (OALL) is one of the most prevalent cardiovascular diseases in the world with high morbidity and economic impact. In Cameroon, this condition is also present but little studied. For this purpose, this study aims to analyze the epidemiological profile and prognosis of patients operated for OALL at the Yaounde General Hospital (YGH). Materials and Methods: We conducted a retrospective longitudinal study in the surgery department of the YGH relating to ninety-seven medical records of OALL operated patients between 2008 and 2018 (ten years) using a quantitative research approach. Results: It emerges from this study that the mean age was 67.1 ± 13.3 years. Male sex was predominant (57.7%). Stroke was the most frequent clinical past history (15.5%). The most frequent cardiovascular risk factors were arterial hypertension (63.9%), diabetes mellitus (41.2%) and smoking (32.9%). Grade III-IV and acute limb ischemia were the most prevalent OALL grades (41.2% and 32% respectively). Amputation was the most practiced surgical procedure (41.2%). The one-year mortality rate was 39.2%. We found no factor associated with one-year survival. Conclusion: We, therefore, suggest that public health actors develop actions and interventions to exercise in order to reduce this health indicator (mortality rate) and revalue the place of psychosocial care in amputees.

Pandemic influenza outbreak detection and response in Farta district, South Gondar zone, Amhara region, Ethiopia, 2016

Introduction: Obliterative Arteriopathy of the Lower Limbs (OALL) is one of the most prevalent cardiovascular diseases in the world with high morbidity and economic impact. In Cameroon, this condition is also present but little studied. For this purpose, this study aims to analyze the epidemiological profile and prognosis of patients operated for OALL at the Yaounde General Hospital (YGH). Materials and Methods: We conducted a retrospective longitudinal study in the surgery department of the YGH relating to ninety-seven medical records of OALL operated patients between 2008 and 2018 (ten years) using a quantitative research approach. Results: It emerges from this study that the mean age was 67.1 ± 13.3 years. Male sex was predominant (57.7%). Stroke was the most frequent clinical past history (15.5%). The most frequent cardiovascular risk factors were arterial hypertension (63.9%), diabetes mellitus (41.2%) and smoking (32.9%). Grade III-IV and acute limb ischemia were the most prevalent OALL grades (41.2% and 32% respectively). Amputation was the most practiced surgical procedure (41.2%). The one-year mortality rate was 39.2%. We found no factor associated with one-year survival. Conclusion: We, therefore, suggest that public health actors develop actions and interventions to exercise in order to reduce this health indicator (mortality rate) and revalue the place of psychosocial care in amputees.

The prevalence of disability at the elderly with peripheral obliterative arteriopathy

Aim: Atherosclerosis is the primary cause of peripheral arterial disease (PAD). Functional ability evaluation of patients can guide clinicians for a good management of treatment. We assess the functionality of elderly patients with arterial disease of the inferior limbs.

Common hepatic artery occlusion secondary to hilar perivascular traumatic neuroma following allograft liver transplantation

Traumatic neuromas of the porta hepatis post liver transplantation were first reported in 1994 occurring in up to 28% of transplants. Clinically significant or symptomatic traumatic neuromas are rare, with reported incidence of 0.5–3.6%; the majority associated with biliary obstruction, and only two instances complicated by hepatic artery occlusion. We report a case of a 44-year-old female, originally transplanted for fulminant hepatitis B in 2009, with a hilar perivascular traumatic neuroma one month after her second allograft liver transplantation, complicated by hepatic artery occlusion. Recurrent biliary sepsis secondary to biliary ischaemia resulted in graft failure and re-transplantation. A perivascular neuroma adjacent to the anastomosis was suspected on imaging as a possible cause of hepatic artery occlusion. The explanted allograft showed hilar scarring with evidence of hepatic artery occlusion and recanalisation accompanied by adjacent traumatic neuromatous proliferation. Her first explanted allograft removed five months previously for chronic rejection interestingly demonstrated similar scarring and traumatic neuromatous proliferation surrounding a narrowed and partially occluded hepatic artery, although without characteristic rejection-associated obliterative arteriopathy changes. Pathologists should be aware of the potential for traumatic neuromas arising post liver transplantation as a cause of biliary, and rarely, vascular obstruction, as illustrated by this case.

Descendo-bifemoral bypass grafting and renal artery revascularization to treat complex obliterative arteriopathy.

Our goal was to describe a new standardized approach in patients with extensive obliterative arteriopathy aimed at distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass grafting and renal artery revascularization. Three patients with Leriche's syndrome and either a compromised single kidney or unilateral significant renal artery stenosis were treated with a standardized surgical approach, restoration of distal perfusion via descendo-bifemoral bypass with synchronous ( n = 2) left-sided renal artery revascularization or metachronous ( n = 1) right-sided renal artery revascularization. The intended surgical aim was achieved successfully in all 3 cases. All patients showed a decline in serum creatinine levels. One patient who needed substitution therapy was free from dialysis 3 months after surgery. Additionally, blood pressure management was substantially reduced because uncontrolled peak systolic episodes were no longer observed and pharmacotherapeutic agents could be partially withdrawn. Distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass and renal artery revascularization is a promising option to treat complex obliterative arteriopathy.

EComment. Descendo-bifemoral bypass grafting with renal revascularization for complex obliterative arteriopathy

eComment. Descendo-bifemoral bypass grafting with renal revascularization for complex obliterative arteriopathy

Modulation of Intersectin-1s Lung Expression Induces Obliterative Remodeling and Severe Plexiform Arteriopathy in the Murine Pulmonary Vascular Bed

Murine models of pulmonary arterial hypertension (PAH) that recapitulate the plexiform and obliterative arteriopathy seen in PAH patients and help in defining the molecular mechanisms involved are missing. Herein, we investigated whether intersectin-1s (ITSN) deficiency and prolonged lung expression of an ITSN fragment with endothelial cell (EC) proliferative potential (EHITSN), present in the lungs of PAH animal models and human patients, induce formation of plexiform/obliterative lesions and defined the molecular mechanisms involved. ITSN-deficient mice (knockout/heterozygous and knockdown) were subjected to targeted lung delivery of EHITSN via liposomes for 20 days. Immunohistochemistry and histological and morphometric analyses revealed a twofold increase in proliferative ECs and a 1.35-fold increase in proliferative α-smooth muscle actin-positive cells in the lungs of ITSN-deficient mice, transduced with the EHITSN relative to wild-type littermates. Treated mice developed severe medial wall hypertrophy, intima proliferation, and various forms of obliterative and plexiform-like lesions in pulmonary arteries, similar to PAH patients. Hemodynamic measurements indicated modest increases in the right ventricular systolic pressure and right ventricle hypertrophy. Transcriptional and protein assays of lung tissue indicated p38MAPK-dependent activation of Elk-1 transcription factor and increased expression of c-Fos gene. This unique murine model of PAH-like plexiform/obliterative arteriopathy induced via a two-hit pathophysiological mechanism without hypoxia provides novel druggable targets to ameliorate and, perhaps, reverse the EC plexiform phenotype in severe human PAH.

Strong Humoral Anti-HLA Immune Response Upon Arbitrarily Chosen Allogeneic Arterial Vessel Grafts

Forty-three patients were grafted with forty-four fresh or cryopreserved allogeneic arterial vessels in order to treat infections of synthetic vascular implants as these often lead to sepsis, amputation and death. All the patients were HLA-typed whereas typing results of the post-mortem donors were inquired or genotyped from residuary vessels’ segments. 84% of the patients were cured from the underlying infections with a re-infection rate of only 9% attesting this therapeutic procedure a high success rate for recovering from the bacterial infections. Since the allografts were chosen without considering HLA-histocompatibility between donors and recipients 95% of the patients developed a humoral anti-HLA immune response with 89% of them giving rise to virtually definable donor-specific antibodies. Regarding the clinical outcome 16% of the patients exhibited thromboses as the most frequent complication. In addition to clinical follow up analyses of all patients, tissue excisions of 11 patients’ allografts due to various complications but not resulting from persisting infections were analyzed in order to compare these vessels’ pre-and post-transplant histological appearance. In contrast to three early excised homografts (after 14 to 45 days) all of the later on explanted vessels (after 8 to 96 months) clearly showed chronic degeneration processes induced by the alloreactive immune response. Although not leading to acute graft dysfunctions comparable to those of solid organs, arbitrarily selected vessels exhibit a high degree of alloimmunization with consequent chronic degeneration processes such as the loss of smooth muscle cells. Additionally, clear signs of fibrosis of the different arterial vessel layers lead to obliterative arteriopathy and thromboses. Thus, apparently the overall practicability of the unmatched allocation of arterial homografts is clearly limited. Further approaches of arterial vessel allo-grafting are required to investigate the hypothesis that the clinical outcome of well HLA-matched homografts may lead to a significantly decreased number of thromboses.

Percutaneous Needle Tenotomy for the Treatment of Muscle and Tendon Contractures in Adults With Brain Damage: Results and Complications

ObjectiveTo study the results and complications of percutaneous needle tenotomy for superficial retracted tendons in patients with brain damage. DesignProspective observational study. SettingUniversity hospital. ParticipantsPatients with severe brain damage (N=38; mean age, 60.7y; age range, 24–93y; 21 women) requiring surgical management of contractures and eligible for percutaneous needle tenotomy were enrolled between February 2015 and February 2016. InterventionsThe percutaneous needle tenotomy gesture was performed by a physical medicine and rehabilitation physician trained by an orthopedic surgeon, under local or locoregional anesthesia. Treated tendons varied among patients. Main Outcome MeasuresAll patients were evaluated at 1, 3, and 6 months to assess surgical outcomes (joint range of motion [ROM], pain, and functional improvement) while screening for complications. ResultsImprovements in ROM (37/38) and contractures-related pain (12/12) were satisfactory. Functional results were satisfactory (Goal Attainment Scale score ≥0) for most patients (37/38): nursing (n=12), putting shoes on (n=8), getting in bed or sitting on a chair (n=6), verticalization (n=7), transfers and gait (n=8), and grip (n=2). Five patients had complications related to the surgical gesture: cast-related complications (n=2), hand hematoma (n=2), and cutaneous necrosis of the Achilles tendon in a patient with previous obliterative arteriopathy of the lower limbs (n=1). ConclusionsPercutaneous needle tenotomy yields good results in the management of selected superficial muscle and tendon contractures. The complications rate is very low, and this treatment can be an alternative to conventional surgery in frail patients with neurologic diseases.

Oxygen-ozone therapy effects on PaO2 value in a diabetic patient suffering from chronic peripheral obliterative arteriopathy

We define chronic occlusive arterial disease of the extremities (COAD) as the aging process of the arterial vessel wall, characterized by the formation of atherosclerotic plaques. Patients suffering from COAD often refer induced pain exercise. Previous studies described benefic effects of oxygen-ozone (O&lt;sub&gt;2&lt;/sub&gt;-O&lt;sub&gt;3&lt;/sub&gt;) therapy in treatment of COAD. We describe a case of a 69-year old man, suffering from COAD, treated with O&lt;sub&gt;2&lt;/sub&gt;-O&lt;sub&gt;3&lt;/sub&gt; therapy. The aim of our report was to evaluate not only the effects of the oxygen-ozone therapy on the patient, but also the influence of this method on the arterial partial pressure of oxygen value.