Peripheral Arterial Disease Research Articles

Association of erectile dysfunction and peripheral arterial disease in NHANES 2001-2004: a cross-sectional study

ObjectiveTo evaluate the association between Erectile dysfunction (ED) and peripheral arterial disease (PAD) in adult American males using a large database.MethodsThe relationship between ED and PAD prevalence among participants in the 2001-2004 National Health and Nutrition Examination Survey (NHANES) database was assessed using a series of statistical analyses. ED was evaluated based on a single-item measure of self-reported erection problems from the Massachusetts Male Aging Study. PAD was defined as ankle-brachial index (ABI) < 0.9 in at least one leg. Multifactorial logistic regression models were used to investigate the association between ED and PAD.ResultsA total of 2394 participants were enrolled, of whom 905 individuals (37.8%) were diagnosed with ED. After adjusting for confounding variables, the association between ED and PAD remained positive, with an odds ratio of 2.05 (95% confidence interval 1.24-3.39). Subgroup analysis revealed that the relationship between ED and PAD was significant in patients aged >50 years old, without hypertension, without diabetes, without cardiovascular disease, without high cholesterol, former smokers, low physical activity levels, and a body mass index of 25-30 (P < 0.05). In addition, all subgroups analyzed were evaluated for any potential interaction, and no statistically significant association was discovered.ConclusionsIn a sample of US adults aged ≥40, this cross-sectional study found that ED is related to a higher occurrence of PAD. ED may be an independent predictor of PAD, and thus it should be considered in the treatment of patients with ED.

Etrinabdione (VCE-004.8), a B55α activator, promotes angiogenesis and arteriogenesis in critical limb ischemia

BackgroundVasculogenic therapies explored for the treatment of peripheral artery disease (PAD) have encountered minimal success in clinical trials. Addressing this, B55α, an isoform of protein phosphatase 2A (PP2A), emerges as pivotal in vessel remodeling through activation of hypoxia-inducible factor 1α (HIF-1α). This study delves into the pharmacological profile of VCE-004.8 (Etrinabdione) and evaluates its efficacy in a preclinical model of critical limb ischemia, with a focus on its potential as a PP2A/B55α activator to induce angiogenesis and arteriogenesis.MethodsVascular endothelial cells were used for in vitro experiments. Aorta ring assay was performed to explore sprouting activity. Matrigel plug-in assay was used to assess the angiogenic potential. Critical limb ischemia (CLI) in mice was induced by double ligation in the femoral arteria. Endothelial vascular and fibrotic biomarkers were studied by immunohistochemistry and qPCR. Arteriogenesis was investigated by microvascular casting and micro-CT. Proteomic analysis in vascular tissues was analyzed by LC–MS/MS. Ex-vivo expression of B55α and biomarkers were investigated in artery samples from PAD patients.ResultsVCE-004.8 exhibited the ability to induce B55α expression and activate the intersecting pathways B55α/AMPK/Sirtuin 1/eNOS and B55α/PHD2/HIF-1α. VCE-004.8 prevented OxLDL and H2O2-induced cytotoxicity, senescence, and inflammation in endothelial cells. Oral VCE-004.8 increased aorta sprouting in vitro and angiogenesis in vivo. In CLI mice VCE-004.8 improved collateral vessel formation and induced endothelial cells proliferation, angiogenic gene expression and prevented fibrosis. The expression of B55α, Caveolin 1 and Sirtuin-1 is reduced in arteries from CLI mice and PAD patient, and the expression of these markers was restored in mice treated with VCE-004.8.ConclusionsThe findings presented in this study indicate that Etrinabdione holds promise in mitigating endothelial cell damage and senescence, while concurrently fostering arteriogenesis and angiogenesis. These observations position Etrinabdione as a compelling candidate for the treatment of PAD, and potentially other cardiovascular disorders.

Incidence and Risk Factors for Amputations in Persons with Diabetes Mellitus: A Retrospective Cohort Study.

The aim of this study was to identify and analyze the incidence rate of amputations and their risk factors in people with Diabetes Mellitus (DM) in two specialized outpatient clinics in Brazil. This is an epidemiological, retrospective cohort study using data collected from electronic health records of 281 adult diabetic patient types 1 or 2; attended in specialized outpatient service between 2015 and 2020. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the risk factors for amputation was carried out through logistic regression. The study was approved by ethical committee. The sample mean age was 65.6 years (SD 13.05), predominating male gender n = 211 (75%), type 2 DM n = 223 (86.7%), with cardiovascular disease n = 143 (63.2%), and about 68.7% (n = 156) with peripheral arterial disease (PAD). Seventy-seven had lower limb amputation (LLA), with a rate incidence of 31.9% during five years. Logistic regression analysis showed the following associations with amputation: Diabetic peripheral neuropathy increased the rate of amputation by 3.6 times (OR = 3.631, 95% CI = 1.214-11.353; P = .022), and peripheral arterial disease increased by 10 times (OR = 10.631; 95% CI = 2.969-57.029; P = .001). The LLA in individuals with DM in two specialized outpatient services was higher compared to international literature; DPN and PAD were confirmed as risk factors for amputation, according to literature. This finding suggests that the study population faces an increased risk of amputation, highlighting the urgent need for targeted interventions and implementing robust preventive strategies to transform the current scenario and mitigate these severe outcomes. A comprehensive approach is essential to proactively address the underlying issues and reduce the prevalence and impact of amputations in Brazil.

Endo-Aortic Clamp for Minimally Invasive Redo Mitral Valve Surgery: Early Outcome

Objective: Redo mitral valve surgery still represents a challenging and high-risk procedure in cardiac surgery. The incidence of cardiac structural injuries during re-sternotomy remains consistent and is reported to be an independent risk factor for hospital mortality. Minimally invasive cardiac surgery with retrograde femoral arterial perfusion and endo-aortic clamping avoids re-entry injuries and reduces the requirement for dissection of adhesions and the risk of damage to cardiac structures. The aim of this study is to analyze redo patients undergoing mitral valve surgery with retrograde arterial perfusion and endo-aortic clamping setting. Methods: A retrospective analysis was performed on patients undergoing surgery from 2006 to 2022. Exclusion criteria were more than mild aortic regurgitation, moderate-to-severe peripheral vascular disease, dilated ascending aorta, and a lack of preoperative vascular screening. The primary outcome was perioperative mortality. Results: Two hundred eighty-five patients were analyzed. Mean age was 63.8 ± 13.3 years, mean EuroSCORE was 16.5 ± 14.5%, and one quarter of the patients had undergone two or more previous procedures via sternotomy. Perioperative mortality was 3.9% (11/285). Stroke was reported in six (2.1%) patients. Median intensive care unit and hospital length of stay were 1 and 8 days, respectively. Conclusions: Endo-aortic clamping setting in redo MV surgery avoids re-entry injuries and allows the surgeon to clamp the aorta and deliver the cardioplegia with minimal dissection of adhesions. In high-volume and experienced centers, this approach can be applied safely and effectively and may in the near future become the standard of care for redo mitral valve surgery.

Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient

Background Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries. The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain. A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy. Conclusion Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showed satisfactory outcomes.

In-Stent Restenosis in Peripheral Arterial Disease: Ultra-High-Resolution Photon-Counting Versus Third-Generation Dual-Source Energy-Integrating Detector CT Phantom Study in Seven Different Stent Types.

The visualization of peripheral in-stent restenosis using energy-integrating detector CT is challenging due to deficient spatial resolution and artifact formation. This study compares the first clinically available photon-counting detector CT to third-generation dual-source energy-integrating detector CT. Nylon cylinders with central bores (4mm, 2mm), mimicking 75% and 95% stenoses, were placed inside seven different 8-mm diameter stents and filled with diluted contrast medium. Phantoms were scanned with photon-counting detector CT at slice thicknesses of 0.2mm (available only in this scanner type), 0.5mm, and 1.0mm versus 0.5mm and 1.0mm in energy-integrating detector CT at matched CT dose indices. Contrast-to-noise ratios were calculated from attenuation rates. Residual lumen size was measured as full width at half-maximum. Subjective image quality was assessed by two independent blinded raters. Mean contrast-to-noise ratio was lowest in photon-counting detector CT at 0.2mm slice thickness (0%, 75%, and 95% in-stent restenosis: 6.11 ± 0.6, 5.27 ± 0.54, and 5.02 ± 0.66) and highest at 1.0mm slice thicknesses with similar measurements in photon-counting detector CT and energy-integrating detector CT (11.46 ± 1.08, 9.94 ± 1.01, 8.26 ± 1.0 vs. 3.34 ± 1.0, 9.92 ± 0.38, 7.94 ± 1.07). Mean full width at half-maximum measurements in photon-counting detector CT at 0.2mm slice thickness for 0%, 75%, and 95% in-stent restenosis were 8.00 ± 0.37, 3.98 ± 0.34, and 1.92 ± 0.16mm. Full width at half-maximum was least precise in 95% in-stent restenosis at 1.0mm slice thickness with similar measurements between scanners (1.57 ± 0.33 vs. 1.71 ± 0.15mm). Interrater correlation coefficient was 0.75 [95% CI: [0.53; 0.86]; subjective scores were best at 0.2mm slice thickness in photon-counting detector CT (19.43 ± 0.51 and 19.00 ± 0.68). In phantom in-stent restenosis in 8mm stents, we observed similar full width at half-maximum for photon-counting detector CT and energy-integrating detector CT in 0% and 75% in-stent restenosis, but at 95% in-stent restenosis, FWHM tended to be more accurate in smaller slice thicknesses in both scanners. Subjective image assessment yielded best results at 0.2mm slice thickness in photon-counting detector CT despite lower contrast-to-noise ratio.

Interpretable prediction of 30-day mortality in patients with acute pancreatitis based on machine learning and SHAP.

Severe acute pancreatitis (SAP) can be fatal if left unrecognized and untreated. The purpose was to develop a machine learning (ML) model for predicting the 30-day all-cause mortality risk in SAP patients and to explain the most important predictors. This research utilized six ML methods, including logistic regression (LR), k-nearest neighbors(KNN), support vector machines (SVM), naive Bayes (NB), random forests(RF), and extreme gradient boosting(XGBoost), to construct six predictive models for SAP. An extensive evaluation was conducted to determine the most effective model and then the Shapley Additive exPlanations (SHAP) method was applied to visualize key variables. Utilizing the optimized model, stratified predictions were made for patients with SAP. Further, the study employed multivariable Cox regression analysis and Kaplan-Meier survival curves, along with subgroup analysis, to explore the relationship between the machine learning-based score and 30-day mortality. Through LASSO regression and recursive feature elimination (RFE), 25 optimal feature variables are selected. The XGBoost model performed best, with an area under the curve (AUC) of 0.881, a sensitivity of 0.5714, a specificity of 0.9651 and an F1 score of 0.64. The first six most important feature variables were the use of vasopressor, high Charlson comorbidity index, low blood oxygen saturation, history of malignant tumor, hyperglycemia and high APSIII score. Based on the optimal threshold of 0.62, patients were divided into high and low-risk groups, and the 30-day survival rate in the high-risk group decreased significantly. COX regression analysis further confirmed the positive correlation between high-risk scores and 30-day mortality. In the subgroup analysis, the model showed good risk stratification ability in patients with different gender, renal replacement therapy and with or without a history of malignant tumor, but it was not effective in predicting peripheral vascular disease. the XGBoost model effectively predicts the severity of SAP, serving as a valuable tool for clinicians to identify SAP early.

Impact of BMI on Recovery and Quality of Life Post-Revascularization in Peripheral Arterial Disease Patients

Impact of BMI on Recovery and Quality of Life Post-Revascularization in Peripheral Arterial Disease Patients

Racial and Socioeconomic Health Disparities in Peripheral Artery Disease.

Peripheral artery disease (PAD) is a progressive atherosclerotic disease that causes lower extremity arterial stenosis or occlusion. Patients with PAD are at increased risk of myocardial infarction, stroke, limitations in ambulation, and amputation. Despite the advances in medicine and technology, the outcomes from PAD, including critical limb-threatening ischemia, acute limb ischemia amputation, and mortality, remain increased among specific racial and ethnic groups that have been historically marginalized in America, including Black, Hispanic, and American Indian individuals in the United States when compared with White persons. The purpose of this review is to summarize PAD literature that incorporates racial and ethnic disparities in PAD. There are a rising number of studies focused on the interface of racial and ethnic disparities and PAD. The majority of these studies are specifically focused on Black race, whereas there are limited studies focused on other minoritized racial and ethnic groups in the United States. The application of race and ethnicity has also been shown to play a synergistic role with socioeconomic status on PAD outcomes. Effective strategies focused on implementing policies that support quality measures and focus on social determinants of health have been shown to promote health equity and reduce disparities. Current evidence suggests that biological differences are less likely to be the leading cause of disparities in PAD between racial and ethnic groups compared with White Americans and supports a renewed focus on social determinants of health to achieve health equity.

Machine Learning in Vascular Medicine: Optimizing Clinical Strategies for Peripheral Artery Disease

Abstract Purpose of Review Peripheral Artery Disease (PAD), a condition affecting millions of patients, is often underdiagnosed due to a lack of symptoms in the early stages and management can be complex given differences in genetic and phenotypic characteristics. This review aims to provide readers with an update on the utility of machine learning (ML) in the management of PAD. Recent Findings Recent research leveraging electronic health record (EHR) data and ML algorithms have demonstrated significant advances in the potential use of automated systems, namely artificial intelligence (AI), to accurately identify patients who might benefit from further PAD screening. Additionally, deep learning algorithms can be used on imaging data to assist in PAD diagnosis and automate clinical risk stratification. ML models can predict major adverse cardiovascular events (MACE) and major adverse limb events (MALE) with considerable accuracy, with many studies also demonstrating the ability to more accurately risk stratify patients for deleterious outcomes after surgical intervention. These predictions can assist physicians in developing more patient-centric treatment plans and allow for earlier, more aggressive management of modifiable risk-factors in high-risk patients. The use of proteomic biomarkers in ML models offers a valuable addition to traditional screening and stratification paradigms, though clinical utility may be limited by cost and accessibility. Summary The application of AI to the care of PAD patients may enable earlier diagnosis and more accurate risk stratification, leveraging readily available EHR and imaging data, and there is a burgeoning interest in incorporating biological data for further refinement. Thus, the promise of precision PAD care grows closer. Future research should focus on validating these models via real-world integration into clinical practice and prospective evaluation of the impact of this new care paradigm.

Towards Standardized, Safe, and Efficacious Screening Approaches to Patients with Lower Extremity Peripheral Arterial Disease in the Setting of Lower Extremity Arthroplasty

Introduction: Peripheral arterial disease (PAD) impedes the ability to recover from lower extremity arthroplasties (LEA) while simultaneously increasing risks of peri- and postoperative complications, morbidity, and mortality. Despite the known risks that PAD presents, there are currently no standards outlining how practitioners should screen patients prior to undergoing LEA. The purpose of this manuscript is to facilitate the improved diagnosis of PAD, leading to appropriate vascular surgery consultation prior to undergoing orthopedic surgeries. Recommendations for Preoperative Assessment: Screening begins with a succinct history and physical exam, looking for signs and symptoms of diminished vascular integrity. A heightened suspicion for PAD should prompt the immediate enactment of an ankle brachial index, or alternatively, a pressure volume recording or the skin perfusion pressure technique.

Recurrence of Cardiovascular Events After an Acute Myocardial Infarction in Patients with Multivessel Disease and Associated Healthcare Costs: A German Claims Data Analysis.

This study sought to quantify the healthcare costs of multivessel disease (MVD) and determine the prevalence and incidence of recurrent major adverse cardiovascular events (MACE) in high-risk patients diagnosed with MVD following an acute myocardial infarction (MI). This retrospective study utilized German claims data (AOK PLUS), between 01/01/2010 and 31/12/2020. Patients were included if they (1) had an inpatient diagnosis of an MI between 01/01/2012 and 31/12/2019 (index date), (2) were ≥ 18 years of age at date of MI diagnosis, and (3) had diabetes or met two of the following criteria: ≥ 65 years old, prior MI, peripheral arterial disease. MACE was defined as (1) MI, (2) stroke, or (3) death with a cardiovascular diagnosis within 30 days prior. To measure the burden of MVD, patients were identified during the index hospitalization by presence of MVD. Healthcare resource use and costs were compared after adjustment based on propensity score matching (PSM). A total of 5158 patients with evidence for MVD were included in the main analysis. 31.17% experienced a MACE within 365 days following the incident MI. After PSM adjustment, 33.22% of the MVD cohort experienced a MACE versus 36.48% of non-MVD patients. MVD patients had a higher rate of recurrent MI (14.22% vs. 9.81%). Additionally, public healthcare costs were about €4 million higher in the total MVD cohort than in the non-MVD cohort in the first year after an MI (€47,896,012.32 vs. €43,718,713.75, respectively), reflecting the MVD cohort's higher use of the public healthcare system. More MVD patients were prescribed guideline-recommended medication (61.4% vs. 46.0%). This study found that presence of MVD contributed to higher rates of recurrent MI. Patients with MVD experienced higher rates of recurrent MI despite a higher proportion of patients receiving guideline-directed medication therapy compared to non-MVD patients. Conversely, there was a higher mortality rate observed in the non-MVD cohort.

Lipoprotein (a) Testing in Patients With Atherosclerotic Cardiovascular Disease in 5 Large US Health Systems.

Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease. However, lipoprotein (a) testing remains variable and it is unclear what factors influence testing and if testing changes clinical management. A retrospective study using electronic medical record data from 5 health systems identified an atherosclerotic cardiovascular disease cohort divided into those with and without a lipoprotein (a) test between 2019 and 2021. Baseline characteristics and lipid-lowering therapy patterns were assessed. Multivariable regression modeling was used to determine factors associated with lipoprotein (a) testing. Among 595 684 patients with atherosclerotic cardiovascular disease, only 2587 (0.4%) were tested for lipoprotein (a). Those who were older or Black individuals were less likely to have lipoprotein (a) testing, while those with familial hypercholesterolemia, ischemic stroke/transient ischemic attack, peripheral artery disease, prior lipid-lowering therapy, or low-density lipoprotein cholesterol ≥130 mg/dL were more likely to be tested. Those with a lipoprotein (a) test, regardless of the lipoprotein (a) value, were more frequently initiated on any statin therapy (30.3% versus 10.6%, P < 0.001), ezetimibe (7.65% versus 0.8%, P < 0.001), or proprotein convertase substilisin/kexin type 9 inhibitor (6.7% versus 0.3%, P < 0.001) compared with those without a test. Those with an elevated lipoprotein (a) level more frequently initiated ezetimibe (11.5% versus 5.9%, P < 0.001) or proprotein convertase substilisin/kexin type 9 inhibitor (10.9% versus 4.8%, P < 0.001). Lipoprotein (a) testing in patients with atherosclerotic cardiovascular disease is infrequent, with evidence of disparities among older or Black individuals. Testing for lipoprotein (a), regardless of level, is associated with greater initiation of any lipid-lowering therapy, while elevated lipoprotein (a) is associated with greater initiation of nonstatin lipid-lowering therapy. There is a critical need for multidisciplinary and inclusive approaches to raise awareness for lipoprotein (a) testing, and its implications on management.

5-years patency results of Zilver PTX on the femoro-popliteal arterial segment: A Northern Sydney experience.

The burden of peripheral arterial disease is increasing. Treatment of femoro-popliteal lesions remains challenging despite novel endovascular devices. Drug-eluting stents suppress post-treatment inflammation and reducing neo-intimal hyperplasia to reduce in-stent restenosis. A multi-centre retrospective 5-years longitudinal study was undertaken to evaluate freedom from clinically driven target limb revascularisation (FF CD-TLR) and patency of Zilver PTX stents in treating symptomatic femoro-popliteal stenotic lesions. Kaplan-Meier survival curves were used to demonstrate FF CD-TLR, primary, primary assisted and secondary patency. There were 148 patients and 183 lesions treated with a mean age of 80.3years and 52% males. The all-cause 5-years mortality was 25%. FF CD-TLR yearly patencies to 5years were 81%, 67%, 62%, 57% and 52%, respectively, with significantly poorer outcomes for in-stent restenosis, longer stent lengths and lesions at the femoro-popliteal junction. Primary patencies were 63%, 47%, 40%, 34% and 24%, assisted primary patencies were 90%, 75%, 68%, 59% and 48% and secondary patencies were 96%, 94%, 94%, 92% and 92%. Major adverse limb events were 5% at 1-year and cumulative at 5-years was 16%. The clinical outcomes in this study population are comparable to recent publications with smaller cohorts. Our study confirms Zilver PTX has very good primary patency over 5years with no discernible effect on all-cause mortality in an elderly cohort with particularly long treated lesions. Our results are similar to those seen in younger patients with shorter lesions. Nonetheless, longer lesions required more reinterventions to maintain patency. Zilver PTX is a safe and durable drug-eluting stent when utilised in the management of femoro-popliteal stenotic lesions with good long-term patency and limited need for re-intervention.

Dual pathway inhibition in peripheral arterial disease

Despite its high worldwide prevalence and the intuitable negative prognostic connotation, for a long time peripheral artery disease (PAD) has not been the subject of particular interest by the cardiac scientific community. The availability of a new therapeutic strategy (low-dose rivaroxaban associated with acetylsalicylic acid) has reignited interest in PAD. The clear evidence derived from the COMPASS and VOYAGER PAD trials, with the possibility of using dual pathway inhibition, has given new energy to the therapeutic front against symptomatic PAD also associated with coronary artery disease. This review article aims to revisit the pathophysiological concepts underlying PAD and the path of the various clinical trials that have led to new scientific evidence.

What Is the Best Experimental Model for Developing Novel Therapeutics in Peripheral Artery Disease?

More than 200 million people worldwide have peripheral artery disease (PAD). PAD affects the quality of life and is associated with significant morbidity and mortality. Standard treatment for severe cases of PAD is surgical or endovascular revascularization. However, up to 30% of patients are not candidates for open or endovascular procedures, due to high operative risk or unfavorable vascular involvement. Furthermore, revascularization procedures may be insufficient to adequately improve microvascular tissue perfusion, wound healing, or limb salvage. Accordingly, regardless of advances in treatment modalities, outcomes of patients with PAD have remained unfavorable. Therefore, new medical therapeutic approaches are much needed. Small animal models are indispensable tools for the understanding of PAD physiopathology and the development of novel medical therapies. Development of animal models that more closely mimic the pathophysiology (with occlusive atherothrombosis and chronic development of limb ischemia) can incorporate the cardiovascular risk factors associated with this disease state, and focus on more clinically relevant outcomes is critical. In practice, this means using both animals that develop atherosclerosis and methods for the application of gradual arterial occlusion to induce hind limb ischemia. Doing so will likely help identify novel targets for intervention and overcome some principal challenges confronted by previous clinical trials. While various rodent models are discussed, the optimal animal model is yet to be defined.

Predictors of Successful Antibiotic Treatment of Osteomyelitis in Diabetic Forefoot Infection.

Osteomyelitis (OM) associated with diabetic foot ulceration (DFU) is a growing public health challenge worldwide. Since 2012 the number of patients presenting with DFU per year to our centre has doubled. This study aims to evaluate outcomes from outpatient antibiotic therapy (OPAT) in the management of OM in DFU patients. A retrospective analysis was performed of medical notes, radiology, and vascular laboratory reports for all DFU patients with OM treated from April 2016 to April 2020. Variables analyzed included age, gender, site of OM, WIfI Score (Wound Ischaemia and foot Infection Score), probe-to-bone test (PTB), imaging (X-ray/magnetic resonance imaging (MRI), co-morbidities (peripheral arterial disease (PAD), chronic kidney disease (CKD), hypertension (HTN), smoking, ischemic heart disease (IHD), and dyslipidaemia. Outcomes evaluated were healing, recurrent DFU, and freedom from amputation at 12months. 185 patients were admitted with 264 infected digits (Male 223; Female 41). The mean age was 66years. Only 168 (63.6%) were fully healed at 12months. Of the 96 patients who failed to heal, 43 underwent a repeat course of prolonged antibiotics without improvement. Factors associated with treatment failure were PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene. Extended outpatient antibiotic therapy (with an inpatient multidisciplinary approach) is an effective treatment for digital OM in DFU with a success rate of 63%. In recurrence, repeating prolonged antibiotics is unlikely to achieve healing. PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene are predictors of treatment failure.

Diagnostic performance of Photon-counting CT angiography in peripheral artery disease compared to DSA as gold standard

BackgroundPhoton-counting (PC) CT has the potential to improve diagnostic confidence and image quality of CT angiography (CTA) in patients with peripheral artery disease (PAD). PurposeTo retrospectively evaluate the diagnostic performance of Photon-counting CT angiography for the assessment of stenotic disease in patients with PAD compared to digital subtraction angiography (DSA) as gold standard. Materials and MethodsAll patients undergoing PC CTA followed by DSA between November 2021 and November 2023 were included in this institutional review board approved HIPAA compliant retrospective analysis. The arterial vasculature of the lower extremity was divided into 10 segments from the iliac vasculature to the calf arterial vasculature. The images were evaluated independently by two experienced readers. Inter-reader agreement was determined using Cohen’s kappa coefficient (κ). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) as well as accuracy were calculated for PC CTA and PC pure lumen reconstruction compared to DSA as gold standard. Results109 patients (mean age 74.68 ± 11.10 years; 77 males, 32 females) were included in the retrospective analysis. PC pure lumen reconstructions was available for 91 patients (83 %). A total of 933 vascular segments for PC CTA and 780 vascular segments for PC pure lumen reconstruction were evaluated. Good to perfect inter-reader agreement was found for PC CTA (κ = 0.791) and for PC pure lumen reconstruction (κ = 0.829). Sensitivity, Specificity and accuracy for PC CTA were 91 %; 95 % and 93 %, respectively. Sensitivity, Specificity and accuracy for PC pure lumen reconstruction were 85 %, 89 % and 88 %, respectively. ConclusionPhoton-counting CTA demonstrates high sensitivity and specificity for the detection and diagnosis of stenotic lesions in PAD. PC non-calcium reconstruction does not further increase the accuracy compared to PC CTA.

Autoimmune diseases and cardiovascular risk: Mendelian randomization analysis for the impact of 19 autoimmune diseases on 14 cardiovascular conditions

BackgroudAutoimmune diseases (AIDs) have been associated with various cardiovascular diseases (CVDs) in observational data. However, the causality of these associations remains uncertain. Therefore, a systematic assessment of the impact of AIDS on cardiovascular risk is required. ResultsWe assessed the impact of 19 common AIDs on 14 CVDs using bidirectional Mendelian randomization (MR). Celiac disease (odds ratio [OR] = 2.949, 95 % confidence interval [CI]: 1.111–7.827, P = 0.030) and type 1 diabetes mellitus (T1DM) (OR = 1.044, 95 % CI: 1.021–1.068, P = 1.82e-4) were associated with an increased risk of peripheral arterial disease (PAD). Additionally, celiac disease was linked to an increased risk of arrhythmia (OR = 1.008, 95 % CI: 1.002–1.013, P = 0.004), multiple sclerosis to venous thromboembolism (OR = 1.001, 95 % CI: 1.000–1.001, P = 0.010), and psoriasis to heart failure (OR = 1.048, 95 % CI: 1.021–1.077, P = 0.001). Sensitivity analyses were conducted to enhance the robustness of these findings. Predominantly, immune response and inflammation-related pathways were enriched in the aforementioned associations. Mediation analysis identified human leukocyte antigen-DR positive myeloid dendritic cells as partially mediating the effect of T1DM on PAD, with a mediated proportion of 16.61 % (P = 0.028). Potential therapeutic agents, such as tumor necrosis factor-alpha inhibitors and interferon, may have efficacy in treating AID-related CVDs. ConclusionsThis study presents genetic evidence of certain AIDs impacting specific CVDs and identifies potential mediators and drugs.

The Differential Diagnosis of Leg Ulcers.

Chronic wounds on the leg (below the knee) are called leg ulcers. They have many causes, and thus patients with leg ulcers are treated by many different kinds of medical specialist. Appproximately 80% of sufferers have chronic venous insufficiency (CVI) and/or peripheral arterial occlusive disease (PAOD). Knowledge of the relevant differential diagnoses is important for appropriate treatment, particularly for patients with atypical findings or an intractable course. This article is based on publications retrieved by a selective search in PubMed, including current guidelines and expert recommendations. The diagnostic evaluation of a leg ulcer can be structured according to the ABCDE rule. This involves individualized, targeted history-taking (anamnesis); bacteriological testing; clinical examination; ancillary testing, particularly for perfusion (defective vascular system); and extras, such as biopsies. Specifically, we present in this article the main aspects of the complex diagnostic evaluation of venous leg ulcers, arterial leg ulcers, vasculitis, vasculopathy, calciphylaxis, pyoderma gangrenosum, necrobiosis lipoidica, ecthyma, and squamous cell carcinoma. There remain many unsolved problems, including interactions between the various areas of clinical treatment and the relative paucity of relevant high-quality research. A timely differential-diagnostic evaluation for the many diseases that can cause leg ulcers, which require treatment from representatives of many different medical specialties and health professions, is a prerequisite for their effective individualized treatment.