Risk Of Vascular Complications Research Articles

Iatrogenic Vascular Injuries in Elective Abdominal and Pelvic Surgery Patients: Retrospective, Single Center, 30-Day Results.

Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery. In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study. In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8±14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed on 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period. Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity.

High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice

IntroductionPeople with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD...

OCT angiography findings in posterior persistent fetal vasculature

Aims/Purpose: To report optical coherence tomography angiography findings in a patient presenting unilateral posterior persistent fetal vasculature (PVF).Methods: We report the case of a 19‐year‐old female patient with longstanding visual impairment of the left eye (LE). Patient was assessed with multimodal imaging including color fundus photography, swept source optical coherence tomography (SS‐OCT) and SS‐OCT angiography (SS‐OCTA) of the macula and the optic disc.Results: The patient had a history of unilateral visual impairment of unknown aetiology and consulted for a routine examination. Best corrected visual acuity was 10/10 in the right eye (RE) and limited to counting fingers in the LE. Ophthalmological examination of the LE revealed a mild exophoria, a quiet anterior segment, a vestigial capsular bag and an inferonasal whitish spot at the posterior lens capsule corresponding to Mittendorf's dot. Dilated fundus examination of the LE showed a lack of foveal reflex, retinal vessel contraction associated to the presence of a fibrovascular stalk extending from the OD to the crystalline lens via the vitreous humour, corresponding to fibrovascular contraction of the persistent and hyperplastic Cloquet's canal. No associated retinal detachment was noted. The clinical diagnosis of posterior PVF was confirmed. Macular SS‐OCT revealed retinal thinning with absence of foveal pit. Optic disc SS‐OCT highlighted a hyporeflective tubular structure overlying a Bergmeister'papilla. Cross‐sectional SS‐OCTA detected a flow signal at the level of Bergmeister's papilla, but no confirmed flow signal was identified at the level of the fibrovascular stalk.Conclusions: PVF is a rare condition characterized by fetal remnant from developmental vascular system defects, clinically recognized in its three forms (anterior, posterior and combined). OCT‐angiography is a useful non‐invasive tool to confirm of persistent hyaloid artery patency and assess risk of vascular complications. Contraction of the fibrovascular mass is prone to tractional retinal detachment and repeated episodes of intravitreal or intracapsular haemorrhage. Monitoring is therefore recommended even in adulthood.

Microalbuminuria in Children with Type 1 Diabetes and Its Relationship with Body Mass Index, Hemoglobin A1c, and Age at Diabetes Onset

Background: Children with type 1 diabetes are at risk of developing microvascular and macrovascular complications, with diabetic nephropathy (DN) being a significant microvascular complication. Microalbuminuria is a crucial diagnostic marker for the early detection of DN and can predict the risk of vascular complications. Objectives: This study aimed to investigate the relationship between microalbuminuria and body mass index (BMI), changes in hemoglobin A1c (HbA1c), and the age of disease onset in children and adolescents with type 1 diabetes. Methods: This cross-sectional study was conducted in Mofid and Imam Hossein hospitals in Tehran, Iran, within 2021 - 2022. This study included 120 children and adolescents aged 5 - 20 years who had been diagnosed with type 1 diabetes for at least 3 years. All patients underwent evaluation for microalbuminuria, and its association with BMI, HbA1c levels, and the age of diabetes onset was assessed. Results: Among the 120 patients, 51% were female. Microalbuminuria was present in 15% of patients; however, 13.3% were overweight or obese. Furthermore, 91% of patients had HbA1c levels above 7%. The mean age of diabetes onset was 13 years, and the mean disease duration was 5.5 years. The study revealed a significant association between microalbuminuria and HbA1c levels, BMI, and the age of diabetes onset (P-values < 0.05). Conclusions: Microalbuminuria showed a positive correlation with increased BMI and poorer glycemic control. An early age of diabetes onset was identified as a risk factor for microalbuminuria in children and adolescents with diabetes.

The Assessment of the Vascular Risk for Facial Procedures using Thermal Scanning Imaging and Doppler Ultrasonography

Introduction: Surgical and non-surgical facial procedures have gained immense popularity thanks to their aesthetic benefits. Understanding the vascularization of the face and assessing potential risks is crucial to ensure patient safety and optimal outcomes. This study aims to evaluate the utility of thermal scanning and Doppler ultrasonography in evaluating the vascular risk for facial procedures. Material and Methods: A cohort of 60 patients were included in this prospective study. Preoperative thermal scanning and Doppler ultrasonography were performed in order to visualize the facial vasculature and identify potential areas of risk. Results: For 30 patients, we performed preprocedural Doppler ultrasound imaging and thermal scanning at the injection site. Only 6.66% of them suffered vascular complications, whilst 23.33% among those who didn’t undergo ultrasound and thermoscanning suffered vascular injuries. The combined use of these tools proved to be valuable in assessing the vascular risk for facial procedures. The findings emphasize the importance of preoperative assessment to identify patients at risk for vascular complications. Conclusions: Thermal scanning and Doppler ultrasonography offer a comprehensive approach to assessing the vascular risk for facial procedures. By ensuring the identification of abnormal vascular patterns and altered blood flow dynamics, these techniques enhance patient safety and procedure planning.

Improving outcomes in single chamber leadless pacemakers: strategies for minimizing vascular complications

BackgroundLeadless pacemaker therapy is associated with a significant reduction in lead-related complication rate compared to conventional transvenous single chamber pacemaker therapy. However, a significant complication rate of 1.2% was observed in vascular access due to the use of large delivery femoral sheath (27Fr). The aim of this study was to evaluate the effectiveness of real-time ultrasound guidance and Z suture technique in reducing total and major vascular complications in leadless pacemaker therapy.MethodIn this study, we performed a retrospective and prospective analysis of all adverse events associated with leadless pacemaker (Micra) implantation by two operators at a single tertiary center from December 2016 to December 2018. To mitigate the risk of vascular complications, all patients underwent real-time ultrasound-guided venipuncture for vascular access, as well as the application of a Z-suture technique for hemostasis at the end of the procedure. Data were collected on implant indications, implant procedure details, complications, and follow-up information.ResultsIn this study, 45 patients with an age range of 24 to 94 years (mean 76 ± 14 years) were recruited, with 21 (46.6%) being female. The pacing indications for the patients included atrial fibrillation (24, 53.3%), vascular (7, 15.5%), infection (9, 20%), cognitive/frailty (3, 6.6%), and occupational (2, 4.4%). The implant procedures were performed under general anesthesia in 6 (13.3%) of the cases, and under local anesthesia and sedation in 39 (86.6%) of the cases. A single deployment was achieved in 43 (95.5%) of the patients, while 2 deployments were required in 2 (4.4%) of the patients. Notably, no vascular or major complications were reported in our cohort of patients.ConclusionsThe results of this observational study indicate that incorporating real-time ultrasound guidance during venipuncture and the use of a Z-suture technique significantly reduce the occurrence of both total and major vascular complications associated with the implantation of leadless pacemaker. However, more robust and larger studies are required in order to confirm these results and implications for clinical practice.

Access site complications in thoracic endovascular aortic repair

BackgroundPercutaneous access and use of vascular closure devices facilitate thoracic endovascular aortic repair (TEVAR) procedures during local anesthesia and allow immediate detection of signs of spinal ischemia. However, the very large bore access (usually ≥22F sheath) associated with TEVAR increases the risk of vascular complications. In this study, we sought to define the safety and feasibility of two percutaneous femoral artery closure devices during TEVAR, in terms of access site vascular complications and major, life-threatening, or fatal bleeding (≥major) within 48 hours. Access site vascular complications were defined as technical failure of vascular closure or later formation of pseudoaneurysm. MethodsFrom March 2010 to December 2022, 199 transfemoral TEVAR were performed at Helsinki University Central Hospital, Finland. We retrospectively categorized these into three groups, based on surgeon preference for the access technique and femoral artery closure method: (1) surgical cut-down and vessel closure, n = 85 (42.7%), (2) percutaneous access and vascular closure with suture-based ProGlide, n = 56 (28.1%), or (3) percutaneous access and vascular closure with ultrasound-guided plug-based MANTA, n = 58 (29.1%). The primary outcome measure was technical success of vascular closure and access site vascular complications during index hospitalization. Secondary outcome measures were ≥major bleeding, early mortality, and hospital stay. ResultsThe technical success rate was 97.6% vs 91.1% vs 93.1% for surgical cut-down, ProGlide, and MANTA, respectively (P = .213). The rate of access site vascular complication was 3.5% vs 8.9% vs 10.3%, respectively (P = .290), with two pseudoaneurysms detected postoperatively and conservatively managed in the MANTA group. The vascular closure method was not associated with increased risk of ≥major bleeding, early mortality, or hospital stay on univariate analysis. Predictors for ≥major bleeding after TEVAR in multivariable analysis were urgent procedure (odds ratio: 2.8, 95% confidence interval: 1.4-5.5; P = .003) and simultaneous aortic branch revascularization (odds ratio: 2.7, 95% confidence interval: 1.3-5.4; P = .008). ConclusionsIn this study, the technical success rates of the percutaneous techniques demonstrated their feasibility during TEVAR. However, the number of access site complications for percutaneous techniques was higher compared with open approach, although the difference was not statistically significant. In the lack of evidence, the safety of the new MANTA plug-based vascular closure for TEVAR warrants further investigation.

Progression to Myelofibrosis in Patients with Essential Thrombocythemia: A Real-World Analysis from the Prospective MOST Study

Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm (MPN) characterized by clonal blood cell proliferation, excessive platelet production, constitutional symptoms, and increased risk of vascular complications, as well as a risk of progression to myelofibrosis (MF). Previous prognostic studies of patients with ET have largely been based on retrospective analyses, and limited prospective data exist regarding disease progression. The prospective Myelofibrosis and Essential Thrombocythemia Observational Study (MOST) collected real-world data from patients with ET. This analysis evaluates disease progression in patients with ET enrolled in MOST. Methods: MOST (NCT02953704) enrolled patients with ET aged ≥60 years, or with a history of thromboembolic events, or who were receiving ET-directed therapy (excluding aspirin only). Baseline clinical characteristics data were collected as previously described (Yacoub A. CLML. 2021). For this analysis, progression from ET to MF was defined as meeting 1 or more of the following criteria during the study period: 1) Bone marrow biopsy with fibrosis grade ≥2 or pathologic diagnosis of MF; 2) death owing to MF/myelodysplastic syndrome/acute myeloid leukemia; 3) circulating blasts >1% and new/worsening splenomegaly (SPM); 4)new/worsening SPM and ≥2 of white blood cell (WBC) count >11×10 9/L, hemoglobin (Hb) <10 g/dL, and platelet count <100×10 9/L. Median (range) follow-up was 57.3 months (42-70). Results: Of the 1237 patients with ET enrolled in MOST; 53 (4.3%) met criteria for progression to MF. Among patients with progression, most had progressed due to fibrosis (criteria 1, 56.6%); 15.1%, 11.3%, and 28.3% of patients progressed due to criteria 2, 3, and 4, respectively. Notably, only 176 patients (14.2%) enrolled in the study had bone marrow data available. Comparison of the enrollment characteristics of patients with and without progression identified no differences in age at enrollment or diagnosis (Table 1). However, time from diagnosis to enrollment and from diagnosis to end of study were significantly longer in patients with progression than those without (median 7.9 vs 4.2 years, median 12.7 vs 9.0 years, respectively; both P=0.001). Of all enrolled patients with vs without progression tested for known driver mutations, a higher percentage with progression were JAK2-positive vs those without progression (80.6% [29/36] vs 69.7% [598/858]). At enrollment, the percentages of patients with vs without progression receiving ET-directed therapies were similar (94.3% vs 94.8%). Among patients with vs without progression, mean baseline Hb was significantly lower (12.5 g/dL vs 13.1 g/dL; P=0.026), mean WBC counts were significantly higher (10.4×10 9/L vs 7.4×10 9/L; P<0.001), and mean platelet counts were comparable (418.6×10 9/L vs 455.0×10 9/L; P=0.466). MPN-SAF TSS was similar for patients with vs without progression at baseline. Fewer patients with vs without progression had ≥1 thrombotic events (1.9% [1/53] vs 3.7% [44/1184]) during the study, whereas a higher percentage of patients had ≥1 hemorrhagic events (7.5% [4/53] vs 1.3% [15/1184]). Conclusions: This real-world analysis of data from MOST showed that 4.3% of patients with ET progressed to MF during the study period. Compared with patients without progression, patients with ET to MF progression had longer duration of disease, higher WBC count, and lower Hb at enrollment; symptom burden at enrollment was similar between the 2 groups. One limitation of this study is the lack of bone marrow data for the majority of patients, suggesting a possible underestimation of progression to MF. These findings and further analysis of MOST data will add insight into disease progression in patients with ET and facilitate clinical management of this patient population.

Cholesterol crystal dissolution rate of serum is associated with iliofemoral calcification and predicts outcomes in patients undergoing TAVR

Abstract Background Calcific Aortic stenosis (AS) has several findings in common with atherosclerosis including inflammation and lipoprotein deposition. Histopathological examination has revealed atherosclerotic lesions, that mainly contain cholesterol crystals (CC) in resected AS cusps. Previous studies have demonstrated that CCs can activate the NLRP3 inflammasome, resulting in an IL-1 driven systemic inflammation, that leads to the development of atherosclerotic plaques. Aims Our aim was to quantify the endogenous cholesterol crystal dissolution rate (CCDR) in AS patients undergoing TAVR. We sought to examine whether CCDR may be associated with iliofemoral calcification and suitable for identifying patients at high risk for vascular complications and increased mortality. Methods The study included 348 AS patients undergoing TAVR. Pre-interventional computed tomography (CT) scans were analyzed to quantify iliofemoral calcification from the femoral artery bifurcation to the aortic bifurcation. The CCDR was measured using flow cytometry to enumerate CC, that were added to a serum solution, at baseline and after two hours of incubation. The dissolution capacity was indicated as percentage change in CC count at baseline and after incubation. The study cohort was stratified according to the median CCDC into high and low CC dissolvers. Results The study population had a mean age of 80.9±6.2 years. CT-based calcium assessment revealed significantly higher right as well as left iliofemoral calcification in low CC dissolvers as compared to high CC dissolvers (1280 vs 1083 mm3, p=0.03; 1292 vs 1043 mm3, p=0.04, respectively). Consistently, an unplanned endovascular intervention for access-related vascular injury was needed more frequently in patients with a low CCDR, as compared to patients with a high CCDR (20.5% vs 12.2%, p=0.04), Figure 1. However, the rate of major vascular complications tended to be higher in the low CCDR group (3.4%) as compared to the high CCDR group (0.6%) but was not significantly different (p=0.12). The one-year all-cause mortality was significantly higher in patients with a low CCDR (13.6%) as compared to patients with a high CCDR (7.0%, p=0.05). This difference was mainly driven by significantly increased cardiovascular death in low CC dissolvers (9.1% vs 1.7%, p=0.03), whereas non-cardiovascular mortality rates were similar between both groups (5.1% vs 5.2%, p=0.81). In multivariate analysis, only low CCDR (OR: 2.51 [95% CI: 1.02 – 6.15], p=0.05) and Albumin (OR: 0.88 [95% CI: 0.79 – 0.98], p=0.03) were independently associated with one-year mortality following TAVR. Conclusion The CCDR is a novel biomarker associated with outcomes in AS patients undergoing TAVR. We have demonstrated, that a low CCDR is associated with increased iliofemoral calcification and vascular injury as well as one-year mortality. Thus, CCDR may provide additional prognostic information to identify vulnerable patients beyond classic risk assessment.Figure 1

Efficacy of Intravascular Lithotripsy (IVL) in peripheral lesions with severe calcification and its use in TAVI procedure: A systematic review and meta-analysis

Abstract Background Heavily calcified peripheral artery lesions increase the risk of vascular complications, constituting a severe challenge for the operator. Intravascular Lithotripsy (IVL) technology disrupts subendothelial calcification by using localized pulsative sonic pressure waves and is a promising technique for patients with severe calcification in peripheral arteries. Purpose Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified plaques in peripheral arteries and its use in Transcatheter Aortic Valve Implantation (TAVI). Methods This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL in peripheral vasculature. The diameter of the vessel lumen before and after IVL was estimated. The occurrence peri-procedural complications were assessed using a random-effects model. Results 20 studies with a total of 1,223 patients with heavily calcified peripheral lesions were analyzed. The mean age of the cohort was 73.8 ± 8.9 years. Successful IVL delivery achieved in 100% (95% CI: 100%-100%, I2=0%), with an increase in the luminal diameter (SMD: 4.66, 95% CI: 3.41-5.92, I2=90.8%) and reduction in diameter stenosis (SMD: -4.15, 95% CI: -4.75 to -3.55, I2=92.8%), and a described low rate of complications. There was not observed any dissection in 97% (95% CI: 91%-100%, I2=81.4%), while dissections of any type (A, B, C, or D) were observed in 6% (95% CI: 2%-10%, I2=85.3%) of the patients. Several rare cases of abrupt closure, no-reflow phenomenon, perforation, thrombus formation, and distal embolization were recorded. Finally, the subgroup analysis of patients who underwent a TAVI with IVL assistance presented successful implantation in 100% (95% CI: 100%-100%, I2=0%) of the cases, with only 4% (95% CI: 0%-12%, I2=68.96%) presented dissections of any sort. Conclusions IVL seems to be an effective and safe technique for preparing severely calcified lesions in peripheral vessels during TAVI interventions. These results support the use of IVL for amelioration of overall outcome in high vascular risk TAVI settings.

Abstract 11994: Lithotripsy-Assisted Transcatheter Aortic Valve Implantation: An Emerging Approach to Vascular Access Issues in Severe Peripheral Arterial Disease

Introduction: Advances in minimally invasive valvular interventions like transcatheter aortic valve implantation (TAVI) allow for treatment of an increasingly older population. Severe calcific iliofemoral peripheral arterial disease (PAD) can preclude large sheath introduction necessary in TAVI. Conventional peripheral angioplasty has limited efficacy in these situations given its high-pressure dilation, which increases the risk of vascular complications. Intravascular shockwave lithotripsy (IVL) for PAD is an emerging and safe alternative for vascular access. Case Description: A 90-year-old man with severe symptomatic aortic stenosis (AS), coronary artery disease (CAD) status-post CABG and extensive PAD was referred for TAVI following balloon aortic valvuloplasty. Transthoracic echocardiogram showed severe, low-flow, low-gradient AS despite recent balloon aortic valvuloplasty. Abdominal imaging showed severe atherosclerosis and calcification of the bilateral common and external iliac arteries. Prior to TAVI, peripheral angiogram was performed, followed by IVL for a total of nine runs, each for fifteen seconds with a 7x60mm balloon to the right iliac and femoral arteries. Then, the right femoral groin sheath was upsized from six to eighteen French, followed by deployment of a 29mm Medtronic Evolute Pro+ self-expanding bioprosthetic aortic valve. Following successful TAVI, the patient was discharged home on aspirin and clopidogrel. Conclusion: IVL utilizes pulsatile mechanical shockwaves to modify plaque burden without altering arterial elasticity or structural integrity, which greatly reduces the risk for vascular complications in severely calcified arteries. The DISRUPT-PAD-III trial showed IVL was superior to percutaneous transluminal angioplasty with fewer complications in patients with calcified PAD. Therefore, IVL can be a safe alternative approach for PAD limiting vascular access in percutaneous valvular interventions.

Arterial thrombosis triggered by methotrexate-induced hyperhomocysteinemia in a systemic lupus erythematosus patient with antiphospholipid antibodies

Systemic lupus erythematosus (SLE) patients have an increased risk of cardiovascular disease and thrombotic events, and the presence of antiphospholipid antibodies further raises the risk of these complications. Here we report a case of a patient with SLE and triple positivity for antiphospholipid antibodies who developed a popliteal artery thrombosis in the context of a severe hyperhomocysteinemia after the introduction of methotrexate (MTX) treatment. MTX is one of the most prescribed medications for a wide spectrum of autoimmune diseases, including SLE. On the other hand, by interfering with folate metabolism, it may induce hyperhomocysteinemia, which, in turn, may increase the risk of vascular complications. Current recommendations suggest screening and, when possible, treating classical and disease-related cardiovascular risk factors in all lupus patients. Based on what observed in our case, we suggest a follow-up of homocysteine levels after the introduction of drugs capable of inducing hyperhomocysteinemia, such as MTX, in SLE patients at high cardiovascular risk.

Quantitative profiling and diagnostic potential of one-carbon and central metabolism pools in MODY2 and T1DM

BackgroundMaturity-onset diabetes of the young type 2 (MODY2) is a rare genetic disorder characterized as mild fasting hyperglycemia with low risk of vascular complications caused by glucokinase gene mutation. This study aims to investigate metabolites alteration associated with MODY2, exploring possible mechanism underlying characteristic clinical manifestations and low cardiovascular risks of MODY2 and providing serum metabolite biomarkers to facilitating MODY2 diagnosis.MethodsFasting serum samples from MODY2, type 1 diabetes (T1DM) and healthy individuals were collected. By using targeted metabolomics via liquid chromatography–tandem mass spectrometry platform, we quantified the metabolites involved in tricarboxylic acid (TCA) cycle and one-carbon metabolism.ResultsMetabolomic profiling revealed significant difference of intermediates from central metabolism cycle, methionine cycle and several amino acids between MODY2 and T1DM groups. Among these, serum citrate, α-ketoglutaric acid, serine, glycine, glutamine and homocysteine were significantly elevated in MODY2 patients compared with T1DM patients; and compared with healthy subjects, malate and methionine levels were significantly increased in the two groups of diabetic patients. The correlation analysis with clinical indexes showed that α- ketoglutarate, serine, glycine, and glutamine were negatively correlated with blood glucose indicators including fasting blood glucose, HbA1c, and GA, while citrate was positively correlated with C-peptide. And homocysteine displayed positive correlation with HDL and negative with C-reactive protein, which shed light on the mechanism of mild symptoms and low risk of cardiovascular complications in MODY2 patients. A panel of 4 metabolites differentiated MODY2 from T1DM with AUC of 0.924, and a combination of clinical indices and metabolite also gained good diagnostic value with AUC 0.948.ConclusionIn this research, we characterized the metabolite profiles of TCA cycle and one-carbon metabolism in MODY2 and T1DM and identified promising diagnostic biomarkers for MODY2. This study may provide novel insights into the pathogenesis and clinical manifestations of MODY2.

Cardiovascular and microvascular outcomes according to vitamin D level and genetic variants among individuals with prediabetes: a prospective study

BackgroundWhether serum vitamin D mediate vascular diseases in prediabetic populations remains unclear. This study aimed to determine the associations between circulating 25-hydroxyvitamin D [25(OH)D] levels and vitamin D receptor (VDR) polymorphisms with the risk of macrovascular complications, including myocardial infarction and stroke, and microvascular complications such as diabetic nephropathy and retinopathy, among adults with prediabetes.MethodsParticipants with prediabetes in UK Biobank were included (N = 56,387). Multivariable dose–response and Cox proportion models were used to explore the relationship of serum 25(OH)D status and the risks of vascular complications. The interaction of VDR polymorphisms with serum 25(OH)D level on risks of vascular events was also assessed.ResultsDuring a median follow-up of 12 years, higher levels of 25(OH)D were significantly and nonlinearly associated with a lower risk of macrovascular diseases among prediabetic individuals. The adjusted hazard ratios (95% confidential interval) of serum 25(OH)D levels of ≥ 75.0 nmol/L versus < 25 nmol/L were 0.75 (0.63–0.88) for myocardial infarction, 0.74 (0.55–1.00) for stroke, 1.02 (0.60–1.74) for diabetic nephropathy, and 1.30 (0.92–1.84) for diabetic retinopathy, respectively. The rs2228570 (FokI) polymorphisms significantly interacted with 25(OH)D on incident myocardial infarction (P-interaction = 0.042) and stroke (P-interaction = 0.033). The individuals with serum 25(OH)D level of 50.0–74.9 nmol/L and rs2228570 (FokI) homozygotes had the lowest risks of vascular complications.ConclusionsLower serum 25(OH)D levels are significantly and nonlinearly associated with an increased risk of cardiocerebrovascular diseases in prediabetic individuals, with VDR polymorphisms of rs2228570 (FokI) modify such associations. Monitoring a safe 25(OH)D concentration is suggested to prevent the vascular complications for prediabetes.

THU219 Vascular Damage After Craniopharyngioma

Abstract Disclosure: J. Beckhaus: None. S. Boekhoff: None. B. Bison: None. C. Friedrich: None. H.L. Muller: None. Craniopharyngiomas are rare, embryonic, malformational tumors of the (supra-)sellar region. Due to tumor and/or treatment-related hypothalamic lesions, patients develop morbid obesity. Obesity is a major vascular risk factor, leading to reduced 20-year overall survival and a 3- to 19-fold higher cardiovascular mortality after craniopharyngioma compared to the general population. An analysis within the Childhood Cancer Survivor Study (CCSS) revelaed a 10-fold higher relative risk for stroke in adult survivors of childhood/young adult cancers compared to their siblings. To study craniopharyngioma-specific risk factors for vascular damages we searched three databases (Pubmed, CINAHL and Web of Science) and included 49 articles after title and abstract screening. Eligible studies were case reports, cohort and cross-sectional studies. Neurovascular damages due to surgical interventions included cerebral infarcts, stroke, aneurysms, anterior/middle cerebral artery syndrome (ACA/MCA), cerebral venous sinus thrombosis, and seizures. Radiation-induced vascular disease described Moyamoya syndrome, radionecrosis and thrombosis. Tumor-induced inflammation is suspected to play a causal role in the etiology of vascular complications in proximity of the tumor. Therefore, early diagnostics such as echocradiography or cardial MRI and risk-adapted prevention and treatment options for vascular disease are needed to improve long-term prognosis after craniopharyngioma treatment. This review summarizes the available evidence for vascular disease after pediatric- and adult-onset craniopharyngioma to derive possible treatment pathways. Individualized, tertiary prevention programs are required for craniopharyngioma patients and survivors to overcome or reduce the risk of vascular complications and elevate their quality of survival. Presentation: Thursday, June 15, 2023

Risk assessment of vascular complications following manual therapy and exercise for the cervical region: diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project).

What is the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework to assess the risk of vascular complications in patients seeking physiotherapy care for neck pain and/or headache? Cross-sectional diagnostic accuracy study. One hundred and fifty patients seeking physiotherapy for neck pain and/or headache in primary care. Nineteen physiotherapists performed the index test according to the IFOMPT framework. Patients were classified as having a high, intermediate or low risk of vascular complications, following manual therapy and/or exercise, derived from the estimated risk of the presence of vascular pathology. The reference test was a consensus medical decision reached by a vascular neurologist and an interventional neurologist, with input from a neuroradiologist. The neurologists had access to clinical data and magnetic resonance imaging of the cervical spine, including an angiogram of the cervical arteries. Diagnostic accuracy measures were calculated for 'no contraindication' (ie, the low-risk category) and 'contraindication' (ie, the high-risk and intermediate-risk categories) for manual therapy and/or exercise. Sensitivity, specificity, predictive values, likelihood ratios and the area under the curve were calculated. Manual therapy and/or exercise were contraindicated in 54.7% of the patients. The sensitivity of the IFOMPT framework was low (0.50, 95% CI 0.39 to 0.61) and its specificity was moderate (0.63, 95% CI 0.51 to 0.75). The positive and negative likelihood ratios were weak at 1.36 (95% CI 0.93 to 1.99) and 0.79 (95% CI 0.60 to 1.05), respectively. The area under the curve was poor (0.57, 95% CI 0.49 to 0.65). The IFOMPT framework has poor diagnostic accuracy when compared with a reference standard consisting of a consensus medical decision.

The potential use of Lucilla sericata larvae in the local treatment of wounds in diabetic foot syndrome – a literature review

Introduction: The increasing prevalence of diabetes poses a heightened risk of vascular complications in the lower limbs. The costs associated with wound management are substantial, accounting for approximately 1-3% of total healthcare expenditures in developed countries. Implementing and maintaining preventative, interdisciplinary, and comprehensive care have become prioritized objectives for scientific societies.&#x0D; Purpose: This study conducts a literature review and analysis concerning the application of Lucilia sericata larvae in the local treatment of wounds in diabetic foot syndrome.&#x0D; Method: Literature analysis spanning from 2012 to 2023 was conducted, utilizing PubMed and Termedia databases with keywords such as diabetic foot ulcer, Lucilia sericata, and maggot debridement therapy. Exclusion criteria comprised studies that treated wounds locally using methods other than larval therapy.&#x0D; Conclusions: Larval therapy in patients with diabetic foot syndrome accelerates wound debridement by stimulating reparative processes within the wound. The use of Lucilia sericata larvae may contribute to the reduction of antibiotic therapy duration, decreased hospitalization rates, and lowered amputation risks.

A Literature Review on Effects of Positioning and Early Ambulation on Coronary Angiography Complication

Introduction: The study was carried out to get a greater awareness of the impact of early ambulation and positioning on coronary angiography complications. And to build an evidence study on what other research said. Objectives: The objective of this study is to review the effect of changing position and early ambulation on coronary angiography complications. Methods: I used search engines were Identified 700 articles, I excluded 500, then screened total of 200 articles, 150 articles are not my concern, I included 36 articles in this research Result: According to the various research early ambulation and early position is safe after coronary angiography because it is effective way to minimize the risk of back pain and has no linkage in increasing risk of vascular complications like bleeding or hematoma.

Real-World Clinical Characterisation of Polycythaemia Vera Patients from a Prospective Registry in Portugal: Is Resistance to Hydroxyurea a Reality?

Patients with polycythaemia vera (PV) are at increased risk of thrombosis and haemorrhages. Although hydroxyurea (HU) has been the frontline therapy for patients at high risk of vascular complications, about 25% of patients develop resistance/intolerance to this therapy. The aim of this non-interventional, multicentre cohort study was to understand the clinical characteristics and HU treatment response of Portuguese PV patients. HU resistance/intolerance was defined according to adjusted European LeukemiaNet (ELN) criteria. In total, 134 PV patients with a mean (SD) disease duration of 4.8 (5.0) years were included and followed up for 2 years. At baseline, most patients were ≥60 years old (83.2%), at high risk for thrombotic events (87.2%), and receiving HU therapy (79.1%). A total of 10 thrombotic events and 8 haemorrhagic events were reported, resulting in a 5-year probability of thrombo-haemorrhagic events of 17.2%. Haematocrit (p = 0.007), haemoglobin (p = 0.012) and MPN10 symptom score (12.0 (11.6) vs. 10.3 (9.1); p = 0.041) decreased significantly at the 24-month visit compared to baseline. Overall, 75.9% of patients met at least one of the adjusted ELN criteria for HU resistance, and 14.4% of patients remained on HU throughout the study. The results from this real-world study may help identify the subset of patients at higher risk for disease sequelae who may benefit from earlier second-line treatment.

A Critical Literature Review Analysing the Evidence Base for the Efficacy of Aspiration Prior to Injection of Dermal Filler as A Safety Measure to Reduce the Risk of Vascular Complications

A Critical Literature Review Analysing the Evidence Base for the Efficacy of Aspiration Prior to Injection of Dermal Filler as A Safety Measure to Reduce the Risk of Vascular Complications