Background: To report long-term outcomes following stenting for aortoiliac occlusive disease, focusing on covered stents (CS) versus bare metal stents (BMS) in a real-world, multicentre European cohort. Design: Multicentre retrospective cohort study. Patients and methods: Prospectively maintained data from nine European vascular centres (2012-2020) were analysed. Two cohorts were evaluated: aortic-only stenting and aortoiliac stenting (stratified as CS/CS, CS/BMS, BMS/CS, and BMS/BMS). Primary outcomes were target lesion revascularisation (TLR), major amputation, and mortality, with median follow-up of 75 months. Cox regression and propensity score matching were performed to adjust for baseline anatomical and procedural differences between stent types. Results: A total of 201 patients were included (50% male, mean age 65 years, 34% with chronic limb-threatening ischaemia). In the aortic-only subgroup (n = 46), outcomes were comparable between CS and BMS. Among aortoiliac reconstructions (n = 155), patients treated with CS/CS had greater anatomical complexity, including higher prevalence of iliac chronic total occlusions, longer lesions, and heavier calcification. Independent predictors of TLR included iliac chronic total occlusion, subintimal aortic recanalization, and concomitant common femoral endarterectomy. After propensity score adjustment, there remained no significant difference in TLR (28/155), major amputation (4/155), or mortality (30/155) between CS/CS and BMS/BMS groups. Conclusions: CS was preferentially employed in more complex aortoiliac occlusive disease and achieved outcomes equivalent to BMS after adjustment for lesion severity using propensity score methods. These findings reinforce that operator selection patterns and lesion complexity, rather than stent type alone, influence the clinical outcomes, underscoring the need for individualised stent selection strategies in advanced aortoiliac disease.
Background: This research was carried out to identify relevant steps to diagnosis and possible treatment regimens regarding angiosarcomas of the popliteal artery associated with true popliteal aneurysms, as they are very rare. Materials and methods: A systematic literature search was conducted in accordance with the Prisma Guidelines. Only publications regarding true popliteal aneurysms in association with true angiosarcomas were taken into account. Furthermore, three well-documented not yet published cases are depicted. Results: 13 case reports could be identified. Besides two initially diagnosed cases (ID), all other cases were diagnosed secondary (SD) and underwent surgery due to ipsilateral aneurysms in the past. For the reported cases, pain was the most frequent symptom (61%), followed by oedema (46%) and localised swelling in the popliteal fossa. 38% of patients showed central metastasis at the time of diagnosis. Both ID patients underwent primary resection of the tumour - in one case followed by arterial reconstruction, local radiotherapy and regional hyperthermal perfusion. 45% of SD patients underwent sole major amputation, the others received varying treatment regimens (chemotherapy, radiotherapy (or combination)) or sole palliative care. The short available follow-up of the two ID cases was uneventful. The median survival time for SD patients treated by major amputation was 8 months (average 19.2 months) and for the others in median 4.5 months (average 11 months). Conclusions: Non-ischaemic pain, swelling and/or sudden regrowth years after treatment of a popliteal aneurysm are highly suspect of malignancy and should be further evaluated (e.g. biopsy/positron emission tomography computed tomography).
Background: To evaluate safety, technical success, and long-term outcomes of endovascular therapy (EVT) in severely calcified aortoiliac occlusive disease (AIOD), focusing on lesion characteristics and the presence of coral reef aorta (CRA). Patients and methods: This single-center retrospective study included 216 patients with angiographically confirmed calcified abdominal aortic stenosis (mean PACSS 3.7 ± 0.8) treated with EVT between 2005 and 2023. Of these, 33 patients had coral reef aorta (CRA). Patients were stratified by lesion location and CRA presence. Primary endpoints were 30-day adverse events and technical success (residual stenosis <30%). Secondary endpoints were major adverse cardiovascular events (MACE), major adverse limb events (MALE), and all-cause mortality. Cox regression identified predictors of outcome. Results: Technical success was achieved in 81.9%. Thirty-day mortality was 0.5%. At 10 years, freedom from MACE was significantly lower in patients with non-bifurcation abdominal aortic stenosis (56% vs. 76%; aHR 2.13, p < .05) and lowest in CRA (30% vs. 71%; aHR 3.17, p < .05). Independent predictors of MACE were CRA, chronic total occlusion (aHR 3.38, 95% CI 1.57-7.29), critical limb-threatening ischemia (aHR 3.67, 95% CI 1.74-7.75), and age (aHR 1.06 per year, 95% CI 1.01-1.11). MALE was more frequent in patients with peripheral arterial disease (aHR 2.07, 95% CI 1.12-3.81), CRA (aHR 2.51, 95% CI 1.17-5.40), and current smokers (aHR 5.10, 95% CI 1.23-21.0). Conclusions: CRA and non-bifurcation abdominal aortic stenosis are associated with reduced long-term freedom from MACE after EVT. These findings define high-risk subgroups within calcified AIOD and highlight the prognostic value of anatomical lesion characteristics for treatment planning and follow-up.
Background: Patients with intermittent claudication (IC) need lifelong treatment with secondary prevention, including smoking cessation, physical activity, and best medical treatment. The deficiency in existing support indicates a need for new strategies to improve self-management of the disease. However, knowledge of electronic health (e-health) as support for these patients is lacking. The primary aim was to evaluate the effect on secondary prevention outcomes and the usability of a web-based application for patients with IC. The secondary aim was to describe the patients' experiences of using a web-based application. Patients and methods: Patients with IC (n=34) were recruited from a vascular outpatient clinic to a randomized controlled pilot trial. The study population had a mean age of 73 years and 52.9% were women. For three months, the intervention group (n=18) reported information through/via the application about physical activity, smoking, medication therapy, blood pressure, pain after activity, and quality of life (QoL). Primary outcome was walking distance, and the secondary outcome included ankle brachial index (ABI), blood pressure measurements, lifestyle factors, health education, and QoL. A linear mixed model was used to determine how the intervention affected the progression of walking distance, ABI, blood pressure measurements and BMI and Wilcoxon signed ranked test for QoL. After completing the study, the intervention group was interviewed in focus groups. Results: The reporting adherence was high (86-93%). QoL were improved in the intervention group (p=.049), and the level of insight into their condition increased in both intervention- (p=.016) and control group (p=.014). No significant differences in variables walking distance, ABI, blood pressure or BMI were observed between the groups. The interviews show an overall positive experience of using the application. Some patients experienced that the application increased their motivation to adhere to lifestyle recommendations. Conclusions: High reporting adherence and improved QoL, together with the participants experiences, indicate that using e-health may support adherence to secondary prevention in patients with IC but needs to be further studied in a full-scale randomized controlled trial.
Background: Pelvic venous disorders (PeVD) are associated with chronic pelvic pain and varicose veins due to venous insufficiency and pooling in the pelvis. Despite increasing interest, there is a lack of widely accepted diagnostic algorithms and validated criteria, which complicates diagnosis and management. This study aimed to develop and validate a diagnostic and therapeutic algorithm for PeVD using expert consensus. Materials and methods: An independent Advisory Board (AB) of 11 Italian specialists (gynaecologist, radiologists, vascular surgeons, and angiologists) was convened. A literature review informed the development of a draft algorithm. Three Delphi survey rounds were conducted, with online and in-person discussions, and a consensus threshold set at ≥70%. Results: All 11 AB members completed the first two survey rounds, and eight completed the third. The median number of diagnosed and treated PeVD cases per expert was 20 and 12 per year, respectively. The group agreed on classifying PeVD into Pelvic Congestion Syndrome (PCS) and compressive/obstructive syndromes. Endovascular therapy was recognised as standard of care: pelvic embolisation for PCS, stenting for obstructive lesions, and combined approaches when both are present. Clinical success was defined as subjective symptom improvement assessed 3-6 months post-procedure. Treatment failure warranted re-evaluation and possible reintervention. Surgical treatment was considered only when conservative and endovascular options failed (37.5% agree, 50% neutral). Conclusions: This Delphi-based consensus produced a validated, multidisciplinary algorithm for the diagnosis and treatment of PeVD. It highlights the need for standardised clinical pathways, but further validation by a broader expert community is warranted.
Early identification of patients with acute pulmonary embolism (PE) who can be safely managed in the outpatient setting has become a central priority in contemporary clinical practice. While haemodynamic instability mandates urgent reperfusion, most patients are hemodynamically stable at admission and therefore require refined risk stratification to guide therapeutic decisions and determine the appropriate level of care. The 2019 European Society of Cardiology guidelines emphasise the importance of identifying low-risk patients who may be eligible for early discharge (within 24-48 h) and home-based anticoagulation. Over the past decade, substantial progress has been made in validating clinical, biochemical, and haemodynamic criteria capable of reliably stratifying low-risk patients. The introduction of direct oral anticoagulants further simplified anticoagulation pathways, enabling shorter hospital stays and safer outpatient management. Nevertheless, the implementation of early discharge and outpatient treatment strategies remains highly heterogeneous across countries, reflecting variations in national recommendations, healthcare system organisation, and resource availability. This review aims to synthesise the current evidence on outpatient management of acute PE, with a focus on risk-stratification strategies, cost-effectiveness considerations, and contemporary guideline recommendations.
Background: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Unplanned rehospitalisation rates after discharge remain high, reflecting the chronic nature of CVD and the frequent need for complex, multidisciplinary follow-up care. Digital interventions may provide a valuable complement to traditional discharge management in addressing these challenges. Patients and methods: This study aims to assess the acceptance of digital discharge management interventions (DDMI) and to investigate the underlying factors influencing acceptance among patients with CVD following inpatient treatment. A cross-sectional survey-based study was conducted from June to October 2024 with N = 259 patients with CVD following inpatient treatment. Sociodemographic, medical, mental health, and e-Health-related data were assessed. Acceptance of DDMI and its underlying factors were assessed using a modified model of the Unified Theory of Acceptance of Use of Technology (UTAUT). Results: The overall acceptance of DDMI was high (M = 3.99, SD = 0.92, range = 1-5). The extended UTAUT model explained 62.7% of the variance in acceptance, with male gender (β = -0.36, p < .001) and the UTAUT predictors effort expectancy (β = 0.40, p < .001), performance expectancy (β = 0.24, p < .001), and social influence (β = 0.20, p < .001) being significant predictors. Conclusions: These findings indicate a generally high acceptance of DDMI among patients with CVD following inpatient treatment. To develop and implement such interventions, key drivers and barriers such as effort expectancy, performance expectancy, and social influence should be addressed. Furthermore, such interventions should be tailored to patients' specific needs.
Background: Pseudoxanthoma elasticum (PXE) is a rare, genetic disorder characterised by progressive vision loss, skin changes, and early-onset arteriosclerosis. The latter makes PXE a risk factor not only for peripheral artery disease (PAD) but may also promote coronary artery disease. In this context, patients with PXE have repeatedly reported problems with the radial access during coronary angiography. Therefore, the aim of this study was to prospectively investigate the prevalence of upper extremity (UE) arterial occlusion in patients with PXE and to identify possible associated risk factors. Patients and methods: Between November 2022 and February 2024, 93 consecutive patients with PXE were examined. 65 eligible patients with PXE were retained for further analysis and compared with 57 in-hospital controls. All patients underwent extensive screening for UE arterial disease using colour-coded duplex sonography (CCDS). Results: UE artery occlusion was significantly more common in patients with PXE than in the control group (58.5% vs. 3.5%; p < .001). The radial arteries were most commonly affected, predominantly bilaterally (50.8% of all PXE patients). Age was significantly associated with the presence of UE artery occlusion with an odds ratio (OR) of 1.06 (confidence interval [CI]: 1.01-1.10; p = .013). Conclusions: Peripheral occlusion of the UE arteries is a common finding in patients with PXE. In clinical practice, these findings suggest that patients with PXE may require a screening for PAD and occlusion of the arteries of the UE using CCDS after the age of 40 years. This is particularly recommended prior to coronary angiography or percutaneous coronary intervention.
Background: Arterio-venous malformations (AVMs) may lead to vessel aneurysms and thus to life-threatening bleeding or malperfusion of the extremities, causing recurrent ulceration. Possible therapies are embolisation and/or resection. This study investigates treatment options for patients with AVM Schobinger stage III and IV for whom embolisation and resection are no longer possible and medical treatment with trametinib, a mitogen-activated protein kinase inhibitor (MEK) was performed. Patients and methods: As part of the German guideline development process for the diagnosis and treatment of vascular malformations (AWMF register number 003-007), a systematic literature search was performed using a professional service provider, followed by a retrospective, exploratory analysis based on a consecutive local registry at an interdisciplinary tertiary care center for vascular anomalies. All patients with AVM Schobinger stage IIII - IV were included. Results: Of the 559 reports on specific medications for vascular malformations, only 4 (0.7%) included treatment with trametinib, and only 2 (0.4%) of them addressed its use in AVMs showing reduced blood inflow in the malformation or volume reduction. In our case series of 99 consecutive patients with AVM Schobinger stage III-IV, nine were treated with trametinib. Out of them, 6/9 (66%) had ulceration. 1/6 (20% of the patients with ulceration died, one patient required major amputation, and 4 (60%) were healed without recurrence through treatment. Three patients with chronic pain showed reduced symptoms without requiring additional analgesics. Conclusions: The single cases found in the literature and our small case series suggest that MEK1-inhibitors, such as trametinib, are an option for treating AVM Schobinger stage III - IV. Further large-scale studies are required to confirm these initial observations and to fully explore the potential of MEK1-inhibitors.
Peripheral artery disease (PAD) is a growing health problem, with symptoms ranging from intermittent claudication to chronic limb-threatening ischemia (CLTI). Balloon angioplasty in below-the-knee (BTK) PAD lesions is the mainstay treatment procedure but still a challenging one, given the heterogeneity in the patient population, multivessel and multilevel involvement, small-vessel size, long lesions (up to 40 cm), calcium burden, and lower flow rates with or without impaired runoff. The technical success of balloon angioplasty is often subverted by flow-limiting dissections, recoil with early restenosis. This review will explore current guidelines, revascularization anatomical planning, interventional approaches, and possible solutions to avoid the feared dissection, recoil and restenosis that our patients currently face.
Background: Peripheral artery disease (PAD) constitutes a major global burden of disease. Regarding patient-cases of patients with PAD, it is of outstanding interest to identify patients with a high risk for adverse in-hospital events. Thus, risk stratification tools including scores are of key interest for prognosis prediction. Materials and methods: The German nationwide inpatient statistics 2005-2018 was used for this analysis. Patient-cases of PAD patients were stratified according to a modified Mansoor's Self-Report Tool for Cardiovascular Risk Assessment class and compared. The predictive performance of this score was evaluated to predict adverse in-hospital events with the help of unadjusted and adjusted logistic regressions. Results: Overall, 2,462,085 patient-cases (36.8% females; 57.4% ≥ 70 years) of patients hospitalised due PAD were included in Germany 2005-2018. According to the Mansoor's self-report tool for cardiovascular risk assessment, 1,101,123 (44.7%) of the PAD patient-cases were classified as low-risk and 1,360,962 (55.3%) as high-risk. High-risk class was predictive for major adverse cardiovascular and cerebrovascular events (MACCE; odds ratio [OR] 1.09 [95% confidence interval [CI] 1.07-1.10], p < .001), acute kidney injury (OR 1.33 [95% CI 1.30-1.36], p < .001) and amputations (OR 1.46 [95% CI 1.44-1.47], p < .001). In contrast, high risk class was not associated with increased rate of arterial and venous embolism/thrombosis and in-hospital death (OR 0.97 [95% CI 0.96-0.99], p < .001). High risk class was associated with coronary revascularization treatments. Conclusions: The modified Mansoor's Self-Report Tool for Cardiovascular Risk Assessment score is a new and effective risk stratification tool to predict individual risk regarding MACCE, acute kidney injury and amputations in PAD patients during their hospitalisation, but the score failed to predict for in-hospital mortality.
Background: Optimal pharmacotherapy is a cornerstone for the treatment of patients with symptomatic peripheral artery disease (PAD). Our aim was to evaluate the impact of adjunct medical therapy, including lipid-lowering and antiplatelet treatment in patients undergoing open or endovascular revascularization due to common femoral artery occlusive disease (CFAOD). Patients and methods: Consecutive patients undergoing either endovascular or open revascularization due to CFAOD were analyzed. Pharmacotherapy before and after treatment was registered and its impact on the following post-procedural outcomes: (i) all-cause mortality and (ii) major adverse limb events (MALE), including major amputation and clinically driven target lesion revascularization (CD-TLR), were systematically analyzed. Results: Patients undergoing endovascular therapy (n=225) were older and exhibited more comorbidities such as diabetes mellitus and heart failure and had more frequently chronic limb threatening ischemia (CLTI) compared to those undergoing open repair (n=662). During 1.73 (0.9-3.3) years of follow-up, 96 (10.8%) deaths and 118 (13.3%) MALE occurred. After endovascular therapy, more patients received clopidogrel (70.2% versus 41.5%) and statins (92.0% versus 74.9%), (p<.001 for both). By multivariable analysis, statin prescription was associated with lower death rates (Odds Ratio (OR)= 0.43, 95%CI=0.25-0.73, p<.002), whereas clopidogrel was associated with lower MALE rates (OR=0.65, 95%CI=0.43-0.97, p=.04). These effects were primarily driven by patients undergoing open repair (effect of statins) and by patients with chronic limb threatening ischemia (effect of clopidogrel). Conclusions: Statin and clopidogrel treatment are important components of the post-procedural treatment of patients with PAD undergoing revascularisation due to CFAOD. Especially statins need to be prescribed based on current national and international guidelines independent of the revascularization type in every patient to reduce death rates.
Background: Apolipoprotein B (ApoB) levels and low-density-lipoprotein-cholesterol (LDL-c)/ApoB ratio have emerged as potential more accurate markers of cardiovascular (CV) risk, than LDL-c concentration alone. However, prognostic values in predicting CV outcomes, including major adverse cardiac and limb events (MACE and MALE) in peripheral artery disease (PAD) remains to be elucidated. Aim is to assess weather correlations exist between lipid parameters and PAD outcomes. Patients and methods: Consecutive PAD patient's first visit data from the Peripheral ARTEry Disease (PARTED) registry (2022-2024) were analysed. Demographic, clinical variables, and lipid parameters (LDL-c, Lp(a) and ApoB concentrations) were collected at time of inclusion. PAD patients were stratified in tertiles based on LDLc/ApoB ratio values. MACE and MALE outcomes arising prior to study inclusion were evaluated. Multivariate logistic regression analysis was performed. Results: A total of 339 chronic PAD patients were included. Mage was 71 years, 68% were males. M LDL-c concentration was 1.9 mmol/L, and only 27% of patients were on target (LDL-c ≤ 1.4 mmol/L). Significant association with prior MACE was found in the lowest and intermediate LDL-c/ApoB tertile group (low: OR 2.09, C-I 1.04-4.21, p < .05; intermediate: OR 2.06, C-I 1.04-4.09, p < .05) while no significant association was found between past MACE and LDL-c or ApoB tertiles. Conclusions: Lower LDL-c/ApoB ratios (LAR) remained associated with prior MACE after multivariable adjustment, highlighting the importance of a comprehensive lipid profile assessment. Whether LAR tracks with treatment intensification or retains associative value with historical events needs to be clarified.
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Background: Complex decongestive therapy (CDT) is the standard conservative treatment for lymphedema. This study aims to provide insights into the maintenance phase of CDT, its impact on health and quality of life over six months, and identify factors influencing these outcomes in individuals with leg lymphedema. Patients and methods: This prospective cohort study assessed health and quality of life by Short-Form-36, Freiburg Quality of Life Assessment for lymphatic disorders (FLQA-lk), Knee Outcome Survey Activities of Daily Living Scale, Symptom Checklist-90 Revised, and Coping Strategies Questionnaire. Health status was expressed by means (±SD) and standardised response means (SRMs). Multivariate linear regression explored the score change of FLQA-lk. Results: Participants were on average aged 53.9 years, female (75.9%), and had two comorbidities (n = 87). On 22/26 dimensions, average improvements ranged from 8.7 to 0.7 (scores) respectively from -0.05 to 0.51 (SRMs). Most participants (89.7%) continued with manual lymphatic drainage and wore stockings regularly (95%) at baseline. Formal education, exercise and compression showed the highest, in trend statistically significant partial correlations. Conclusions: Health and quality of life in individuals with leg lymphedema can be stabilised and slightly improved during the maintenance phase of the CDT with regular use of compression stockings and manual lymphatic drainage.
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Background: Atherectomy devices have become a widely used tool to treat peripheral vessels in a variety of clinical situations. This trial assesses the efficacy, safety and clinical success of the Rotarex Catheter, a rotational athero-thrombectomy system, for the treatment of acute, subacute and chronic occlusions in peripheral arteries including native arteries, bypasses and in-stent restenosis, used alone or as an adjunctive tool. Patients and methods: 220 patients were enrolled in this prospective, multicentre, single-arm study in Europe. Procedural success was measured after the index procedure. Freedom from major adverse events (MAEs), was collected through 30 days. Primary patency was collected at 1, 6, 12, and 24 months. Secondary outcomes included safety events, freedom from target lesion and vessel revascularization (TLR and TVR) and quality of life improvement. Results: Procedural success of Rotarex with an adjunctive treatment was 94.1%. Primary patency was 87.2%, 68.1%, 57.8% and 49.1% at 1, 6, 12 and 24 months, respectively. Freedom from MAEs through 30 days was 96.3%. The MAE rate was 21.0%, 31.0% and 41.1% at 6, 12 and 24 months. Freedom from TLR was 97.7%, 81.0%, 72.0% and 64.3% at 1, 6, 12 and 24 months. Freedom from TVR was 95.8%, 79.0%, 69.9% and 62.3% at 1, 6, 12 and 24 months. Most subjects showed improvement in Rutherford Class and in the quality-of-life measures. Conclusions: These results show that Rotarex performs effectively and safely when it is being used as an adjunctive treatment in acute, subacute and chronic occlusions of native arteries, ISR and bypass.
Background: To compare the effects of conventional approaches based on compression stockings and preventive measures with a combined program including these techniques, together with therapeutic exercise and self-manual lymphatic drainage instructed by a physiotherapist on functionality, general physical activity, and oedema in individuals with chronic venous insufficiency. Patients and methods: A randomized controlled clinical trial with two parallel groups (conventional approach and conventional plus physiotherapy approach) and a single-blind design was conducted. Oedema (circumferences), functionality (6-Minute Walking Test and the Five-Repetition Sit-to-Stand Test), physical activity level (International Physical Activity Questionnaire), and prevention measures were assessed before and after the intervention. Repeated measures ANOVA was used for statistical analysis. A total of 55 participants composed the final sample (13 women and 42 men, mean age: 60.49 years [15.05]). Results: No significant changes were found for the main effect of time or group-time-adherence interaction in any variable, while circumference at 10, 20, and 30 cm from the heel in both legs, and the 6-Minutes Walking Test showed a significant main effect for time in the conventional-approach group with high adherence. Conclusions: A multicomponent approach combining physiotherapy and medicine does not appear to be better than the conventional approach applied at primary care centres for improving functionality and oedema in patients with chronic venous insufficiency.
Background: Endothelial cell biopsy (ECBx) is a promising tool to obtain endothelial cells (EC) for research purposes from a range of patients, however the minimally invasive procedure has not been described in the critically ill. Our study set out to demonstrate the feasibility of performing ECBx using discarded guidewires used as part of standard care (SOC). Patients and methods: Guidewires from central venous catheters (CVC) and arterial lines were collected from surgical patients prior to major surgery (n = 16) and from patients upon admission to the Intensive Care Unit (ICU) (n = 16). In surgical patients, additional ECBx were performed from cubital veins. Quantification and characterization of EC was performed using flow cytometry. Results: A total of 44 wires were collected with a similar yield of EC from standard of care CVC (2,265 IQR881-6,610 /wire, n = 20) and arterial lines (2,109 IQR 1,288-2,682 /wire, n = 13), and purposely performed cubital veins biopsies (2,089 905-3,636 /wire, n = 11; p = .83). Comparison of the phenotype of EC between cohorts showed a significant increase in size (p = .01) and internal complexity (p < .01) of cells in the ICU cohort compared to the surgical cohort. Conclusions: It is feasible to collect EC from discarded guidewires used in SOC. The data demonstrate phenotypic differences between EC between cohorts and that ECBx is a safe and well tolerated technique. Our findings suggest that ECBx can provide valuable insights into clinically relevant EC pathophysiology and may help guide future research.