BACKGROUND:Advanced Practice Nurses (APNs) were introduced in France in 2019 to address chronic disease burden, healthcare access inequalities, and medical workforce shortages. By the end of 2024, 751 APNs had graduated in France, with Stabilized Chronic Diseases (PCS) representing the predominant specialty (54-57%). APNs specialized in Stabilized Chronic Diseases are expected to collaborate with vascular physicians, although their role continues to evolve following recent authorization of direct patient access and independent prescribing rights. This study aimed to assess the implementation of APNs in vascular medicine in France. METHODS:An online survey was conducted between December 2025 and February 2026 among French vascular physicians through the mailing list of the Collège des enseignants en médecine vasculaire. Separate questionnaires were distributed to APNs and vascular physicians to evaluate referral pathways, clinical activities, delegated tasks, and prescribing practices. RESULTS:Four hospital-based APNs and 40 vascular physicians participated in the survey. APN activities mainly included therapeutic education, chronic wound management, thromboembolic disease follow-up, and technical vascular assessments such as ankle-brachial index measurements and walking tests. Thirty-three physicians reported active collaboration with APNs, mainly for follow-up consultations and to reduce delays in specialist care. However, cardiovascular risk factor management remained limited, and only 61.8% of physicians supported independent prescribing authority for APNs. DISCUSSION:APNs are progressively being integrated into vascular medicine teams in France, particularly in hospital settings. Although international evidence supports the safety and effectiveness of APN-led care, clearer role definition and broader integration into chronic vascular disease management remain necessary within the French healthcare system.
BACKGROUND:Peripheral arterial abnormalities (PAA) are increasingly recognized in heritable thoracic aortic disease (HTAD), yet no standardized definitions or imaging protocols exist. This heterogeneity limits clinical interpretation, longitudinal follow-up, and comparability across studies. We conducted a French national Delphi consensus to establish uniform criteria for the identification, classification, and measurement of PAA in Marfan syndrome (MFS) and related HTAD. METHODS:A two-round modified Delphi process was completed by national experts in vascular medicine, radiology, and cardiology. Round 1 addressed definitions, reference diameter selection, tortuosity assessment, and imaging methodology. Round 2 refined key items based on qualitative feedback. Strong consensus was predefined as ≥85% agreement. RESULTS:Of 45 invited experts, 22 responded to round 1 (49% response rate) and 18 completed round 2 (82% retention). Strong consensus was reached for standardized definitions of aneurysm (focal dilatation ≥150% of reference diameter), ectasia (125-149%), mega-artery (diffuse non-focal dilatation ≥150% of reference diameter), and arterial tortuosity (≥2 inflexions). A hierarchical reference diameter approach was validated, prioritizing the adjacent non-pathological segment, followed by the contralateral artery and population-based norms. Perpendicular measurement to the vessel axis achieved unanimous agreement (100%). The term tortuosity was preferred over dolichoartery (89%). Divergent opinions persisted regarding ultrasound measurement technique, leading to pragmatic recommendations aligned with existing aortic imaging practices. CONCLUSIONS:This French national Delphi consensus provides a standardized framework for defining and assessing PAA in MFS and related HTAD. The harmonized terminology and imaging recommendations will enhance diagnostic consistency, facilitate multicentre research, and support integration of PAA into comprehensive vascular evaluation within specialized HTAD care networks.
Acceleration time (AT) is a pulsed-wave Doppler ultrasound parameter reflecting the time interval between the onset of systolic flow and peak systolic velocity. Although described several decades ago, AT has remained underutilized in routine practice. Recent evidence, however, has highlighted its diagnostic and clinical value in lower extremity peripheral artery disease (PAD), particularly in situations where the ankle-brachial index is unreliable. This manuscript provides a comprehensive and practical overview of AT, focusing on its physiological basis, technical requirements for accurate measurement, and clinical applications in PAD. We detail standardized measurement conditions, emphasize common pitfalls, and underline the importance of adequate Doppler acquisition parameters to ensure reproducibility. The diagnostic performance of AT is reviewed across different arterial levels, showing its ability to detect significant upstream stenoses and to exclude hemodynamically relevant disease with high sensitivity and specificity. In advanced PAD, particularly chronic limb-threatening ischemia, the concept of maximal acceleration time (ATmax), defined as the highest AT measured in distal pedal arteries, is discussed as a reliable marker of severe hypoperfusion. ATmax shows strong correlation with toe pressure and has demonstrated prognostic value following revascularization. In addition, maximal systolic acceleration (ACCmax) is complementary Doppler-derived parameter, reflecting the rate of systolic flow acceleration and providing further hemodynamic insight although with higher technical demands. Overall, AT, ATmax and ACCmax are simple, reproducible, and non-invasive markers that enhance vascular ultrasound assessment of PAD. Their systematic integration into clinical practice may improve diagnostic accuracy, disease severity evaluation, and patient management.
LDL cholesterol (LDL-C) measurement is a key component in assessing cardiovascular disease risk and managing dyslipidemia. Despite irrefutable evidence that LDL-C-targeted strategies effectively reduce the risk of cardiovascular events, there is considerable variability among individuals in response to lipid-lowering therapies and in the resulting reduction of cardiovascular risk. Focusing solely on LDL-C assessment and management is no longer an optimal strategy for all patients. A major concern also lies in the potential for substantial errors in risk estimation, given the recognized measurement or calculation inaccuracies of LDL-C in patients with hypertriglyceridemia. Furthermore, the imprecision of calculated or measured LDL-C is less acceptable in the era of new lipid-lowering therapies that achieve very low LDL-C levels. This text, through existing recommendations, highlights the reasons why it has become necessary to use biomarkers beyond LDL-C to identify and treat patients at high cardiovascular risk.
INTRODUCTION:Carotid web (CaW), a focal intimal dysplasia, is a potential cause of embolic ischemic stroke (IS). The optimal therapeutic approach for symptomatic CaW remains unclear. METHODOLOGY:Since January 2016, patients hospitalized for IS with an ipsilateral CaW, identified during etiological workup, are prospectively included in this ongoing single-center observational cohort study. RESULTS:Until April 2024, 32 patients (59% men; mean age 48±7.5 years; mean NIHSS score 8±6) were included. Seven patients (22%) had a history of prior IS. Thrombolysis and/or thrombectomy were performed in 15 patients (47%). During follow-up, recurrent IS occurred in 6 patients (19%), while on antiplatelet therapy (APT), with a median recurrence time of 39 days (IQR 8-144). Etiological workup identified CaW on CT angiography in 30 patients (94%) and on arteriography in 17 patients (53%). CaW was suspected on ultrasonography in 26 patients (81%) and confirmed with a second imaging modality. CaW was identified as the primary etiological diagnosis in 29 patients. Alternative diagnoses in 3 patients included atrial fibrillation (n=1), patent foramen ovale (n=1) and inherited thrombophilia (protein S deficiency) associated with a suspected right-to-left pulmonary shunt on transesophageal echocardiography (n=1). Among the 29 patients with symptomatic CaW, anticoagulation was prescribed in 21 cases (72%). Antiplatelet therapy (APT) was prescribed in 8 patients (28%), primarily due to hemorrhagic transformation in 7 of them. Carotid endarterectomy (26 patients) or angioplasty with stent placement (3 patients) was performed within a median of 28 days (IQR 14-84) with no major complications (2 spontaneously resolving laryngeal edema). Histopathological analysis of 19 endarterectomy specimens revealed associated thrombus in 5 cases (26%). Postoperatively, all patients were prescribed APT. No ischemic recurrence or death was reported during a mean follow-up of 24±20 months. CONCLUSION:Medical management alone for symptomatic CaW was associated with IS recurrence. Combined interventional approach effectively prevented cerebrovascular events. Further randomized studies are needed to determine the optimal therapeutic approach, particularly the preferred revascularization strategy.
Introduction & Objectives Pulmonary embolism (PE) is a common and potentially fatal cardiovascular emergency, the diagnosis of which relies on a combination of clinical, laboratory, and imaging data [1]. However, routine access to imaging can be limited, especially in sub-Saharan Africa [2]. Machine learning models that simultaneously integrate multiple variables offer an innovative approach to estimating the probability of PE, thus facilitating clinical decision-making [3]. This study aims to develop a machine-learning model that can be used to predict PE based on existing models. Methodology In this retrospective cross-sectional study, 400 patients suspected of pulmonary embolism were recruited, of whom 237 had a PE confirmed by CT angiography and 163 had an unconfirmed PE. The variables used were sociodemographic, clinical, biological, electrocardiographic, and echocardiographic. Several machine-learning models were trained and evaluated using the Area Curve–Receiver Operating Characteristic (AUC-ROC). Results The combined model (Naive Bayes+XGBoost) achieved the best performance, with an AUC-ROC of 84%, an accuracy of 82%, and a sensitivity of 81%. This allowed us to develop an application called the PE predictive score (NSANGOU-KONIN SCORE), which demonstrates excellent discriminatory power between patients with confirmed PE and those with unconfirmed PE, with respective average scores of 81.5% and 26.6%. Discussion The combined model offers the best overall performance; this model balances sensitivity and specificity, reducing the risk of false negatives, a crucial aspect in clinical practice [3]. The NSANGOU-KONIN SCORE provides similar positive predictive values to this combined model. Conclusion Integrating machine learning into PE diagnosis enhances diagnostic accuracy and facilitates clinical decision-making, particularly in countries where imaging is not readily available. Our application demonstrates strong PE prediction capabilities; however, a large-scale study is needed to confirm its robustness and clinical generalizability.
Introduction & Objectives Anticoagulation treatment of venous thromboembolism (VTE) carries potential risks, including major bleeding and recurrent VTE, often due to poor adherence, which is itself associated with insufficient patient knowledge. Objectives To investigate patient knowledge over time to evaluate the effectiveness of the strategy of patient education employed in our clinic. Methodology We created a short patient questionnaire (7VTE-Quest), completed in the waiting room and used to guide patient education during consultation. Patients requiring anticoagulant therapy≥3 months and having completed the 7VTE-Quest at 2 different consultations between March 2022 and December 2024 were included. The primary endpoint was improved score (≥1 point) at second completion of the questionnaire. Results A total of 135 patients completed the questionnaire a second time a mean (±SD) 211 (±169) days after the initial completion. After excluding 4 patients who achieved a perfect score both times, the score improved for 56.5% (74/131) of patients. The change in total score ranged from -3 to +4. The greatest overall gain was for questions on management of forgotten medication dose (20.0%, 27/135) and interaction between anticoagulants and NSAIDs (11.1%, 15/135). A regression in the number of patients providing correct answers was observed for all questions. The greatest regression was observed for NSAID contraindication: 40.0% (14/35) of patients could no longer recall this contraindication, while 29.0% (29/100) of those who could not initially recall this contraindication did so at the second completion. Discussion Over half of patients improved their understanding of VTE after completing the 7VTE-Quest and receiving personalized education. Older age and multiple medications were linked to poorer initial knowledge, but all benefited equally. Awareness of NSAID–anticoagulant risks declined over time, stressing the need for ongoing education. Despite limitations, the strategy proved effective in enhancing and maintaining patient knowledge on VTE and treatment safety. Conclusion The strategy we propose shows an improvement of patient knowledge on their VTE disease and treatment.
Introduction & Objectives Polyvascular disease (PVD), characterized by the simultaneous involvement of multiple arterial territories, poses a significant challenge in vascular pathology. Its increasing prevalence, particularly among elderly patients with multimorbidity, underscores the need for an integrated diagnostic and therapeutic approach. This study aimed to evaluate the prevalence of PVD and identify predictive risk factors, integrating artificial intelligence (AI) to achieve more precise cardiovascular risk stratification Methodology A cross-sectional study was conducted on 302 patients hospitalized for coronary artery disease. Clinical, biological, and angiographic data were collected. PVD was defined as significant involvement in at least two vascular territories (coronary, carotid, peripheral arteries). Statistical analyses were performed to identify risk factors associated with PVD. An AI-based algorithmic approach was explored to predict the risk of PVD from clinical and biological data Results The prevalence of PVD in our cohort was 13.24%. Significantly associated risk factors included advanced age, diabetes (OR=3.83; P<0.001), hypertension (OR=2.08; P=0.011), dyslipidemia (OR=2.00; P=0.007), and the presence of carotid stenosis (OR=3.72; P<0.001). The AI-based algorithm improved PVD risk prediction compared to traditional models, with an area under the ROC curve of 0.85. Discussion PVD is a common entity among coronary artery disease patients, associated with a high cardiovascular risk profile. The integration of AI enhances risk stratification and optimizes prevention and management strategies, especially in elderly patients with multimorbidity. Conclusion These results highlight the importance of a comprehensive and personalized approach to reduce the burden of PVD.
Introduction & Objectives Filaminopathy A is a rare heritable connective tissue disorder associated with vascular fragility and increased susceptibility to infectious complications. We report a case of prosthetic aortic graft infection and mediastinitis occurring shortly after a lip piercing in a patient previously treated with valve-sparing aortic root and arch replacement. Methodology A retrospective review of clinical, microbiological, imaging, and operative data was performed, focusing on diagnostic features, surgical findings, and postoperative evolution. Results A 32-year-old woman presented three weeks after a lip piercing with fever, chest pain, and dyspnea. CT angiography demonstrated a periaortic collection around the ascending aortic graft, and blood cultures grew methicillin-sensitive Staphylococcus aureus. Despite intravenous cefazoline, repeat imaging showed rapid progression to a 45×32×78mm mediastinal abscess with graft involvement. Complete explantation of the infected Thoraflex prosthesis and cTAG endograft was required, followed by in situ reconstruction using cryopreserved aortic allografts, including a Yacoub root replacement, a 28-mm arch allograft, and separate supra-aortic reimplantations. Postoperative complications included recurrent laryngeal and phrenic nerve injury, deep vein thrombosis, and a small pseudoaneurysm that stabilized on follow-up. Antibiotic therapy consisted of six weeks of intravenous cefazoline followed by prolonged oral trimethoprim–sulfamethoxazole and rifampicin. At four months, CT angiography showed patent allografts and resolution of infection. Discussion This case illustrates how transient bacteremia from oral piercings can lead to life-threatening prosthetic infections in patients with filaminopathy A. Tissue fragility, altered inflammatory regulation, and the presence of prosthetic material likely contributed to the rapid extension of infection. Conclusion Patients with filaminopathy A or vascular prostheses should be explicitly advised to avoid procedures associated with transient bacteremia, including body piercings. Early recognition and aggressive surgical management are essential for favorable outcomes.
Introduction & Objectives Thoracic outlet syndrome (TOS) is a rare but well-described cause of upper extremity deep vein thrombosis (UEDVT). It may lead to pulmonary embolism (PE), including recurrent events despite anticoagulation. Methodology We report a case of recurrent pulmonary embolism (PE) despite full-dose anticoagulation, complicated by chronic thromboembolic pulmonary hypertension (CTEPH) secondary to venous TOS. Clinical, imaging, and hemodynamic data were collected from the patient's medical record in accordance with institutional ethical standards. Results A 26-year old woman was treated for symptomatic PE related to right UEDVT in the context of bilateral venous TOS. The etiological work-up (contraceptive use, malignancy, and thrombophilia screening) was negative. The clinical course was marked by two symptomatic, intermediate–high risk PE recurrences despite curative-dose anticoagulation (apixaban, then low-molecular-weight heparin).Four months after the initial event, the course was unfavorable, with severe CTEPH characterized by major pulmonary vascular obstruction (Meyer score: 75%) and severe right heart failure (cardiac index: 2.1L/min/1.73m2). A multimodal and sequential management approach combined anticoagulation, dual oral therapy for CTEPH, and pulmonary angioplasties. Functional rehabilitation followed by right-sided surgical decompression was performed to prevent further thrombotic recurrence. Discussion This case illustrates the diagnostic and therapeutic challenges of venous TOS. Although rare, this syndrome is a recognized cause of UEDVT and may lead to recurrent PE despite adequate anticoagulation. Management of TOS should be multidisciplinary, predominantly conservative, based on physiotherapy, with surgical decompression discussed in thrombosed cases to relieve mechanical compression. Conclusion Venous TOS should be systematically investigated in patients presenting with UEDVT, particularly in the absence of identifiable risk factors. It may be associated with PE, including recurrent events under anticoagulation. Early recognition guides therapeutic strategy and helps prevent recurrence.
Introduction & Objectives Pelvic congestion syndrome is a common but underdiagnosed cause of chronic pelvic pain in women. It is generally linked to ovarian venous reflux, but some forms may only affect the hypogastric network. This clinical case highlights the diagnostic value of Doppler ultrasound in the investigation of pelvic varicose veins and offers a new therapeutic approach. Methodology We report the case of a 46-year old woman, G4P3, who had been experiencing symptoms of pelvic pain of multifactorial origin for several years. Previous digestive, gynaecological, urological and radiological investigations were inconclusive. Results Pelvic Doppler ultrasound revealed reflux in the left perineal vein (point P) and perivaginal plexuses, without ovarian incontinence or pelvic venous compression. An investigation of this reflux by puncture of the left perineal vein with injection of contrast medium under fluoroscopy confirmed the presence of a large varicose vein bundle. Selective embolisation was performed using the same approach without any immediate complications. The outcome was favourable, with a noticeable improvement in perineal heaviness. Discussion Pelvic Doppler ultrasound is a valuable, non-invasive, and dynamic tool that can be used to accurately locate perineal leakage points, such as point P in our observation. Diagnostic confirmation by direct puncture with contrast injection provides both anatomical validation and targeted therapeutic access. Conclusion This case illustrates the diagnostic value of Doppler ultrasound, which can be used to identify forms of pelvic congestion limited to the hypogastric region. Targeted transcutaneous access to the leak point offers an innovative, effective and rapid minimally invasive treatment option that avoids the need for a more complex endovascular approach.
Introduction & Objectives Peripheral artery disease in its chronic threatening ischemia stage carries a substantial risk of major amputation and mortality, yet evidence regarding optimal local management of arterial ulcers remains limited. FLAMMACERIUM® (1% silver sulfadiazine and 2.2% cerium nitrate), traditionally used in deep burns, could offer therapeutic value in this setting. Methodology This prospective, open-label, single-center study, conducted at the Toulouse University Hospital wound healing center between September 2021 and June 2025, evaluated the effect of FLAMMACERIUM® on one-year outcomes in patients with atheromatous arterial ulcers present for more than two weeks. The primary endpoint was a composite of all-cause mortality or major amputation at one year, while secondary outcomes assessed healing, minor amputations, and changes in local clinical parameters such as exudate, inflammation, and pain. Results Among 166 screened patients, 51 were included (mean age 76.9±14.1 years, 68.6% men). At initiation of FLAMMACERIUM®, 41.2% were in critical ischemia, with a mean toe pressure of 35.8±15.2mmHg. Ulcers had been present for an average of 7.5 months, and 22% of patients had associated osteitis. At one year, amputation-free survival reached 71.4% (95% CI: 55.6–82.4). The all-cause mortality rate was 26.3%, predominantly of cardiovascular origin, while the major amputation rate was 5.6%. Healing was achieved in 64.7% of patients. Significant improvements in local ulcer characteristics were observed: exudates decreased from 81% to 33% (P=0.006), peri-lesional inflammation from 78.3% to 30.4% (P=0.001), and toe necrosis from 41% to 15% (P=0.016). No adverse events attributable to the treatment were reported. Discussion Randomized controlled trials are required to confirm these results and better define the therapeutic role of FLAMMACERIUM® in the management strategy of arterial ulcers. Conclusion These findings suggest that FLAMMACERIUM® is a safe and potentially beneficial local treatment for arterial ulcers, associated with improved healing parameters and a major amputation rate lower than expected from WIfI-based predictions and published data.
Introduction & Objectives Right-to-left shunts (RLS) allow unfiltered venous blood to pass into the systemic arterial circulation, exposing patients to paradoxical embolism. Patent foramen ovale (PFO), the most frequent cause of RLS, is implicated in a significant proportion of cryptogenic strokes, particularly among younger individuals. Accurate detection of these shunts is essential to guide management, especially percutaneous closure procedures. Transcranial Doppler (TCD) is considered the reference technique, but its use may be limited by the absence of an adequate temporal acoustic window. This study aimed to assess the diagnostic performance of carotid Doppler ultrasound (CDU) with contrast injection for RLS detection and grading, compared with reference methods (TCD and transthoracic echocardiography–TTE). Methodology A retrospective, single-center study was conducted in the vascular medicine department of Dijon University Hospital between July 2024 and June 2025. Eighty-three patients who simultaneously underwent CDU at the level of the internal carotid artery and TCD when a temporal window was available and/or TTE for the detection of RLS were included. The standardized protocol involved two microbubble injections, at rest and during the Valsalva maneuver. Patient data and imaging reports (CDU, TCD, TTE) were retrospectively analyzed using the DxCare software. Results An RLS was identified in 50 patients, 82% of which were related to a PFO. CDU demonstrated a sensitivity of 98% and a specificity of 100%. Excellent agreement was observed between CDU and TCD for RLS grading, both at rest and during Valsalva, with high kappa and Spearman correlation coefficients. In several symptomatic patients, CDU led to diagnostic reconsideration and subsequent referral for percutaneous PFO closure when TTE had failed to detect the shunt. Discussion These findings suggest that CDU is a reliable alternative for RLS detection, particularly in patients without an adequate temporal acoustic window. Its simplicity, availability, and reproducibility strengthen its value as a routine diagnostic tool in vascular practice. Conclusion Contrast-enhanced carotid Doppler ultrasound is a high-performing, non-invasive, and complementary method for screening and quantifying right-to-left shunts, contributing to improved diagnostic and therapeutic management of patients at risk for paradoxical embolism.
Introduction & objectives Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a frequent, potentially serious, and preventable hospital-acquired complication among medical inpatients. In France, current guidelines (AFSSAPS 2009) recommend almost systematic prophylaxis with low-molecular-weight heparin (LMWH) without decision-support tools, leading to possible overprescription and unnecessary medical, economic, and environmental burden. Validated clinical scores such as IMPROVE and IMPROVE bleeding allow individual assessment of thrombotic and bleeding risk. Methodology We conducted a retrospective, single-center study in the Internal Medicine Department of Rouen University Hospital. Patients hospitalised between March 1 and April 1, 2024, excluding those under therapeutic anticoagulation, were included. IMPROVE and IMPROVE bleeding scores were retrospectively calculated. Prescription appropriateness was evaluated according to an algorithm combining both scores. Results Of 167 hospitalised patients, 99 were analysed. The mean length of stay was 10±6.3days. Thromboprophylaxis was prescribed in 79 patients (79.8%). The theoretical model would have led to LMWH prescription in only 46 cases. Thus, 33 prescriptions (33.3%) appeared avoidable, representing 292 doses, corresponding to an estimated saving of €233.60 and 489kg of CO2 emissions avoided (P=0.0112, Fisher's exact test). Discussion These findings highlight persistent empirical prescribing habits in the absence of decision-support tools. Using IMPROVE and IMPROVE bleeding together could rationalise thromboprophylaxis while improving safety, reducing costs, and lowering environmental impact. Despite the retrospective monocentric design and limited sample size, this approach shows promising potential. Integrating these scores into electronic prescribing systems could harmonise clinical practice and promote a more sustainable and evidence-based use of LMWH in internal medicine. Conclusion The combined use of IMPROVE and IMPROVE bleeding scores could rationalise thromboprophylaxis prescriptions in internal medicine, improving patient safety while reducing costs and environmental impact. Integrating these scores into electronic prescribing systems may facilitate their clinical adoption.
Endovenous techniques are now widely established in the treatment of chronic venous disease; however, recurrent venous reflux after endovenous intervention remains a common and incompletely understood finding. Reported recurrence rates vary considerably, reflecting differences in follow-up duration, ultrasound criteria, and definitions of recurrence. Recurrent reflux may result from recanalization of the treated vein, progression of venous disease in untreated segments, or the development of alternative reflux pathways involving tributaries or perforator veins. While endovenous procedures have reduced the incidence of classical neovascularization observed after surgical stripping, altered venous hemodynamics and redistribution of flow appear to play a key role in the emergence of new reflux patterns over time. Importantly, ultrasound-detected reflux recurrence does not systematically translate into clinical recurrence. A proportion of patients remain asymptomatic despite documented reflux, questioning the assumption that anatomical recurrence necessarily reflects procedural failure or mandates reintervention. Taken together, these findings suggest that reflux recurrence after endovenous treatment reflects not only technical or anatomical factors, but also the complex and evolving pathophysiology of chronic venous disease. A better understanding of the mechanisms underlying post-treatment reflux is essential to distinguish clinically relevant recurrence from benign imaging findings and to guide appropriate long-term management.
Introduction & Objectives Lymphedema (LO) is a chronic condition and associated with a poor quality of life and complications that require significant healthcare resources. To compensate for this lack of access to quality care, particularly for financial and geographical reasons, the Toulouse and Montpellier University Hospitals have created the LYMPHORAC 51 program. To evaluate the impact of this coordinated and integrated care pathway, organized between the Toulouse University Hospital's expert center and community care providers, on the management of LO, particularly in terms of reducing the volume of the affected limb, complications and healthcare consumption Methodology Prospective, single-center study conducted at Toulouse University Hospital between June 2022 and June 2024. The most severe cases received 5 days of decongestive therapy, after which all patients received bandaging performed by a trained local healthcare team. The primary endpoint was a>10% reduction in the volume of the index limb between inclusion and the 1-year visit. Secondary endpoints included infectious complications, quality of life assessment, and healthcare consumption Results Of the 100 patients included, 88 patients underwent a 1-year evaluation. At 1 year, 75% of patients had stabilized or reduced the volume of their LO. A reduction in limb volume>10% at 1 year was observed in 30.7% of patients. This reduction was statistically significant for stage 2b LO (P=0.04). The percentage of erysipelas at 1 year was 7.95% (95% CI: 3.26–15.7). Although not statistically significant, quality of life improved, and anxiety decreased significantly at 1 year (P=0.01). Healthcare consumption decreased significantly, with the proportion of patients in package 3 falling from 46% to 21% in 1 year, reflecting the reduction in healthcare needs. There were no hospitalizations for LO complications during the 1-year follow-up period Discussion The reduction in volume is greater in cases of high-volume lymphedema, as shown in several studies. Conclusion The coordinated and integrated care pathway, LYMPHORAC 51, led to a reduction in the volume of the index limb, particularly in severe stages, with a decrease in complications and healthcare consumption. Longer-term evaluations of all patients included in the LYMPHORAC 51 program by the Toulouse and Montpellier university hospitals are necessary to confirm these results and enable the program to be rolled out nationwide.
Extensive epidemiological, experimental, and genetic evidence confirms a direct effect of Lp(a) in the development of atherothrombotic complications, which become a clinical reality in individuals with elevated plasma Lp(a) levels. Lp(a) readily accumulates in the intima of the arterial wall because it has a higher binding capacity to fibrin and proteoglycans than other lipoproteins (such as LDL). In addition, the transendothelial passage of Lp(a) is facilitated directly by Lp(a) itself through the promotion of endothelial dysfunction and mural thrombosis. Within the arterial wall, Lp(a) is easily taken up by macrophages, promoting the formation of foam cells and the production of pro-inflammatory cytokines. Moreover, oxidized phospholipids preferentially bind to Lp(a), allowing their pro-inflammatory and pro-atherogenic activity to develop within the arterial wall. Beyond its pro-atherogenic effects, Lp(a) also exhibits pro-thrombotic properties. Apo(a), the specific component of Lp(a), has structural similarities with plasminogen. Thus, Lp(a) competes with plasminogen for binding to fibrin and to cellular plasminogen receptors. This decreased binding of plasminogen to fibrin and its receptors reduces its activation and leads to impaired fibrinolysis. It has been shown that lower-molecular-weight apo(a) isoforms exhibit the highest affinity for fibrin. In addition, Lp(a) increases the expression of plasminogen activator inhibitor-1 (PAI-1), further contributing to reduced fibrinolysis. Lp(a) also enhances platelet aggregation and activation. Moreover, Lp(a) promotes endothelial dysfunction, resulting in reduced endothelium-dependent vasodilation.
