Objective:This study is aimed at evaluating the impact of Type 2 diabetes mellitus (T2DM) duration on major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI). Methods:A single-center prospective cohort study was conducted in which 465 T2DM patients undergoing PCI and completing the 1-year follow-up were enrolled. Patients were divided into three groups based on duration of DM: < 5 years, 5-10 years, and > 10 years. The primary endpoint was MACE, a composite of nonfatal myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG), repeat PCI, and mortality. Results:The incidence of MACE increased progressively with longer diabetes duration: 3.7% (< 5 years), 8.1% (5-10 years), and 13.9% (> 10 years), with particularly higher rates of stroke (0.6%-3.0%) and repeat PCI (1.8%-6.0%) among T2DM patients after PCI. The Kaplan-Meier analysis demonstrated a clear stepwise rise in cumulative MACE incidence over 12 months, with the highest event rates observed in patients with diabetes for more than 10 years (log-rank p < 0.004). Consistently, Cox proportional hazards models showed significantly elevated risk compared with the < 5-year group, with adjusted hazard ratios of 3.16 (95% CI: 1.06-9.47, p = 0.039) for 5-10 years and 4.37 (95% CI: 1.59-12.01, p = 0.004) for > 10 years. Conclusion:Patients with longer duration (> 10 years) of T2DM had the highest incidence and hazard of adverse cardiovascular events compared to shorter duration (< 5 years and 5-10 years). These results suggest that targeted preventive strategies and closer post-PCI monitoring are essential for patients with prolonged diabetes duration.
Background:Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and is associated with significant morbidity and mortality. Data on AF in hospitalized patients in the Middle East are limited. Methods:We analyzed 536 hospitalized patients with nonvalvular AF from the Jordan atrial fibrillation (JoFib) registry. A prospective multicenter study of 2020 patients enrolled between May 2019 and December 2020. Patients were stratified into new-onset atrial fibrillation (NOAF) and previously diagnosed AF, and their clinical characteristics and in-hospital outcomes were compared. Results:The cohort had a mean age of 70.2 ± 14.1 years, and 48.7% were male. The most common comorbidities were hypertension (77.6%), diabetes (52.1%), and heart failure (31.3%). NOAF patients were significantly younger and more likely to be smokers, whereas those with prior AF had more comorbidities and larger left atrial size. Overall, in-hospital mortality was 6.7% but was significantly higher in NOAF patients. Conclusions:Hospitalized patients with NOAF are younger, more often smokers, and face higher in-hospital mortality compared with chronic AF, underscoring the need for early recognition and risk factor modification to prevent hospitalization. Trial Registration:ClinicalTrials.gov Identifier: NCT03917992.
Background:Peripheral arterial disease (PAD) with chronic limb-threatening ischemia (CLTI) represents advanced systemic atherosclerosis and carries high risks of amputation and mortality. Multilevel arterial involvement is common and often requires revascularization of both inflow and outflow segments. However, midterm outcome data in Vietnam remain limited. Objectives:This study is aimed at evaluating midterm clinical outcomes and identifying factors associated with wound healing, all-cause mortality, and major limb amputation after an endovascular-first revascularization strategy for multilevel PAD with CLTI. Methods:This retrospective case series included 91 patients with multilevel PAD (≥ 2 anatomical levels according to TASC II) and CLTI (Rutherford 4-6) treated at a tertiary hospital in Vietnam from 2017 to 2019. Patients were followed for 24 months. Kaplan-Meier analysis was used to describe survival, limb salvage, and wound healing over 24 months. Univariable and multivariable logistic regressions were used to identify factors associated with fixed-time binary outcomes within 24 months, including wound healing, mortality, and major limb amputation. Results:The mean age was 74.0 ± 11.6 years, and 82.4% were male. The ankle-brachial index improved significantly after intervention (0.2 vs. 0.5; p < 0.001). The mean follow-up duration was 18.9 ± 8.3 months. At 24 months, mortality was 27.5%, major amputation occurred in 18.7% (limb salvage 81.3%), and 62.2% of patients with tissue loss achieved wound healing (median 5 months). Age ≥ 75 years and neutrophil-to-lymphocyte ratio ≥ 3.5 were independently associated with reduced wound healing. Wound healing was associated with lower mortality and amputation risk. Adjunctive open surgery reduced limb amputation. Conclusion:An endovascular-first revascularization strategy for multilevel PAD with CLTI achieved acceptable midterm limb salvage and wound healing, although mortality remained considerable. Risk stratification and multimodal care are essential to improve outcomes.
Aims:This review is aimed at systematically identifying, evaluating and synthesising the influence skin tone has on patient assessment and patient journey in people with chronic venous insufficiency. Background:Chronic venous disease of the lower limb typically presents with cutaneous manifestations that differ across skin tones. However, its impact on patient assessment and patient journey is unknown. Design:This systematic review and evidence synthesis were conducted following a protocol prospectively registered in PROSPERO (CRD42023459310) and reported using the PRISMA 2020 guideline. Methods:Primary research studies, quality improvement projects or case reports published in English up to February 2025 were included. Screening, data extraction and quality appraisal were undertaken independently by two authors. As skin tone was rarely reported, ethnicity or race was used as a proxy, introducing a misclassification risk. Meta-analysis compared clinical classifications on CEAP, and other data were discussed narratively. Data Sources:Data sources include MedLine, Excerpta Medica Database (EMBASE), Cumulated Index of Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), Scopus and registries of ongoing studies (ISRCTN registry and ClinicalTrials.gov). Results:Twenty-two studies were included involving 111,090 individuals. Findings indicate that people of Black and Thai ethnicities may have pathophysiological changes associated with venous disease without some or all the clinical presentations of venous insufficiency. It is hypothesised that this contributes to people with dark skin tones not receiving timely vascular care and appropriate management in the early stages of venous hypertension. However, insufficient reporting on skin tone limits the interpretation of findings.Evidence suggests treatment disparities across ethnic groups, with people of Black ethnicity having higher treatment costs, more interventions and the least improvements following interventions. However, the contribution of skin tone and clinical presentation remains unclear due to a lack of qualitative data and the influence of other covariables, such as health-seeking behaviours and compression use. Conclusions:Visible varicose veins appear to be unreliable indicators of venous disease, which may contribute to diagnostic challenges and health inequity. However, improved skin tone reporting is needed to enable clinical presentation to be considered independently of the social constructs of ethnicity.
Background:Serum activin A level is a promising prognostic biomarker for pulmonary artery hypertension (PAH). In this study, we aim to investigate serum activin A levels and their associations with 1-year mortality in atrial septal defect (ASD)-associated PAH patients. Methods:This was a case-control study of adult Indonesian patients diagnosed with ASD-PAH from the COHARD-PH registry. Cases were subjects deceased in a 1-year follow-up, whereas controls were those survived. Serum activin A was measured at the index of diagnosis. The demographics, clinical parameters, hemodynamic, and mortality data were retrieved from the registry database up to a 1-year follow-up period. These data were compared and analyzed between the case and control groups. Results:From the 1-year follow-up data, 44 cases (deceased group) and 102 controls (survived group) were identified. The deceased group had significant lower bodyweight (p < 0.001), body mass index (BMI) (p < 0.01), with higher NT-proBNP level (< 0.0001), higher proportion of Eisenmenger syndrome (p < 0.05), higher right atrial (RA) area (p < 0.0001), lower tricuspid annular plane systolic excursion (TAPSE) (p < 0.01), and a significant increase in mean right atrial pressure (mRAP) (< 0.0001). There was no difference in the activin A level between deceased and survivors (506.3 ± 259.1 pg/mL vs. 536.1 ± 293.9 pg/mL, p > 0.05, respectively). Moreover, activin A level did not associate with the mortality risk among subjects (OR = 0.9996; 95% CI: 0.9982-1.00087; p > 0.05). Conclusion:Serum activin A level did not associate with 1-year mortality in adult patients with ASD-associated PAH.
Background:People with peripheral arterial disease (PAD) have high levels of sedentary behaviour (SB), which contributes to declining mobility, poorer quality of life and increased cardiovascular risk; however, few studies have targeted reducing SB in this population. Objective:The study is aimed at evaluating the feasibility and acceptability of delivering and evaluating a 12-week remotely delivered intervention designed to reduce sedentary time in people with PAD. Methods:This was a single-arm, single-centre feasibility study in participants with PAD. The intervention combined online education, a wearable physical activity tracker and weekly coaching calls. At baseline and 12 weeks, SB and physical activity were measured with activPAL, functional capacity was assessed remotely using the Timed Walk app for the 6-min walk test and semistructured interviews were conducted at 12 weeks to evaluate acceptability. Results:Thirty participants provided consent (77% recruitment rate) and took part in the study, with 21 (70%) attending follow-up. Valid activPAL data at baseline and follow-up was provided by 18 participants (60% of those consented). At baseline, participants spent 63% of their waking day sitting (9.58 h/day), which was slightly lower at 12 weeks (60%). Qualitative analysis identified four themes covering awareness, motivation, engagement and barriers. Participants valued weekly calls and feedback on physical activity from the wearable. Conclusion:Overall, the intervention was feasible and acceptable, and data suggest that it may reduce sedentary time. Methods to enhance retention and compliance with the activPAL would be needed for a larger trial. Trial Registration:ClinicalTrials.gov identifier: NCT05961943.
Vascular anomalies, including aneurysms, dissections, varicose veins, and abnormal branching, arise from both genetic and environmental influences. While rare monogenic disorders underscore the genetic basis of vascular structure, common single-nucleotide polymorphisms (SNPs) may also shape vascular morphology. SNPs collectively contribute to disease susceptibility and provide insight into pathways underlying vascular integrity. This systematic review, registered in PROSPERO (CRD42024519126) and conducted under PRISMA guidelines, searched PubMed, Embase, Web of Science, and Cochrane Library (February–May 2024; updated December 2024). Abstracts were screened in Rayyan by two reviewers, with study quality assessed using STREGA criteria and risk of bias using the Q-Genie tool. Ninety-five studies were included, reporting 697 SNPs. Most variants were intronic or regulatory, with 87 coding (12%). Associations were strongest for aortic disease and varicose veins. Effect sizes were generally modest, though rs1998049 (β=17.04, varicose veins) and rs1961177 (β=6.52, abdominal aortic aneurysm) showed stronger effects. Substantial interstudy heterogeneity in phenotype definitions, ancestry, and analytical approaches limited quantitative synthesis and asked for cautious interpretation of pooled findings. Gene Ontology analysis revealed enrichment of blood vessel morphogenesis, vasculogenesis, ventricular cardiac muscle tissue morphogenesis, and SMAD signaling q<1.00×10−6. Evidence is most robust for aortic disease and varicose veins, while data on peripheral vasculature remain limited. Larger, ethnically diverse studies are needed to validate these associations and to clarify their biological and translational relevance.
Background:The study was aimed at evaluating the efficacy, safety, and outcomes of endovascular intervention (EVT) among patients with acute inferior deep vein thrombosis (DVT), as well as revealing the risk factors associated with postthrombotic syndrome (PTS) in these patients. Methods:This retrospective study was conducted at the Department of Vascular Surgery, C.R. Hospital, Vietnam. The study enrolled all the patients diagnosed with acute lower limb DVT and underwent EVT (thromboaspiration, thrombolysis, balloon angioplasty, and stent placement) between January 2017 and December 2022. All the patients were recorded with treatment outcomes, postinterventional complications, and factors relating to PTS on the follow-up at 1 week and at 1 month after intervention. Results:A total of 37 patients met the inclusion criteria. Baseline characteristics included a mean age of 55.8 ± 13.3 years, female sex (75.5%), body mass index (BMI) ≥ 23 kg/m2 (63.2%), and inferior DVT on the left side (91.9%). Location of thrombus was noted at the iliac vein (97.3%), the femoral vein (70.3%), and the popliteal vein (97.3%). Postoperative length of stay was 5.5 ± 2.7 days, and clinical symptoms reduced in 2.5 ± 0.9 days. There were two cases of bleeding at the interventional site and two cases of death. Partial stenosis at 1 week and 1 month regarding the iliac vein, the femoral vein, and the popliteal vein was 71.4% and 54.3%, 14.3% and 37.1%, and 20.0% and 40.0%, respectively. None of the cases were observed with complete stenosis. In addition, 62.9% of cases reported no PTS. 37.1% of cases were noted with mild PTS. Advanced age, high BMI, duration time of thrombolysis, and underlying diseases were all associated factors relating to PTS. Noticeably, comorbidities and overweight/obesity increased 18.7- and 17.33-fold risk of PTS (p < 0.05), respectively. Conclusions:EVT is an acceptable alternative method in the treatment of acute inferior DVT. A decision-making of EVTs for acute lower limb DVT should be implemented after assessment of risk factors in large centers with professional conditions and facilities.
Background:Complex decongestive therapy is recognized as the primary treatment of lymphedema. While the influence of weight on the lymphedema appearance and evolution is well known, the relationship between weight and complex decongestive therapy outcome remains underexplored. Purpose:The purpose of this research is to evaluate the impact of body mass index on the effectiveness of intensive complex decongestive therapy in patients with primary and secondary lower limb lymphedema. Methods:We conducted a prospective study on 159 patients who underwent 551 complex decongestive therapy programs at the CHU UCL Lymphedema Reference Center from April 1, 2018, to March 19, 2021. Patients were categorized by body mass index ranges (18.5-24.9, 25-29.9, 30-34.9, 35-39.9, and 40-55 kg/m2). Before and after treatment, limb volumes were calculated using the truncated cone formula and functional impairments using the Lymph-ICF-Lower-Limb questionnaire. Linear regression models were used to evaluate the association between weight categories and treatment outcomes and were adjusted for relevant confounding factors. Results:Higher body mass index was associated with larger initial lymphedema volumes and lower functional status. Complex decongestive therapy reduced the relative lymphedema volume of 7% and improved functional status irrespective of body mass index groups. Conclusion:Although weight is correlated with an initial greater lymphedema volume and a lower functional status, it does not influence the ability of complex decongestive therapy to reduce limb volume and improve function. Complex decongestive therapy is recommended regardless of a patient's body weight.
Background:Heparin-induced thrombocytopenia (HIT), often accompanied by thrombotic events and collectively referred to as heparin-induced thrombocytopenia and thrombosis (HITT), is worthy of attention. Herein, we analyzed the features of HITT in patients with or without a thrombophilia background present prior to heparin exposure, aiming to identify and customize treatment. Methods:We searched PubMed and EMBASE to identify studies published up to November 2024, via the keywords "heparin," "thrombocytopenia," "thrombosis," and "thrombophilia." Case series and reports with confirmed HITT were included. Results:A total of 602 patients (277 males and 325 females with a mean age of 57.00 ± 17.20 years), reported in 481 papers, were carefully analyzed. The median time of thrombocytopenia and thrombosis onset postheparin exposure was Day 9 (5-12) and Day 9 (6-12), respectively. The abnormal platelet counts recovered by Day 5 (3-7) after the cessation of heparin. A more pronounced platelet count reduction was shown in patients with a thrombophilia background than those without this entity (p = 0.004). In this HITT cohort, patients with a thrombophilia background were more likely to develop newly formed venous thrombosis, whereas those without thrombophilia were more prone to arterial thrombosis after heparin use. Anti-platelet factor 4 (PF4)/heparin antibody assay was the mainstream diagnostic method for HITT. Conclusions:HITT typically presents as newly formed venous thrombosis in patients with a thrombophilia background and as arterial thrombosis in those without thrombophilia. Whereby, screening for thrombophilia in patients with HITT is suggested, as well as considering prolonged alternative anticoagulation therapy in patients with a thrombophilia background.
Background:Endovenous laser ablation (EVLA) is a widely accepted treatment for varicose veins, offering effective results with minimal invasiveness. However, postoperative complications remain a concern. This study examines risk factors associated with adverse outcomes and evaluates long-term clinical efficacy over 48 months. Methods:This retrospective, single-center study was conducted from January 2020 to January 2024 and included 500 patients with symptomatic varicose veins due to saphenous vein incompetence. All underwent preoperative clinical and duplex ultrasound evaluation; Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification; and Venous Clinical Severity Score (VCSS) scoring. Patients with postthrombotic syndrome, congenital malformations, or active DVT were excluded. EVLA using a 1470-nm laser was performed by an experienced vascular surgeon. Follow-up visits were scheduled periodically over 48 months. Primary outcomes included postoperative complications, while secondary outcomes focused on VCSS trends and patient satisfaction. Results:The cohort had a mean age of 38 years and was 56.8% female. Most were CEAP C4 or C5 with Grade 3 venous reflux. Minor complications included hematoma (6.4%), swelling (7.2%), infection (4%), and nerve injury (3.6%). Deep vein thrombosis occurred in 2% of patients; no pulmonary embolism or major cardiac events were reported. Endothermal heat-induced thrombosis occurred in 9%, with only 0.8% reaching Grade 3. Hypertension, diabetes, and obesity were associated with higher complication rates. By 48 months, all patients showed clinical improvement with VCSSs below 5. Conclusions:EVLA is a safe, effective treatment for varicose veins, even in advanced CEAP stages. Identifying patient-specific risk factors may help reduce complications and improve outcomes.
Introduction: Arteriovenous fistulas (AVFs) are the best choice for providing vascular access for hemodialysis patients. AVF maturation is essential for successful hemodialysis. However, up to 60% of AVFs fail to mature due to multiple risk factors. Thus, this study is aimed at investigating the association of anatomical location and preoperative blood parameters with AVF maturity. Methods: This is a retrospective cohort study of 206 patients who underwent their first AVF creation at the Hasheminejad Kidney Center, Tehran, Iran, from January 2016 to January 2019. Demographic and clinical characteristics and blood biomarkers were recorded for all patients preoperatively. Results: The total maturation rate was 67.2%. The primary failure rate of AVFs was 5.8%. Regarding AVF location, wrist fistulas had a higher rate of maturation than antecubital fistulas (73.2% vs. 55.9%, p = 0.013, OR = 2.15). The WBC (p = 0.03), RBC (p = 0.008), and hemoglobin (p = 0.009) levels were lower in the matured AVFs than in the nonmatured groups. Most kidney function biomarkers were not significantly related to AVF maturation. However, the mature wrist AVFs had lower levels of albumin and calcium-phosphorus index. The wrist AVF in patients with calcium levels under 8.5 mg/dL worked more efficiently than antecubital group (76.4% vs. 52.9%, p = 0.015, OR = 2.87). Conclusion: This study supports the evidence that wrist AVF could be a preferred AVF choice in the patients who met its clinical criteria.
Objective: Diagnosis of Takayasu arteritis (TA) is based on a combination of demographic, clinical, biological, and imaging data, but the diagnostic value of each clinical sign remains undetermined. The objective of this rapid review and meta-analyses was to estimate the diagnostic accuracy of these clinical signs. Methods: Eligible studies compared the initial clinical presentation of TA with appropriate controls. The diagnostic reference standard had to be specified. We searched PubMed, Embase, and Google Scholar until May 17, 2024. We assessed bias using the QUADAS-2 tool. We performed meta-analyses using a bivariate random effects model for sensitivity and specificity and a sampling-based approach for positive and negative likelihood ratios (PLR, NLR). Results: Of 15 studies included, 13 were case-control. All studies had a high risk of bias. Overall, 1980 patients with TA were compared to 3129 controls, with the majority having another vasculitis, mostly giant cell arteritis (GCA). Among 29 signs, the most suggestive of TA were vascular signs: blood pressure asymmetry (PLR 9.53, 95% CI 3.43-21.9), vascular bruits (9.0, 2.94-22.4), decrease or absent pulse (8.15, 2.35-22.2), and carotid artery with decreased pulse or tenderness (7.23, 3.64-12.5). Compared to GCA only, several signs reduced the likelihood of TA: headache (0.51, 0.25-0.86), jaw claudication (0.15, 0.05-0.35), polymyalgia rheumatica (0.07, 0.01-0.48), and scalp tenderness (0.04, 0.01-0.30). Conclusion: This review highlights the most useful signs for suspecting the disease when compared to other vasculitis and mimics. This will assist clinicians in estimating the likelihood of TA and guiding investigations.
Objectives: This review assessed the burden of catheter-related infections (CRI), existing gaps in catheter care, and prevention recommendations for catheter-related bloodstream infections (CRBSIs). The review further discusses how the emergence of coronavirus disease (COVID-19) influenced CRBSI rates and prevention strategies in the post-COVID-19 era. Methods: A targeted literature search was conducted of Embase, Ovid MEDLINE, and EBM Reviews. Where applicable, supplemental hand searches were performed to identify evidence for gaps in the targeted search results. The authors reviewed each study and selected those for inclusion based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria. Relevant studies were assessed for inclusion in the present review. Results: Both "active" methods (scrubbing, flushing, and locking) and "passive" methods (disinfection caps) have consistently been shown to reduce CRBSI risk when assessed individually. These practices have markedly improved CRBSI rates over the past two decades, although there are ongoing gaps in catheter care and adherence to best practices. COVID-19 reversed the trend towards improving CRBSI rates, and persistent challenges for nurse staffing and training have resulted in a failure to return to pre-COVID-19 CRBSI rates in the current post-COVID-19 era. These challenges are further compounded by limited rigorous comparative evidence assessing the relative efficacy of individual CRBSI prevention methods. Conclusions: Improving adherence to hub disinfection, along with catheter care and maintenance protocols, is essential for the prevention of CRIs. Further, innovative approaches for simplifying protocols and "forcing function" may increase compliance with CRBSI prevention strategies. In our practice, we routinely use disinfection caps in addition to standard scrubbing and flushing, alongside increased training and monitoring procedures. Additional studies are needed to assess which individual or combination prevention strategies are most efficacious and feasible in the post-COVID-19 era.
Background: Heart failure (HF) is a growing clinical syndrome with high morbidity and mortality. Galectin-3, a key player in cardiac fibrosis and inflammation, has emerged as an important biomarker for HF. This bibliometric analysis is aimed at exploring global scientific output and research trends on the relationship between galectin-3 and HF. Methods: A bibliometric literature search was conducted on the Web of Science in September 2024. Microsoft Excel and VOSviewer were used for scientometric analysis and to visualize scientific achievements, including publication counts, key authors, countries, organizations, journals, and research hotspots in the field. Results: A total of 705 publications met the inclusion criteria after screening. Research on galectin-3 and HF is currently experiencing rapid growth. The United States, China, and the Netherlands produced the most articles, contributing approximately 55% (388/705) of all papers. Most institutions and authors were from the United States and the Netherlands, with the University of Groningen (Netherlands) being the top publishing institution. Key authors include De Boer RA, Januzzi JI, and Van Veldhuisen DJ. The European Journal of Heart Failure was the most cited journal and had the highest number of publications. Key research topics include the relationship between galectin-3 and HF prognosis, fibrosis, mortality, and conditions leading to HF. Conclusion: This is the first bibliometric analysis of publications on the association between galectin-3 and HF. This study provides researchers with valuable insights into the most influential articles on this biomarker and its role in HF. Key research areas focus on galectin-3 role in the diagnosis, pathology, and prognosis of various HF types, causes, and outcomes. Further research should explore how galectin-3 can facilitate earlier diagnosis of HF or fibrosis, with increased international collaboration among researchers.
Objective: This study is aimed at evaluating the predictive value of high-sensitive cardiac troponin T (hs-TnT), and N-terminal probrain natriuretic peptide (NT-proBNP), for cardiovascular events and/or survival in stable adult congenital heart disease (ACHD) patients. Methods: A systematic review along with a meta-analysis was done on studies from 2014 to 2024 that examined hs-TnT, NT-proBNP, and their association with cardiac events and/or mortality in adult patients with congenital heart disease. A comprehensive search was conducted across major databases, and studies reporting biomarker levels and relevant outcomes were included. Data on study characteristics and hazard ratios (HRs) were extracted, and pooled estimates were calculated using random-effects meta-analysis, with heterogeneity assessed through the I 2 statistic. STATA software was used for data analysis. Results: A total of five studies, consisting of 1294 adult congenital heart disease (ACHD) patients, were included in this meta-analysis. Elevated NT-proBNP levels were significantly associated with an increased risk of mortality or cardiac events (HR: 2.13; 95% CI: 1.84-2.42), which remained significant after adjustment for confounding factors (adjusted HR: 2.34; 95% CI: 1.55-3.13). Elevated hs-TnT levels were also associated with a higher risk of adverse outcomes (HR: 1.57; 95% CI: 1.36-1.78), with the association remaining significant after adjustment (adjusted HR: 2.65; 95% CI: 1.22-5.76). Sensitivity analysis excluding a study with a lower hs-TnT cut-off further strengthened the association (adjusted HR: 3.03; 95% CI: 0.86-5.21) and reduced heterogeneity. Conclusion: In conclusion, this meta-analysis shows the prognostic value of both NT-proBNP and hs-TnT in adults with congenital heart disease. Each of these markers offered a distinct but complementary clinical insight. Although methodological differences of the included studies limit direct comparison, our systematic review supports the potential value of incorporating both biomarkers into routine risk assessment.
Introduction: Varicose veins are a common condition affecting millions worldwide. Cyanoacrylate closure (CAC) and radiofrequency ablation (RFA) are widely used minimally invasive treatments. CAC offers advantages such as eliminating tumescent local anesthesia (TLA) and reducing nerve injury risk. However, there are few reports comparing CAC and RFA outcomes in Japan. This study is aimed at evaluating the efficacy and safety of CAC and RFA for treating great saphenous vein (GSV) and small saphenous vein (SSV) varicose veins. Materials and Methods: A retrospective, single-center study was conducted with 157 patients (178 limbs) who underwent either CAC (n = 96) or RFA (n = 82) from January 2020 to October 2023. Postoperative occlusion rates, complications, and risk factors for phlebitis were analyzed. Follow-up ultrasound examinations were conducted at up to 3 months postoperatively. Statistical analyses included t-tests, Mann-Whitney U tests, and multivariate logistic regression. Results: Both CAC and RFA achieved a 100% occlusion rate at 3 months. In the CAC group, significantly longer vein segments were treated compared to those in the RFA group (46 ± 14 cm vs. 35 ± 13 cm, p < 0.05). However, phlebitis occurred in 15% of the CAC group, whereas none were reported in the RFA group (p < 0.05). Multivariate analysis identified preoperative swelling (OR: 5.60, 95% CI: 1.33-23.6, p < 0.05) and treated vein length as independent risk factors for phlebitis. All phlebitis cases resolved with conservative treatment. One patient in the RFA group experienced transient paresthesia. Conclusion: CAC is a viable alternative to RFA, demonstrated equivalent occlusion rates, though CAC exhibited a higher incidence of phlebitis. Careful patient selection and perioperative management may help mitigate risks. Further studies with larger cohorts and longer follow-up are needed to optimize treatment protocols and long-term outcomes.
Objective: The objective of this study was to evaluate the incidence of thrombocytopenia following elective abdominal aortic surgery and identify the associated risk factors. Methods: From 2009 to 2020, all consecutive patients undergoing elective open infrarenal abdominal aortic repair for aneurysms (AAAs) or aortic occlusive disease (AOD) were included in a prospectively maintained dedicated database and subsequently analyzed retrospectively. The perioperative dataset included the duration of surgery, aortic clamping time, graft configurations, blood loss, and blood products administered during the procedure. Univariate and multivariable analyses were conducted to identify risk factors for postoperative thrombocytopenia and assess its clinical consequences. Results: A total of 100 patients (male n = 81, mean age of 68 ± 9.3 years) were included in the present study. The AAA group showed a higher prevalence of hypertension ( n = 58 [76%]) versus AOD ( n = 12 [50%]) with p = 0.014 and the use of vancomycin presurgery prophylaxis, n = 36 (47%) and n = 7 (29%), respectively, with p = 0.033. The AOD group presented a higher number of active smokers ( n = 19 [79%]) versus AAA group ( n = 30 [39%]) with p < 0.001. The overall mean operative aortic clamping time was 91.6 ± 35 min, with a significantly longer time in the AAA group (96.0 ± 36.1 min vs. 78.8 ± 28.5 min in the AOD group) with p = 0.046. The mean estimated blood loss was 1383 ± 834 mL, with a higher average of 1546 ± 878 mL in the AAA group versus 933 ± 472 mL in the AOD group with p = 0.002. A decrease in the platelet count was observed immediately after surgery, with a mean reduction from baseline of 40.5 % ± 16.3 % in the AAA, 41.9 ± 16.4 % compared to 35.9 % ± 15.4 % in the AOD group with p = 0.553, reaching its nadir on postoperative Days 2 and 3. No major bleeding events associated with thrombocytopenia during the postoperative period were recorded. In 54 patients (54%), the platelet count returned to baseline by postoperative Day 5 (POD 5). Five patients exhibited a sustained platelet count drop of > 50% from baseline on POD 5 and were tested for heparin‐induced thrombocytopenia, all of which returned negative results. On multivariable analysis, the patient age (OR 1.125; 95% CI: 1.024–1.236; p = 0.014) and clamping time (OR 1.034; 95% CI: 1.011–1.058; p = 0.004) were independently associated with a decrease in the platelet count. Conclusion: Postoperative thrombocytopenia is common following an elective abdominal aortic surgery, but it was demonstrated that it typically resolves on its own by POD 5 without significant clinical consequences. The study identified the patient age, and aortic clamping time as independent risk factors for the development of thrombocytopenia. However, further research involving larger cohorts is needed to confirm these findings and better understand the underlying mechanisms and potential implications.
