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.
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: 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: 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.
: Background: Supervised Exercise Therapy (SET) improves walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication, yet implementation and adherence remain inconsistent. This study evaluated functional outcomes, ankle-brachial index (ABI), quality of life (QoL), and adherence to SET in a real-world clinical setting. Materials and methods: This monocentric retrospective cohort study included 190 patients with PAD Fontaine stage II treated at a university vascular outpatient clinic between 01.01.2018 and 31.12.2022. Exposure was participation in SET compared with standard care without SET. Claudication onset distance (COD), peak walking distance (PWD), and ABI were assessed at baseline and after 3, 6, 12, and 24 months. Health-related QoL was evaluated using the SF-36 questionnaire. Adherence and reasons for dropout or non-participation were extracted from medical records. Results: Of the 190 patients (mean age 71.4 years; 60.5% male), 32 (16.8%) completed 12 months of SET, while 158 (83.2%) served as the comparison group. SET participants were older and predominantly male. COD and PWD improved significantly after 6 months (p = .0001 and p = .041) and continued to rise through 24 months, whereas ABI showed no significant changes. Adherence to SET was low. Dropout was mainly related to clinical deterioration, comorbidities, or hospitalisation, with additional sociodemographic and motivational barriers contributing to non-participation. SF-36 scores did not differ significantly, although trends toward reduced pain and improved physical functioning were observed. Conclusions: In this single-centre cohort, SET was associated with improved walking performance but low adherence and no significant changes in ABI or overall QoL.
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: Acute abdominal aortic occlusion is a rare vascular emergency associated with high morbidity and mortality. To date, the topic has hardly been addressed scientifically. Most case series are afflicted with small cohort numbers. The aim of this study was to identify risk factors after invasive treatment of acute abdominal aortic occlusion and changes over time. Patients and methods: Using case-based nationwide hospital statistics (diagnosis-related group [DRG] statistics) from 2009 to 2020, all cases with ICD-10 codes for embolism and thrombosis of the abdominal aorta in conjunction with acute limb ischaemia and consecutive invasive treatment (endovascular or open surgery) were included. The analysis included patient characteristics, treatment, mortality, amputation, and complications. The primary outcome was in-hospital death. A multivariable regression model was applied to detect risk factors. Results: A total of 1160 cases (66% male) with acute abdominal aortic occlusion were identified (941 open; 219 endovascular). Between 2009 and 2020, the rate of endovascular treatments (2010: 6%; 2020: 29%; p<.001) increased significantly over the years. Older patients (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.64-0.9, p=.002) and women (OR 0.65; 95% CI 0.48-0.88, p=.006) were more likely to receive endovascular care. In-hospital mortality was 13% after open surgery and 14% after endovascular treatment, with no significant change in open surgery, but high variability in endovascular treatment during the observation period (2009-2011: open 14%; endovascular 25%; 2018-2020: 10%; 11%). In-hospital mortality increased significantly with higher age (OR 2.19 per 10-year increase; 95% CI 1.79-2.7, p<.001) and comorbidities (OR 1.1 per Elixhauser point; 95% 1.07-1.11, p<.001). Conclusions: Acute aortic occlusion remains a rare but life-threatening emergency. Use of endovascular revascularization techniques is increasing, while in-hospital mortality rates remain high, specifically for older and morbid patients.
Background: Data on volume changes after complex decongestive therapy (CDT) for leg lymphedema are sparse. This naturalistic prospective cohort study aimed to quantify the intraindividual changes of leg volume after comprehensive inpatient rehabilitation, focusing on intensive CDT, and to relate these changes to health-related quality of life (HRQOL). Patients and methods: Limb volume of patients with leg lymphedema (n = 101; 75 women) were measured between entry and discharge (3 weeks later) by the 4 cm measurement method according to Kuhnke and the Perometer® method. Changes were also expressed as standardised response means (SRM). The change on the Freiburg Quality of Life Assessment for lymphatic disorders, short version (FLQA-lk) total score was predicted using multivariate linear regression analysis with volume data adjusted for various confounders. Results: The overall mean volume decrease on the 4 cm/Perometer® method for both legs combined was 1.94/1.31 l for all patients, corresponding to SRMs of 1.04/0.86. In the lymphedema-affected limbs, the decreases ranged between 1.03 and 1.40 l/0.77 and 0.99 l (SRMs 0.70-1.72/0.67-1.28). The total volume loss (4 cm) of both legs of all n = 101 patients correlated by 0.240 (bivariate, p = .010) and by 0.216 (multivariate, adjusted, p = .045). Conclusions: After multidisciplinary rehabilitation focusing on intensive CDT, moderate to large effects on reducing limb volume were observed. Volume reduction was positively associated with improvement in HRQOL.
Background: This proof-of-concept study aims to determine whether the haemodynamic effect of saphenous treatment can be predicted using the saphenous occlusion test (SOT). Materials and methods: Fifteen legs (11 patients) with chronic venous disease and 12 legs of healthy controls were assessed using air plethysmography (APG) on a manually operated tilt table transitioning from near-standing to a -40° head-down position and back to control leg filling via APG. Measurements were taken: (i) preoperatively, (ii) during ultrasound-guided compression of the saphenous vein at the thigh (SOT), and (iii) after treatment of the GSV with proximal short-segment endovenous laser ablation (EVLA, not the controls). Clinical CEAP classification: C2 = 2, C3 = 4, C4a = 10, and C6 = 1, median Venous Clinical Severity Score (VCSS) of 5 [2-14]. Median follow 73 [30-89] days. Results: Both, the venous filling index (VFI, mL/s) and venous filling time (VFT90, in seconds) improved significantly with GSV probe compression and EVLA (p < .0005): VFI from baseline 2.6[2-3.3] and predicted 1.2 [1.1-1.6] to postoperative 1.3 [1.1-1.7], VFT90 from baseline 34.7 [23.8-40.1] and predicted 71.4 [46-89.9] to 70.7 [47.9-76]. No significant difference was found between the predicted and actual post-treatment values for VFI (p = .601) or VFT90 (p = 1). Significant difference between controls and patients (VFT90 p < .01, VFI p < .001) was lost after treatment (VFT90 p = .751, VFI p = .826). Conclusions: The haemodynamic effect of saphenous reflux correction can be accurately predicted using the saphenous occlusion test with APG together with orthostatic manoeuvres. This method may serve as a standardised, objective tool to evaluate the need for GSV intervention in patients with visible varicose veins.
Background: Spot-stent grafting (SSG) for acute/subacute Stanford type B aortic dissection (ADB) and intramural hematoma (IMHB) entails selective coverage of the primary tear in the distal thoracic aorta (zones 4 or 5), with the stent graft fully deployed within the dissected segment-an intentional use beyond the Instructions for Use (IFU) aimed at minimising aortic coverage and preserving spinal cord perfusion. While early outcomes were favourable, long-term data on durability and reintervention remain limited. Materials and methods: In a single-centre retrospective analysis, all patients with acute/subacute ADB or IMHB treated with SSG between 03/1997 and 08/2024 were evaluated. The primary endpoint was the cumulative incidence of reintervention using a competing risk model over a median follow-up of 6.9 years (range 1.7 months-16.9 years). Secondary endpoints included technical success, aortic remodeling (AR), and false lumen thrombosis (FLT). Results: Of 270 TEVAR-treated patients with ADB or IMHB, 30 (16 ADB, 14 IMHB) underwent SSG. The cumulative incidence of reintervention at 30 days, one year, and three years was 6.7%, 16.7%, and 20%, respectively. Technical success was 100% with no 30-day mortality, stroke, or spinal ischaemia. Limited FLT occurred in 29/30, complete AR in 22/30. Reinterventions (7/30-23.3%) were distal (4) or proximal (3) extensions. Six-year survival was 66.7%. Conclusions: SSG demonstrated perioperative safety and mid-term efficacy beyond the IFU. However, higher reintervention rates - mainly proximal or distal extensions - may be expected, reflecting a trade-off for enhanced spinal cord protection in distal thoracic lesions when applied in carefully selected patients.
Background: This study compared outcomes of a pharmacomechanical thrombectomy (PMT)-first strategy using the AngioJet™ system versus catheter-directed thrombolysis (CDT) in the treatment of acute limb ischemia (ALI). Patients and methods: We retrospectively analysed 100 patients with ALI (Rutherford I-IIb) treated between January 2016 and September 2024. Patients received either primary PMT with AngioJet™ (n = 57) or primary CDT (n = 43). The primary endpoint was amputation-free survival (AFS). Secondary endpoints included technical success, major amputation, mortality, reintervention, and in-hospital cost. Cox regression was used for time-to-event data; cost analysis employed a generalised linear model. Results: Technical success was higher with AngioJet™ (96.5% vs. 65.1%, p < .001). Median thrombolysis duration (1 h vs. 24 h, p < .001), hospital stay (6 vs. 11 days, p = .002), and ICU stay (1 vs. 2 days, p < .001) were significantly reduced. Median inpatient costs were lower in the AngioJet™ group (€9,298 vs. €13,790; exp(B) 1.308, 95% CI 1.07-1.6, p = .009). No significant differences were observed in 30-day mortality, major amputation, bleeding, or acute kidney injury. At 12-months AFS was similar (57.9% vs. 51.2%, p = .55). While major amputation was less frequent after AngioJet™ (5.4% vs. 18.6%, p = .05), this was not significant in multivariate analysis. CDT was independently associated with higher reintervention rates (HR 2.57, p = .03). Conclusions: In this cohort, a primary AngioJet™ strategy was associated with advantages in technical outcomes, hospitalisation, costs, and reinterventions, while amputation-free survival remained comparable to primary CDT. These findings support its use as an effective endovascular option in selected ALI patients.
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.
Background: This study aimed to examine 5-year all-cause mortality in endovascularly treated patients with peripheral arterial disease of the lower extremities with and without diabetes mellitus (DM), and to identify factors associated with mortality in the DM subgroup. Patients and methods: Patients treated between January 2016 and December 2018 were analysed. Multivariable models were adjusted for age, sex, smoking, chronic limb-threatening ischaemia (CLTI), malignancy, dyslipoproteinaemia, heart failure, fibrinogen, and estimated glomerular filtration rate (eGFR). Results: A total of 676 patients were included; 59.6% had DM. Patients with DM had higher mortality compared to those without DM (56.8% vs. 37.0%, p < .001). DM was associated with higher mortality in univariable analysis (hazard ratio (HR) 1.73; p < .001), but not in multivariable analysis (HR 1.19; p = .329). Among patients with DM, higher mortality was associated with CLTI (HR 1.62; p = .022), and treatment of two or three anatomical regions (HR 1.36; p = .033). Higher fibrinogen (HR 1.17 per 1 g/L; p < .001) and lower eGFR (HR 0.98 per 1 ml/min/1.73 m2; p < .001) were associated with increased mortality. Mortality was lower in patients who underwent ipsilateral reintervention (HR 0.61; p = .005), amputation (HR 0.65; p = .011), or contralateral intervention (HR 0.58; p = .004). Conclusions: Mortality did not differ between patients with and without DM after multivariable adjustment. In patients with DM, CLTI, multiregional treatment, higher fibrinogen, and lower eGFR were associated with increased mortality; ipsilateral reintervention, amputation, and contralateral intervention were linked to lower mortality.
Background: To compare the clinical outcomes and the costs of the plug-based- versus suture-based vascular closure device following large-bore percutaneous aortic procedures. Materials and methods: This single-centre retrospective analysis included 68 consecutive patients undergoing endovascular aortic procedures between January 2024 and May 2025. Femoral artery closure was achieved using either the MANTA (Teleflex, Wayne, Pennsylvania) or Perclose ProStyle (Abbott Vascular, Abbott Park, Il) vascular closure device. Procedural details, anatomical parameters, and access-site outcomes were analysed. The primary endpoint was technical success. Secondary endpoints included bleeding, vessel occlusion, pseudoaneurysm, access-site thrombosis, surgical conversion, and device-related cost per access site. Results: Sixty-eight patients with 111 femoral access sites (71 MANTA, 40 Perclose ProStyle) were included. No differences were observed between groups regarding aortic pathology, access vessel diameter, or calcification severity. Technical success was high in both groups (97.5% Perclose ProStyle vs. 93.0% MANTA; p = .312). Access-site complications occurred more frequently in the MANTA group, including all pseudoaneurysms (2.8%) and most surgical conversions (7.0% vs. 2.5%), although differences were not statistically significant. No access-site thrombosis was observed. Mean device-related cost per access site was significantly higher for MANTA than for Perclose ProStyle (€466 vs. €290; p = .001). Conclusions: Both MANTA and Perclose ProStyle devices achieved high rates of successful large-bore femoral closure. However, the suture-based ProGlide system was associated with lower cost and fewer access-site complications. Given the retrospective design and operator-driven device selection, these findings should be interpreted with caution.
Background: Several studies have shown LDL-Cholesterol to be a main risk-factor in the development of atherosclerosis and that the reduction of LDL-Cholesterol leads to a substantial decrease in cardiovascular morbidity and mortality. Patients with proven PAD are considered to be at very high risk for cardiovascular events and a reduction of LDL-Cholesterol to 55 mg/dl and to 50% of the baseline is recommended in this population. Material and methods: Patients with symptomatic PAD from 7 Vascular Surgery Centres in Germany were included in the study. It was assessed if the patients were on Cholesterol-lowering drugs at admission and the Cholesterol und LDL-Cholesterol levels upon admission were obtained. A total of 884 patients were included in the analysis. Results: Only 537 (61%) patients were on Cholesterol-lowering drug therapy. In this subgroup, Cholesterol levels ≤ 100 mg/dl were found in 384 cases (72%), ≤ 70 mg/dl in 191 (36%) and ≤ 55 mg/dl in 87 (16%) of cases. Conclusions: Despite overwhelming evidence for the beneficial effects of adequate LDL-Cholesterol reduction, only 61% of PAD-patients were on Cholesterol-lowering drug therapy and only 16% achieved the LDL-Cholesterol levels advocated inn recent guidelines. The vascular community must undertake a bigger effort to implement Cholesterol-lowering drug therapy in PAD patients.
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: 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.
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: Vascular access-site complications after catheterization remain a significant cause of morbidity and mortality. While patient- and procedure-related risk factors are well described, the impact of structured, interdisciplinary training programs is less well established. We evaluated the effect of a structured training program for cardiologists and interventional staff on access-site-related complications after transfemoral coronary interventions. Patients and methods: Over 36 months, we tracked all elective transfemoral coronary interventions at our institution. After an initial 6-month observational phase, we implemented a structured training program for cardiologists and catheter lab staff, using initial complication rates as the baseline. The training included quarterly sessions, pre-interventional angiological assessment for high-risk patients, pre-interventional assessment for all patients, and sheath removal by assistants. We prospectively assessed all access-site related complications using a standardized protocol and analysed incidence changes with a regression model, adjusting for patient-specific risk factors over time. Results: Quarterly training and pre-interventional angiological assessment for high-risk patients did not significantly impact complication rates. However, pre-interventional angiographical assessment for all patients and sheath removal training for assistants significantly reduced complication rates. The results remained consistent after adjusting for patient-specific risk factors. Conclusions: Structured angiological training for interventional staff significantly reduces access-site related complications. Interdisciplinary collaboration enhances patient safety and minimizes adverse events.
Background: Radiofrequency ablation (RFA) and mechanochemical ablation (MOCA) have emerged as less invasive alternatives to traditional surgical interventions, offering reduced recovery times and comparable efficacy. This study aims to compare the efficacy, safety, and patient-reported outcomes between RFA and MOCA in treating SSV insufficiency. Materials and methods: this is a retrospective, nonrandomized study that involved patients who underwent either RFA or MOCA between 2015 to 2019. Data collected included demographics, clinical grading, procedural specifics, and follow-up outcomes. The primary endpoint was the comparison of freedom from recanalization and freedom from reinterventions rates, while secondary endpoints focused on recurrences rates and clinical outcomes assessed by revised clinical severity score (rVCSS), and Aberdeen Varicose Vein Questionnaire (AVVQ). Results: A total of 132 limbs were treated (n=72 RFA; n=60 MOCA). Baseline demographics and clinical severity were comparable between groups. At 5 years, freedom from recanalization rate was significantly higher in the RFA group compared to the MOCA group (91.7% vs 66%; p=.0014). Clinical recurrence rates at 5 years were 11.7% for RFA and 22% for MOCA (p=.0023), while freedom from reintervention rates were 93.3% and 72.7%, respectively (p=.0011). Although both groups showed clinical improvement over time, patients treated with MOCA exhibited a significant worsening in rVCSS and AVVQ at 3 and 5 years compared to the RFA group (p<.0001). Conclusions: RFA demonstrates greater long-term stability, lower recurrence and reintervention rates compared to MOCA, suggesting it may be a preferable option for SSV insufficiency treatment in terms of durability and patient outcome.
