Peripheral artery disease (PAD) is a common manifestation of systemic atherosclerotic cardiovasculardisease and is associated with a substantial risk of major adverse cardiovascular and limb events,functional impairment, and limb loss. Despite its clinical and prognostic significance, PAD remainsunderdiagnosed and undertreated. This interdisciplinary expert consensus provides a practicalframework for the diagnosis and comprehensive management of patients with PAD in everydayclinical practice. The document emphasizes early recognition based on clinical assessment, theankle–brachial index, and appropriate vascular imaging, together with systematic evaluation of cardiovascularrisk, polyvascular disease, and cardiometabolic comorbidities. Comprehensive optimalmedical therapy represents the cornerstone of management and includes intensive lipid-loweringtherapy, individualized antithrombotic treatment, blood pressure and glycemic control, managementof obesity and chronic kidney disease, smoking cessation, structured exercise, and otherlifestyle interventions. Revascularization should complement rather than replace optimal medicaltherapy and should be individualized according to clinical presentation, limb severity, anatomicalcomplexity, procedural risk, life expectancy, and patient preferences. Particular attention should begiven to chronic limb-threatening ischemia and concomitant coronary, cerebrovascular, and venousdisease. Long-term multidisciplinary, patient-centered care is essential to reduce cardiovascular andlimb events, preserve functional status, and improve quality of life.
Median arcuate ligament syndrome (MALS, Dunbar syndrome) is caused by compression of the celiactrunk and the autonomic nerve plexus surrounding the artery by the median arcuate ligament of thediaphragm. The condition is a diagnosis of exclusion because its symptoms are nonspecific. These include postprandial abdominal pain and dyspeptic symptoms leading to anorexia and eating disorders.Diagnostic imaging is based on Doppler ultrasonography and computed tomography. Surgery is thetreatment of choice. Its aim is to decompress the celiac trunk using open or, increasingly, minimallyinvasive techniques, including laparoscopic or robotic surgery. The aim of this paper is to present the correct technique for laparoscopic decompression of the celiac trunk, taking into account our own tips and tricks. Furthermore, the most common complications anda comparison of open, laparoscopic, and robotic methods in terms of early and long-term outcomesare presented. In summary, laparoscopic management is safe and feasible for well-selected patients with MALS at experienced centers. To establish it as a standard of care, future clinical studies comparing the threeapproaches — open, laparoscopic, and robotic — should be undertaken.
Introduction. The dynamic development of intravascular techniques has revolutionized the treatmentof cardiovascular diseases; however, these procedures carry a risk of iatrogenic vascular injuriesand local complications. Although rare, they can cause serious clinical consequences requiringsurgical treatment. This study aimed to evaluate the risk factors, types, and frequency of vascular complications,diagnostic methods, surgical treatment options, and perioperative mortality in patientsafter endovascular procedures. Material and methods. This retrospective analysis included 101 patients treated between 2021 and 2023 at the Department of Vascular Surgery of the Medical University in Poznan for iatrogenicvascular injuries. Clinical data, comorbidities, medications, primary procedure type, nature of complications,diagnostic imaging, surgical treatment, and outcomes were evaluated. Statistical analyseswere performed using R 4.4.1 with a significance level of p < 0.05. Results. The most common complications were pseudoaneurysms (47.52%), bleeding (24.75%) and arteriovenous fistulas (9.9%). Significant risk factors included advanced age, overweight, hypertension,ischemic heart disease, diabetes, atherosclerosis and anticoagulant therapy. Doppler ultrasoundwas the predominant diagnostic method, whereas CT angiography was used to assess limbischemia and aortic dissection. A total of 60.4% of patients underwent primary surgical treatment,mainly with the open method. Perioperative mortality rate was 5.94%. Conclusions. Iatrogenic vascular injuries occur mainly in older patients with cardiovascular disease who receive anticoagulant therapy after therapeutic procedures performed via femoral access. Thestudy results confirm the importance of considering comorbidities, the patient’s general condition,and anticoagulant therapy during follow-up, as these are associated with an increased risk ofcomplications. If complications are suspected, appropriate imaging studies are crucial.
Introduction. The benefit of carotid revascularization in asymptomatic carotid stenosis was establishedin trials conducted before the widespread adoption of contemporary optimized medicaltherapy (OMT). Despite substantial advances in cardiovascular prevention over the past two decades,the incremental benefits of revascularization in the modern era remain uncertain. Material and methods. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing carotid revascularization [carotid endarterectomy (CEA) or carotidartery stenting (CAS)] plus contemporary OMT vs. OMT alone in adults with ≥ 50% asymptomaticor low-to-intermediate-risk symptomatic carotid stenosis. The primary outcomes were any strokeand all-cause mortality. Secondary outcomes included ipsilateral stroke, transient ischemic attack(TIA), perioperative stroke or death, and myocardial infarction. Random-effects models using the restricted maximum likelihood method were applied. Meta-regression assessed effect modification by revascularization modality. Results. Four multicenter RCTs (2009–2024) comprising 3481 patients (1878 revascularization; 1603 control) were included. Revascularization was not associated with a reduction in stroke [hazardratio (HR) 1.02 (0.78–1.35); I2 = 0%] or all-cause mortality [HR 0.85 (0.67–1.07); I2 = 17.7%]. Nosignificant differences were observed for ipsilateral stroke, TIA, and myocardial infarction. However,revascularization was associated with a higher risk of the perioperative composite outcome of strokeor death [risk ratio 4.33 (1.45–12.91); I2 = 0%). Meta-regression analyses did not show significantdifferences between CEA and CAS. Conclusions. In this subset of patients treated with contemporary OMT, carotid revascularizationwas not associated with a significant reduction in stroke or mortality but increased periproceduralcomplications. These findings suggest OMT alone as an appropriate first-line strategy in this population.
Endovenous laser ablation (EVLA) has become one of the leading minimally invasive techniques forthe treatment of chronic venous disease of the lower limbs. This review summarizes the historicaldevelopment of EVLA, including the evolution from early hemoglobin-targeting lasers to modernwater-absorbed wavelengths and radial fiber systems, which improved procedural safety, reducedpostoperative pain, and increased patient comfort. Current evidence and international recommendationssupport endovenous thermal ablation as a first-line treatment for superficial venous reflux, particularly in cases involving the great saphenous vein and other major superficial venous trunks.The article also discusses recurrence patterns, the role of flush ablation, and the limitations ofprophylactic treatment of accessory veins. Special attention is given to hybrid approaches combiningEVLA with foam sclerotherapy, particularly the use of Pro Fiber technology, which allows precise foam delivery through a side channel and may reduce the number of needle punctures andprocedure-related trauma.
