Vascular endothelial growth factor (VEGF)-targeted therapies have been associated with thromboembolic events, although the magnitude and nature of this risk vary substantially according to the specific agent, mechanism of VEGF-pathway inhibition, malignancy, concomitant therapy, and patient-related factors. This comprehensive narrative review examines the epidemiology, mechanisms, clinical characteristics, and management of VTE in cancer patients receiving VEGF inhibitors. Evidence from clinical trials, observational studies, pharmacovigilance analyses, and preclinical investigations is synthesized to provide a clinically oriented overview of VEGF-targeted therapy-associated thrombosis. Reported VTE incidence ranges from 2.5% to 15.7% across studies, with substantial heterogeneity according to the VEGF-targeted agent, cancer type, treatment setting, and study design. Bevacizumab-treated patients receiving chemotherapy demonstrated increased arterial and venous thromboembolism risk (relative risk 1.32–2.45). Plasminogen activator inhibitor-1 (PAI-1) upregulation, endothelial dysfunction, and tissue factor activation represent key pathogenic mechanisms. Careful patient selection, risk stratification using validated scoring systems, thromboprophylaxis strategies, and individualized anticoagulation approaches are essential for managing this complication. Direct oral anticoagulants, particularly apixaban, demonstrate favorable efficacy and safety profiles compared to traditional anticoagulants in cancer-associated VTE. This review provides clinicians with comprehensive, evidence-based guidance for preventing and managing VTE in the growing population of cancer patients receiving VEGF-directed therapies.
Objective: To assess the clinical use of the UltraScore balloon in a real-world setting. Methods: This is a prospective, multicenter, single-arm, real-world study to assess the clinical use of the UltraScore balloon for the treatment of stenotic lesions of the superficial femoral artery (SFA), popliteal and below-the-knee (BTK) arteries. A total of 350 subjects were treated with the study device and follow-up was performed at hospital discharge, 30 days, and 6 and 12 months post-index procedure. The primary endpoints were technical success and optimal PTA, defined as ≤30% residual stenosis without major flow-limiting dissection. Secondary endpoints included rate of bail-out stenting, freedom from target lesion revascularization (TLR), freedom from major amputation and clinical improvement measurements. Results: Technical success was 100% and optimal PTA was 72.8%. The rate of bail-out stenting was 4.0%; freedom from TLR was 100% at 30 days, 93.5% at 6 months and 88.2% at 12 months. Freedom from major amputation was 97.4% at 30 days, 94.7% at 6 months and 93.4% at 12 months. Conclusions: This study supports the feasibility and potential clinical utility of the UltraScore balloon when used during the endovascular treatment of stenotic and calcified lesions in the SFA, popliteal and BTK arteries.
Thoracic endovascular aortic repair is established for complicated type B aortic dissection, but extension of disease toward the aortic arch and involvement of supra-aortic branches may require technically demanding, individualized solutions. We report a multistage endovascular strategy in a 56-year-old man who presented with acute Stanford type B aortic dissection, hypertensive crisis, right renal malperfusion, and bovine arch anatomy. Right renal artery stenting was followed by thoracic endovascular aortic repair because of persistent pain and rapid enlargement of the distal arch. At 1 year, computed tomography angiography (CTA) demonstrated aneurysmal progression with type IA and IB endoleaks. A custom-made fenestrated arch endograft was deployed to preserve the common origin of the brachiocephalic and left common carotid arteries. Device malrotation caused acute bilateral carotid hypoperfusion, which was successfully treated by bailout parallel stenting; one bridging stent migrated to the abdominal aorta. Five months later, distal endograft extension excluded the type IB endoleak, and the migrated stent was retrieved with a snare. Follow-up imaging showed exclusion of both endoleaks, patent carotid vessels, and stable renal function. This case illustrates both the versatility and the procedural hazards of total endovascular arch repair. Meticulous CTA planning, immediate availability of bailout strategies, multidisciplinary expertise, and structured imaging surveillance are essential when treating complex post-dissection arch disease.
Objectives: This study investigated the effects of exercise selection and rest interval duration on post-exercise cardiac autonomic modulation following resistance exercise (RE). Methods: Eleven (4 females) resistance-trained individuals performed a single RE session consisting of either a multi-joint exercise (back squat) or a single-joint exercise (leg extension), using rest intervals of 1 or 2 min between sets. Heart rate variability (HRV) was assessed at baseline (pre-exercise) and 30 min following the RE session. RR intervals were recorded for 15 min with participants resting in the supine position on an examination bed in a quiet environment. For HRV analysis, a 5-min artifact-free segment of RR intervals was selected and processed using Kubios HRV software, version 4.3.0 (Kubios Oy, Kuopio, Finland). The HRV metrics analyzed included the root mean square of successive differences (RMSSD), low-frequency normalized (LF), the low-frequency/high-frequency (LF/HF) ratio, and the standard deviation of transverse dispersion (SD1). Results: A significant main effect of time was observed for RMSSD, LF, and the LF/HF ratio. The back squat exercise elicited a significant reduction (p < 0.05) in vagal-related indices (RMSSD and SD1) regardless of interval duration. Longer rest intervals were associated with increased (p < 0.05) sympathetic modulation, as reflected by higher LF and LF/HF values 30 min post-exercise. No significant time × group interactions were observed for most HRV variables. Conclusions: Exercise selection and rest interval duration differentially influence post-exercise cardiac autonomic responses following RE. Multi-joint exercises induce greater vagal withdrawal, whereas longer rest intervals favor sympathetic predominance during recovery. These findings highlight the importance of manipulating RE variables to manage autonomic stress and recovery.
Transgender individuals face unique challenges in vascular health due to the complex interactions between gender identity, psychosocial determinants of health, and medical interventions such as gender-affirming hormone therapy (GAHT). Growing evidence indicates that transgender populations may exhibit distinct patterns of vascular disease risk compared with cisgender individuals; however, available data remain limited and heterogeneous. A narrative review of the literature was conducted using major biomedical databases to identify studies examining the vascular and cardiovascular effects of gender-affirming hormone therapy in transgender individuals. This review provides a comprehensive overview of vascular health in transgender people, with particular attention to both venous and arterial disease. We summarize current epidemiological evidence on vascular outcomes and explore biological mechanisms through which exogenous sex hormones, including estrogens, anti-androgens, and testosterone, may influence endothelial function, vascular remodeling, inflammation, and coagulation pathways. Specific emphasis is placed on venous disorders, such as thromboembolic disease and chronic venous disease (CVD), as well as arterial conditions, including chronic peripheral arterial disease (PAD). In addition, we discuss the contribution of traditional vascular risk factors, minority stress, disparities in healthcare access, and social determinants of health in shaping vascular risk profiles. Clinical implications for vascular risk assessment, prevention strategies, and long-term monitoring in transgender individuals receiving GAHT are addressed. Finally, key knowledge gaps and priorities for future research are identified, underscoring the need for robust, longitudinal studies to support personalized and evidence-based vascular care in transgender populations.
