Journal of Vascular Diseases

Serum calcium levels are known to influence vascular function. Cells infected with human T-cell leukemia virus 1 (HTLV-1) impact serum calcium levels and also affect the endothelium. Since a damaged endothelium causes functional atherosclerosis, serum calcium levels in HTLV-1 carriers may be positively associated with functional atherosclerosis. This cross-sectional study enrolled 1694 Japanese individuals aged 60 to 89 years. Functional atherosclerosis was defined as a cardio-ankle vascular index (CAVI) ≥ 9.0. Logistic regression analysis was used to evaluate the relationship between HTLV-1 carrier status and both serum calcium level and functional atherosclerosis. Even after adjusting for known confounding factors, the serum calcium level was significantly positively associated with functional atherosclerosis only in asymptomatic HTLV-1 carriers. The fully adjusted odds ratio and 95% confidence interval of functional atherosclerosis in relation to a one-standard-deviation increment of serum calcium level (0.4 mg/dL in both men and women) were 1.54 (1.18, 2.01) for HTLV-1 carriers (n = 322) and 0.99 (0.87, 1.13) for HTLV-1 non-carriers (n = 1372), respectively. The serum calcium level was positively associated with functional atherosclerosis only among older carriers of HTLV-1 infection. This finding can help effectively estimate the risk of functional atherosclerosis in asymptomatic HTLV-1 carriers. Full article

Bisphosphonates remain a first-line treatment for osteoporosis. The most-widely used is zoledronate, which is well tolerated by most patients, but may rarely cause acute inflammatory reactions, which resemble those of large vessel vasculitis (LVV). We report a third case of LVV associated with zoledronic acid infusion, presenting with a 2-week history of fever up to 40 °C, flu-like symptoms, left jaw pain, myalgia, arthralgia, ankle stiffness in the morning, and intermittent claudication, diagnosed by the hybrid imaging modality 18F-FDG PET/CT with isolated lower extremity involvement and successfully treated with glucocorticoids. Full article

Cerebrovascular disease (CVD) is a global health concern, and early detection is crucial for effective intervention. This case report presents a 31-year-old male patient with multiple cardiac risk factors who underwent positron emission tomography/computed tomography (PET/CT) with ¹⁸F-sodium fluoride (NaF) and ¹⁸F-fluorodeoxyglucose (FDG) to evaluate for the presence and degree of atherosclerosis in the aorta, carotid arteries, coronary arteries, iliac arteries, and the femoral arteries. Elevated NaF uptake within the bilateral carotid arteries signified substantial ongoing vascular microcalcification. Reduced global brain metabolism and region-specific hypometabolism measured with FDG PET indicated potential cerebrovascular mechanisms that may be influencing neurological function. The findings highlight the potential of emerging PET tracers, such as NaF, to improve the diagnostic accuracy and therapeutic management of CVD. This case emphasizes the importance of a comprehensive diagnostic approach as well as continued investigation into CVD pathophysiology using PET-based techniques, which may guide the development of innovative therapeutic strategies. Full article

Background: Previous studies suggest variability in the management of cardiogenic shock (CS). Methods: An anonymous survey was sent to Spanish hospitals. Results: We obtained 50 answers, mainly from cardiologists (36–72%). The annual average of ECMOs is 16.7 ± 11.3 applications in CS patients and of Impellas is 8.7 ± 8.3 applications in CS patients. Intra-aortic balloon counterpulsation is used in the majority of CS ECMOs (31–62%), and Impella is used in 7 (14%). In 36 (72%) cases, ECMO is used as a treatment for cardiac arrest. In 10 cases, ECMO removal is percutaneous (20%). In 25 (50%) cases, age is a relative contraindication; 17 have a mobile ECMO team (34%); and 23 (46%) have received ECMO patients from other centers in the last year. Pre-purged ECMO is only used in 16 (32%). ECMO implantation is carried out under ultrasound guidance in 31 (62%), only with angiography in 3 (6%) and with both in 11 (22%). The Swan–Ganz catheter is used routinely in 8 (16%), only in doubtful cases in 24 (48%), and in most cases in 8 (16%). The ECMO awake strategy is used little or not at all in 28 (56%), in selected cases in 17 (34%), and routinely in 5 (10%). Conclusion: Our study shows a huge variation in the management of patients with CS. Full article

Metalloproteinases (MPs) belong to the superfamily of zinc endopeptidases, which are called metzincins. Three families of MPs have been studied in healthy and diseased conditions in humans. The first study on MPs was published in 1962, and following that, several studies characterized their activity and their effect on health and disease. Several diseases have been related to MPs, such as cardiovascular disease, cancer, inflammatory diseases, gynecological disorders, and others. Moreover, tissue inhibitors of metalloproteinases (TIMPs) have been widely studied, and drugs and artificial molecules that could target MP activity have been evaluated. MPs are relevant to public health because of their role in several diseases and, most of all, their role as biomarkers that also impact the quality of life and the psychosocial dimension of affected patients. In this context, new pathways to precision health and precision medicine have been opened in the area of MPs. This review describes, from the initial studies, the complex dimensions of MPs and related issues centered on health and disease dimensions. Full article

Numerous studies have investigated in-stent restenosis (ISR) predictors in first-generation drug-eluting stents (DESs), but only a few have investigated second-generation DESs. We aimed to investigate the ISR predictors following a successful DES implantation in coronary artery disease (CAD) patients. A systematic review and meta-analysis study was conducted. Diabetes mellitus (DM) (OR 1.47; 95% CI 1.19 to 1.83; p < 0.01), family history of CAD (OR 1.26; 95% CI 1.03 to 1.55; p 0.03), and smoking (OR 1.23; 95% CI 1.02 to 1.48; p 0.03) were the strong predictors for the DES-ISR. The DES-ISR was more common in DESs with smaller stent diameter (MD −0.12; 95% CI −0.16 to −0.08; p < 0.01) and longer stent length (MD 2.24; 95% CI 1.36 to 3.13; p < 0.01). Angiography characteristics, including multi-vessel disease (MVD) (OR 1.45; 95% CI 1.07 to 1.97; p 0.02), type B2/C lesions (OR 1.56; 95% CI 1.06 to 2.30; p 0.02), and type C lesion (OR 1.33; 95% CI 1.09 to 1.62; p < 0.01), were also associated with DES-ISR. We confirmed that DM, family history of CAD, smoking, MVD, smaller stent diameter, longer stent length, and type B2 or C lesions were proven to be ISR predictors following DES implantation. Full article

Motor imagery (MI) and action observation (AO) techniques are two movement representation strategies that are widely used in multiple fields of study. MI is defined as the cognitive skill that involves the representation of an action, internally, without actual motor execution. AO training evokes internally, and in real time, a simulation of the actual motor gestures that the observer is visually perceiving. Both cognitive processes cause an activation of the brain areas related to the planning, adjustment, and automation of voluntary movement in a similar way as when the action is carried out in a real way. Movement representation strategies have shown that they can be a very useful complement to physical practice to improve some particularly relevant aspects in neurological and musculoskeletal patients. In this narrative review, we discuss the effect that the implementation of these motion representation strategies might have on patients with cardiovascular disease. At the cardiovascular level, MI and AO training should be considered as interventional tools for the management of these patients. With these clinical tools, we could try to improve the generation of cardiopulmonary adaptations, improve exercise tolerability, and also increase functionality. However, more research is needed in this field where these clinical tools are combined with cardiac rehabilitation programs to see if the clinical effect is greater than cardiac rehabilitation programs in isolation. Full article

Background: Vein of Galen malformation (VGM) is a congenital intracranial vascular anomaly consisting of arteriovenous fistulas and/or malformations between various arterial feeders and the median prosencephalic vein of Markowski (MPV). Despite its rare occurrence, VGM is of particular clinical relevance, as the excessive intracranial shunt volume leads to high mortality without appropriate treatment. Methods: The objective of this article is to review the published data on neurointerventional treatment and compare outcome quality in the included studies. Eight studies were included and synthesized. One study was multicentric and the rest were retrospective monocentric (level 4 evidence studies according to the Oxford Centre for Evidence-based Medicine). Results: The total number of included patients was 480 and patient age ranged from 1 day to 18 years. Mild or severe heart failure, hydrocephalus, and other reasons led to the indication for neurointerventional treatment, which was performed in all studies in the form of embolization. Under consideration of the introduced semiquantitative multidimensional scoring system, the highest total score, i.e., the best outcome quality, was found for the study “Houston” 2002–2018 (19 points) and the study “Duisburg” 2001–2010 (19 points). Conclusions: Neurointerventional treatment represents the essential pillar in the interdisciplinary management of patients with VGM, although standardization is lacking—based on the results of the structured review. As complementary treatments, pediatric critical care is mandatory and includes medical hemodynamic stabilization. Full article

Since their first approval in 2010, direct oral anticoagulants (DOACs) have become attractive for anticoagulant treatment. DOACs are indicated for the prevention and treatment of several cardiovascular conditions and have now emerged as leading therapeutic options. Every year, large number of patients receiving DOACs routinely are scheduled for invasive surgical procedures and need specific perioperative management. Moreover, recently published trials have provided arguments for a larger future use of DOACs, including during the postoperative period after vascular surgery and for high-risk cardiovascular patients. In this communication, we discuss the perioperative management of DOACs for patients undergoing vascular surgery. Full article

Background: Intracranial aneurysms (IAs) are found in around 3–4% of elderly people. The authors attempt to answer why IAs develop exclusively in the circle of Willis (CW) and why IAs in the frontal cerebral arteries are unusually frequent in men. Methods: The location and frequency of IAs were analyzed using relevant publications (MEDLINE and PubMed). Results: It is suggested that superposed blood pulse waves may have an influence on the development of IAs. The superposition of blood pulse waves is caused by the meeting of the bilateral cerebral arteries in the CW. The predominance of IAs in women is striking (about 1.7:1). However, IAs in the anterior cerebral arteries and anterior communicating artery are significantly more common in men than in women (approximately 1.8:1). The authors hypothesize that greater nicotine abuse in men may explain this phenomenon. Cigarette smoke apparently reaches the anterior cerebral arteries via the olfactory pathway. Conclusion: It seems possible that superposed pulse waves are a substantial factor in the occurrence of IAs. The toxic effects of tobacco smoke appear to have greater impact on IA development than the sex-specific influences that are responsible for the predominance of IAs in women. Full article

Background: Osteoarthritis (OA) of the knee is an inflammatory joint disorder of the cartilage, joint capsule, synovium, and surrounding bone. Intraarticular inflammation induces angiogenesis leading to pain and inflammation. Research suggests a relationship between patients with osteoarthritis of the knee and venous insufficiency or contributing arteriovenous malformations (AVMs). Similar to genicular artery embolization (GAE), transvenous or transmalformation cannulation and embolization offers a minimally invasive treatment modality for patients with mild to moderate osteoarthritis. Case presentations: Here, we present the successful treatment of OA of the knee using direct puncture transmalformation cannulation and embolization in five patients. Direct puncture, a technique used to embolize peripheral AVMs, is a safe, less invasive method for the treatment of osteoarthritis with associated AVMs. Conclusions: For patients with OA-related knee pain and associated AVMs, the advancement of endovascular techniques offers alternative approaches to the treatment of mild to moderate OA. Direct puncture and transmalformation cannulation and embolization reduce the risk of intra- and post-operative complications, improve recovery time, and minimize operating time and operating costs. In review of the literature, this is one of the first published reports describing the use of direct puncture transvenous or transmalformation cannulation and embolization to treat OA-related pain. Full article

Subarachnoid hemorrhage (SAH) is a medical emergency that requires immediate intervention. The etiology varies between cases; however, rupture of an intracranial aneurysm accounts for 80% of medical emergencies. Early intervention and treatment are essential to prevent long-term complications. Over the years, treatment of SAH has drastically improved, which is responsible for the rapid rise in SAH survivors. Post-SAH, a significant number of patients exhibit impairments in memory and executive function and report high rates of depression and anxiety that ultimately affect daily living, return to work, and quality of life. Given the rise in SAH survivors, rehabilitation post-SAH to optimize patient outcomes becomes crucial. The review addresses the current rehabilitative strategies to combat the neurocognitive and behavioral issues that may arise following SAH. Full article

Objective: To explore the association between hypochloremia and mortality in critically ill patients with chronic heart failure (CHF). Methods: This is a retrospective cohort study from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database of patients with CHF diagnosed according to ICD-9 or ICD-10. Patients were divided into three groups according to serum chloride values. A multivariable logistic regression analysis was used to investigate the relationship between hypochloremia and short-term mortality. Results: A total of 2103 patients with CHF were enrolled in our study. The 30-day mortality was 6.7%. After adjusting for confounders, the 30-day mortality risks of the hypochloremia group were significantly higher than that of the group with normal serum chloride (OR 2.23, 95% CI 1.27–3.92, p = 0.005). Hypochloremia was consistently associated with increased mortality in patients that were older or had sepsis. Conclusion: Hypochloremia is associated with increased mortality in intensive care patients critically ill with CHF. Full article

The purpose of this study is to compare IVC Celect and ALN filters in regard to their efficacy, retrievability, and one-year follow-up after retrieval. Materials and Methods: This is a prospective randomized study, conducted in three centers between April 2020 and May 2021. A total of 115 participants were randomized, of which 15 participants were excluded for various reasons. Each group of 50 participants was finally assigned a type of filter (Celect n = 50 and ALN = 50). Tilt angles at placement and retrieval, rates of overall filter retrieval, complications, complex retrieval, and clinical follow-up at 12 months were compared. Results: One hundred participants (59 men and 41 women) were included. The mean age was 62.4 ± 13.3, with no significant differences between both groups (p 0.503). The mean of dwelling time was 44.7 ± 93 days. (p 0.520) Filter retrieval was successful in all participants (100%). The main complication in CT prior to removal was tilt >15° (31%) and filter tip embedment (16%). No significant differences were observed in the type of retrieval (standard or complex) between both filters (p 0.24); however, fluoroscopy time was significantly longer in the complex removal of the Celect filter: 29.1 ± 12 min vs. 17.5 ± 10.3 (p 0.005). After one year, no recurrent pulmonary embolism was observed in both types of filters. Conclusions: The ALN filter had a significantly lower rate of tip and filter tip embedding, with no differences in complexity or removal success rate. There were significant differences in the fluoroscopy time consumed for standard and complex retrievals between both filters, with less time for the ALN filter. Full article

Background: Obstructive sleep apnea (OSA) and sarcoidosis have both been implied to be risk factors for increased arterial stiffness. However, it is unclear whether an elevated apnea–hypopnea index (AHI) in sarcoidosis patients increases arterial stiffness and thus the cardiovascular risk. Methods: We performed non-invasive applanation tonometry in 57 adults with sarcoidosis. The participants underwent SphygmoCor to assess arterial stiffness using an aortic augmentation index with a heart rate of 75/min (AIx) and level-3 respiratory polygraphy. An AHI of ≥5/h, ≥15/h, and ≥30/h defined mild, moderate, and severe OSA, respectively. Multivariate regression analysis was used to investigate the association between AIx and AHI, adjusted for prespecified risk factors for AIx. Results: 23 (40%) sarcoidosis patients had at least mild OSA (AHI ≥ 5), while 7 (12%) patients showed AHI ≥ 15/h. AHI was significantly associated with AIx (coef. (95%CI) of 0.31 (0.09/0.52), p = 0.006) even after adjustment for known risk factors of arterial stiffness. While severe OSA was positively associated with increased AIx, mild and moderate OSA were not associated with increased AIx after adjusting for known risk factors. Conclusions: Increased AHI is independently associated with increased arterial stiffness in sarcoidosis patients. Further investigations are needed to underline the association between OSA severity and the magnitude of arterial stiffness. Full article

The Framingham Heart Study (FHS) began in 1949 with the goal of defining the epidemiology of hypertensive or arteriosclerotic heart disease in the population of Framingham, Massachusetts, a primarily Caucasian suburb west of Boston with a population of approximately 28,000. The participants were without previous symptoms of heart disease and were followed for the occurrence of Cardiovascular Disease (CVD). The study documented a comprehensive medical history that included current symptoms, family history, past cardiac history, social history, and medications. The medical exam included diagnostic studies of chest X-ray, electrocardiogram (EKG), complete blood count (CBC), uric acid level, blood glucose, urinalysis, and venereal disease research laboratory test; Syphilis (VDRL). Serum lipids, recognized at the time to be associated with cardiovascular disease, were also measured. These included cholesterol, total phospholipids, and the Gofman’s S_f 10–20 fraction. Study participants underwent four examinations at 6-month intervals to document any clinical manifestation of CVD. The present understanding of the epidemiologic factors that influence cardiovascular disease risk (CVD-R) is based on the first report of study results at a 6-year median follow-up and numerous subsequent analyses of long-term follow-up data from the original Framingham cohort as well as their offspring. In this paper, we review the Framingham cohort study with regards to the risk factors of peripheral vascular disease. Full article

Objective: To compare the quantitative susceptibility mapping (QSM) susceptibility values and pathology composition with different types of thrombi in the middle cerebral artery (MCA), and assess the value of susceptibility weight imaging in thrombus component diagnosis in stroke. Materials and methods: This study included 15 patients (73.47 ± 10.7 years; 6 males and 9 females) who underwent magnetic resonance imaging before mechanical thrombectomy due to acute middle cerebral artery occlusion between January 2017 and December 2019. All patients had the susceptibility vessel sign (SVS) on SWI (susceptibility weighted imaging), and the thrombus susceptibility was measured by signal processing in nuclear magnetic resonance SPIN software. The retrieved thrombi underwent histopathologic analysis, and the correlation between thrombus susceptibility and the pathologic composition was analyzed by two independent Kolmogorov–Smirnov tests. The location and length of thrombi were evaluated on both SWI and DSA, and the correlation was explored using two independent samples Wilcoxon rank test. The correlations between susceptibility and the infarct core volumes (ADC < 620 mm²/s volume map), hypoperfusion volumes (Tmax > 6 s volume map), 90-day modified Rankin scale (mRS), and the National Institutes of Health Stroke Scale (NIHSS) at admission were analyzed by Spearman’s correlation analysis. Results: Among the 15 retrieved thrombi, the mean thrombus susceptibility of RBC-dominant and fibrin-dominant thrombi were 209.88 ± 11.32 and 155.70 ± 28.20 (ppb), respectively (p = 0.037). The average distance of the proximal end of the thrombi to the midline was 24.67 ± 8.43 mm and 24.62 ± 8.44 mm, as measured by SWI and DSA (digital subtraction angiography), respectively (p < 0.001). The correlation between thrombus susceptibility was weakly negatively correlated with ADC < 620 mm²/s volume map (r = 0.356, p = 0.193) and poorly correlated with Tmax > 6 s volume map (r = 0.252, p = 0.365), 90-day mRS (r = 0.182, p = 0.517), and NIHSS at admission (r = 0.262, p = 0.345). Conclusions: The measurements of the Quantitative susceptibility value of thrombi may help predict the composition of thrombi in patients with acute middle cerebral artery occlusion. QSM provides a more accurate method to evaluate the thrombi. Full article

Purpose: This study was conducted to evaluate the effectiveness and safety of apixaban in patients with cancer for the treatment of venous thromboembolism (VTE) at a tertiary medical institution in Saudi Arabia. Methods: An observational retrospective cohort study was conducted on adult patients with cancer who were diagnosed with VTE and received apixaban therapy from August 2016 to October 2020. Results: A total of 478 patients were screened; 99 patients were included in the final analysis. Of those included, 38 (38%) were female, 74 (77.1%) had a solid tumor, and 36 (36.4%) were receiving apixaban therapy due to developing proximal deep vein thrombosis (DVT), and the mean age was 58.59 (±14.77). At six months, thrombotic events occurred in 11 patients (11.1%), and bleeding events occurred in 14 (14.1%) of the included individuals. Mortality occurred in 9 (9.09%) of the included individuals. Close to 32% individuals discontinued apixaban therapy at six months. Conclusion: The prevalence of recurrent VTE and bleeding events in patients with cancer using apixaban for treating VTE is in line with many other real-world studies but slightly higher compared to the patients enrolled in the Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer (CARAVAGGIO) trial. Full article

In Malaysia, heart disease is a major non-communicable disease and a leading cause of morbidity and mortality. Individuals need to understand the risk factors of heart disease, including health-related behaviors. This study was done to determine the perceived risks of heart disease and to estimate the willingness to pay (WTP) for its diagnosis. One-way analysis of variance was used to determine the significance of mean differences among the other demographic variables, followed by Tukey’s post hoc test to determine the differences between groups. The Spearman Rho test was employed to determine the correlations between participants’ perceived heart disease risk and their WTP for its diagnosis. The Perception of Risk of Heart Disease Scale (PRHDS) mean score of participants with a family history of heart diseases (25.32 ± 2.81; n = 556) was significantly higher than those who did not have such a family history (22.14 ± 3.42; n = 761; p = 0.04). The participants with a family history of heart disease showed a greater WTP for diagnostic tests compared with those without a family history. The participants who were ready to spend within the range of Ringgit Malaysia (RM) 1-RM1000 were willing to pay for diagnostic testing of heart diseases based on their family history and socioeconomic background. This study demonstrated a higher perception of the risk of heart disease in people with a family history of heart disease, who also demonstrated a greater WTP for diagnostic tests. Individuals ready to spend up to RM 1000 were willing to pay for diagnostic testing for heart diseases. The individuals with a family history of heart disease perceived a higher risk of heart disease and were willing to pay to improve life expectancy per year. Hence, the information on family history can be used as a tool for the holistic approach to educate individuals on their risk factors for heart disease and encourage them to do early screening for cardiovascular diseases. Full article