J. Vasc. Dis., Volume 1, Issue 2 (December 2022) – 5 articles

Background: Pulse pressure (PP), a marker of arterial stiffening, is closely related to adverse outcomes in hypertensive patients. Correspondingly, less attention has been paid to the value of PP in the population with normal blood pressure. Methods: The study included normotensive elders aged over 60 years from the 1999–2014 National Health and Nutrition Examination Survey (NHANES). All included participants were followed up until the date of death or 31 December 2015. Restricted cubic spline analyses were used to explore the associations of PP with cardiovascular mortality and all-cause mortality. The population was categorized into two groups according to the optimal cut-off of PP for all-cause mortality by X-tile software. Propensity matching score analysis was further performed to reduce confounding bias. The Kaplan–Meier curves and Cox proportional hazard models were applied to estimate the associations of widening PP cardiovascular mortality and all-cause mortality. Subgroup analyses were also conducted. Results: A total of 6309 participants were included (52.9% men and median age 69 (63, 75) years). The median follow-up duration was 74 (42, 114) months. The restricted cubic spline analyses revealed that continuous PP was linearly related to cardiovascular mortality (p for linearity < 0.001; p for nonlinearity = 0.284) and nonlinearly related to all-cause mortality (p for nonlinearity = 0.001). After propensity score matching, 1855 subjects with widening PP and 1855 matched counterparts were included (50.2% men and average age 72 (66, 78) years, 50.9% men and average age 72 (66, 78) years, respectively), of which 966 (26.0%) died during a median follow-up duration of 71 (39, 105) months. In the Cox proportional hazards model, widening PP was associated with increased cardiovascular mortality Hazard Ratio (HR) 1.47; 95% Confidence Interval (CI) 1.07–2.00, p < 0.05] and all-cause mortality (HR 1.15; 95% CI 1.01–1.31, p < 0.05). After adjusting for other traditional risk factors, the association of widening PP with cardiovascular mortality (HR 1.44; 95%CI 1.05–1.98, p < 0.05) remained, and the association of widening PP with all-cause mortality was not statistically significant (p > 0.05). Conclusion: In the normotensive elder population, a low-risk population without traditional coronary risk factors, PP is an independent risk factor for cardiovascular mortality. Full article

Hemophilia A is an X-linked coagulopathy, where there is a deficit in the production of the coagulation factor VIII. Even though there is a higher incidence of hemophilia A than of hemophilia B, it is still considered a rare disease, as its incidence is of 1 in 10,000 people born. We have applied three questionnaires regarding quality of life: Haem-A-QoL, Haemo-SYM and EQ-5D-5L to 101 adult patients with hemophilia A, which were separated into two groups: on-demand and prophylactic treatment. The results showed a relatively young lot, with medium and high education, but with a sedentary lifestyle and are pensioners. They also seem to have moderate mobility issues but, overall, a good quality of life. The quality of life in our studied lot is relatively good, but a more diverse lot is advised. Full article

Background: The epicardial left atrial appendage (LAA) closure may induce unwanted natriuretic peptides caused by the isolation of the LAA from circulation. Thus, this study aims to explore the possible change of blood pressure and electrolytes following the procedure. Methods: This was a retrospective, observational study including 52 atrial fibrillation (AF) patients with a history of thrombolic stroke who underwent thoracoscopic LAA clipping. Electrolytes, blood pressure, and brain natriuretic peptide were measured before the procedure, immediately after the device release, on the 1st day, the 2nd day postoperation, and discharge. Results: Thirty-five (66.04%) patients’ serum sodium level decreased by more than 4 mmol/L during 48 h postoperation. The systolic blood pressure at discharge was significantly lower than the baseline level (118.99 ± 12.29 mmHg vs. 122.93 ± 13.82 mmHg, p = 0.034), while the diastolic blood pressure was not significantly different to the baseline (78.00 ± 7.39 mmHg vs. 77.22 ± 7.72 mmHg, p = 0.502). A significant increase in brain natriuretic peptide was observed postoperatively, although it showed a trend of decline at discharge. Conclusion: Epicardial LAA clipping could induce an acute decrease in serum sodium postoperation, which indicates to the surgeons that the postoperative intake fluid amounts and serum sodium level management should be more appropriate. The decrease in systolic blood pressure indicates the possibility of expanding the benefits that patients received from LAA clipping, though further studies are needed to determine if this phenomenon is persistent in the long-term follow-up. Full article

Background: Readmission within 30 days of discharge for heart failure (HF) has become a challenging public health issue. Predicting the risk of 30-day readmission may assist clinicians in making individualized treatment plans for HF patients. Methods: A total of 2254 patients were enrolled in this study. The risk predictors associated with 30-day readmission were selected using the least absolute shrinkage and the selection operator regression model. The performance of the nomogram was evaluated using the receiver operating characteristic (ROC) curve, Hosmer–Lemeshow (HL) test, and decision curve analysis (DCA). Results: The 30-day all-cause readmission rate was 7.1%. Thirteen clinical parameters were identified as the risk predictors, including age, cystatin C, albumin, red cell distribution width coefficient variation, neutrophils, N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, myoglobin, sex, dyslipidaemia, left ventricular ejection fraction, left ventricular end-diastolic dimension, and atrial fibrillation. The nomogram showed good discrimination, with an area under the ROC curve of 0.653 (95% confidence interval: 0.608–0.698) and good calibration results (HL test p = 0.328). The DCA showed that the nomogram would have good clinical utility. Conclusions: This predictive model based on clinical data makes it simple for clinicians to assess the 30-day HF readmission risk. Full article

Both occlusion and pseudoaneurysm are complications of femoropopliteal bypass surgery. Open revision is the gold standard, but it is associated with high morbidity and mortality compared with endovascular treatment. Percutaneous stent-graft repair is a valid option either for recovering the patency of occluded prosthetic femoropopliteal bypass or for excluding anastomotic pseudoaneurysm. In this report, it is presented a case of occlusion concomitant to a pseudoaneurysm of the distal anastomosis in a previous prosthetic femoropopliteal bypass; a simultaneous endovascular treatment of both complications has been performed through self-expanding stent-graft (Viabahn) placement. Full article