Journal of Vascular Diseases

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

Focal vibration therapy seeks to restore the physiological function of tissues and the nervous system. Recommendations for vibration settings, e.g., that could improve residual limb health and prosthesis acceptance in people with amputation, are pending. To establish a physiological connection between focal vibration settings, clinical outcomes, and molecular and neuronal mechanisms, we combined the literature on focal vibration therapy, vibrotactile feedback, mechanosensitive Piezo ion channels, touch, proprioception, neuromodulation, and the recovery of blood vessels and nerves. In summary, intermittent focal vibration increases endothelial shear stress when applied superficially to blood vessels and tissues and triggers Piezo1 signaling, supporting the repair and formation of blood vessels and nerves. Conversely, stimulating Piezo1 in peripheral axon growth cones could reduce the growth of painful neuromas. Vibrotactile feedback also creates sensory inputs to the motor cortex, predominantly through Piezo2-related channels, and modulates sensory signals in the dorsal horn and ascending arousal system. Thus, sensory feedback supports physiological recovery from maladaptations and can alleviate phantom pain and promote body awareness and physical activity. We recommend focal vibration of phantom limb maps with frequencies from ~60–120 Hz and amplitudes up to 1 mm to positively affect motor control, locomotion, pain, nerves, and blood vessels while avoiding adverse effects. Full article

Background: A large amount of sclerosant is needed for the treatment of saphenous vein insufficiency with mechanochemical ablation (MOCA) for three or four veins with chronic venous insufficiency. In addition, what constitutes a safe amount is not clearly defined. In this study, we evaluate the feasibility of the combined endovenous laser and mechanochemical ablation to reduce the amount of sclerosant as compared with mechanochemical ablation monotherapy. Methods: A total of 327 patients diagnosed with superficial vein insufficiency between June 2018 and May 2020 and treated in a single center by one surgeon were evaluated retrospectively. There were 130 patients included who were treated with mechanochemical ablation (MOCA, Group I) and 197 patients who were treated with combined endovenous laser ablation and mechanochemical ablation (EVLA and MOCA, Group II). Results: The amount of sodium tetradecyl sulfate (STD) used per number of limbs was 5.5 ± 2.05 mL in Group I and 4.51 ± 1.2 mL in Group II (p < 0.001). The amount of STD used per number of veins was 4.77 ± 1.91 mL versus 3.12 ± 1.02 mL in Groups I and II, respectively, (p < 0.001). Recanalization rates within 52 weeks were 0% (0/130) in Group I and 5.58% (11/197) in Group II, while after 52 weeks they were 2.31% (3/130) in Group I and 6.60% (13/197) Group II and were not statistically significant. Complications within 4 weeks were 3.84% and 7.11% in Groups I and II, respectively. Conclusions: The results of this study show that combined EVLA and MOCA reduces the amount of sclerosant per the number of veins and legs treated as compared with MOCA monotherapy for three or four veins with chronic venous insufficiency. The combined EVLA and MOCA treatment in patients with three or four varicose veins has few side effects, reduces the amount of sclerotic agent, and can be considered to be an effective treatment method for inducing venous occlusion. Full article

While the imaging of arteries and veins by CT, MRI, and angiography is standard practice in large and small hospitals as well as in outpatient practices in developed countries, the diverse and sophisticated radiological procedures for imaging lymph ducts are often unknown and available only in a few specialized institutions [...] Full article

The aim of this article is to assess the most studied anthropometric measurements in a population of patients with vascular disease (VD) such as chronic venous disease (CVD), carotid stenosis (CS), abdominal aortic aneurysm (AAA), and peripheral artery disease (PAD). This is a cross sectional study that recruited consecutive patients with VD (CVD, CS, AAA, PAD) referred to Vascular Surgery Units of two hospitals in the period July 2019–March 2022. Several anthropometric measurements such as height, weight, body mass index (BMI), waist circumference, waist-to-BMI, waist-to-hip ratio (WHR), A Body Shape Index (ABSI), waist-to-stature ratio (WSR) were recorded. In a one-way ANOVA test, no statistical significance for all anthropometric variables were found, but the post hoc analysis performed with Tuckey test, show significant difference for height (p-value: 0.017) and WHR (p-value: 0.005) when compared AAA and CS groups with CVD, respectively. Height seems positively associated with AAA, and negatively associated with CVD. WHR seems positively associated with CS and negatively associated with CVD. Further studies are needed to clarify the role of anthropometric measures as independent predictors for vascular disease onset, progression, and response to treatments. Full article

There is a high incidence of postoperative delirium (POD) following microvascular decompression (MVD) surgery. Neuronal survival, differentiation, and neurite regeneration are regulated by neuro-specific enolase (NSE). Therefore, we investigated and assessed whether circulating NSE levels are related to POD after MVD surgery. We recruited a total of 209 patients and 209 age- and gender-matched healthy controls. A retrospective review of electronic medical records was conducted, and serum NSE levels were measured in the serum of patients before and after surgery, as well as the serum of controls. Patients were categorized according to the presence of POD. Postoperative patient serum levels of NSE were significantly higher compared to preoperative levels. Additionally, postoperative serum NSE levels were remarkably higher in POD patients than non-POD patients. In addition, there was no significant correlation between NSE levels and the type and severity of postoperative delirium. Age (OR = 1.153, 95% CI = 1.040–1.277, p = 0.006), the levels of serum NSE (OR = 1.326, 95% CI = 1.177–1.494, p < 0.001), and the levels of serum S100β (OR = 1.006, 95% CI = 1.000–1.012, p = 0.048) were the three independent variables for predicting POD. A significant correlation existed between serum S100β levels and serum NSE levels (t = 2.690, p = 0.008). In terms of area under the precision–recall curve, the discriminatory ability of serum NSE levels (AUC = 0.876, 95% CI = 0.829–0.924, p < 0.0001) was close to that of the serum S100β level (AUC = 0.879, 95% CI = 0.825–0.933, p < 0.0001) and significantly higher than that of age (AUC = 0.813, 95% CI = 0.755–0.871, p < 0.0001). Combining all three features produced a dramatic improvement over individual effects. The NSE level in serum was a stronger indicator of the likelihood of POD after MVD surgery in the older population. The clinical determination of this factor might be useful for distinguishing older patients at risk of POD after MVD surgery on the basis of their clinical findings. Full article

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