J. Vasc. Dis., Volume 3, Issue 4 (December 2024) – 12 articles

Background/Objectives: Venous ulcers are the most common type of ulcerated wounds in the lower limbs and result from chronic venous insufficiency. The treatment of venous ulcers is multidisciplinary, with physiotherapy intervention serving as an adjuvant therapy in managing these wounds. This study investigated physiotherapeutic interventions for the management of venous ulcers. Methods: This was an exploratory and descriptive study using the Delphi method. The panel comprised 12 experts in wound care, including 25.0% physicians, 41.7% nurses, and 33.3% physiotherapists. Two rounds of analysis were conducted. A quantitative analysis was performed to assess the level of agreement in responses, while qualitative analysis was applied to the experts’ comments. Results: In the first round, consensus varied between 80% and 100%, and in the second round, it ranged from 83.3% to 100%. In the second round, all interventions obtained at least 80% consensus. The interventions included the use of compression therapy and therapeutic exercise: resistance training (2–3 sets of 10–25 repetitions, 3 times/day, for at least 12 weeks), aerobic exercise (at least 30 min, 3 times/week, for 12 weeks), stretching, balance training, and the use of a vibrating platform. Conclusions: Physiotherapy may be beneficial as an adjuvant therapy alongside specific local treatments for venous ulcers. Therapeutic exercise and compression therapy are commonly utilized interventions that could support overall treatment outcomes. Full article

Background and significance: The coronary artery disease (CAD) epidemic has seen a logarithmic increase in morbidity and mortality over the past decade. Cardiovascular diseases account for about 19.1 million deaths annually—with 80% of reports coming from low and middle-income countries, which have been attributed to a lack of infrastructure, human resources, and financial coverage. In tandem with the developed world, India has also seen significant growth in interventional and surgical cardiovascular care. The dominance of coronary artery bypass grafting (CABG) procedures in India has attracted the attention of the world. With this review, the authors aim to highlight the role of cardiac surgeons in India as the “unsung heroes” of coronary interventions. Observations: A pernicious atherosclerotic pathology develops in thendian population as a result of genetic and socio-cultural predispositions, which is further complicated by anatomical and physiological differences. The pathology manifests as a diffuse disease in relatively small caliber coronary arteries, necessitating the consideration of CABG over interventional procedures. Indian cardiac surgeons have stood up to the challenge and have powered health tourism to India from around the world due to the excellent success rate and long-term outcomes at a 50–80% lesser cost than most developed countries. Beyond the costs, a major highlight is the high rate of arterial bypass and off-pump surgery. These balance the unbridled exuberance of the interventional cardiology medical–industrial complex, providing a critical balance that benefits patients and improves acute and long-term outcomes. Conclusions: Indian cardiac surgery is now known globally not only for its affordability but also for the skill set and the quality of surgeons. The surgeons’ vast experience and risk-taking capacity have made them an indispensable part of the interventional cardiology team and has allowed a multidisciplinary collaboration that inspires the world. This is evident from the rising trend of medical tourism to India. Full article

Background/Objectives: Insufficient blood supply to the brain, whether due to blocked arteries (ischemic stroke) or bleeding (hemorrhagic stroke), leads to brain cell death and cognitive impairment. Ischemic strokes, which are more common, occur when blood flow to the brain is obstructed. Magnetic resonance imaging (MRI) scans are essential for distinguishing stroke types, but precise and timely identification of ischemic strokes is crucial for effective treatment. Manual diagnosis can be difficult due to high patient volumes and time constraints in hospitals. This study aims to investigate the use of deep learning techniques for predicting ischemic strokes with high accuracy, enabling earlier diagnosis and intervention. Methods: The study utilized advanced deep learning algorithms, specifically ConvNeXt Base, to analyze large datasets of medical imaging data, focusing on MRI scans. The model was trained and validated on a labeled dataset to identify critical indicators and patterns associated with stroke risk. The performance of the model was evaluated based on accuracy metrics to determine its predictive capabilities. Results: ConvNeXt Base achieved an overall accuracy of 84% on the validation set, demonstrating its effectiveness in identifying ischemic strokes. The model was able to detect key patterns linked to stroke risk, highlighting its potential for use in clinical settings to aid in early diagnosis and decision-making. Conclusions: ConvNeXt Base reveals promise in improving stroke prediction accuracy, enabling earlier diagnosis and personalized treatment, which could lead to faster, more effective medical interventions. Full article

Background: This study evaluates the use of transbrachial artery access for endovascular treatment of iliac artery lesions, with a focus on its efficacy and safety outcomes. Methods: Between January 2020 and May 2023, 94 patients with iliac artery disease underwent endovascular procedures via a transbrachial access approach. The majority of patients (n = 68; 72%) presented with lifestyle-limiting claudication (Rutherford category 3). Diagnostic angiography identified Transatlantic Inter-Society Consensus II (TASC) C/D lesions in 54 patients (57%). The primary outcome was achieving technical success with transbrachial access, while secondary outcomes included secondary technical success (necessitating additional transfemoral access), access site complications, and cerebrovascular events. Results: The primary and secondary technical success rates were 82% and 92%, respectively. Access site-related adverse events occurred in 12 patients (12%), primarily hematomas (seven events, 7.4%; two requiring transfusion) and pseudoaneurysms (four events, 4.2%). Thrombotic occlusion was observed in one patient (1%), and brachial arterial bleeding requiring urgent surgical intervention occurred in three patients (3.2%). Neurological complications included two cerebrovascular events (2.1%), although no permanent or transient median nerve injuries were observed. Conclusions: The transbrachial approach represents a potential alternative to the femoral artery route in patients with iliac artery lesions. However, the relatively higher incidence of access site complications may limit its broader application in clinical practice. Full article

The development of new organic nitrates is still relevant due to the clinical limitations of their use. Tetrahydrofurfuryl nitrate (NTHF) is a new organic nitrate obtained through a synthetic route of sugarcane. The aim of this research was to investigate the cardiovascular effects promoted by NTHF in rats. Isolated vascular smooth muscle cells (VSMC) were incubated with a specific probe and were analyzed in a flow cytometer to measure the NO concentration after NTHF treatment. Rat superior mesenteric rings were isolated and used for isometric tension recordings and the evaluation of the vasorelaxant activity induced by NTHF. For the in vivo study, polyethylene catheters were implanted into the abdominal aorta and inferior vena cava of the rats (weighing 250–300 g). NTHF increased NO levels in rat VSMCs. In anesthetized rats, NTHF induced hypotension and bradycardia after intravenous administration. These effects were attenuated after the administration of a sGC inhibitor, methylene blue. In the phenylephrine pre-contracted superior mesenteric artery of rats, NTHF (1 pM–10 μM) induced concentration-dependent vasodilatation in both the intact and removed endothelium. Furthermore, in the presence of NO° scavenging (C-PTIO and HDX) or ODQ, a sGC inhibitor, the vasorelaxation induced by NTHF was decreased. NTHF tolerance was evaluated in mesenteric artery rings previously exposed with isolated concentrations of the new organic nitrate. The vasorelaxant effect was not modified by exposure to nitrate. These results demonstrated that NTHF induced hypotension and bradycardia in vivo and a vasorelaxant effect with the participation of the NO-sGC-PKG pathway and triggering calcium-activated K⁺ channels without vascular tolerance induction. Full article

The microvessel neurovascular unit, with its brain endothelial cells (BEC) and blood–brain barrier remodeling, is important in the development of impaired cognition in sporadic or late-onset Alzheimer’s disease (LOAD), which is associated with aging and is highly prevalent in older populations (≥65 years of age). It is also linked with vascular dementia and vascular contributions to cognitive impairment and dementia, including cerebral amyloid angiopathy in neurodegeneration. LOAD is considered to be the number one cause of dementia globally; however, when one considers the role of mixed dementia (MD)—the combination of both the amyloid cascade hypothesis and the vascular hypothesis of LOAD—it becomes apparent that MD is the number one cause. Microvessel BECs are the first cells in the brain to be exposed to peripheral neurotoxins from the systemic circulation and are therefore the brain cells at the highest risk for early and chronic injury. Therefore, these cells are the first to undergo injury, followed by excessive and recurrent wound healing and remodeling processes in aging and other age-related diseases such as cerebrocardiovascular disease, hypertension, type 2 diabetes mellitus, and Parkinson’s disease. This narrative review explores the intricate relationship between microvessel remodeling, cerebral small vessel disease (SVD), and neurodegeneration in LOAD. It also discusses the current understanding of how microvessel dysfunction, disruption, and pathology contribute to the pathogenesis of LOAD and highlights potential avenues for therapeutic intervention. Full article

Background and Purpose: The cerebral circulation is highly regulated to maintain brain perfusion, keeping an equilibrium between the brain tissue, cerebrospinal fluid (CSF) and blood of the arterial and venous systems. Cerebral venous drainage abnormalities have been implicated in multiple cerebrovascular diseases. The purpose of this study is to evaluate the relationship between the arterial inflow (AI) and the cerebral venous outflow (CVO) and their correlation with the cardiac outflow in healthy adults and children to understand the role of the emissary veins in normal venous drainage. Materials and Methods: A total of 31 healthy volunteers (24 adults (39.5 ± 16.0) and seven children (3.4 ± 2.2)) underwent intracranial 4D flow with full circle of Willis coverage and 2D PC-MRI at the level of the transverse sinus for measurement of the AI and CVO, respectively. The AI was calculated as the sum of the flow values in the bilateral internal carotid and basilar arteries. The CVO was calculated as the sum of the flow values in the bilateral transverse sinuses. The cardiac outflow was measured via 2D PC-MRI with retrospective ECG gating with images acquired at the proximal ascending aorta (AAo) and descending (DAo) aorta. The ratios of the AI/AAo flow and CVO/AI were calculated to characterize the fraction of cerebral arterial inflow in relation to cardiac outflow and venous blood draining through the transverse sinuses, respectively. Results: The AI and CVO were significantly correlated (r = 0.81, p < 0.001). The CVO constituted approximately 60–70% of the AI. The CVO/AI ratio was significantly lower in children versus adults (p = 0.025). In adults, the negative correlation of the AI with age remained strong (r = −0.81, p < 0.001). However, the CVO was not significantly associated with age. Conclusion: The CVO/AI ratio suggests an important role of the emissary veins, accounting for approximately 30–40% of venous drainage. The lower CVO/AI ratio in children, although partially related to decreased AI with age, suggests a greater role of the emissary veins in childhood, which strongly decreases with age. Full article

Background/Objectives: Head and neck free-flap reconstructions are often required to treat tumors or extensive post-traumatic jaw defects. The facial artery is the standard receiving vessel for intraoral microvascular anastomoses. However, its use is associated with several disadvantages, such as lesions of buccal nerve branches of the facial nerve or the parotid duct, as well as variability in course and diameter. The aim of this study is to investigate whether branches of the sublingual artery can be considered as an alternative intraoral supply vessel to the facial artery to avoid these drawbacks. Methods: Twelve formalin-fixed cadaveric heads with 24 sides (n = 24) were dissected. The origin, course, branching pattern, and distribution of the sublingual artery were examined. In addition, the diameters of the branches of the sublingual artery were assessed to identify potential supply vessels for anastomoses. Results: In ten of the twenty-four cases (41.7%), the sublingual artery originated from the lingual artery, and in nine cases (37.5%), the lingual artery originated from the facial artery. The main trunk of the sublingual artery was present in the floor of the mouth in all cases (100%), with a diameter of ≥0.9 mm in vitro (1 mm in vivo). In 15 of the 24 half heads (62.5%), branches of the sublingual artery with ≥0.9 mm were identified in this space, with the main branch being considerably stronger. Conclusions: The large diameter of the sublingual artery in the floor of the mandible suggests that this vessel or its branches could be considered as alternative pedicles for intraoral anastomoses in mandibular microvascular free-flap grafts. Full article

The perivascular adipose tissue (PVAT) regulates the arterial tone by releasing vasoactive molecules. PVAT dysfunction favoring the vasorelaxation response could contribute to the development of kidney disease in metabolic syndrome (MetS). Previously, we demonstrated that overactivation of angiotensin II signaling in the PVAT deteriorates the compensatory PVAT effects in rats with MetS (SHRSP.Z-Lepr^fa/IzmDmcr (SPZF) and SHR/NDmcr-cp (CP) rats). Apelin is an endogenous regulator of angiotensin II. Therefore, we investigated whether changes in apelin levels in the PVAT alter PVAT function and impair kidney function in MetS. Twenty-three-week-old male and female SPZF and CP rats were used. In the female CP rats, apelin mRNA levels in renal arterial PVAT, enhancing effects of the PVAT on acetylcholine-induced relaxation in renal arteries, and estimated glomerular filtration rate (eGFR) were the highest, and urine protein levels and homeostasis model assessment of insulin resistance (HOMA-IR) were the lowest. Apelin mRNA levels were positively correlated with the enhancing effects of the PVAT on vasorelaxation and eGFR but negatively correlated with urine protein levels and HOMA-IR. Moreover, apelin levels positively correlated with mRNA levels of angiotensin-converting enzyme 2 and angiotensin II type 1 receptor-associated protein, which are negative regulators of angiotensin II. This study suggests that a decline in apelin levels in the PVAT, probably owing to angiotensin II, is associated with PVAT dysfunction on vascular tone, resulting in impaired kidney function in MetS. Full article

Purpose: This study investigated the impact of two different resistance training (RT) protocols on cardiac autonomic modulation during exercise recovery in trained individuals. It was hypothesized that a hypertrophic resistance training program would induce more significant stress and negatively affect cardiac autonomic modulation compared to a power/force resistance training program. Methods: Six healthy, trained participants (aged 18–40) were randomized in a crossover and controlled pilot study. Participants performed two RT protocols: (i) three sets of 10 repetitions with 85% of 10 RM, 60 s inter-set rest (3x10_60s) and (ii) eight sets of three repetitions with 85% of 3 RM, 120 s inter-set rest (8x3_120s). Heart rate variability (HRV) was measured before and 30 min after each RT session. Results: Significant reductions in HRV parameters (RMSSD, HF, and SD1) were observed following the 3x10_60s protocol (hypertrophic design) compared to baseline. Conversely, the 8x3_120s (power/force design) protocol did not show significant changes in HRV parameters. A significant interaction effect for time and RT protocol was found for all HRV measures with more significant reductions observed after 3x10_60s compared to 8x3_120s. Conclusions: The hypertrophic RT session (3x10_60s) significantly reduced HRV parameters, suggesting higher physiological stress and potentially negative implications for cardiac autonomic recovery than the power/force RT session (8x3_120s). These findings highlight the importance of considering exercise intensity and protocol design to manage cardiac autonomic stress during resistance training. Full article

Shear stress is one of the major hemodynamic forces acting on the endothelium. However, it is not well known how endothelial cells (EC) respond mechanically to these stimuli in vivo. Here we investigated whether changes in biomechanics properties and shear stress could increase cell susceptibility to injury, contributing to vascular fragility. We surgically implanted a shear stress modifier device on the carotid artery of ApoE-knockout mice (ApoE^−/−), which, due to its shape, causes a gradual stenosis in the vessel, resulting in distinct shear stress patterns. Our data show actin fibers accumulation in areas with higher lipid deposition in ApoE^−/−, indicating that dyslipidemia might interfere with EC actin cytoskeleton organization. We also showed that both shear stress and dyslipidemia were important for EC susceptibility to injury. Furthermore, lysosomal distribution, an important organelle for plasma membrane repair, was altered in ApoE^−/−, which could compromise EC’s ability to repair from damage. Therefore, dyslipidemia and variations in shear stress patterns not only affect cellular mechanics by compromising the actin cytoskeleton organization, but also enhance cell susceptibility to injury and alter vesicle trafficking in vascular cells. This may likely contribute to vascular fragility and thus to the initial steps of atherosclerosis development. Full article

The term “Transgender” is used to describe individuals whose gender identity is different from their external sexual anatomy at birth. The number of people identifying as transgender has increased in recent years, and consequently, the number of gender affirmation surgeries and the use of hormonal therapies has also increased. A wide range of hormonal therapies has emerged considering the target population, age, and final outcomes, and as such these are becoming increasingly developed and complex in order to be the most appropriate for each individual. However, the side effects of these therapies remain to be fully understood. Therefore, this review aims to assess the impact of hormone therapy, in both transgender men and women of different ages, on the lipid profile. From the studies analyzed, it is possible to conclude that there is a relationship between hormone therapy and the lipid profile, with different outcomes between transgender men and women. There is a reduction in cardiovascular risk for transgender women as opposed to transgender men, in whom cardiovascular risk seems to increase due to lipid changes. It is now necessary to understand the mechanisms involved in order to reduce the consequences of these therapies and promote positive health outcomes. Full article