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Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (15 January 2023) | Viewed by 33500

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Special Issue Editors

Prof. Dr. Dan Mircea Olinic

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Guest Editor

1. Internal Medicine Department, Medical Clinic no. 1, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
2. County Emergency Hospital Cluj-Napoca, 400000 Cluj-Napoca, Romania
Interests: vascular medicine; atherothrombosis; cardiology
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Agata Stanek

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Guest Editor

Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
Interests: physical medicine; thermal imaging; cryotherapy; cryogenic temperatures; vascular medicine; oxidative stress; rehabilitation; internal medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Vascular diseases have an increasing morbidity and mortality impact, related among others to population aging, socio-economic factors or increasing of risk-factors prevalence, such as diabetes. The ongoing Covid-19 pandemia is related to major vascular complications, both on the arterial and venous sites. Vascular medicine is not just a field of intense medical research, but has also become a distinct medical specialty or subspecialty in many countries. Vascular diseases involve peripheral arteries and veins, aorta and visceral abdominal vessels, as well as cervical vessels, such as carotids and vertebral arteries. Cardiac and cerebral complications are often related to vascular diseases. Coronary, carotid and peripheral arterial have common atherothrombotic etiology and share many clinical diagnostic, prognostic and therapeutic interrelations. Microcirculation is a field of increasing fundamental and clinical research interest, for both arterial and venous diseases. The research field in vascular diseases and vascular medicine is broad and opened to contribution from fundamental medicine (genetics, haemostasis, biochemistry e.g.) and clinical medicine. Diagnosis and therapy of vascular diseases are performed by medical, surgical and interventional procedures and specialists. The clinical research cover specific arterial and venous diseases, their specific impact on organ diseases, as well as the interrelationship among vascular diseases, at multiple sites. New drugs are developed for risk factors control (dyslipidemia, hypertension, diabetes, e.g.) or for antiplatelet and anticoagulant therapy, with a significantly benefic prognostic impact. Surgical revascularization at different arterial sites improves morbidity and mortality. Interventional procedures gain ground on both arterial and venous sites and prove safe and effective. The aim of this Special Issue is to offer an overview of the richness in vascular fundamental and clinical medicine, covering all aspects of the etiologic, diagnostic, prognostic and therapeutic research results.

Prof. Dr. Dan Mircea Olinic
Prof. Dr. Agata Stanek
Guest Editors

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Keywords

vascular diseases
etiology
diagnosis
prognosis
therapy

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Published Papers (13 papers)

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Editorial

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4 pages, 196 KiB

Open AccessEditorial

Vascular Diseases: Etiologic, Diagnostic, Prognostic, and Therapeutic Research

by Dan Mircea Olinic and Agata Stanek

Life 2023, 13(5), 1171; https://doi.org/10.3390/life13051171 - 12 May 2023

Cited by 2 | Viewed by 1228

Abstract

The impacts of vascular diseases (VD) include increased morbidity and mortality, which are related to factors such as population aging, socio-economics, or an increasing prevalence of risk factors, e [...] Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

Research

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13 pages, 793 KiB

Open AccessArticle

The rs2682826 Polymorphism of the NOS1 Gene Is Associated with the Degree of Disability of Erectile Dysfunction

by Leticia Perticarrara Ferezin, Cezar Kayzuka, Vitória Carolina Rondon Pereira, Murilo Ferreira de Andrade, Carlos Augusto Fernandes Molina, Silvio Tucci, Jr., Jose Eduardo Tanus-Santos and Riccardo Lacchini

Life 2023, 13(5), 1082; https://doi.org/10.3390/life13051082 - 25 Apr 2023

Cited by 2 | Viewed by 1802

Abstract

Erectile dysfunction (ED) is a common male disorder, often associated with cardiovascular disease and ageing. The Sildenafil, a PDE5 inhibitor, can improve the erectile function by prolonging the nitric oxide (NO) downstream effect. NO is a molecule of pivotal importance in erection physiology and is mainly produced by neuronal nitric oxide synthase (nNOS) and endothelial NO synthase (eNOS). While it has been shown that eNOS and nNOS genetic polymorphisms could be associated with Sildenafil responsiveness in ED, no study so far has assessed whether nNOS polymorphisms and PDE5A polymorphism could be associated with increased risk to ED or with intensity of symptoms. A total of 119 ED patients and 114 controls were studied, with evaluation of the clinical disability by the International Index for Erectile Function instrument, plasma assessment of nitrite levels and genomic DNA analysis regarding the rs41279104 and rs2682826 polymorphisms of the NOS1 gene and the rs2389866, rs3733526 and rs13124532 polymorphisms of the PDE5A gene. We have found a significant association of the rs2682826 with lower IIEF scores in the clinical ED group. While this result should be confirmed in other populations, it may be helpful in establishing a genetic panel to better assess disease risk and prognosis on ED therapy. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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14 pages, 3099 KiB

Open AccessArticle

ZJUSAH Classification: A New Classification for Primary Brainstem Hemorrhage

by Jingyi Zhou, An Ping, Jizhong Mao, Yichen Gu, Fengqiang Liu and Anwen Shao

Life 2023, 13(3), 846; https://doi.org/10.3390/life13030846 - 21 Mar 2023

Cited by 1 | Viewed by 2626

Abstract

To analyze and improve ZJUSAH classification for primary brainstem hematoma, we retrospectively reviewed 211 patients with primary brainstem hemorrhage who were admitted to our institution between January 2014 and October 2020. The primary clinical outcomes were the 30-day survival rate and 90-day consciousness recovery rate, which were evaluated using the National Institutes of Health Stroke Scale score. Univariate logistic regression and multivariate Cox regression analyses were performed to evaluate the prognostic model. The overall 30-day survival rate of the 211 patients was 69.7%. The 30-day survival rate was 95% among Type 1 patients, 77.8% among Type 2 patients, and 63.2% among Type 3 patients. The 90-day consciousness recovery rate was 63.2% among Type 1 patients, 61.9% among Type 2 patients, and 30.2% among Type 3 patients. Our findings suggest that ZJUSAH classification can be optimized according to hematoma volume, with Type 3 patients with a hematoma larger than 12.4 mL tending to have a worse state of consciousness. Additionally, we discovered that ZJUSAH classification is valuable in predicting 30-day survival rates in conservative treatment patients. In conclusion, our study established and optimized a new CT-based hematoma classification system for primary brainstem hematoma, which facilitates treatment selection and prognostic prediction. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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12 pages, 1283 KiB

Open AccessArticle

Age-Dependent Decline in Common Femoral Artery Flow-Mediated Dilation and Wall Shear Stress in Healthy Subjects

by Mariam Bapir, Gavrielle R. Untracht, Julie E. A. Hunt, John H. McVey, Jenny Harris, Simon S. Skene, Paola Campagnolo, Nikolaos Dikaios, Ana Rodriguez-Mateos, David D. Sampson, Danuta M. Sampson and Christian Heiss

Life 2022, 12(12), 2023; https://doi.org/10.3390/life12122023 - 4 Dec 2022

Cited by 6 | Viewed by 1986

Abstract

Femoral artery (FA) endothelial function is a promising biomarker of lower extremity vascular health for peripheral artery disease (PAD) prevention and treatment; however, the impact of age on FA endothelial function has not been reported in healthy adults. Therefore, we evaluated the reproducibility and acceptability of flow-mediated dilation (FMD) in the FA and brachial artery (BA) (n = 20) and performed cross-sectional FA- and BA-FMD measurements in healthy non-smokers aged 22–76 years (n = 50). FMD protocols demonstrated similar good reproducibility. Leg occlusion was deemed more uncomfortable than arm occlusion; thigh occlusion was less tolerated than forearm and calf occlusion. FA-FMD with calf occlusion was lower than BA-FMD (6.0 ± 1.1% vs 6.4 ± 1.3%, p = 0.030). Multivariate linear regression analysis indicated that age (−0.4%/decade) was a significant independent predictor of FA-FMD (R² = 0.35, p = 0.002). The age-dependent decline in FMD did not significantly differ between FA and BA (p_{interaction agexlocation} = 0.388). In older participants, 40% of baseline FA wall shear stress (WSS) values were <5 dyne/cm², which is regarded as pro-atherogenic. In conclusion, endothelial function declines similarly with age in the FA and the BA in healthy adults. The age-dependent FA enlargement results in a critical decrease in WSS that may explain part of the age-dependent predisposition for PAD. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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11 pages, 441 KiB

Open AccessArticle

Perioperative Prevention of Venous Thromboembolism in Abdominal Surgery Patients Based on the Caprini or the Padua Risk Score—A Single Centre Prospective Observational Study

by Jasna Klen, Gašper Horvat and Aleš Blinc

Life 2022, 12(11), 1843; https://doi.org/10.3390/life12111843 - 11 Nov 2022

Cited by 5 | Viewed by 2209

Abstract

Surgical patients should receive perioperative thromboprophylaxis based on risk assessment, and the Caprini score is validated for this purpose. Whether the Padua score, originally devised for medical patients, can be useful in surgical patients remains to be fully clarified. This study aimed to evaluate perioperative thromboprophylaxis based on the Caprini or the Padua score in elective abdominal surgery. A total of 223 patients undergoing elective abdominal surgery for malignant or benign disease were prospectively evaluated. The patients were divided into two groups in which thromboprophylaxis was prescribed according to either the Caprini score (n = 122) or the Padua score (n = 101). Patients with high-risk scores in both groups received nadroparin. The alternate risk score in each group was calculated for evaluation purposes only. During a 3-month follow-up, we assessed patients for symptomatic venous thromboembolism (VTE), bleeding, or mortality. In the Caprini score group, 87 patients (71%) had a high risk for VTE (≥5 points), while 38 patients (38%) had a high risk for VTE (≥4 points) in the Padua score group; p < 0.00001. The overall correlation between the Caprini and Padua scores was moderate (r= 0.619), with 85 patients having high Caprini and discordant Padua scores. Ten patients died during follow-up (4.5%), and five developed non-fatal symptomatic VTE (2.2%). Among the five major bleeding incidents recorded (1.8%), two cases were possibly associated with pharmacological thromboprophylaxis. The incidence of adverse outcomes did not differ between the two groups. The odds ratio for adverse outcomes was significantly higher with a high Caprini or Padua risk score, malignant disease, age ≥65 years, and active smoking. We found no significant differences in adverse outcomes between abdominal surgical patients who received perioperative thromboprophylaxis based on either the Caprini or the Padua risk score. However, a discordant Padua score was noted in almost 40% of patients who had a high Caprini score, suggesting that the latter may be more sensitive than the Padua score in surgical patients. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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10 pages, 1406 KiB

Open AccessArticle

Influence of Different Types of Retinal Cameras on the Performance of Deep Learning Algorithms in Diabetic Retinopathy Screening

by Ramyaa Srinivasan, Janani Surya, Paisan Ruamviboonsuk, Peranut Chotcomwongse and Rajiv Raman

Life 2022, 12(10), 1610; https://doi.org/10.3390/life12101610 - 15 Oct 2022

Cited by 6 | Viewed by 1758

Abstract

Background: The aim of this study was to assess the performance of regional graders and artificial intelligence algorithms across retinal cameras with different specifications in classifying an image as gradable and ungradable. Methods: Study subjects were included from a community-based nationwide diabetic retinopathy screening program in Thailand. Various non-mydriatic fundus cameras were used for image acquisition, including Kowa Nonmyd, Kowa Nonmyd α-DⅢ, Kowa Nonmyd 7, Kowa Nonmyd WX, Kowa VX 10 α, Kowa VX 20 and Nidek AFC 210. All retinal photographs were graded by deep learning algorithms and human graders and compared with a standard reference. Results: Images were divided into two categories as gradable and ungradable images. Four thousand eight hundred fifty-two participants with 19,408 fundus images were included, of which 15,351 (79.09%) were gradable images and the remaining 4057 (20.90%) were ungradable images. Conclusions: The deep learning (DL) algorithm demonstrated better sensitivity, specificity and kappa than the human graders for all eight types of non-mydriatic fundus cameras. The deep learning system showed, more consistent diagnostic performance than the human graders across images of varying quality and camera types. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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11 pages, 599 KiB

Open AccessArticle

Increased Carotid Intima-Media Thickness in Asymptomatic Individuals Is Associated with the PCSK9 (rs2149041) Gene Polymorphism in the Mexican Mestizo Population: Results of the GEA Cohort

by Rosalinda Posadas-Sánchez, Gilberto Vargas-Alarcón, Óscar Pérez-Méndez, Nonanzit Pérez-Hernández and José Manuel Rodríguez-Pérez

Life 2022, 12(10), 1531; https://doi.org/10.3390/life12101531 - 30 Sep 2022

Cited by 3 | Viewed by 1508

Abstract

The increase in carotid intima-media thickness (CIMT) and coronary artery calcification (CAC) are features of subclinical atherosclerosis that might be determined by the genetic background of patients. Among the multiple risk factors, the proprotein convertase subtilisin kexin type 9 (PCSK9) has a great impact on atheroma development. Then, we focused on the potential association of the PCSK9 gene polymorphism (rs2149041) with the risk of an increased CIMT. We included 881 unrelated, asymptomatic individuals (732 normal CIMT and 149 increased CIMT) who lacked coronary calcification (CAC score = 0). Under the recessive inheritance model and adjusted by several cardiovascular risk factors, the rs2149041 polymorphism, determined by TaqMan genotyping assay, was associated with a high risk of increased CIMT (OR = 2.10, 95% IC = 1.26–3.47, P recessive = 0.004). Our results suggest that the rs2149041 polymorphism could be a risk marker for increased CIMT in asymptomatic individuals without coronary artery disease determined by the absence of a CAC score. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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14 pages, 642 KiB

Open AccessArticle

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia

by Emil Marian Arbănași, Adrian Vasile Mureșan, Cătălin Mircea Coșarcă, Réka Kaller, Theodor Ioan Bud, Ioan Hosu, Septimiu Toader Voidăzan, Eliza Mihaela Arbănași and Eliza Russu

Life 2022, 12(6), 822; https://doi.org/10.3390/life12060822 - 31 May 2022

Cited by 29 | Viewed by 3343

Abstract

Acute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study with longitudinal follow-up aimed to confirm the relevance of the preoperative inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the 30-day poor prognosis of patients with Rutherford classification (RC) grades II and III ALI. The ROC analysis found a strong association of an NLR > 4.33 with all studied outcomes, while a PLR > 143.34 was associated with all studied outcomes, except the composite endpoint in all RC stages. Depending on the optimal cut-off value, the ROC analysis found a higher incidence of all adverse outcomes in all high NLR (>4.33) and high PLR (>143.34) groups. A multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of amputation (OR:11.09; 95% CI: 5.48–22.42; p < 0.0001; and OR:8.97; 95% CI: 4.44–18.16; p < 0.0001), mortality (OR:22.24; 95% CI: 9.61–51.47; p < 0.0001; and OR:8.32; 95% CI: 3.90–17.73; p < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91–60.79; p < 0.0001; and OR:9.98; 95% CI: 3.89–25.55; p < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73–14.26; p < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73–14.26; p < 0.0001), mortality (OR:8.40; 95% CI: 4.08–17.31; p < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48–25.56; p < 0.0001), respectively. The NLR and PLR are excellent predictors of risks associated with ALI for primary and secondary prevention. Our study showed that increased pre-operative values for NLR and PLR are indicators of a poor outcome in patients with RC grades II and III ALI. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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16 pages, 1362 KiB

Open AccessArticle

Atherosclerosis and Its Impact on the Outcomes of Patients with Deep Venous Thrombosis

by Karsten Keller, Jürgen H. Prochaska, Meike Coldewey, Sebastian Göbel, Volker H. Schmitt, Omar Hahad, Alexander Ullmann, Markus Nagler, Heidrun Lamparter, Christine Espinola-Klein, Thomas Münzel and Philipp S. Wild

Life 2022, 12(5), 734; https://doi.org/10.3390/life12050734 - 14 May 2022

Cited by 2 | Viewed by 3097

Abstract

Introduction: Atherosclerosis and pulmonary embolism (PE) affect cardiovascular mortality substantially. We aimed to investigate the impact of atherosclerosis on the outcomes of patients with deep venous thrombosis (DVT) and to identify the differences in DVT patients with and without PE. Methods: Patients with DVT with and without symptomatic atherosclerosis (defined as coronary artery disease, myocardial infarction and/or peripheral artery disease) as well as with and without PE under oral anticoagulation were enrolled during January 2011–April 2013 and compared. The impact of symptomatic atherosclerosis on several outcomes was analyzed. Results: Overall, 509 DVT patients (70.0 [56.0–77.0] years, 51.9% females) were included in this study. Among them, 179 (36.3%) had symptomatic atherosclerosis and 204 (40.1%) a concomitant PE. DVT patients with symptomatic atherosclerosis were older (74.0 [IQR 65.0–80.0] vs. 63.0 [48.0–75.0] years, p < 0.0001), more often male (56.4% vs. 43.9%, p = 0.0087) and had a higher prevalence of classical CVRF and a higher Charlson comorbidity index (7.00 [5.00–8.00] vs. 4.00 [2.00–6.00], p < 0.001). Symptomatic atherosclerosis was associated with increased mortality (HR 1.98 [95%CI 1.12–3.49], p = 0.018) and hospitalizations (HR 1.64 [95%CI 1.21–2.21], p = 0.0012) and primary long-term outcome (HR 1.99 [95%CI 1.31–3.04], p = 0.0013) during the 2 years follow-up-period in DVT patients. DVT patients without PE had diabetes mellitus (28.2% vs. 16.3%, p < 0.01) and symptomatic atherosclerosis (42.9% vs. 26.4%, p < 0.001) more often compared to DVT patients with PE, and symptomatic atherosclerosis was associated with isolated DVT (without PE) (OR 2.01 [95%CI 1.28–3.16], p < 0.01). Conclusions: Atherosclerosis was associated with isolated DVT (without PE) and increased mortality in DVT patients under oral anticoagulation. The profile of CVRF and comorbidities differed between DVT patients with and without a concomitant PE. In the case of DVT or PE, patients should be screened for concomitant atherosclerotic disease. Clinical Trial Registration: at clinicaltrials with Unique identifier NCT01809015. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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Review

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11 pages, 2110 KiB

Open AccessReview

Bleeding Risk in Patients with Peripheral Arterial Disease

by Adriana Visonà, Chiara Zurlo, Chiara Panzavolta, Annachiara Gobbo and Beniamino Zalunardo

Life 2023, 13(1), 47; https://doi.org/10.3390/life13010047 - 23 Dec 2022

Cited by 1 | Viewed by 3069

Abstract

Patients with peripheral arterial disease (PAD) are at high risk of major adverse cardiac events (MACE) and major adverse limb events (MALE). Recently, antithrombotic therapies employing antiplatelet and anticoagulant drugs have proven to be valid in reducing MACE in patients with PAD and polyvascular disease and MALE, particularly in patients who have already been revascularized and remain at increased risk of MALE. However, more aggressive antithrombotic therapies lead to an increased risk of bleeding. Antithrombotic therapy and revascularization procedures entail an increased hemorrhagic risk that is also linked to having received more vigorous antithrombotic therapies. Therefore, it appears crucial to have specifically targeted scores for a PAD patient to assess bleeding and thrombotic risks. The correct utilization of a risk score will determine the variable risk factors for bleeding that can be corrected or modified, as well as identify patients at high risk that require regular reexamination and follow-up. Clinical risk scores do not represent the absolute reality, and inter-score variability must be taken into account. Moreover, several risk scores have been created to be basic and to facilitate and improve clinical decisions in daily practice. Many risk scores based on points vary according to the configuration of the studies, population type, and ethnic group, and many of the risk factor elements in a specific score are unlikely to sustain same weight for that risk. The best approach continues to be devising an uncomplicated, functional, validated, and precise score that can be adjusted to different clinical contexts and populations, while considering the mutable composition of clinical risk. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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13 pages, 2186 KiB

Open AccessReview

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions

by Alexandru Achim, Orsolya Ágnes Péter, Kornél Kákonyi, Viktor Sasi, Attila Nemes, Călin Homorodean, Agata Stanek, Dan Mircea Olinic and Zoltán Ruzsa

Life 2023, 13(1), 25; https://doi.org/10.3390/life13010025 - 22 Dec 2022

Cited by 14 | Viewed by 4972

Abstract

In an effort to refine transcatheter vascular interventions, radial artery access has moved more distally at the anatomical snuffbox. Here, more challenges appear as the artery is smaller, more angulated, and more difficult to palpate. Including ultrasound guidance as a mandatory step during puncture may encourage more operators to switch to this approach. In the femoral approach, ultrasound guidance is strongly recommended because of bleeding complications, whereas in the proximal (conventional) radial approach, the role of ultrasound remains optional, and in current practice, almost all cases are performed by palpation of the pulse only. However, in distal radial access, the situation is different because the artery differs in caliber and position, and imaging can help the operator for a clean puncture, especially since repeated punctures are not only painful but also any hematoma formation leads to the complete compression of the artery and failure of access. The aim of this review is to investigate the rationale of vascular ultrasound during distal radial access and to establish some techniques and anatomical landmarks for the ultrasonographic exploration of the dorsal area of the hand. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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12 pages, 1241 KiB

Open AccessBrief Report

Patterns of Care in Patients with Basilar Artery Occlusion (BAO): A Population-Based Study

by Mudassir Farooqui, Asad Ikram, Sajid Suriya, Fares Qeadan, Piotr Bzdyra, Syed A. Quadri and Atif Zafar

Life 2023, 13(3), 829; https://doi.org/10.3390/life13030829 - 19 Mar 2023

Cited by 2 | Viewed by 2085

Abstract

Basilar artery occlusion (BAO) is associated with high morbidity and mortality. Endovascular therapy (EVT) has been shown to be beneficial in acute BAO patients. This retrospective observational study used the National Inpatient Sample (NIS) database to identify BAO patients using the International Classification of Diseases (ICD). Multivariable models were used to evaluate the association of risk factors, comorbidities, length of stay (LOS) in hospital, total cost, disposition, and transfer status. A total of 1120 (447 females, 39.95%) patients were identified, with a higher proportion of White individuals (66.8% vs. 57.6%), atrial fibrillation (31.5% vs. 17.2%; p < 0.0001), and peripheral vascular disease (21.2% vs. 13.7%; p = 0.009). A lower proportion of individuals with diabetes mellitus (32.1% vs. 39.5%; p = 0.05) was found in the EVT group. Majority of the patients (924/1120, 82.5%) were treated at the urban teaching facility, which also performed most of the EVT procedures (164, 89.13%), followed by non-academic urban (166, 14.8%) and rural (30, 2.7%) hospitals. Most patients (19/30, 63%) admitted to rural hospitals were transferred to other facilities. Urban academic hospitals also had the highest median LOS (8.9 days), cost of hospitalization (USD 117,261), and disposition to home (32.6%). This study observed distinct patterns and geographical disparities in the acute treatment of BAO patients. There is a need for national- and state-level strategies to improve access to stroke care. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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6 pages, 1407 KiB

Open AccessCase Report

Prone Positioning May Improve the Treatment of Diffuse Alveolar Hemorrhage and Severe Acute Respiratory Distress Syndrome (ARDS) Secondary to ANCA Associated Vasculitis: A Case Report

by Shang-Ju Wu, Yong-Chen Hsu, Kao-Lun Wang and Pin-Kuei Fu

Life 2022, 12(2), 235; https://doi.org/10.3390/life12020235 - 3 Feb 2022

Cited by 2 | Viewed by 2417

Abstract

Diffuse alveolar hemorrhage (DAH) secondary to anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is rare in clinical practice and may present as severe acute respiratory distress syndrome (ARDS) with high mortality. Extracorporeal membrane oxygenation (ECMO) has been reported to be a salvage treatment providing the time necessary for immunosuppressive treatment in cases accompanied by severe ARDS. Prone positioning (PP) has been proven to reduce the mortality in patients with severe ARDS. However, there is no consensus about choosing PP or ECMO in severe ARDS due to DAH secondary to ANCA-associated vasculitis. We reported a case of microscopic polyangiitis (MPA)-related DAH and severe ARDS treated with PP successfully providing the time necessary for early glucocorticoids and plasma exchange to control the underlying disease. Since anticoagulation therapy is not necessary in PP, it does not increase the risk of bleeding tendency unlike ECMO. PP has a life-saving role in the management of patients with severe ARDS due to ANCA-associated pulmonary vasculitis. Full article

(This article belongs to the Special Issue Vascular Disease: Etiologic, Diagnostic, Prognostic and Therapeutic Research)

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