Un caso complejo de isquemia mesentérica crónica: Reporte de caso y revisión de la literatura / A complex case of chronic mesenteric ischemia: Case report and literature review

Introducción. La isquemia mesentérica crónica es una entidad infrecuente, con una prevalencia de 0,03 %, donde más del 90 % son debidas a enfermedad arterioesclerótica que compromete principalmente la arteria mesentérica superior. Sus síntomas son dolor abdominal crónico y pérdida de peso, asociado a alteraciones imagenológicas que hacen el diagnóstico. El tratamiento depende de las condiciones clínicas del paciente y el número de vasos comprometidos. Es claro que la enfermedad multivaso sintomática requiere revascularización. Caso clínico. Mujer de 67 años, fumadora activa con antecedentes de hipertensión arterial y dislipidemia, con cuadro de crisis hipertensiva tipo urgencia que requirió manejo en Unidad de Cuidados Intensivos. Se hizo diagnóstico de aneurisma toracoabdominal Crawford IV, oclusión aorto-ilíaca (TASC D) y oclusión crónica del tronco celíaco y la arteria mesentérica superior. Por los síntomas de isquemia mesentérica crónica fue llevada a tratamiento quirúrgico con baipás aorto-bifemoral más baipás retrógrado a la arteria mesentérica superior por vía abierta. Resultado. La paciente tuvo mejoría de la sintomatología y aumentó 13 % del peso al seguimiento a los 3 meses. Conclusión. La isquemia mesentérica crónica es una condición subdiagnosticada, marcador de riesgo cardiovascular, con alta carga de morbilidad y mortalidad, en la cual, con una identificación temprana se puede ofrecer una terapia de revascularización, sea por vía endovascular o abierta, con el fin de mejorar la calidad de vida y la ganancia de peso, y evitar la necrosis intestinal.

Introduction. Chronic mesenteric ischemia is a rare entity, with a prevalence of 0.03%, where more than 90% are due to arteriosclerotic disease that mainly affects the superior mesenteric artery. Its symptoms are chronic abdominal pain and weight loss, associated with imaging alterations that make the diagnosis. Treatment depends on the patient's clinical conditions and the number of vessels involved. It is clear that symptomatic multivessel disease requires revascularization. Clinical case. A 67-year-old woman, an active smoker with a history of high blood pressure and dyslipidemia, presented with an emergency-type hypertensive crisis that required management in the Intensive Care Unit. A diagnosis of Crawford IV thoracoabdominal aneurysm, aorto-iliac occlusion (TASC D), and chronic occlusion of the celiac trunk and superior mesenteric artery was made. Due to the symptoms of chronic mesenteric ischemia, she underwent surgical treatment with aorto-bifemoral bypass plus retrograde bypass to the superior mesenteric artery via an open approach. Result. The patient had improvement in symptoms and gained 13% weight at 3-month follow-up. Conclusion. Chronic mesenteric ischemia is an underdiagnosed condition, a marker of cardiovascular risk, with a high burden of morbidity and mortality, in which, with early identification, revascularization therapy can be offered, either endovascularly or open, in order to improve quality of life and weight gain, and avoiding intestinal necrosis.

Systematic evaluation and network meta-analysis of different cell therapies in the treatment of critical limb ischemia / 中国药房

OBJECTIVE To systematically evaluate the efficacy and safety of the four most common cell therapies， namely purified CD34+ （PCCs）， bone marrow mononuclear cells （BMMNCs）， bone marrow mesenchymal stem cells （BMMSCs） and peripheral blood mononuclear cells （PBMNCs） in the treatment of critical limb ischemia （CLI）. METHODS PubMed， Scopus， Embase， Cochrane Central Register of Controlled Trials （CENTRAL） and Web of Science databases were searched from the establishment of each database to June 2023 to collect randomized controlled trials （RCTs） comparing the efficacy and safety of four different cell therapies， namely PCCs， BMMNCs， BMMSCs and PBMNCs， with other cell therapies or standard therapy （ST） in the treatment of CLI. The outcomes indexes included amputation rate， ankle-brachial index （ABI）， transcutaneous oxygen partial pressure （TCPO2）， ulcer healing rate， pain-free walking distance （PFWD） and angiogenesis. After data extraction from clinical studies that met the inclusion criteria， the RoB 2.0 tool was used to assess the risk of bias， and Stata 15.0 software was used for statistical analysis. RESULTS Meta-analysis included 22 studies， involving 1 318 patients. The treatment groups involved 4 types of cell therapies， namely PCCs，BMMNCs， BMMSCs， and PBMNCs. Network meta-analysis showed that the amputation rates of the four cell therapies groups were lower than that of ST group， and only the difference in PBMNCs group was statistically significant（P＜0.05）. Four cell interventions were better than ST in improving ABI （P＜0.05）， and BMMNCs had the most significant effect on improving ABI. PBMNCs and BMMNCs groups had statistically significant differences in improving TCPO2， compared with ST group and BMMSCs group （P＜0.05）. Four cell interventions were better than ST in improving ulcer healing rate， among which BMMNCs group had no statistical difference with ST group （P＞0.05）； ulcer healing rates of the other three groups were higher than that of ST group （P＜0.05）， and those of PBMNCs and BMMSCs groups were significantly higher than that of BMMNCs group （P＜ 0.05）. BMMSCs group had a significantly better effect on improving the PFWD of patients than the ST group after transplantation， with statistical significance （P＜0.05）， but there was no significant difference in PBMNCs and BMMNCs groups compared with ST group （P＞0.05）. The three cell therapies of BMMSCs， BMMNCs and PBMNCs had a significantly better effect on angiogenesis than the ST group， and the BMMSCs group had a significantly better effect than the BMMNCs and PBMNCs groups， with statistical significance （P＜0.05）. CONCLUSIONS The four cell therapies can improve the prognosis of CLI patients to varying degrees. PBMNCs show the lowest amputation rate after transplantation and have the most significant effect on improving TCPO2 and improving the ulcer healing rate. BMMNCs possess the most significant effect on improving ABI. BMMSCs represent obvious advantages in PFWD and angiogenesis.

Duplex ultrasound and pedal acceleration time as tools to evaluate foot perfusion: a literature review / Ultrassonografia dúplex e tempo de aceleração plantar como ferramentas para avaliar a perfusão do pé: uma revisão da literatura

Abstract Currently, the standard non-invasive test for diagnosing Peripheral Arterial Disease is the Ankle-Brachial Index. However, this test becomes unfeasible in a certain population. New evidence proposes the pedal acceleration time, an ultrasound index, as an alternative test. An integrative bibliographic review was carried out between June 3, 2022 and January 8, 2023, to investigate this new index as a tool to assess foot perfusion. Papers published in English, Portuguese, or Spanish between 2012 and 2022 were searched on PubMed, Google Scholar, and Scielo, using the keywords "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Research that didn't assess foot perfusion using the methods of interest or did not present human data and also case series or reports were excluded. Seven out of the sixty-six articles identified in the searches were selected for the review, all of which had notable methodological limitations. Pedal acceleration time seems to be able to diagnose and stratify and may reflect prognosis.

Resumo Atualmente, o teste não invasivo padrão para diagnosticar a doença arterial periférica é o índice tornozelo-braquial, porém, em uma determinada população, este torna-se inviável. Novas evidências propõem o tempo de aceleração plantar, que é um índice ultrassonográfico, como alternativa. Para investigá-lo no contexto do estudo da perfusão do pé, uma revisão bibliográfica integrativa foi realizada entre 03/06/2022 e 08/01/2023. Artigos em inglês, português ou espanhol, publicados entre 2012 e 2022 foram pesquisados através das ferramentas PubMed, Google Scholar e SciELO, com as palavras-chave "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Pesquisas que não avaliaram a perfusão do pé pelos métodos de interesse, sem dados em humanos e relatos ou séries de casos, foram excluídos. Dos 66 artigos, 7 foram selecionados; todos com notáveis limitações metodológicas. O tempo de aceleração plantar aparenta ser capaz de diagnosticar, estratificar e prognosticar os doentes.

Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease.

Relação entre o índice de resistência vascular e o sucesso hemodinâmico de revascularizações distais dos membros inferiores / Vascular resistance index and the immediate hemodynamic success of lower limb distal artery revascularization

Resumo Contexto A cirurgia de revascularização é proposta para restaurar o fluxo sanguíneo para o pé nos casos de isquemia crítica (IC) devido a doença arterial obstrutiva periférica dos membros inferiores (MMII). O uso de ultrassonografia com Doppler (USD) vem despontando nos últimos anos como um método de grande valor para o planejamento cirúrgico dessa intervenção. Objetivos Avaliar a relação entre o índice de resistência (IR), mensurado por meio de USD, e o sucesso hemodinâmico imediato da cirurgia de revascularização dos MMII em pacientes com IC. Métodos O tipo de estudo empregado foi a coorte prospectiva, na qual foram avaliados 46 pacientes portadores de IC dos MMII submetidos à operação de revascularização infrainguinal por angioplastia ou em ponte de agosto de 2019 a fevereiro de 2022. Todos os pacientes foram submetidos à avaliação clínica vascular, à USD com medida do IR das artérias distais dos MMII, à arteriografia dos MMII e à aferição do índice tornozelo-braquial (ITB) no período pré-operatório. No pós-operatório imediato, todos os pacientes foram submetidos à nova aferição do ITB. Resultados Entre os 46 pacientes avaliados, 25 (54,3%) eram do sexo masculino. A idade variou de 32 a 89 anos (média de 67,83). Quanto ao sucesso hemodinâmico, avaliado pela comparação do ITB pré e pós-operatório, constatou-se que 31 (67,4%) pacientes apresentaram sucesso hemodinâmico após cirurgia de revascularização (aumento do ITB em 0,15 ou mais). Foi observada correlação positiva (p ≤ 0,05) entre o IR da artéria distal revascularizada do MMII e o sucesso hemodinâmico imediato avaliado pela aferição do ITB (IR menor e sucesso hemodinâmico). Conclusões Na presente pesquisa foi observada uma correlação positiva entre o índice de resistência arterial distal e o sucesso hemodinâmico nas revascularizações dos membros inferiores, avaliada através do índice tornozelobraquial, de forma que, quanto menor foi o IR, maior o sucesso hemodinâmico obtido.

Abstract Background Revascularization surgery is used to attempt to restore blood flow to the foot in patients with critical ischemia (CI) caused by peripheral arterial occlusive disease of the lower limbs (LL). Ultrasonography with Doppler (USD) SAH emerged in recent years as a highly valuable method for planning this surgical intervention. Objectives To evaluate the relationship between the resistance index (RI), measured with USD, and immediate hemodynamic success of LL revascularization surgery in patients with CI. Methods The study design was a prospective cohort assessing 46 patients with LL CLI who underwent operations to perform infrainguinal revascularization by angioplasty or bypass from August 2019 to February 2022. All patients underwent preoperative clinical vascular assessment with USD including measurement of the RI of distal LL arteries, LL arteriography, and measurement of the ankle-brachial index (ABI). All patients had their ABI measured again in the immediate postoperative period. Results Forty-six patients were assessed, 25 (54.3%) of whom were male. Age varied from 32 to 89 years (mean: 67.83). Hemodynamic success was assessed by comparison of preoperative and postoperative ABI, showing that hemodynamic success was achieved in 31 (67.4%) patients after revascularization surgery (ABI increased by 0.15 or more). A positive correlation (p ≤ 0.05) was observed between the RI of the distal revascularized LL artery and immediate hemodynamic success assessed by ABI (lower RI and hemodynamic success). Conclusions This study observed a positive correlation between the resistance index of the distal artery and immediate hemodynamic success of lower limb revascularizations, as assessed by the ankle-brachial index, so that the lower the RI the greater the hemodynamic success achieved.

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores / Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p< 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p < 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

Abstract Background Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Comparação entre ecografia vascular com Doppler e exames contrastados na doença arterial crônica periférica / Comparison between vascular Doppler ultrasound and contrast exams in chronic peripheral arterial disease

Resumo Contexto A ecografia vascular com Doppler (EVD) evoluiu nos últimos anos devido ao aprimoramento da tecnologia de aquisição e processamento da imagem. A disponibilidade do exame, o baixo custo e a ausência de efeitos deletérios de radiação e contraste tornam este método uma excelente opção no diagnóstico da doença arterial periférica. As quebras nas cadeias de suprimentos devido à pandemia de covid-19 levaram a uma escassez global de contraste iodado, reforçando a importância de validar abordagens alternativas. Objetivos Utilizar a EVD na decisão entre cirurgia aberta ou endovascular para doença arterial femoropoplítea e comparar os resultados com exames de contraste iodado. Métodos Comparamos EVD com exames contrastados (angiotomografia e arteriografia) em relação à localização de estenoses/oclusões e indicação do tratamento cirúrgico (by-pass vs. endovascular). Em uma primeira fase, os resultados foram apenas comparados entre EVD e angiotomografia. Numa segunda fase, os resultados da EVD foram usados na triagem entre by-pass vs. endovascular), sendo comparados com angiotomografia nos casos de cirurgia aberta e comparados com a arteriografia nos casos de tratamento endovascular. Resultados A sensibilidade da EVD em comparação com a angiotomografia na fase 1 foi de 100% para o território da artéria femoral superficial. Ao considerar apenas a indicação de by-pass versus endovascular, os resultados mostraram 100% de concordância para a Fase 1 e 94% para a Fase 2. Conclusões Com a ressalva do tamanho amostral, o estudo cumpriu seu objetivo de demonstrar a confiabilidade da EVD na indicação do tratamento cirúrgico entre aberto ou endovascular.

Abstract Background Vascular Doppler ultrasound (DUS) has evolved over recent years because of improvements in the technology involved in the acquisition and processing of sound and image data. The method is an excellent option for use in diagnosis of peripheral arterial disease considering its availability, low cost, and absence of harmful effects. The breakdown of logistics supply chains caused by the COVID-19 pandemic caused worldwide shortages of iodinated contrast, highlighting the need to validate alternative diagnostic methods. Objective To use DUS for decision-making when choosing between by-pass and endovascular surgery for femoropopliteal arterial disease and compare the results to those of iodinated contrast exams. Methods We compared DUS with examinations using contrast for identification of stenoses/occlusions and indication of surgical treatment (by-pass vs. endovascular). In the first phase of the study the results were merely compared, DUS vs. angiotomography. Then, in the second phase, the vascular ultrasound results were used for screening between by-pass and endovascular treatment, comparing DUS with angiotomography in cases scheduled for by-pass and with arteriography in endovascular patients. Results In phase 1, the sensitivity of DUS compared to CT angiography was 100% for the SFA territory. When considering solely the choice of bypass vs. endovascular treatment, the results showed 100% agreement for phase 1 and 94% for phase 2. Conclusion Notwithstanding the sample size, the study fulfilled its objective of demonstrating the reliability of DUS for indicating the treatment choice between by-pass and endovascular surgery.

Biocellulose-based hydrogel dressing as a strategy for the management of chronic arterial wounds

Purpose: To evaluate using a biocellulose-based hydrogel as an adjuvant in the healing process of arterial ulcers. Methods: A prospective single group quasi-experimental study was carried out with chronic lower limb arterial ulcer patients. These patients received biocellulose-based hydrogel dressings and outpatient guidance on dressing and periodic reassessments. The primary outcomes were the ulcer-healing rate and product safety, which were assessed by ulcer area measured in photographic records of pre-treatment and posttreatment after 7, 30, and 60 days. Secondary outcomes were related to clinical assessment by the quality-of-life scores (SF-36 and EQ-5D) and pain, evaluated by the visual analogue scale (VAS). Results: Seventeen participants were included, and one of them was excluded. Six patients (37%) had complete wound healing, and all patients had a significant reduction in the ulcer area during follow-up (233.6mm2 versus 2.7mm2) and reduction on the score PUSH 3.0 (p < 0.0001). The analysis of the SF-36 and EQ-5D questionnaires showed a statistically significant improvement in almost all parameters analyzed and with a reduction of pain assessed by the VAS. Conclusions: The biocellulose-based hydrogel was safe and showed a good perspective to promoting the necessary conditions to facilitate partial or complete healing of chronic arterial ulcers within a 60-day follow-up. Quality of life and pain were positively affected by the treatment.

Enfermedad arterial periférica en población trabajadora: factores de riesgo y estilo de vida

Introducción: La Enfermedad Arterial Periférica (EAP) es definida como la oclusión de las arterias de las extremidades, se reconoce como la tercera causa de morbilidad vascular aterosclerótica, después del infarto agudo de miocardio y el accidente cerebrovascular. Aunque las enfermedades cardiovasculares se han relacionado con la ocupación, la información sobre la relación entre el trabajo con la EAP es escasa. Objetivo: Identificar la prevalencia de EAP en población laboralmente activa y su relación con variables sociodemográficas, clínicas y estilo de vida. Metodología: Se realizó un estudio analítico de tipo transversal, en 203 sujetos de 40 años o más, laboralmente activos de Popayán. Tras la firma del consentimiento, se realizó una entrevista, y se registraron las variables sociodemográficas y clínicas. Para el tamizaje de EAP se evaluó el índice tobillo brazo (ITB). Los participantes se clasificaron en categorías basadas en el ITB de la siguiente manera: EAP ≤ 0,90; 0,91 a 0,99 normal; y no compresible > 1,40. Los datos fueron analizados con el programa SPSS versión 26.0, se aplicó la prueba de Kolmogorov-Smirnov como prueba de normalidad, la t Student para evaluar diferencias de medias entre los grupos de estudio y la prueba de Chi-cuadrado. Resultados y discusión: La prevalencia fue del 2,5 % para EAP, siendo el primer estudio reportado para población trabajadora en Colombia. La EAP fue más prevalente en empleados manuales (2,8 %) e ingresos bajos (30 %); además, fueron obesos y fumadores. El riesgo encontrado para edad fue OR 1,5; IC95 % 1,17 a 2,14, género OR 1,2; IC95 % 1,20 a 3,28 y DM2 OR 1,5; IC95 % 1,23 a 6,68. Conclusión: Se estableció por primera vez la prevalencia de EAP (2,5 %) en una población laboralmente activa de Popayán, siendo más prevalente en los individuos con ingresos bajos, expuestos a factores de riesgo cardiovascular y con antecedente familiar de DM2.

Introduction: The Peripheral Arterial Disease (PAD) is defined as the occlusion of the extremities' arteries, and it is known to be the third vascular atherosclerotic cause of death after acute myocardial infarction and brain stroke. Even though cardiovascular diseases had been linked to occupation, information about the relation between PAD and labor activity runs short. Objective: To identify the PAD prevalence in the working population and its relationship with sociodemographic, clinical and lifestyle variables. Methodology: A cross-sectional analytical study was conducted in 203 people of >40 years, actively working in the city of Popayán. After consent signing, interviews were completed to record such variables. PAD testing was evaluated through Ankle-Brachial Index (ABI). Participants were grouped into categories based on ABI as follows: PAD ≤0.90; normal 0.91 to 0.99; and non-compressible >1.40. Collected data was analyzed in SPSS version 26.0, applying Kolmogorov-Smirnov test as the normal; t Student test to evaluate mean differences between study groups and Chi-square. Results and discussion: PAD prevalence was 2.5 % being the very first report done for Colombia's working class. PAD was prevalent for manual-labor employees (2.8 %), low-income people (30 %), adding obesity and smoking to their profile. Age risk found was (OR 1.5; IC 95 % 1.17 to 2.14), by gender (OR 1.2; IC 95 % 1.20 to 3.28); DM2 (OR 1.5; IC 95 % 1.23 to 6.68). Conclusion: It was determined for the first time a prevalence of (2.5 °%) PAD for a population actively working in Popayán, being more frequent with individuals with low income, people exposed to higher cardiovascular risks, and for people with family DM2 records.

Factores asociados al éxito de la cirugía revascularizadora en diabéticos con isquemia crítica crónica de las extremidades / Factors associated with the success of revascularization surgery in diabetic patients with chronic critical limb ischemia

Introducción: La cirugía revascularizadora es una de las estrategias fundamentales para el tratamiento de la isquemia crítica crónica de los miembros inferiores. Objetivo: Identificar los factores asociados al éxito de la cirugía revascularizadora de los miembros inferiores en diabéticos con isquemia crítica crónica. Métodos: Se realizó un estudio descriptivo, prospectivo y de tipo cohorte en pacientes diabéticos sometidos a una cirugía revascularizadora, por presentar isquemia crítica crónica de la extremidad. Estos fueron seguidos durante seis meses en el Instituto Nacional de Angiología y Cirugía Vascular entre septiembre de 2019 y enero de 2021. La variable principal de salida resultó los factores pronosticadores del éxito de la cirugía, la cual se consideró exitosa cuando el paciente permaneció vivo y sin una amputación mayor. Resultados: Se incluyeron 50 pacientes con una edad promedio de 64 ± 10,21 años y un 24 por ciento de mujeres. El 88 por ciento fueron fumadores; y el 78 por ciento, hipertensos. La efectividad global de la cirugía resultó del 64 por ciento (IC al 95 por ciento 50 por ciento-78 por ciento). Solamente el sexo femenino, con una probabilidad de 0,053 y un Odds Ratio de 4,23; el antecedente de enfermedad cerebrovascular (p: 0,13 y OR: 6,98); y la infección (p: 0,18 y OR: 2,7) mostraron una tendencia a asociarse de forma estadísticamente significativa con el éxito de la cirugía. Conclusiones: El sexo femenino, el antecedente de enfermedad cerebrovascular y la presencia de infección fueron los principales candidatos para estudiarse como variables pronosticadoras del éxito de la cirugía revascularizadora(AU)

Introduction: Revascularizing surgery is one of the fundamental strategies for the treatment of chronic critical ischemia of the lower limbs. Objective: To identify the factors associated with the success of lower limb revascularization surgery in diabetics with chronic critical ischemia. Methods: A descriptive, prospective, cohort-type study was conducted in diabetic patients undergoing revascularization surgery due to chronic critical limb ischemia. The patients were followed for six months at the National Institute of Angiology and Vascular Surgery from September 2019 to January 2021. The primary endpoint variable was the predictor of the success of surgery, which was considered successful when the patient remained alive and without major amputations. Results: 50 patients with an average age of 64 ± 10.21 years and 24 percent women were included. 88 percent of the patients were smokers; and 78 percent hypertensive ones. The overall effectiveness of surgery was 64 percent (95 percent CI 50 percent-78 percent). Only the female sex, with a probability of 0.053 and an Odds Ratio of 4.23, history of cerebrovascular disease (p: 0.13 and OR: 6.98); and infection (p: 0.18 and OR: 2.7) showed a tendency to be statistically, significantly associated with the success of surgery. Conclusions: Female sex, history of cerebrovascular disease and presence of infection were the main candidates as prognostic variables of the success of revascularizing surgery(AU)

Características sociodemográficas y clínicas de pacientes con hipertensión arterial en un área de salud de Niquero / Sociodemographic and clinical characteristics of patients with hypertension in a health area of Niquero

Introducción: La hipertensión arterial es la enfermedad crónica de mayor morbilidad a escala mundial, la cual representa un problema de salud por su multicausalidad y sus consecuencias. Objetivo: Describir las principales características sociodemográficas y clínicas de pacientes con hipertensión arterial, pertenecientes a un área de salud de Niquero. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 370 pacientes con hipertensión arterial, quienes pertenecían al Consultorio Médico de la Familia No. 4 de Niquero, provincia de Granma, desde junio de 2021 hasta igual mes de 2022. Se estudiaron las variables edad, sexo, color de la piel, clasificación según cifras tensionales y evolución, así como estado del paciente y complicaciones. Resultados: Predominaron los grupos etarios de 40-59 (37,6 %) y 60-79 años (36,5 %), el sexo femenino (58,4 %), así como el color de la piel mestizo (55,9 %). Resultaron mayoría los pacientes con hipertensión arterial de grado II en fase 1 (44,3 %) y los parcialmente compensados (55,9 %). La enfermedad arterial periférica fue la principal complicación (21,1 %). Conclusiones: La descripción de las características sociodemográficas y clínicas de los pacientes con hipertensión arterial constituye un elemento a tener en cuenta para el adecuado control de los afectados en las áreas de salud.

Introduction: Hypertension is the chronic disease of more morbidity worldwide, which represents a health problem due to its multicausality and consequences. Objective: To describe the main sociodemographic and clinical characteristics of patients with hypertension, belonging to a health area of Niquero. Methods: An observational, descriptive and cross-sectional study of 370 patients with hypertension who belonged to the Family Doctor Office No. 4 of Niquero, Granma province, was carried out from June, 2021 to the same month in 2022. The variables age, sex, color of the skin, classification according to tension figures and evolution were studied, as well as patient state and complications. Results: There was a prevalence of the 40-59 (37.6 %) and 60-79 (36.5 %) age groups, female sex (58.4 %), as well as the mixed race color of the skin (55.9 %). The patients with grade II hypertension in phase 1 (44.3 %) and partially compensated (55.9 %) were the majority. Peripheral arterial disease was the main complication (21.1 %). Conclusions: The description of the sociodemographic and clinical characteristics of patients with hypertension constitutes an element to take into account for the appropriate control of those affected in the health areas.

Ultrasound findings and related factors of lower extremity arterial disease in patients with type 2 diabetes mellitus / 中国基层医药

Objective:To investigate the value of ultrasound findings in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus and correlate it with clinical factors.Methods:A total of 535 patients with type 2 diabetes mellitus who received treatment in Taiyuan Second People's Hospital from January 2016 to June 2019 underwent color Doppler ultrasound examination (T2DM group). Vascular inner diameter, intima-media thickness, atherosclerotic plaque formation, lumen stenosis or occlusion, and hemodynamic characteristics were determined in patients with type2 diabetes mellitus compared with those in 107 patients with non-type 2 diabetes mellitus (non-T2DM group). These parameters were correlated with the course of the disease, blood glucose level, concomitant hypertension or not, and clinical Wagner grade.Results:The incidences of intima-media thickening, atherosclerotic plaque, stenosis, and occlusion of lower extremity arteries were 69.9%, 89.0%, 77.0% and 11.6% respectively, in the T2DM group, which were significantly higher than 41.1%, 78.5%, 72.0%, and 1.9% respectively in the non-T2DM group ( χ2 = 32.52, P < 0.001; χ2 = 8.76, P = 0.003; χ2 = 27.77, P < 0.001). With the prolongation of the course of T2DM, the incidence of arterial lesions in the lower extremities increased ( P < 0.001). The incidences of intima-media thickening, atherosclerotic plaque, stenosis, and occlusion of lower extremity arteries were significantly greater in the poor blood glucose control group and non-hypertension group compared with the good blood glucose control group and hypertension group (all P < 0.05). The degree of lower extremity arterial stenosis in T2DM patients was related to Wagner's grade. As the degree of stenosis increased, Wagner's grade increased correspondingly and significantly ( P < 0.001). Conclusion:Color Doppler ultrasound examination has an important value in evaluating lower extremity arterial lesions in patients with T2DM. The degree of arterial lesions in the lower extremities of T2DM patients is correlated with the course of the disease, blood glucose levels, concomitant hypertension, and clinical Wagner grade. Color Doppler ultrasound examination has an important clinical significance in evaluating the degree of vascular lesions and guiding early interventions in the clinic.

Vascular endothelial cell dysfunction and Alzheimer's disease / 中国药理学与毒理学杂志

Alzheimer's disease(AD)is a neurode-generative disease with complex pathological mecha-nism characterized by accumulation of amyloid plaques and neurofibrillary tangles in the brain.Increasing evi-dence suggests that vascular dysfunction due to endothe-lial cell injury may have a pathogenic role in the occur-rence and development of AD.Malfunction of the blood-brain barrier caused by endothelial cell dysfunction is associated with the accumulation of several neurotoxic molecules within brain parenchyma,a reduction in cerebral blood flow,amyloid-β transfer and hypoxia,especially at the early stages of the disease.At the same time,it can-not be ignored that the peripheral arterial vascular endo-thelial cell dysfunction also seems to be closely related to the risk and the severity of symptoms of AD.Some mole-cules are thought to be messengers connecting the central and peripheral endothelial cells.Peripheral and central vascular endothelial cells communicate with each other and influence the progression of AD through some common mechanisms.In this review,we provide an ap-praisal of the endothelial cell dysfunction in cerebral and systemic vasculature,and give the evidence that vascular pathology is inextricably linked to disease onset and pro-gression of AD.

Long-term results of stent graft in the treatment of TASC C, D femoropopliteal artery occlusive disease / 中华普通外科杂志

Objective:To evaluate the long-term outcome of Viabahn stent graft in the treatment of complex femoropopliteal occlusive lesions.Methods:From Sep 2013 to Mar 2020, clinical data of TASC C and D femoropopliteal lesions treated with Viabahn were retrospectively analyzed. Patency rates, the freedom rate from clinically-driven target lesion revascularization (F-TLR), limb salvage and survival after five years were calculated.Results:A total of 65 patients (67 lower limbs) were included. 20 limbs were TASC C lesions, 47 limbs were TASC D lesions. The mean lesion length was (29.1±9.4) cm, including 48 chronic total occlusion (CTO) lesions (71.6%) with mean lesion length of (26.1±10.4) cm. Technique success rate was 98.6%. Mean length of stent graft was (31.3±10.1) cm.Major amputation was performed in 4.2% cases within 5 years. All-cause mortality in 5 years was 23.1%. Primary patency rates at 1,3,and 5 years were 76.8%,59.4%,50.9%, Assisted primary patency rates were 88.4%, 83.4%, 83.4% and secondary patency rates were 88.4%, 85.8%, and 85.8% . F-TLR at 1, 3 and 5 year was 88.2%,76.9%,73.1% .Conclusion:Viabahn for complex and long femoropopliteal artery occlusions is an acceptable treatment with fair long-term outcome.

Advancement in endovascular treatment of lower extremity therosclerotic occlusive disease / 国际外科学杂志

Lower extremity atherosclerotic occlusive disease is a common vascular disease, mainly peripheral arterial disease caused by atherosclerotic plaque formation of lower extremity arterial stenosis, occlusion, resulting in chronic ischemia of the limbs. In recent years, endovascular therapy has made remarkable progress and has become the treatment of choice for atherosclerotic occlusive disease of the lower extremities. With the continuous improvement of surgical methods, the success rate of endovascular treatment has increased dramatically, but there are some differences between different interventional modalities, and the adaptive population may be different, this paper provides a review of the current progress of endovascular treatment and combines the relevant literature at domestic and international.

Analysis of influencing factors of catheter-related bloodstream infection with peripheral arterial / 中国实用护理杂志

Objective:To anaylyze the influencing factors of peripheral arterial catheter-related bloodstream infection (CRBSI), and provide theoretical basis for clinical medical staff to control CRBSI.Methods:Adopting cross-sectional survey method. Convenient sampling method was used to select 331 patients with arterial catheterization in Tianjin Beichen Hospital from January 2021 to January 2022. The general status, catheter related infections,local skin abnormalities and catheterization status of the subjects were collected. The positive microbial culture at the tip of the catheter after extubation was taken as the outcome index, the influencing factors of peripheral arterial CRBSI were analyzed.Results:The incidence of CRBSI was 8.15% (27/331). Adjusted Logistic regression showed that age ( OR=3.013, 95% CI 1.158-14.365), local abnormality ( OR=3.357, 95% CI 1.670-9.269), number of days of catheterization ( OR=2.338, 95% CI 1.127-4.183) and location of catheterization (lower limb) ( OR=3.325, 95% CI 1.007-3.954) were the risk factors of peripheral artery CRBSI (all P<0.05). Conclusions:Peripheral artery CRBSI is more likely to occur in ICU patients aged ≥65 years, with local skin abnormalities, catheterization days ≥14 d and catheterization site in lower extremity. Paying attention to the elderly, paying attention to the integrity of the sterile barrier at the puncture site, shortening the catheterization days and avoiding lower extremity puncture can reduce the occurrence of peripheral artery CRBSI.

Mid-term outcome of drug coated balloon in the treatment of femoropopliteal artery disease / 中华普通外科杂志

Objective:To evaluate the mid-term outcome of drug coated balloon (DCB) in the treatment of femoropopliteal artery occlusive disease(FPOD). Methods Clinical date of FPOD patients receiving DCB treatment at Renji Hospital from Dec 2016 to Dec 2020 were retrospectively analyzed . The primary patency, primary assisted patency, secondary patency, free from clinically-driven target lesion revascularization (F-TLR) and the safety outcomes such as perioperative adverse events, major amputation rate and all-cause mortality were calculated. Results:One hurdred and seventy two patients (191 lower limbs) received DCB treatment. Among them, 13 lesions were TASC A (6.8%), 38 lesions were TASC B (19.9%), 98 lesions were TASC C (51.3%), and 42 lesions were TASC D (22.0%). One hundred and twenty six lesions were de novo lesions (66.0%), 33 lesions were in-stent restenosis (17.3%, ISR), and 32 lesions were both de novo lesions and ISR (16.8%). The average length of lesions was (27.8±10.4) mm. Fourty-eight lesions were mildly calcified (25.1%), 20 lesions were moderately calcified (10.5%), and 25 lesions were severely calcified (13.1%). Among de novo lesions, 97 lesions were chronic total occlusion (CTO) lesions (61.4%), and the average length of CTO lesions was (17.2±12.4) cm. The technical success rate was 97.4%.The provisonal stent rate was 22.0%. 12 month and 24 month after operation, the primary patency rate was 68.4% and 55.9%, the primary assisted patency rate was 78.8% and 69.8%, the secondary patency rate was 95.8% and 91.5%, and the F-TLR rate was 85.3% and 81.9%. The de novo lesion subgroup had a 24-month postoperative primary patency rate of 62.7%, while the in-stent restenosis subgroup had a rate of 44.9%.All cause mortality was 13.4% and major amputation rate was 4.7%. Chronic limb-threatening ischemia ( P=0.046) and CTO lesions length ≥15 cm ( P=0.006) were independent risk factors affecting the primary patency rate. Conclusion:DCB is a safe and effective endovascular intervention therapy for the treatment of femoropopliteal artery disease.

Proposed public policies to improve outcomes in vascular surgery: an experts' forum

ABSTRACT Objective To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. Methods This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. Results There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. Conclusion After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery.

Influência dos fatores de risco para aterosclerose na distribuição anatômica da doença arterial periférica em pacientes com isquemia crônica crítica de membros: um estudo transversal / Influence of atherosclerosis risk factors on the anatomical distribution of peripheral arterial disease in patients with chronic limb-threatening ischemia: a cross-sectional study

Resumo Contexto Os fatores de risco para aterosclerose podem ter influência distinta nas doenças cardiovasculares, impactando também no território da doença arterial periférica (DAP). Objetivos Estudar a influência dos diferentes fatores de risco para a aterosclerose na distribuição anatômica da DAP em pacientes com isquemia crítica crônica de membros (ICCM). Métodos Foi realizado um estudo observacional, transversal e analítico, incluindo 476 doentes internados devido à ICCM por DAP. Foram estudados, comparativamente, os pacientes com DAP dos três distintos territórios anatômicos (aortoilíaco, femoropoplíteo e infragenicular) em relação à presença dos fatores de risco para a aterosclerose (idade, gênero, diabetes mellitus, tabagismo e hipertensão arterial). A análise multivariada foi realizada para testar a associação entre os fatores de risco e a distribuição anatômica da DAP. Resultados A média de idade dos pacientes foi de 69 anos, 249 (52%) eram homens, e 273 (57%), diabéticos. Predominaram os pacientes na Categoria 5 da Classificação de Rutherford (353/74%). Na análise multivariada, as mulheres tiveram chance 2,7 (IC: 1,75-4,26) vezes maior de doença do território femoropoplíteo. Os doentes tabagistas tiveram 3,6 (IC: 1,54-8,30) vezes maior risco de doença do território aortoilíaco. Diabéticos apresentaram 1,8 (IC: 1,04-3,19) vezes maior chance de obstrução apenas do território infragenicular. Conclusões O estudo mostrou que gênero, diabetes mellitus e tabagismo influenciam no padrão de distribuição da DAP em pacientes com ICCM. Os doentes diabéticos apresentaram maior chance de doença isolada do território infragenicular, as mulheres tiveram maior risco de DAP do território femoropoplíteo e os tabagistas possuem maior chance comprometimento aortoilíaco.

Abstract Background Atherosclerosis risk factors can have different impacts on cardiovascular diseases and on the anatomical distribution of Peripheral Arterial Disease (PAD). Objectives To study the influence of atherosclerosis risk factors on the anatomical distribution of PAD in patients with chronic limb-threatening ischemia (CLTI). Methods We performed an observational, cross-sectional, and analytical study that included 476 hospitalized patients with CLTI due to PAD. We compared the presence of atherosclerosis risk factors (age, gender, diabetes mellitus, smoking, and hypertension) in patients with PAD involving three different anatomic areas (aortoiliac, femoropopliteal, and infrapopliteal). Multivariate analysis was performed to identify associations between atherosclerosis risk factors and PAD distribution. Results The mean age of the 476 patients was 69 years, 249 (52%) were men, and 273 (57%) had diabetes. Seventy-four percent (353) had minor tissue loss. Multivariate analysis identified three risk factors associated with PAD anatomical distribution (gender, smoking, and DM). Women had a 2.7 (CI: 1.75-4.26) times greater chance of having femoropopliteal disease. Smokers had a 3.6-fold (CI: 1.54-8.30) greater risk of aortoiliac disease. Diabetic patients were 1.8 (CI: 1.04-3.19) times more likely to have isolated infrapopliteal occlusive disease. Conclusions The study showed that gender, DM, and smoking impact on the anatomical distribution of PAD in patients with CLTI. Diabetic patients were more likely to have only infrapopliteal disease, women had a greater risk of femoropopliteal PAD, and smokers had a greater risk of aortoiliac occlusive disease.