Influence of cardiovascular risk factors on levels of matrix metalloproteinases 2 and 9 in human abdominal aortic aneurysms.

OBJECTIVE: To evaluate the influence of cardiovascular risk factors on levels of matrix metalloproteinases (MMP) 2 and 9 in human abdominal aortic aneurysms (AAA). METHODS: Aortic samples were collected from patients who underwent AAA repair (n = 89). Patients were stratified according to the maximum transverse aorta diameter: small diameter (<55 mm), moderate diameter (55-69.9 mm) and large diameter (≥70 mm). Aortic walls were studied using real-time PCR and immunohistochemistry. MMP-2, MMP-9, α-actin, CD45, and CD68 transcript levels were determined relative to ß-actin. Quantitative data were expressed as median (IQ-range). RESULTS: No differences were found in MMP-2 expression between the patient groups, which was mainly associated with vascular smooth muscle cells (VSMC); however, MMP-9 displayed the maximum level in the moderate-diameter group, associated with infiltrating macrophages. Current smoking (CS) and renal insufficiency (RI) significantly increased local levels of MMP-2 (CS 349.5 [219.5-414.1] vs. no-CS 184.4 [100.0-320.5]; p < .008; RI 286.8 [189.6-410.8] vs. no-RI 177.3 [99.3-326.9]; p = .047). Nevertheless, after stepwise linear regression analysis only CS remained as an independent variable predicting local levels of MMP-2 (p = .002). No risk factors influenced local levels of MMP-9. CONCLUSIONS: The results show that local levels of MMP-2, an important factor for AAA development, were increased in current smoking AAA patients. MMP-2 was mainly associated with VSMC. It is suggested that MMP-2 could contribute significantly to the increased AAA growth rate observed in current smoking patients. These findings support inclusion of smokers in screening for aneurysmal disease, and emphasize the need for more aggressive monitoring of aneurysmal disease outside the surgical range in patients who smoke at the time of diagnosis and in those who continue to smoke during follow-up.

A computational fluid dynamics study on hemodynamics for different locations of the distal anastomosis of a bypass nearby a collateral vessel in the femoropopliteal area.

Revascularization of the femoropopliteal sector is often performed by the placement of a bypass. In this paper, we have studied the effects of hemodynamics on patency of the bypass for different positions of the distal anastomosis close to a collateral artery. Computational fluid dynamics (CFD) are used for this study. The cardiac cycle-averaged wall shear stress (WSS) and oscillation index (OSI) have been analyzed. Low WSS and high OSI may increase the risk of intimal hyperplasia (IH), which may reduce bypass patency. From the CFD simulations, spots of low WSS and high OSI are found within and near the entrance of the collateral artery, near the suture line, at the floor, toe, and heel. We regarded flow ratios of 20:80 and of 35:65. It is found that for the high flow ratio anastomosis located proximal to the collateral artery is clearly more advantageous. However for the low flow ratio anastomosis located distal to the collateral artery seems to be slightly more advantageous, the results are less conclusive. One of the studied flow geometries has been validated by in vitro experiments using a time resolved particle image velocimetry technique. Velocity fields from these experiments are in good agreement with the CFD results.

Healthcare quality indicators of peripheral artery disease based on systematic reviews.

OBJECTIVES: Peripheral artery disease (PAD) is a major health problem whose clinical management includes multiple options regarding risk factor control, diagnosis, and medical and surgical treatment. The aim was to generate indicators based on systematic reviews to evaluate the quality of healthcare provided in PAD. METHODS: Electronic searches were run for systematic reviews in The Cochrane Library (Issue 6, 2011), MEDLINE, EMBASE, and other databases (up to June 2011). Conclusive systematic reviews of high methodological quality were selected to formulate clinical recommendations. Indicators were derived from clinical recommendations with moderate to very high strength of evidence as assessed by the GRADE system. RESULTS: From 1,804 reviews initially identified, 29 conclusive and high-quality systematic reviews were selected and nine clinical recommendations were formulated with a moderate to very high strength of recommendation. Six indicators were finally generated: four on pharmacological interventions, antiplatelet agents, naftidrofuryl, cilostazol, and statins; and two lifestyle interventions, exercise and tobacco cessation. No indicators were derived for diagnostic tests or surgical techniques. Most indicators targeted patients with intermittent claudication. CONCLUSIONS: These quality indicators will help clinicians to assess the appropriateness of healthcare provided in PAD. The development of evidence-based indicators in PAD is limited by the lack of methodological quality of the research in this disease, the inconclusiveness of the evidence on diagnostic and surgical techniques, and the dynamic nature of the vascular diseases field.

La insuficiencia venosa crónica en el Sistema Nacional de Salud. Diagnóstico, indicaciones quirúrgicas y priorización de listas de espera. Documento de la Sociedad Española de Angiología y Cirugía Vascular (SEACV) y del Capítulo de Flebología y Linfología de la SEACV / Chronic venous insufficiency in the National Health System. Diagnosis, surgical indications and waiting list priorities. A document from the Spanish Association of Angiology and Vascular Surgery (SEACV) and the SEACV Phlebology Chapter

En un entorno de recursos limitados y de crisis, es importante clarificar las indicaciones absolutas y relativas de la cirugía de las varices para garantizar dicha prestación dentro del Sistema Nacional de Salud (SNS) en los casos necesarios y con los máximos criterios científicos disponibles. La Sociedad Española de Angiología y Cirugía Vascular (SEACV), como depositaria de la representatividad profesional, científica y/o técnica de todos sus socios en relación con las administraciones sanitarias, está obligada a estudiar y analizar las necesidades actuales y/o futuras que se presenten en la población de su ámbito, con respecto a la demanda de la especialidad. Presentamos un documento oficial de la SEACV y de su Capítulo Español de Flebología y Linfología (CEFyL) que sienta las bases científicas de la patología venosa y los criterios a tener en cuenta en el momento de valorar su aplicación futura en el SNS(AU)

In an environment with limited resources and a crisis, it is important to clarify the absolute and relative surgical indications of varicose veins, in order to guarantee this service within the National Health System in necessary cases, and with the maximum scientific criteria available. The Spanish Association of Angiology and Vascular Surgery (SEACV,), as the office that represents the professional, scientific and/or technical aspects of all its members with the Health Administrations, is obliged to study and analyse the current and future needs of the population in its area, as regards the demands of the Specialty. We present an official document by SEACV and its Spanish Chapter of Phlebology and Lymphology (CEFandL) that sets the scientific basis of venous pathology and the criteria to take into account when assessing its future application with the National Health System(AU)

Métodos de estudio de las enfermedades complejas: aneurismas de la aorta abdominal / Methods for studying complex diseases: abdominal aortic aneurysm

Las enfermedades vasculares, particularmente el aneurisma de la aorta abdominal (AAA), tienen una base multifactorial compleja, donde múltiples interacciones entre factores genéticos y ambientales contribuyen al desarrollo de la enfermedad. Sin embargo, pese a los avances en la última década, nuestros conocimientos sobre la base genética de estas patologías son aún escasos. Este artículo presenta una revisión de los métodos para el estudio de las bases genéticas de las enfermedades vasculares focalizada en el AAA desde un enfoque de enfermedad compleja, y de índole multifactorial. La identificación y el análisis de los genes causantes de esta patología nos permitirán realizar una estratificación de los individuos con diferentes riesgos de desarrollar esta patología, mejorando las opciones preventivas y terapéuticas, lo que se traducirá en una mayor calidad de vida de las personas en riesgo(AU)

The aetiology of vascular diseases, such as abdominal aortic aneurysm (AAA), is complex and multi-factorial. The complexity derives from different genetic and environmental factors contributing to the development of these diseases. Despite the fact that a great effort has been made in the last decade to understand the genetic basis of these complex diseases there is still much to be learned. The present review deals with the methods that have been used to study the genetic bases of vascular diseases. In addition, we will focus on AAA as a complex multi-factorial disease. The identification of the genes involved in the pathophysiology of AAA will allow us to stratify individuals with different risks of developing disease, as well as improving preventive and therapeutic strategies. All of this will increase the quality of life of the persons who are in risk(AU)

Placa móvil carotídea / Mobile carotid plaque

Introducción. La literatura sólo observa la publicación de siete casos de placa móvil sobre carótida cuya descripción imprecisa dificulta que se diferencie de las lesiones móviles de tipo trombo. Por otra parte, la historia natural de este tipo de lesiones no es conocida y su tratamiento resulta controvertido por cuanto existe la tendencia de elegir el tipo de tratamiento a seguir de acuerdo con el `potencial embolígeno' de la afección. Casos clínicos. Se describen dos casos de placa móvil sobre carótida. El diagnóstico se ha practicado en ambos casos mediante ecografía Doppler. El primer caso es un paciente neurológicamente sintomático, cuya placa móvil está asociada a una estenosis superior al 70 por ciento. Se le se indica tratamiento quirúrgico. El segundo caso es neurológicamente asintomático. En el estudio mediante ecografía Doppler se observa el fragmento de placa móvil sobre la carótida común, en la zona del seno carotídeo, sobre una estenosis del 30-50 por ciento. En la zona distal de la misma, sobre el bulbo de la carótida interna, se encuentra una estenosis >70 por ciento. En este caso se indica tratamiento médico debido al deteriorado estado general del paciente. Ambos pacientes han evolucionado favorablemente. Conclusiones. Sumados al segundo caso aquí descrito, son tres los pacientes con placa móvil carotídea (neurológicamente asintomáticos) que han evolucionado favorablemente con tratamiento médico. Mientras no se disponga de más datos acerca de la historia natural de estas lesiones no deberían considerarse, por sí mismas, motivo suficiente para indicar la endarterectomía carotídea. La posible indicación de tratamiento quirúrgico estará en función del grado de estenosis carotídea (AU)

[Mobile carotid plaque]. / Placa móvil carotídea.

INTRODUCTION: In the literature only seven cases have been published describing a mobile carotid plaque, and lack of precise description makes it difficult to differentiate these lesions from mobile thrombotic lesions. The natural history of these lesions is not known and their treatment is controversial, although there is a tendency to choose the type of treatment to be given according to the embologenic potential of the lesion. CLINICAL CASES: We report two cases with mobile carotid plaques. In both cases diagnosis was made on ultrasound Doppler. The first patient had neurological symptoms and a mobile plaque associated with stenosis of over 70%. Surgical treatment was indicated. The second patient had no neurological symptoms. On ultrasound Doppler studies there was a fragment of mobile plaque in the common carotid artery, in the region of the carotid sinus with stenosis of 30 50%. Distal to this zone, in the bulb of the internal carotid artery there was stenosis of >70%. In this case medical treatment was given in view of deterioration in the patient s general state. Both patients improved. CONCLUSIONS: Including our second case, three patients with mobile carotid plaques (neurologically asymptomatic) have now been reported to have made good progress with medical treatment. Until there is more data regarding the natural history of these lesions, they should not be considered to be in themselves sufficient reason for carrying out carotid endarterectomy. The possibility of indicating surgical treatment depends on the degree of carotid stenosis.

[Indications for carotid endarterectomy without arteriography. A validation study using eco-Doppler]. / Indicaciones de endarterectomía carotídea sin arteriografía. Estudio de validación mediante eco-Doppler.

INTRODUCTION: The possibility of diagnosing carotid stenosis and carrying out surgery without arteriography has increased with the use of different diagnostic methods. The eco-Doppler has been shown to be a useful method, although it requires previous individualised validation. OBJECTIVE: We aim to validate our Vascular Diagnostic Laboratory in the diagnosis of stenosis of the carotid bifurcation using eco-Doppler as compared with angiography, and the therapeutic indication thus obtained. PATIENTS AND METHODS: We made a prospective study for one year of 62 consecutive patients diagnosed on eco-Doppler as having carotid stenosis of over 70% and subsequent carotid arteriography. The treatment indicated is given, without waiting for the result of the angiography, on clinical evaluation, computerized tomography or cranial magnetic resonance and eco-Doppler, and subsequently on angiography. The degree of correlation of both methods, both for the therapeutic indication and for the degree of stenosis was determined. RESULTS: In five cases there was discrepancy and the therapeutic indication was different. Three of these were related to the diagnosis of carotid occlusion and in the other two cases there were bilateral lesions of over 50% on eco-Doppler, which were classified as minor on angiographic study. In the group with stenosis of over 70% with < 50% contralateral stenosis, eco-Doppler showed sensitivity and specificity of 100%, with a kappa correlation index = 1. CONCLUSION: It is possible to indicate carotid endarterectomy in patients with unilateral stenosis greater than 70% and contralateral stenosis < 50%, based on the eco-Doppler studies done in our Vascular Diagnostic Laboratory.

Indicaciones de endarterectomía carotídea sin arteriografía. Estudio de validación mediante eco-Doppler / Indications for carotid endarterectomy without arteriography. A validation study using eco-Doppler

Introducción. La posibilidad de diagnosticar la estenosis carotídea y realizar su cirugía sin arteriografía se ha extendido con la utilización de diferentes métodos diagnósticos. La eco-Doppler ha demostrado ser un método útil, aunque exige una validación previa individualizada. Objetivo. Pretendemos validar nuestro Laboratorio Diagnóstico Vascular (LDV) en el diagnóstico con eco-Doppler de la estenosis de la bifurcación carotídea, respecto a la angiografía, y la indicación terapéutica que genera. Pacientes y métodos. Realizamos un estudio prospectivo, durante un año, en 62 pacientes consecutivos con el diagnóstico por eco-Doppler de estenosis carotídea superior al 70 por ciento y posterior arteriografía carotídea. Se lleva a cabo la indicación terapéutica primero sin conocer el resultado de la angiografía, mediante valoración clínica, tomografía computarizada o resonancia magnética craneal y eco-Doppler y, posteriormente, con angiografía. Se determina el grado de correlación para ambos métodos tanto para la indicación terapéutica como para el grado de estenosis. Resultados. Hubo cinco casos de discrepancia que variaron la indicación terapéutica: tres de ellos relacionados con el diagnóstico de oclusión carotídea y los otros dos con lesiones bilaterales mayores del 50 por ciento según la eco-Doppler, que fueron catalogadas como menores en el estudio angiográfico. Para el grupo de estenosis superiores al 70 por ciento, con contralateral <50 por ciento, la eco-Doppler obtuvo una sensibilidad y especificidad del 100 por ciento, con un índice de correlación kappa= 1. Conclusión. Es posible la indicación de endarterectomía carotídea en pacientes con estenosis unilaterales superiores al 70 por ciento, con contralateral <50 por ciento, basada en estudios con eco-Doppler practicados en nuestro LDV (AU)