Neovascularization as a Leading Mechanism of Intraplaque Hemorrhage and Carotid Plaque Destabilization: A Narrative Review.

Intraplaque neovascularization (IPN) is considered a leading mechanism causing carotid plaque destabilization. We provide an objective and comprehensive summary of the biology, imaging techniques, and treatment options related to carotid IPN. Plaque neovascularization has been reported to originate mainly from the adventitial vasa vasorum as a response to hypoxia. The leakage and rupture of neovessels lead to the formation of extravasations and foci of inflammation that destabilize the plaque. Vascular endothelial growth factor and its receptors are key regulators of neoangiogenesis. Neovascularization can be analyzed by advanced computed tomography and magnetic resonance imaging. The basic tools for the ultrasound assessment of IPN are contrast-enhanced ultrasound, superb microvascular imaging, and ultrasound molecular imaging. A promising direction of research seems to be the identification of patients with advanced plaque neovascularization. A simple test assessing low-velocity flow in the IPN can detect patients at risk of stroke before they experience rupture of defective neovessels and intracerebral embolism. In addition to surgical treatment, the stabilization of carotid atherosclerotic plaque can be supported pharmacologically. Statins have the best-documented role in this respect. The ideal moment of intensified therapeutic intervention in patients with previously stable carotid plaque is its increased neovascularization. However, the time frame in which intracerebral embolization may occur is unknown, and therapeutic intervention may be too late. The formation of deficient neovessels can currently be non-invasively evaluated with ultrasound. Superb microvascular imaging may change the clinical approach for asymptomatic patients at risk of cerebral ischemia.

The impact of the first and the second wave of the COVID-19 pandemic on vascular surgery practice in the leading regional center: a comparative, retrospective study.

BACKGROUND: We conducted an analysis of the vascular surgery regional center reorganization in response to the first and the second wave of the coronavirus disease-2019 (COVID-19) pandemic to see what lessons we learned from the first wave. METHODS: The study included a total of 632 patients admitted to the vascular surgery department in three periods: March-May 2020, October-December 2020, and October-December 2019 as a control period. RESULTS: In the pandemic periods the number of admitted patients decreased in relation to the control period. There was a reduction in performed procedures. We observed an increase in the ratio of less invasive procedures. There was a significant decline in hospitalization time in comparison to the control period. CONCLUSIONS: The reduction of scheduled admissions and procedures affected vascular centers all over the world. Minimally invasive procedures were more willingly performed to shorten the hospitalization time and reduce the patient's exposure to hospital infection. It allowed us to treat more patients during the second wave. Nevertheless, an increased number of vascular patients should be expected in the future, which will result from the failure to perform elective procedures during the pandemic.

The Role of Health Behaviors in Quality of Life: A Longitudinal Study of Patients with Colorectal Cancer.

Colorectal cancer (CRC) is the third most common malignancy and the second most common cancer-related cause of death worldwide. CRC incidence depends, in part, on the health behaviors that make up an individual's lifestyle. We aimed to assess the influence of health behaviors and quality of life (QoL) among patients with CRC receiving surgical treatment. In this single-center questionnaire study, 151 patients were surveyed 1 week before and 6 months after colorectal procedures (laparoscopic hemicolectomy, low rectal anterior resection, abdominoperineal resection, and others). This study demonstrated a significant decrease in alcohol consumption and physical activity following the execution of colorectal procedures. No statistically significant changes were observed in smoking or the consumption of healthy food. Global QoL did not change significantly; however, a decrease in physical and role-related functioning was observed. Significant improvements in emotional functioning were also observed. A detailed analysis showed that physical and social functioning were related to smoking, the consumption of healthy food, physical activity, and additional therapies. Emotional functioning was related to smoking, the consumption of healthy food, and complementary treatments. Six months following an operation, it was also dependent on alcohol intake. Physical functioning was the area that decreased the most in the six months after colorectal tumor surgery compared to the period before surgery. Health behaviors such as cessation of smoking, engagement in physical activity, and the consumption of healthy food contributed to a higher quality of life among patients prior to resecting colorectal cancer and six months after the procedure. Patients who received adjuvant/neoadjuvant therapy had a lower quality of life than patients who did not receive this type of therapy. The kind of surgery (laparoscopic hemicolectomy, lower anterior rectum resection, or abdominoperineal rectum resection) was not related to QoL six months after surgery.

Improved Detection of Endoleaks in Virtual Monoenergetic Images in Dual-Energy CT Angiography Following EVAR.

OBJECTIVES: The objective of this prospective study was to evaluate the virtual monoenergetic images (VMI) and virtual noncontrast (VNC) phase in the detection of endoleaks after endovascular abdominal aortic repair (EVAR). The potential dose reduction of abbreviated examination protocols was calculated. MATERIALS AND METHODS: Ninety-seven patients after the EVAR procedure were enrolled in this study. An initial single-source noncontrast acquisition was followed by two dual-energy acquisitions (arterial and 60 s delayed). Fast-kVp switching scanner was used. VNC images were reconstructed from the delayed phase. First examination session (reference) included a full triphasic study protocol consisting of true noncontrast (TNC) images and two postcontrast phases, the latter ones presented as classical polyenergetic reconstructions. Reading sessions II and III were performed by two independent and blinded readers evaluating VMIs in abbreviated protocols-biphasic (VNC + arterial, delayed phase), monophasic (VNC + delayed phase). The diagnostic accuracy of sessions II and III was calculated. RESULTS: The calculated sensitivity of the biphasic protocol with the use of VMIs in endoleak detection was 100%, with a statistically significant increase in the number of endoleaks detected in comparison with the reference study. The monophasic protocol showed 83.33% sensitivity. The use of abbreviated examination protocols led to a decrease in the mean effective dose (ED) of 23.28% (biphasic protocol) and 61.37% (monophasic protocol). CONCLUSION: The use of VMIs increases the number of endoleaks diagnosed with a possible radiation reduction by up to » (biphasic protocol). Further reduction to a monophasic protocol leads to over 60% dose reduction but with a decrease in diagnostic accuracy.

New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review.

Indications for intervention in hemodynamically relevant carotid artery stenosis (carotid endarterectomy or stenting) are primarily based on a degree of stenosis and symptomatology. To date the plaque vulnerability is rarely taken into account in clinical decision making although development of molecular imaging allows a better understanding of plaque biology and provides new techniques detecting potentially vulnerable plaque at risk. A significant number of reports describing the mechanisms of unstable plaque formation suggest that it is a multifactorial process. Inflammation, lipid accumulation, apoptosis, proteolysis, the thrombotic process and angiogenesis are among the main factors of carotid plaque destabilization. Although inflammation is a key process in development of plaque vulnerability, the hemostasis and neoangiogenesis should be regarded as equally important. Only a small group of asymptomatic patients may benefit from the invasive treatment and it remains a challenge to determine whether initially asymptomatic carotid plaque become unstable or vulnerable. Currently, the main task of research on atherosclerotic lesion imaging is focused on functional state of the plaque. The presence of one or more features such as stenosis progression, large plaque area, large juxta-luminal black area, plaque echolucency, intra-plaque hemorrhage, impaired cerebral vascular reserve and spontaneous embolization may indicate patients at higher risk for stroke suitable for revascularization. Treatment of carotid stenosis as one of the manifestations of generalized atherosclerosis requires a broad approach. Nowadays pharmacological treatment options for the atherosclerotic process are largely aimed at stimulating the plaque stabilization, but in symptomatic patients and selected asymptomatic patients, carotid plaque should be removed as a potential source of embolism.

The prevalence of abdominal aortic aneurysms in the rural/urban population in central Poland - Gniewkowo Aortic Study.

BACKGROUND AND AIM: Abdominal aortic aneurysm (AAA) is a widening of the aorta below the renal arteries with a diameter equal to or greater than 3 cm. The prevalence of AAA is estimated at 4-8% in men aged 65 years or older and 1-2% among women over 65 years old. Participation in screening programmes has decreased the number of aortic ruptures. METHODS: All men aged 60 years and older, and women aged 65 years and older living in the rural/urban commune in central Poland were invited to participate in the study. In total 922 persons (61% of the invited population) entered the study. The men were divided into two groups: 60-64 years old, and 65 years and older. Screening abdomen ultrasound was performed and demographic data was collected. RESULTS: Among the 922 examined persons two (1.01%) AAAs were diagnosed in the group of men 60-64 years of age, three (0.82%) AAAs amongst women ≥ 65 years old, and 33 (9.29%) AAAs were found in the group of men aged 65 years and older. A positive relationship between the presence of AAA and smoking (p = 0.0048), age of men (p = 0.0009), and history of myocardial infarction/acute coronary syndrome (MI/ACS) (p = 0.0079) was found. There was no correlation between the frequency of AAA and diabetes mellitus (p = 0.46), hypertension (p = 0.38), and family history of AAA (p = 0.44). CONCLUSIONS: The prevalence of AAA in men aged 65 years and older is seemingly larger than in previously conducted studies, while among men 60-64 years of age and women aged ≥ 65 it is similar. Older age, smoking, and a history of MI/ACS were the most important risk factors of AAA occurrence.

Cross-sectional study of the ankle-brachial index and cardiovascular risk factors in postmenopausal women.

BACKGROUND: The incidence of peripheral artery disease (PAD) and cardiovascular (CV) events in the female population has been on the increase. AIM: To analyse the risk factors of a CV event and PAD in women and to assess the usefulness of the ankle-brachial index (ABI). METHODS: Evaluation of selected parameters in a cohort of 365 women living in the same district. The following data were prospectively recorded: weight, height, waist size, hip circumference, smoking, the intima-media complex, ABI value, and laboratory results. PAD symptoms, CV events and neurological events were noted. ABI was analysed assuming pathology for values: ≤ 0.9 or ≤ 1.0. RESULTS: Age, plasma glucose level, atrial fibrillation, and nicotine addiction were correlated independently with CV disease and stroke (p < 0.001). The high-density lipoprotein cholesterol level, height, and systolic blood pressure were correlated independently with ABI values (p < 0.05). There was no correlation between the occurrence of a CV event in the past and the ABI, irrespective of the cut-off point for the reference value (p = NS). CONCLUSIONS: There is no evidence that stricter criteria for the assessment of ABI better represent the vascular status in the female population.

Does morphology of carotid plaque depend on patient's oxidative stress?

OBJECTIVES: This study explored the relationship between oxidative stress biomarkers and stability of carotid plaque. We decided to analyze the broad range of parameters describing oxidative stress in patients with carotid stenosis. DESIGN AND METHODS: 124 consecutive patients undergoing carotid endarterectomy were enrolled in the study group. The control group consisted of 49 patients without symptoms of atherosclerosis. The stability of carotid plaques was assessed using GSM (gray-scale median) scoring system and the study group was divided into three subgroups according to echogenicity of the plaque. The following parameters of oxidative stress/DNA damage were analyzed: i) urinary excretion of the products of oxidative DNA damage repair; ii) the background level of 8-oxo-7,8-dihydro-2'-deoxyguanosine in leukocytes' DNA and in atherosclerotic plaques; and iii) the concentrations of antioxidant vitamins, uric acid and C-reactive protein in plasma. RESULTS: Oxidative stress (described by redox status) was higher in the patient group than in the control group. There is a correlation between oxidative stress of the patients and stability of the plaque, echolucent plaques (GSM<25) being associated with the highest antioxidant level and lowest excretion of DNA repair markers. CONCLUSIONS: The plaque formation/morphology may depend on local environment and is independent of oxidative stress/inflammation observed on the level of the whole body.

DNA damage products (5'R)- and (5'S)-8,5'-cyclo-2'-deoxyadenosines as potential biomarkers in human urine for atherosclerosis.

We hypothesized that DNA damage products (5'R)-8,5'-cyclo-2'-deoxyadenosine (R-cdA) and (5'S)-8,5'-cyclo-2'-deoxyadenosine (S-cdA) may be well-suited biomarkers of risk and diagnosis for atherosclerosis. We tested this hypothesis by measuring the levels of R-cdA and S-cdA and another product, 8-hydroxy-2'-deoxyguanosine (8-OH-dG), in urine of atherosclerosis patients and healthy individuals using liquid chromatography-tandem mass spectrometry with isotope dilution. We showed the presence of these products at significantly greater concentrations in urine of atherosclerosis patients than in that of healthy individuals. Our data suggest that R-cdA and S-cdA can be accurately and reproducibly measured in human urine as potential biomarkers of risk and diagnosis for atherosclerosis.

Predicting time to healing by anatomical assessment of venous pathology.

BACKGROUND: The aim of the study was to assess the clinical effectiveness of multilayer compression in aspect of anatomical site of venous pathology and ulcers. MATERIAL/METHODS: The study was conducted between 2000 and 2006 among 112 patients with 121 ulcers treated in the Venous Ulcer Outpatient Clinic of the Chair and Clinic of Surgery, Biziel Hospital in Bydgoszcz, Poland. Patients between 31 and 89 years old (mean age - 63.6 years, median 65) were randomized into two groups treated with two- and four-layer compression system. Healing process dynamics were assessed by planimetry. Maximum period of observation was 48 weeks. RESULTS: The longest mean time of ulcer healing and the highest values of cumulated indicator of unhealed ulcers were observed among patients with simultaneous insufficiency of two venous systems - superficial and deep (p=0.0034, test log-rank) and among patients with insufficiency of deep, superficial and perforating venous system (p=0.0001, test log-rank). Significantly longer mean healing time was characteristic for localization on the back calf region (p=0.01, test log-rank). Dynamics of healing of ulcers treated by two- and four-layer systems were compared. CONCLUSIONS: Anatomical localization of venous pathology and ulcer localization were found as important prognostic factors; longer healing time and lower probability of healing was observed among patients with deep venous insufficiency and when the ulcer was localized in the atypical back calf region. No differences of healing time between groups in aspect of used system were showed.