CD14+CD16+ monocytes in coronary artery disease and their relationship to serum TNF-α levels

SummaryMonocytes play a central role in the inflammatory disease atherosclerosis. CD14+CD16+ monocytes are considered proinflammatory monocytes, as they have an increased capacity to produce proinflammatory cytokines, such as TNF-α, and are elevated in various inflammatory diseases. We hypothesized that patients with coronary artery disease (CAD) have increased levels of CD14+CD16+ monocytes, and that CD14+CD16+ monocytes are associated with inflammation markers. We investigated CD14+CD16+ monocytes in 247 patients with CAD and 61 control subjects using flow cytometry. In addition serum concentrations of TNF-α, IL-6, and Hs-CRP were assessed. Patients with CAD had higher levels of CD14+CD16…

Diabetes Mellitus and Its Impact on Patient-Profile and In-Hospital Outcomes in Peripheral Artery Disease

Background: In patients with peripheral artery disease (PAD), the impact of diabetes mellitus (DM) on patient-profile and adverse in-hospital events is not well investigated. Methods: The German nationwide inpatient sample 2005–2019 was used for this analysis. Hospitalized PAD patients were stratified for DM and the influence of DM on patient-profile and adverse in-hospital events was investigated. Results: Our study comprised 2,654,871 hospitalizations (54.3% aged ≥70 years, 36.7% females) of patients with PAD in Germany 2005–2019. Among these, 864,691 (32.6%) patients had DM and 76,716 (2.9%) died during hospitalization. Diabetic PAD patients revealed an aggravated cardiovascular profile …

Value of the deep femoral artery as alternative inflow source in infrainguinal bypass surgery.

Background The purpose of this study was to analyze the long-term results of infrainguinal bypass surgery using the deep femoral artery (DFA) as the inflow source. Methods Between 1998 and 2011, 88 bypasses of the lower limb were placed in 86 patients (mean age 71 years) using the deep femoral artery as inflow. Patients' records were retrieved from a computerized database and analyzed retrospectively. Results Critical limb ischemia (rest pain/tissue loss) was the indication in the majority (87.5%) of cases. The distal anastomosis of the bypass grafts was located at the popliteal level in 32 cases and the tibial (pedal) level in 52 cases, respectively, with the autologous vein as conduit in …

Impact of atrial fibrillation/flutter on the in-hospital mortality of ischemic stroke patients.

Stroke is the second leading cause of death worldwide. Ischemic strokes, which are caused by atrial fibrillation/flutter (AF), may be more devastating than those that occur without AF.The purpose of this study was to investigate the impact of AF on adverse events in hospitalized ischemic stroke patients and to estimate the elevated impact of AF on the occurrence of these adverse events.The nationwide German inpatient sample of the years 2005-2015 was used for this analysis. Ischemic stroke patients were identified by ICD code I63 and stratified by AF. Logistic regression models were used to investigate the impact of AF on adverse in-hospital events and adjusted for age, sex, and comorbiditi…

Telemedicine-Based Specialized Care Improves the Outcome of Anticoagulated Individuals with Venous Thromboembolism-Results from the thrombEVAL Study.

Venous thromboembolism (VTE) is a life-threatening disease with risk of recurrence. Oral anticoagulation (OAC) with vitamin K antagonists (VKA) is effective to prevent thromboembolic recurrence. We aimed to investigate the quality of OAC of VTE patients in regular medical care (RMC) compared to a telemedicine-based coagulation service (CS). The thrombEVAL study (NCT01809015) is a prospective, multi-center study to investigate OAC treatment (recruitment: January 2011&ndash

Determinants of arterial stiffness in pre- and postmenopausal women

External polytetrafluoroethylene reinforcement of varicose autologous vein grafts in peripheral bypass surgery produces durable bypass function

Abstract Objective Use of autologous veins as peripheral bypass graft may become critical in the presence of significant varicose degeneration of the harvested vein. External support of such dilated veins with standard polytetrafluoroethylene (PTFE) prostheses was recommended as an option to use these veins for peripheral bypass. A single-center experience with this technique regarding long-term graft function, secondary reinterventions, and potential graft degeneration is presented. Methods Between January 1995 and January 2006, there were 54 patients with varicose veins who underwent 57 consecutive infrainguinal vein bypass operations with PTFE reinforcement in 57 limbs. Indications for s…

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) : Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries

Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction.

Background— An ankle-brachial index (ABI; ratio of ankle and brachial systolic blood pressure) <0.9 indicates peripheral arterial disease (PAD) and is a strong predictor of cardiovascular events. The aim of the present study was to address the prognostic value of different methods of ABI calculation. Methods and Results— In 831 patients admitted with chest pain for diagnostic heart catheterization, blood pressure of both anterior and posterior tibial arteries was measured. ABI was calculated for each leg with the higher of the 2 ankle pressures (current definition of the American Heart Association) or with the lower of the 2 ankle pressures (modified definition) in relation to the highe…

Intérêt des fistules artérioveineuses pour les pontages distaux à haut-risque d’échec précoce

Les resultats des fistules arterioveineuses adjuvantes (FAV) dans la chirurgie de pontage en cas de mauvaise artere receveuse, de flux peroperatoire severement altere, ou de revision pour defaillance precoce et restauration du flux ont ete analyses dans une etude retrospective. De janvier 1998 a decembre 2006, 24 FAV adjuvantes ont ete construites sur la veine autologue ou des pontages distaux composites ayant un mauvais debit peroperatoire, une mauvaise artere pedieuse, ou en cas de reprise precoce de pontage reussie pour empecher un echec de pontage. Toutes les revascularisations sous-inguinales etaient enregistrees dans une base de donnees automatisee prospective. Les pontages distaux av…

Survival Benefit of Obese Patients With Pulmonary Embolism.

To investigate the impact of obesity and underweight on adverse in-hospital outcomes in pulmonary embolism (PE).Patients diagnosed as having PE based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification code I26 in the German nationwide inpatient database were stratified for obesity, underweight, and normal weight/overweight (reference group) and compared regarding adverse in-hospital outcomes.From January 1, 2011, through December 31, 2014, 345,831 inpatients (53.3% females) 18 years and older were included in this analysis; 8.6% were obese and 0.5% were underweight. Obese patients were younger (67.0 vs 73.0 years), were mo…

Are Morphological or Functional Changes in the Carotid Artery Wall Associated With Chlamydia pneumoniae, Helicobacter pylori, Cytomegalovirus, or Herpes Simplex Virus Infection?

Background and Purpose —Chronic infection with Chlamydia pneumoniae , Helicobacter pylori , cytomegalovirus (CMV), and herpes simplex virus (HSV) has been implicated in the pathogenesis of atherosclerosis. The carotid intima-media thickness (IMT) can be taken to indicate early atherosclerosis, the presence of a carotid stenosis is a marker of a manifest carotid atherosclerosis, and an increase in arterial stiffness is used as marker of structural and functional changes in an atherosclerotic vessel wall. Methods —In 504 patients (75% men; mean age 62.9 [SD 10] years), we measured the IMT and the elastic pressure modulus (EP; n=445) of the common carotid artery and the prevalence of a intern…

B-Type Natriuretic Peptide and the Risk of Cardiovascular Events and Death in Patients With Stable Angina Results From the AtheroGeneStudy

ObjectivesThe aim of this study was to assess the predictive value of the cardiac hormone B-type natriuretic peptide (BNP) for long-term outcome in a large cohort of stable angina patients.BackgroundRecent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes.MethodsIn 1,085 patients with coronary artery disease (CAD) baseline levels of BNP were prospectively associated with cardiovascular (CV) events during a mean follow-up of 2.5 years.ResultsBNP concentrations were significantly elevated in patients with future CV events (median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p…

Pedale Bypasschirurgie bei diabetischen Fußsyndrom: Indikation, Technik und Ergebnisse

Die periphere arterielle Verschlusskrankheit des diabetischen Patienten ist bevorzugt durch einen langstreckigen Verschluss der Unterschenkelarterien uner teilweiser Aussparung der Fusarterien gekennzeichnet. Aufgrund der begleitenden Polyneuropathie und der erhohten Infektanfalligkeit besteht fur diese Patienten ein dramatisch erhohtes Amputationsrisiko. Dieses Verschlussmuster ermoglicht aber die Anlage pedaler Venenbypasse speziell auch unter Uberbruckung kurzerer Distanzen als sog. “distal origin bypass”.

Influence of HMG-CoA reductase inhibitors on markers of coagulation, systemic inflammation and soluble cell adhesion.

Abstract Background: Beneath its lipid-lowering properties additional non-lipid effects of statin therapy are discussed. We therefore examined the impact of statins on laboratory markers of coagulation, inflammation and soluble cell adhesion to further explore these effects in 950 hospitalised patients with angiographically proven CAD. Methods and results: Although no significant differences were found in total cholesterol, LDL and HDL and triglyceride levels a statistically lower value in 277 statin-treated patients was found for von Willebrand factor [162(130/224) vs. 208(154/283)%, P =0.0001], leukocyte count [6.9(5.8/8.4) vs. 7.3(6.1/9.4)/nl, P =0.0005], high sensitive CRP [4.3(1.8/10.8…

One simple claudication question as first step in Peripheral Arterial Disease (PAD) screening: A meta-analysis of the association with reduced Ankle Brachial Index (ABI) in 27,945 subjects

Purpose and methods A meta-analysis using data from seven German population-based cohorts was performed by the German Epidemiological consortium of Peripheral Arterial Disease (GEPArD) to investigate whether one question about claudication is more efficient for PAD screening than established questionnaires. Claudication was defined on the basis of the answer to one question asking for pain in the leg during normal walking. This simple question was compared with established questionnaires, including the Edinburgh questionnaire. The associations of claudication with continuous ABI values and decreased ABI were analyzed by linear and logistic regression analysis, respectively. The results of t…

Inflammation, atherosclerotic burden and cardiovascular prognosis.

The aim of this study was to evaluate the impact of various inflammatory markers on atherosclerotic burden and cardiovascular prognosis.In a prospective study 720 patients preceding coronary angiography were enrolled. In all patients carotid and leg arteries were examined using sonographic methods and C-reactive protein, fibrinogen, interleukin-18 (IL-18) and interleukin-6 have been determined. Patients were compared with regard to atherosclerotic burden: no clinically significant stenosis (N=57, 7.9%), coronary artery disease only (N=362, 50.3%), coronary artery disease with peripheral atherosclerosis (=multi-vascular atherosclerosis, N=301, 41.8%).Follow-up data after a median of 6.5 year…

Tissue optical perfusion pressure: a simplified, more reliable, and faster assessment of pedal microcirculation in peripheral artery disease

Oscillometry is an alternative to continuous-wave Doppler (cw-Doppler) to determine peripheral artery disease (PAD) severity using the ankle-brachial index (ABI). cw-Doppler ABI differentiates systolic pressure of ATP and ADP where either one of both values in most patients is higher (high) and the other value is lower (low). In contrast, oscillometric ABI measures the strongest signal and hence misses the lower value. Both do not take pedal perfusion into consideration. Simultaneous determination of tissue microperfusion cares for pedal PAD. ABI was determined by cw-Doppler and oscillometry. Tissue optical perfusion pressure (TOPP) was taken from the first toe using photoplethysmography. 3…

Isolated Pulmonary Embolism Is Associated With a High Risk of Arterial Thrombotic Disease

Background Isolated PE is associated with a higher burden of atherosclerotic disease than other manifestations of VTE. Research Question We hypothesized that the presence of isolated PE may signal a chronically elevated risk of arterial thrombotic disease. Study Design and Methods Data from the VTEval Study, a prospective cohort study enrolling individuals with clinical suspicion and imaging-based diagnosis or exclusion of VTE, were analyzed. Patients with PE received whole-leg ultrasonography to assess presence of DVT. Regularized logistic regression identified features that discriminate between isolated PE and other VTE phenotypes at clinical presentation. Survival analyses were performed…

VS07�EXCELLENT LATE OUTCOME WITH DENATURATED HUMAN UMBILICAL VEIN (HUV) IN FEMOROPOPLITEAL BYPASS SURGERY - A GOOD EXAMPLE FOR THE IMPORTANCE OF BIOLOGICAL MATERIALS IN VASCULAR SURGERY

Purpose:   Femoropopliteal bypass with autologous vein provides excellent long term results in lower limb bypass. In case of unsuitable vein generally synthetic PTFE prostheses are preferred. Denaturated human umbilical vein was used as femoropopliteal bypass graft when autologous vein was not available. Long term results of a consecutive single center series are presented. Methodology:   HUV was implanted in femoropopliteal position in case of unavailable vein for symptomatic peripheral vascular disease or popliteal aneurysm. Follow-up examinations were performed after 3, 6, 12, 18, 24 months and annually thereafter. Duplex scan was used for detection of potential biodegeneration of the HU…

Antithrombotische Therapie bei peripherer arterieller Verschlusskrankheit

Was ist neu? Antithrombotische Therapie bei stabiler PAVK Die aktuellen deutschen und europäischen Leitlinien empfehlen bei Patienten mit einer peripheren arteriellen Verschlusskrankheit (PAVK) die Monotherapie mit einem Thrombozytenaggregationshemmer (ASS 100 mg oder Clopidogrel 75 mg).In der COMPASS (Cardiovascular OutcoMes for People using Anticoagulation StrategieS) -Studie wurde Patienten mit PAVK 2 × 2,5 mg Rivaroxaban zusätzlich zu ASS 100 mg gegeben. Dies führte zur signifikanten Reduktion kardiovaskulärer Ereignisse (MACE = Major Adverse Cardiovascular Events) wie kardiovaskulärer Tod, Myokardinfarkt und Schlaganfall. Ebenfalls signifikant reduziert wurden periphere Ereignisse (MAL…

Impact of routine angiographic follow-up after angioplasty

Abstract Background There is an ongoing controversy as to whether repeat coronary angiography should be routinely performed after successful percutaneous transluminal coronary angioplasty (PTCA). Methods We examined the 10-year outcome in 400 patients who had or had not undergone an angiographic control 6 months after successful PTCA and a subsequent event-free 6-month period. Our comparison was based on data gathered by questionnaire and telephone interview in 315 patients with (group A) and 85 patients without (group B) a routine 6-month angiographic control. Multivariate analysis (Cox model) was performed to identify predictors of adverse events. Results During the 10-year follow-up peri…

Resistin, acute coronary syndrome and prognosis results from the AtheroGene study

Resistin, an adipocyte and macrophage derived cytokine, causes insulin resistance and glucose intolerance. We investigated the impact of resistin as a diagnostic marker in patients with acute coronary syndrome and its prognostic value for future cardiovascular events.Resistin levels were determined in 1153 patients with stable angina (SAP), 380 patients with unstable angina, 278 patients with non-ST-elevation myocardial infarction (NSTEMI) and 111 patients with ST-elevation myocardial infarction (STEMI). All patients have been followed up for a median follow-up of 2.6 years. During follow-up, 70 patients died from cardiovascular causes.Compared to SAP, resistin levels (5.1 ng/mL in SAP) wer…

Das akute Koronarsyndrom (ohne ST-Hebung)

Die Therapie bei akutem Koronarsyndrom sollte die moglichst fruhe Gabe von Acetylsalizylsaure 100 mg taglich (loading dose 250–500 mg) und Clopidogrel 75 mg taglich (loading dose 300 mg) umfassen. Daruber hinaus ist eine Antikoagulation mit unfraktioniertem oder niedermolekularem Heparin einzuleiten. Glykoprotein-IIb/IIIa-Rezeptorblocker konnen bei Patienten mit hohem Risiko (Troponin positiv) im Sinne einer Upfronttherapie (Eptifibatide/Tirofiban) oder gezielt nur bei Patienten mit Koronarintervention im Katheterlabor (Abciximab) verabreicht werden. In der Langzeittherapie ist Clopidogrel fur mindestens 9 Monate indiziert, ASS lebenslang. Alle Hochrisikopatienten sollten innerhalb von 48 S…

Cardiac biomarkers and arterial stiffening: data from the Gutenberg Health study

Peripheral artery disease, redox signaling, oxidative stress – Basic and clinical aspects

Reactive oxygen and nitrogen species (ROS and RNS, e.g. H2O2, nitric oxide) confer redox regulation of essential cellular signaling pathways such as cell differentiation, proliferation, migration and apoptosis. At higher concentrations, ROS and RNS lead to oxidative stress and oxidative damage of biomolecules (e.g. via formation of peroxynitrite, fenton chemistry). Peripheral artery disease (PAD) is characterized by severe ischemic conditions in the periphery leading to intermittent claudication and critical limb ischemia (end stage). It is well known that redox biology and oxidative stress play an important role in this setting. We here discuss the major pathways of oxidative stress and re…

Psoriasis and its impact on the clinical outcome of patients with pulmonary embolism

Abstract Background Venous thromboembolism (VTE) is common and associated with high morbidity and mortality. Although chronic inflammation was not categorized as a traditional risk factor for VTE, chronic inflammation might increase the risk to develop VTE events. While studies confirmed an increased cardiovascular morbidity and mortality in psoriatic patients, data regarding the influence of psoriasis on patients' cardiovascular profile and on prognosis of patients with pulmonary embolism (PE) are sparse. Purpose We aimed to investigate the impact of psoriasis on prognosis of PE patients. Methods Hospitalized PE patients were stratified for psoriasis and the impact of psoriasis on outcome …

Questionable Value of Adjuvant Arteriovenous Fistula in Pedal Bypass at High Risk for Early Failure

Results of an adjuvant arteriovenous fistula (AVF) in pedal bypass surgery in the presence of poor status of the recipient artery, severely impaired intraoperative runoff, or revision for early failure and flow restitution were analyzed in a retrospective study. From January 1998 to December 2006, 24 adjuvant AVFs were constructed in autologous vein or composite pedal bypasses with low intraoperative bypass flow, poor status of the pedal artery, or during successful early bypass revision to prevent graft failure. All infrainguinal bypass operations were registered in a computerized database and prospectively followed. Pedal bypasses with adjunctive AVF were reviewed for fistula function, gr…

Impact of chronic obstructive pulmonary disease on the outcomes of patients with peripheral artery disease.

Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are both related with high in-hospital mortality. We aimed to investigate the impact of COPD on the in-hospital outcomes in PAD.PAD patients were selected based on ICD-code I70.2 of the German nationwide database, stratified for COPD and compared regarding adverse in-hospital outcomes.Between 01/2005-12/2015, 5,611,827 inpatients (64.8% males) were diagnosed with PAD; of those, 13.6% were coded additionally with COPD. Overall, 277,894 PAD patients (5.0%) died during in-hospital course. Prevalence of cardiovascular diseases as well as cancer (12.1% vs. 7.0%, P  0.001) was higher in PAD patients with COPD compare…

Drug coated ballons for femoro-popliteal interventions.

Response to Letter Regarding Article, “Different Calculations of Ankle Brachial Index and Their Impact on Cardiovascular Risk Prediction”

We thank Jaquinandi et al for their interest in our publication. We want to stress that the patient population of the AtheroGene study is not comparable with the patient populations reported in the articles from Lee et al and Kreitner et al, which included only patients with known advanced peripheral arterial disease.1,2 The AtheroGene study includes primarily patients with coronary artery disease, no patient had rest pain or peripheral ulcers and only 52 patients (6.3%) had intermittent claudication.3 In addition, …

Moderne Therapie bei akutem Koronarsyndrom

Inhibition of platelet aggregation with aspirin and anticoagulation with unfractionated heparin can be considered the gold standard treatment of patients with acute coronary syndromes. Replacement of unfractionated heparins by low-molecular weight heparins seem to further improve the cardiovascular risk. Additional treatment with glycoprotein IIb/IIIa receptor blockers led to a further reduction of the clinical event rate, especially in patients undergoing coronary interventions during an acute coronary syndrome (more than 30% relative risk reduction). However, the latter substances did only lead to marginal improvements in the setting of a conservative stabilization of patients with acute …

Antithrombotische Therapie nach peripherer Revaskularisation

Was ist neu? Gerinnungshemmende Therapie nach peripherer Intervention In Analogie zur Koronarintervention wird nach Katheterinterventionen peripherer Gefäße meist passager eine duale Thrombozytenaggregationshemmung (TZAH) mit ASS 100 mg und Clopidogrel 75 mg durchgeführt. Größere Studien zu diesem Vorgehen fehlten bisher und die Empfehlungen der aktuellen Leitlinien haben den Charakter eines Expertenkonsens. Gerinnungshemmende Therapie nach peripherer Bypassoperation Nach peripherer Bypassanlage empfehlen die aktuellen Leitlinien in der Regel die Monotherapie mit einem TZAH (ASS 100 mg oder Clopidogrel 75 mg). In Einzelfällen wird bei venösen Bypässen eine orale Antikoagulation oder bei Kun…

Neue orale Antikoagulanzien zur Therapie der venösen Thromboembolie

In the current treatment of venous thromboembolism most patients are treated with vitamin K antagonists (VKA). VKA have many disadvantages including slow onset of action, multiple food and drug interactions and a large inter-individual variability in their efficacy. Recently several alternative oral anticoagulants have been developed, which have several advantages in comparison to VKA. So far two large randomized studies comparing new oral anticoagulants with VKA in patients with venous thromboembolism have been published: the RECOVER study with the oral direct thrombin antagonist dabigatran and the EINSTEIN-DVT study with the oral direct factor Xa-antagonist rivaroxaban. With regard to rec…

Infrapopliteal Composite Bypass with Autologous Vein and Second Generation Glutaraldehyde Stabilized Human Umbilical Vein (HUV) for Critical Lower Limb Ischaemia

Objective. To audit a single center consecutive series of infrapopliteal composite bypasses with second generation glutaraldehyde stabilized human umbilical vein. Design. Retrospective study. Patients. From January 1996 to July 2006 89 femoro-distal bypasses were constructed in 85 patients with HUV and residual vein segments as composite grafts in the absence of sufficient length of autologous vein. Methods. All patients with infrainguinal bypass operations were registered prospectively. Bypasses to infrapopliteal arteries performed with HUV-composite grafts were reviewed for graft patency, limb salvage, patient survival and possible biodegeneration of the HUV. Results. Early graft thrombos…

Manifestationen der Atherosklerose in verschiedenen Gefäßregionen

Aus pathologischen Untersuchungen ist bekannt, dass es sich bei der Atherosklerose um eine Erkrankung handelt, die den gesamten Gefasbaum betrifft. In der Framingham-Studie wurden Risikofaktoren der Atherosklerose ermittelt, die fur die Lokalisation der Atherosklerose in verschiedenen Gefasprovinzen eine unterschiedliche Wertigkeit besitzen. Patienten mit Manifestationen der Atherosklerose in Herz-, Hals- und Beinschlagadern haben im Vergleich zu einem Normalkollektiv eine schlechtere Prognose. Auserdem liegt eine hohe Koinzidenz von atherosklerotischen Lasionen in den verschiedenen Gefasregionen vor. Besonders ungunstig ist die Prognose fur Patienten, die zum Zeitpunkt der Untersuchung ber…

e-Health-based management of patients receiving oral anticoagulation therapy: results from the observational thrombEVAL study

Essentials e-Health based health care by an expert centre may advance management of oral anticoagulation. Outcome of patients was compared between an e-health based coagulation service and regular care. Patients in the coagulation service cohort experienced a significantly better clinical outcome. Lower risk for adverse events was related to anticoagulation-specific and non-specific outcome. SummaryBackground Management of oral anticoagulation (OAC) therapy is essential to minimize adverse events in patients receiving vitamin K-antagonists (VKAs). Data on the effect of e-health-based anticoagulation management systems on the clinical outcome of OAC patients are limited. Objectives To compar…

Predictors of new-onset peripheral artery disease Comment on Krause et al., p. 403 - 410.

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

Summary: More than 6,000 publications were found in PubMed concerning aneurysms and dissections, including those Epub ahead of print in 2019, printed in 2020. Among those publications 327 were selected and considered of particular interest.

Follow-up of patients after revascularisation for peripheral arterial diseases: a consensus document from the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery

International audience; Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often chall…

Association between multiple biomarkers and classical risk factors with early carotid atherosclerosis

Diagnostik und konservative Therapie der peripheren arteriellen Verschlusskrankheit (PAVK)

Die periphere arterielle Verschlusskrankheit (PAVK) hat eine hohe Pravalenz. Patienten mit PAVK haben ein hohes Risiko fur kardiovaskulare Ereignisse. Ein Screening von Risikopersonen durch Ermittlung des Knochel-Arm-Index erscheint daher wichtig. Die zentrale Methode in der angiologischen Diagnostik ist die Duplexsonografie. Zur Beurteilung des Kompensationsgrads und zur Therapieplanung eignen sich erganzend funktionelle Untersuchungsmethoden wie beispielsweise die Laufbandergometrie. In der konservativen Therapie ist die konsequente Einstellung der kardiovaskularen Risikofaktoren wichtig. Patienten mit Claudicatio intermittens sollten zu konsequentem, strukturiertem Gehtraining angehalten…

Utilidad cuestionable de la fístula arteriovenosa auxiliar en el bypass distal de riesgo

En un estudio retrospectivo se analizaron los resultados de la colocacion de una fistula arteriovenosa (FAV) auxiliar en la cirugia de bypass distal en presencia de una arteria receptora de mala calidad o con severa alteracion de la circulacion colateral. Desde enero de 1998 hasta diciembre de 2006, se crearon 24 FAV auxiliares en venas autologas o en bypass distales mixtos que presentaban un flujo intraoperatorio bajo, arteria distal de mala calidad, o durante la revision inicial de un bypass para prevenir su fracaso. Todas las cirugias de bypass infrainguinal se registraron en una base de datos informatizada y se realizo su seguimiento de forma prospectiva. En los bypass distales con FAV …

Comparison of Arterial and Venous Blood Flow Between Patients with Pressure Dressing or a New Hemostatic Puncture Closure Device After Cardiac Catheterization

The aim of the study was to compare arterial and venous flow volume in the punctured leg in patients given a conventional pressure dressing and those given a new hemostatic puncture closure device (Angio-Seal) after cardiac catheterization. We prospectively measured blood flow in 25 patients with pressure dressing (group A) and 25 patients with Angio-Seal (group B) after cardiac catheterization. Duplex sonographic measurements were performed at the superficial femoral artery and vein of the punctured leg. In group A measurements were performed before catheterization, during pressure dressing, and after removal of pressure dressing. In group B we performed the measurements before catheteriza…

Der kurze popliteodistale Venenbypass beim diabetischen Fußsyndrom DFS

Purpose: World wide increase of diabetes compound with diabetic foot syndrome becomes a challenge in vascular surgery to avoid limb loss. In diabetics a special pattern of atherosclerosis is prevalent with disease limited to the infrageniculate arteries but sparing inflow vessels and distal tibial and pedal arteries. This provides short bypass grafting from popliteal to tibial and pedal arteries, a concept first described by F. Veith in 1981. Methods: Diabetics with severe atherosclerotic disease and limb-threatening ischemia got general evaluation and vascular imaging. Falling in this special category the patients underwent short vein bypass grafting originating at the first or third popli…

Durability of open popliteal artery aneurysm repair

Objective The objective of this study was to analyze our long-term results after open surgery for popliteal artery aneurysm. Methods Records of patients who received surgery between 1998 and 2010 were retrieved from a computerized database and analyzed retrospectively. End points of the study were perioperative mortality and morbidity and patency and limb salvage rate. Results Two hundred and six popliteal aneurysms (median diameter, 30 mm; interquartile range, 18 mm) were treated (161 elective, 45 emergent) in 154 patients (mean age, 67 ± 11 years) using vein grafts (82%) via the medial approach (92%). Above-knee popliteal artery (45%) and below-knee popliteal artery (65%) were the predomi…

Cytomegalovirus infection with interleukin-6 response predicts cardiac mortality in patients with coronary artery disease.

Background —Prospective data relating previous exposure to cytomegalovirus (CMV) to the risk of cardiac mortality are controversial. We investigated the effect of previous exposure to CMV infection on the risk of future cardiac disease–related death in relation to an underlying inflammatory response. Methods and Results —Coronary angiography was performed in 1134 subjects, and 989 patients with documented coronary artery disease were studied prospectively. CMV-IgG titers and interleukin (IL)-6 levels were measured before angiography. Increasing titers of CMV correlated with the elevation of IL-6 levels ( P <0.001) after adjustment for possible confounders. All patients were followed up …

Ten-year outcome after coronary angioplasty in patients with single-vessel coronary artery disease and comparison with the results of the Coronary Artery Surgery Study (CASS).

The 10-year results of randomized trials comparing percutaneous transluminal coronary angioplasty (PTCA) in patients with single-vessel coronary artery disease (CAD) with coronary artery bypass grafting (CABG) and medical treatment are not available yet. The aim of this evaluation was to compare our 10-year follow-up results after PTCA in patients with single-vessel CAD with the 10-year follow-up results after CABG and medical treatment in the Coronary Artery Surgery Study (CASS) trial. We evaluated the clinical outcome of 509 patients with single-vessel CAD 10 years after coronary angioplasty. The data were compared with the results of 214 patients with single-vessel CAD after CABG or medi…

Impact of inflammatory markers on cardiovascular mortality in patients with metabolic syndrome.

Recent investigations suggest the inclusion of inflammatory markers in the definition of the metabolic syndrome (MS). The aim of this study was to address the role of C-reactive protein, fibrinogen, interleukin-6 (IL-6) and IL-18 (IL-18) on cardiovascular prognosis in accordance to MS.A total of 1263 patients with documented coronary artery disease were prospectively included. We defined MS (MS yes: N=533, 42.2%) as the presence of at least three of the following criteria: triglyceridesor=150 mg/dl; low high-density lipoprotein cholesterol (men:40 mg/dl women:50 mg/dl); body mass index greater than 30 kg/m; blood pressureor=130/85 mmHg; fasting glucoseor=100 mg/dl. In addition, we determine…

Association Between Chromosome 9p21 Variants and the Ankle-Brachial Index Identified by a Meta-Analysis of 21 Genome-Wide Association Studies

Background— Genetic determinants of peripheral arterial disease (PAD) remain largely unknown. To identify genetic variants associated with the ankle-brachial index (ABI), a noninvasive measure of PAD, we conducted a meta-analysis of genome-wide association study data from 21 population-based cohorts. Methods and Results— Continuous ABI and PAD (ABI ≤0.9) phenotypes adjusted for age and sex were examined. Each study conducted genotyping and imputed data to the ≈2.5 million single nucleotide polymorphisms (SNPs) in HapMap. Linear and logistic regression models were used to test each SNP for association with ABI and PAD using additive genetic models. Study-specific data were combined using fi…

External reinforcement of varicose veins with PTFE prosthesis in infrainguinal bypass surgery -- clinical results.

OBJECTIVE Segmental varicose degeneration of the autogenous greater saphenous vein may limit its use in infrainguinal bypass surgery. Wrapping a PTFE prosthesis around dilated veins has emerged as an option to create externally reinforced vein bypasses. Results regarding graft patency and limb salvage were analyzed. METHODS Between September 1995 and January 2001, 35 infrainguinal bypass operations in 33 patients were performed with greater saphenous veins exhibiting segmental varicose dilatation. Grafts were followed by duplex scan and retrospective analysis of graft patency and limb salvage was performed. RESULTS One bypass prompted successful revision for early occlusion. Four bypasses r…

Periphere arterielle Verschlusskrankheit: Wann ist ein PCSK9-Inhibitor sinnvoll?

ZusammenfassungDie Leitlinie der Europäischen Gesellschaft für Kardiologie empfiehlt bei Patienten mit manifester peripherer arterieller Verschlusskrankheit (PAVK) ebenso wie bei KHK oder zerebrovaskulärer Erkrankung einen LDL-C-Zielwert < 70 mg/dL oder eine Reduktion um 50 %, wenn der Ausgangswert zwischen 70 und 135 mg/dL liegt. Die Applikation eines PCSK9-Inhibitors ermöglicht die Zielwerterreichung für viele Patienten, die dies unter einer maximalen Statintherapie in Kombination mit Ezetemib nicht erreichen. In der Fourier-Studie konnte für Patienten mit PAVK, die bei Studieneinschluss weder einen Myokardinfarkt noch einen Apoplex erlitten hatten, eine deutliche Risikoreduktion (RR) …

Supervised exercise training in peripheral arterial disease increases vascular shear stress and profunda femoral artery diameter

Background Arteriogenesis is promoted by flow- and pressure-related forces such as tangential wall stress and laminar shear stress. Exercise training (ET) is known to promote arteriogenesis in peripheral arterial disease (PAD) patients. It remains unclear whether supervised ET (SET) promotes arteriogenesis more efficiently than non-SET (nSET). Methods and results Forty PAD patients participated in a SET or nSET training programme ( n = 20 each) and were compared to 20 healthy individuals without any history of cardiovascular events. Femoral artery diameter, flow and velocity were measured by ultrasound. Tangential wall stress and laminar shear stress were calculated for femoral arteries. Fo…

The diagnostic performance of renal function-adjusted D-dimer testing in individuals suspected of having venous thromboembolism

Renal impairment, a source of chronic hypercoagulability[1][1] and inflammation,[2][2] is known to reduce the specificity of the D-dimer test in the diagnosis of venous thromboembolism (VTE).[3][3] This leads to many false positives in such patients and consequently to additional costs, as well as

Sequential Femorodistal Composite Bypass with Second Generation Glutaraldehyde Stabilized Human Umbilical Vein (HUV)

Abstract Objective To evaluate the performance of sequential composite bypasses with second generation glutaraldehyde stabilized human umbilical vein (HUV) and autologous vein. Design Retrospective study of consecutive patients, in a single centre. Patients From January 1998 to December 2003, 54 femoro-distal HUV-autologous vein sequential composite bypasses were constructed in 52 patients with critical leg ischemia and absence of sufficient length of autologous vein. Methods All infra-inguinal bypass operations were registered in a computerized database and prospectively followed. Bypasses using sequential HUV-composite technique were reviewed for graft patency, limb salvage and patient su…

Survival and quality of life after early discharge in low-risk pulmonary embolism.

IntroductionEarly discharge of patients with acute low-risk pulmonary embolism requires validation by prospective trials with clinical and quality-of-life outcomes.MethodsThe multinational Home Treatment of Patients with Low-Risk Pulmonary Embolism with the Oral Factor Xa Inhibitor Rivaroxaban (HoT-PE) single-arm management trial investigated early discharge followed by ambulatory treatment with rivaroxaban. The study was stopped for efficacy after the positive results of the predefined interim analysis at 50% of the planned population. The present analysis includes the entire trial population (576 patients). In addition to 3-month recurrence (primary outcome) and 1-year overall mortality, …

The Diagnosis and Treatment of Peripheral Arterial Vascular Disease

Background In peripheral arterial occlusive disease (PAOD), arterial stenosis or occlusion impairs perfusion in the territory of the distal portion of the aorta and the iliac and leg arteries. In Germany, the prevalence of PAOD rises with age, reaching 20% among persons over age 70. Methods This guideline was prepared by a collaboration of 22 medical specialty societies and two patient self-help organizations on the basis of pertinent publications that were retrieved by a systematic search in PubMed for articles that appeared from 2008 to April 2014, with a subsequent update to May 2015. Results 294 articles were assessed, including 34 systematic reviews and 98 randomized controlled trials …

Glutathione Peroxidase-1 and Homocysteine for Cardiovascular Risk Prediction

Objectives This prospective study was designed to evaluate the effect of joint determination of two important contrary biomarkers—homocysteine and glutathione peroxidase (GPx)-1—on cardiovascular risk stratification. Background Homocysteine plasma levels have been associated with cardiovascular risk. Experimental data suggest that antioxidative GPx-1 activity modulates cardiovascular risk associated with homocysteine. Methods In 643 patients with coronary artery disease, we performed a prospective study to assess the risk of homocysteine plasma levels and GPx-1 activity on long-term cardiovascular risk with a median follow-up of 7.1 years. Results Both homocysteine and GPx-1 were among the …

Subtherapeutic Anticoagulation Control under Treatment with Vitamin K-Antagonists—Data from a Specialized Coagulation Service

AbstractIn contrast to overanticoagulation, evidence on risk factors and outcome of subtherapeutic oral anticoagulation (OAC) with vitamin K-antagonists (VKAs) under optimum care is limited. We investigated the clinical phenotype, anticoagulation control, and clinical outcome of 760 VKA patients who received OAC therapy by a specialized coagulation service in the thrombEVAL study (NCT01809015). During 281,934 treatment days, 278 patients experience ≥ 1 episode of subtherapeutic anticoagulation control and had lower quality of OAC therapy compared to 482 patients without subtherapeutic international normalized ratio: 67.6%, interquartile range (IQR) 54.9%/76.8% versus 81.0%, IQR 68.5%/90.4%;…

Outcomes of complex femorodistal sequential autologous vein and biologic prosthesis composite bypass grafts

Objective Femorodistal autologous vein bypass proves to be the preferred surgical therapy for long arterial occlusions and provides excellent early and long-term results in critical lower limb ischemia. Whenever vein length was insufficient and two distal outflow arteries were present, a sequential composite bypass configuration was chosen with human umbilical vein (HUV) or ovine collagen prosthesis (Omniflow II; Bio Nova International Pty Ltd, North Melbourne, Australia) as the proximal prosthetic part of the bypass. Single-center experience with this technique regarding limb salvage, graft function, secondary reinterventions, and biodegeneration is presented. Methods Between January 1998 …

Leukocyte–platelet aggregates—a phenotypic characterization of different stages of peripheral arterial disease

The formation of monocyte-platelet aggregates and neutrophil-platelet aggregates (MPA and NPA, respectively) is influenced by inflammation, but also might contribute to an exacerbation of inflammatory responses in atherosclerotic plaque. The purpose of this study was to analyze MPA and NPA proportions in regard to different stages of peripheral arterial disease (PAD). Forty-five patients with intermittent claudication (IC) (3 groups: Rutherford (R)-1, R-2, and R-3; each n = 15), 20 patients with critical limb ischemia (CLI) (Rutherford 5 (40%) and 6 (60%)), and 20 healthy controls were studied. Analyses of monocyte (Mon) subpopulations (CD14++CD16- (classical) Mon1, CD14++CD16+ (intermediat…

Polyvascular disease: A narrative review of current evidence and a consideration of the role of antithrombotic therapy.

Abstract Background and aims Polyvascular disease (PVD) affects approximately 20% of patients with atherosclerosis and is a strong independent risk factor for ischemic outcomes. However, guidelines do not address screening or treatment for PVD, and there have been no PVD-specific trials. We reviewed subgroup analyses of large randomized controlled trials of more intense antithrombotic therapy to determine whether increased intensity of therapy improved ischemic outcomes in patients with PVD. Methods MEDLINE, MEDLINE in-Process, EMBASE, and the Cochrane Library were queried for randomized controlled trials larger than 5000 patients evaluating secondary prevention therapies in patients with c…

Relevance of Polypharmacy for Clinical Outcome in Patients Receiving Vitamin K Antagonists.

BACKGROUND Although polypharmacy is associated with a negative clinical outcome in various settings and commonly observed in patients receiving oral anticoagulation therapy, evidence on the relevance for the clinical outcome of anticoagulated patients is currently limited. The aim of the study was to investigate the effect of polypharmacy on the clinical outcomes among patients taking phenprocoumon. DESIGN Prospective cohort study. SETTING Regular medical care. PARTICIPANTS Information on 2011 individuals receiving vitamin K antagonists was available for analysis from the prospective multicenter thrombEVAL study. MEASUREMENTS Data were obtained from clinical visits, computer-assisted interv…

Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy

AbstractThe aim of this collaborative document is to provide an update for clinicians on best antithrombotic strategies in patients with aortic and/or peripheral arterial diseases. Antithrombotic therapy is a pillar of optimal medical treatment for these patients at very high cardiovascular risk. While the number of trials on antithrombotic therapies in patients with aortic or peripheral arterial diseases is substantially smaller than for those with coronary artery disease, recent evidence deserves to be incorporated into clinical practice. In the absence of specific indications for chronic oral anticoagulation due to concomitant cardiovascular disease, a single antiplatelet agent is the ba…

Femoropopliteal prosthetic bypass with glutaraldehyde stabilized human umbilical vein (HUV).

Objective Femoropopliteal bypass still is the standard surgical therapy for disabling claudication and critical ischemia. When autologous vein is not suitable synthetic or biological prostheses may be considered. Second generation glutaraldehyde tanned human umbilical vein (HUV) graft was chosen for above and below knee femoropopliteal bypass when autologous vein was not available. A single center experience regarding long-term graft function, secondary reinterventions, and potential biodegeneration of the HUV is presented. Methods Between January 1994 and January 2005, 211 consecutive femoropopliteal bypass operations with HUV (65 above knee and 146 below knee) were performed in 197 patien…

β-Blockers in Patients With Intermittent Claudication and Arterial Hypertension

The use of β-receptor blockers in peripheral arterial disease is controversial for their impact on vasomotor tone. The β-blocker nebivolol possesses vasodilating, endothelium-dependent, NO-releasing properties that might be beneficial in peripheral arterial disease. The aim of the study was to evaluate the effects and tolerability of nebivolol in comparison with metoprolol in these patients. A total of 128 patients with intermittent claudication and essential hypertension were included and double-blind randomized to receive 5 mg of nebivolol (N=65) or 95 mg of metoprolol (N=63) once daily. End points were changes in ankle-brachial index, initial and absolute claudication distance, endothel…

Acute deep vein thrombosis suppresses peripheral T cell effector function

Endovaskuläre Aneurysmatherapie - Langzeitergebnisse nach 7 Jahren

Hintergrund: Seit der Entwicklung von Stentprothesen und deren kommerzieller Verfugbarkeit 1994 gibt es eine neue, sich zunehmend verbreitende endovaskulare Methode der Aneurysmatherapie.

Sex differences in early carotid atherosclerosis (from the community-based Gutenberg-Heart Study).

The objectives of this study were to describe gender differences in intima-media thickness (IMT) in a community-based population study and to define normal IMT values for healthy men and women. In total, 4,814 participants (aged 35 to 74 years; 2,433 men, 2,381 women) from the Gutenberg-Heart Study (GHS) were included. IMT was measured at both common carotid arteries using an edge detection system. Median IMT was 0.62 mm (25th percentile 0.55, 75th percentile 0.70) in women and 0.65 mm (25th percentile 0.57, 75th percentile 0.75) in men and was significantly associated with age (p0.0001). On multivariate analysis, advanced age, smoking, and arterial hypertension were positively associated w…

Direct measurement of left ventricular outflow tract by transthoracic real-time 3D-echocardiography increases accuracy in assessment of aortic valve stenosis.

Evaluation of aortic valve stenosis is a major clinical application of echocardiography. The widely employed continuity equation requires determination of the left ventricular outflow tract (LVOT) area. We aimed at testing whether direct area measurement in a volume data set is superior to conventional calculation from the LVOT diameter.We performed LVOT measurement in 20 normal subjects and 83 patients with moderate to severe aortic stenosis with a transthoracic real-time three-dimensional echocardiography (3D-TTE) technique in two systolic frames. The off-line 3D-evaluation allows full choice of section planes within the acquired volume data set. The aortic valve area was calculated from …

B-Type Natriuretic Peptide and the Risk of Cardiovascular Events and Death in Patients With Stable Angina

B-Type Natriuretic Peptide and the Risk of Cardiovascular Events and Death in Patients With Stable Angina: Results From the AtheroGeneStudyRenate Schnabel, Edith Lubos, Hans J. Rupprecht, Christine...

Krurale und pedale Bypasschirurgie bei kritischer Isch�mie und nicht heilenden Fu�l�sionen

Die Ischamie ist der haufigste Grund fur nicht heilende Lasionen an den Fusen. Mit der weltweiten Zunahme vaskularer Erkrankungen und insbesondere des diabetischen Fussyndroms steigt auch die Zahl der Patienten, die durch eine Revaskularisation geheilt werden konnen, momentan aber uberwiegend (25.000/Jahr in Deutschland) amputiert werden. In den letzten Jahrzehnten sind in der Gefaschirurgie subtile Methoden entwickelt worden, die auch eine Revaskularisation und Bypassoperationen bei Patienten mit einem distalen Verschlusstyp, der immer haufiger und gerade beim Diabetiker angetroffenen wird, zulassen. Eine besondere Rolle spielt hier der Venenbypass aus V. saphena magna oder alternativen Ve…

Chronic venous insufficiency, cardiovascular disease, and mortality: a population study

Abstract Aims  Evidence regarding the health burden of chronic venous insufficiency (CVI), its clinical determinants, and impact on outcome is scarce. Methods and results  Systematic phenotyping of CVI according to established CEAP (Clinical-Etiologic-Anatomic-Pathophysiologic) classification was performed in 12 423 participants (age range: 40–80 years) of the Gutenberg Health Study from April 2012 to April 2017. Prevalence was calculated age- and sex-specifically. Multivariable Poisson regression models were calculated to evaluate the relation of CVI with cardiovascular comorbidities. Survival analyses were carried out to assess the CVI-associated risk of death. Replication of findings was…

Editor's Choice – Follow-up of Patients After Revascularisation for Peripheral Arterial Diseases: A Consensus Document From the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery

International audience; Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often chall…

Association of adiponectin with adverse outcome in coronary artery disease patients: results from the AtheroGene study

In primary prevention, the adipocytokine adiponectin seems to be protective against diabetes mellitus and cardiovascular disease. Data in patients with manifest coronary artery disease (CAD) are scant stimulating the investigation of the association of adiponectin concentrations and cardiovascular outcome in a prospective CAD cohort.In 1890 consecutive patients with documented CAD [1130 with stable angina (SAP) and 760 with acute coronary syndrome (ACS)] baseline concentrations of adiponectin were measured by enzyme-linked immuno assay. During a median follow-up of 2.5 years cardiovascular events were registered (cardiovascular deaths 70; non-fatal myocardial infarction 46). Baseline adipon…

Contemporary results with the biosynthetic glutaraldehyde denatured ovine collagen graft (Omniflow II) in femoropopliteal position

Abstract Objective The objective of this study was to analyze the outcome of a contemporary series of femoropopliteal bypass operations with the glutaraldehyde denatured polyester mesh-reinforced ovine collagen prosthesis (OCP; Omniflow II [LeMaitre Vascular, Inc, Burlington, Mass]). The experience of two tertiary centers regarding long-term graft function, secondary reinterventions, and biodegeneration of the OCP prosthesis is presented. Methods Between January 2006 and January 2014, a series of 205 consecutive operations with the OCP in the femoropopliteal position (54 above knee and 151 below knee) were performed in 194 patients in 202 limbs for disabling claudication (72), chronic criti…

Impact of C-reactive protein and fibrinogen on cardiovascular prognosis in patients with stable angina pectoris: the AtheroGene study.

Aims C-reactive protein and fibrinogen have been extensively studied and shown to be predictive for a first cardiovascular event in healthy individuals. We evaluated the potential clinical use of C-reactive protein and fibrinogen in patients already suffering from coronary artery disease (CAD). Methods and results In a substudy of the prospective Athero Gene registry, we assessed in 1806 patients with documented CAD and stable angina pectoris, the risk of cardiovascular death and non-fatal myocardial infarction ( n =183) over a median follow-up of 3.5 (maximum 7.7) years according to baseline levels of C-reactive protein and fibrinogen. C-reactive protein and fibrinogen were associated with…

Specialized Management of Oral Anticoagulation Therapy Improves Outcome in Patients with Chronic Renal Insufficiency

Oral anticoagulation (OAC) is effective at preventing and treating thromboses and thromboembolism in patients with normal renal function. We aimed to research the impact of severe renal failure (RF) on patient outcome and to determine the potential benefit of caring for these patients in a specialized coagulation service (CS). A total of 1516 usual medical care patients and 756 CS-managed patients of the thrombEVAL multicenter (21 centers), prospective, cohort study (NCT01809015) were analyzed in a 3-year follow-up. Patients with RF (serum creatinine &gt

Inflammatory markers and cardiovascular risk in the metabolic syndrome

Elevated blood glucose, obesity, high blood pressure, elevated triglycerides and low high density lipoprotein (HDL) cholesterol are well accepted risk factors in the development of coronary artery disease. Clustering of at least three of these factors in an individual is defined as metabolic syndrome (MetS). Obesity is a central pathological mechanism in the disease and it is expected that the incidence of this condition will increase dramatically within the next years. The visceral adipose tissue is not only an energy depot but also an endocrine organ which produces a large number of bioactive molecules, the so called adipokines. In the setting of obesity, the over-production of proinflamm…

Phenotypic characterisation of pro-inflammatory monocytes and dendritic cells in peripheral arterial disease

SummaryAtherosclerosis is a chronic inflammatory process involving antigen-presenting cells like monocytes and dendritic cells (DC). The aim of this study was to perform a phenotypic characterisation of these cell types in patients with different degrees of peripheral arterial disease (PAD). Sixty patients with PAD [N= 30 intermittent claudication (IC), N= 30 critical limb ischemia (CLI)] and 30 controls were included. Peripheral blood leucocytes were analysed from peripheral blood by flow cytometry using different gating strategies to directly identify and analyse monocytes, myeloid DC, (mDC) and plasmacytoid DC (pDC). PAD patients showed a significantly higher proportion of proinflammator…

Periphere arterielle Verschlusskrankheit als Zusatzdiagnose bei koronarer Herzerkrankung – Einfluss auf Diagnostik, Therapie und Prognose

Das Vorliegen einer PAVK verschlechtert die Prognose eines Patienten mit KHK und sollte daher bei Diagnostik und Therapieplanung berucksichtigt werden. Ist eine weiterfuhrende Diagnostik bei V. a. eine KHK geplant, sollte man an mogliche Limitationen durch das Vorliegen einer PAVK denken. Bei einer Ergometrie sind PAVK Patienten moglicherweise aufgrund einer Claudicatio weniger gut belastbar, bei einer invasiven Diagnostik konnen Probleme beim Gefaszugang auftreten. Die Einstellung der kardiovaskularen Risikofaktoren ist bei allen Manifestationen der Arteriosklerose wichtig. Herbei sind die Empfehlungen der Leitlinien bei PAVK und KHK vergleichbar. Ebenso sind Thrombozytenaggregationshemmer…

Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles.

Abstract Purpose: Despite a rapid spread of the technique, very little is known about the laser-tissue interaction in endovenous laser treatment (EVLT). We evaluated EVLT of the incompetent greater saphenous vein (GSV) for efficacy, treatment-related adverse effects, and putative mechanisms of action. Methods: Twenty-six patients with 31 limbs of clinical stages C 2-6 , E P , A S,P , P R with incompetent GSV proven by means of duplex scanning were selected for EVLT in an outpatient setting. A 600-μm fiber was entered into the GSV via an 18-gauge needle below the knee and proceeded to the saphenofemoral junction (SFJ). After infiltration of tumescent local anesthesia, multiple laser pulses o…

Risk Factors for Pulmonary Embolism in Patients with Paralysis and Deep Venous Thrombosis

Background. Venous thromboembolism is a frequent complication and an important cause of death in patients with paralysis. We aimed to investigate predictors of pulmonary embolism (PE) and the impact of PE on the survival of patients with paralysis in comparison to those with deep venous thrombosis or thrombophlebitis (DVT). Methods: Patients were selected by screening the German nationwide inpatient sample (2005–2017) for paralysis, and were stratified for venous thromboembolism (VTE) and the VTE-sub-entity PE (ICD-code I26). Impact of PE on mortality and predictors for PE were analyzed. Results: Overall, 7,873,769 hospitalizations of patients with paralysis were recorded in Germany 2005–20…

Treatment of Venous Thromboembolism in Special Populations with Direct Oral Anticoagulants

AbstractAs a result of the successful completion of their respective phase III studies compared with vitamin K antagonists (VKAs), four direct oral anticoagulants (DOACs) have been approved for the treatment and secondary prevention of venous thromboembolism (VTE). These DOACs—apixaban, dabigatran, edoxaban, and rivaroxaban—have subsequently seen a steady uptake among clinicians since their approval. Despite the suitability of DOACs for a broad range of patients, they are not appropriate in certain situations, whereas in others they require additional considerations such as dose reductions. Subanalyses of phase III trials and studies on specific VTE patient populations have been conducted t…

Critical limb ischaemia is characterised by an increased production of whole blood reactive oxygen species and expression of TREM-1 on neutrophils

Atherosclerosis is a chronic inflammatory process involving polymorphonuclear neutrophils (PMN) and formation of reactive oxygen species (ROS). The aim of the present study was to investigate the phenotype of inflammatory cells in regard to the expression of triggering receptor expressed on myeloid cells (TREM)-1 and its soluble form (sTREM-1) as well as its relationship with oxidative stress in peripheral artery disease (PAD) patients.In total 90 patients with PAD (N = 30 intermittent claudication (IC)300 m absolute walking distance, N = 30 IC300 m absolute walking distance, N = 30 critical limb ischaemia (CLI)) and 30 control persons were included. ROS formation was measured at basal or s…

History of depression but not current depression is associated with signs of atherosclerosis: data from the Gutenberg Health Study.

ObjectivesTo test the vascular depression hypothesis in the general population, we analyzed the association between current depression, medical history of depression, cognitive and somatic depressive symptom dimensions and measures of atherosclerosis [intima–media thickness (IMT) and carotid plaques].MethodWe included a representative sample of 5000 participants from the Gutenberg Health Study (GHS). Depression was assessed by the nine-item Patient Health Questionnaire (PHQ-9), and IMT and carotid plaques were measured at both common carotid arteries using an edge detection system. Regression analyses were performed separately for participants with and without cardiovascular disease, adjust…

Einfluss genetischer Variationen des Cholesterylestertransferproteingens auf die Pr�valenz der koronaren Herzerkrankung

Mehrere funktionelle Polymorphismen des Cholesterylestertransferprotein( CETP)-Gens beeinflussen die CETP-Aktivitat und die High-density-lipoprotein(HDL)-Cholesterin-Konzentration. Neben anderen funktionellen Varianten wird vornehmlich der Promotorpolymorphismus CETP/C-629A als Risikofaktor der koronaren Herzerkrankung (KHK) diskutiert. Wir untersuchten in einer grosen Fall-/Kontroll-Studie den Einfluss verschiedener CETP-Genotypen und Haplotypen auf die HDL-Konzentration sowie die Pravalenz der KHK. Bei 1214 Patienten mit dokumentierter KHK sowie 574 Populationskontrollen wurden neben den klassischen Risikofaktoren folgende CETP-Polymorphismen bestimmt: C-629A, TaqIB, I405V, R451Q und A373…

Impact of infectious burden on extent and long-term prognosis of atherosclerosis.

Background — Recent findings suggest a causative role of infections in the pathogenesis of atherosclerosis. In hypothesizing an association between infectious agents and the development of atherosclerosis, we would expect a correlation to the extent of atherosclerosis. Moreover, this effect could be multiplied by the number of pathogens to which an individual had been exposed. Methods and Results — In 572 patients, IgG or IgA antibodies to herpes simplex virus 1 and 2, cytomegalovirus, Epstein-Barr virus, Hemophilus influenzae , Chlamydia pneumoniae , Mycoplasma pneumoniae , and Helicobacter pylori were measured. The extent of atherosclerosis was determined by coronary angiography, carotid…

Impact of infectious burden on progression of carotid atherosclerosis.

Background and Purpose— Recent findings suggest a causative role of infections in the pathogenesis of atherosclerosis. The extent of atherosclerosis and the prognosis of patients with atherosclerosis seem to be increased by the number of infections to which an individual has been exposed. In a prospective study, we evaluated the effect of 8 pathogens and the aggregate pathogen burden on the progression of carotid atherosclerosis. Methods— In 504 patients (74.9% men; age, 62.9±10 years), we measured intima-media thickness and prevalence of carotid artery stenosis. Follow-up measurements after a mean of 2.5 years were available in 427 patients (85%). Blood samples were taken, and IgG or IgA …

Protein expression profiling suggests relevance of noncanonical pathways in isolated pulmonary embolism

Abstract Patients with isolated pulmonary embolism (PE) have a distinct clinical profile from those with deep vein thrombosis (DVT)-associated PE, with more pulmonary conditions and atherosclerosis. These findings suggest a distinct molecular pathophysiology and the potential involvement of alternative pathways in isolated PE. To test this hypothesis, data from 532 individuals from the Genotyping and Molecular Phenotyping of Venous ThromboEmbolism Project, a multicenter prospective cohort study with extensive biobanking, were analyzed. Targeted, high-throughput proteomics, machine learning, and bioinformatic methods were applied to contrast the acute-phase plasma proteomes of isolated PE pa…

Editorial Comment—Is Heme Oxygenase-1 a Causal Player for Plaque Stability?

Inflammatory mechanisms play an important role in all stages of the atherosclerotic process.1 Various studies implicate that certain infectious agents represent candidates that trigger these inflammatory responses.2 An association of viral infection with atherosclerosis was first reported in the 1970s, when experimental infection of germ-free chickens with an avian herpes virus was found to produce arterial disease.3 Although several infectious pathogens have been detected within the atherosclerotic plaque, including Chlamydia pneumoniae , Cytomegalovirus, and Helicobacter pylori , the precise role of these pathogens in causing atherosclerosis or in aggravating the atherosclerotic process r…

Reentry devices for chronic arterial occlusions.

Glutathione Peroxidase-1 Activity, Atherosclerotic Burden, and Cardiovascular Prognosis

Recent findings suggest that erythrocyte intracellular glutathione peroxidase-1 (GPX-1) activity is related inversely to future cardiovascular events. The aim of this study is to evaluate the association of GPX-1 activity to extent of atherosclerosis, as well as its long-term prognosis in context with atherosclerotic burden. In a prospective study, we included 508 patients before coronary angiography. Atherosclerosis of carotid and leg arteries was documented using sonographic methods. Blood samples were drawn after an overnight fasting period, and GPX-1 activity was determined in washed erythrocytes. GPX-1 activity tended to decrease with increasing numbers of atherosclerotic vascular beds…

The difference between men and women

Asymmetric Dimethylarginine and the Risk of Cardiovascular Events and Death in Patients With Coronary Artery Disease

As a competitive inhibitor of endothelial nitric oxide synthase, asymmetric dimethylarginine (ADMA) has been related to atherosclerotic disease. Little is known about the prognostic impact of baseline ADMA determination. In a prospective cohort of 1908 patients with coronary artery disease, we assessed baseline serum concentration of ADMA in 1874 consecutive patients with coronary artery disease. One hundred fourteen individuals developed the primary end point of death from cardiovascular causes or nonfatal myocardial infarction during a mean follow-up of 2.6±1.2 years. Median concentrations of ADMA levels were higher among individuals who subsequently developed the primary end point than …

Predictive value for cardiovascular events of common carotid intima media thickness and its rate of change in individuals at high cardiovascular risk – Results from the PROG-IMT collaboration

AIMS: Carotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk. METHODS AND RESULTS: From 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, s…

Einfluss eines gest�rten Glukosestoffwechsels auf Manifestationen und Prognose der Atherosklerose in verschiedenen Gef��regionen

Patienten mit kardiovaskularen Erkrankungen haben eine deutlich schlechtere Prognose, wenn ein Diabetes mellitus (DM) vorliegt. Bereits bei Vorliegen eines abnormalen Nuchternglukosewertes ist die Inzidenz kardiovaskularer Ereignisse erhoht. Ziel dieser Untersuchung war es, den Einfluss diabetischer Stoffwechselstorungen auf die Inzidenz atherosklerotischer Manifestationen und auf die Langzeitprognose von Patienten mit Atherosklerose in multiplen Gefasregionen zu erfassen. Wir schlossen 906 Patienten (73% Manner, mittleres Alter 62,5 ± 9 Jahre) vor geplanter Koronarangiographie prospektiv in die Untersuchung ein. Bei allen Patienten wurde der periphere Gefasstatus mittels Duplexsonographie …

Obesity paradox in peripheral artery disease

Background & aims: Previous studies have suggested an obesity survival paradox in patients with peripheral artery disease (PAD). We investigated the influence of obesity and underweight on adverse in-hospital outcomes in PAD. Methods: Patients diagnosed with PAD based on ICD-code I70.2 of the German nationwide database were stratified for obesity, underweight and a reference group with normal-weight/over-weight and compared regarding adverse in-hospital outcomes. Results: Between 01/2005-12/2015, 5,611,484 inpatients (64.8% males) were diagnosed with PAD; of those, 8.9% were coded with obesity and 0.3% with underweight. Obese patients were younger (70 (IQR 63/76) vs. 73 (66/80) years, P < 0…

Langzeitverlauf über 10 Jahre nach Ballondilatation bei stabiler und instabiler Angina pectoris

OBJECTIVE To assess the cardiac status of patients ten years after percutaneous transluminal coronary artery angioplasty (PTCA). PATIENTS AND METHODS Data of 534 patients (436 men, 98 women; mean age 53.2 +/- 8 years) in whom a PTCA had been performed between 1983 and 1986 were analysed, based on a questionnaire answered 121 +/- 11 months after the initial procedure. At the time of PTCA 184 patients (35%) had unstable angina, 350 (65%) stable angina. RESULTS 116 patients (63%) with unstable angina and 164 (47%) with stable angina had at least one cardiac event after the initial PTCA (repeat PTCA, bypass operation, myocardial infarction, death). None of these events occurred in 68 patients (…

Impact of Metabolic Syndrome on Atherosclerotic Burden and Cardiovascular Prognosis

Patients with metabolic syndrome (MS) are at increased risk of cardiovascular atherosclerosis. The aim of this study was to evaluate the impact of MS on cardiovascular prognosis in context with atherosclerotic burden. A total of 811 patients with coronary heart disease (CHD) were included and carotid and leg arteries were examined using sonographic methods. Patients with low (CHD only, n = 428, 52.8%) or high atherosclerotic burden (CHD and peripheral atherosclerosis, n=383, 47.2%) were compared. Patients withor=3 of the following criteria: triglyceridesor=150 mg/dl, high-density lipoprotein cholesterol40 mg/dl (men) and50 mg/dl (women), body mass index30 kg/m2, blood pressureor=130/85 mm H…