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Advances in Peripheral Vascular Disease: Diagnosis, Management and Surgical Interventions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (20 June 2026) | Viewed by 1397

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Dr. Nikolaos Zacharias

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Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
Interests: peripheral vascular disease; abdominal and thoracic aortic aneurysms; carotid artery disease; venous disease; vascular and endovascular surgery

Special Issue Information

Dear Colleagues,

Peripheral Artery Disease (PAD) represents a major global health burden, affecting millions worldwide and leading to significant morbidity, mortality, and reduced quality of life as well as high rates of limb loss. With current advances in diagnostic techniques and revascularization therapies, early detection, risk stratification, and long-term management of PAD remain challenging. This Special Issue aims to advance the understanding of PAD through manuscripts involving the early diagnosis, best medical therapy, and appropriate intervention for PAD. The scope of this Special Issue encompasses clinical studies of limb salvage outcomes of medical and surgical interventions for critical limb-threatening ischemia, as well as appropriate interventions for claudication to improve patients’ quality of life.

Dr. Nikolaos Zacharias
Guest Editor

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Keywords

atherosclerosis
peripheral artery disease
claudication
critical limb threatening ischemia
infrainguinal bypass
femoral stenting

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Published Papers (3 papers)

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Research

18 pages, 3736 KB

Open AccessArticle

Drug-Coated Balloon Versus Plain Old Balloon Angioplasty in Isolated Popliteal and/or Superficial Femoral Artery Disease: A Retrospective Single-Center Comparative Cohort Study

by Volkan Tasci, Erbil Arik, Muhammed Said Besler, Ali Fuat Tekin, Mehmet Ali Durmus, Hakan Adakan, Onur Taydas, Mustafa Ozdemir, Omer Faruk Topaloglu and Mehmet Halil Öztürk

J. Clin. Med. 2026, 15(13), 5152; https://doi.org/10.3390/jcm15135152 (registering DOI) - 2 Jul 2026

Abstract

Background/Objectives: Drug-coated balloons (DCBs) deliver paclitaxel to the vessel wall and leave nothing behind, which makes them mechanistically appealing here, yet head-to-head data confined to the isolated popliteal/SFA segment are still scarce. We directly compared 12-month hemodynamic, symptomatic, and patency loss outcomes between DCB and plain old balloon angioplasty (POBA) in this anatomical setting. Methods: We retrospectively reviewed 401 consecutive endovascular procedures performed at a single center between January 2021 and December 2024 for isolated popliteal and/or SFA disease, comprising 179 DCB and 222 POBA cases. 12-month endpoints of composite clinical success, asymptomatic recovery, and composite patency loss were analyzed. The composite patency loss endpoint was further fitted to a multivariable logistic regression with baseline ABI, baseline Rutherford category, lesion length, and total occlusion as covariates. The composite patency loss endpoint was further fitted to a multivariable logistic regression with baseline ABI, baseline Rutherford category, lesion length, and total occlusion as covariates, designated as the principal effect estimate. Kaplan–Meier cumulative incidence plots are presented descriptively only. Results: The study population comprised 401 patients (mean age 68.4 ± 10.6 years; 316 male [78.8%]), with 179 in the DCB arm (mean age 65.3 ± 10.5 years; 80.4% male) and 222 in the POBA arm (mean age 71.0 ± 9.8 years; 77.4% male). DCB-treated lesions started out more advanced: longer (94.5 ± 48.2 vs. 82.7 ± 43.3 mm; p = 0.010), more often totally occluded (39.7% vs. 19.4%; p < 0.001), and weighted toward TASC II C/D (p < 0.001). Mean ABI improved by +0.27 in both arms, with no detectable between-arm difference (p = 0.860; within-arm p < 0.001 in each). Asymptomatic recovery at 12 months was more common after DCB (62.0% vs. 51.4%; p = 0.033; OR 1.55, 95% CI 1.04–2.31), and composite patency loss was roughly halved (6.7% vs. 12.6%; p = 0.050; OR 0.50, 95% CI 0.25–1.01). Documented TLR (4.5% vs. 7.2%; p = 0.251) and composite clinical success (86.6% vs. 82.4%; p = 0.255) did not reach significance. Conclusions: Across 401 real-world procedures in isolated popliteal and/or SFA disease, mean ABI gain was identical between arms, yet DCB delivered measurably more complete symptomatic recovery and a near-significant halving of composite patency loss at 12 months, with both signals robust to multivariable adjustment. In this real-world setting, DCB was associated with more complete symptomatic recovery and a numerically lower composite patency loss rate; these findings are hypothesis-generating and require confirmation in adequately powered randomized trials. Full article

(This article belongs to the Special Issue Advances in Peripheral Vascular Disease: Diagnosis, Management and Surgical Interventions)

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16 pages, 1349 KB

Open AccessArticle

Association of Hyperbaric Oxygen Therapy with Platelet Reactivity in Patients with Advanced Peripheral Arterial Disease: A Prospective Observational Study

by Dragan Knezevic, Vladimir Zivkovic, Vladimir Jakovljevic, Nikola Mirkovic, Milena Ilic, Marija Andjelkovic, Jelena Mijajlovic, Vladimir Fisenko, Goran Balovic and Djordje Kolak

J. Clin. Med. 2026, 15(10), 3723; https://doi.org/10.3390/jcm15103723 - 12 May 2026

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Abstract

Objective: Peripheral arterial occlusive disease (PAOD) is characterized by impaired tissue perfusion, chronic ischemia, and increased platelet reactivity. Hyperbaric oxygen therapy (HBOT) is used as adjunctive treatment in advanced PAOD, but its effect on platelet function remains insufficiently studied. This study examined the association between HBOT and platelet aggregation. Methods: This prospective observational study included 90 patients with Fontaine stage IV PAOD and chronic ulceration, assigned to an HBOT group (n = 60) or waiting-list control group (n = 30). Patients were predominantly male; mean age was 66.82 ± 9.42 years in the study group and 63.00 ± 8.31 years in controls, and diabetes mellitus was present in 55.0% and 63.3%, respectively. Prior revascularization included open surgery in 33.3% and 30.0%, endovascular treatment in 36.7% and 43.3%, and no option for revascularization in 30.0% and 26.7%, respectively. HBOT was administered over 4 weeks (20 sessions, 2.0–2.5 ATA). Platelet aggregation was measured by impedance aggregometry using arachidonic-acid-induced aggregation (ASPI), adenosine-diphosphate-induced aggregation (ADP), and thrombin-receptor-activating peptide-induced aggregation (TRAP) agonists. Changes were analyzed using generalized estimating equation models adjusted for antiplatelet therapy, diabetes mellitus, smoking, and C-reactive protein (CRP). Results: Significant group × time interactions were observed for all platelet activation pathways, indicating greater reductions in the HBOT group than controls: ASPI (β = −290.5; p < 0.001), ADP (β = −243.6; p < 0.001), and TRAP (β = −330.9; p < 0.001). No significant change was observed in controls. HBOT was associated with reduced pain intensity, while CRP and platelet-to-lymphocyte ratio (PLR) remained stable. Ulcer size showed no significant change after 4 weeks. Conclusions: In patients with PAOD, HBOT was associated with reduced platelet reactivity independent of antiplatelet therapy. Further randomized studies are needed to determine its clinical significance. Full article

(This article belongs to the Special Issue Advances in Peripheral Vascular Disease: Diagnosis, Management and Surgical Interventions)

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15 pages, 946 KB

Open AccessEditor’s ChoiceArticle

Predictors of Mortality in Peripheral Arterial Disease After Endovascular Lower Limb Revascularization and Development of a Risk Score Based Solely on Clinical Presentation

by Gladiol Zenunaj, Lorenzo Ciofani, Luca Erbazzi and Aaron Thomas Fargion

J. Clin. Med. 2026, 15(4), 1364; https://doi.org/10.3390/jcm15041364 - 9 Feb 2026

Cited by 1 | Viewed by 627

Abstract

Background: Patients with peripheral arterial disease (PAD) undergoing endovascular revascularization remain at high risk of long-term mortality. While anatomical characteristics such as the length of the lesion, chronic total occlusions and multi-segmental distribution strongly influence revascularization strategy and limb outcomes, their prognostic impact on survival is less clearly defined. The combination of clinical comorbidities, clinical limb presentation and anatomical factors may help to better predict mortality rate before endovascular lower limb revascularization. The primary endpoint of this study was to identify independent predictors of mortality in PAD patients, and the secondary endpoint was to develop a simple clinical risk score for individualized prognostic stratification. Methods: We conducted a single-center retrospective observational study including 476 consecutive PAD patients undergoing endovascular revascularization over a 6-year period. The endpoint target considered was all-cause mortality. Cox proportional hazards regression was used to identify independent predictors of mortality. A prognostic model was derived and subsequently simplified into a point-based clinical risk score (GZ-PAD Mortality Score). Model performance was assessed within the study cohort using Kaplan–Meier survival stratification and receiver operating characteristic (ROC) analysis. Results: Multivariable analysis identified age (HR 1.041 per year, p < 0.001), coronary artery disease (CAD) (HR 1.56, p < 0.001), chronic kidney disease (CKD) (HR 1.52, p = 0.038), dialysis dependence (HR 2.50, p < 0.001), and tissue loss (Rutherford 5–6; HR 5.33, p < 0.001) as independent predictors of mortality, whereas anatomical variables such as lesion length, chronic total occlusions and poor run-off vessel lost prognostic significance. For each patient, the linear predictor (XBETA) was calculated from the coefficients of the final Cox regression model and used to build the mortality score. Based on the 33rd and 66th percentiles of the XBETA distribution, patients were stratified into three prognostic categories: low risk (XBETA ≤ −0.43081), moderate risk (−0.43080 to 0.50835), and high risk (>0.50836). Kaplan–Meier analysis showed a significant discrimination (log-rank χ² = 102.441; p < 0.001) and good discriminative performance (AUC 0.752). Next the model based on the XBETA predictor was simplified into the global ischemic-systemic risk score (GZ-PAD) assigned for ages 60–69 years = 1 point; 70–79 years = 2 points; ≥80 years = 3 points, CAD = 2 points; CKD = 1 point; Dialysis dependence = 3 points; and tissue loss = 6 points. The new model assessed with survival curves provided robust risk stratification across low-, moderate-, and high-risk groups (log-rank χ² = 88.883; p < 0.001) and preserved predictive accuracy (AUC 0.769). Conclusions: In PAD patients undergoing successful endovascular revascularization, long-term survival appeared to be related to systemic clinical factors and ischemic severity rather than anatomical lesion complexity. The GZ-PAD Mortality Score offers a simple and clinically applicable tool for mortality risk stratification. Further studies, including external validation in independent and multicenter cohorts, are needed to confirm the robustness and generalizability of the proposed risk score. Full article

(This article belongs to the Special Issue Advances in Peripheral Vascular Disease: Diagnosis, Management and Surgical Interventions)

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