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Treatment of Peripheral Vascular Disease – Present and Future
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Treatment of Peripheral Vascular Disease – Present and Future

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 (27 December 2023) | Viewed by 10571

Special Issue Editors

Dr. Jörn F Dopheide

E-Mail Website
Guest Editor
1. Department of Medicine I, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
2. Bern University Hospital, University of Bern, 3010 Bern, Switzerland
3. Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), 6800 Feldkirch, Austria
Interests: vascular medicine; peripheral arterial disease; lipid lowering therapy; lipidology
Prof. Dr. Heinz Drexel

E-Mail Website
Guest Editor
1. Department for Internal Medicine, Hospital Bregenz, Bregenz, Austria
2. Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
Interests: cardiovascular disease; diabetes; metabolism; cholesterol and pain research

Special Issue Information

Dear Colleagues,

At present, cardiovascular disease still takes the highest death toll worldwide. Peripheral artery disease (PAD) patients suffer from a particularly poor prognosis. With this knowledge, efforts to reduce ischemic events and improve cardiovascular outcomes have been the driving force behind cardiovascular research in recent decades. 

One central strategy to improve cardiovascular outcomes is lipid lowering. For the time being, the most important drugs to reduce cholesterol still are statins. They are widely known to be beneficial in both primary and secondary prevention of major cardiovascular events (MACE) and there is convincing evidence that they consistently reduce total and cardiovascular mortality. Next to statins, PCSK-9 inhibitors have already shown their benefit in PAD. Alternatively, non-statin lipid-lowering therapy, i.e ezetimibe or bempedoic acid has yet to prove its value beyond combination.

Next, improvement of diabetic state and prevention of aggravation and associated complications, i.e., diabetic foot, are also of decisive importance. The recent progress in anti-diabetic medication, i.e., SGLT2-inhibitors and GLP-1 receptor antagonists, and their beneficial effects, has yet not been studied regarding their influence on the peripheral vasculature.

Another important field in the treatment of peripheral arterial disease is by influencing platelet aggregation and coagulation. This remains of great importance especially before, during and after vascular intervention or surgery.

Finally, anticoagulation management especially in secondary prophylaxis of deep vein thrombosis and pulmonary embolism is a challenging task, especially in situations with the rare thrombophilic predisposition. When and what to test for in this regard, as well as how to contextualize the results is of crucial importance and needs the input of specialists in the field.

This Special Issue of the Journal of Clinical Medicine will cover the following important aspects for medical treatment of peripheral artery disease:

1. Lipid-lowering therapy

  • Standard or high-intensity statin treatment and/or combination and its effects on peripheral artery disease
  • Non-statin lipid-lowering therapy (PCSK-9 inhibitors, ezetimibe, bempedoic acid) and its effects on peripheral artery disease
  • Statin adherence and intolerance in peripheral artery disease
  • Age and adherence to lipid-lowering therapy (review)

2. Antidiabetic medication

  • Old age (octogenarians): diabetic treatment for prevention of diabetic complications
  • SGLT2 inhibitors and GLP-1 receptor antagonists in the prevention of vascular disease

3. Platelet inhibition and anticoagulation

  • Management of anticoagulation before, during and after peripheral intervention or surgery, i.e., aspirin and/or clopidogrel with or without anticoagulation
  • Gender and antithrombotics in arterial and venous disease

Dr. Jörn F Dopheide
Prof. Dr. Heinz Drexel
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral artery disease
  • deep venous thrombosis
  • statins
  • PCSK-9 inhibitors
  • lipid lowering therapy
  • diabetes mellitus
  • anti-diabetic medication
  • platelet aggregation
  • anticoagulation

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Published Papers (3 papers)

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20 pages, 11441 KiB  
Article
Angiosome-Targeted Infrapopliteal Angioplasty: Impact on Clinical Outcomes—An Observational Study
by Mircea Ionut Popitiu, Vlad Adrian Alexandrescu, Giacomo Clerici, Stefan Ionac, Gloria Gavrila-Ardelean, Miruna Georgiana Ion and Mihai Edmond Ionac
J. Clin. Med. 2024, 13(3), 883; https://doi.org/10.3390/jcm13030883 - 2 Feb 2024
Viewed by 1516
Abstract
Background: Revascularization based on the angiosome concept (AC) is a controversial subject because there is currently no clear evidence of its efficacy, due to the heterogeneity of patients (multiple and diverse risk factors and comorbidities, multiple variations in the affected angiosomes). Choke [...] Read more.
Background: Revascularization based on the angiosome concept (AC) is a controversial subject because there is currently no clear evidence of its efficacy, due to the heterogeneity of patients (multiple and diverse risk factors and comorbidities, multiple variations in the affected angiosomes). Choke vessels change the paradigm of the AC, and the presence or absence of the plantar arch directly affects the course of targeted revascularization. The aim of this study was to evaluate the effect of revascularization based on the AC in diabetic patients with chronic limb-threatening ischemia (CLTI). Methods: This retrospective analysis included 51 patients (40 men, 11 women), with a mean age of 69 years (66–72) and a total of 51 limbs, who presented with Rutherford 5–6 CLTI, before and after having undergone a drug-coated balloon angioplasty (8 patients) or plain balloon angioplasty (43). Between November 2018 and November 2019, all patients underwent below-the-knee balloon angioplasties and were followed up for an average of 12 months. The alteration of microcirculation was compared between directly and indirectly revascularized angiosomes. The study assessed clinical findings and patient outcomes, with follow-up investigations, comparing wound healing rates between the different revascularization methods. Patient records and periprocedural leg digital subtraction angiographies (DSA) were analyzed. Differences in outcomes after direct revascularization and indirect percutaneous transluminal angioplasty (PTa) were examined using Cox proportional hazards analysis, with the following endpoints: ulcer healing, limb salvage, and also amputation-free survival. Results: Direct blood flow to the angiosome supplying the ulcer area was achieved in 38 legs, in contrast to 13 legs with indirect revascularization. Among the cases, there were 39 lesions in the anterior tibial artery (ATA), 42 lesions in the posterior tibial artery (PTA), and 8 lesions in the peroneal artery (PA). According to a Cox proportional hazards analysis, having fewer than three (<3) affected angiosomes (HR 0.49, 95% CI 0.19–1.25, p = 0.136) was associated with improved wound healing. Conversely, wound healing outcomes were least favorable after indirect angioplasty (p = 0.206). When adjusting the Cox proportional hazard analysis for the number of affected angiosomes, it was found that direct drug-coated angioplasty resulted in the most favorable wound healing (p = 0.091). At the 1-year follow-up, the major amputation rate was 17.7%, and, according to a Cox proportional hazards analysis, atrial fibrillation (HR 0.85, 95% CI 0.42–1.69, p = 0.637), hemodialysis (HR 1.26, 95% CI 0.39–4.04, p = 0.699), and number of affected angiosomes > 3 (HR 0.94, 95% CI 0.63–1.39, p = 0.748) were significantly associated with poor leg salvage. Additionally, direct endovascular revascularization was associated with a lower rate of major amputation compared to indirect angioplasty (HR 1.09, 95% CI 0.34–3.50, p = 0.884). Conclusions: Observing the angiosomes concept in decision-making appears to result in improved rates of arterial ulcer healing and leg salvage, particularly in targeted drug-coated balloon angioplasty for diabetic critical limb ischemia, where multiple angiosomes are typically affected. Full article
(This article belongs to the Special Issue Treatment of Peripheral Vascular Disease – Present and Future)
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13 pages, 1422 KiB  
Article
Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus
by Lorenz Meuli, Thomas Stadlbauer, Barbara E. Stähli, Christine Espinola-Klein, Alexander Zimmermann and on behalf of the PATENT Study Collaborators
J. Clin. Med. 2023, 12(9), 3223; https://doi.org/10.3390/jcm12093223 - 30 Apr 2023
Viewed by 3170
Abstract
(1) Background: High-level evidence on antithrombotic therapy after infrainguinal arterial bypass surgery in specific clinical scenarios is lacking. (2) Methods: A modified Delphi procedure was used to develop consensus statements. Experts voted on antithrombotic treatment regimens for three types of infrainguinal arterial bypass [...] Read more.
(1) Background: High-level evidence on antithrombotic therapy after infrainguinal arterial bypass surgery in specific clinical scenarios is lacking. (2) Methods: A modified Delphi procedure was used to develop consensus statements. Experts voted on antithrombotic treatment regimens for three types of infrainguinal arterial bypass procedures: above-the-knee popliteal artery; below-the-knee popliteal artery; and distal, using vein, prosthetic, or biological grafts. The treatment regimens for these nine procedures were then voted on in three clinical scenarios: isolated PAOD, atrial fibrillation, and recent coronary intervention. (3) Results: The survey was conducted with 28 experts from 15 European countries, resulting in consensus statements on 25/27 scenarios. Experts recommended single antiplatelet therapy after above-the-knee popliteal artery bypasses regardless of the graft material used. For below-the-knee popliteal artery bypasses, experts suggested combining single antiplatelet therapy with low-dose rivaroxaban if the graft material used was autologous or biological. They did not recommend switching to triple therapy for patients on oral anticoagulants for atrial fibrillation or dual antiplatelet therapy in any scenario. (4) Conclusions: Great inconsistency in the antithrombotic therapy administered was found in this study. This consensus offers guidance for scenarios that are not covered in the current ESVS guidelines but must be interpreted within its limitations. Full article
(This article belongs to the Special Issue Treatment of Peripheral Vascular Disease – Present and Future)
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12 pages, 1571 KiB  
Article
False versus True Statin Intolerance in Patients with Peripheral Artery Disease
by Jörn F. Dopheide, Patrick Gillmann, David Spirk, Meisam Khorrami Borozadi, Luise Adam and Heinz Drexel
J. Clin. Med. 2022, 11(22), 6619; https://doi.org/10.3390/jcm11226619 - 8 Nov 2022
Viewed by 5232
Abstract
Background: Statin intolerance (SI) is often documented in patients’ charts but rarely confirmed by objective methods. Objective: We aimed to identify the rate of true SI in a large population with peripheral artery disease (PAD) as well as the subsequent use of such [...] Read more.
Background: Statin intolerance (SI) is often documented in patients’ charts but rarely confirmed by objective methods. Objective: We aimed to identify the rate of true SI in a large population with peripheral artery disease (PAD) as well as the subsequent use of such drugs and the impact on cardiovascular outcomes. Methods: Patients with PAD and reported SI were retrospectively classified in those with “probable/possible” (pp) and “unlikely” (u) SI, after the application of the “Statin Myalgia Clinical Index Score” (SAMS-CI). Both groups were compared after 62 months (date of observation period?). Results: Among the 4,505 included patients, 139 (3%) had been reported as having SI. Of those, 33 (24%) had ppSI, and 106 (76%) had uSI. During the observation period, statin use decreased in patients with both ppSI (from 97% to 21%; p < 0.0001) and uSI (from 87% to 53%; p < 0.0001). At the end of the observation period, patients with ppSI more often received PCSK9 inhibitors (55% vs. 7%; p < 0.0001), had a stronger decrease in LDL-C from baseline to follow-up (1.82 ± 1.69 mmol/L vs. 0.85 ± 1.41 mmol/L; p < 0.01), and a lower rate of mortality (3% vs. 21%; p = 0.04) than those with uSI. Conclusions: SI is low in PAD patients (3.1%), with only one quarter fulfilling the criteria of ppSI. The overdiagnosis of SI is related to an underuse of statins and an increased mortality in a short time period. Full article
(This article belongs to the Special Issue Treatment of Peripheral Vascular Disease – Present and Future)
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