Search Results (480)

Background/Objectives: The increasing use of endovascular procedures with common femoral artery (CFA) access has led to a rise in iatrogenic arterial injuries at this site. The most frequent injuries are pseudoaneurysms (PSA), retrograde dissections (RD), arteriovenous fistulas (AVF), and arterial perforations. Surgical repair is the standard treatment; however, the use of covered stents (CS) may represent a valid alternative, despite current instructions for use (IFU) not recommending CFA implantation. Methods: We conducted a single-center retrospective study on a prospectively maintained database. Patients undergoing transcatheter aortic valve repair (TAVR), endovascular aortic repair EVAR, diagnostic or therapeutic coronary angiography, or peripheral percutaneous transluminal angioplasty, who were subsequently treated for CFA injury with CS implantation between February 2015 and May 2024, were included. Endpoints were technical success (complete arterial repair), 30-day mortality, overall mortality, reintervention rates, and long-term stent patency. Results: A total of 41 patients were included: 10 (24.4%) PSA, 3 (7.3%) AVF, 27 (65.8%) perforations, and 2 (4.9%) RD. Of which 28 (68.3%) were treated with self-expandable CS and 13 (31.7%) with balloon-expandable CS. Additionally, 33 (80.5%) underwent urgent treatment. Technical success was achieved in 97.5%. Thirty-day mortality was 7.3%, with no procedure-related deaths. At a mean follow-up of 50.8 months (range 1–109), survival was 63.4%, with 100% stent patency and no procedure-related reinterventions. Conclusions: CS implantation for CFA iatrogenic injuries achieved high technical success and excellent long-term patency, representing a viable alternative to open repair. Further studies are needed to integrate CS use for CFA injuries into treatment algorithms and to update device IFUs accordingly. Full article

Background: Peripheral artery disease (PAD) is a manifestation of atherosclerosis that affects the extremities, leading to reduced perfusion and functional impairment. Non-contrast magnetic resonance angiography (NC-MRA) provides a safe and quantitative approach for early detection of PAD without the risks associated with contrast agents. The purpose of this study was to demonstrate the application of standard and centric ky-kz FBI techniques for rapid three-station NC-MRA of the entire lower extremity. Methods: This prospective cross-sectional study compared standard three-station fresh blood imaging (sFBI) with centric ky-kz ordered fresh blood imaging (cFBI) sequences in 10 healthy subjects and 3 patients with PAD (age range: 23–79 years; 7 females) using a 3-Tesla magnetic resonance imaging (MRI) system. Both sequences were acquired at the iliac, femoral, and tibial stations. Image quality (0–4 scale), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated. Statistical analysis was performed using repeated-measures analysis of variance (ANOVA) with significance set at α = 0.05. Results: Image quality did not differ significantly between sFBI and cFBI (p = 1.0). The iliac station exhibited lower image quality than the femoral station (p < 0.01). In a PAD patient with an iliac stent, cFBI preserved good image quality in the femoral and tibial stations, whereas sFBI was affected by N/2 aliasing artifacts. Both methods failed to visualize the stented iliac segment. Compared to sFBI, cFBI yielded significantly lower SNR (p < 0.01) and CNR (p < 0.001) but reduced total scan time by approximately 40% (468 s vs. 291 s). Conclusions: Three-station non-contrast FBI MRA of the peripheral arteries is feasible. The cFBI sequence substantially shortens scan time without compromising diagnostic image quality, offering practical advantages for clinical implementation, improved patient comfort, and reduced motion artifacts. Full article

Background: Acute and chronic hyperglycemia in patients with type 2 diabetes mellitus (T2DM) causes endothelial dysfunction and arterial stiffness, contributing to early mortality from cardiovascular disease (CVD). Although L-citrulline (CIT) supplementation improves endothelial function in older women and decreases fasting glucose in those with T2DM, whether it improves vascular function and blood glucose during acute hyperglycemic states in T2DM is unknown. Methods: We randomized 16 patients with T2DM (age 62 ± 6 years) to consume either CIT (6 g/day) or placebo for 4 weeks. Brachial artery flow-mediated dilation (FMD), brachial and aortic blood pressure, aortic and leg arterial stiffness (pulse wave velocity, PWV), and blood glucose concentration were assessed in the fasted state and 60 min following glucose ingestion (during acute hyperglycemia). Results: Four weeks of L-citrulline supplementation improved FMD, femoral-ankle PWV, aortic systolic blood pressure, and blood glucose concentration in the fasted state compared to placebo (all p < 0.05). During acute hyperglycemia, CIT supplementation increased FMD and reduced femoral-ankle PWV, aortic systolic BP, and glucose levels compared to placebo (all p < 0.05). Conclusions: CIT supplementation is beneficial to improve vascular function and glucose levels during chronic and acute hyperglycemia in middle-aged and older adults with T2DM. Full article

Introduction: Although the incidence of mechanical complications of myocardial infarction is decreasing, the associated mortality rate remains high. Such complications require an early diagnosis and multidisciplinary management. In most cases, surgery is the only definitive treatment, despite it being associated with high peri-operative mortality and morbidity. An intra-aortic balloon pump (IABP) or Extracorporeal Membrane Oxygenation (ECMO) may also be required for unstable patients. After the employment of mechanical assistance, ultrasound and chemical parameters are associated with successful weaning, indicating adequate cardiac function, perfusion, and oxygen delivery. Case presentation: The aim of this case report is to describe the weaning from the extracorporeal support in a case of post-myocardial-infarction ventricular septal defect (VSD) and Left ventricle (LV) apical aneurysm. The patient underwent surgery for VSD closure and aneurysm exclusion. After the emergency surgery, the patient developed a severe post-cardiotomy cardiogenic shock, which required veno-arterial femoral–femoral extracorporeal membrane oxygenation (VA-ff-ECMO), IABP, and maximal pharmacologic support. During the ICU stay, we weaned the patient from the ECMO support based on transesophageal echocardiography (TEE) imaging and pulmonary artery catheter (PAC) monitoring and quantified the shunt fraction. On the fifth post-operative day, we started the weaning trial. Hemodynamic and ultrasound monitoring showed an adequate cardiac function, and the shunt fraction calculated with both the ultrasound parameters and Fick’s law was acceptable. We removed the ECMO the day after, and the weaning was successful. Discussion: Data deriving from the Swan–Ganz catheter has been found to be important in guiding the process of weaning a patient from extracorporeal support. Nevertheless, the TEE played a pivotal role in the decision-making process and in clinical management. We reduced the ECMO blood flow following a real-time echocardiographic cardiac function assessment. Conclusions: Following the fundamental guides for both PAC monitoring and TEE imaging, we successfully removed the extracorporeal support, with a positive outcome. Full article

Background: Vasopressin (AVP) and its V1a receptor (V1aR) are involved in the regulation of the cardiovascular system. Limited evidence suggests that AVP may also contribute to respiratory regulation. Arterial chemoreflex is the main reflex involved in cardiorespiratory regulation and is triggered from the carotid bodies (CBs), specialized organs that detect changes in arterial blood content. Both increased activity of the vasopressinergic system and enhanced arterial chemoreflex have been found in hypertension. Here, we aimed at determining cardiorespiratory responses to AVP in normo- and hypertensive rats and the involvement of CBs and V1aRs. Methods: Experiments were performed in urethane-anesthetized adult male spontaneously hypertensive (SHR) and normotensive Wistar Kyoto (WKY) rats. Arterial blood pressure (MABP), heart rate (HR), femoral artery blood flow (FABF), minute ventilation (MV), respiratory rate (RR), and end-tidal carbon dioxide (ETCO2) were recorded. We evaluated cardiorespiratory responses to arterial chemoreflex activation with potassium cyanide, intravenous AVP, V1aR antagonist, and CB denervation. Results: In comparison to normotensive animals, SHR rats had significantly greater resting MABP, HR, MV, and enhanced pressor and ventilatory components of arterial chemoreflex. CB denervation caused insignificant changes in cardiorespiratory parameters. Intravenous administration of AVP resulted in a significant increase in MABP in both groups, which was greater in SHR rats, and in ventilatory inhibition, which was present only in SHR rats. CB denervation reduced the pressor response to AVP in normotensive rats and abolished the inhibitory effect of AVP on ventilation in SHR rats. Intravenous administration of the V1aR antagonist caused a significantly greater decrease in MABP in the hypertensive group. Only SHR rats responded with an increase in ventilation after the V1aR antagonist. Effects of AVP were abolished after blockade of V1aRs in both groups. Conclusions: Our study indicates that (i) SHR rats show augmented cardiorespiratory response to AVP, (ii) cardiorespiratory effects of AVP depend on V1aRs; and (iii) respiratory effects of AVP in the hypertensive rats appear to be primarily mediated by CBs. Full article

Background: Common femoral artery aneurysms are rare and are usually associated with aneurysms at other sites, mainly the aorta, iliac, popliteal, superficial femoral, and profunda femoral artery. This combination poses the challenge of synchronous repair for clinically relevant aneurysms. Although endovascular abdominal aortic aneurysm repair is the main type of treatment for abdominal aortic aneurysms nowadays, this is not true for common femoral aneurysms, where open repair remains the gold standard. These two distinct operations could be combined in a one-stage procedure when aortoiliac and common femoral aneurysms present simultaneously. This approach potentially saves time and costs, without increasing complications. Methods: A retrospective search was conducted in the Vascular Surgery Department database of a tertiary referral center for vascular surgery, covering procedures from January 2005 to May 2025. Patients were included if they had undergone simultaneous endovascular abdominal aortic aneurysm repair and open repair of a common femoral artery aneurysm. Clinical records, operative details, imaging studies, and follow-up data were reviewed. We additionally provide a literature review regarding this approach. This review additionally incorporates the current knowledge regarding the treatment of common femoral artery aneurysms. Results: Out of 668 endovascular abdominal aortic aneurysm repair procedures, three patients (0.45%) were identified. These three patients were among five patients who were treated for true common femoral artery aneurysm by open repair in the same time interval. All of the patients are currently in good condition without late complications. One patient, who had not performed any follow-up imaging, was diagnosed with large aneurysms at other sites, 10 years later. Conclusions: The combined one-stage endovascular abdominal aortic repair and open repair of a common femoral artery aneurysm by interposition grafting is technically a simple approach that led to satisfactory outcomes. Full article

Background and Clinical Significance: Concomitant severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) in elderly patients presents a significant therapeutic challenge. While transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) have become established minimally invasive treatments for high-risk patients, simultaneous management of both conditions remains rare. Case Presentation: We report the first documented case in Serbia of a simultaneous TAVR and EVAR in a 75-year-old male with severe symptomatic AS and AAA. The patient had a history of hypertension, diabetes mellitus, atrial fibrillation, prior radiofrequency pulmonary vein ablation, and pacemaker implantation. Echocardiography demonstrated severe AS with a transvalvular gradient of 116/61 mmHg, an aortic valve area of 0.6 cm², and a left ventricular ejection fraction of 30–35%. Coronary angiography revealed 50–60% stenosis of the right coronary artery. Following evaluation by a multidisciplinary Heart and Vascular Team, a combined procedure was performed under general anesthesia via bilateral femoral access. TAVR with a Medtronic Evolut R valve was successfully deployed, followed by EVAR with satisfactory stent graft positioning and angiographic results. The patient’s postoperative course was uneventful, and he was discharged on the ninth day. At six-month follow-up, echocardiography showed optimal valve function, and CT identified a type II endoleak, which was managed conservatively. Conclusions: This case demonstrates the feasibility and safety of simultaneous TAVR and EVAR in a high-risk elderly patient, emphasizing the importance of careful preoperative planning and a coordinated multidisciplinary approach. Further studies are warranted to establish standardized guidelines for the management of patients with coexisting severe AS and AAA. Full article

Background/Objectives: The Kocher–Langenbeck approach is widely used for surgical fixation of posterior acetabular wall fractures. While previous studies have focused on mechanical outcomes and the risk of post-traumatic osteoarthritis, the effects on peripheral circulation and neuromuscular recovery remain underexplored. This study aimed to evaluate dynamic changes in neuromuscular function and microcirculation following open reduction and internal fixation (ORIF) using this approach. Methods: A retrospective analysis was conducted on 34 patients (aged 23–75) treated for posterior acetabular wall fractures between 2014 and 2022. All patients underwent ORIF via the Kocher–Langenbeck approach. Assessments at 8 and 12 months postoperatively included electromyography (EMG), chronaximetry, and rheovasography (RVG). Asymmetry coefficients were calculated to quantify blood flow and functional differences. Results: At 12 months postoperatively, significant microcirculatory asymmetry persisted in the operated limb, with arterial and venous coefficients exceeding 25% (27.5% and 26.8%, respectively). EMG revealed sustained reductions in gluteus maximus and rectus femoris activity (asymmetry ~39%). Chronaximetry showed delayed nerve conduction recovery, particularly in the common peroneal nerve (AC = 44%). The femoral segment demonstrated the most severe impairment in both arterial inflow and venous outflow. Conclusions: ORIF via the Kocher–Langenbeck approach is associated with long-term disturbances in neuromuscular function and regional circulation. Further research should explore alternative surgical approaches (e.g., ilioinguinal, Stoppa) in prospective studies, assess vascular integrity using advanced imaging (e.g., contrast-enhanced ultrasound), and incorporate long-term functional outcomes. Studies on neurovascular-sparing techniques and optimised rehabilitation protocols may help reduce postoperative morbidity and improve recovery. Full article

We examined whether synchronizing and analyzing three data sources, active personal dosimeter (APD) information, in-room monitoring camera footage, and the operator’s main angiography panel video, could identify opportunities to reduce occupational radiation exposure during cerebral angiography without therapeutic intervention. We analyzed the behavior of eight physicians and radiation doses measured outside the lead apron during 12 diagnostic cerebral angiography procedures performed between January and April 2024. Appropriate use of a ceiling-suspended radiation protective shield (CSRPS) was associated with approximately 70% exposure reduction. In addition, exposure during femoral arteriography (catheter advancement from femoral artery puncture to the aortic arch) accounted for approximately 50% of the total exposure, identifying both as effective intervention points. This approach identified operators’ incorrect use of radiation protection equipment and enabled clear feedback to operators on areas for improvements in radiation protection practices. Full article

Background: Arterial stiffness assessed by measuring pulse wave velocity (PWV) is a well-established predictor of cardiovascular mortality. To our knowledge, no studies on arterial stiffness in kidney transplant recipients (KTRs) from Tunisia have been conducted. The present study aimed to assess arterial stiffness in Tunisian KTRs and to identify the key predictors associated with its increase. Methods: We conducted a cross-sectional, single-center study enrolling Tunisian KTRs aged 18 years or older with a minimum post-transplant follow-up of six months. Arterial stiffness was measured as pulse carotid–femoral PWV (CF-PWV) by a Complior device. A CF-PWV ≥ 10 m/s was defined as elevated. Results: Fifty-four KTRs were included (mean age: 42.55 ± 10.61 years). Among them, 19 (35.2%) had a CF-PWV ≥ 10 m/s. The univariate analysis showed a significant association between elevated CF-PWV and the following parameters: age, hypertension prior to transplantation, dyslipidemia, donor age, parameters obtained through office blood pressure measurement (systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP)), central SBP recorded by the Complior device, nocturnal SBP obtained through 24 h ambulatory blood pressure monitoring (ABPM), and fasting blood glucose. A multivariable analysis with CF-PWV ≥ 10 m/s as a dependent variable retained the following independent factors: dyslipidemia (p = 0.015; OR = 60.32), donor age (p = 0.014; OR = 1.16), SBP obtained through office blood pressure measurement (p = 0.015; OR = 1.25), and fasting blood glucose (p = 0.034; OR = 22.35). Conclusions: Given the major impact of cardiovascular disease on post-transplant outcomes, understanding the determinants of arterial stiffness is crucial for improving patient care. Routine PWV assessment may not be feasible in all centers due to cost or limited equipment availability. Therefore, identifying the clinical and biological markers associated with arterial stiffness offers a low-cost and widely accessible alternative for evaluating cardiovascular risk. These findings may support the development of a simple risk score to help nephrologists detect and manage high-risk KTRs more effectively. Full article

Background and Objectives: Femoral neck fractures are common among elderly patients and are typically managed surgically to restore mobility and reduce complications. Total Hip Replacement (THR) and Hemiarthroplasty (HA) are standard interventions. While both procedures are widely used, the comparative risks of thromboembolic complications remain unclear. This study aimed to systematically compare the risk of Venous Thromboembolism (VTE), including Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Arterial Thromboembolic events in patients undergoing THR versus hemiarthroplasty for femoral neck fractures. Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Google Scholar, and OVID-Medline for studies published between 2000 and 2024. Eligible studies included patients aged ≥50 years with femoral neck fractures treated with THR or Hemiarthroplasty and reported thromboembolic outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale and the RoB 2 tools. Meta-analysis was performed using RevMan software (Version 5.4). Results: Twelve studies were included in the systematic review, and ten in the meta-analysis, encompassing over 160,000 patients. THR was associated with a significantly increased risk of DVT (RR = 1.53; 95% CI: 1.40–1.68, p = 0.00001) and combined VTE (RR = 1.48; 95% CI: 1.36–1.61, p = 0.00001) compared to HA. No significant difference was observed in PE risk. Interestingly, THR was linked to a lower risk of Arterial Thromboembolic events, such as Ischemic Stroke. Conclusions: Compared with Hemiarthroplasty, THR increases the risk of VTE, including DVT, with no increased risk of PE. Surgical decisions should be guided by individual patients’ risk factors for thrombotic and cardiovascular events. Full article

Background/Objectives: The aim of this study was to determine whether incomplete follow-up and competing event risks may be associated with the clinical course after treatment and with known risk factors, such as chronic limb-threatening ischemia (CLTI), in peripheral artery disease (PAD) patients. Methods: Patients hospitalized with PAD who were treated by endovascular or open-surgical means and followed up were included in this retrospective observational study. The primary outcome was reintervention-free survival (RFS); the secondary outcomes and competing events were major amputation and death. The follow-up index (FUI), defined as the ratio between the real and the maximal follow-up interval, was determined for each patient. Results: The FUI depended significantly on the disease stage of CLTI (estimate: −0.16; p: 0.003), endovascular (0.17; p: 0.007) or open-surgical intervention (0.21; p: 0.007) and intra-hospital re-operation (−0.29; p: 0.002) and tended to decrease with age (−0.004; p: 0.09). Independent of disease stage, patients with claudication or CLTI with an FUI < 0.5 had shorter RFS than patients with a FUI ≥ 0.5 (Cox regression, p: 0.07; log-rank test, p: 0.03). When both the FUI and competing risks were considered using Fine–Gray regression analysis, CLTI was associated with RFS (p: 0.016), while FUI (p: 0.004), CLTI (p < 0.001), and the involvement of common femoral (p < 0.001) and posterior tibial arteries (p < 0.001) were associated with major amputation-free survival. Conclusions: Incomplete follow-up is associated with advanced PAD and may itself mask a worse outcome, such as reintervention, restenosis, major amputation, or death. Competing events should also be considered potential sources of bias. Therefore, the FUI and competing events should be reported, and conclusions should be drawn cautiously in both observational and randomized prospective clinical studies. Full article

Background/Objectives: Ischemic cardiomyopathy is a major cause of morbidity and mortality. Obesity is paradoxically associated with better outcomes, while clustering of cardiometabolic risk factors (CMRFs)—diabetes mellitus, arterial hypertension, and hyperlipidemia—is associated with worse prognosis in heart failure (HF) patients. The interplay between vascular function, obesity and clustering of CMRFs in ischemic HF is not thoroughly investigated. Methods: In a prospective, single-center cohort study, 560 patients with ischemic cardiomyopathy were followed for a median of 43 months. Baseline BMI, CMRFs and markers of vascular function including flow-mediated dilation (FMD), and carotid–femoral pulse wave velocity (cf-PWV) were assessed. Major adverse cardiovascular events (MACE), including death, myocardial infarction, coronary revascularization, stroke, and hospitalization for heart failure or other cardiovascular causes, were recorded. Cox proportional hazards models and cubic spline analyses evaluated associations and nonlinear relationships. Results: Obesity was independently associated with a 50% lower risk of MACE (HR 0.50; 95% CI 0.32–0.981; p = 0.01) and improvement of FMD by 1% corresponded to a 7% reduction in MACE risk (HR 0.93; 95% CI 0.87–0.99; p = 0.03) after adjusting for multiple confounders. Clustering of all three CMRFs predicted greater MACE risk (HR 1.42; 95% CI 1.03–1.95; p = 0.03). No significant differences in FMD or cf-PWV were observed across BMI groups. cf-PWV values were impaired among patients with all 3 CMRFs but cf-PWV did not predict MACE. Conclusions: Higher BMI and FMD each independently predict improved outcomes in ischemic cardiomyopathy. The clustering of cardiometabolic risk factors is a strong predictor of adverse events. Full article

Chronic type B aortic dissection (cTBAD) is a challenging condition frequently complicated by persistent false lumen (FL) perfusion, leading to aneurysmal degeneration. Despite significant advances in thoracic endovascular aortic repair (TEVAR), long-term management remains challenging because of continuous FL backflow from distal re-entry tears and progressive aortic dilatation. We present the first documented case of FL exclusion using a custom-made false lumen occlusion device (FLOD). A 77-year-old male who had undergone TEVAR in 2017 underwent computed tomography angiography (CTA) in 2025, with the results revealing aneurysmal degeneration of the descending thoracic aorta (maximum diameter 58.5 mm) and two distal re-entry tears with substantial FL perfusion. Following multidisciplinary evaluation, the patient underwent endovascular reintervention with proximal stent graft extension and the deployment of a custom FLOD into the FL via femoral access. Completion angiography confirmed proper FL exclusion with preservation of visceral artery patency. Transesophageal echocardiography demonstrated rapid FL thrombosis. The patient was discharged on postoperative day 5 in good condition without complications. This case highlights that combining endograft extension with a dedicated FLOD is a safe and effective strategy for selected patients with complex cTBAD anatomy. Full article

Bleeding remains the most common complication following transcatheter aortic valve implantation (TAVI), despite a decline in its incidence over time. Periprocedural (≤30 days) major or life-threatening bleeding is reported to occur in 2.0–6.6% of patients undergoing TAVI. Major bleeding events carry a significant risk of mortality, with rates of 14.1% at 30 days and 27.8% at one year. The timely identification and management of patients at an elevated risk are therefore essential. Preventive measures include optimizing antithrombotic therapies, utilizing ultrasound-guided femoral access, employing single arterial access or a radial artery for secondary access, and administering unfractionated heparin under close monitoring. Long-term follow-up is essential for recognizing and managing late hemorrhages. In this review, we aimed to provide an in-depth analysis of bleeding events associated with TAVI and the most recent updates regarding the antithrombotic therapy of TAVI patients and its clinical impact. Full article