Search Results (345)

Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) increasingly co-occur in low- and middle-income countries and aging populations. Prior pulmonary TB is a robust, smoking-independent determinant of COPD and is linked to persistent systemic inflammation, endothelial dysfunction, dyslipidemia, and hypercoagulability axes that also amplify cardiovascular disease (CVD) risk. We conducted a targeted narrative non-systematic review (2005–2025) of PubMed/MEDLINE, Embase, Scopus, and Web of Science, selecting studies for clinical relevance across epidemiology, clinical phenotypes, pathobiology, biomarkers, risk scores, sleep-disordered breathing, and management. No quantitative synthesis or formal risk-of-bias assessment was performed. Accordingly, findings should be interpreted as a qualitative synthesis rather than pooled estimates. Prior TB is associated with a distinctive COPD phenotype characterized by mixed obstructive–restrictive defects, reduced diffusing capacity (DLCO), radiographic sequelae, and higher exacerbation/hospitalization burden. Mechanistic insights: Convergent mechanisms chronic immune activation, endothelial injury, prothrombotic remodeling, molecular mimicry, and epigenetic reprogramming provide biologic plausibility for excess CVD, venous thromboembolism, and pulmonary hypertension. Multimarker panels spanning inflammation, endothelial injury, myocardial strain/fibrosis, and coagulation offer incremental prognostic value beyond clinical variables. While QRISK4 now includes COPD, it does not explicitly model prior TB or COPD-TB outcomes, but data specific to post-TB cohorts remain limited. Clinical implications: In resource-constrained settings, pragmatic screening, prioritized PAP access, guideline-concordant pharmacotherapy, and task-shifting are feasible adaptations. A history of TB is a clinically meaningful modifier of cardiopulmonary risk in COPD. An integrated, multimodal assessment history, targeted biomarkers, spirometry/lung volumes, DLCO, 6 min walk test, and focused imaging should guide individualized care while TB-aware prediction models and implementation studies are developed and validated in high-burden settings. Full article

Background: Preserving arm veins is important for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD), as mature AVF is the preferred hemodialysis access. Midline catheters introduced into AVF candidate veins may cause thrombosis, hindering AVF formation. This study aims to determine ultrasonographic rates of midline-associated upper extremity deep venous thrombosis (UE-DVT) or superficial venous thrombosis (SVT) in patients with advanced CKD. Methods: We conducted a prospective study involving subjects with advanced CKD, who had a point-of-care ultrasound-guided midline placed in an arm vein. Within 35 days of midline insertion, participants underwent routine bilateral UE venous duplex ultrasound. The primary outcome was a composite occurrence of UE-DVT/SVT ipsilateral to the midline. Comparative analyses were performed based on patient demographics and device-specific variables. Results: 49 subjects with advanced CKD received midlines. The median midline catheter dwell time was <6 days for 15/49 patients (30.6%). The primary outcome occurred in 15/49 patients (30.6%), mostly asymptomatic thrombosis. No significant associations were found between outcomes and patient or device characteristics. Conclusions: Our study identified frequent use of midlines with short dwell times in subjects with advanced CKD which calls into question proper device selection. In this cohort, midline-associated arm clots were frequent. Full article

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated not only with respiratory illness but also with profound vascular and coagulation disturbances. Long COVID (LC) is characterized by persistent symptoms such as fatigue, dyspnea, cognitive impairment, and palpitations. Mechanistically, SARS-CoV-2 induces direct endothelial injury, promotes a pro-inflammatory cytokine milieu, and activates platelets, leading to immunothrombosis and impaired fibrinolysis. Consequently, patients exhibit microthrombosis, elevated plasma D-dimer, fibrinogen dysregulation, and persistent hypercoagulability. Clinically, this translates into an increased risk of venous thromboembolism, including deep vein thrombosis and pulmonary embolism, as well as arterial thrombotic events such as myocardial infarction and stroke, which may persist months after acute infection. Understanding the interplay between endothelial injury, inflammation, and coagulation is crucial for risk stratification and the development of preventive and therapeutic strategies. We conducted a systematic narrative review of the literature, including human clinical and mechanistic studies identified through PubMed, Scopus and Web of Science up to 30 September 2025. This review synthesizes current evidence on vascular complications in LC, highlighting endothelial dysfunction as a central pathophysiological nexus linking the acute phase of SARS-CoV-2 infection with chronic LC manifestations. Full article

Millions of people suffer from chronic venous disease (CVD), a common vascular condition that frequently causes pain, edema, and skin ulcers. For treatment to be effective, its stages must be accurately and promptly classified. This study offers a deep learning-based framework for classifying CVD stages using medical images, such as limb photos or ultrasound scans. For training and assessment, convolutional neural networks (CNNs) are used in conjunction with pre-trained models like ResNet, VGG, and Efficient Net. Metrics like accuracy, precision, recall, and F1-score are used to evaluate the model’s performance. The encouraging findings suggest that deep learning tools can greatly facilitate the diagnosis of CVD and may be integrated into clinical decision support systems for quicker, more precise evaluations. Full article

Background/Objectives: Chronic limb-threatening ischemia (CLTI) represents the most severe stage of peripheral arterial disease and is associated with high risks of limb loss. Novel approaches are needed for patients who are not candidates for conventional revascularization. This study is to evaluate the clinical efficacy of a venous arterialization-based extracorporeal perfusion technique in patients with CLTI. Methods: A retrospective single-centre, non-randomised comparative cohort study was conducted involving 76 patients with chronic limb-threatening ischemia (CLTI), retrospectively assigned into a perfusion group (n = 38) and a control group (n = 38), with longitudinal pre-/post-treatment assessments at baseline and Day 7 and 6-month limb-salvage follow-up. Patients in the perfusion group received daily extracorporeal perfusion for 6 h over 7 consecutive days. Clinical efficacy was assessed by comparing pre- and post-treatment changes in ankle–brachial index (ABI), transcutaneous oxygen pressure (TcPO₂), skin temperature, wound area, and Visual Analogue Scale (VAS) pain scores. Limb salvage rates were recorded at 6-month follow-up. Results: The perfusion group exhibited significant improvements in ankle–brachial index (ABI) (increase of 0.20 ± 0.02 vs. 0.02 ± 0.01 in the control group, p < 0.001), transcutaneous oxygen pressure (TcPO₂) (increase of 5.24 ± 0.35 mmHg vs. 0.10 ± 0.04 mmHg, p < 0.001), skin temperature (increase of 1.19 ± 0.09 °C vs. 0.02 ± 0.01 °C, p < 0.001), The mean wound healing rate at 7 days was significantly higher in the perfusion group (23.16 ± 2.30%) compared to the control group (5.62 ± 1.23%) (p < 0.001), and Visual Analogue Scale (VAS) score improvement (3.05 ± 1.01 vs. 1.29 ± 0.61, p < 0.001) compared with the control group. The 6-month limb salvage rate was significantly higher in the perfusion group (86.8% vs. 26.3%, p < 0.001), complete wound healing was achieved in 57.9% of the perfusion group versus 10.5% of the control group (p < 0.001). Conclusions: Venous arterialization-based extracorporeal perfusion significantly improves microcirculation and clinical symptoms in CLTI patients and may serve as an effective adjunctive therapy to enhance limb salvage outcomes. Full article

Chronic kidney disease (CKD) affects nearly 850 million people worldwide, and most patients with kidney failure are treated with kidney replacement therapy. Despite technological progress, venous congestion remains a major determinant of morbidity and mortality, and is often underdetected by conventional tools such as clinical evaluation, weight changes, blood pressure measurement, or bioimpedance. Point-of-care ultrasonography (PoCUS) has transformed this diagnostic landscape by providing real-time, physiology-based insights into both left- and right-sided filling pressures. In dialysis care, multiple or confluent B-lines and subtle pleural irregularities suggest elevated pulmonary capillary wedge pressure, while a dilated inferior vena cava (IVC) with reduced collapsibility and increased portal vein pulsatility indicate elevated right atrial pressures. Integrating these sonographic findings into a multiparametric assessment that also includes clinical assessment, bioimpedance, and biosensor feedback enhances diagnostic sensitivity and refines fluid management. Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations of the lungs, IVC, portal venous system, arteriovenous access, and skeletal muscle, translating ultrasound findings into physiological interpretations that guide individualized ultrafiltration strategies and patient care. Nutritional ultrasound (NUS) further complements congestion assessment by quantifying muscle mass and quality, linking nutritional reserve and functional status with hemodynamic tolerance. The implementation of structured education, competency-based training, and standardized scanning protocols allows nurses to incorporate these techniques safely and reproducibly into daily dialysis workflows. By integrating PoCUS and NUS within interdisciplinary decision-making, nursing practice evolves from procedural to diagnostic, supporting early identification of congestion, protection of vascular access, and detection of malnutrition. This multiparametric, physiology-guided approach exemplifies the concept of precision nursing, where patient evaluation becomes continuous, individualized, and grounded in real-time pathophysiological insight. Full article

Background: Fontan-associated liver disease (FALD) is a progressive condition resulting from chronic hepatic venous congestion following the Fontan procedure for univentricular heart defects. As survival improves in these patients, recognition and management of FALD have become increasingly important. Objective: To describe the pathophysiological mechanisms, imaging findings, and diagnostic approach to FALD, with a focus on the role of ultrasonography, including contrast-enhanced ultrasound (CEUS). Methods: This narrative review explores the evolution of FALD through a multidisciplinary lens, integrating cardiovascular and hepatic imaging data. Particular attention is paid to Doppler ultrasound and CEUS, both in early parenchymal changes and in the differential diagnosis of potential complications such as hepatic nodules. Results: FALD is characterized by progressive fibrosis due to long-standing passive congestion, resulting in a wide spectrum of imaging findings. B-mode ultrasound reveals hepatomegaly, heterogeneous parenchyma, and gallbladder wall thickening. Doppler studies show altered hepatic venous flow patterns, while CEUS provides dynamic vascular evaluation, highlighting areas of altered perfusion. In advanced stages, hypo-vascular areas in the late phase may simulate malignant lesions, emphasizing the need for careful interpretation. The role of liver biopsy, though limited by invasiveness, remains crucial in selected cases. Surveillance strategies are not standardized but require close multidisciplinary follow-up. Conclusions: FALD presents complex diagnostic challenges requiring integrated imaging and clinical assessment. CEUS emerges as a valuable, non-invasive tool in characterizing hepatic congestion and guiding management. Increased awareness and standardized protocols are essential for early detection and tailored care in this growing patient population. Full article

This review explores the evolving role of endoscopic ultrasound (EUS) in the diagnosis and management of liver diseases, with a particular focus on chronic liver disease, focal hepatic lesions, portal hypertension, and post-transplant anatomy. A comprehensive literature review of PubMed, MEDLINE, and Embase studies up to August 2025 was conducted to identify the latest evidence on EUS-guided procedures, comparing them with traditional techniques. In diagnostics, EUS-guided liver biopsy provides real-time visualisation and precise tissue sampling, achieving longer specimen lengths and better patient outcomes compared to traditional percutaneous and transjugular approaches. For portal hypertension assessment, EUS-guided portal pressure gradient measurement is a promising alternative to conventional methods, with validation studies demonstrating strong correlation with hepatic venous pressure gradient measurements. In therapeutic applications, EUS facilitates precise interventions including gastric variceal treatment through combined coil and glue injection, management of visceral arterial pseudoaneurysms, selective portal vein embolisation, and targeted tumour ablation. While some applications remain in developmental stages, studies support the safety and efficacy of EUS in improving diagnostic accuracy and expanding therapeutic options for liver diseases. Ongoing technological advances in needle design, imaging capabilities, and artificial intelligence integration are expected to further enhance the utility of EUS in hepatology. Full article

Background: Chronic venous disease (CVD) is a prevalent condition associated with significant morbidity and impaired quality of life. Venoactive nutraceuticals are widely used as part of conservative management and are cited in major guidelines, yet recommendations remain heterogeneous and clinical practice varies substantially. This study aimed to establish expert consensus on the clinical use of these agents in CVD within the Italian vascular community. Methods: A three-round modified Delphi was conducted among 21 Italian vascular specialists (May–July 2025). Consensus was defined as ≥70% agreement. Statements addressed CEAP classification, symptom assessment, use and perceived effectiveness of individual agents, combination regimens, and topical formulations. Results: Consensus supported routine use of CEAP and its 2020 revision, the clinical distinction between CVD (C0–C2) and chronic venous insufficiency (CVI) (C3–C6), and systematic classification of patients as symptomatic or asymptomatic. Strong agreement endorsed the use of selected venoactive nutraceuticals across all CEAP classes and supported combination therapy as more effective than monotherapy. An oral fixed-dose combination of diosmin, ruscus, melilotus, Vitis vinifera, and horse chestnut extract, pre-selected as a test case to evaluate the plausibility of combining agents with complementary mechanisms, was considered a reasonable first-line conservative option. Topical preparations were endorsed across C1–C6, particularly for CVI and to reduce heaviness, reflecting their perceived value as safe adjuncts despite the limited availability of high-quality evidence. No consensus was reached for ruscus, horse chestnut, hydroxyethylrutosides, red vine leaf extract, anthocyanosides, or β-arbutin in monotherapy. The panel agreed on the need to update clinical guidelines to reflect emerging evidence on venoactive nutraceuticals. Conclusions: This Delphi provides structured expert consensus on the use of venoactive nutraceuticals in CVD. Combination therapy integrating multiple physiological effects is considered more effective than single agents. Further research is required to validate combination regimens and topical formulations and to determine their impact on patient-reported outcomes. Full article

Background: Chronic venous disease (CVD) substantially influences workers’ comfort, productivity, and capacity to remain employed, yet many occupational settings complicate the implementation of effective symptom management strategies. Temperature fluctuations, in particular, influence daily functioning: heat often worsens swelling, heaviness, pain, and fatigue, while cold may offer partial relief. This study examines how workplace thermal and organizational conditions affect adults with CVD, paying attention to the challenges they face in applying clinical recommendations. Methods: Fifty adults with CEAP C1–C6 disease were interviewed and observed in clinical settings. A qualitative descriptive approach was adopted to capture workers’ accounts rather than generate a new theory. Data were analyzed using Braun and Clarke’s reflexive thematic analysis within a qualitative descriptive framework. Results: Heat exposure consistently aggravated swelling, pain, and fatigue, whereas moderate cold often improved comfort and functional capacity. Participants highlighted numerous workplace barriers, including rigid schedules, restrictive uniforms, and difficulties maintaining compression in hot environments. Supportive supervisors, micro-breaks, access to hydration, and flexibility in posture facilitated better symptom control. Workers frequently described tensions between clinical advice and job demands, noting that instructions such as leg elevation or frequent breaks were often unrealistic in their occupational context. Conclusions: Aligning clinical guidance with workplace realities is essential for the well-being and long-term employability of individuals with CVD. Climate-sensitive and ergonomic job design represents an important strategy for supporting employees’ ability to manage symptoms and sustain productivity amid increasing thermal variability. Full article

Objectives: To study the associations of central retinal vein occlusion (CRVO) with glaucoma and cataract before and after the onset of CRVO. Methods: This study included 439 fundus photographically verified CRVO cases and a 5:1 set of 2195 registry-based age- and sex-matched control subjects without a record of CRVO. The study assessed rates of cataract and glaucoma before and after CRVO based on diagnoses, procedures, and prescriptions and analyzed their association with CRVO. Odds ratio (OR) and incidence rate ratio (IRR) estimates for 10 years prior to a subject’s first CRVO and incident comorbidity after CRVO were compared. Results: The median age at the time of presentation of 439 eligible patients with CRVO was 71 years (interquartile range 11 years). In the 10 years leading up to the incidence of CRVO, the ORs for glaucoma and cataract were 6.01 (95% confidence interval (CI95) 4.05 to 8.94) and 2.13 (CI95 1.45 to 3.12), respectively. During a mean follow-up of 5.7 years after CRVO, the incidence rate ratios for glaucoma and cataract were 16.7 (CI95 9.32–30.1) and 1.99 (CI95 1.39–2.84), respectively. Conclusions: Glaucoma and cataract occurred at elevated rates compared with the background population, both before and after the clinical presentation of CRVO. The results fit a disease model where retinal perfusion is compromised by chronic venous congestion, leading to glaucomatous retinal degeneration. Chronic venous congestion may subsequently convert to clinically manifest CRVO when retinal capillaries have been sufficiently weakened to produce hemorrhage, edema and vision loss. Full article

Tricuspid atresia (TA) is a cyanotic congenital heart defect defined by agenesis of the tricuspid valve and resultant right ventricular hypoplasia, representing 1.4–2.9% of congenital heart disease. Survival depends on interatrial and interventricular shunts that permit systemic and pulmonary blood flow, with staged surgical palliation culminating in the Fontan procedure. While surgical advances have improved long-term outcomes, Fontan circulation remains a delicate physiology characterized by preload dependence, elevated pulmonary vascular resistance, chronic venous hypertension, and a prothrombotic state. These features predispose patients to arrhythmias, lymphatic complications, hepatic congestion, and progressive circulatory failure. For anesthesiologists, perioperative management of TA and Fontan patients is uniquely complex. Anesthetic considerations include meticulous preload optimization, modulation of systemic and pulmonary vascular resistance, and ventilatory strategies that minimize adverse effects on venous return. Additional challenges include the high risk of air embolism, individualized anticoagulation needs, and hemodynamic sensitivity to patient positioning. Preoperative evaluation with echocardiography and electrocardiography provides critical insight into anatomy and physiology, while intraoperative planning must emphasize goal-directed fluid management, careful agent selection, and tailored ventilation. Postoperatively, vigilant monitoring, effective pain control, and prevention of complications are essential. This review synthesizes classification systems, pathophysiology, and the evolution of surgical palliation, while emphasizing anesthetic principles for the perioperative care of patients with TA and Fontan circulation. As survival improves and the population of Fontan patients expands, a nuanced understanding of this physiology is essential for optimizing outcomes across cardiac and non-cardiac surgical settings. Full article

Background/Objectives: Chronic venous disease is a very common disease. Recent studies suggest a potential link between this condition and cardiovascular disease or mortality. Common pathophysiological features include endothelial injury, hypercoagulability, and systemic inflammation. Conservative management of chronic venous disease includes compression therapy and pharmacological treatment. However, there is some controversy regarding the exact place of pharmacological treatment in the management of this condition. We conducted the VeinHeart Survey to gather information on the management of patients with chronic venous disease referred to vascular specialists in Italy. Methods: The present survey involved 78 Italian phlebologists, angiologists, and vascular surgeons, with data from a total of 1621 patients. Results: Drug therapies prescribed by vascular specialists participating in this survey included: glycosaminoglycans, topical phlebotonics, systemic phlebotonics, and supplements. The most commonly prescribed medications were glycosaminoglycans, both at the first visit and at follow-up. The meantime since the first visit was 56.4 days. Both symptoms and signs improved at follow-up. The most improved signs at follow-up were edema and venous ulcer healing. The prevalence of CEAP classes C3 and C4 also showed a decrease at the follow-up visit. Conclusions: The findings of this survey provide a picture of the state of the art of current pharmacological treatments prescribed by expert clinicians in the management of patients with chronic venous disease in Italy. This may offer some useful insights for the optimization of current therapeutic options, in order to improve the clinical management of this disease. Full article

Background: The prevalence and the prognostic impact of chronic obstructive pulmonary disease (COPD) and asthma in patients with myeloproliferative neoplasms (MPNs) are unknown. Methods: This retrospective multicenter cohort analyzed the prevalence and prognostic implications of COPD and asthma in 246 patients with essential thrombocythemia (ET) and polycythemia vera (PV). Results: A total of 6.5% and 1.6% patients had COPD or asthma, respectively, without statistically significant differences with respect to disease phenotype. The presence of COPD/asthma was more frequently associated with active/prior smoking (p = 0.021) and constitutional symptoms (p = 0.001). After the median follow-up of 47.5 months, the presence of COPD/asthma was univariately associated with an inferior time to thrombosis (TTT; median 135 vs. 190 months, 95% confidence interval (CI) 1.8–29.5, hazard ratio-HR 7.75, p = 0.005), mainly driven by venous (HR 37.3, 95% CI 3.2–43.6, p = 0.003) and not arterial events (HR 1.77, 95% CI 0.40–7.78, p = 0.445, p = 0.445). Statistically significant interactions existed between COPD/asthma, female sex (HR 3.94, 95% CI 1.01–11.02), ET phenotype (HR 7.1, 95% CI 15.3–16.7), JAK2 positive status (HR 4.17, 95% CI 1.04–6.9), hydroxyurea use (HR 4.67, 95% CI 1.10–7.43), and the presence of other cardiovascular risk factors (HR 8.1, 95% CI 1.55–10.72) with overall thrombotic risk (interaction p < 0.050 for all analyses). Finally, the negative effect of COPD/asthma on TTT persisted in the multivariate analysis (HR 6.54, p = 0.010) independently of older (>60 years) age (p = 0.030) when being adjusted for other clinically meaningful variables. There was no effect of COPD/asthma on overall survival. Conclusions: These results provide an important signal regarding the potentially inferior outcomes in ET/PV patients presenting with these common respiratory disorders and may help to further personalize MPN management. Full article

Background: In patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (summarized as pulmonary vascular disease; PVD), it is unclear whether the brain is protected against acute hypoxia and whether acute pulmonary vascular dilatation by sildenafil would influence cerebral and muscle tissue oxygenation whilst breathing normoxia or hypoxia. Methods: Adult patients with PVD underwent right heart catheterization, while cerebral and muscular tissue oxygenation and tissue hemoglobin index were measured using near-infrared spectroscopy along with arterial and mixed-venous blood gases. Participants underwent a four-stage protocol in which they were blinded to breathing either normoxia (FiO₂ 0.21) or normobaric hypoxia (FiO₂ 0.15), both before and after a single oral dose of sildenafil (50 mg) according to a randomized, cross-over design. Results: In 22 PVD patients (9 women, age 54 ± 14 y) under hypoxia, mean cerebral tissue oxygenation decreased by −2% (95% CI −4 to 0%, p = 0.046), muscular tissue oxygenation by −1% (95% CI −3 to 0%, p = 0.011) and mean arterial partial pressure of oxygen by −2.3 kPa (95% CI −2.7 to −1.8 kPa, p < 0.0001). Sildenafil improved the cerebral tissue hemoglobin index under hypoxia compared to hypoxia without sildenafil by 0.12 (95% CI 0.00 to 0.23, p = 0.049), but not the muscular tissue hemoglobin index. Conclusions: In PVD patients, acute exposure to normobaric hypoxia leads to a reduction in arterial oxygenation as well as cerebral and muscular tissue oxygenation. Sildenafil improves cerebral blood flow but has no effect on arterial, cerebral or muscular oxygenation. Full article