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Background: Previous studies have reported a protective effect of type 2 diabetes on the incidence and progression of aortic aneurysms. We investigated whether this protective effect extends to aortic dissections. Methods: Data from the US Nationwide Readmission Database (2016–2019) were analyzed. Patients admitted for open surgery repair of acute type A aortic dissection (TAAD) were initially analyzed (index group). Those discharged alive were followed for up to 30 days (readmission group). The co-primary outcomes were in-hospital and 30-day mortality. Results: Between 2016 and 2019, 7,324 patients were admitted for open surgical repair of acute TAAD, of whom 965 (13.2%) had diabetes. Patients with diabetes were older and had a higher prevalence of obesity, hypertension, smoking, dyslipidemia, and chronic kidney disease (CKD). 15.2% of patients with diabetes and 14.6% without diabetes died; hence, diabetes did not have a significant impact on in-hospital mortality (adjusted odd ratio [aOR] = 1.02 [0.84–1.24]). Similarly, diabetes was not associated with a higher adjusted risk of atrial fibrillation (aOR = 1.03 [0.89–1.20]), stroke (aOR = 0.83 [0.55–1.26]), cardiogenic shock (aOR = 1.18 [0.98–1.42]), but increased the risk of acute renal failure (aOR = 1.20 [1.04–1.39]). Within 30 days of discharge, 154 (15.9%) patients with diabetes and 952 (15%) from the non-diabetes group were readmitted. Readmitted patients with diabetes were older and had a higher prevalence of cardiovascular comorbidities. We didn't observe any significant difference in the adjusted risk of 30-day mortality between the diabetes and non-diabetes groups (adjusted hazard ratio [aHR] = 0.81 [0.41–1.60]). However, diabetes was associated with a lower risk of readmission (aHR = 0.81 [0.68–0.97]). Age was the most significant predictor of all outcomes. CKD was the most significant predictor of 30-day mortality, with the risk increasing five-fold in patients with diabetes (HR = 5.58 [2.58–6.62]. Cardiovascular-related conditions were the most common causes of readmission in both groups. However, respiratory-related conditions were more prevalent in the diabetes group compared to the non-diabetes group (19.5% vs. 13%, respectively, p = 0.032). Conclusions: Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for Type A aortic dissection. [ABSTRACT FROM AUTHOR]

The 35th Annual Vascular Scientific Sessions by the Society for Vascular Medicine (SVM) in 2024 was a successful event held in Houston, featuring high-quality science, diverse attendees from 10 countries, and engaging sessions. The conference included various lectures, workshops, and networking opportunities, with a focus on advancing vascular medicine and improving patient care. The event showcased cutting-edge research, recognized outstanding contributors in the field, and provided a platform for professionals to collaborate and stay updated on the latest developments in vascular medicine. [Extracted from the article]

Perfusion asymmetries have been associated with vascular pathology. Physical activity is a component of vascular health. Here, we investigate the impact of a thirty-day regular home-based physical activity program in older individuals with multiple age-related comorbidities. Eleven participants of both sexes were included. Skin perfusion was assessed in both feet by laser Doppler flowmetry (LDF, for deeper perfusion) and polarized light spectroscopy (PSp, for superficial perfusion). At baseline, participants had significant perfusion differences between right and left feet (p = 0.005 with LDF; p = 0.028 with PSp), which disappeared with activity and reappeared in recovery. After 30 days, both feet showed significant perfusion increases as assessed with LDF (p = 0.005) compared to D0. At this point, the perfusion asymmetry observed at D0 was no longer present. However, the superficial perfusion asymmetry assessed by PSp persisted at D30 (p = 0.028). Data show that regular physical activity positively altered the lower limb perfusion pattern. Systolic pressure and mean arterial pressure were also significantly reduced at D30. These impacts seem to be directly related to the physical activity program introduced in the day-by-day routines of these participants. These also encourage further research on the role of symmetry–asymmetry in prevention, treatment, and rehabilitation in vascular medicine. [ABSTRACT FROM AUTHOR]

Endothelial inflammation plays a crucial role in vascular-related diseases, a leading cause of global mortality. Among various cellular players, endothelial progenitor cells (EPCs) emerge as non-differentiated endothelial cells circulating in the bloodstream. Recent evidence highlights the transformative role of EPCs in shifting from an inflammatory/immunosuppressive crisis to an anti-inflammatory/immunomodulatory response. Despite the importance of these functions, the regulatory mechanisms governing EPC activities and their physiological significance in vascular regenerative medicine remain elusive. Surprisingly, the current literature lacks a comprehensive review of EPCs' effects on inflammatory processes. This narrative review aims to fill this gap by exploring the cutting-edge role of EPCs against inflammation, from molecular intricacies to broader medical perspectives. By examining how EPCs modulate inflammatory responses, we aim to unravel their anti-inflammatory significance in vascular regenerative medicine, deepening insights into EPCs' molecular mechanisms and guiding future therapeutic strategies targeting vascular-related diseases. [ABSTRACT FROM AUTHOR]

Atherosclerotic cardiovascular disease (ASCVD) is the most important cause of morbidity and mortality worldwide. While it is traditionally attributed to lipid accumulation in the vascular endothelium, recent research has shown that plaque inflammation is an important additional driver of atherogenesis. Though clinical outcome trials utilizing anti-inflammatory agents have proven promising in terms of reducing ASCVD risk, it is imperative to identify novel actionable targets that are more specific to atherosclerosis to mitigate adverse effects associated with systemic immune suppression. To that end, this review explores the contributions of various immune cells from the innate and adaptive immune system in promoting and mitigating atherosclerosis by integrating findings from experimental studies, high-throughput multi-omics technologies, and epidemiological research. [ABSTRACT FROM AUTHOR]

Aims Recent evidence from randomized trials demonstrates that colchicine can reduce the risk of major adverse cardiovascular events (MACE) in patients with coronary artery disease. Colchicine's effect on lower-extremity peripheral artery disease (PAD) is not known. Methods and results To make inferences about the real-world effectiveness of colchicine in PAD, we emulated two target trials leveraging the variable prescribing practice of adding colchicine vs. a non-steroidal anti-inflammatory drug (NSAID) to urate-lowering therapy in patients with gout and PAD. Emulated Trial 1 compared colchicine initiators with NSAID initiators. Emulated Trial 2 compared long-term (indefinite) and short-term (3 months) treatment strategies after initiating colchicine. Eligible individuals were those continuously enrolled in Medicare receiving care at a multicentre academic health system between July 2007 and December 2019. The primary outcome for both trials was a 2 year composite of major adverse limb events (MALE), MACE, and all-cause mortality. Secondary outcomes included MALE and death, MACE and death, and individual components of the primary outcome. Inverse probability weighting was used to adjust for confounding. Percentile-based 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping. A total of 1820 eligible patients were included; the mean age was 77 years [standard deviation (SD) 7], 32% were female, and 9% were non-White. The mean (SD) duration of colchicine and NSAID therapy was 247 (345) and 137 (237) days, respectively. In the emulation of Trial 1, the risk of the primary composite outcome of MALE, MACE, and death at 2 years was 29.9% (95% CI 27.2%, 32.3%) in the colchicine group and 31.5% (28.3%, 34.6%) in the NSAID group, with a risk difference of −1.7% (95% CI −6.5%, 3.1%) and a risk ratio of 0.95 (95% CI 0.83, 1.07). Similar findings were noted in the emulation of Trial 2, with a risk of the primary composite outcome at 2 years of 30.7% (95% CI 23.7%, 38.1%) in the long-term colchicine group and 33.4% (95% CI 29.4%, 37.7%) in the short-term group, with a risk difference of −2.7% (95% CI −10.3%, 5.4%) and risk ratio of 0.92 (95% CI 0.70, 1.16). Conclusion In a real-world sample of patients with PAD and gout, estimates of the effect of colchicine were consistent across two analyses and provided no conclusive evidence that colchicine decreased the risk of adverse cardiovascular or limb events and death. The cardiovascular and limb benefits of colchicine in older, comorbid populations with PAD and advanced systematic atherosclerosis remain uncertain. [ABSTRACT FROM AUTHOR]

The document acknowledges and thanks the Guest Editors and Peer Reviewers who contributed to Vascular Medicine from September 1, 2023, to August 31, 2024. It highlights the importance of the multi-disciplinary pool of expert Peer Reviewers, with 269 individuals completing 631 reviews. The document also recognizes the "Blue Ribbon Peer Reviewers" who made outstanding contributions, as well as Dr. Bruce Gray, who received the Peer Reviewer of the Year award for his exceptional work during the period. [Extracted from the article]

All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research. [ABSTRACT FROM AUTHOR]

Early in the COVID-19 pandemic, cardiology clinics rapidly implemented telemedicine to maintain access to care. Little is known about subsequent trends in telemedicine use and visit volumes across cardiology subspecialties. We conducted a retrospective cohort study including all patients with ambulatory visits at a multispecialty cardiovascular center in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). Telemedicine use increased from 3.5% of visits (1200/33,976) during the pre-COVID period to 63.0% (21,251/33,706) during the COVID period. Visit volumes were below pre-COVID levels from March to May 2020 but exceeded pre-COVID levels after June 2020, including when local COVID-19 cases peaked. Telemedicine use was above 75% of visits in all cardiology subspecialties in April 2020 and stabilized at rates ranging from over 95% in electrophysiology to under 25% in heart transplant and vascular medicine. From June 2020 to February 2021, subspecialties delivering a greater percentage of visits through telemedicine experienced larger increases in new patient visits (r = 0.81, p = 0.029). Telemedicine can be used to deliver a significant proportion of outpatient cardiovascular care though utilization varies across subspecialties. Higher rates of telemedicine adoption may increase access to care in cardiology clinics. [ABSTRACT FROM AUTHOR]

Background: Supervised exercise therapy (SET) is the cornerstone of medical therapy for symptomatic peripheral artery disease (PAD). Despite the efficacy of SET, initial reports following the 2017 Centers for Medicare and Medicaid Services (CMS) reimbursement decision indicate low SET uptake, referral, and completion. Vascular medicine specialists are key to the success of such programs. We examined rates of SET referral, completion, and outcomes in a health system with a robust SET program during the first 5 years of CMS reimbursement. Methods: A retrospective chart review of patients with PAD referred to SET between October 1, 2017 and December 31, 2022 was conducted. Patient demographic and medical characteristics, SET indication, referring provider specialty, SET participation (e.g., exercise modality, number of sessions, treadmill prescription), and outcomes were abstracted. Descriptive statistics, t -tests, and multiple linear regression were used to examine the sample, evaluate outcomes, and explore outcomes by relevant covariates (i.e., age, sex, referring provider specialty). Results: Of 5320 patients with PAD, N = 773 were referred to SET; N = 415 enrolled and were included in the present study. Vascular medicine and vascular surgery specialists were the two primary sources of referrals (30.6% and 51.6%, respectively). A total of 207 patients (49.9%) completed SET. Statistically significant and clinically meaningful improvements were observed in all outcomes. Conclusion: SET referral and completion rates are low in the 5 years following CMS reimbursement, despite the advocacy of vascular medicine specialists. SET is effective in improving patient functional capacity and quality of life. Additional efforts are needed to increase both SET availability and referrals as part of comprehensive treatment of PAD. [ABSTRACT FROM AUTHOR]

Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention. [ABSTRACT FROM AUTHOR]

Background: Telemedicine is increasingly used in several fields of healthcare, including vascular medicine. This study aimed to investigate the views of experts and propose clinical practice recommendations on the possible applications of telemedicine in vascular medicine. Methods: A clinical guidance group proposed a set of 67 clinical practice recommendations based on the synthesis of current evidence and expert opinion. The Telemedicine Vascular Medicine Working Group included 32 experts from Europe evaluating the appropriateness of each clinical practice recommendation based on published RAND/UCLA methodology in two rounds. Results: In the first round, 60.9% of clinical practice recommendations were rated as appropriate, 35.9% as uncertain, and 3.1% as inappropriate. The strongest agreement (a median value of 10) was reached on statements regarding the usefulness of telemedicine during the 2019 coronavirus disease (COVID-19) pandemic, its usefulness for geographical areas that are difficult to access, and the superiority of video calls compared to phone calls only. The lowest degree of agreement (a median value of 2) was reported on statements regarding the utility of telemedicine being limited to the COVID-19 pandemic and regarding the applicability of teleconsultation in the diagnosis and management of abdominal aortic aneurysm. In the second round, 11 statements were re-evaluated to reduce variability. Conclusions: This study highlights the levels of agreement and the points that raise concern on the use of telemedicine in vascular medicine. It emphasizes the need for further clarification on various issues, including infrastructure, logistics, and legislation. [ABSTRACT FROM AUTHOR]

Embolization of de novo pulmonary arteriovenous malformations (PAVMs) using high-volume detachable non-fibered (HVDNF) coils was compared to traditional non-HVDNF coils. Persistent-occlusion rates were evaluated. A total of 272 de novo (previously untreated) PAVM treatments were retrospectively stratified into those treated with non-HVDNF coils only (n = 192) and those treated with HVDNF coils with or without other coils (n = 80). Propensity score matching, followed by survival analysis and cost analysis, was performed. The overall persistent-occlusion rate was 86.0% (234/272). Persistent occlusion was achieved in 81.8% of PAVMs using non-HVDNF coils, compared with 96.3% using HVDNF coils (p = 0.0017). The mean follow-up was 30.7 ± 31.9 months versus 14.7 ± 13.4 months, respectively (p < 0.0001). Propensity-matched survival analysis demonstrated PAVMs treated with HVDNF coils recurred significantly less frequently than PAVMs treated with non-HVNDF coils (p = 0.023). The use of HVDNF coils was more expensive than standard coils, however not significantly different for the treatment of complex PAVMs. The use of high-volume detachable non-fibered coils was associated with higher persistent-occlusion rates when compared with non-HVDNF coils. HVDNF coils were more expensive on average; however, cost was similar between groups for the treatment of complex PAVMs. [ABSTRACT FROM AUTHOR]

Introduction: Low-density lipoprotein cholesterol (LDL) is a known contributing factor to atherosclerotic cardiovascular disease (ASCVD) and a primary therapeutic target for medical management of ASCVD. Non-high-density lipoprotein cholesterol (non-HDL) has recently been identified as a secondary therapeutic target but is not yet widely used in vascular surgery patients. We sought to assess if vascular surgery patients were undertreated per non-HDL therapeutic guidelines. Methods: This was an observational study that used a single-center database to identify a cohort of adult patients who received care from a vascular surgery provider from 01/2001 to 07/2021. ICD-9/10-CM codes were used to identify patients with a medical history of hyperlipidemia (HLD), coronary artery disease (CAD), cerebrovascular occlusive disease (CVOD), peripheral artery disease (PAD), hypertension (HTN), or diabetes mellitus (DM). Patient smoking status and medications were also identified. Lab values were obtained from the first and last patient encounter within our system. Primary outcomes were serum concentrations of LDL and non-HDL, with therapeutic thresholds defined as 70 mg/dL and 100 mg/dL, respectively. Results: The cohort included 2465 patients. At first encounter, average age was 59.3 years old, 21.4% were on statins, 8.4% were on a high-intensity statin, 25.7% were diagnosed with HLD, 5.2% with CAD, 15.3% with PAD, 26.3% with DM, 18.6% with HTN, and 2.1% with CVOD. At final encounter, mean age was 64.8 years, 23.5% were on statins with 10.1% on high-intensity statin. Diagnoses frequency did not change at final encounter. At first encounter, nearly two-thirds of patients were not at an LDL <70 mg/dL (62.3%) or non-HDL <100 mg/dL (66.0%) with improvement at final encounter to 45.2 and 40.5% of patients not at these LDL or non-HDL treatment thresholds, respectively. Patients on statins exhibited similar trends with 51.1 and 50.1% of patients not at LDL or non-HDL treatment thresholds at first encounter and 39.9 and 35.4% not at LDL or non-HDL treatment thresholds at last encounter. Importantly, 6.9% of patients were at LDL but not non-HDL treatment thresholds. Discussion: Among vascular surgery patients, over half did not meet non-HDL targets. These results suggest that we may be vastly under-performing adequate medical optimization with only about one-fourth of patients on a statin at their final encounter and approximately one-tenth of patients being treated with a high-intensity statin. With recent evidence supporting non-HDL as a valuable measurement for atherosclerotic risk, there is potential to optimize medical management beyond current high-intensity statin therapy. Further investigation is needed regarding the risk of adverse events between patients treated with these varied therapeutic targets. [ABSTRACT FROM AUTHOR]

Segmental arterial mediolysis (SAM) is a rare vascular disease, characterized by acute but transient vulnerability of the wall of medium-sized arteries. The most characteristic feature of SAM is its biphasic course: an injurious phase marked by acute weakness of the arterial wall leading to acute dissection and/or hemorrhage, followed by a reparative phase in which granulation tissue and fibrosis restore the injured arterial wall. Residual stenosis, aneurysms, and/or arterial wall irregularities may remain visible on future imaging studies. Differentiating between SAM and other arterial vasculopathies is difficult due to its similarities with many other vascular diseases, such as vasculitis, fibromuscular dysplasia, inherited connective tissue disorders, and isolated visceral artery dissection. In this systematic review, we provide an overview on SAM, with an emphasis on the differential diagnosis and diagnostic work-up. We propose new diagnostic criteria to help establish a prompt diagnosis of SAM, illustrated by case examples from our multidisciplinary vascular clinic. [ABSTRACT FROM AUTHOR]

Hypertension (HTN) is one of the largest contributors to cardiovascular (CV) morbidity and mortality in the USA and is estimated to affect 47% of the US population; however, recent estimates suggest that over 40% continue to have uncontrolled HTN. In the past decade, multiple placebo- controlled randomized studies have shown the safety and efficacy of renal denervation as an adjunctive therapy, culminating in the recent approval of two devices by the US Food and Drug Administration (FDA). These devices use either radiofrequency or ultrasound energies to ablate the perivascular sympathetic nerves in the renal arteries and have been shown to reduce blood pressure. In this immediate post- FDA approval era, there are still multiple issues regarding the future of the technology in its applications and reimbursement landscapes. [ABSTRACT FROM AUTHOR]

This article discusses a case of Klippel-Trenaunay syndrome (KTS) in a 55-year-old man. KTS is a congenital anomaly characterized by cutaneous port-wine capillary malformations, hemihypertrophy of bone and soft tissues, and venous malformations. The patient had a history of vascular malformations, recurrent bleeding, and pulmonary embolism. The diagnosis was established based on the clinical presentation. Treatment for KTS involves a multidisciplinary approach, with symptomatic care being the mainstay and the potential use of low-dose sirolimus or targeted therapies. [Extracted from the article]

This article discusses the use of high-resolution CT imaging to detect and monitor arterial calcification in patients with CD73 deficiency, a rare autosomal recessive disease. The study focuses on two patients and shows the progression of the disease over a 2-year and 3-year time period. The images obtained through the CT scan provide detailed information about the location and extent of calcification in the lower extremities and hands. The findings of this study are supported by previous reports, and the authors suggest that CT imaging can be a valuable tool for monitoring and treating patients with CD73 deficiency. [Extracted from the article]

This article discusses a rare case of a hepatic artery aneurysm in a 25-year-old woman with polyarteritis nodosa. The woman initially sought consultation for recurrent abdominal pain, discomfort, nausea, and vomiting, which were initially managed as acid reflux disease. However, further workup revealed a dilated common hepatic artery with an aneurysm. The patient underwent open surgical resection of the aneurysm and received high-dose intravenous steroid therapy postoperatively. The article emphasizes the importance of maintaining a high index of suspicion for vasculitis, especially among young women, to avoid missing this diagnosis. [Extracted from the article]

Vascular disease is a significant cause of illness and death in the United States, but the field of vascular medicine lacks recognition as a certified specialty. Despite efforts to establish vascular medicine as a distinct field, it has not yet been recognized by the American Board of Medical Specialties or accredited by the American College of Graduate Medical Education. However, the Society for Vascular Medicine has made progress in standardizing knowledge and certification in the field. Several studies published in Vascular Medicine demonstrate the value of vascular medicine specialists in providing guideline-recommended therapies, improving patient outcomes, and collaborating with other specialists. The journal is now calling for more papers to further demonstrate the value of vascular medicine in practice. The SVM Vascular Medicine Subspecialty Recognition Taskforce continues to work towards achieving recognition for vascular medicine as a subspecialty. [Extracted from the article]

This article discusses the management of advanced Raynaud's disease, a condition characterized by episodic digital vasospasms primarily triggered by cold exposure. The study analyzed data from hospitalized patients with Raynaud's phenomenon (RP) and found that the majority had an underlying connective tissue disease and a high prevalence of cardiovascular risk factors. The study also revealed that amputation rates were relatively high, while angiograms and sympathectomy procedures were performed infrequently. The authors suggest that a multidisciplinary team approach, involving vascular medicine specialists, may be beneficial in managing severe RP cases and improving outcomes. However, further research is needed to determine the optimal care for advanced RP. [Extracted from the article]

The article summarizes the highlights of the 2023 SVM Vascular Scientific Sessions, a conference organized by the Society for Vascular Medicine. The conference aimed to create a great experience for attendees and featured various sessions, including speed mentoring, networking, ping-pong tournaments, and presentations of scientific research. The conference also included keynote speakers, a "shark tank"-like session, point-of-care ultrasound training, and a risk-factor management session. The article expresses gratitude to the organizers, award recipients, and partners who made the conference possible. [Extracted from the article]

Lower-extremity peripheral artery disease (PAD), the accumulation of atherosclerotic plaque in the arteries of the legs, causes substantial morbidity and mortality. Frequent under- and delayed diagnosis result in poor outcomes, disproportionately affecting individuals from racial and ethnic minority groups. To understand barriers to early detection and treatment and factors contributing to disparities, American Medical Group Association (AMGA) conducted roundtable discussions and semistructured interviews in 2021. Eighteen participants discussed PAD evaluation, diagnosis, early medical management, and disparities in care. A qualitative case study approach and data reduction methods were used to generate themes, draw conclusions, and make actionable recommendations. Identified themes included lack of (1) prioritization of PAD for population health; (2) engagement of primary care providers in early evaluation and referral; (3) "ownership" of lower-extremity PAD within health systems; and (4) focus on disparities in care. Participant solutions included (1) financial impact of early PAD management, in the context of value-based payment; (2) embedding an advanced practice provider into a vascular surgery practice to facilitate evaluation and provide medical therapy; and (3) leveraging care coordination, multidisciplinary clinics, and telehealth technology to provide comprehensive care for patients with PAD and address disparities. A deliberate focused effort is necessary to close gaps and the accompanying disparities in early evaluation, diagnosis, and treatment for people with lower-extremity PAD. The authors describe 3 models that can be emulated to improve care for this high-risk population. With improved reimbursement and better medical therapies, now is the time to focus on early diagnosis and management of PAD. [ABSTRACT FROM AUTHOR]

Cardiovascular disease(CVD) has become a major disease burden affecting people's health in China. Blood vessels are very important for human health and are the "sentinel" for the development of many cardiovascular and cerebrovascular diseases. The key to effectively preventing fatal, disabling heart, brain and peripheral vascular events lies in controlling traditional and non-traditional risk factors for vascular health from the source, and early assessment and intervention of early vascular lesions. Since 2004, China government promoted the early detection technology of vascular lesions and vascular medicine, and proposed the Beijing Vascular Health Stratification (BVHS) to provide suggestions for the examination, evaluation and management of risk factors, and to provide new ideas for lifelong maintenance of vascular health. This review mainly introduces the establishment and development of the clinical discipline of "vascular medicine" in the past 20 years in China, introduces the indicators for detecting vascular function and structure and the predictive value of vascular events, and carries out intelligent and digital management of vascular health throughout the life cycle of individualized prevention, treatment and rehabilitation for people with different parts or degrees of lesions, effectively reducing the occurrence and development of cardiovascular and cerebrovascular diseases, and the prospect of new technology in maintaining vascular health. [ABSTRACT FROM AUTHOR]

Poster No. 66 Abstract ID No. 1499427 The tale of an aortic thrombus I Nichole E. Brunton, DO, Ana Casanegra, MD i I Mayo Clinic i I Background: i Aortic thrombus is rare in patients without aneurysm or atherosclerosis, usually occurring in young patients with prothrombotic disorders. Poster No. 105 Abstract ID No. 1496248 Two strokes of luck: a case of descending thoracic aneurysm in an elderly patient with multip... I Julianne Marie E. Yamamoto, Flordeliz F. Lontok, Ronald S. Reodica, Fabio Enrique B. Posas, Marvin Martinez, Precious Samonte, Arvinjay Bautista i I St. Luke's Medical Center - Bonfacio Global City i I Background: i Treating a patient with aneurysms in multiple segments of the aorta and its branches is a challenge, especially in the elderly with a history of open surgical repair of abdominal aorta aneurysm. I Conclusions: i The variability of CHD and aneurysm presentations in patients with NOTCH-related disease indicate that these genes should be included in any aortopathy or arterial disease gene testing strategy. In patients with underlying connective tissue disease, such as Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, and Marfan syndrome, dissecting pseudoaneurysm should be considered in the differential diagnosis. Abstract ID No. 1494785 Venous inflammation might be one of the features of VEXAS syndrome and associated thrombosis I Hazan Karadeniz SP 1 sp , Mahinur Cerit SP 1 sp , Seyma Yildiz SP 1 sp , Abdurrahman Tufan SP 2 sp , Yogen Kanthi, MD SP 3 sp SP 1 sp Gazi University Faculty of Medicine, SP 2 sp National Human Genome Research Institute/NIH, SP 3 sp National Institutes of Health i I Background i : VEXAS syndrome is an often fatal, X-linked disease characterized by hematological dysplasia overlapping with severe autoinflammatory manifestations. [Extracted from the article]

Vascular aging, i.e., the deterioration of the structure and function of the arteries over the life course, predicts cardiovascular events and mortality. Vascular degeneration can be recognized before becoming clinically symptomatic; therefore, its assessment allows the early identification of individuals at risk. This opens the possibility of minimizing disease progression. To review these issues, a search was completed using PubMed, MEDLINE, and Google Scholar from 2000 to date. As a network of clinicians and scientists involved in vascular medicine, we here describe the structural and functional age-dependent alterations of the arteries, the clinical tools for an early diagnosis of vascular aging, and the cellular and molecular events implicated. It emerges that more studies are necessary to identify the best strategy to quantify vascular aging, and to design proper physical activity programs, nutritional and pharmacological strategies, as well as social interventions to prevent, delay, and eventually revert the disease. [ABSTRACT FROM AUTHOR]

Vascular dementia is a serious neurological disease associated with reduced perfusion of the brain. No western drugs have been approved for the treatment of vascular dementia. Oral Chinese drugs are commonly employed for vascular dementia in China. The purpose of this scope review is to review the recent evidence from clinical trials regarding the benefits of traditional oral Chinese medicines and to outline their effects on vascular dementia. Seventeen Chinese herbal medicines used in vascular dementia were systematically searched from 7 databases, such as EMBASE, Cochrane, PubMed, China Sci-Tech journal database, China National Knowledge Infrastructure, Chinese Biomedical Database as well as Wanfang database. Data were obtained from guidelines, consensus, meta-analyses and systematic reviews and randomized controlled trials. A revised Cochrane Risk Assessment Instrument was applied to evaluate the risk of bias with respect to the intention-to-treat effect on eligible randomized controlled trials. Microsoft Excel 2019, GraphPad Prism and RSTUDIO statistics were employed for data integration and process. As the data show, the number of research published increased between 2009 and 2014, while the most studied medicines were TianZhi, Ginkgo biloba leaf and NaoXinTong. A low overall bias risk of intention-to-treat was achieved in only 7 trials. More consistent benefits were observed with Ginkgo biloba leaf and TianZhi for amelioration of mini-mental state examination score deficits and activities of daily living impairments. The overall reporting quality of randomized controlled trials of traditional oral Chinese medicines for vascular dementia was poor and the transparency of these randomized controlled trials must be urgently improved. Oral Chinese drugs may be beneficial to patients with vascular dementia, but they need to be further assessed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Prophylactic doses of low-molecular-weight heparins or fondaparinux showed their efficacy and safety for treatment of all superficial vein thrombosis (SVT) of the lower limbs, yet not for those extended to the last 3 cm of the great saphenous vein, close to the sapheno-femoral junction, or considered as a deep-vein thrombosis. Some experts suggest that these patients should be managed with full anticoagulant doses but evidence to support this recommendation is lacking, suggesting the need for a properly designed trial. Materials and Methods: Before starting a new trial, the Italian Society of Angiology and Vascular Medicine (SIAPAV) decided to verify the common therapeutic approaches for patients with an SVT in Italian vascular centers based on a hypothetical significant variation in each daily clinical practice. A standardized questionnaire of 10 questions was administered to all SIAPAV affiliates by means of the official Society website. Results: From 1 December 2022 to 20 January 2023 a total of 191 members (31.8%) answered the questionnaire, showing a detailed and a substantial heterogeneity in the therapeutic approach to SVT patients among experienced vascular physicians and angiologists. Detailed results are reported in the relative section. Conclusions: The therapeutic approach of SVT extended to the iuxta-femoral segment of the great saphenous vein is still a matter of debate, and data to support therapeutic strategies are lacking. The wide heterogeneity in the management of SVT patients, including those with more extended thrombosis, confirmed that a randomized controlled clinical trial investigating the efficacy and the safety of a tailored therapeutic regimen in this particular subgroup of patients is strongly warranted. [ABSTRACT FROM AUTHOR]

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Opportunities and pitfalls of current technologies as well as the clinical impact of single-cell technologies in CVD patient care are highlighted, advocating for multidisciplinary and international collaborative efforts to join the cellular dots of CVD. The role of cardiologists in stroke is expanding from diagnostic help (to reveal the cause of stroke) to acute therapy in those regions where such up-to-date Class Ia treatment is not yet available. The authors conclude that the VTE-PREDICT risk score can be applied to estimate risk and benefits of extended anticoagulant treatment for individual patients with VTE and to support shared decision-making. [Extracted from the article]

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu disease, is a rare disorder with a case prevalence as high as one in 5000, causing arteriovenous malformations in multiple organ systems. HHT is familial with autosomal dominant inheritance, with genetic testing allowing confirmation of the diagnosis in asymptomatic kindreds. Common clinical manifestations are epistaxis and intestinal lesions causing anemia and requiring transfusions. Pulmonary vascular malformations predispose to ischemic stroke and brain abscess and may cause dyspnea and cardiac failure. Brain vascular malformations can cause hemorrhagic stroke and seizures. Rarely, liver arteriovenous malformations can cause hepatic failure. A form of HHT can cause juvenile polyposis syndrome and colon cancer. Specialists in multiple fields may be called to care for one or more aspects of HHT, but few are familiar with evidence-based guidelines for HHT management or see a sufficient number of patients to gain experience with the unique characteristics of the disease. Primary care physicians and specialists are often unaware of the important manifestations of HHT in multiple systems and the thresholds for their screening and appropriate management. To improve familiarity, experience, and coordinated multisystem care for patients with HHT, the Cure HHT Foundation, which advocates for patients and families with this disease, has accredited 29 centers in North America with designated specialists for the evaluation and care of patients with HHT. Team assembly and current screening and management protocols are described as a model for evidence-based, multidisciplinary care in this disease. [ABSTRACT FROM AUTHOR]

A popliteal vein aneurysm is a "true" aneurysm involving all three layers of the blood vessel wall, which are called the intima, media, and adventitia.[1] The exact size to define a popliteal vein aneurysm remains controversial,[2] but generally is around 1.5 cm or larger. The most important complication of an untreated popliteal vein aneurysm is a blood clot, which may be a deep vein thrombosis (DVT) and/or a pulmonary embolism (PE). Keywords: deep vein thrombosis (DVT); popliteal vein aneurysm; pulmonary embolism (PE); venous thromboembolism (VTE) EN deep vein thrombosis (DVT) popliteal vein aneurysm pulmonary embolism (PE) venous thromboembolism (VTE) 168 171 4 04/12/23 20230401 NES 230401 What is a popliteal vein aneurysm?. [Extracted from the article]

The text is a presidential address given by Herbert D. Aronow at the 34th Annual Vascular Scientific Sessions. Aronow expresses gratitude to various individuals and committees who have contributed to the growth and success of the Society for Vascular Medicine (SVM). He highlights the increase in SVM membership and financial stability. Aronow also discusses the importance of addressing public trust in vascular healthcare providers and the need for self-policing within the vascular community to ensure quality care. He emphasizes the significance of universal participation in quality improvement efforts and the potential benefits of random case reviews. Aronow concludes by expressing his honor and privilege in serving as President of SVM. [Extracted from the article]

This document, titled "Cause of death in patients with acute pulmonary embolism," discusses the causes of death among patients diagnosed with acute pulmonary embolism (PE). The study aimed to determine whether deaths in the context of acute PE are primarily driven by PE directly or underlying illness. The researchers conducted a retrospective chart review of patients admitted to their institution with a diagnosis of acute PE between August 2012 and July 2018. They found that PE-related death was the primary cause of death in high-risk PE patients but was rare in intermediate- and low-risk PE. The study highlights the importance of risk stratification in determining appropriate therapy for acute PE. However, the study has limitations, including its single-center nature and retrospective design. Further investigation is needed to optimize selection for advanced therapies, particularly in patients with intermediate-risk PE. [Extracted from the article]

The patient also underwent a total body CT scan, which revealed no other aneurysms as well as stability of left carotid aneurysms. Computed tomography angiography (CTA) showed a 13 × 14 mm diameter saccular aneurysm in the right extracranial internal carotid artery (ICA) with concomitant carotid kinking and two other small aneurysms (2 mm in diameter) in the left ICA (Panels A1 and A2, arrows). An angiography confirmed the presence of carotid aneurysms (Panels B1 and B2, arrows) and the absence of arteriovenous malformations or cerebral vasospasm. [Extracted from the article]

Vascular malformations are anomalies in vascular development that portend a significant risk of hemorrhage,morbidity and mortality. Conventional treatments with surgery, radiosurgery and/or endovascular approaches are often insufficient for cure, thereby presenting an ongoing challenge for physicians and their patients. In the last two decades, we have learned that each type of vascular malformation harbors inherited germline and somatic mutations in two well-known cellular pathways that are also implicated in cancer biology: the PI3K/AKT/mTOR and RAS/RAF/MEK pathways. This knowledge has led to recent efforts in: (1) identifying reliable mechanisms to detect a patient's mutational burden in a minimally-invasive manner, and then (2) understand how cancer drugs that target these mutations can be repurposed for vascular malformation care. The idea of precision medicine for vascular pathologies is growing in potential and will be critical in expanding the clinician's therapeutic armamentarium. [ABSTRACT FROM AUTHOR]

A 23-year-old man was referred to the vascular medicine clinic after experiencing a spontaneous splenic artery aneurysm rupture, requiring coiling, a few months previously. Owing to the patient's remarkable CTA findings in the setting of his young age and lack of significant prior medical history other than spontaneous arterial rupture, the patient was referred for genetic testing to evaluate for connective tissue disorder. The mild arterial wall irregularities seen on carotid ultrasound and the faint beading of the distal left ICA seen on CTA, along with the presence of aneurysms and dissections, meant fibromuscular dysplasia (FMD) was considered; however, connective tissue disease was thought to be much more likely. [Extracted from the article]

We describe a novel case of rivaroxaban treatment failure in a patient with COVID-19 infection who previously demonstrated efficacious treatment of prior pulmonary embolism (PE) with rivaroxaban I Case presentation i : A 75-year-old male patient originally presented for syncope and was found to have acute submissive PE on Computed tomography angiogram of his (CTA) chest. Here, we present a unique case of a missed ruptured AAA (rAAA) in a paraplegic patient atypical of the classical at-risk patients, where complications led to limb ischemia and resulting cryoamputation. There has been growing success with stent-supported recanalization and this case illustrates how it can be a durable alternative to surgery in elderly patients or in patients with severe comorbidities. Graph: Poster 67 Panels A-G Poster Number: 68 Abstract Number: 1272222 The approach to a patient with superficial femoral artery aneurysm with concomitant mycosis d... I B Emilita S. Lapuz, MD, FPCP b , Reynald Evan Tugade, Jenny L. Beltran i I St. Luke's Medical Center Quezon City i I Background i : Superficial femoral artery aneurysm is a rare disease usually discovered in elderly male patients. Poster Number: 75 Abstract Number: 1278722 Porto-mesenteric venous thrombosis in patients with complicated intra-abdominal infections: a... I B Nyssa Elline M. Palileo, MD, FPCP, DPCC b , Johanna Lynne M. La Rosa, MD, Myra Canlas, MD, FPCP, FPCC, FPSVM i I St. Luke's Medical Center Quezon City i I Background i : Portomesenteric venous thrombosis is a rare disease, difficult to diagnose and can lead to mortality. [Extracted from the article]

This article discusses a case of fibromuscular dysplasia (FMD) with an abdominal aortic aneurysm (AAA) in a 68-year-old woman. The patient presented with chest pain and a history of smoking, hypertension, and other medical conditions. The CT scan revealed a 5.5-cm AAA and severe tortuosity of the left external iliac artery. The angiogram showed a "string of pearls" sign, indicative of FMD. FMD is a rare arterial disease that primarily affects medium-sized arteries, more commonly in women and smokers. The case highlights the importance of considering FMD in patients with AAA and tortuous iliac arteries, as it can cause operative difficulties. [Extracted from the article]

This article discusses a case of Madelung disease, a rare fat deposition disorder, in a 59-year-old man with a history of excessive alcohol consumption. The patient presented with swelling in his upper arms and torso, along with other symptoms such as gynecomastia and fat deposition throughout his body. Madelung disease is closely linked to chronic alcoholism and primarily affects males. The diagnosis can be made through a history and physical examination, and imaging techniques may be used to confirm the diagnosis and assess for complications. The only effective treatments for Madelung disease are extensive lipectomy and/or liposuction. Alcohol abstinence may help reduce the rate of recurrence. [Extracted from the article]

This article, published in Vascular Medicine, discusses the case of a patient with two idiopathic internal mammary artery (IMA) aneurysms. IMA aneurysms are rare and often caused by medical procedures or underlying conditions. However, this patient had no history of trauma or vascular pathology. The aneurysms were successfully treated using an endovascular approach with coils. This case highlights the importance of considering IMA aneurysms in patients without clear etiology and suggests that endovascular treatment is a low-risk option. [Extracted from the article]

This article discusses the potential use of protein kinase C (PKC) inhibitors in the treatment of GNAQ/11-related phakomatoses, which are vascular anomalies. The authors explain that many targeted therapies for vascular anomalies have been adapted from oncology treatments due to similarities in genetic mutations. They specifically focus on the role of GNAQ/GNA11 variants in activating PKC and its downstream signaling pathways. The authors suggest that PKC inhibitors, such as darovasertib, may have promise in treating these vascular anomalies, but further research and validation are needed before clinical trials can be conducted. The article emphasizes the importance of staying informed about advances in oncogene research for potential precision medicine opportunities in the future. [Extracted from the article]

This article discusses a case of nonuremic calciphylaxis, a rare condition characterized by nonhealing skin ulcers caused by arterial calcification and thrombosis. The patient, a 66-year-old woman with a history of coronary artery disease, presented with a necrotic ulcer on her left calf and unintentional weight loss. Initial laboratory assessments were unremarkable, but a biopsy of the ulcer revealed calciphylaxis. Further investigation found a renal mass, confirming renal cell carcinoma. The patient was started on sodium thiosulphate treatment but unfortunately died shortly after a nephrectomy. Nonuremic calciphylaxis is associated with various factors, including vitamin D toxicity, primary hyperparathyroidism, malignancy, and anticoagulation. Sodium thiosulphate is considered the main treatment for this condition. [Extracted from the article]

This article discusses the impact of vascular medicine specialists on the utilization and management of inferior vena cava (IVC) filters in hospitalized patients. The study found that vascular medicine specialists recommended IVC filter placement in approximately one-third of consults, but also identified alternative strategies to filter placement in the majority of cases. Vascular medicine consultation contributed to lower IVC filter use at the institution, resulting in estimated cost savings. The study also highlighted the importance of vascular medicine follow-up in improving retrieval rates and individualizing patient evaluation. The authors suggest that future initiatives led by vascular medicine could further improve evaluation, tracking, and follow-up of IVC filters. [Extracted from the article]