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The article discusses the field of vascular medicine and the importance of collaboration for success in this specialty. Vascular medicine intersects with various disciplines, and practitioners aim to provide comprehensive, patient-centered care. Early career professionals face challenges such as limited training programs and competition for positions, but they can strategically navigate this terrain by researching available programs and seeking mentorship. Mid-career professionals must balance collaboration and expertise to avoid dissatisfaction, while senior career professionals play a crucial role as mentors and advocates for the field. By prioritizing collaboration, ongoing professional development, and strategic networking, vascular medicine specialists can make a lasting impact on patient care, research, and education. [Extracted from the article]

Background: Persons living with human immunodeficiency virus (HIV, PLWH) have an increased risk of peripheral artery disease (PAD) in comparison to the general population. However, a gap remains in understanding optimal management for this condition. This study assesses longitudinal outcomes associated with peripheral endovascular intervention (PVI) for PAD among PLWH. Methods: All Medicare fee-for-service patients undergoing femoropopliteal artery PVI between April 1, 2015 and December 31, 2018 were identified and stratified by HIV serostatus. The primary outcome was major adverse limb events (MALE), defined as major amputation or arterial embolism/thrombosis following an index procedure. The subdistribution hazard was used to evaluate the association between HIV serostatus and MALE, accounting for the competing risk of death. Results were adjusted for sociodemographics and major comorbidities. Results: Of 168,553 patients who underwent PVI, 357 (0.21%) were PLWH. The average age was 77.0 ± 7.6 years; 80.3% had hypertension, 70.3% had hyperlipidemia, and 24.6% had tobacco use disorder. Compared to those without HIV, PLWH were younger and had a higher burden of cardiovascular risk factors. MALE were substantially more frequent among PLWH, with a cumulative incidence of 24.6%, compared to 14.5% among those without HIV. The adjusted subdistribution hazard ratio was 1.26 (95% CI 1.00–1.58, p = 0.05). The use of guideline-directed statin therapy was low in both groups in the 90 days following revascularization (57.9% in PLWH vs 58.1% in those without HIV, p = 0.95). Conclusion: Among US Medicare beneficiaries, PLWH had poorer long-term outcomes following PVI. Greater attention to the management of symptomatic PAD is warranted for the HIV population, particularly following revascularization. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) is a progressive atherosclerotic disease associated with high rates of morbidity and mortality. Symptomatic PAD typically presents with claudication, and symptom severity strongly associates with reduced health-related quality of life (HRQoL). Existing treatment strategies for PAD are aimed at reducing symptom severity and improving functional outcomes. However, there is a need to incorporate patient-reported outcome measures (PROMs) into PAD treatment and research in order to provide more patient-centered care. This review will discuss the impact of PAD on HRQoL, existing PROMs available to assess PAD-related HRQoL, utilization of PROMs in research studies and registries, and challenges and solutions related to the integration of PROMs into research and clinical settings. [ABSTRACT FROM AUTHOR]

Going forward, contemporary surveillance data for PAD devices are, however, very much needed as it can help tailor the most favorable benefit-risk ratio of drug-coated devices to patient-level factors and angiographic-level factors. Keywords: drug coated balloon; peripheral artery disease (PAD); utilization EN drug coated balloon peripheral artery disease (PAD) utilization 73 74 2 02/04/22 20220201 NES 220201 Paclitaxel-coated devices were frequently used for the treatment of femoropopliteal peripheral artery disease (PAD) after the first FDA-approved device came to market at the end of 2012.[1] Since then, a series of paclitaxel drug-eluting stents (DES) and drug-coated balloons (DCB) have been developed and are currently approved for the treatment of femoropopliteal PAD.[1],[2] Paclitaxel, a chemotherapeutic agent, prevents neointimal hyperplasia resulting in improved patency and freedom from reintervention when compared with bare metal stents (BMS) and plain balloon angioplasty (POBA).[2],[3] Despite superior efficacy outcomes, recent events have taken place that may have impacted paclitaxel devices' widespread use. [Extracted from the article]

Keywords: pulmonary embolism (PE); catheter-directed treatment; thrombolysis EN pulmonary embolism (PE) catheter-directed treatment thrombolysis 75 76 2 02/04/22 20220201 NES 220201 Systemic thrombolysis remains a guideline-recommended treatment for high-risk pulmonary embolism (PE).[1] Although it is associated with improved survival, it is associated with a 9% risk of major bleeding.[1],[2] Catheter-directed thrombolysis (CDT) delivers thrombolytic agents directly into the pulmonary arteries with a lower total dose of thrombolytic and potentially a lower risk of bleeding compared with systemic thrombolysis.[3] Therefore, CDT may be an alternative advanced therapeutic option to systemic thrombolysis. CDT, catheter-directed thrombolysis; PE, pulmonary embolism. Thrombolysis, pulmonary embolism (PE), catheter-directed treatment. [Extracted from the article]

As endovascular therapies have become more frequently utilized in the management of patients with atherosclerotic disease, there has been greater interest in applying these treatments to the infrapopliteal vascular beds.[1],[2] In particular, advances in peripheral interventional technology with novel and dedicated equipment have created opportunity to address peripheral artery disease (PAD) involving the most distal vascular beds. For instance, the NIH-sponsored BEST-CLI trial (ClinicalTrials.gov Identifier: NCT02060630), which randomized patients with CLI to either a "best" endovascular treatment strategy versus a "best" surgical revascularization strategy, has finished enrollment and is completing follow-up. This clinical trial has the opportunity to substantially impact clinical practice, and having real-world safety and effectiveness benchmarks to compare endovascular treatment outcomes will be useful when understanding the generalizability of the BEST-CLI trial results. [Extracted from the article]

Pulmonary embolism (PE) is the third-leading cause of cardiovascular mortality, accounting for 100,000 deaths per year in the United States. Although sex-based disparities have previously been described in this population, it is unclear if these differences have persisted with the expansion of PE evaluation and treatment approaches. The purpose of this study is to investigate sex-based differences in the evaluation, management, and outcomes of patients with acute PE.We performed a retrospective analysis of patients enrolled in the national Pulmonary Embolism Response Team (PERT) Consortium database between October 2015 and October 2022. We evaluated patient demographics, clinical characteristics, diagnostic imaging performed, treatment at several phases of care (pre-PERT, PERT recommendations, and post-PERT), and clinical outcomes.A total of 5722 patients with acute PE (2838 [49.6%] women) from 35 centers were included. There were no differences in PE risk category between male and female patients. Women were less likely to undergo echocardiography (76.9% vs 73.8%) and more likely to receive no anticoagulation prior to PERT evaluation (35.5% vs 32.9%). PERT teams were more likely to recommend catheter-based interventions for men (26.6% vs 23.1%), and men were more likely to undergo these procedures (21.9% vs 19.3%). In a multivariable analysis, female sex was a predictor of in-hospital mortality (OR 1.53, 95% CI 1.06 to 2.21).In this analysis, we identified sex-based differences in the evaluation and management of patients presenting with acute PE. Subsequently, women presenting with acute PE were at higher risk of in-hospital mortality. [ABSTRACT FROM AUTHOR]

This document discusses the underutilization of supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) among Medicare beneficiaries. Despite being recommended and approved for coverage by the Centers for Medicare & Medicaid Services (CMS), SET is not widely used. The study found that only 1.8% of patients with claudication, a symptom of PAD, were enrolled in SET. There were disparities in enrollment based on race, sex, socioeconomic status, and geographic region. Efforts are needed to improve awareness, access, and adherence to SET for patients with PAD. [Extracted from the article]